How Partnerships Help Us Achieve Health Equity

Achieving health equity can feel like a daunting challenge, but working together with partners committed to long-term solutions can help us do it. Listen as our expert discusses the work being done today to make equity possible tomorrow. 

Transcript

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Hello everyone, and welcome to. That's understandable. I'm your host, Brendan McEvoy, US head of External Communications at AstraZeneca. If this podcast has been enjoyable and informative for you, take a moment to like and follow on your favorite streaming service. And if you know anyone else interested in today's topic, be sure to share because our goal is to help everyone to better understand what science can do. When we all work together, have you ever seen an old western where a house catches fire and it threatens to engulf the entire town? A crowd gathers. A few people grab buckets and start running back and forth, bringing water to the fire, trying to put it out on their own. Suddenly, a town elder steps up and forms the crowd into two lines from the fire to the water. She tells one line to pass filled buckets from the water source toward the fire, and she tells the other line to pass the empty buckets from the fire back to the water source. Within minutes, the fire is doused and the house and town are saved. There are several issues facing US health care that are like the house on fire and if not quickly contained, could wreak havoc on the entire system, causing devastating impact on patients, particularly those from marginalized communities. One of the hottest burning fires is the issue of equity, especially access to care. The National Academies of Sciences, engineering and Medicine stated that many people face barriers that prevent or limit access to needed health care services, which may increase the prevalence of disparities and poor health outcomes. Some of these barriers include a lack of adequate health insurance, affecting nearly 43% of all working age Americans. Language barriers impacting 1 in 5 U.S. households. An implicit bias impacting millions of patients annually. Until now, our system has operated a lot like the townspeople. In my example from earlier individual groups or organizations are figuratively throwing water on a raging inferno. But fortunately, we're seeing a rise in corporations thinking creatively and leading into what they do best to forge partnerships, some of which are unlikely to address these barriers, benefiting patient health and increasing equity. Joining us today is someone who has dedicated his career to help foster such partnerships. Doctor Kedar Mate, president and CEO of the Institute for Health Care Improvement, also known as IAG, an assistant professor of medicine at Weill Cornell Medical College. Doctor Mate has more than 20 years of experience in health care management, public health and health care quality improvement. He leads IAI and its mission to use improvement science to advance and sustain equitable health outcomes across the world. Welcome to. That's understandable, Doctor Mate. Thank you for being here. Well, it's a pleasure to be here. And thank you for having me on. So let's jump in. I'd like to start today's episode by asking you to give us a brief description of what IHG does and how organizations like yours are working to address access barriers and challenges to health equity. Well, once again, thanks for having me on. so let me start with IHG, the institute that I have the privilege of leading, this year for healthcare improvements been around for about 35 or so years. it was started here in the US, primarily with the idea that we could make health care a lot safer, a lot more reliable, a lot more efficient and a lot more equitable. The origin of the organization is that it was borrowing methods from industry, from manufacturing, from aviation, from nuclear power, from our military, methods that had been used for decades in those industries to help make the production of new products or services more reliable. make them safer, so that everyone could benefit from the products and services that were out there in a way that was, better. And that was indeed more equitable. and the idea that the founder of I tried, a gentleman named doctor Don Berwick had was that those methods from other industries could be brought to health care to make health care more efficient, more effective, more reliable, safer, etc.. and in the mid 1980s, they ran an experiment essentially, to prove that that could be true. They took 20 American hospitals. They partnered them with 20, industrial partners, major corporations, as you describe places like at the time, GE, Florida Power and Lights, Corning Xerox, Fedex, major fortune 50, fortune 100 companies, all of them who had experience using those methodologies, called quality improvement to help make services more reliable. and the companies taught the hospitals how to use those methods. And guess what? They worked in health care just as they did in other industries. They made care safer. They made care more efficient in emergency rooms, in operating rooms. They reduced error rates in in hospitals. and very quickly, the institute was born to help teach those methods to other parts of the health care industry. So that's the story of how I got started. And really, to this day, 30 plus years later, that's what I tried out as a teachers, hospitals and health systems all over the world. Now, how to use those methodologies to make care safer, more reliable, more patient centered, more consumer centric, more efficient, etc. and indeed more equitable, which I know we're going to talk a lot more about. you know, you also asked a little bit in your question about how we're working on overcoming barriers and challenges related to health equity. And again, part of that origin story is about equity. But in in our work at the Institute, we focused, on our on the work that we do. we worked with Health systems, through an initiative called Pursuing Equity, which is now engaged over 200 health systems, all over the United States, and indeed all over the world, use those same methods of making care more reliable to also, reduce the inequities that health systems are seeing in their patient populations. We now run a coalition, a multi-sector coalition called the Rise to Health Coalition, that coalition partners, pharmaceutical companies, together with health care delivery organizations, health systems and hospitals and together with with payer organizations, health insurance companies, and, and regulators, federal agencies and state agencies and all together, this ecosystem, if you will, providers, is now all working together. There's no single part of the health system can solve the challenge of, a big challenge like health inequity on its own. We need to work with payers. Need to pay to solve, inequities. Delivery systems need to respond to that pharmacy. So, companies need to make their, products and services more accessible, more affordable to folks. So we need to be working across an ecosystem to try to create more equitable care and health outcomes. And that's, a lot of what I, I, spent his time working on doing. That's that's fascinating. So it's it's it's, you know, expansive in many ways, in terms of the, the types of organizations or in sort of non health care related organizations that are partnering with, with those in the health care sector. What are the you know, as, as you think about some of the the the partnerships that have occurred, how how are these sort of impacting patients directly, you know, or how is it how are you seeing, improvements in, in sort of tackling in the health equity or access issue. Yeah. You know, so we've had a lot of experience now working across those different factors on health inequities. I'll give you an early story from our work with a health care delivery organization. This is a, health system in the Pacific Northwest and in the US. very early on in our personal equity initiative, which was a group of health systems, basically about 25, 30 health systems, we put them together in something we call a collaborative. So all the health systems are there. They talk openly about the inequities that they're seeing. And they start with, you know, the concept of the collaborative is interesting. It's the basic idea is that someone, somewhere has solved the problem that you're facing today. and together we go faster, you know, essentially towards solving all those problems. So in this case, this health system in the northwest and had noticed actually in its data, that, the patients who were coming into their emergency rooms is a big system. So they had many emergency rooms. patients were coming in, black and white patients who had exactly the same signs and symptoms of a stroke. so they came in with similar, clinical, presentations. They actually experienced a big delay. Black patients experience and big delay compared to white patients in getting stroke care. Now for for our audience is stroke, you know, blood clots in the brain or, blood vessel in the brain, exploding, essentially causing a big bleed in the brain. those situations are highly timed, dependent. So delays in care of any kind, can result in disability, long term disability, and, in many cases, death. you know, avoidable, potentially death. And so a delay of any kind, would result in a significant amount of morbidity and potentially mortality. And what they found was black patients who had the same symptoms and same signs, the same concerns, the same complaints were essentially having their care delayed about twice as long as has white patients. So the time to getting a clot busting medicine twice as long. And what these folks did with this, you know, the first part of their experience in this collaborative was questioning the data. You know, there's a very common experience. So the data aren't right. The data are problematic. The data aren't fully adjusted for risk or otherwise. all these kinds of, in some sense is excuses for not, really understanding what the data are telling us. but then we, we, we did the work of, or they did the work, I should say, of really digging in to try to understand. And they proved that the data were, in fact, correct, that there was a problem present that was not simply attributable to risk adjusting or otherwise, that they had a problem that needed to solve. And once they got to that point, and this is the the you know, the thing that I have a lot it gives me a lot of comfort and faith in American health care providers and systems is that once, once clinicians sort of get it in their, understanding that there's a problem here, none of them can really conscience the fact that there's such an inequitable care outcome taking place. And they started working on what we do, essentially use our methods of quality improvement, which are again, sort of at their very basic, their very basic problem solving methods that have been used across industries, as I said earlier. And they started applying those methods, in incremental tests of change, to try to figure out how to solve these delays. And it worked. After, a period of and this is the other part that I find really interesting about this story, is that it didn't take them years to conquer this problem. It took them 11 weeks to go from problem recognition to complete resolution. In other words, they eliminated the gap in care that eliminated the inequity. when they did that in 11 weeks. And one other aspect of this story that I find really interesting is that not only did care get better for the black patients in the emergency rooms, that were present, but care got better for everyone, whether you were black, brown, Alaskan, Native American, Indian or white. care across the entire system got better because they had standardized their care practice with regards to, stroke. And so everyone got faster and better stroke care as a result of this, any inequity or the that the delay had evaporated. Is it are the the corporations that are that are sort of opting in to participate, if you will, are the what's that process look like? You know, is it are you all going out there and, you know, seeking part, you know, collaborative partners or are or organizations coming to you because they have, a keen interest. You know, there's an issue and they're have a keen interest in helping to improve it. What's kind of the. Yeah. So so the Rise to Health Coalition, which is now this multi-sector partnership that I was just describing a moment ago. you know, we we have a, pharma bio research company, subgroup, if you will, or it's we call it a pillar in the campaign. so there's a group of about 35 or so, pharma research organizations, biotech companies that are all part of that, that part of that work. And they join that through visiting rights to health equity. The name of the website is is Rise to Health equity.org. so it's a very straightforward thing. And you can on that on their website is a join you know, button to join. and essentially the companies come in and what they, what they're committing to is participate in a collaborative not unlike the collaborative I described earlier of health systems that were coming together to solve each other's problems. In this case, it's a collaborative of pharmaceutical companies, biotech organizations and research companies, and they are, working together to help, understand what how the inequities are, present in the, populations that they try to take care of, that they're producing, products for and services for. They talk a lot about, both, commercial aspects of their enterprise, you know, how can they make their products more affordable, accessible. They also talk about the research side. how do we diversify clinical trials? How do we make sure that the things that we're studying are actually the the conditions and diseases that affect, vulnerable, marginalized communities more often? they also talk a little bit about how they, are trying to change themselves. And this is another thing aspect of how I try has gone about this. Not only are we trying to address outwardly, the inequities that we see in the world, but we're also trying to improve ourselves, as an organization. And the pharma biotech companies that we work with often are trying to do the same on their side. how do they diversify hiring, for example, how do they, ensure that the vendors that they work with, are committed similarly to, solving inequities? How do they source, from, local businesses if possible? Not everything is sourced from local businesses. But how do they if they can, that kind of thing. So all of those types of ways. so there's sort of three ways in which these companies or three types of commitments these companies are making. One is to, make themselves more equitable inside. The other is to how to make their products, on the commercial side of the business, more affordable and accessible, to populations that need them. And then on the research side, how do we ensure that we're studying the conditions that affect the vulnerable and marginalized? well, more often and again, all of that, you can find more information on that, rise to health equity talk. Right. I think there's a, maybe a misperception then that I think your example is, is helping to to remedy in that throughout the whole health care ecosystem that maybe, you know, each is sort of operating in its own silo. Right. And there's resistance to collaboration or there's competition between, you know, industry partners. And I think the way that what I'm hearing from you, which is, is great. I mean, I'm, I'm, you know, work at a pharmaceutical company. So I get to see this, but but not everyone gets to see. Is that there to your point, very. there are issues, right, that every company, every industry, the health care system or hospitals are all facing, right. And so the power of coming together to tackle those, it doesn't take anything away from any one, you know, hospital system, pharma company, other health care, partner. But ultimately kind of puts them all on an equal playing field or kind of gets them all into an equal spot that then they can even advance further, you know, either individually or collaboratively. Well, I mean, in the end, Brendan, I think there's a lot of opportunity in, in working on health equity, very real opportunity. And, and so there's a lot of discussion about making the business case around equity. And I think, you know, just to be clear about this, and I do want to talk about a little bit about that, but there is a obviously a a moral case, a social case, you know, that that is very obvious and apparent and probably doesn't need to be fully stated, but it does need to be remote. We need to be aware of that and conscious of that and be, addressing that. And then on its own is in some ways the only case that needs to be made. but I would argue that to make the work on equity, sustainable for the long haul, we do also need to make sure that we are building the equity programs that we're building in a manner that is sustainable for the long haul, and that sometimes means that we need to be making, economic arguments alongside of those moral and social arguments. And the truth is that they are not hard to make. You know, that that's the that's the interesting aspect of this, this, effort which is that for a pharmaceutical company, for example, you know, finding a way to access a market that has been underserved, with products, medicines that are accessible and affordable to their community makes, in a sense, logical sense for a company that is trying to have its products be sold. and concerned by the markets. And so right now, we are by by virtue of creating inequities or perpetuating inequities, we are actually denying, ourselves opportunities, for, creating, not only better health but also better business. so I think in this particular case, we can both do good and do well. and that's true not only of pharma, but it's also true of of organizations. It's true of delivery organizations. As long as we have a fee for service system or some part of the fee for services, that is true even in value based arrangements. so in truth, equity in it can be or the pursuit of equity can in fact be a win across the board for pharma, for, for delivery environments, for payers, and indeed for and most importantly, for patients and communities. it's it's, you know, you're, it's almost taking it from what sometimes is considered sort of a social issue into, I'd say maybe like a business imperative. Right. Like it's it's obviously you know, it's an important issue that needs to be solved regardless. But I think to your point, there's looking at it from a business standpoint as well. Whatever. I guess essentially whatever it takes, right? For people to focus and improve the issue. But and sometimes you have to make that case differently depending on who it is that you're trying to get sort of involved or engaged or part of the solution. And the arguments are not mutually exclusive. Right? You could have both. It turns out in this particular case, we we were doing some work recently through our to health coalition on lung cancer. and there's about 50,000 cases of lung decline, cancers right now that are in underserved communities that are undiagnosed or under addressed. In other words, they're either at a the patient doesn't know that they have lung cancer at all, or they might know, but they are not getting care that is appropriate for their level of cancer or those situation as it present. Every one of those cases, means an opportunity to both do better by the patient and to be, you know, creating, a, a better care environment for them, you know, whether it's in the delivery system, providing the care, whether it's a payer, providing the economics to make that care possible, or whether there's a pharmaceutical company providing the medications that, are needed or the treatments and services that are needed for that individual to have a better outcome. And all together, we estimate that even if you take a small, proportion of that total, a fit, about 20% of that, that's an addressable economic opportunity of $1 billion. and that one, then one under addressed. That's one condition, with only 15 to 20% of that being addressed. there's $1 billion, you know, that's ordered that we're leaving right now on the table, not not actually finding where to create. So that's value that there's value out there. Inequity. that is going to be really important for all of us. And it and again, the moral and social position the human case is, the more important case is the is the, vital case. But there is a sustainability issue that we need to be able to address. And I think that takes economics as long. Doctor Mate really brought home the impact of inequity, both in terms of patient outcomes and the economic impact on the entire system. With this in mind, I wanted to learn more about what was being done to address it, especially as it pertains to technological innovators. And in the last few years, I think we've seen specifically around tech giants that have really sort of revolutionized everything that we do, how we make reservations, etc. and now many of them are turning their attention to providing solutions in the healthcare space. But obviously there's, you know, a potentially a bit of a disconnect, right, in that, you know, what they might be good at sort of helping someone shop. but with our product, they might not be as good or it's not the same as finding, you know, a health care provider per se. so how can big corporations best partner with health organizations to address the issues like you've outlined? Yeah. You know, I think that technology is going to be really important. Almost every, you know, as we look into the future, almost every possible future that we imagine is, is technology enabled in some way. Right. And I think that's going to be true of every industry is certainly true of health care. So, I mean, just to think a little bit about what is coming at us in health care, and then I think it will become apparent how those things are going to be important for us. But, you know, I think that technology and I think care is moving closer to where all of us are on a daily basis that, you know, not so much, there will be certain issues that we need to hospital for, right. you know, traumatic injury. You want to be close to a major trauma center with all the, you know, technologies and services that are present in that institution. But for chronic disease care and even some forms of acute care, we're increasingly moving that care into the community. We're moving it into the home. We're moving it into the workplace. We're moving it into the schools. In some cases, and all of that is happening because of technology enablement. You know, we're able to do those things, move, care closer where people are because of the technologies that are enabling us to have this conversation today. Right. If if we can be on a on a video chat like this, talking about what we're talking about, you can also be on a video chat with your provider. and increasingly, assistive technologies like medical devices are making it possible first and capture. But what is happening to an individual on a regular basis? you know, you know, technologies like continuous glucose monitors are putting care not just into the home, but they're also putting care into the hands of the patient. So we're allowing patients to co-producer outcome with respect to diabetes, because we can now follow our glucose on a continuous basis and figure out that when I and have this type of food, it makes my blood sugar do this when I have this other type of food and it makes my blood sugar better. Right. And therefore, I should maybe for dessert, maybe I have this instead of that. You know, that kind of thing is co-producing your health care outcome. So technology as a whole and big corporations that are creating these technologies are allowing us to move care closer to where we are, allowing us to engage with our our care and our health in ways that we've never been able to do before. Where there's devices on our wrist like smartwatches or whatever you like, or in your pockets, like your phones, they're allowing us to self-manage our care better than ever before, or at least understand it. Even if we're not actively managing or or clinical situations, at least we're have a greater awareness of, you know, how many steps I took, what I've been eating, what and how I've been sleeping, which is generally that awareness, you know, I forget who was it since, but awareness being the first step to solving, you know, whatever it is that's happening. But certainly our awareness is increasing of, whether we are creating or making healthy choices in our lives. and again, those are all the products that sort of technology is making that stuff possible. Yeah. Yeah. It's been fascinating to see. You know, you mentioned like wearable devices. It's been fascinating to see how they have sort of transitioned from maybe more of a, sort of a fitness athletic type of, you know, and from that, that field, or use to now even more cases are uses within, you know, the health care industry or are there other sort of tech innovations that you're seeing, maybe even in the early stages that didn't necessarily, you know, weren't necessarily intended to help from a health care perspective, but maybe are starting to, you know, be utilized in a new or different way. Yeah. I mean, look, I think that AI is going to be interesting to watch right in this space, right? I don't think I was created for health care applications, to be sure. if nothing, computational helping us with, large data set data processing kind of questions, those are sort of what the AI tools were really created for in the early days. But, but, you know, what do we ask Google for information on when we Google things? where where should I go for X or Y travel plans? And then what? What is this constant Google? What is this constellation of symptoms that I'm experiencing? Please give me a different diagnosis for whatever it is. Okay. Exact, very common experience for all of us, even clinicians like myself to, to have had now with artificial intelligence tools, we're able to, the sophistication of how we interact with those tools is increasing so that it almost feels like we're having a conversation with a fairly knowledgeable clinician type, you know, and that is that is a predictable future that is on the horizon for us to have essentially doctor bots or clinician bots. you know, many are developing those right now. I think those will be on the horizon pretty soon you'll be able to talk to your bot. it's either through your health system or through, a subscription type process that is to essentially have a conversation around your, your, your either a known clinical condition that you already have in terms of how you manage it more effectively or, you know, to help with differential diagnosis and understanding what you might have, so that you can, proceed accordingly. So I think, you know, those kinds of tools which, you know, again, we're not created at all for this purpose are certainly going to be, utilized, I think, for this purpose. But in this context, I mean, you know, talking about equity in all these technologies, you know, we do have some it's going to be interesting to watch us, figure out how to solve for those types of, access challenges that will inevitably, plague us in the future. Yeah. And actually, our next episode will discuss health care deserts. And the one after that, we'll discuss telehealth. So this is very timely. And I think there's some applicability here as well as we see technology sort of helping to maybe bridge that, either physical distance or other distance between, you know, patients and their ability to physically be in front of a doctor or at a health system. Yeah. I had a, you know, just another, another sort of you asked about technologies that were not invented for health related purposes. We're combining this with this comment about health deserts. I was in a rural India, a couple years ago now, and VR goggles were clearly not intended to help with rural India's diabetic retinopathy problems. but, this one institution or even care, we're in a partnership with Google. As it turns out, we're using a VR eye goggles essentially to take pictures of the on the back of your eye. and in order to help, they then they were conveying those pictures to central, uploading that essentially to a central, place where the, where the, the and the physicians were reading those images, and then basically instantaneously communicating back with somebody in the field thousands of miles away, as to whether or not the person had a condition called diabetic retinopathy, which is, a problem with the back of your eye. If you have diabetes. And not only were they able to do that, but they were able to then dispense with the person taking the picture with the roughly with the VR goggles had on them, medications or eyedrops or otherwise that the patient could use. So if the patient had a confirmed diabetic retinopathy, you could start addressing that on the spot, which is the kind of thing that, again, the technologies were not built for this purpose. But humans are creative, and we can find other ways of using these technologies to actually help us to, to solve some of these problems of inaccessibility, to cure. It was interesting to hear how innovations that weren't necessarily designed for health care were being adapted to provide benefits for patients, and how there was so much potential, but it also raised questions what challenges did these innovations pose? Providers, patients, and the entire system? So we spent some time talking about, you know, how major corporations can partner, collaborate and address some of these challenges in health care. But there are also, you know, potential issues with with, you know, sort of non health care related companies getting involved in patient care. I mean we've seen, you know, headlines, recently and it's obviously sort of a you know, more likely occurrence around data leaks and security breaches and all of that. so as you think about it, companies or sort of health care, health care organizations, hospital systems, as they start to think about getting, collaborating or potentially partnering with non-healthcare related companies, what should they be sort of wary about? Or, you know, what? What should there should be on their list or on their radar, things they should be considering or asking about before, before collaborating or partnering. You know, we've seen we've seen some interesting things, even just I don't know exactly when this episode is going to air, but, we just this last weekend, we had this enormous challenge with CrowdStrike. you know, taking down, I don't know, some 10 million, some odd windows computers, Microsoft computers causing all kinds of havoc with airlines and banks and retailers and other other associated industries. we have, I don't know, at this point, it feels sort of common to have, credit cards being stolen. I think AT&T like two weeks ago, AT&T had a major hack that basically meant that all of your call logs from a certain period of 2022 and 23 were all stolen by someone who had no idea what they're going to do with that interesting information. But, you know, this is a sort of it's it's sort of a it has become so common at this point that it I almost, I almost expect that some portion of my information is going to find its way out of my hands at some point in time, you know, and we are, you know, as, as evidenced by the CrowdStrike thing, we are highly dependent on, on these technologies, at this point, as a, as a community. Right? So and that makes us more vulnerable to, cyber security issues. It makes us hugely vulnerable to data leakage problems. I think that, with, with artificial intelligence now coming into more common usage and health systems, you know, I, you know, we everybody in a health system today ought to be every leader in the health system today ought to be concerned that frontline staff might be dropping into, you know, GPT ChatGPT, which then becomes part of the public domain. There's a you know, there have already been findings that have been in, administered to health systems, who have leaked AI through AI bots like that, you know, thousands, tens of thousands, hundreds of thousands of dollars are being spent on these things. Now. So I think this is going to be a huge these are going to be big issues. We're going to find we're going to have to find a way to ensure that we create we don't become too complacent with the technology that we have that we create redundancies so that when a machine goes down, or maybe not millions of machines, but when some machines go down, that we have ways of, of, backstopping against that possibility. I think that, companies that are using artificial intelligence tools, I think it's a little bit of the exuberance of ChatGPT has in, in terms of its applications in, in, in health care, Ali has been a little bit slower to be adopted because we are working through today. There's a lot of work going into how do we ensure we don't suffer AI leakage for personal health information being leaked? How do we make sure that these, hey, AI bots are, accurate, that they you're providing us with information that's reliable. How do we plan for workflows that keep humans in the loop? which are which are kind of the big kind of present challenges that we're facing with regards to these technology developments? but I think the other big issue is that we have to make sure that they, we don't bake biases, and inequities into the technologies that we're using. either, I take tools where they're trained on data sets that are biased to begin with or, that we don't baking into the, implementation of technologies, the inequities that have always been present. And we actually guard against that notion from the start. So there are ways of, I think, ensuring more accessibility to technologies right from the start, rather than kind of discovering several months or years later that we have a, you know, an increasing inequity in our system going forward. So, that type of opportunity, I think, is present for us, with new technology developments in the future. and we're actually, believe it or not, we're we're sort of nearing our the end of our conversation here. And my last question was really going to be, I think, to further extend the last comment you just made, which is sort of more of the, like looking ahead, for the future, what we can expect. But but before I ask that, I just wanted to, to see if there was anything else on your mind that we, you know, based on the conversation that we've had so far, that may be you is still kind of lingering in your head that you want to make sure you get out to the audience before before we move to that last question. Well, yeah. I mean, I'd love to love to we'll say a little bit more about one thing that I think that's, maybe something worth to. Just saying. So I think there's something really interesting going on right now in with regards to equity and, technologies. I think that something really interesting going on right now in the patient communities that we all work with, both is pharmaceutical companies, provider organizations. I think there's a lot of there's there's a sort of, renewed interest in activation, not across the board. Not every single person and every single patient. But I, I see that type of, but whether it's the technologies themselves, the, you know, the wearables, etc., that are creating this level of engagement or the fact that our technologies are now allowing people to meet each other and find each other. So, that type of connectivity combined with more access to your information is leading to a type of engagement from patients and families that I think is, is a I believe truly is a positive development in the future and I hope will lead to not only, better, technology because the patients will tell us what they, what they want and need. but I hope, this will lead to, you know, more equitable technology distribution in the future, as, again, patients tell us for what they want and need. Yeah, that's a great point. So it's it's almost like there, you know, patients are being connected to, you know, others with similar conditions or other health, you know, similar health needs, getting that information. And then they're coming to health care providers and other, organizations with what the ask of. Well, yeah, that's that's interesting. Yeah, that's I mean, that's the there's a, there's an amazing story. I mean, just really quickly, I'll tell you the start. Really good research. we, I learned about this through a podcast that, that I host, actually. So, Don Berwick, the founder of the institute that I now lead, and I run a have a podcast called turn on the lights. and turn on the lights is all about exploring kind of innovations in health care that are particularly interesting and that we think have a lot of promise. And I, we are interviewing with, Susanna Fox, who wrote a book called Rebel Rebel Health Care, and she was telling, this is very interesting story about, a guy named John Kostic who is a software engineer, and his four year old daughter had type one diabetes. And so she needed a, continuous glucose monitor, in her, in her arm that basically senses and understands what her or her blood sugar level is on a continuous basis. So the way it used to be is you had a prick yourself in the finger and take a blood sample once a day. In this case, it was constantly sensing what the blood sugar was. Now, the problem was that, this, caustic, the software engineer discovered the problem was that you could only get that data from the company. You had to apply to get the CGM that was in his daughter's arm. He couldn't read that information from the CGM, so he basically hacked this device. He was an engineer. So he had the device and he had the device basically send the the blood sugar information to his mobile mobile phone, instead of sending it to the cloud and then on to the company. and that way he could follow his blood sugar, his daughter's blood sugar, and then figure out if she became had a low blood sugar overnight or whether she was responding differently, etc.. he posted this information on Twitter, right? He posted, this is when Twitter was Twitter or not. Whatever it is now, and he posted it there and, very quickly, he was. Yeah, I think he got to be known as diabetes, dad. And like, all of a sudden there was like thousands of other people out there who wanted to know how to hack their CGM devices, and they taught each other. And this, became like, a phenomenon that they were teaching each other how to do this. And some of the other people that were on this, Twitter thread created other applications that like first, for example, sounded a really loud alarm on your iPhone. If your blood sugar got too low, somebody else created an automatic insulin dosing app for their Apple iWatch. you know, it's like amazing stuff that these patients created together and combination, you know, having a need which, you know, she clearly had to know his daughter's blood sugar. and then having the sort of smarts and creativity and then this network of other creative people out there who, all had similar needs and they found each other, and then they built all this amazing stuff that that now is, by the way, several of these things that they've created are now features of these devices, currently, which is kind of interesting as well as part of the story. Yeah. That's incredible. Before we, before we wrap, I just want to ask one more question, which is really sort of asking you to put on your your fortune tellers hat doctor Marty. So how do you see partnerships like those we've discussed during our conversation today, helping patients better experience care over the next five years? And then are there any sort of current trends that you're seeing right now that, either you expect to expand or do you see any sort of new, trends on the horizon that we should be keeping an eye on? Yeah, well, they need a lot of that. A lot of what I would think is coming to us in the future is contained in that last story I just told about that, about John Carr stake in his daughter in the network that they found. But, you know, I would say this, that, you know, increasingly we've we've treated data and health information as a commodity, with everybody trying to, accumulate as much of it as they can. essentially over time, whether you're insurance provider or pharmaceutical company or research, or a delivery system, but our data, your data is a currency, and there's increasing interest in your data as a patient. Whoever's out there listening to this at the moment, there's increasing interest in your data, Brendan. And my data. And so our data as individuals, and especially our data, as communities are increasingly of interest to organizations, corporations and others out there, we trade some of that. Each time we have an encounter with a clinician, we give a little bit of information to the system in order for us to get healthier. But, and then they a there's a whole discussion at the moment about who owns that data. Once we've given some of it to, a provider of some kind. You know, when John Costa created that, his doc, when he put a CGM on his daughter's arm to help understand what her blood sugar was, was that her information anymore? Was it now the company's information that was tracking that and his basic premise was, I need to hack this device so that I can reclaim that information, make it mine and my daughter's, and then we can activate around that and do whatever is necessary. So I think, you know, that notion, this notion that data, our data is a currency that we can use, to to help us get healthier and help others get healthier is, I think, a big part of our future, going forward and how we, how we leverage that information, to both create more health, as individuals and how companies use that information to create more health for communities, I think is going to be a big part of, of the future development here. But it's this combination of technology, activated patients in communities like I talked about a minute ago, networks, and all of that helps health care move closer to us. as individuals moves into our homes. technology enables that. And it also enables us to make health care instead of a full service. We go somewhere else to get health care. Health care becomes a lot more self-service. and we, sort of own and help create the care that we want to need. And because we started with equity, not all of us will have equal opportunities to to engage in that notion of, becoming activated patients and consumers. And I think our job, part of our job and part of our work, going forward will be about how do we engage as many, individuals and communities in our society to become activated in the way that I just described. That's great. It's a two great, optimistic, inspiring points to end on there. So I really thank you so much, Doctor Mate, for your time. It's been a really, really great conversation. and I know this... I know for me this is sort of sparking additional interest. So I hope it does the same for our listeners as well. Well, thank you, Brendan. It's great pleasure to be on the program with you. It seems like it's an exciting time in healthcare as partnerships bring advances that can help us break down long lasting barriers and overcome challenges. I'm certainly glad that organizations like I exist to help shape the future of public health and increase equity. Thanks again for joining us, and that's understandable. For more information about today's episode, be sure to check the show notes. Until next time, be well. Be healthy. Be understanding.