The MATTER Health Podcast

Scaling Access: Innovations in Healthcare Deserts

April 11, 2023 MATTER Season 3 Episode 3
The MATTER Health Podcast
Scaling Access: Innovations in Healthcare Deserts
Show Notes Transcript

More than 80 percent of counties across the United States lack adequate access to healthcare, with a third of the U.S. population living in a healthcare desert, an area with insufficient access to primary care providers, pharmacies, hospitals, trauma care centers, optometrists and more. While access has been scaled broadly in the last decade across multiple industries, including banking, entertainment, fashion and food, it has remained elusive in healthcare. However, in recent years, products, services and models that have been driving access and growth in other industries are finally beginning to find traction in healthcare.

Join VSP Global Innovation Center Head Ruth Yomtoubian, PlenOptika CEO and Co-founder Shivang Dave, Homeward SVP of market strategy and development Stephanie Gutendorf, and Deloitte Center for Health Solutions and Deloitte Health Equity Institute Executive Director Jay Bhatt for a panel discussion on the innovations, trends, technologies and startups transforming both access and how people in healthcare deserts receive care.

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Jeana Konstantakopoulos, Sr. Director, MATTER (00:13):

Hello and welcome to Scaling Access Innovations in Healthcare Deserts. We're so happy to have you. I'm Jeana Konstantakopoulos, Senior Director of Corporate Innovation at MATTER. Uh, for those of you who don't know, MATTER is a healthcare technology incubator and innovation hub. Really built on the concept that collaboration between entrepreneurs and industry leaders is the best way to develop healthcare solutions. And our mission is to accelerate the pace of change of healthcare. And really we do three things in service of this mission. So, first, we incubate startups. Since we launched eight years ago, we've worked with more than 800 companies that range from really early stage startups. Um, and we have a suite of services to really help them At every stage of development, our member companies have raised more than 5 billion to really fuel their growth. So second, we work with large organizations such as health systems, life sciences companies, payers to strengthen their innovation capacity, and we help them find value in emerging technology solutions, really unlocking the full potential of their internal innovators, and create a more human-centered healthcare experience through really system level collaborations.


And third MATTERs a nexus for people who are passionate about healthcare innovation. We like to bring people together to be inspired to learn to connect with each other, and we produce a lot of events. Some of them are open to the public like this session, and many of them are exclusive to our members and partners. So today's event is about access to care. We know that more than 80% of counties across the United States lack adequate access to healthcare with a third of the population living in a healthcare desert. Uh, in recent years, access to care has received more and more attention, but we know there's still serious room for improvement and innovation in this space. So, with that, we're really thrilled to co-host today's program with MATTER's newest partner VSP Global Innovation Center. VSP Global Innovation Center is the innovation hub at VSP Vision, which many of you may know, is America's largest vision payer, and the leader and health focused vision care. VSP provides affordable access to eyecare and eyewear for more than 85 million members through a network of more than 41,000 doctors.


Recently, VSP published a report on the future of Healthcare Desert Solutions, and we're really excited to convene four leaders in this space to unpack how innovation can increase access to healthcare. So with us today is Stephanie Stephanie Gutendorf SVP of Market Strategy and Development at Homeward, a technology enabled healthcare provider delivering care to those who don't have it, starting in rural America. Prior to Homeward, Stephanie served in leadership roles at Grail and Livongo. Also with us is Jay Bhatt, the managing director of Deloitte's Center for Health Solutions and Health Equity Institute. In this role, Jay directs the research and insights agenda across the life sciences and healthcare industry, while working with community organizations on high-impact collaborations to and fabs health equity. In addition to his role at Deloitte, Jay continues to practice medicine at local community health centers in the Chicagoland area.


Welcome, Shivang Dave is the CEO and Co-founder of PlenOptika, a startup that designs and produces tools to vastly expand access to vision care globally as CEO. Shivang led PlenOptika's growth from startup to an international company with products in global distribution, improving vision for millions of patients worldwide. Prior to founding PlenOptika Shivang was at two commercial startups and continues to mentor rising entrepreneurs. And last but not least, moderating today's conversation is Ruth Yomtoubian, the head of the VSP Global Innovation Center. Ruth joined VSP Vision to launch the Global Innovation Center as an important innovation player and disruptor and the healthcare and technology industries prior to VSP Ruth led AT&T Foundry where she drove the adoption and alignment of numerous startup solutions across various lines of business. So with that, thank you all for joining us today. I'm really looking forward to the conversation, but before I turn it over to Ruth to get started, one housekeeping note for our audience. If you have questions for Stephanie, Jay and Shivang, please drop them into the chat and Ruth will try to weave them into the conversation as we go. We'll retain a little bit of time at the end to to hit them. So with that, Ruth, take it away.

Ruth Yomtoubian, VSP Global Innovation Center (04:50):

Thank you to the MATTER team for, uh, inviting us to be a partner. We're very excited about this collaboration from the VSP Global Innovation Center perspective. This is, uh, a real opportunity, um, as was just shared by the MATTER team to bring our futurist report to life. Um, so before we jump in and we're gonna really start with what, um, uh, having our panelists tell them about ourselves, but also tell them about our access story. Um, I just wanna tell you a little bit about why VSP cares about healthcare access. And this is not a new effort to VSP Vision. We are here to bring eyecare, um, to those who have, um, not just benefits through their company, but we're also empowering millions of Americans who lack that basic access to care. And, you know, their, their need to see the world clearly.


And your vision is actually connected to your overall health. There's screening and detection, uh, through your eyes that relates to diabetes, hypertension, as well as, uh, many other health conditions. Um, secondly, it's your vision's also connected to your livelihood. So you cannot have economic growth in a community if you do not have children who can see, or professionals who have, um, strong vision. So thi this is our access story. This is why access to care MATTERs to us. It's connected to people's overall health and it's connected to their livelihood. Um, so I would love to just kick off this conversation with this great group of panelists here by having you just take a minute or two to share a little bit about yourself and, and your access story. So, uh, let's, let's start with Jay.

Jay Bhatt, Deloitte Health Equity Institute (06:33):

Thank you so much, Ruth. Uh, thrilled to be here with all of you and, uh, working together, uh, in this conversation. I'm a primary care physician on the south side of Chicago, and this issue of access shows up in my exam room, shows up in the homes I visit, shows up in the mobile units that goes to communities because the stories of individuals who didn't have access or, or coverage or didn't know where to go and how to navigate our system has led to progression of preventable conditions or chronic disease with like diabetes you mentioned and has impacted, uh, uh, their whole body, whole body health as well. And I would say that the other way that it shows up is that we think that, uh, health equity, uh, is access and, uh, the ability to, to live a healthy, productive life and have the drivers of health support you, uh, and address those. So we released a report, uh, last summer, which estimated the cost of health inequities in this country to be 320 billion today. And that's by looking at five common conditions, asthma, cardiovascular disease, diabetes, breast cancer, colorectal cancer, and it's would become 1 trillion in 2040 if we don't adopt a perspective and care model and approach that promotes and restores health. And accesses certainly an important part of that. And so looking forward to the, the conversation with you all today.

Ruth Yomtoubian, VSP Global Innovation Center (07:57):

Yeah. Sounds like Jay, you have both a, a wide perspective from your role with Deloitte and also a, um, real tangible frontline perspective, uh, as a practitioner yourself. So we're, we're really happy to have your voice here. Uh, and then Stephanie, why don't you go next?

Stephanie Gutendorf, Homeward (08:15):

Thank you, Ruth. And it is, uh, such a privilege and honor to be with this group today. I'm really excited about the conversation we're about to have together. Um, but my role within Homeward is really overseeing our market strategy. And at Homeward, our mission is to rearchitect the delivery of healthcare for rural communities across the country. And as we think about health inequity, the rural aspect of the United States is a major factor as we think about places by which are frankly becoming forgotten in many ways. So my background prior to my life at Homeward was I grew up in rural Ohio. My mom's a primary care physician, and I remember many times we were bandaging bones and things of that nature, whether in the back of church or in our family living room. And the reality is, for me, that was normal. The fact of the MATTER was that was because we had such a lack of access to care in those communities, and it was such a long transition point for folks into appropriate care facilities.


And that was even, I'm not gonna tell you how old I am, but that was even, you know, well over 20 years, 30 years ago today. Um, so as you look at where we are right now, I think it continues to be an acute challenge. I think when we think about access, we talk a lot about urban environments in the United States, but rural is becoming an ever-growing problem. So 40% of rural hospitals are set to close in the next year. You have, um, only about half of the PCP availability that you see in urban environments, one eighth of the specialists available. And so all of this comes together and leads to confounding issues where you have now a 23% higher mortality rate by virtue of just living in a rural community across the country. So if there's a way by which we can figure out all of these wonderful things that are working in terms of health inequity and urban environments can then translate into rural with us as well.

Ruth Yomtoubian, VSP Global Innovation Center (10:03):

Yeah. So it sounds like you have personal experience in this space, and I know we said bef before we started, that you had a number of different experiences in your career, but it sounds like you've come back to your roots to help solve this problem.

Stephanie Gutendorf, Homeward (10:19):

That's right. Yeah, absolutely.

Ruth Yomtoubian, VSP Global Innovation Center (10:21):

Great. So moving over to my, my partner in Vision Care Shivang.

Shivang Dave, PlenOptika (10:27):

Hi, thanks for having us. Um, really excited to be part of this group and part of this discussion. So I'm Shivang. Um, I spent the last 20 years of my career, um, as a translational medicine researcher, um, developing technologies to improve, uh, improve healthcare outcomes. And as an, uh, social impact entrepreneur, what we do at PlenOptika is we make medical devices and digital health technologies to improve access to care. Why, as Ruth, Ruth has already kind of ex expanded some of the impacts. You know, we also work very internationally. We work in about 45 countries now, and what motivated us was, there's something about around 1.1 billion people in the world who don't have the glasses they need. They have uncorrect or refractive errors, and this impacts seven of the 17 UN sustainable development goals. So we thought it's a, a huge problem and a problem that, um, you know, can be solved with simple pair of glasses. And if you can do that, you have these really huge, uh, impacts on education, worker productivity, and just overall quality of, of life. And, um, yeah, so I'm excited to be part of this panel and, uh, looking forward to the discussion.

Ruth Yomtoubian, VSP Global Innovation Center (11:26):

Great. Well, I, I know Shivang, that vision care is an area that can, uh, ha has its own health deserts, but can also help close these health care desert gaps. Um, so I know we're gonna share more about that. Uh, so before we get into it, we wanna make sure we're, we're gonna take some principles from our futurist report and from in our innovation work at the Global Innovation Center, we always start with making sure we have common definitions. Uh, because as we know, if we're trying to get directional feedback or solve problems and we're not on the same page, um, then we, we might be going after, um, different problems. Uh, so we wanna make sure that we define exactly what we're talking about here. And I would also encourage people aside from questions, this is a practice that my team does, is w to help synthesize in this virtual world, we'll sometimes pick out quotes or statements or those definitions that really resonate with us. So I definitely want to invite the audience if something's resonating with you, um, to be a part of this collective synthesis, um, of this conversation here. So you're welcome to do that. So starting with our, our first definition, what is a healthcare desert? How can you identify one, um, and how prevalent are they? Um, so I'll open this one to, to everyone here to jump in.

Jay Bhatt, Deloitte Health Equity Institute (12:51):

Hey, Ruth, maybe I'll just, uh, start and I say I think that, uh, I would look at it as the lack of, uh, uh, proper access to those services, uh, needed to promote and maintain health. And when we look, think about those that include healthcare, delivery organizations, hospitals, uh, trauma centers, vision, pharmacy, dental, primary care being, I think foundational to, uh, promoting, maintaining health and, and community health centers. But it also includes, uh, as we're growing virtual and digital access, uh, thinking about connectivity and broadband, but also access to those, um, drivers of health that impact 80% of health outcomes, uh, including food, housing, transportation. Uh, and then we think about our environments. I say often say to patients that we could do everything right clinically, but people go back to the conditions that might make them sick. And how do we think about those, uh, conditions? And so, you know, as COVID has illuminated, if you're taking care of employees, every company is a health company. And so there's also important opportunity to align stakeholders, uh, around these issues.

Ruth Yomtoubian, VSP Global Innovation Center (14:11):

Mm-hmm. <affirmative>,

Shivang Dave, PlenOptika (14:12):

I would later onto that. Um, also, you know, is the care affordable that population, it's not just an access problem or an awareness problem, but you know, is it accessible financially?

Ruth Yomtoubian, VSP Global Innovation Center (14:24):

Mm-hmm. <affirmative>. Yeah, I think that was something that was put in the chat is the affordability piece. And arguably awareness is part of, um, accessibility as well. Stephanie, anything you wanna add to,

Stephanie Gutendorf, Homeward (14:37):

I would say prevalence,

Ruth Yomtoubian, VSP Global Innovation Center (14:38):


Stephanie Gutendorf, Homeward (14:39):

Yeah, absolutely. So I think a big part of it too, if you think about access is the ability around transportation. Um, especially as you get into more rural communities and places like that. Like we continually see ongoing issues where there's just a lack of providers. There's no new infusion of providers into these communities, which is why organizations like Homeward are coming together and sort of reinventing what does it mean to be a provider in a rural community. Um, and then really thinking about from an access perspective, like healthcare's really the only industry where if something breaks, we ask you to come to us, right? Your car breaks down, AAA is right there, you get a flat tire, someone can quickly be there to help you tow your car, right? You break your leg though, particularly in a lot of these rural counties across the country, and we're telling you, you need to drive two hours to the local hospital to get your leg set, right? So there's gotta be a way we can do this better. And it's just, when you really look at the practicality of folks living in these access deserts, the challenges they're up against are tremendous in terms of being able to get the care they need.

Ruth Yomtoubian, VSP Global Innovation Center (15:41):

And Stephanie, can you just expand on that? Like the, I I love this metaphor with mm-hmm. <affirmative>, uh, your car breaking down. I mean, just, uh, you know, spell it out for us. What's the difference between AAA and having an emergency or a non-emergency, let's say, related to your health?

Stephanie Gutendorf, Homeward (15:58):

Yeah, no, I think that's, that's a great question. So, I mean, I'll give you a very, uh, real world example that happened just a week ago in my house, which is I have a nine-year-old son and he managed to, um, in his afternoon with his grandfather fishing about an hour outside of even where we live now in rural Ohio, get a fish hook stuck in his hand, right? So they immediately call me, they say he's a fish hook in his hand, what do we do? There's blood everywhere, he's gonna need stitches. I'm like, you need to call the doctor. We call the doctor. They can't fit him in until the next day. So they answer was go to the nearest urgent care. So they look up where the nearest urgent care is from where they were, and it was gonna be a 90 minute drive, right?


All to get four stitches in your hand, which are necessary, um, in that sense. But if you think about the inverse, right? If we had had a flat tire, my grand, you know, my son and his grandfather had a flat tire in the same environment, right? Very quickly, they could have had AAA right there, like usually within a MATTER of minutes, right? 30 minutes or less. Typically they get the tire changed on the spot and then they'd be able to go about their day. So it's a very micro example, but I think it shows you sort of in real life ways and purposes, like a lot of the issues that folks have in terms of being able to get the care that they need.

Ruth Yomtoubian, VSP Global Innovation Center (17:13):

Mm-hmm. <affirmative>, this kind of relates to what Shang was just saying a, a second ago about access, uh, affordability mm-hmm. <affirmative>. And so this doesn't happen because of that very important factor, right? I don't know, Shang or Jay, if you wanna expand there on that factor of transportation and cost.

Shivang Dave, PlenOptika (17:31):

Yeah. So, and, and there's some questions about, you know, um, tying in this, uh, from the US perspective or global health perspective. So I'll try to do both. So, um, the, like, there's some statistic, like 90% of the US population lives within 10 miles of the Walmart, and that's considered accessible cuz of cars and, and transportation here, when you look in the global health context, it's something like, um, for something to be considered accessible, it needs to be like three to five kilometers. Mm-hmm. Which is like a mile or two right? When you do the conversion. And that's because of lack of transportation or how costly it is for a daily wage earner to take time off and to try to like get transported somewhere. So these are, um, gives you some, some I guess, metrics and, um, someone else was kind of asking how, how do you bring care?


You, I think what the panel's not saying is that all care has to be accessible everywhere, right? It would be clearly we couldn't have an M r I machine stock with, you know, specialist at every, at every mile, right? But it's about making a system where if you are, um, further out that you can still get high quality care and get triage and there are mechanisms to pull you up higher and higher up the, the healthcare ladder. And we see that a lot in, in eyecare in other countries where they have these eyecare pyramid systems where they have satellite clinics out in rural and low income areas that can triage very well. They can support a lot of, um, the basic diseases. And then they, if they find out you, you can't be treated there, they have transportation systems to pull you up into higher, higher levels of, of care within their system. You see this a lot in India and eye care systems.

Jay Bhatt, Deloitte Health Equity Institute (19:05):

Now, I would add and layer on, uh, cuz to this, uh, also thought that how we define affordability, it can affordability to whom. And so as you think about it from different perspectives, I think about it from the, if, if we're in this conversation around, uh, out-of-pocket costs for consumers, right? And in this moment we're in a, we're in a pretty historic moment around the challenges, uh, that inflation and the economic environment is placing people, um, where they're having to make trade-offs. And it's not just trade-offs between tangible things, but like to the point earlier about their time, their livelihood, their, um, families, their kids about whether they can afford certain things. I have for the first time in, in my clinic, patients and families coming and asking for services that they never asked for before. So, um, it, you know, I think we also, there's this piece around care delivery model and what is the payment and reimbursement structure to support the care delivery model that generates whole body health.


And I think that some pockets of that, but we've gotta do that certainly at scale. Uh, and, um, and I think that, that that's more, and we, you know, the other thing is that these are intersectional issues. It's often not one driver of health, but that there's a combination. We have a dashboard that we did with Marcha dimes around maternity care deserts that you can see the overlay of care desert with, um, uh, environmental, uh, and other, uh, socioeconomic characteristics. And you see that sort of inter intersectional nature, which requires, um, a a cohesive coordinated approach. And that, you know, health equity is everybody's business. Uh,

Ruth Yomtoubian, VSP Global Innovation Center (20:51):

So that's a, that's a great point about the climate change overlay, um, is in increasingly a lens to look at health access through, but also healthcare benefits, um, asthma. There, there, there's a number of different, um, factors that can be detected through that overlay. But of course, as you just pointed out, you need that comprehensive view. You need that data to be coordinated, which is certainly a challenge. So before we get to what's stopping us, let's wrap up this, um, first piece on just our definitions and laying some of the groundworks about the factors. And then we'll get into what's stopping us, and then we'll hear more from this group about what are the solutions I, I know that I can see in the chat, we're itching to get there. But first, what are those factors? I, I think we popped up a few of those, like costs and affordability, um, social determinants of health. I is a big one, it's a bit of a buzzword. So would someone wanna maybe define social determinants of health and, and maybe health equity for the audience here? And why, why is that a factor in this conversation?

Shivang Dave, PlenOptika (21:56):

Jay, do you wanna kick it off?

Jay Bhatt, Deloitte Health Equity Institute (21:57):

Yeah, yeah. I, well, let me, I I'll say the way we define health equity is it's a fair and just opportunity for, uh, everyone to have their highest potential for health and wellbeing, regardless of circumstance, background. And, uh, you know, that we, we think about social determinants of health as drivers of health, and, uh, because some of these things aren't naturally determined mm-hmm. <affirmative>. And so when you think about the drivers of health, it's also about language that MATTERs. So if I were to say, if I were to help someone get housing bec or improve their housing status, that's a social need in terms of if they've got mold, it's dry causing symptoms, causing them to, uh, access care if the lack of affordable housing in a neighborhood, uh, is a, um, a driver of health. And then the decades of discriminatory policy zoning and other issues is a systemic and structural mm-hmm.


<affirmative> issue mm-hmm. <affirmative>. And so it depends where you're intervening along that continuum, uh, in terms of what the strategy is and what, um, so I, I think that's often it's important to understand because this gets all jumbled together, and, and person with unstable housing on average has a 27 year less life expectancy, uh, than someone with stable housing. And we're seeing dramatic impact on life expectant expectancy over the last several years where we're approaching 1997 levels of life expectancy, 76 years on average, spending 3 trillion more. Mm-hmm. And a Rwandan black man has a better life expectancy than of the black male. So, um, you know, we've gotta, we've gotta turn the tide. Uh, there's a lot to be proud of, but, but we've gotta scale the things that work towards health.

Ruth Yomtoubian, VSP Global Innovation Center (23:42):

Mm-hmm. <affirmative>. So that a great point. And you, I know you brought in that international piece and we're going to cover that later in the conversation. I know there's a question, um, in the chat about that. So we will get to that piece. So thank you for providing that definition. It's an important lens, and it shows that this is not just a conversation in a vacuum with just healthcare professionals and that, and, and, and needs to be, uh, a dialogue across various sectors. Um, Stephanie actually, since you brought up an example of, of seeing this problem for decades now, can you tell us a little bit about what's changed? Um, what hasn't changed? Are you optimistic?

Stephanie Gutendorf, Homeward (24:24):

Yeah, I think to Jay's point, there's a lot to be optimistic about. I think first and foremost, we're finally having this conversation in a very real and tangible way in the industry. Um, and being able to look at meaningful data points that compares us to other countries where we can take a hard look at ourselves as a nation and say, this is working or not working. And that, that's an open dialogue now. I think that's a, a huge step forward. I think the other big, um, factors, at least from a homeward point of view, that make us very optimistic about new models of care into this space around health inequity. Um, one is related to payment re reform, right? So the traditional fee for service constructs of healthcare being challenged at every corner, rightfully. And there's a huge push across, you know, all lines of healthcare business toward value-based care models where we can really align around outcomes and build care delivery models that make sense for the communities we serve.


You know, I think what we see at Homeward is we think about rural communities is the fee for service construct just doesn't work. I mean, that's why you're seeing all these rural hospitals being forced to close. That's why you're seeing an exodus of specialty care out of a lot of those communities. And so with a value-based payment model, you can really redesign, um, and be purpose-built for these rural communities and, and other communities you serve to make sure you have the right parts and pieces. And we can talk about care delivery in a minute of what makes the most sense for that, that individual living in that community in order to get the care that they need. So I think value-based payment models are, make us super optimistic. The other thing I would say is just with the ab advent of covid and the acceptance of telehealth, and I think there are some things in the chat about telehealth.


You know, I think, um, as you think about rural, there's a lot to be, and another big inequity piece is broadband and access to broadband and internet, and how that then limits your access to things like virtual based care. But there is a lot with telehealth to be optimistic about, and the acceptance of it across all age groups. Um, when we think about consumers during covid was, I think a turning point for us as an industry and allows for a lot of opportunity and latitude, is we think about redesigning and reinventing what it means to be a provider in these communities where there's, uh, a lack of health equity. Um, and so for us at Homeward, it's, you know, understanding that telehealth is part of that solution, but trust is another big component of that relationship. And without some form of in-person connectivity to build that local trust, the telehealth piece we've seen is challenged to get off the ground, but if you can establish that trust locally first, and we'll talk about sort of how you can use sort of medical assistance and other, um, you know, different level licensure folks to build trust locally, once you have that trust, trust that telehealth piece can be something that you can leverage and scale.

Ruth Yomtoubian, VSP Global Innovation Center (27:08):

Mm-hmm. <affirmative>,

Stephanie Gutendorf, Homeward (27:09):

That's a really long-winded answer than what you're looking forward.

Ruth Yomtoubian, VSP Global Innovation Center (27:11):

No, no. I, I, I was really trying to help everyone understand what has changed since this conversation has been going on for a long time. And suddenly you see interest from companies like VSP and other organizations and an investment from Deloitte and other sort of aggregators of, of voices and ecosystems, um, trying to pull together and, and solve this problem. And perhaps Covid was an IPEs to say, okay, th this is an, this is enough. Uh, so the spicy question, what is, or what has been causing this low velocity of innovation in healthcare? And we have a very real group here, so you you're gonna get some good answers. I have a feeling. So Shivang, take us off.

Shivang Dave, PlenOptika (27:57):

Yeah. I I also wanna kind of quickly address one thing. Yeah. You know, you are asking what was social determinants of health? I think one thing that I see that's progress and gives you the definition of social determinants of health and kind of answering some of these questions is everything is connected, right? And we are raising that on many levels as a society now, right? If you look at biology used to do very reductionist based biological experiments. Now we do multi-variable kind of analyses. We usually look at just one population. Now. We look at effects of drugs on different populations. We look at how the economy affects health and vice versa. So I think what it is, is just this general awareness in all areas of knowledge of the interconnectedness of things and health gets affected by many different things. And so that, that's my, and I think that is, um, one level of progress as a society, just how we think about problems and unfold them.


Um, and yeah. What are barriers causing the slow, uh, velocity? Uh, I think historically it was stuff like infrastructure, like the internet, you know, wasn't allowing streaming videos 20 years ago, right? And, and, um, for everyone, or is very expensive. It's the revolution on the smartphones and things like that have helped expand. But what slows things down, I think are investments tend to be focused on, on things that sound very sexy in healthcare, but not, might not actually have a long-term view of impact or might not really address the underlying barriers that cause a health inequity to exist. Um, and so, and that's partly all of our faults, right? It's the innovators who build sexy stuff that they know is not gonna have impacts. It's the doctors who work on it and might promote it. It might be the investors who invest in it, it can be everyone, but at at least they're doing something, right. But I think if we want to have more impacts and increase the velocity, we have more technological capability now. It's really about raising awareness of what is barrier and is that technology really addressing that barrier or multiple barriers. Um,

Ruth Yomtoubian, VSP Global Innovation Center (29:48):

And, and I definitely wanna hit on, uh, one of your points about the provider shortage. I think that's related to what you, what you're alluding to. So we're gonna get to that in a second. What, what else is causing this low velocity of innovation in healthcare? Um, Stephanie or Jay?

Jay Bhatt, Deloitte Health Equity Institute (30:05):

No, I would, I would say it's interesting, um, because, uh, covid illuminated that, um, people could have increasing confidence in innovation that that necessity was a mother of invention and innovation because we accelerated plans in short order that were longer originally, right? So I also, I think that that's important to say, well, what worked there? How do we apply that to driving innovation now? Um, I think one is potentially misaligned incentives. Um, and, uh, the other is linear versus exponential thinking. I mean, you have various parts of the ecosystem where there is exponential thinking, but there are other places where it's, it's very linear and, and that's, uh, can be due in a number of different reasons. But I also think that, you know, every system designed the results. It's, it's designed to get, and, uh, if we, we want to enhance innovation, we've gotta drive both policy systems and uh, uh, alignment around incentives towards that.


Um, so I think that's important. And I would say trust, you know, we think about trust, like health equity moves at the speed of trust, but trust is one of these things that you can build. And it takes time to build, but you can lose quickly. I mean, I see it in my patient's eyes when they expect something to come through from another care setting or imaging study or labs. And it's not there because our system of inter lack of interoperability or challenges, it don't bring it. And this is where the fragmentation and the friction we create in accessing health and maintaining health is, um, uh, a barrier. So, uh, again, I think, uh, we've gotta say how do we scale the things that work in the principles that work on driving innovation? What's working in other industries that we bring to our, uh, health Interesting? What is work globally global advantage, you know, and how do we scale that? Community health worker is a great example where we haven't figured out the workforce integration and the reimbursement model to scale here in our country where it scales and is used effectively in the developing world.

Ruth Yomtoubian, VSP Global Innovation Center (32:19):

Yeah. So, so Jay, you brought up a lot of points about the, the business model, about, uh, the, the customer trust, or really it's in this case, the patient trust, but also the provider trust. And in our, uh, team and in the innovation world, sometimes we talk about alibis against innovation or to do, uh, something or, and, and, and that might be the trust between the provider and the tools the provider trusting telehealth or virtual screenings, um, or new types of products, um, like the, the ones that Chivon is bringing to the vision care community. So there's trust with the patient and there's also trust, um, with the providers. So Shang, do you wanna pick it up on the, on the low velocity and build

Shivang Dave, PlenOptika (33:06):

On Yeah, yeah, yeah. One, one more thing. You know, there's trust between the provider and the patient, but there's also trust issues between the reimbursers or the providers and technology. And part of that is there's a lot of technologies that's come out and flamed out. Cause it wasn't, didn't have a strong foundation. There's others that, that do. I mean, again, it goes to your point of building trust takes a long time and doing good science, building good tech takes a long time. Um, right Jay, and, um, someone was asking, you know, what, what is another problem? And is it, you know, how do we get more doctors into these settings? And that's part of the low velocity is the cost it takes and the time it takes to get trained to be a healthcare professional. Mm-hmm. I mean, you then have certain, you know, loans that you want to pay back and you tend to then say, okay, I need to first pay these back.


I need to be in a high resource setting. And that does, uh, accelerate the problem. We don't talk about it a lot, but some of the med schools have done innovative things where they've made healthcare tuition free for all the students. I think it was nyu. And that really gave those students, uh, a pos an opportunity to go where their passion was and serve the communities they want without being bound by their loans and having to pay that back, um, very quickly. So I think that's a barrier that doesn't get talked a lot about, and I'm glad someone brought it up in the, in the questions,

Ruth Yomtoubian, VSP Global Innovation Center (34:15):

The trajectory of these students and the providers and their limitations is very different from 30 years ago. And do, do you, do we think that those providers kind of in practice for 30 or 40 years understand the challenges of those coming into, um, the, the profession?

Jay Bhatt, Deloitte Health Equity Institute (34:35):

Yeah, I think there, there's certainly challenges there. You know, there's different ways of working. There's training that's evolving. There's, um, the multidisciplinary team-based care that's so important. You know what, we recently published a report, uh, called a talent emergency about the provider shortage. And one of the, the data points from that survey is that 26% of clinicians frontline, um, trust the leadership in their organization. So there is also a leadership deficit, um, when it comes to some of these issues within the care delivery, um, system. Uh, and, and I think the provider shortage is a critical, critical issue. Gotta reimagine care delivery and redesign the work. And part of that's investing in technology to give time back to workers, rethinking where care is delivered, redesigning work teams, injecting flexibility in your jobs and investing in your people. And then restoring trust in organizational leadership, uh, I think is, uh, gonna be really important.

Ruth Yomtoubian, VSP Global Innovation Center (35:31):

Mm-hmm. <affirmative>. Yeah, it's, it sounds like there's some of this responsib, a lot of this responsibility put the provider and I, I think there was a plus one for the community health workers. Um, but there's also quite a bit put on the patient whether that means, uh, transportation, affordability or other kind of barriers in including education. And sometimes the patient comes in and educates the provider. Um, so that's just an another factor in, in the mix. So on this topic of the provider shortage, um, Stephanie, um, Homeward is taking an innovative approach to working with those local providers and community resources. Can you just talk a little bit about, um, how you approach that within rural settings?

Stephanie Gutendorf, Homeward (36:16):

Yeah, absolutely. So at Homeward, everything that we've done has truly been purpose-built for rural communities and redesigning what does it mean to be a provider in a rural community. Um, and a lot of that comes back to sort of team-based care, getting all the providers to operate at top of licensure, leveraging some of the lessons around what works in other countries, particularly developing countries around community-based health workers. And thinking through how can we leverage folks like LPNs and medical assistants to be sort of the boots on the ground support for the primary care physician that's more centrally like held and located, right? So at Homeward, a big focus for us is really meeting people where they are. So our team goes usually into the homes, into the communities. We have mobile clinics as well, but typically into the home, we're establishing trust with that medical assistant team.


We have the provider, um, online with the patient sort of face-to-face through a virtual connection point with the medical assistant physically there to build and establish that trust. And then, you know, over time, this is where that technology piece comes in, right? How do we leverage technology as a way to stay con, continually connected, making it easy for people to access care, um, and then really leveraging that team that's there in person to build and establish that trust over time. I think there's a lot we can learn from other countries around what could and should work highly effectively here, particularly under value-based payment models that'll help us to align all the asen incentives appropriately. Cause I do think Jay's earlier point on that was, uh, a critical one is we think about how do you really truly scale this over time? The model we're delivering with Homeward under a fee for service construct, it doesn't make sense financially in a rural community in the United States today. So you have to be able to rethink the payment delivery models as well as you think through sort of what does it mean to be a provider.

Ruth Yomtoubian, VSP Global Innovation Center (38:10):

Mm-hmm. <affirmative>. So you, your organization is taking a portfolio approach.

Stephanie Gutendorf, Homeward (38:14):


Ruth Yomtoubian, VSP Global Innovation Center (38:14):

Right. Multi tactics, categories, uh, all working together. Um, so this, this conversation is obviously not just about the deserts, but it's about the innovations in these deserts. So, uh, Shang, I have a two-part question for you. Um, how did you land on hardware as an access solution, especially in this world where so many, uh, innovators and startups are, have been focused in the last few year on years on, uh, software or services. And then, you know, you've brought quickie all over the world, so what are some things we can learn about scaling access in other countries? And, um, and I'm gonna layer on one more question from the audience. So hardware taking quickie internationally, and, uh, we, we have a question from Al Shami. He's an social activist from Israel, and, you know, he wanted to know how according, um, to the US government, um, can we practice and improve accessibility of poor and low socioeconomic groups, um, to, to use modern healthcare?

Shivang Dave, PlenOptika (39:18):

Sounds good. I think I can tie all three of them together. Okay.

Ruth Yomtoubian, VSP Global Innovation Center (39:21):

That's what I thought.

Shivang Dave, PlenOptika (39:22):

<laugh>, what we do is we make a handheld auto fracture. Why did we make it? I already talked about these huge barriers, right? Uh, there were other companies that tried to do stuff on smartphone, do stuff with just software. And we chose this kind of longer path, uh, took us six years to bring our product to market and do about six clinical studies across multiple countries. And they took them one or two years cuz they just did software. The reason we did hardware is, uh, not cause we love hardware. Being hard was cuz it was the right thing to do. If you think about, if you want to improve access to care, you also have to think about is the device I'm developing maintaining that standard of care that the physician wants? Is it getting the data not so that the physician can screen, but this is it getting data so the physician can diagnose, right?


And, and that's a big difference. And so what happens, I think a lot of times with software based only solutions, I'm not talking about dermatology and radiology and AI there, but, um, you can do screening and triaging, but you can't actually diagnose and then actually get treatment. And so we took this very long path, uh, and that's because our DNA is that we wanted to make technologies that when they were used outside of traditional clinical settings, maintain clinical quality diagnostic capability in any lighting setting. Whether it's in the hands of a professional or the hands of community health worker or a nurse or a volunteer and in, you know, in the US or in any of these countries we, we operate. And so I think, um, this is something that for innovators, we're often, uh, excited by the software only solution. Cause it's easier, it's faster, and it's a little more controllable.


Um, but it actually doesn't have that long term impact. And in terms of scaling, you know, and this ties into a lot of these questions, it's about working with partners, right? That's not just working with patients and doctors, but with distributors that are ethical, working with the regulators to make sure you can get your device accepted into those countries, right? Working with global health, uh, groups and NGOs who are helping, uh, drive, um, you know, technology adoption policy. And, you know, in terms of the, the question from the activists from, uh, Israel, I forgot his name, I saw it there. Um, you know, I think one thing that's really cool that once you develop really good technology that builds the trust and is validated, you can start doing task shifting mm-hmm. <affirmative>. And then you can effectively scale up the effective manpower of your organization, your healthcare organization.


Task shifting means, you know, a hundred years ago a doctor used to do, uh, do your blood pressure, right? They'd come to your home, they'd put the swingometer on there and do all that. Now a nurse slaps something on your arm, walks away and does some other tests, right? And that's task shifting that makes everything more efficient for the doctor, for the nurse. And so developing technologies that can be task shifted, and especially in these settings, if you can empower community health workers with more technology that's diagnostic and tied in with the doctor, you can effectively scale manpower.

Ruth Yomtoubian, VSP Global Innovation Center (42:07):


Shivang Dave, PlenOptika (42:08):

You. Hope I answered all three

Ruth Yomtoubian, VSP Global Innovation Center (42:09):

Fitting that all in. Um, I'm, I'm gonna go to Jay and then I'm gonna take, do a lighting round from the chat, and then I'll end with the final question since we're at 15 minutes. So this has gone really fast. I hope everyone's paying attention because I'm about to ask Jay a very important question for innovators. Uh, so on the front lines, right, you have this frontline perspective, you're working at community health centers, what innovations are you seeing that are really delivering an impact? And then this is the question for the audience of entrepreneurs. What's missing? What should they be focused on?

Jay Bhatt, Deloitte Health Equity Institute (42:42):

So I, I think that, uh, there's a lot of interesting work, uh, going on, particularly community health centers. And I think one, I would say there's a set of activity around, uh, care model and payment model associated CMMI just, uh, released recently the reach ACO, the reach accountable care organization to try to help support, um, value-based care adoption and underserved communities. And I think when we think about FQHCs or community health centers, they have alignment with this kind of, uh, value-based care agenda. Um, the standard reimbursement structure that community health centers have now don't give them the flexibility to invest in services that provide upstream care and and care towards health. So, um, some of the innovations we're seeing are around that with, we have, you know, supplemental benefits with Medicare, uh, vantage, as well as, you know, some changes in Medicaid that are impacting ability to support driver drivers of health.


Um, we're also seeing digital technology. So, you know, health systems and, and health centers are actively reimagining consumer health, working to just shift away from treatment toward health and wellbeing enabled by digital technologies. Um, you're also seeing, uh, that, uh, the use of virtual and, and, uh, digital, uh, combined with trying to help get connectivity in places there isn't. But we found that more than 55% of people of color are interested in using virtual, uh, health for preventive health and mental health needs. And so, um, I think it's, it's also innovations around the drivers of health. You know, how community health centers, you know, and how we're, uh, supporting, um, uh, digital food delivery or, uh, mobile care, uh, and trying to bring together an ecosystem that delivers the services that, um, historically underserved in vulnerable populations.

Ruth Yomtoubian, VSP Global Innovation Center (44:41):

Mm-hmm. <affirmative>, no, thanks. Thanks for

Jay Bhatt, Deloitte Health Equity Institute (44:44):

Sharing. And hospital at home is the other thing I would say. Yeah. Is an interesting evolution. And, you know, the role of community health centers as, as collaborators in that ecosystem along with, with other provider pro uh, provider organizations, you know, dental eye, uh, and other needs, uh, that may be important at home. Uh, but we gotta make sure those services are available. Like sometimes it's hard to get an oxygen tank on a Sunday or other things if we're gonna drive a hospital at home model.

Ruth Yomtoubian, VSP Global Innovation Center (45:16):

Yeah. Okay. So not only virtual everything, but at home, everything sounds like that's, that's one of the themes in addition to these, um, in innovations that can provide access, like the, the quick see from plank. So lightning round on some questions and we'll just see if anyone in the group can answer these. Um, first from Monica, she had asked, um, as you think about bringing both services and products to healthcare deserts, what are your thoughts on supply chain needs? It's one thing to have RNs, PCPs travel, but how do you ensure clinicians have the resources they need to treat patients for a variety of conditions and situations? Is this even an issue at this point?

Stephanie Gutendorf, Homeward (46:00):

I'm happy to take an initial stab at that. So I think, um, I think it depends a little bit on the community and where you are. I think as you get into this, you can, you can carry forward a care delivery model that, you know, can scale and have the technology behind it to scale it. I think there are two upfront challenges. First is trust. And I cannot underscore enough the importance of trust. I think if I were to say the primary barrier to all of this in terms of innovation is how do we have the best technologies, the best solutions, but how do we do it in a way that brings consumers back into the healthcare ecosystem because they've lost trust in the past. Mm-hmm. <affirmative>. Um, so as we think about that, you know, I think trust is a big component of it.


I think the other aspect in terms of connecting back to other healthcare resources is at a hyper-local level, who are those local allies? Who are those community organizations? Who are those, um, you know, food banks, things like that, that can help address a lot of the social determinants of care. And then ultimately, who are those specialty groups that downstream that you're gonna build alignment and partnership with and alignment even financially in terms of incentives as well to help provide comprehensive care over time. So I think it's an ecosystem that has to be built out around these hyper-local trust oriented care delivery models.

Ruth Yomtoubian, VSP Global Innovation Center (47:18):

Hmm. Okay. I'm gonna move on cause it's a lightning round. Um, so we have from Samantha, who's an MPH student at gw, uh, graduating. Congratulations Samantha. Uh, how have your organization's leveraged innovation to provide a care continuum that incorporates social determinants of health, social drivers in health and health related social needs? Um, so it sounds like it's focused on preventative care and healthcare deserts, which is interesting. I mean, because we've been mostly talking about access when something's wrong, but h how, what's an approach? Uh, I would say vision care maybe fits into that preventative approach. Uh, but anyone have some something they wanna jump on? Yeah,

Shivang Dave, PlenOptika (48:01):

I'll, I'll take a stab. That's a complex question. Um, so one of the things we did is we developed our technology so it could be affordable in lower income areas and low resource countries and what that allows. And, but it's, it's very accurate and it's easy to use by community health workers. So what iCare hospital systems have done in, um, like India for instance, is they'll put, uh, use this device not only in screening where they go do a screening camp, you know, in a village, let's say once or twice a year, but that's not kind of permanent access. So what they've also been able to do is put these envision centers that are embedded in those communities and it, they can relay the, the data to the doctors. And so it brings some of that technology to that front line. Um, the Veterans Affairs, um, is using our technology in, in a similar way for satellite clinics in the US to reach rural vets. So I think, um, you know, one of the, the determinants is, is that travel access and that, and, and that's how we're addressing that piece.

Ruth Yomtoubian, VSP Global Innovation Center (48:54):


Jay Bhatt, Deloitte Health Equity Institute (48:57):

There's a quick, you know, I think there are a number of, uh, approaches, I think thinking about this for and with community as you're designing. And so charettes are an interesting example where healthcare organizations are together with the community having, uh, a set of discussions identify what may be the issues in that community. So one, um, community health systems and health centers and community based organizations got together and identified that employment unemployment was an issue. So they helped start 14 small businesses and an ecosystem around entrepreneurship that not only impacted the economic mobility, but the health of that community. Um, so it was started by asking the community what they were, were struggling with and what they needed, um, and then letting that drive the action.

Ruth Yomtoubian, VSP Global Innovation Center (49:45):

Okay, I'm gonna stay on that point of communities and ask a question from Nancy, but I know there's a lot also about payment and business models. We'll go to that in a second. First, um, from Nancy, do you view healthcare system CEOs as drivers of innovation? Or do you see most coming from community providers and companies?

Shivang Dave, PlenOptika (50:06):

I guess, uh, I, I'll say I think some are innovative, um, and, and some aren't, right? And so I don't think we can lump all CEOs. I mean, Ruth, you're CEO of the innovation center and you're helping put this together with, with MATTER. Um, right. Myself and my co-founders and our team, we've been very dedicated to this problem. So I think CEOs do drive innovation. Um, and, you know, when they get to larger, um, scale companies and maybe they have to drive innovation in different ways, cuz now they have many more things they have to focus on and we're focused on vision care and they might have to focus on a thousand things. So they drive innovation in their own way. Not everyone does, but not everyone is, uh, against innovation either if they're a ceo.

Ruth Yomtoubian, VSP Global Innovation Center (50:49):

Anyone else wanna answer that one? Okay. We'll move on to the next. So a few people ask this question a different way if they'll try and create a combo here. Colby had asked, uh, and pointed out about, you know, broadband access, SDOH, transportation, environmental factors, um, but with the people with the money and those that have the most to gain from these factors, primary health plans aren't putting up the money to fund solutions. How do you, how do we solve that? And how can entrepreneurs better collaborate with plans to launch pilots and close contracts? Uh, we also had Mark say, our health system is a business and our business models broken. That prevents a real market formation. We need to seek new models which are based on care and service for patients. The main issue in our current system is indirect payment system that does not have accountability. And, um, we all said, Alexis, our U risk contract with insurance providers in the area to provide value-based care. So I'm trying to pull together a number of these, but there were a few that were, that were really addressing the payment models and how do we, um, look at innovations in the payment models and, um, I think there were several others. So if someone wants to just generally address, um, innovations in the business model, in the payment models and that structure, that would be great.

Stephanie Gutendorf, Homeward (52:10):

I mean, I can speak from a homeward point of view. So what Jay mentioned before around ACO reach and some of the innovations coming outta C M M I around managed care markets, so Medicare or Medicaid, there is, um, you know, a fair amount of innovation around payment reform right now that's beneficial to providers to try to address health inequities. There's a lot of special programs too that have been launched in the last year around health inequity that providers and, uh, innovators can take advantage of that are out there today. Um, for us at Homeward, we also partner very closely with health plans and we've started in the Medicare advantage market, in part because the financial incentives do make sense there to deliver this type of care. And there's a business opportunity for health plans to look at expansion into rural, where most of the market is still traditionally Medicare fee for service. So there's a win-win in terms of business case plus an opportunity for a health plan to continue to grow their footprint. Um, but I think you have to have all those pieces there in terms of alignment before it will see wide, wide scale shift change around that.

Jay Bhatt, Deloitte Health Equity Institute (53:10):

Mm-hmm. <affirmative>, I would, I would echo, uh, the piece around alignment and, and this issue is this, we've thought about it as a moral imperative, but it is a business imperative and has business solutions as well. And there's demonstration of that. It's helping organizations see how to do that, uh, and where, um, to try to then scale those models. It's also, you know, there's a lot of things we do because they're mission and we don't track them, but if we were to track them, we're able to then make the business case like a social, um, worker or community health worker within, integrate within a team and then you track that and show the impact. So I think we have to be as rigorous about the work on health and equities as we are on finance, on operations, on strategy on quality. And quality and equity are two sides of the same point. I would say that health equity can't be a side gig. It's part of the main work that we do and that mindset and shift to say that there's a business, uh, and impact and, uh, an impact on outcomes.

Ruth Yomtoubian, VSP Global Innovation Center (54:08):

Mm-hmm. <affirmative>. Yeah. Someone put in the, in the chat what gets me measured gets managed, right? I think we know that dashboard mentality that you just really can't escape in operational settings. Um, there, there was just one more from Liz, um, that I think we'll try and hit quickly and then wrap up. Uh, would there be significant benefit to customer facing digital wellness apps that help users develop mindfulness, assess their own risk and set intentions for behavioral change, for prevention and to know when they need to escalate to contact with a provider.

Shivang Dave, PlenOptika (54:42):

I think sh you know, it seems like the answer would be yes, but I, let me, you know, Ruth, you want a little spice, right? Why does it have to be an app, right? Why can't it just be education, right? We are becoming very, uh, app dependent and, and as there's this kind of, you know, we have to have, solve every problem with an app. And I would encourage the audience, cause there's so many of you, and a lot of you are clinicians and innovators. Think outside of that. Do you really, is that really the only way to, to drive that change? And or is it most effective and hasn't that already been done? There's so many mindfulness apps and things like that. So also be mindful of not reinventing something in a slightly different variant, which then dilutes the overall messaging for the, the patient base. How do they decide between the a hundred different mindful apps?

Jay Bhatt, Deloitte Health Equity Institute (55:24):

Yeah, I would add literacy is so important and helping people through and using text messaging and other other capabilities that already are embedded at, uh, I think important to consider.

Ruth Yomtoubian, VSP Global Innovation Center (55:35):

Yeah, it's a spectrum because for some, the buried in a portal, your healthcare information buried in a portal is not helpful and an app is better than buried in a portal and a desktop, which you might not even have. But then, as you said, education and literacy in a native way, whether that's text, where you're used to receiving information, we have to get creative here. Um, so I'll ask everyone to just answer this in 30 seconds so I can make sure to wrap up. So maybe use one word or just a phrase, what should the future look like when it comes to healthcare access? Just one phrase and we'll start with, with Stephanie.

Stephanie Gutendorf, Homeward (56:14):

Well, I think that's, that's pretty easy based on my last, uh, run through. But for me it's trust, right? So how do you leverage technology providers innovation and scale, but do it in a way that's oriented around rebuilding trust into these communities? I think that's vital and can't be overlooked as we have this conversation.

Ruth Yomtoubian, VSP Global Innovation Center (56:32):

Okay. Uh, sh Shivang

Shivang Dave, PlenOptika (56:35):

Connected. Uh, like I said earlier, everything is connected, right? Health is, and and we are also talking about connection in terms of it, connection and, and as a way to connect to healthcare. So the word is connection.

Ruth Yomtoubian, VSP Global Innovation Center (56:48):

Jay, what about you?

Jay Bhatt, Deloitte Health Equity Institute (56:50):

I would say, uh, a business, uh, uh, case that's, that's frictionless.

Ruth Yomtoubian, VSP Global Innovation Center (56:57):

Ooh, love that. Smooth, not frictionless. And I, I will just say that this is a group of people who are not just challenging the status quo. A lot of challenging the status quo is just having an opinion, poking holes and musing about the future. But this is a group of innovators who are going beyond challenging the status quo, which requires having that holistic view, looking at all the components and pieces. And so I see the future as, um, a collection of those people who are going beyond challenging status quo, not just, um, trying to poke holes in the existing state. So fantastic conversation was definitely spicy and dynamic and I hope everyone enjoyed it. And please, you know, check out our futures report. Um, feel free to contact the VSP Global Innovation Center. We are looking forward to helping build momentum to solve this problem of healthcare access. Um, have a good one. Everyone. Thank you so much for joining.