Episode Transcript:
Dr. Pooja Mittal
With improving your experience, I build trust with you. And when I build trust with you, your outcomes will improve. Right? And so, I think having consumer demand around “I need a better experience and I need to feel seen, and I want my care customized for who I am.”
Robert Traynham
Thank you, it's good to see you. Really appreciate you having some time to spend with me. I would love to open this up Pooja with a really interesting question in my mind, and that is, what are some of your vices, what is the one thing that quite frankly, behind closed doors, the cameras are not rolling that’s uniquely you?
Mittal
You know, one of the things that I love to do when I'm away, or have some downtime, is read fiction. And I read a lot of fiction. And I think, I do think it informs my work actually.
Traynham
How so?
Mittal
Well, when you're in a character's mind, you really do get to experience what they're going through. And I read a lot of really diverse fiction, and I pick fiction on purpose that has some applicability to health equity, often, and so I feel like I get to understand people's experience through reading about reading fiction around, you know, different experiences, whether it be whether it be something around a mother who's, you know, going through something, and she's and she's living in a rural part of the country or, or anything else.
Traynham
Is there any particular book and/or genre of fiction that you would recommend?
Mittal
A book. I love the book "Homegoing." So, I don't know if anybody's read that. But it's an amazing story of two sisters in Africa, and one becomes a slaver, and one becomes enslaved, and it follows their families all the way down to present day. Really, it's, it's incredible. And it really does give you a sense of the black experience all the way from Africa through modern day America.
Traynham
I have to take a look at that. Yeah, the one thing about fiction and biographies for me is that you can get lost in someone else's story. And figuratively, you can walk their shoes, in many ways. And look, in many ways, if it's really, really well written, you're so immersive into it. It's almost like you and the character become, I don't know if you've become friends, but you, you get to know them and their idiosyncrasies. Does that make sense?
Mittal
Yeah, absolutely. And you get to be inside their heads and feel what they feel.
Traynham
You feel their pain. And their highs and lows in many ways.
Mittal
Yes, absolutely.
Traynham
Thanks for sharing.
Traynham
I want to talk for a few moments about healthcare and loneliness. And where I'm going with this is someone's journey, where they are experiencing pain, whether it be mental or physical, or both. And they're searching for answers. They're searching for some type of solution. But for whatever reason, it could be physical loneliness, it could be emotional loneliness, they're doing this journey alone. And I want to walk through why that has to be, because in many ways, Pooja, for me, that's actually kind of cruel. But it happens. Let's just be honest, it happens. Probably more than we probably know.
Mittal
Yeah.
Traynham
Explain.
Mittal
Yeah, I mean, loneliness is such an epidemic today. As you know, the surgeon general just released a report about how pervasive it is. And I think that we have to think about it differently for different people, right? There's a huge spike in loneliness from ages 18 to 24. And I think a lot of that has to do with transitions in life, and also a lot of social media use, and so disconnecting from people in person and just focusing on social media use.
And then for our older adults, right, we're not living in communities anymore, often. And so, there's not a lot of social connection naturally, I think, that a lot of people have.
And I heard about — as we were thinking about loneliness, and we've been thinking about it broadly I heard about this community in Texas. And I don't know if you heard this story, but there was a podcast about it, called Century Lives. And this community in Texas is one of the poorest communities in the country, has very little medical care, pretty poor diet, quite rural. And yet they have the ninth highest life expectancy in the United States. And when they dug into why that was, it was because of the community. There's a lot of social connection within that community. And a lot of families live together in multi-generational families, and they stay together over the years, and the grandparents support by taking care of their kids. And so, you know, thinking about loneliness as such a pervasive issue in our society, I do think that a lot of the solutions lie around simple things like creating community and connection.
Traynham
How do we get there? How do we build community? To your earlier point, technology is a part of our lives, love it or hate it. You could make the argument that, for some people, technology is community in terms of them connecting in a way that they're comfortable with. But to your point, there also is a disconnection there, figuratively speaking. How do we get to a path where families are more communal? How do we get to — and that could be your chosen family? Right? In many ways, it could be, look, this is my chosen family, because this is my new community. How do we get there?
Mittal
Yeah, that's a great question. I, you know, part of what I think about in terms of technology, because technology is so pervasive, is how can we use it as a conduit to that, right? How can we use it as a connector? And so, a couple of the things that we've been really interested in are these applications that are naturally fitting into people's lives, that built community, right? So, there are some apps that really focus on creating meetups for seniors, that sort of sit outside of the religious institution space, because, of course, religion is a great community builder.
But for some people who are not interested in that, we need to find ways to build community outside of that. And so, I think there's a way for us to use technology as a connector to bring people together in person. And that's, one thing to think about. I think the other thing, really, with especially younger folks is to find ways to pull them out of the technology and create more in person connection. And that's hard to do. But often, I think about an easier place to do that is sports or activities outside of school and finding ways to make those attractive to kids.
Traynham
We're seeing this growing trend of chief equity health officers around the country, at the hospital space in the health care space, and so forth. One, is this a good thing? And two, what role do you see they play in helping build a community?
Mittal
Yeah, you know, I do think it's a really good thing, I think it means that we're putting a lot of emphasis on health equity. And we're also making sure that it's a leadership position that is focused on health equity. That being said, I think it's really important to keep in mind that we need to resource the chief health equity officers, right? They have to have funding, and they have to have leadership support and buy in, executive sponsorship, essentially. And without those things, they're not going to be successful, because as one person, as a leader in the organization, they can't drive organizational change without support.
Traynham
And when it comes to support, is there anything else besides the funding, and obviously, the chief executives sponsoring this person and position? Is there anything else we can be doing from a consumer standpoint, to help make this position even more equitable? Should we become more informed? Do we need to show up a certain way? Anything?
Mittal
You know, I think the medical space is, and health care in general is quite behind in terms of responding to consumer questions, needs, etc. I mean, there are so many organizations that do it better than health care. And so, I think the more that consumers demand that from us and focus on their experience and wanting a better experience, the more important it makes my role, because I really think, in the end, I can focus on improving outcomes, and outcomes are important. But that's a longer-term goal. I think, in the meantime, the thing that I can focus on improving is consumer experience. And with improving your experience, I build trust with you. And when I build trust with you, your outcomes will improve, right? And so, I think having consumer demand around, “I need a better experience, and I need to feel seen, and I want my care customized for who I am.”
Traynham
I'm a big believer in really building relationships. I'm of the philosophy that “trash in, trash out” or “good things in, good things out.” In other words, it takes some work. It takes some work in building that relationship and establishing trust and maintaining trust. Look, in my mind, it's almost like a marriage. And that's some work. I mean, I look at my parents’ relationship or whatever relationship, it's a lot of give and take. It's a lot of communication. It's a lot of trust. So, I want to focus on that for a few moments, because I believe that could maybe help with loneliness, but also it could also help with the chief equity health equity officer position as well.
Mittal
The building of relationships? Yeah, I think that's right. I mean, part of what I've had to do in my role, and I think all chief health equity officers do to some extent, is focus on building relationships internally and getting trust internally because naturally, this role requires a lot of difficult conversation. And I have to come, come into a room being prepared to be, to being open and listening. And also finding ways to connect internally with other folks within my organization so that we all feel a connected sense of purpose. And I think that gets back to loneliness, too. How, in an organization, are you feeling like you're part of the greater good, and you're part of the greater mission. And then from an external perspective, that relationship building that we do with the community, I think also fill some of those gaps in terms of loneliness, right? Because the more that we can create an ecosystem of care that supports people in the community, where they're at, the better that we can support people's needs around everything, with their health, including loneliness.
Traynham
Totally. Do you believe we have made progress in building bridges of opportunity in the health care system? And the second part of my question is, do you believe that the equity that these positions, these newly created positions, are having? How can we help them? How can we support them? What does that look like in terms of building those bridges?
Mittal
So, I think we're recognizing the need to build trust within communities. And I think we're also recognizing some of the historical harms that the health care system is built upon. And we're starting to build those relationships and really recognize the expertise that lives in the community. So, I think there's a lot of work to be done still in terms of relationship building and connecting with the community. But I think as plans, we're finally being very clear on the need to do that.
Traynham
So, there's an intent. Can you give any examples?
Mittal
Yeah. So in 2019, at Health Net, we launched a community doula program. And this program was actually the first of its kind in Medicaid to provide free doula services to black birthing women in Los Angeles County. And we established a relationship with a community-based organization called Frontline Doulas. And we thought we were entering into that relationship in a very intentional way, where we were supporting their autonomy as an organization that had the expertise and the lived expertise to do the work. And what we realized was that, that they were still viewing us with a big power differential. And they were really viewing us as funders and not as partners. And that really resulted in some difficulty in the relationship because they didn't come to us when there were issues in terms of executing.
Traynham
Yeah, almost like an imbalance in the relationship.
Mittal
Imbalance definitely. And, and again, despite our intentional going in trying to create a balance in that relationship, there was still a huge power differential. And that was something that in my first foray into working in community work, I didn't realize that even with the intention to create a balanced relationship, that because we're such a large organization, and are the funder, that that power differential is still going to exist. And so, I learned a lot about how to come in and intentionally build relationship in a way that slowly cedes power over time, right? So that it becomes clear that that balance is shifting, instead of expecting that it should shift right away.
Traynham
That's right. In many ways, it's like this, and it slowly should be like this.
Mittal
Right?
Traynham
Slowly, over time. And I believe that's through trust.
Mittal
Right. Exactly. And, you know, it was a worthwhile investment in that work, because we continue to be solid partners, foundational partners to this day. The state just launched a community doula benefit, they are one of our key partners for that. We've done other work with them where we've supported their work in ways that are outside of our core work together. And so, it's been a worthwhile investment. And it's been a wonderful relationship.
Traynham
What's the next chapter for equity at Health Net?
Mittal
Yeah, there's so much. One of the things that we're working on building — and we've been doing health equity work at Health Net for a long, long time. We were the first plan to have the health equity accreditation in all three lines of business since 2011. So, health equity as part of our DNA in terms of how we do work. What we're doing right now is we're shifting to being a lot more “place based” in terms of our work. So let me explain a little bit better.
As we think about systemic and structural inequities. We know that they occur in a certain region in a certain geography, right. And each geography has its unique intersectionality. Right? Whether it's rural or urban. What are the main types of people that live there from a race-ethnicity perspective, from a disability perspective, from a veteran perspective? And we know that each community has its own strengths and its own challenges and so we've been laying out a foundational set of health equity improvement zones, which are place-based delineations that'll allow us to really customize the work in each geography and partner locally.
Traynham
Right. So, it's unique to the area, it's not one size fits all.
Mittal
Exactly, because each area has different strengths and challenges.
Traynham
Right. And I could make the argument that each neighborhood and/or place has their own unique influencers, ecosystem, whatever you want to call that, that reinforces this relationship that you're trying to build.
Mittal
Right. And the structural inequities are unique to each place, right? Like when we look at in California and the Central Valley, it is the agricultural region of the country and has the highest food insecurity of any place.
Traynham
I never would have thought that.
Mittal
And you would never have thought that. But when we look at that, and when we think about farm workers and how to support farm workers who are food insecure, that approach is very different than the rural North where, where it is a really different population. And we have to think about that.
Traynham
Interesting. I never thought about it that, which would be completely different — I’m making this up — than San Francisco, or whatever the case may be.
Mittal
Right.
Traynham
Yeah, interesting. Last question for you Pooja, and that is: the next big thing in health from your perspective?
Mittal
You know, I think the next thing that we really have to focus on as a community is “Techquity.”
Traynham
I've never heard this terminology before. Say it again?
Mittal
Techquity. So, technology and equity. And it's a really broad term. And so maybe I, I break it down a little bit. So, we're thinking about AI, right, and algorithmic bias. And so that's one way of thinking about equity and technology and the things that we have to consider.
We're thinking about technology and applications, right? And how are they built from an equity perspective? Like, are they really built in a way where they're designed for the user? Are we building tech in a way that fits into people's lives? Are we expecting people to come to us for the technology they want to use? And then of course, broadband access, right? I mean there's clear evidence that in communities that are underserved, broadband access is more expensive than in richer communities. So even thinking about broadband access, and equitable access is really important.
So, all of the things sort of encompassing technology and equity — that’s sort of the next horizon that we have to consider.
Traynham
No one will believe me who's watching this, but I just wrote that. I probably didn't spell it correctly. But that is, I've never heard of that before. Did you make that up? In other words?
Mittal
No. You know, it's being talked about more broadly, I think overall, in health care, but the Health Foundation is working on a whole set of definitions around techquity and different case studies around it. So that's a place to go for some more information.
Traynham
Wow. Can you do me a favor? Can you make a promise that you'll come back on and talk about this in greater detail at a later date? Because I actually find this really interesting.
Mittal
Yeah, that sounds great. And I'm happy to share some information.
Traynham
Please do. Thank you very much. Appreciate it.
Mittal
Sure. Thank you.
