EP347: Rolling Out Healthcare Initiatives That Actually Get Uptake With the Populations You Aim to Serve, With Ian Tong, MD, About the Black Community Innovation Coalition

I attended the STAT Summit last week and heard the heart-wrenching story told by Charles Johnson, who is the founder of 4Kira4Moms, which is a group dedicated to improving maternal health equity. Charles’s family is African American. After a planned C-section, his otherwise-healthy wife died an avoidable death because 10 hours after the clinical team was alerted that she had internal bleeding—10 hours later—they got around to wheeling her into surgery. At that point, she had three liters of blood in her abdomen. She bled out and died, leaving her newborn infant motherless. This all went down at a large, incredibly well-respected integrated delivery network.

One of the biggest issues in healthcare today … well, there are many issues, so maybe I should start again. One of the biggest issues in healthcare that is going to be discussed on this podcast today is how to engage those patients or members or employees or consumers who might need our healthcare industry to work better on their behalf.

This is especially a problem (a well-known problem) when we consider those patients who our healthcare system in so many ways does not serve well: many minority patients, Black people, other people of color, the LGBTQ community, people who do not speak English as their first language. These patient cohorts emerge on the other side of our healthcare industry sporting patient outcomes that are even worse than our usual not-so-great average patient outcomes.  

In this healthcare podcast, we’re gonna talk about a new coalition formed by Walmart and six other employers, plus Included Health, which is the combined entity of Grand Rounds and Doctor On Demand. (They merged recently.) So, there was a coalition that was formed. It’s called the Black Community Innovation Coalition, and in short, it’s a new virtual-care program aimed at combating health disparities among African American workers.

I wanted to learn more about this coalition, so in this episode I’m speaking with Ian Tong, MD, about the aforementioned Black Community Innovation Coalition—the how and also the intent. Dr. Tong is the chief medical officer over at Included Health and also a clinical assistant professor and adjunct faculty in the medical school at Stanford.

One reason I was so intrigued is that the Black Community Innovation Coalition leverages ERGs (employee resource groups) in a way I thought was different. If you’re unfamiliar, ERGs or, as I said, employee resource groups, used to be called employee affinity groups. Many big companies have them. These ERGs bring together groups with shared identities, shared experiences, shared interests. What I thought was worth contemplating if you’re interested in improving health equity, health outcomes … through these existing ERG organizations, it might be possible to pull the healthcare system and these patients closer together to create healthcare benefits and care delivery models that are designed with them in mind.

So, what I think might be actionable to others relative to this coalition and its methodology is the best practice of building the engagement mechanism into the design of the initiative. So often it’s an afterthought if you think about it. We build the thing, and then we wonder how to “market” it—like the “marketing” is this separate and sequential function. It’s not. And marketing is also probably a limiting misnomer. This is especially true, though, when contemplating minority populations for a whole bunch of reasons that we get into in this conversation. So that’s number one: Build the engagement mechanism into the program design.

But here’s number two: Consider the engagement mechanism relative to existing channels of engagement, re: ERGs or otherwise.

Other links on the show include:

Rebecca Etz, PhD (EP295) talking about some best ways to measure primary care quality.

The Harvard Implicit Bias Test

You can learn more by checking out the Implicit Bias Test, the CDC REACH site, and includedhealth.com. 

Ian Tong, MD, is chief medical officer at Included Health (formerly Doctor On Demand and Grand Rounds Health). In this role, Ian leads all clinical care delivery, including clinical products and service lines, clinical quality, and practice performance of the clinical staff.

Prior to Doctor On Demand, Ian held leadership roles including chief resident of Stanford Internal Medicine and co-medical director of the Arbor Free Clinic. He also founded and was medical director of The Health Resource Initiative for Veterans Everywhere (THRIVE), honored with the Award for Outstanding Achievement in Service to Homeless Veterans in 2008 by the US Secretary of Veterans Affairs.

A national collegiate champion in rugby at the University of California at Berkeley, Ian was named to the All-American Team in 1994. He graduated from Berkeley with a bachelor’s degree in English, then earned his medical degree from The University of Chicago Pritzker School of Medicine. He completed residency and chief residency at Stanford Hospital and Clinics and is currently a clinical assistant professor (affiliated) at Stanford University Medical School. He is board certified in internal medicine.

Ian has dedicated his career to improving equity in, and access to, high-quality care. He lives in the San Francisco Bay area.

04:33 What is the Black Community Innovation Coalition?
05:06 Who are the partners behind the Black Community Innovation Coalition?
06:23 How is the Black Community Innovation Coalition focusing on patients?
08:05 “If you take a one-size-fits-all approach to your employees, that is not going to be adequate or complete.”
08:56 How the Black Community Innovation Coalition is incorporating engagement into its core foundation.
13:18 “There’s a great deal of hesitancy around engaging care, and there’s a high level of avoidance.”
15:26 EP338 with Nikki King, DHA.
16:34 “The technology is not making that experience worse. It’s a bad experience, and it’s broken already.”
23:27 “I feel very strongly that everyone should probably have a virtual primary care clinician.”
27:20 EP295 with Rebecca Etz, PhD.
28:15 “We really want to pay attention to that encounter being the best encounter possible because that … might be the only chance you get to engage that patient.”
29:00 Why is virtual care important for self-insured employers?
32:08 “We cannot afford to have low-value encounters.”

You can learn more by checking out the Implicit Bias Test, the CDC REACH site, and includedhealth.com.