Episode Transcript:
Michael Hochman
So, the first thing I have to do is remember that this is a person, and we need to establish that trust. And every patient is different. Sometimes you go out there and the patient is ready to start working with you. And you get that trust really early. Other times it takes two or three or 10 interactions. And that's one thing we really believe in — is that just keeping coming back, showing up, being there, that we'll eventually get that trust.
Robert Traynham
Mike, welcome to the program.
Hochman
Thank you very much for having me.
Traynham
It's good to see you. I want to start with a curveball question and that is, your favorite food?
Hochman
Well, that's not a curveball question. That comes right at the tip my tongue: Chicago pizza, deep dish.
Traynham
Deep dish. So, there's a big deal, right? There's the deep dish and there's the thin and you're saying deep dish.
Hochman
Deep dish all the way!
Traynham
And that’s because why? Is it just the taste? How you grew up?
Hochman
It’s really good. You know, I grew up in the east coast. So, I’m used to the thin crust, New York pizza, but when I went to Chicago, it was just an order of magnitude better and ever since I've been hooked.
Traynham
Okay, so follow-up question not about pizza, but it's about a really good snack. Chicago Mix and Garrett's Popcorn. Are you familiar with this?
Hochman
I've heard of it. But I can't say I’ve ever had it.
Traynham
You must run — not walk — you must run to Garrett's popcorn, and get the Chicago mix, which is caramel popcorn and cheddar popcorn mixed together. It sounds a little funky, but it's delicious. It's actually probably absurd. It's probably on par with Chicago deep dish pizza. I know that sounds weird. But it's trust me. It's good.
Hochman
That sounds very interesting. And I am sold on that.
Traynham
Stick with me. You'll be OK, if you stick with me.
Let's talk about a more serious topic, which is unfortunate, but it is a painful truth. And that is that there are people that look like you and I, that are living paycheck to paycheck, that perhaps have food insecurity, folks that have no idea where they're going to sleep tonight, right? So, these are people that have a lot of issues going on. And the underlying issue could be health, whether it be mental or physical.
This is something that's deeply important to you. Why?
Hochman
Well, you know, I think like many people, happenstance takes you in a certain direction.
You know, there was a lot of mental illness in my family, my father spent time in mental health facilities when I was young, that really influenced me. But it really was in my medical training that I started working in public-safety-net settings, I did my training in the safety net in Massachusetts. And I just found it very rewarding helping the most vulnerable patients. And I came to Los Angeles, and I saw a big need for it and had an opportunity to develop a group focused on unhoused populations.
Traynham
And what is your role at Healthcare in Action?
Hochman
I am a practicing physician, first and foremost in the group, and I am the CEO of the group as well.
Traynham
What's more important?
Hochman
Well, they're both really important. I, my favorite part of my day is seeing patients, that's what really keeps it real for me, it lets me know what the problems are and what the priorities are. But being the CEO, I also am able to sort of craft the strategy and think how can we expand this? How can we help more people?
Traynham
Let's unpack this a little bit more. What is the strategy? What is the mission of your organization?
Hochman
So, we are one of the only, if not the only group that I'm aware of, medical group that's exclusively dedicated to unhoused populations. We provide general medical services, behavioral health treatment, addiction, and case management for unhoused populations in California. And we don't have any brick-and-mortar clinics. So, we bring care to patients where they are — in mobile vans and backpacks — whatever it takes to bring care to the unhoused.
Traynham
So, you go to them, there is no expectation for them to come to you?
Hochman
That's right.
Traynham
Why?
Hochman
Well, I worked for many years at the county hospital system at federally qualified health centers. These are great safety net institutions where I did work with a number of homeless patients. But one thing I think all of us realize is that the most vulnerable, the ones who need it the most, the ones with the most severe mental health disorders are the ones that don't even make it in the door because of transportation issues, because of organization issues, because of the health problems they have.
Traynham
So, I want to go back for a second. You're the CEO of the organization. Do you literally sometimes put on a backpack or get in the van and actually go to where the community is? Do you do that?
Hochman
I do. I actually spend about 30% of my time doing direct care.
Traynham
Oh, wow.
Hochman
So, I go out in the vans. I see patients in homeless encampments. I do a lot of shelter work in shelters, and interim housing sites.
Traynham
And, any success stories that you can share? Any examples that perhaps maybe you can say, literally, I saw this homeless person and I treated him or her. And now they are…
Hochman
Yeah, well, I think the statistic that we're most proud of in the past year that our group has had about 100 patients with a housing success, meaning either they were living on the streets, and they were moved into a shelter setting, or they were in a shelter setting, and they’ve gotten moved into a permanent environment.
And I have probably half a dozen myself that I've worked with where I've seen that outcome. I have one person in particular, he was attacked, he was in a hospital, he was living in an encampment, and our team met him. And now he's reconnected with his 13-year-old daughter. He is living in a sober living house, and he has a job and he's supporting himself. And it's really been a 360 turn around.
Traynham
So, you're putting on the backpack. And or you're getting in the van. You are going to the place where the person is living, and/or experiencing some trauma. Walk us through what you're thinking, walk us through what you think that patient is experiencing, and walk us through the success story.
Hochman
Right. So as a medical provider, I have my goals and priorities. I'm thinking about the blood pressure, and the diabetes, and the mental health conditions, and all the medications that I want to start. But it's not as simple as that, right? When you go out and meet somebody for the first time, and they have no idea who I am. They don't know if I'm friend or foe. They've lost trust in systems that have failed them, in many cases multiple times. So, the first thing I have to do is remember that this is a person, and we need to establish that trust. And every patient is different. Sometimes you go out there and the patient is ready to start working with you. And you get that trust really early. Other times it takes two or three or 10 interactions. And that's one thing we really believe in — is that just keeping coming back, showing up, being there, that will eventually get that trust going.
Traynham
I'm curious, how do you introduce yourself as Dr. Michael? “I’m Mike? I'm here to help?” How do you establish that first connection?
Hochman
Well, one thing that we've, that I've, really been heartened to see is that medical professionals are viewed favorably by unhoused populations. I'm not sure we deserve it. But we are. And so, we have found that when we say that we're a medical provider, “I'm Dr. Mike, I'm here to help you,” that that goes well. Not everybody. But that is a way that sort of breaks the ice and people understand what I'm there for.
Traynham
When you're finished treating that patient in their environment. Let's go there. Let's say it's a tent. That's their home. That's their home in that moment. When you leave their home, how do you feel?
Hochman
It really is a mix. Sometimes I go in and I say I didn't get that connection that I was hoping for. We're not ready to take the next steps. And I start worrying, are we really making progress here? And then when you least expect it, and you feel like you have that trust, and you're able to get that person that first step or second step or eventually get them into housing, it just really feels like nothing else I've done in healthcare.
Traynham
Do you get any feedback sometimes from the unhoused?
Hochman
We have gotten some of the most grateful notes and letters of appreciation that I've gotten in my entire medical career. I've worked in academic settings with upper middle-class populations. And I've never gotten more grateful feedback than what I've gotten from some of our clients.
And if you wanted to know about a specific case or story, there was one couple that was living on the streets. And they came to me because they had a rash. And it turned out to be scabies, and that was what they were concerned about. And we were able to give them a treatment for that and made them feel better. And all of a sudden, they started to trust us and realize we were there to help them. And they didn't have their driver's license or their birth certificate. And so they were open to the possibility of us getting that. And we took them all the way along the process. And now they're living in a transitional housing center together, and it's really rewarding. But what started that was the trust we got from just treating this one irritating condition that was bothering them.
Traynham
What do you think is the biggest misperception about homelessness that most Americans quite frankly may not know about?
Hochman
Well, the first thing you said that really caught my attention is people who look like you and me. And when you first go out there and a lot of times the patients we see are disheveled and they're dirty, they haven't had a shower. But once you get them on the medical treatments, and you get them thinking a little more coherently and get them in the shower. You realize that they’re the same people that you and I are the same hopes, fears, dreams, goals.
Traynham
Yes, I want to put a finer point. They’re someone's aunt, someone's uncle, someone's parents, someone's brother or sister. They're you and I. Let's be clear.
Hochman
They absolutely are. And on top of that, because they have had a harder life than many of us have, I find them to be some of the most empathetic people I've ever met.
Traynham
Yeah, because I think they could say, “I’ve kind of been there at rock bottom. So, I kind of know what that feels like and looks like in many ways.”
Hochman
I think that's exactly right. And it gave an appreciation and a resilience about them that that they've earned from, from what they've gone through.
Traynham
So, the New York Times recently published a story about the unbelievable work that you're doing. What exactly did they highlight that you're most proud of?
Hochman
Well, I think they highlighted our staff, they picked one member on our team who went out and met a patient and connected with him in a very human way. She provided great medical care and social service. But even more than that, it was just the interpersonal connection that was probably more valuable than any of that she went through in the journey. She followed him longitudinally; it was not a one and done situation. And the part that The New York Times didn't mention is that that patient is now housed in a, in a sheltered environment, we were crossing our fingers, it stays that way. But it was really that human connection that got him there.
Traynham
Another success story.
Hochman
That's right.
Traynham
You know, I'm going to contradict myself here, Michael, because in many ways you want to scale this. And so, I want to talk about that. But in some ways, I know this will sound strange. Do you really want to scale this? Because of the really strong relationships that you have on the ground?
I guess that's the question. How do you maintain that deep level of trust where you're going to someone's home, and really connecting on a deeply personal level? How do you scale that?
Hochman
Well, you put your finger on the precise tension that we struggle with. Helping people is a one-on-one activity that we that we do face-to-face, but yet, there's 600,000 unhoused people in the United States, there's 70,000, in Los Angeles County, a couple 100,000 in California. And if we started thinking about the tens, and thousands, and hundreds of thousands, you can't do the day-to-day work. But that's why we're really blessed to be partnered with SCAN group, our parent company, and many of the other health plans at this AHIP meeting. They can really think about the big picture and can give us the partnership and the infrastructure that we can take the day-to-day work to a bigger scale.
Traynham
Healthcare in Action. Its mission in three sentences or less.
Hochman
So, we are a medical group that is exclusively dedicated to unhoused populations. We provide medical care, behavioral health treatment, addiction, and case management. And our goals are twofold: to stabilize the health conditions of our patients, and just as importantly, to work to getting them housed.
Traynham
So, we know there's a lot of folks out there that have a really good heart, and their mission is very clear. That's in this space. How is your organization different?
Hochman
I should begin by acknowledging the people who have really been the godfathers of this field, Boston Healthcare for the Homeless, the University of Southern California has had a very well-established street medicine program. So, there are, as you said, many other groups that are doing really wonderful work. What we're doing that's different is that we're trying to find a sustainable business model. And that's been really through the partnership with our parent company SCAN Group, which is a managed care organization, that has allowed us to think how do we sustain this? How do we create a business model so that as a nonprofit, we can keep growing and caring for more patients, rather than just the ones that we are able to support through charity or philanthropy?
Traynham
Walk us through the journey, the life cycle, if you will. So, I'm projecting here a little bit, but is it that you just take care of the situation then, and then you walk away? Or is it that you take care of the situation, and you help them through the whole entire journey, whatever that journey might look like.
Hochman
So, in the homeless field, we talked about a continuum of care. You start with somebody who's on the street, and maybe they get moved into an interim housing situation where they get stabilized, and then they find a good long-term permanent solution for them.
And I wish I could say that it's always a perfectly straight line…
Traynham
It never is!
Hochman
…But people are always falling off that path. Maybe it's in transitional housing, maybe it's even after they've gotten into permanent housing. And they realize that they're isolated from that community that they knew on the streets. It's not a community that you and I would find enriching, but it's their community. And that's why we really believe it's it's not good enough just to get them into that permanent housing, but we actually have to stick with them. We try to stay with them for at least three months, but in many cases, it requires longer than that, because your risk of falling back into homelessness is so high in those first three to six months.
Traynham
So, the life cycle, as I understand it, is pretty cross functional. There are a lot of teams that pretty much help an individual or their families go through this cycle. Walk us through that.
Hochman
Well, our team looks a lot different than many other community health centers or clinics, we have medical providers. But more, at least as importantly, I should say, we have community health workers or peer navigators. These are folks who, in many cases themselves have been homeless or struggled with substance use, and they're able to connect with the patients in ways that standard medical professionals might not be able to. And they are just so important for that rapport building. We also have social workers. We are heavier in our behavioral health and substance use services. So, it really does take a multidisciplinary team and it's not just the medical provider that's important about what we do.
Traynham
So, for the folks out there, Mike, that are watching this and incredibly inspired by Healthcare in Action, how can they help when it comes to rolling up their sleeves and volunteering? Rolling up their sleeves in the boardroom? What does that look like for you? How can folks show up and help?
Hochman
Well, I think that health plans and managed care organizations in general have a unique opportunity to be helpful in this space. I think because of the population health focus that many health plans have, we need to start thinking about it from that perspective, from a public health perspective, from population health from a managed care perspective. And, you know, I think health plans are the ones that can create the infrastructure, the contracts, that will make homeless healthcare services sustainable to acknowledge that this does require an investment. But there's a return on that investment, we get somebody out of the streets, they're going to be healthier, they're going to have fewer ER and hospital visits, they're going to need less specialty care. And more importantly, they're going to be able to give back to society, they're going to get back to jobs and taking care of their kids and their families. So, I really do think that health plans, I'm excited about the opportunity to partner with them, together, to take this challenge on.
Traynham
Mike, the next big thing in health, according to you is…
Hochman
Well, we have amazing tools. Since I went to medical school graduated 20 years ago, the genetic progress that's been made, the pharmaceutical progress that's been made, surgical – surgery – has progressed, the technology – what we need to do is bring that to a wider population so that everyone benefits.
Traynham
So, scale. It's another scale question.
Hochman
Yes. Right.
Traynham
You know, it's interesting, how do you innovate? And how do you scale but how do you do it in a way that's compassionate? And how do you do it in a way where the relationship still is authentic? When you scale sometimes you lose some of that secret sauce, which is exactly what you know what?
Hochman
Well, that's what we struggle with on a day-to-day basis. Whenever we try to think big. We forget about the one-on-one interactions and healthcare is all about those one-on-one interactions. That's where the rubber meets the road.
Traynham
Very well said. Thank you very much for joining us.
Hochman
Thank you very much.
