Interview with Healthcare Ready President Tom Cotter

Tom Cotter from Healthcare Ready joins the podcast to discuss  the impact of disasters on vulnerable communities. Tom brings a combination of professional expertise and humanitarian insight to the conversation. We delve into the complex interplay of social and economic factors that make certain populations more vulnerable to emergencies, drawing upon his experiences and academic research, including his time in Manila and his long-ago encounter with Dr. Paul Farmer.

The episode explores the evolution of Healthcare Ready, an organization formed in the wake of Hurricane Katrina and further developed during the COVID-19 pandemic. We examine how Healthcare Ready has effectively utilized public-private partnerships to create equitable health solutions in crisis situations. 

We discuss the response to the recent Maui wildfire, illustrating successful collaboration between non-governmental organizations and the importance of pooling resources and knowledge for community benefit.

As of March 2025 HealthBiz is part of CareTalk. Healthcare. Unfiltered and can be found at the following links:

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• Apple https://podcasts.apple.com/us/podcast/caretalk-healthcare-unfiltered/id1532402352
• YouTube https://www.youtube.com/@CareTalkPodcast
• CareTalk website https://www.caretalkpodcast.com/

Host David E. Williams is president of healthcare strategy consulting firm Health Business Group.

Episodes through March 2025 were produced by Dafna Williams.

Transcript

0:00:10 - David Williams
Nearly two decades after Hurricane Katrina struck New Orleans and four years since COVID arrived, we still find ourselves asking why are some communities disproportionately harmed by natural disasters and emergencies, and what can be done about it? Hi everyone, I'm David Williams, president of Strategy Consulting from Health Business Group and host of the Health Biz podcast, a weekly show where I interview top health care leaders about their lives and careers. My guest today is Tom Cotter, president and executive director of Healthcare Ready, which brings together the public and private sector before, during and after emergencies to protect at-risk patients. If you like the show, please subscribe and leave a review, tom. Welcome to the Health Biz podcast. David, thanks so much for having me. Pleasure to be here Outstanding. Well, before we talk about Healthcare Ready, let's talk about your background, your upbringing. What was your childhood like? Any influences that have stuck with you? 

0:01:07 - Tom Cotter
Oh gosh, yeah, I mean, it really did take a village to raise a child like me. Even as a young, young man, my parents instilled in me a spirit of volunteerism which has served me well, I think, in my career, where I remember my mother bringing me to serve food at food pantries and things like that. There is one moment that I think sticks with me the most. If you remember the late and great Paul Farmer and as someone from Boston, I'm sure you do he came to speak at my high school. This was just after Tracy Kidder's novel Mountains Beyond Mountains came out. It was kind of a big deal. 

My entire high school was in the gymnasium. This is at Boston College High School. It was time for questions and answers. I remember raising my hand and after hearing Dr Farmer speak for some time about all the change he's doing in the world and how everyone needs to be doing their part, and saying, hey, listen, Dr Farmer, not for nothing, but I'm just a regular high school student, there's not really anything I can do. In front of my entire high school, all my friends, he said well, if you believe that you're an idiot, it was a tough love moment that, I think, really steered a lot of where I went post that moment. I think the world lost a great one with his passing, but I know his organization, his spirit of reaching out and meeting people where they are is so important and so valuable a lesson to learn, especially as a young man. 

0:02:44 - David Williams
That's good, In case you were going to forget that lesson. It sounds like all your buddies are there to remind you about it. 

0:02:49 - Tom Cotter
Oh yeah, lots of quotes in the yearbook about that. 

0:02:53 - David Williams
That's a good one. Then I saw education wise for somebody who's not a professor. You've been to a lot of different universities and I saw it maybe somewhere in that spirit of volunteering. I saw a stint in the Philippines, I think, even when you were in school. What was your higher education path? Help unpack that a little bit. 

0:03:11 - Tom Cotter
So I got a master's in public health with a focus on international health and humanitarian emergency response management from Boston University and part of that study, part of that curriculum, was you had to go do fieldwork and there was a good nature jab in the international health concentration that the program mandates that you do 60 hours of quote unquote fieldwork and in the international health department they said it should take you 60 hours to get to where you're going to start your fieldwork and so kind of, through that and with a lot of encouragement, support from the school and from my friends and family, I decided to move to Manila and pursue at least a semester of study at the University of the Philippines, specifically around the socioeconomic impacts, determinants of health, I should say. 

And it was phenomenal, it was a great program. It put me in places that I never could even imagine, as someone who grew up in the self shore of Massachusetts, yeah, and you know anything from collecting snails to study schistosomiasis and how it's impacting farmers health. And I won't go into the weeds on what schistosomiasis is, but suffice to say we don't have a lot of it here in the US. 

0:04:34 - David Williams
We don't have it here and we don't want it. 

0:04:36 - Tom Cotter
No, no, no, no. Stay away from snails. But the you know, down to understanding how people are paying for health care in the central part of the Philippines and these rural, really remote island chains. You know, I spoke to some folks in a small village in the province of Samar who they raised pigs and the pigs are the community pigs and whenever somebody gets sick they sell a pig and then they get a piglet and that was their insurance, that was their insurance plan. So it really taught me, you know, the strength of community innovation and really that international lens of what's working over here, what's not working over here, that we can apply into our current situation. 

And likewise it was fantastic and you know I think I'd be remiss if I didn't mention that. You know I didn't. I didn't start this kind of health equity expert understanding socioeconomic status and historical injustices that have led to our current situation. There's been a lot of people in my life, you know, a lot of people who have explained patiently and sometimes not so patiently, you know, to give me course corrections around my thinking and understanding about why things are the way they are, whether it's in this country or others, and I owe them a great debt, you know I owe them a great debt. I'm not there, there is no finish line to this, but they've given me a huge boost and being able to support programs and communities that I think I'm well positioned to do so and it's a privilege to do so. 

0:06:13 - David Williams
So I saw at some point maybe throughout your career you've been in EMT like riding ambulances in between classes, or how does that work out? 

0:06:20 - Tom Cotter
That's kind of exactly what happened. 

You know, I think it helps me to have Saturday nights reserved in college to ride on an ambulance rather than spend a bunch of money on alcohol. 

But I could do that all the other six days of the week, but it was great. You know, I think it was really important in understanding, you know, not only the wholesale application of health but what I call the retail application the patient encounters and developing a compassionate bedside manner, developing the ability to be decisive under immense pressure, being able to work as a team for a common outcome and treating the whole patient. You know, one of my favorite things and I learned it from another EMT I can't take credit for it was when you have a kid in the back of the ambulance, you better be blowing up a glove and drawing a face on it, you know, and kind of leveraging personality and leveraging your whole self to treat that whole self and I think is really great and I think there's no substitute for direct patient care when it comes to you know that one on one and having someone rely on you and trust you and wanting to follow through with that and with all of your whole self. 

0:07:36 - David Williams
I think it's a great experience. I often speak to medical students or others that are doing. That is just actually coaching my nephew, who's going to, wants to be an EMT part time and then going to medical research the other half, as he graduates from college and said I think it's a good idea. 

0:07:50 - Tom Cotter
It's huge. 

You know, if you, if you go in, I was premed, so I'm allowed to say that but if you go into med school and all you've got is premed under your belt, you're missing a critical part of patient care. Same thing with public health. If you're going to be a public health practitioner and you graduate from your MPH and you haven't really done any one on one health training yeah, practitioner practicing I should say go find those opportunities. If you're an undergrad, listen to this. If you're, if you're in a higher education, listen to this. Go find those opportunities to be a volunteer EMT. It's fantastic. 

0:08:22 - David Williams
Yeah, well, I promise that if you, if you get EMT certified, you will be able to find someone to ride the ambulance with, because they need them right now. 

0:08:30 - Tom Cotter
So yeah, or any other medical profession for that matter. 

0:08:33 - David Williams
That's true too. So, all right, I'm merit cares, so you spend some time at merit cares. What's that about? 

0:08:40 - Tom Cotter
Yeah, so AmeriCares. I was fresh off a stint doing domestic preparedness work in the DC area and developing exercise and trainings for emergency managers and decision makers, and I didn't love it, to say the least. It was a fine and I was happy with the work, but there was always that part of me that wanted to go back into the international realm. So an opportunity came up with this NGO called AmeriCares in Connecticut to develop an emergency response function, and one of the things that I brought I think I developed there and then brought with me, you know, in future jobs like Project Toe, which I'll talk about in a second was the decentralization of emergency response. 

So we've got this idea of international emergency response and you can draw the parallels domestically as well, where we send, frankly, whites, middle-class people, volunteers, who have the best intentions there is no doubt in my mind, everyone has the best intentions and we send them to places that are affected to do work, whether it is medical, volunteering or even unskilled labor you know, building houses and things like that. 

But if you decentralize that, if you decentralize that model, you now are sending much more resources, a bigger percent of resources that you're getting as an NGO, down to the communities that need it. Not down but over to the communities that need it, I should say, and it's a model that is really effective because there's a lot of competent people when disasters hit and there's always going to be need for help. I'm not saying nobody should go and effort, but I think, being really discerning in terms of listen, do we need to send a medical team to the Philippines when they've got one of the most robust nursing fields in all of Southeast Asia and, frankly, the world? You know we're importing Filipino nurses faster than anyone else. Do we need to send medical teams. 

No, but what can we do to ensure and to send resources and train and provide technical guidance so that there is not that dependence except for resources? You know, my goal is always to you know, and every other humanitarian is the same which is we want to work ourselves out of a job. And this is how we do it. We provide the structure and support that is asked of us and then we just send resources, money, technical expertise, maybe a person or two, and in that way we're kind of breaking the cycle of dependence and indeed I think we're also finding ways to invest in the preparedness and resilience to mitigate the effects of these disasters. 

So I went from AmeriCares to Project OBE. Project OBE is a fantastic organization. I was their first director of emergency response and it took with this, took with me this lesson, and I was working for and with people who were true believers, true humanitarians, who said you know, this is why we hired you to do this job, because we're we're drinking the same, you know, kool-aid as you and we've got country offices all around the world. We want you to come in and train them all how to do emergency response so that they're not dependent on us at the DC office to do it and it was largely successful. I went around the world and trained people so that, you know, we had these focal points around the world where we would just send money and resources to these teams and they could manage their own responses and I would provide technical expertise. This became really important, that Project OBE, because about six months into my tenure there, that's when the pandemic hit. 

0:12:19 - David Williams
Right. 

0:12:20 - Tom Cotter
And all of a sudden we couldn't travel anymore. It wasn't even an option. So now this model is not only very cost effective, very much culturally appropriate and has that cultural humility aspect to it, but now operationally, it's mandatory. So now, when we get a volcano going off or a hurricane in Honduras or any other natural disasters, we're reliant on our local partners. We're reliant on our local colleagues and you know, I think it was it was very validating to see that work and it is something that Project OBE continues today. I think they're doing a great job. 

0:12:58 - David Williams
That's great. All right, I see how all these themes are coming together here, so let's talk about healthcare ready and my understanding and I have a vague recollection of it sort of coming together after Hurricane Katrina. But what you know, how did this organization come into existence in the first place? 

0:13:14 - Tom Cotter
So Hurricane Katrina obviously a lot of lessons learned, and we'll talk about that at some point, I'm sure. But the one of the great frustrations was there was a lack of ability for private sector corporations to lend resources to the larger response. So a Pfizer, for example, or a Cardinal Health, or a, the distributor formerly known as a Amerisource Bergen. they were able to effectively integrate and collaborate and coordinate with FEMA or HHS or even local government, and it wasn't anybody's fault, it just wasn't a system that had been set up. So they developed healthcare ready to be that facilitator, to say, listen, here's a 501c3 nonprofit and that's what healthcare ready is, that can come in and facilitate these discussions and essentially match resources to unmet needs. And of course, corporations have a fair amount of resources and they're really invested in the communities in which their staff work, in the communities that they are working with patients in, and so there was a lot of vested interest in this. So healthcare ready was born of that need and our mission still does closely align to our inception, which is we try to manage and facilitate public private partnerships and coordination and collaboration to meet patient needs around the country and around the nation. 

And I think what I bring to this job and I've been here for about a year and a half so far. I'm still kind of the new guy, but I think I bring that international lens and that that that desire to find local partners and send them resources and training, and it creates a much better environment. I will say for a response where it's not top down. No program, especially around healthcare or anything else, should be according to life. According to Tom Cotter from the South Shore Massachusetts, it should be what folks think they need and what folks are asking for, and so by bringing that into our identity, I think we're much stronger than we ever have been and we've been a great organization for a long time and have been doing aspects of this. Health equity has been at the core of everything we've done since the inception. There's a recognition that that's inseparable from our mission and our work. 

0:15:42 - David Williams
So Katrina was a while ago. It was a real wake up call. Both inspired folks to start an organization like healthcare ready and a lot of other changes as well. What has changed since Katrina in terms of the overall readiness of the country or just the attitude toward these sort of disasters and what you do about? 

0:16:03 - Tom Cotter
them. I think Katrina was one of those moments and I think the pandemic was another one and I'll even invoke 9-11 on this where we saw how bad it could get. And I think that when I think about the pandemic and I'll come back to Katrina, when I think about the pandemic early February, I'm sending a message to my parents saying, hey, get two weeks worth of goods and maybe a mask or two. And it's like I didn't even have the imagination, even with my background, I had no imagination how bad this could get. And I think that that was a real, that was an inflection point. 

As a country Hurricane Katrina we understood here's how bad it could get if we don't set up proper mechanisms that are well thought through and better information sharing, better work, collaboration, better engagement at the local level by federal entities. And we're seeing that right. It's not perfect. It's never going to be perfect. Every disaster we're going to find new ways to improve it. But we are finding a lot more robust and mercy management I'll say bubbles that now are closer aligned with each other, whether it is at a tribal, a state, a local, a county, federal, et cetera level. And then you have now hospitals have really robust incident management systems. They're activating HICS and I hope they're activating HICS regularly for a lot of different things and scaling it appropriately. 

But again it's. I think it was a lesson in connecting the dots and I think a lot of the dots are connected. The lines can be more bold the lines, the pen can be pushed into the paper harder, but I think we're in the right direction because of that lesson learned. And again, we pay it a heck of a price as a country, and certainly the people who lived there before, during and after. But hopefully it was a lesson that was well learned and not just a lesson observed. 

0:18:02 - David Williams
You know what are the challenges beyond just the lack of the mechanism for coordination among the different organizations was just it's hard to get medical records and prescription records, even if they were digitized in some form or another. Now, not related specifically disasters, but you know, more broadly, the federal government has been involved in more interoperability and trying to address this question. So, as you look and you know, sitting here in 2024, is it a different starting point just from that standpoint? So you still have to get the different groups together, but then they've got more infrastructure to work with at a federal level, or or do you not see that come through so much? 

0:18:43 - Tom Cotter
That's a very good question and it's a very complex answer because I think that there has been the infrastructure. If we look at the country's pandemic response and we're talking about interagency, operability, interoperability there was a lot of successes. There was lessons observed and lessons learned, but there's a lot of successes Asper under HHS, the Administration for Strategic Response and Preparedness, or Preparedness and Response, rather. They found that their procurement methods were not robust enough that would allow them to buy a bunch of masks or whatever supplies or hire a bunch of people, so they turned to the Department of Defense. Department of Defense is very good at staffing up and getting resources very quickly. So that was a pretty interesting, I think, case study of that interoperability, kind of shoring up a larger response to be all alignment. 

But, as I talked to you today, in 2024, we're not operationalizing a lot of the lessons learned from the pandemic that I'm afraid we're losing momentum on. If we look at post-Katrina, post-911, massive movement across government to ensure that this never happens again, or, if it happens again, it's never as bad as it was and it was like a whole of government and it wasn't perfect. There was a lot of things that could have gone better or could have been thought through better, but right now we're looking at cuts in public health, spending A year and a half outside of a acute pandemic. That cost a lot of people's lives and untold economic damage to the world. Like a lot of the country, we're cutting funding on that. So when you talk to me about infrastructure, yes, but it needs to be maintained A lot of the things that we put together with chewing gum and paper clips that worked during the pandemic it needs to be reinforced and that's going to take a lot more resources and a lot more investment on the government's part. 

0:20:48 - David Williams
You have something called RxOpen. What is that and how does it address some of these issues we've been talking about? 

0:20:55 - Tom Cotter
RxOpen is a tool that Healthcare Ready established many, many years ago, and originally it was designed to communicate the operational status of a pharmacy after a disaster. Where most people get their health care that's, most people's intersection with the health care infrastructure is at their pharmacy. And so what this tool is? It's very simple. Of course, the team that works on it will not be happy to be saying it's simple because it's not, but as a user, it looks very simple. It's a Google map with colored pins on it Green means open, red means closed and so we activate this after a disaster and we get data from a lot of different sources to ensure that not only patients know where to go get medicine and providers know where to send patients to go pick up their prescriptions, but emergency managers can also see oh my, all of the pharmacies are closed in this particular county or this neighborhood. We need to move in that direction Now, since that that original creation of it, which was, I think, a stroke of genius by our predecessors, we've now added dialysis center operating status, thanks to our partners in the dialysis realm, and this year we're actually adding substance use disorder treatment centers, free and charitable clinics, community health centers and, hopefully hospitals into our XOPEN so we can provide a much more comprehensive picture, with the aim, of course, of making sure that both decision makers but, more importantly, providers and patients, can make informed decisions and get access to the things they need when they need it. 

In disaster, demand goes up and the access tends to go down. So this is a tool that we develop and operate for that purpose, and, alongside our XOPEN, we also run a hotline, which you can find on our website, rxopenorg, but also healthcarereadyorg that patients call all around the country and they say I've lost access to this, can you help us? And we operate a bespoke service to ensure people can get an Uber ride or can get emergency electrical supply if they've got electrical dependent equipment keeping them healthy. So we do this I call it wholesale and retail aid and it really allows us to serve the communities that need us really well. 

0:23:21 - David Williams
So let's talk about now maybe less or less abstract question about infrastructure and federal policy and all that, and maybe more concrete, let's talk about a recent disaster. So let's say, like the Maui wildfire you know that was another comparable thing, in the sense, I think, to Katrina and that it just, although wildfires are known and you might expect it, you know nobody expected something that big and that devastating, that fast to happen and a lot of the initial response systems broke down, causing a lot of problems. Did you have a role in that wildfire and how did it go? 

0:23:57 - Tom Cotter
We did. You know, I think, once we understood the massive impact to that particular, to that to, and you know again, if you look at the numbers, it wasn't as big as Katrina, but that doesn't matter to a community that is a, an island and and B is is so Devastated in such a comprehensive way. You know, it's really hard to imagine not only your home being affected, not only your kids school being affected. Your business is affected, your roads are affected, your, your, everything has been thrown up in the air and and everything's in question right now, and so I'll get ready our response. You know, typically we do what we do every day, which is public, private collaboration, coordination, having unmet, needs to available resources. 

But what we found in Maui, which I think was interesting, is that and we've seen this in other times too, but we decided to try something new, which is there was a lot of health and medical NGOs, non-profit organizations from across the country with significant resources. I mean these NGOs bring a lot of time, talent and money to to their emergency response work and and Typically, how NGOs coordinate and disasters through the national system called national voluntary organizations, active and disasters Voad, and Voad liaises with FEMA and FEMA liaises with Voad and and it's a really, I think, a good system. But but outside, but health is so specialized it doesn't necessarily fit within that. You know, health is not in FEMA's mandate, health is an Asper's mandate. So what we, what we approached Voad to do, was do you mind if we Set up a health and medical working group to coordinate the specialty health and medical assets that NGOs are bringing to the table? And they said, yes, that seems like a good idea. We've got all these health and medical NGOs and and so we started having calls and we started working to liais with the Hawaii emergency management, hawaii Department of Health, maui same thing, and Asper, again for the for our usual mission, which is supporting communities that need us the most in an equitable way by meeting, by meeting on that needs. And you know I it wasn't perfect this was our first go at it at healthcare ready, but it's led to a lot of really interesting conversations, I you know. A couple weeks after that I Got called by Hawaii emergency management to do a deep reef, which again, has never really happened in this country, for I was I was so floored that they were like this thing happened and we should capture the lessons learned from that. 

There in the US, you have to understand there is no mechanism for health NGOs to coordinate directly the departments of health or to coordinate directly with ESF. 8 functions, emergency support, 8, which is health and medical. You know, we saw the same thing in Hurricane Maria, right. So again, floor, that they wanted to unpack what happened and it showed a real, I think, positive deviation, as we call it, in the public health field of. We saw, we want to include more people into this. We saw that you brought a lot of resources. We didn't, we weren't, we weren't able, right, for very good reasons, to leverage them maybe to their absolute effectiveness and efficiency. But we could do better next time. 

And, and it's a real ground shift, I can't, I can't overstate, yeah, the ground shift this is and again this is a no fault statement of I'm saying the country's emergency management Infrastructure is not set up to engage with outside Players, to engage with NGOs, to engage with corporate. 

You know there's, there's individual, you know external affairs departments, but not in a real comprehensive, really in the weeds, sharing data sharing, you know resources kind of way, and so that's that's where we come from, that help. 

You're ready. 

And so Our role in Maui was was to be that facilitator and and I think you know this is something we're having conversations of very senior levels of government to improve, enhance and expand, as well as with the NGOs themselves, to understand here's how you work with the US government. 

You know here's a good way to work with the US government because a lot of the NGOs, a lot of especially the national NGOs, including myself from experience we used to working internationally, right internationally it's a whole different ball game governments are Really willing and able to build a long table for you to come in and to Directly support their mission and their objectives and share your data as an NGO. You know, under what's called the cluster system and others, and you go into an EOC in, in, in in a lot of different countries. You know, especially in the in the geographic south. You'll find a lot of NGOs there. You know, as if they were part of the emergency management network, because they are. And in this country, you know the government has not had any kind of reliance on external external partners to any significant extent and I think the pandemic you know, I think was a huge win on the public private coordination, how quickly that got set up. 

But but there is no. I think there's a lot of sensitization and socialization in this country about the, the amount of resources NGOs bring, the amount of willingness that corporate America has To lend their resources to a particular response. So that's one of the lessons I think I bring you know from from my experience internationally that a lot of people have. There's nothing particularly unique about me, but I see us going in that direction and it is really, I think, encouraging for a lot of us. And keep in mind, a lot of the national NGOs and local NGOs played a huge role in the pandemic response, played a huge role in communication. Public health communication played a huge role in mobilizing communities and getting people out to get vaccinated. 

0:30:17 - David Williams
More of that. More of that, please, sounds good. Well, tom, I have a last question for you, which is going to turn a little bit away from what we've been discussing, unless you turn it back and that is a question about if there's any good books that you've read lately and anything that you might recommend to our audience. 

0:30:34 - Tom Cotter
So it's an interesting question. I am about to become a new father. My wife and I are expecting our firstborn in a couple months, so I am knee deep in every being a dad for dummy's book you can imagine. So I recommend one of those and I'll go to one of my favorite books. But the one that I like the most if you're about to be a new dad, or even a new parent of any flavor, is the Expectant Father by Armin Brott. It's not condescending, it's not too groey, but it's funny, it's science-based and I recommend that for anybody who's expecting. 

Now one book and I'll probably take us back to some topics we touched on before but one book that I always recommend and I actually read this in college, I probably read it a dozen times since is called the Spirit Catches you and you Fall Down, and it's written by Anne Fadiman. 

It's an older book I think it was written in the 90s but what it does is chronicle in a very compelling way the journey and the experience and the frustration of a immigrant family from Southeast Asia with the US healthcare system, and it follows the family as they're kind of battling this really significant, acute needs of their child and the misunderstandings and it tells it from both the doctor's standpoint and the family standpoint. And I want to tie that back to what I said earlier around health equity being at the center of what healthcare ready does. We focus a lot on cultural competency and I think that that's a red herring. I think we need to focus more on cultural humility and it's at the core of healthcare ready's mission. Again, doing a needs-based response and asking people what they need They'll tell you, I promise you and having that humility to not come in with an intervention in mind or a program in mind, and listen to people. I think that's my biggest takeaway. It served me well, it served healthcare ready well and I hope it serves your audience well. 

0:32:34 - David Williams
Great Well, tom Cotter, president and executive director of healthcare, ready. Thank you for joining me today on the Health Biz podcast. 

0:32:41 - Tom Cotter
Absolute pleasure. 

0:32:45 - David Williams
Thank you, David. You've been listening to the Health Biz podcast with me, David Williams, president of Health Business Group. I conduct in-depth interviews with leaders in healthcare, business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services in healthcare, check out our website, healthbusinessgroupcom.