Relentless Health Value

I had a hard time coming up with the title for this episode. I decided to go with “Integrating Social Determinants of Health Into the Clinical Workflow” because Dr. Ram Raju gives some very actionable advice to this end. I could easily have also called it the Social Determinants of Health Movement. Or the Journey to Discover Social Determinants of Health. Not a whole lot of guests could have pulled off these more sweeping titles, but Dr. Ram Raju on the podcast today can certainly do so. He’s been on top health care influencer lists around his work in social determinants of health for years.

Dr. Raju is with Northwell Health and working on an initiative that will fold social determinants of health risk scores right alongside clinical risk scores so that patients can get the care they need but also so that providers understand how the care they provide is being impacted by forces outside of medicine.

I never thought of this before, but patients are currently risk stratified by clinical markers like high blood pressure or BMI. But a patient’s social circumstances drive 80% of their ultimate outcomes. So, if you have a patient living in a mansion with a master’s degree with the same HBA1c as a patient across the tracks living in a food desert, these patients are not at the same risk.

Ram Raju, MD, brings vast executive leadership experience and a keen understanding of New York’s health care delivery system to Northwell Health. As senior vice president and community health investment officer, he evaluates the needs of Northwell’s most vulnerable communities and provides solutions for them by collaborating with community-based organizations. He’s responsible for promoting, sustaining, and advancing an environment that supports equity and diversity, and helping the health system eliminate health disparities.

Prior to Northwell, Dr. Raju served as president and CEO of NYC Health + Hospitals from January 2014 to November 2016. Dr. Raju also served as CEO for the Cook County Health and Hospitals System in Chicago, the nation’s third-largest public health system, where he improved cash flow by more than $100 million and changed the system’s financial health during his tenure from 2011 to 2014.

Dr. Raju served as vice-chair of the Greater New York Hospital Association and currently sits on the boards of numerous city, state, and national health care organizations, including the American Hospital Association, the New York Academy of Medicine, and the Asian Health Care Leaders Association.

Dr. Raju earned a medical diploma and Master of Surgery from Madras Medical College in India. He underwent further training in England, where he was elected as a Fellow of the Royal College of Surgeons. He later received an MBA from the University of Tennessee and CPE from the American College of Physician Executives.

03:01 The factor of health care that makes all the difference—and why the zip code matters.
04:20 Compensating by writing more prescriptions.
04:34 The 80/20 split.
05:13 Dissecting the 80% side of patient health care.
06:50 “How do we get this information to the patient … and how do we [get it to them] at the right time?”
08:54 What Dr. Raju is asking people to do differently.
10:43 The first step health systems should take to combat social determinants.
12:08 The program like Healthify that Dr. Raju has health systems use to help physicians integrate crucial data.
15:40 Providing an algorithm and, subsequently, a foundational metric.
16:13 The advantages to assigning a social score.
16:38 The components to having a great plan to tackle social determinants.
18:32 How Dr. Raju sees this system changing and evolving.
19:49 The barriers to rolling out Dr. Raju’s program.
20:12 “This … is a moment.”
25:08 Larger forces at work, too.
26:30 Why Dr. Raju refers to it as a “movement.”
29:27 “Keeping people healthy is not good for the health care industry.”
30:00 EP189 with Alex Jung of Ernst & Young.
30:55 “The culture is a problem; the economy is a problem.”
31:15 “You can’t just fix one; you got to fix the whole thing.”