NBTH — Inside the Mind of a Global Health Equity Expert: Dr. LaShawn McIver

If you hear the words “health equity,” know this: It’s the idea that we do all we can to create ways for every American to attain their highest level of health and well-being — regardless of their race, ethnicity, sexual orientation or gender identity, or where they live.

And it’s the driving force behind the work of LaShawn McIver, MD, MPH, AHIP’s senior vice president and chief health equity officer. We dove into Dr. McIver’s recent experience as the former director of the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health to discover how together we can create better systems of care for everyone.

Listen in for her thoughts on how health insurance providers are making health care better and more accessible. And where they are focusing next to make a difference.

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Episode Transcript:

Dr. LaShawn McIver

The next big thing in health for me, sitting in this space right here, is that we finally work towards getting it right. That we actually work towards creating a health care system where it doesn't matter who you are, where you live.

Robert Traynham

Dr. LaShawn McIver, our new chief health equity officer, welcome to the program and welcome to AHIP.

McIver

Thank you. I am really excited to be here and excited for our conversation today.

Traynham

All right, Dr. McIver, we know you wear the white coat. You have Dr. LaShawn McIver, that is important. Let's talk about Dr. McIver and your personal life. Anything you want to share?

McIver

I love to travel. I've been traveling since I was a young, young kid. I remember traveling across the country to live in South Dakota. I lived in the Philippines years ago. And so, all of those experiences just gave me a hunger for traveling. And I've traveled probably to about 30 countries at this point. And I have a little secret, I collect aprons, …

Traynham

Okay.

McIver

… recipes, and I do like to visit spas in different countries and understand how people sort of relax and do that. And it's just been wonderful. I love getting out in markets and talking to people and things like that. So, in my spare time, I love to travel, I love to cook. And now, you know, my children are older. And so, they've seen my pictures over the years, and each person has picked out where we're going to travel next.

So just something that I enjoyed doing, and it's just made my life so much richer. And I appreciate learning about people's journey. And so that's, that's something I like to do in my spare time.

Traynham

So, let me speak on behalf of the organization and say, we're excited to have you here, because we all know that health equity is not about folks that look like – it is about folks that look like you and I — but it's much, much broader, much, much broader and deeper than just that, right?

McIver

Yes! So, one of the biggest lessons I've learned over the last couple of years is that when people hear the term “health equity,” they sort of, as you said, narrow their focus of who this work impacts. And really, health equity impacts millions of Americans.

You know, there are many definitions for health equity, but at the core root of what we're striving towards, through creating equitable health care for everyone in this country, is the opportunity for everyone to attain their highest level of health and well-being. So, if you were to just go full stop there, that's really what health equity is about.

It shouldn't matter where you live, what's your race, what's your ethnicity, you know, what is your sexual orientation, or gender identity? You know, all of these different things, it really shouldn't matter. We are working towards making sure everyone has a fair opportunity to attain their highest level of health. So that's what that this work is about. And the health insurance industry is in a historic space that we've never been before. So, this is why it's really exciting to be here during this time.

Traynham

Indeed. You know, I tell folks — and you correct me if I'm wrong — it’s about every zip code. It's about every gender, it's about every race, religion. And the reason why I say zip code is because whether it's rural, whether it's urban, it doesn't matter. It really affects everyone in terms of health equity, in many ways.

McIver

It does. And, you know, over the years, I have traveled to many parts of our country. And my background is actually international health and medicine. So, I'm a physician. I've worked in public health, though, for now over 20 years, and I've seen what, you know, what it looks like when you're in a community that is well, and what it looks like when you're in a community that is plagued by health disparities and health inequalities. And most recently, especially after the pandemic, in my previous role, I had a chance to see different parts of the country. And I remember thinking, you know, it doesn't really matter where you are, but your zip code does matter.

It doesn't matter what part of the country you’re in. I visited Alaska for example, and if you choose to live in Alaska, you should be able to get the health care that you need. And there are many challenges and barriers that people have. If you're in the U.S. territory, sometimes we don't always think about the territories, as we're sort of focusing on this conversation. But they're a part of this discussion. And having gone to Puerto Rico recently this year, and seeing, you know, some of the barriers that people have to attaining their greatest health and well-being, we as a health care system, we have to do better. And what I'm excited about is that “the better” is happening. But there's still much more work to come.

Traynham

Dr. McIver before we talk about the much more work to come to your point, I want to hit the rewind button. You alluded to an international background, you alluded to your journey, CMS and so forth. Let's talk about that. Let's talk about your story leading up to this work. So, you are a physician?

McIver

Yes, yes. So, I'm a physician, as I said, my backgrounds in international health and medicine. And I often think about the poem about the road less traveled. And if you were to look at the experiences that I've had in my career, they've not been the expected steps. But every single turn and twist in the journey has made all the difference in how I show up in a space when it comes to working to meet the needs of individuals.

So, you know, I studied, as I said, in international health and medicine. I have my master’s in public health from Johns Hopkins. And my journey into this work started there. I went into international health and medicine thinking I would do a lot more work internationally. I'm a — I don't want to say a “military brat,” but my dad was in the Air Force. So, I had the opportunity to live in different parts of the world and was just intrigued with different cultures and how other people approach life, how they live their lives.

And when I came back to the United States, and did some work, through this program at Hopkins, we had to do a community project. And I started working in some of the communities in Baltimore and things that I saw in developing countries, you, you kind of saw a different iteration of that in our country. And it made me think that there's a lot of things that I can also do here in the United States to address the needs of medically underserved populations.

So, my first step into this work was as the director of a program at the Baltimore City Health Department, which was essentially a SDOH model, it was a social determinants of health model, identifying young men who were at highest risk of being murdered in Baltimore due to gun violence. It was a gun violence youth prevention program. And we had to get the city to do wraparound services to help these young people.

And, you know, they would say, “Well, why is the health department meeting with the police department? Meeting with, you know, this group and that group?” And so that just shows you how far back that was, where people really weren't making the connections of what it means, how social determinants impact one's health. But that was the number one health concern. Then you fast forward today, we're still seeing, you know, seeing that impact.

So over time, I just began to understand that policy is a critical part of the health care system. And I didn't really encounter a lot of physicians in this space who were using their voices to help elevate this work and advance health policy. So, I went and did an internship or a fellowship with the Congressional Black Caucus foundation and had a chance to work on the Hill. And then I worked at the American Diabetes Association and had the opportunity, and what I would say is the honor, to represent the needs of people living with diabetes.

So fast forward, I spent the last nearly three years at CMS as the Director of the Office of Minority Health. And when I talked earlier about this being a historic time, under the current administration, there's historic things that are happening in the health care system that I think we can't go back from, right, like the conversations, the momentum, the understanding of what we're actually trying to achieve through this work. We've never been here before.

And so, working at CMS and helping to develop our agency policy in this work and strategies in this work was very exciting, and impactful. And so, a lot of things we're seeing implemented now originated from the leadership that I provided during my time at CMS. And now my road is here at AHIP, and people asked me like, “Why are you here at AHIP?” You know, CMS covers over 150 million people. Our membership, as a trade association, we cover over 200 million. So, this is an opportunity to bridge equity across the health care system, because every single person at the table plays a role in what the health care system of the future looks like.

Traynham

Look, you said it so eloquently and I want to just acknowledge that all of these building blocks, it appears, have created the foundation for your life's work and what you're doing now. So, it feels like and you, Dr. McIver, this is your story. But it feels like you're now at an inflection point, to take that work to the next level. And to your earlier point, and to – and this is not hyperbole – to really impact north of 200 million people.

McIver

Yes.

Traynham

So, let's talk about that. Let's talk about 200 million people. And let's talk about equity in that space, and how, and I know you just started, but let's talk about your overall vision for this work at this level now.

McIver

So, you know, I'm, I'm really excited because I am seeing the impact of the work that I did at CMS. So, I know that there are 150 million people whose lives will be better because of this work. And so now focusing on the private health insurance space, wherein, you know, having worked with these organizations and companies over the last couple of years, I know that we're in different places across the health care system. And I see myself as you know, someone who will meet you, where you are in this process, and walk alongside you, no matter where you're starting out, because some, some organizations are very advanced in this work, and others are really just trying to understand what it is, “what can I do in this space to have an impact?” And so, for AHIP, you know, we represent the health insurance industry. So, we play, we are important, we have an important role and important voice in helping to shape how we as an industry will be impactful in this space.

So, I'm very excited. I've met with about 25% of our membership to date, and I'm learning so much about one, what they're doing, what the opportunities are and what success looks like, where there's still opportunities for us to think about how do we do this differently or together? And so, my hope is, you know, from a payer perspective, that we're going to pay for health care – which we know is very expensive. We still spend the most for health care of all high-income countries, and our health outcomes are still last. So, if we are paying for health care, what are we actually paying for? And how do we make it better for everyone? So, a lot of strategizing and finding those areas where we can lean in as an industry to improve the lives of all that we serve.

Traynham

Dr. McIver, I know we're running low on time. But I have to ask this question. And that is, we keep hearing about social determinants of health. And we also hear health equity. And I don't know if that's one and the same, or is that, do they complement each other? What is that? When we talk about those two terminologies? What does it mean?

McIver

So, they're, they're not the same, they're slightly different. The best way I can describe it is, you know, when we think about health equity, we're working towards removing the barriers that will allow everyone to attain their highest level of health and well-being – that they'll have a fair opportunity to do that. So, we're going to put a pin mark in “fair,” right? And then, we think about the social determinants of health, they’re the factors that influence one's health. For example, we often say where people live, work, grow, play, and pray. And so, you mentioned earlier about your zip code, when you think about the social determinants of health, where you live absolutely has an impact on your health.

As I mentioned, working in Baltimore, years ago, and even today, if you live in certain zip codes, you can't walk, you can't. You know you should walk, at least try and get in a 30-minute, a 20- to 30-minute walk a day. But if you're terrified to go down your street, which I know there are some people that can't even go to the end of their street, that is a social determinant of health.

And so, a lot of times when you think about policy, and we're a policy-making organization, policies, many policies have led to the inequities in our society, but policy can change, can change those things. So, for example, when we think about education, if you have, you know, if you have limited educational opportunities, it will have an impact on your health eventually. And there's research that that documents that. But there are policies that you can pass to improve the educational opportunities in a community.

So, we think about social determinants of health, those social factors that impact one's health, they're not quite the same, per se, but they usually travel together.

Traynham

I see what you’re saying. Dr. McIver last question for you. And that is I love to ask all of our guests and from your perspective, the next big thing in health, what does that look like for you? What does that feel like for you?

McIver

The next big thing in health for me, sitting in this space right here, is that we finally work towards getting it right. That we actually work towards creating a health care system where it doesn't matter who you are, where you live, you know, all of these things that we talked about earlier, that it won't matter about those things, but that we have created a health care system where we're meeting the needs of every person.

Traynham

Are you optimistic that we can get there in our lifetime?

McIver

I don't know that we can get there in our lifetime. And I often think about the quote by Martin Luther King about the arc…

Traynham

The arc of justice, it bends slowly.

McIver

Yes, it bends slowly. And I've seen it bend in my lifetime. And I'm raising up a generation in my own home to keep bending that arc. And working in the health care system, as I said, through these partnerships, more and more people are going to be working to bend this arc for health care. So, I don't know if it will be in my lifetime, I hope to live to be 100, or so.

Traynham

You and I both. In good health.

McIver

In good health.

Traynham

Good quality of life in good health. Yeah. And I think this is important to end on this: we are so thankful and grateful that you're with us on this journey, to really help, to use Dr. King's words, to keep bending that arc, which is slow, sometimes a little frustrating, but marching towards that space of equity for all.

So, Dr. LaShawn McIver, thank you very much for joining us. Thank you very much for helping us lead this conversation as we think about building a greater society for all and health equity. Thank you very much for being with us.

McIver

Thank you.