By Asif Dhar M.D., US Life Sciences & Health Care leader, Deloitte Consulting LLP
This week’s blog appeared first as a US Centre for Health Solutions Health Forward Blog The blog introduces Dr Jay Bhatt who has joined Deloitte as the executive director of both the US Center for Health Solutions and the Deloitte Health Equity Institute. Dr Bhatt is a physician executive, public health leader, internist, geriatrician, and innovator. He also continues to provide primary care to underserved communities in Chicago and surrounding areas. The blog is based on a conversation between Dr Asif Dhar, a Vice Chair and US Life Sciences and Healthcare leader for Deloitte and Dr Bhatt to garner Jay’s views on a broad range of topics. Given the relevance of the insights to our own Future of Public Health research series, we are using this week’s blog to introduce Dr Bhatt to our network and look forward to sharing future insights and content from the US Center.
Asif: In your new role, you will be overseeing the Deloitte Center for Health Solutions and the Deloitte Health Equity Institute. What excites you about being a part of these two groups?
Jay: I'm honoured to be in this role and to build on a legacy of those who came before me. The mission of these two organisations reflects my own values and aspirations. We are at an inflection point in health and health care in the US with the traditional models of care continuing to evolve. Stakeholders are starting to meaningfully address the social, economic, and environmental factors that influence health. At the same time, the pandemic and expectations from the public are driving innovation and leading to unique collaborations and possibilities.
Asif: Let’s go back to your early days. Why did you decide to pursue a career in medicine?
Jay: I grew up on the south side of Chicago…the son of South Asian immigrants. My mom was a factory worker, and my dad, a pharmacist. I would often tag along when he delivered medications to his patients. That gave me a front-row seat to the challenges that many people face in low-income communities. When I left for college, I had to find a new barber. I walked into a local barber shop near my dorm and found a community inside. A number of Black physicians from the neighbourhood had been working to set up a clinic in the back of the shop. Customers could get a free haircut if they saw the doctor. These doctors were meeting patients where they were. My early experiences—combined with the challenges my parents experienced with their health—convinced me not just to become a doctor, but to become someone who could meet the needs of underserved populations and empower people to take control of their own health.
Asif: You will continue to practice medicine. Why is that important to you?
Jay: I think it will help to keep me grounded. It will also give me a frontline view into the impact health policy has on care delivery. I enjoy building relationships and helping people along their health journey. I will also continue to serve on the board of a Hispanic civil rights and advocacy organisation that is driving a community-based health agenda.
Asif: As a physician, have you been using virtual and digital tools to stay connected to your patients?
Jay: I've used a mix of approaches. While there is a lot that can be done virtually, we should integrate that technology with in-person care. I recently visited a patient who was having some difficulty breathing but had no way to get to the clinic. Providing care to that patient in her home likely prevented a visit to the ER. I have provided blood-pressure cuffs and glucose monitors to patients for use at home. I can monitor them remotely and help them manage their chronic conditions. Care is shifting back to the community—whether that's in-person, virtually, or through a connected digital device.
Asif: Incentives can encourage people to make healthy choices. Can incentives also push stakeholders to focus more on health and less on unnecessary care?
Jay: Absolutely. I had a patient who had fee-for-service health coverage before moving to Chicago from another state. This patient had diabetes, poor eyesight, mobility challenges, and had been to the emergency room 12 times in one year. We moved her into an Accountable Care Organisation. Under that payment model, the health system had a financial incentive to keep the patient healthy and out of the ER. We assigned a care manager to conduct a home visit. She saw that the patient didn’t have a refrigerator to keep her medications cold, and she had a difficult time navigating the stairs in her home. With the help of partner organisations, we installed a refrigerator and a ramp, provided her with eyeglasses and connected her to a community health worker. Over the course of the next year, she had just one ER visit. Care models should help people align life goals and health goals effectively. In my leadership roles at the American Hospital Association, the Illinois Hospital Association, and the Chicago Department of Public Health, I have worked to advance care models that are affordable, high quality, and equitable.
Asif: We are entering the third year of the COVID-19 pandemic and are just beginning to recover from the latest surge in infections. What have we learned over the past two years and are we better prepared for the next health emergency?
Jay: The pandemic brought public health challenges into sharper focus and illuminated the need for structural and systemic reforms. From a public health standpoint, it's clear that the existing infrastructure can be an impediment to improving health. As an occasional contributor to ABC News, I have heard stories from patients and caregivers on the frontline. Affordability, health outcomes, equity, and patient experience can all be improved if we are able to deliver the right care, at the right place, at the right time, for the right population. But we need to do a better job at helping stakeholders address population segments. Stakeholders need to create and implement new care models and realign resources that incentivise health—rather than maintain a system that just responds when people are sick. We will likely continue to see differences and inequities in care delivery if the existing model and infrastructure remains in place. Health care organisations and life sciences companies should move to a human-centred approach. The lived experience should be table stakes.
Asif: Based on your experience, what role do health systems, health plans, and life sciences companies play in making health care more equitable?
Jay: Health inequity is a chronic condition in this country, and it has existed for generations. We have historically put Band-Aids on problems that require upstream intervention. But I believe there is an incredible window of opportunity to make sustainable changes. The pandemic showed us how interrelated all these sectors really are, and how they can work together to impact health. But organisations are all at a different point along their journey to improve health equity. Achieving health care equity means reshaping care so that it is available to everyone when, where, and how it's needed. For Deloitte, we should understand where each organisation is, what they're interested in achieving, and then help them systematically progress from one step to the next. Curing or preventing health inequities will require collaboration among stakeholders. And every stakeholder across the industry will need to develop a credible and measurable strategy. You can't improve what you don't measure.
Asif: Is there a business case to be made for health equity?
Jay: People are beginning to understand that health equity is not just the right thing to do morally. It is the smart thing to do, financially. It is a business imperative. For example, health inequities can have a significant impact on workforce productivity, financial inclusion, and education. Racial inequities cost the US health system an estimated $93 billion a year in excess medical costs, and $42 billion in lost productivity.
Asif: The health care and life sciences sectors are in the midst of a digital transformation, which could help advance health equity. But could technology also inhibit it?
Jay: Digital technology has enormous potential to make care and resources more available to underserved populations and communities. Data and digital tools can help us understand the health risks individuals and communities face, which could help prioritise care. However, digital technology could also make health less equitable. For example, while broadband access can expand the reach of clinicians, patients who lack digital literacy could be left behind if they can’t navigate digital apps or other technologies.1 Our challenge will be to stay high-touch and personal as we embrace digital, remote, and virtual. There is also the potential for algorithmic bias. 2 Technologies should be tested for unintended or unconscious biases before they get scaled. That is critically important.
Asif: A few years ago, Deloitte outlined its vision for the Future of HealthTM, which is what we thought health care would look like by 2040. We envisioned early detection and prevention of disease, always-on sensors that continually monitor our health, and consumers who are empowered with their own health data. Based on your clinical experience, are you seeing signs that we're headed toward that vision?
Jay: Deloitte is spot-on regarding the destination. I believe that we are more than halfway into a 50-year transformation. A system that allows people to achieve their highest potential for health is the aspiration, and I’m seeing large pockets of action moving us toward this future. However, the safety-net system through which I provide care still lacks the resources, infrastructure, and workforce needed to reach that future. We are just beginning to figure out how to effectively drive care to the community. We need to understand the social, economic, and environmental influences on health. It really comes down to this…you can have amazing technology, a great care model that is integrated, and unlimited resources. But if you don’t have leadership and the ability to implement and execute effectively, then you won't realise the potential of all those assets.
Asif: We are seeing a convergence of our work in health equity and in planetary health (the impact humans have on the environment and the impact the environment has on humans). Can health equity be addressed without also focusing on planetary health?
Jay: Place-based inequities are important to address. The health care sector has—in some cases—exacerbated inequities and environmental harm to communities, which impacts planetary health. Health care and life sciences companies should look for ways to help heal the communities they serve and help improve the health of the planet. Health is impacted by where people live, where they worship, where they work or go to school. There is a business case to be made for improving planetary health that is similar to my earlier comments about health equity. For example, a health system that is powered by renewable energy will have a favourable impact on the environment and could also help reduce the health system’s spending on utilities. Planetary health, building trust with community-based organisations, diversity, and inclusion are table stakes for any health-equity strategy.