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June Kissel, Exygy:

Thanks everyone.

Eric Lam, Exygy:

Thank you June. And thanks to everybody for joining. Good morning, folks, I would love to start with introductions. If we can each go around, share our names, our organizations, and the roles, and I'm happy to kick it off. As you said, my name is Eric Lam I'm with the Exygy team where we partner with social impact organizations, like the amazing ones that you see here today to design and build that improves lives. I'm one of the partners and I lead our health work, which includes supporting community health centers in making their services more accessible, as well as making direct services like affordable housing, more accessible with our Bloom work, and so forth. So happy to dive in there, super excited for this conversation. Sophie, would you like to go next and then maybe we can pass it to Sylvia and Mike afterward,

Sofi Bergkvist, Center for Care Innovation:

Happy to, and thank you, Eric, for, bringing us together here for the conversation today, I'm Sofi, and I'm president of the Center for Care Innovations, and we have a vision that everyone has fair, just, and inclusive opportunities to be healthy, which is a definition of health equity. And, therefore I'm very happy to have the conversation here today. And what we do is that we spark seed and spread innovations to improve health and wellbeing among historically underinvested communities. Everything we do is in partnership with everyone on this call and many of the people in the audience. So we're happy to foster those partnerships further and I'll hand it over to Sylvia.

Sylvia Hacaj, Lifelong Medical Care:

Yes, good morning everybody. My name is Sylvia Hacaj. I am the Director of Development and Communications at Lifelong Medical Care. We are a federally qualified health center serving, three counties in the East Bay; Contra Costa, Alameda, and a small part of Marin. And we basically provide, high quality health, mental health, social and dental services, to folks regardless of their, ability to pay, their housing status, or immigration status. We were founded, and we really grew out of the Civil Rights Movement, and health equity and health access is really what our main mission is.

Mike Lok, Asian Health Services:

Good morning, everyone. My name is Mike. I go by he/him/his, and I'm Planning Manager at Asian Health Services, and like Lifelong and it's great to be here with Lifelong and Sylvia, we're another FQHC, you know, serving Alameda County, actually Asian Health Services, and Lifelong are two of eight FQHCs,serving the great and diverse Alameda County. At AHS, we serve over 50,000 patients a year in 14 different languages. And, my role at AHS, focuses on, you know, advocacy and empowerment of our patients and the broader communities that we serve. And that sometimes involves, everything fromhealthcare reform to language access, to hyperlocal, you know, pedestrian safety issues and things of that nature. At AHS and I could see say with a lot of FQHCs, you know, we consider advocacy, just as importance as patient care. So look forward to talking with you.

Eric Lam, Exygy:

Thank you for that. So how we actually came about this topic and creating this health equity series is our team was reflecting that we're in the third year of the Pandemic and healthcare has obviously been at the center of it. And we've also seen a lot of healthcare organizations innovate, pivot. We've seen telehealth become more prominent. We've seen data collection increase. And so we started asking ourselves and taking a step back and trying to see is the progress that we're making actually advancing health equity specifically for the safety net population. Have we made care more or less accessible to those that we are trying to serve? And so the first question that I wanna kick off for this panel is what are ways in which advancement in healthcare over the past couple years, has made care more equitable and ways it hasn't? Sophie, I'd love for you to start that conversation.

Sofi Bergkvist, Center for Care Innovation:

Thank you, Eric. Yeah, the last two years has really been a stress test on all health systems in the world. And in many places it's put a spotlight on the weaknesses more than anything. I'm from Sweden, and there it's universal health coverage. It's a good healthcare system, but in that case, you see that there's been real weaknesses in care of elderly and especially immigrant elder families getting the care that they needed. And here in the US, we have had deep inequities for a long time, and we are not in a better place. We have seen a much larger drop in life expectancy for Black and Hispanic Americans over the last two years than for compared to white Americans. So I think it's important to recognize that we're not in a better place. We shouldn't frame it as if we are heading in the right direction.

Sofi Bergkvist, Center for Care Innovation:

This has been two years of stress testing and really uncovering the deep, deep issues that we have. But that being said, we also have advancements in certain areas and it's important to look at those promising practices and pay attention to those and continue to invest in those to improve equity and access to care and ultimately improve equity in outcomes. And one of those indications, I think, is the drop in no show rates. So people that used to schedule an appointment then not being able to see their provider for different reasons are now much more likely to attend the appointment that they have made and who are behind those drops in no show rates there's far more research needed, but we have heard that it relates to people that face transportation challenges that had work, that didn't allow them to see their provider as timely or at all, but also people that are caring for family members, being it children, being it elderly at home. So that drop in no show rates, I think is a really telling story. And where, where does that come from? It is really the increase in modalities that you now can your provider over video and also call your provider that is one step towards more patient centered care, that I think we should build on and do far more around.

Eric Lam, Exygy:

Yeah. I love the focus on drop in no show rates and really seeing that as a metric and also agree that I think we do need more research and more investment in the promising practice that we have seen to see what work we have been doing and where we continue to fall short because we know that video visits work for some, but they aren't always accessible for everybody.Sylvia, what are you seeing from your end? What has been advancing and what have we been short on?

Sylvia Hacaj, Lifelong Medical Care:

Well, I will just echo Sophie for where we are short. I think most of us know that there are really severe problems in our healthcare system. But to focus on a bright spot similarly to what's happened, if I may introduce a current event, you hear a lot of news analysis right now about what the war in Ukraine has done for the NATO Alliance. For example, this shocking event has galvanized people in a way, you know, in a week that hadn't been able to happen in years. For me, the bright spot was around the care of the unhoused.You know, we, I think in the years leading up to the pandemic folks began to realize, or not just realize, but start to implement policies that said, okay, you've gotta house people first to help them overcome addiction, to get help them get jobs and things like that, the pandemic, because it was a public health crisis, and so transmissible raised the need and not just the need, I mean, raised the awareness and the, importance of addressing healthcare for the unhoused.

Sylvia Hacaj, Lifelong Medical Care:

I mean, it's always been there. I don't wanna minimize, it's always been there, but there was a greater, effort made to address this issue. And, what we saw was more money and more grants, aimed specifically at meeting the healthcare needs of the unhoused and themovement of unhoused people into housing throughout California, through Project Room Key, um, which took over a lot of hotels and just ensured that unhoused folks were, separated to help reduce transmission and be housed. And, I think that was, a great, a positive in all of this, and I hope that that can continue here in California in particular.

Eric Lam, Exygy:

Yeah. So if you think for that example, I know, leading up to this, we talked about Project Room Key and I'd love to dive in deeper later on in this conversation too, and learn a bit more about that intersection between health and a lot of other very needed, direct social services. Before diving into that, Mike, I'd love to hear from your end, what has been seen.

Mike Lok, Asian Health Services:

Yeah. You know, and I think it was mentioned before, these are great points made by my colleagues and Sophie was mentioning about the reduced No Show rates. You know, that's definitely something that we saw because with adding in telehealth into our services, a big point I wanted to mention for the audience, if they weren't aware is that, telehealth was not reimbursable under Medicaid and Medicare until the Pandemic— it was a special policy put in. So that was a big game changer when the Pandemic started where I think a lot of our clinics and other clinics were almost a hundred percent telehealth for a while in order to set up the infrastructure, get the PPE needed.

Mike Lok, Asian Health Services:

There were supply chain issues and we were collecting donations from, nail salons and wherever we could in order to be able to put up infrastructure until we were able to have the testing and all the systems in place. I'll just mainly add as you know, as far as who's being left out, is there are tremendous, still language barriers that are impacting, limited English speaking immigrant communities. I mentioned before AHS, we serve, you know, 14 different languages, and you know, not a lot of them are provided as far as language access when it comes to a lot of these safety net programs. I believe unemployment, you know, EDD is still only in Chinese and Spanish. but for a lot of the other communities we serve, including Vietnamese, Korean, Burmese, Filipino, and many more, because whether it's been forms or even just flyers, we've sometimes, had to our staff create some of those materials, those translations, just to be able to point folks in the right direction.

Mike Lok, Asian Health Services:

And oftentimes, you know our patients, whether they do come to us for renewal and MediCal and CalFresh and other programs, but they're coming to us for help with how do I fill out unemployment? How do I apply for the rent assistance program? And those are things that a lot of our staff aren't trained for, but, the role that FQHCs play, we know that we play a wide range of roles. So, I just say the language barrier is something that still definitely needs to be addressed.

Eric Lam, Exygy:

Thanks for highlighting that, Mike, I think something that I'm hearing across, well with Sophie and Sylvia, you mentioned there are some bright spots and there has been motivation and spotlight on advances. And at the same time, we still recognize huge areas for improvements, including language barriers. And I think you, the three of you, as well as a lot of the safety net see a lot of that firsthand. I want to talk a little bit about data and how we are able to communicate what we are seeing in some ways, a quantitative way to others who may not be on the front lines as well. We know that tracking data has been more prevalent, obviously data on COVID rate and people are able to speak a lot of statistics. But how about data with respect to who is being left out of accessing care and social services and data health equity itself? And so my next question is how have data collection and analysis changed during the Pandemic and where is there a clear room for improvement? Sylvia would, do you like to start with that?

Sylvia Hacaj, Lifelong Medical Care:

Yeah. And it's an interesting question that clearly even predates the Pandemic. And as Mike mentioned, we are, serving the same county and we are two of eight health centers. And so one thing that happened is that as a consortium of health centers, we have worked together more and more to have data collection systems that are that are the same. So that as patients sometimes transition between our health centers, we are able to keep them in the system and collect data more smoothly. And, one of the things that was fairly interesting for Lifelong was we transitioned to the Epic Electronic Health Record System right before the Pandemic hit. In fact, I believe the transition was really happening was kind of continuing, to happen just at that moment.

Sylvia Hacaj, Lifelong Medical Care:

So I joined Lifelong in January of 2020, when we were undergoing this transition. And while it was difficult because any kind of transition to electronic health record system is difficult, it turned out to be quite fortuitous in the end partly because of the needs of data collection in the Pandemic. So, investing in data collection at the lowest levels of the health system is the way, and it has to be an investment from the ground up so that, you know, as a state, as a country, we're collecting data, it's super important. So that was one of the changes we made that ultimately made both communicating with our patients and also collecting data for on them more smooth.

Sylvia Hacaj, Lifelong Medical Care:

There's always a tension between collecting data and serving a patient in the sense that any data collection involves questions and filling out forms and collecting information that not everybody's comfortable giving. And it can be a barrier to care, but it's also actually, something that ultimately can help improve access to care. The importance of it became very clear during the Pandemic.In California, for example, the data is showing us that the death rate for Latino/a folks is 15% higher, statewide than for their proportion to the population, it is 77% higher for Pacific Islanders. And the death rate for Black folks is 17% higher. And for communities with a median income of less than $40,000 that the case rate is 24% higher. So we are able to cut data by ways we're used to, by ethnic group or income. We also know that housing density where there are folks packed into more places, also led to higher cases. So all of that was super important during COVID and remains important as we exit COVID to include, to continue to improve our own healthcare systems.

Eric Lam, Exygy:

Yeah. Sylvia, something that you said that I want to underscore is you said that one of the efforts that you and Lifelong Medical has been part of is the consortium of health centers. And what I understand is that when we are looking at the safety net, people transition from one health center to the other. So continuation of that data collection and knowing who that person is, is critically important, which is, I don't wanna say unique, but it is a big factor that we cannot overlook if we really want to be caring holistic for a person.

Sylvia Hacaj, Lifelong Medical Care:

Yeah. I mean, just from your own personal experience, imagine when you've changed a job or your job has changed their healthcare provider, it's not easy to navigate for anybody. And then you take some of the most vulnerable populations, there's so many ways our populations are vulnerable. It's just that much more of a barrier. So the more we can do to help smooth that out the better.

Eric Lam, Exygy:

Yeah, absolutely. Mike with Asian Health Services, are you also seeing people kind of transitioning into the Asian Health Services and your clinics and transitioning out? What collaborations are you seeing from a data collection for perspective with other health centers?

Mike Lok, Asian Health Services:

Yeah. Great question, Eric and I think what Sylvia brought up about transitioning to Epic and all of the eight health centers and the Alameda Health Consortium were able to transition, and that change to Epic was Epic. Sorry, I didn't mean to make a pun there, but, among other things is that being, the same health record system that a lot of the local and regional hospitals use so they're being that compatibility and being able to help look at the continuum of care, like you said, if the folks went to a different health center or went to a hospital, and just shout out to my team's information systems and all our clinicians, because not just the transition to Epic, but in COVID it has been a lot of work, meaning their new workflow, patient workflows that are being changed weekly, if not multiple times a week, based on schedule changes, trying to figure out billing codes for telemed, whenever we have a new test site or new vaccination pop up, and needing to have things set up for that.

Mike Lok, Asian Health Services:

I'll just say that you know, in strong consultation with other health centers and with the county public health departments, looking at the neighborhoods and zip codes that had the highest case rates and highest hospitalization rates, something AHS has been doing is trying to go out in the community and do mobile vaccination sites,in some of those communities and being able to not just, you know, hoping they will come come to our clinics. Our clinics are nice, but to have mobile teams to be out in those communities and partner with different community stakeholders, whether it being churches, nonprofits, anybody who will listen, in order to try to reach the communities that have been hard to reach as far as both testing and vaccinations. And just with the data, the data's been very crucial in being able to help us find, just going off of testing, you know, it doesn't show the full picture, but being able to use that data as well as work with trusted community providers and leaders figuring out ways to do some targeted work to reach the hardest to reach.

Eric Lam, Exygy:

Absolutely. Sophie I saw you go off mute did you have something to add?

Sofi Bergkvist, Center for Care Innovation:

Oh, that wasn't a technical mistake, but I'm happy to build on what Mike just said. The opportunity that I see is during the pandemic, the sharing of data as has been pointed out, it was a necessity for being more targeted with the vaccine outreach, but how can we build on that? The allowing that sharing of data to guide resources across the board in a much more proactive way. So now we have a better sense of who is facing digital barriers, where are the connected homes and which homes are not connected, because that starts to be all the social determinant of health. It impacts your education, it impacts your ability to navigate other social services. And there's a lot of resources FCC and others are working to connect homes. And how can then healthcare be more of an enabler to make those homes connected?

Sofi Bergkvist, Center for Care Innovation:

So this sharing of data, but also sharing of data to guide resources as a real opportunity. And then we've started to see more and more of these collaborations to use data, to guide payments towards value based care. So that's another opportunity with the data and the data sharing that you can actually, what is the benefit of assuring healthy food? What are the health benefits? And, let that then start to build a case, to do invest for better access to healthy foods and housing and so forth. And then a third area is it's just much more data with remote patient monitoring. It's, it's a tsunami of data. And how can we make sure that we are being more ahead of the curve of building capabilities to analyze that data? Because if we don't, systems will start to build on biases, and drive. There's algorithms being developed that are guided based on a population group that is not the communities we serve. So how can we make sure that we are serving historically underinvested communities, making sure that we are on top of building the data analytics capabilities, given the amount of data that is coming our way. So those are three opportunities or challenges that I see.

Eric Lam, Exygy:

Yeah. Thank you for highlighting those Sophie. We've touched on a little bit around social determinants of health, and we know when engaging communities that people don't think about healthcare alone. When they think about healthcare, when we interview people, they're talking about housing needs, food security, maybe other things. And while there's been a lot of talk and some really great initiatives to push attention on social determinants of health, I'm uniquely curious about the three of your perspectives on what has worked on the ground that has led to real change. So if each of you can give an example of a sustainable collaboration across the social safety net? Sophie, did you want to start with that?

Sofi Bergkvist, Center for Care Innovation:

There's several. So we work with federally qualified healthcare centers, but also with community based organizations and more and more so with collaborations between the two. Starting off with making sure there's cross-functional teams to build humility and curiosity. So it really starts with that because very often you bring in community members, but if you are not allowing and being prepared to drastically pivot, when you bring in community members to the table, you're not doing justice to that opportunity. So we often start with just building mindsets and for collaborations and teams working with the community around curiosity and humility and supporting leadership to be allowing things to go in the direction they originally didn't intend. And the reason I mentioned that is because every single successful partnership that we have seen has really been a result of leadership and teams' ability to pivot and end up doing things they originally didn't intend to do.

Sofi Bergkvist, Center for Care Innovation:

So one example was CCLAC Venice Clinic and Food Forward. They went through our catalyst program, which is capability building for human centered design. They originally thought about how they could improve just food distribution, and then they did interviews with the community and realized that, oh, the food that they were distributing, wasn't helpful for the community. They actually needed prepared food because so many of the people they were serving didn't have an ability to prepare the food that they were giving. So that was the first pivot, but where's the sustainability in that? There was an excess of food to be distributed, but how are they gonna sustain this work? So they started to do interviews with health plan, and there was more than one health plan who said I would be interested in making sure that this continues if you can show me that this is benefiting the health of the community.

Sofi Bergkvist, Center for Care Innovation:

So this partnership between three organizations became a data initiative where they started to collect data on the health outcomes. And they're starting to see some very, very promising results that then together with the health plan, they can look at actually, this is making financial sense for us to bring resources and support this. So this is an example of, of thinking outside of the box, taking input from the community to make sure that what you offer is actually what that community needs, but then also daring to think out of the box and speaking to health plans and others to sustain the work. So that's one example.

Eric Lam, Exygy:

Awesome. Thank you, Sophie. Mike, is there an example that you've seen from your experience?

Mike Lok, Asian Health Services:

Yeah. You know, AHS in our almost 50 years, of existence, we have had strong partnerships with different community based providers, agencies and has led a lot of strategic coalitions on trying to work on some of these things. And I'll just say during COVID working with providers to make sure unhoused folks in our communities, were getting vaccinated, and, making sure we were working with some of the affordable housing providers to make sure that folks had access to testing and vaccinations. One thing in particular that I'd like to mention is, we heard from one of our community partners, the Asian Pacific Islander Legal Outreach team, who they were during COVID saying that the managing attorney at the time who works with a lot of child custody cases. They were saying that at the time of COVID there needed to be like the judge had ruled that there needed to be clear plans as far as COVID testing when dealing with the shared custody situation.

Mike Lok, Asian Health Services:

And they had mentioned that having access to our COVID test site and having pretty quick turnaround time on tests helps make those shared custody situations work. So definitely working, in partnership with other service providers in the area during this time makes it work.

Eric Lam, Exygy:

Yeah. I love that angle of the partnership as well. It seems like was an example of where there is a big health initiative that is needed for community benefit in this case, vaccine rollout. And that kind of drove some of the partnership, which is in some ways, a little different than what Sophie shared, but equally as important. Sylvia, how about from your end? Is there an example that you like to highlight?

Sylvia Hacaj, Lifelong Medical Care:

There's a couple— one was definitely centered around food security, probably something similar to the one that Sophie highlighted. There was, before COVID, a for profit catering kitchen that was struggling during the pandemic to figure out what to do. And ultimately, I think at first they charitably made meals and gave them away, but then they found that there were grants available to do that. And we partnered with them to get some prepared meals to particularly our seniors, our senior community home bound, and seniors in general. So that was one partnership. And we did have another partnership with a church in West Oakland, which was a trusted community partner around administering vaccines. And that partnership improved the uptake of vaccines in one of the hardest hit communities in Oakland. So, you know, those partnerships, those relationships going forward, I'm not personally privy to what's gonna happen next, but clearly those relationships, changed during the pandemic and can only be a good thing, if we're work able to work together to do the kinds of things that Sophie talked about. So those were two examples of some new partnerships for Lifelong.

Eric Lam, Exygy:

Great. Thanks for adding that Sylvia. I'm recognizing time, and I am seeing a couple Q&A come in and I'd love to jump into those. So the first one that I'm seeing is, someone's asking how can private sector players, so startups in particular play a role in addressing some of the gaps you're seeing. How do you approach piloting new innovation?

Sylvia Hacaj, Lifelong Medical Care:

That would be a good one for Sophie to start with. What do you think Sophie?

Sofi Bergkvist, Center for Care Innovation:

Sure. I can try. There's not lack of challenges to work on. So that's the good news and there's a lot of opportunity to improve things. I think many startups are fueled by brilliant minds and hard work, and very often designed for a population where the money is and not to underestimate what it takes to actually serve the communities we work with. Language was being brought up by Mike — don't have that as an after to thought, but really lead with it. You engage consumers and users early on to design your solutions. So be committed to it. And if you're committed to it, make sure that you engage with the users and include them from the GetGo in the design. And then it's about partnerships again. I mean, in order to pilot test something, you very often need a partner to pilot test.

Sofi Bergkvist, Center for Care Innovation:

So how do you establish those relationships, and starting off by understanding the community, understanding Medicaid, or Medical in California, understanding reimbursements, how you can make it billable, make it easy for the FQHCs, it's some homework to do, but if you do that homework, hey, it's a huge market. So language and understanding the population and rebuilding the relationships after you've educated yourself on what it takes to be successful and money, money speaks. So how you are able to pay for it is a big piece.

Sylvia Hacaj, Lifelong Medical Care:

I think that what Sophie outlined earlier in the partnership piece is just as applicable, if not more so around the issues of curiosity, humility, and also human center design.

Eric Lam, Exygy:

And that actually perfectly segues into another question that someone had. They're asking Sophie, if you could talk more about building mindsets of cultural humility and curiosity among safety net leaders, what challenges do you encounter in that work?

Sofi Bergkvist, Center for Care Innovation:

I mean, start off with myself. I have to always remember to be humble and curious, and so that is it's for all of us. We can all work on that. I think that's the first piece, but if you look at leaders in the safe net today, one of the main challenges is retention. The workforce challenges we're facing are huge. So recognizing that, I think is an, opening to work with the leadership of building humility and curiosity, and really lean into the biggest challenges. And what we hear from many of the frontline staff is they want to serve their community better. They want to feel empowered to change the way of working, to serve their community better. So the examples we have seen where frontline staff are given the time to do interviews and take input from the community and then really be empowered to make changes based on the feedback, that helps retention. So if you can engage the leadership to see that opportunity, that it actually works using, for example, human centered design helps retention of your workforce and helps you serve your community better. Then you build that muscle of humility and curiosity very often. If you define a problem with a community and bring it to the leadership, very often, it sparks curiosity. You want to find out more, but if you package it with in how it actually is going to support the retention of your workforce, I think you're more likely to be successful.

Eric Lam, Exygy:

And if I can add to that, Sophie, I think continuing to be self-aware around who is making those decisions on a day to day basis. It is us or simply people in leadership, then that is a challenge in itself. I know when we're talking to Mike specifically thinking about how we can be more community driven, how we can have a community be in positions of power and make decisions. And Mike, you were talking a bit about your board makeup. Can you talk a little bit about what that structure looks like?

Mike Lok, Asian Health Services:

Yeah. So with Federally Qualified Health Centers, it's actually a requirement to have patients on your Board of Directors. And that's something that we take to heart here at Asian Health Services. Not only do we have patients on our board members, as our board members, but we have different advisory groups, including what we call Patient Leadership Councils. And we have seven different Patient Leadership Councils, which are done in languages that's Chinese, Mandarin, Vietnamese, Korean, Tagalog, Burmese, and I can't remember the last one. The point is to be able to really get direct feedback from the community and not just tell us what we want to hear, but really tell us about what their needs are. And when I occasionally get a chance to interface with patients in my broken Cantonese, I know enough to be able to understand, to hear, what some of the things that they're going through and they'll mention not just things related to patient care, but they mention some of the needs right now that they're facing, including, right now, with some of the increased, tension in Asian communities about feeling, not safe to leave their houses.

Mike Lok, Asian Health Services:

But I think that it's definitely important to get that feedback. And during this time, where a lot of us have had to transition to Zoom or other ways, we've still been able to do that, get that patient feedback, but it's been harder because our strength has always been the face to face interfacing with folks. At parks, at face to face meetings, going to the cultural festivals, being in and around the community. But you know, we tried our best to still be able to get an idea on the pulse of the communities andwhat their greatest needs are. I wouldn't say it's perfect. I don't think anything can really replace the face to face interactions that going door to door, so to speak. But, we're trying,

Eric Lam, Exygy:

Thank you, Mike. One of the things that I've admired about a lot of your organizations is how you have used your organizations as a platform for the community. And I think a lot of our roles is in amplifying the challenges that we're seeing, not making decisions unilaterally, but how we can be promoting more of the causes and care about of the people that we're trying to serve. So I see another couple of Q&A, I think we have time for one more. This one might be a tough one. So the question is with staffing challenges born out of the pandemic, how might safety net clinics rethink how they get patient health information in an era of health information exchange, population, social determinants of health, et cetera. So this is in the context of the medical record management office. I'm happy to repeat that,, if that'd be helpful. So the question is what the staffing challenges were born out of the pandemic? I believe this is referring to us seeing more and more staffing shortages. How is that affecting, patient health information exchanges and some of the technology that we are using and data collection that we're introducing as it compares to the traditional way in which we're managing medical records.

Sylvia Hacaj, Lifelong Medical Care:

I have to admit this is not an area that I feel very able to comment on because the question is very operational. So for me, it's a hard one to answer.I think again, the Pandemic forced an injection of having to leapfrog quickly to newer, better, more efficient systems. So I think we are doing a lot more training. We're investing partly that's part of due partly to retention issue, and trying to really help our staff that are, as you said, stressed out and, in retention is a huge issue, doing everything we can to give them the tools they need from the provider level down to be collecting that. So sometimes that means investing more in staff in, for example, more medical scribes.

Sylvia Hacaj, Lifelong Medical Care:

On the other hand, it also means making sure that the staff that are dealing with some of these systems are better trained. I don't think that's quite what the question was getting to, but that is something I know that we are doing. I also would say that in the macro sense, another thing we are doing related to this data is collecting it. I mean, Epic was one change we made, but we're also working together in a Tableau system, which is an even greater input of collection of data. And then, sharing it in more, much more real time in our system. Again, that's not quite what the question I believe is asking, but that's just an element of it that I can comment on.

Eric Lam, Exygy:

I appreciate that. So Sophie, did you have any ideas to chime in?

Sofi Bergkvist, Center for Care Innovation:

Yeah, I can try. This is hard. It's also framed very technical, far more technical than I normally operate at. But as we talked about earlier, there's more and more data and we have more and more systems and different forms of applications feeding that data. And then, as the person is saying, this is in the context of a traditional medical record management office. I think it's important to, to recognize we don't need to do everything in house. There are many of our partners are, for example, they're remote patient monitoring, partnering with organizations that also come with analytics. You don't need to feel that you need to do it all in house. Then over time you can figure out what you may want to insource, but there are partners that, and it's important to do the legwork, to know where is their interoperability with the systems that you have, to not build additional legacy systems that will be hard in the future, but we've seen that work really successfully. There are vendors that, and especially if you can start to actually do some work where you share the upside, if you're paying them based on improved outcomes, you get more payment from the health plan because you're improving the blood pressure control together with this vendor and they bring the analytics. So they're being creative in how you work with partners can actually help also on the side of managing the information systems.

Sylvia Hacaj, Lifelong Medical Care:

I'd like to add. One more thing that I did forget about that may be pertinent, which is Lifelong has implemented data governance committee, that was brought together by a newly created position. We have a Chief Medical Information Technology Officer, she's a Nurse Practitioner, but it's about data transparency and governance. And that is one way, I think when you're talking about managing patient and health information, making it more transparent to everyone that needs to see it, and also, in much more real time so that we can influence better health outcomes. That might be a good topic for another conversation, because that's an initiative that I know our CEO was extremely proud of.

Eric Lam, Exygy:

Yeah, absolutely. And this may also relate to one of the first questions that asks how can private sector players play a role. This may be an opportunity to really recognize what is your superpowers and how you can elevate a lot of the community health centers and the work that they're doing as well. So I know we are coming up on time. We did have a question that we didn't get to, but we can probably circle back around with that person and share the answer with the rest of this group. So final question for each of the panelists, what advice do you have for people working towards addressing health equity? Mike, would you like to start?

Mike Lok, Asian Health Services:

Thanks Eric, I'm pretty sure that hopefully a takeaway that you have heard is about the importance of data, and the right type of data. I'll just say also, this'll be my plug for disaggregated data, that the data points that are out there really needing to dig to the level either community level or by some other demographics to be able to really dig deep on the most underserved communities. I think it actually goes back to the last question, but even the data that we collect, at times we've tried to push for state and federal policy makers to increase the data points that they collect, and that can make things a little bit easier on everybody. I'd say right now it's definitely important to get more data and to connect with people, and we're still doing that.

Mike Lok, Asian Health Services:

We're getting some of our patients on Zoom meetings or also just calling patients. We're finding even just, when we call folks, just like reminder calls for appointments, they end up being 20 minutes because the patients have a lot of stuff they want to share, but this is all stuff that we need to hear. And, we need to be out there to speak and just seeing, get out there in the community and that will help illuminate where we need to do more as far as improving equity.

Eric Lam, Exygy:

Mike I really love the encouragement to really engage with the community. Sylvia. Uh, advice do you have?

Sylvia Hacaj, Lifelong Medical Care:

Well, it's impossible to, I think, separate out health equity from equity at large, and bringing it to sometimes another current, example I think about: there's been a lot of discussion I've been hearing lately about climate change as a big issue and the notion between individual action and systemic change. And so, when I put health equity into the context of equity at large, I think an important piece of advice I have is not to forget about the advocacy component and the component of collective action.We all may be doing this in a different way. Somebody may be on the health center floor with patients dealing with our health record system. And I'm doing broad communications and fundraising, for example, but we're driving toward the same conclusion of quality healthcare for all.

Sylvia Hacaj, Lifelong Medical Care:

And I think that not forgetting about the need to put it into a collective action and advocacy context and taking whatever actions we can, as an individual, of course, but even within our organizations, whatever we're allowed to do. And, that is an important part of what FQHCs do, and it is really at the heart of my career. I've been mission driven since my first job on, and, and I've been involved in advocacy, for most of my career one way or another. So that's the piece of advice I would give.

Eric Lam, Exygy:

Thank you, Sylvia. That definitely hits home for me as well. Sofi, final advice?

Sofi Bergkvist, Center for Care Innovation:

I feel Mike and Sylvia have made fantastic points. I was thinking along the lines, which is our vision around fair, just and inclusive opportunities to be healthy. Starting off with Mike, we can't be fair if we don't look at the data and we have to disaggregate and really challenge ourselves of how we identify where is it not fair today? And look outside of the datasets. You have yourself, who is not being seen at all, making sure no one is left behind and really aiming for being inclusive, but to be just, data is not enough. We need to do, like Mike said, and Sylvia's point it's not only within health care, listen deeply to the community to understand where the challenges are and feel empowered by what you hear and create space for people to bring that voice forward. You don't need to, you should use that when you speak to funders, when you speak to leadership, but also create space for others.

Sofi Bergkvist, Center for Care Innovation:

A couple of weeks ago, I realized, again, I made a mistake. I am the leader of this organization. I'm a white woman sitting on this panel. I could have created an opportunity for someone else, because I think there's more systemic challenges in terms of power dynamics and who is speaking, where, and when, and many of us can do far more at an individual level to challenge ourselves of how we create opportunities for others. We don't need to speak on behalf of others. We can actually give the floor and lift others in other ways. So constantly challenging ourselves and supporting each other to, really disrupt the deeply unjust system that we all work within.

Eric Lam, Exygy:

Thanks Sophie. And specifically for that self-awareness, that you bring, to your leadership. So we are up on time. For questions that we did not get a chance to answer, we'll do our best to get those answers and get those back to you. To Sophie, Mike and Sylvia, thank you so much for being part of the panel, for people who want to stick around and learn more about this series for health equity, please do sign up for our newsletter. You can check that exygy.com/newsletter and I think that's it. So thank you panelists. Thank you everybody, and have a great Tuesday and the rest of the week. Take care.

Sylvia Hacaj, Lifelong Medical Care:

Bye everybody. Thanks for joining us, And Happy International Women's Day.

Eric Lam, Exygy:

Absolutely Happy International Women's Day.

Sylvia Hacaj, Lifelong Medical Care:

Yes. Women are making history every day at our centers. That's for sure. Changing somebody's life

Sofi Bergkvist, Center for Care Innovation:

And thank you for bringing us together.

Eric Lam, Exygy:

Absolutely. All right. Bye everyone.

Sofi Bergkvist, Center for Care Innovation:

Bye.