Transforming Healthcare: Tech, Equity, and Kindness (ft. Shantanu Agrawal)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation challenges and opportunities across healthcare and life sciences. And now, your host, Ed Marx.

Hey, it's Ed here. Thank you for joining us on Digital Voices. We love to cover everything digital and digital transformation, not just on the provider side, but also in life sciences, and especially in this episode on the payer side. And we have no one better than the Chief Health Officer for Elevance Health, Shantanu Agrawal. So Dr. Agrawal, welcome to Digital Voices.

Thanks, Ed. It's really nice to be here. Thanks for the invitation.

Yeah, it's, it's going to be really cool because I love your background and what you represent and the different things that you're doing. And I think we're going to dig into some of that. Passion. So, I'm ready to jump in. And so, I normally talk about when we first met, and it really is now. So, I know you from the online presence and everything that you put out in terms of the great things that you're doing. And of course, from your history pre-Elevance Health, it's just fantastic. So, it's like, I want to meet this person and learn more about him. So, again, thank you for being our guest. But the most important question of all the questions we're going to ask today is the very first one, and that is, Songs on your playlist?

It's a good, it's a good one. It's a good way to get started. So, um, I, you know, I listen to a lot of Pandora and maybe my favorite station is just the '90s station. Uh, I find that when I just listen to songs that I grew up, literally grew up with in high school and all that, like it just takes me back. I love it. One of my favorite, uh, is a song from The Cure, Friday I'm in Love.

Uh-huh.

I really play that over and over, especially for my kids, and gotten them into it. I do try to keep up with my kids. I've got 2 teenage daughters. They have tastes that are probably a little different from mine. Interestingly, not very much Taylor Swift, but they do love more sort of rock stuff. So they listen to a lot of AJR, for example. So I try to keep up with that just to have something else to talk to them about.

Yeah, no, that's good. And that's being a good dad right there. Yeah, the Friday I'm in Love is perfect because we're actually recording on a Friday.

Yeah, yeah. I hope to play it later today.

It'll be good. Got that song now playing in my head for the rest of our time together. No, that's really cool. What about a life message or mantra? Are there certain words that you live life by?

You know, I think really at the highest level, it's just be kind to people, be nice to people, I think the biggest thing is just be easy to work with. I have had the good fortune of working in a lot of great organizations with a lot of great people. I have been able to learn from so many of them and just, I've seen it so many times in my life and in others. Just be nice to the people you work with because our, you know, at the end of the day, healthcare is actually a very small industry as a whole. You run into the same people over and over again. You treat them with respect, you work together well, and people come back and, you know, can, You'll work with them again, or they'll introduce you to some opportunity. It doesn't matter if they're working for you, you're working for them. It's a small community.

Yeah, no, that— those are excellent. In fact, we're building a list that we'll publish soon of all of our guests and all of their words to live by, and certainly being kind should be at the top of that list. Tell us a little bit about your story. You can go as deep as you want, personal, professional. We already know that you have 2 teenage daughters, but what else about your growing up that maybe informed you all the way to present day?

Yeah, so a lot of things. I mean, I was born in India. I grew up in Ohio in actually a pretty small community. My father was, you know, an anesthesiologist in the community hospital of that town for decades. You know, probably a lot of that has informed the way I think about health and healthcare. I've definitely seen rural America. I tagged along with my dad a lot when he went to the hospital. It was a great way to kind of hang out with him and also see what he was doing. And there were lots of people, his patients who couldn't afford care. And so there's sort of like this informal bartering system that he got involved in where they give him something that they grew and he'd be their anesthesiologist. So, um, I, that was, I think, really impactful for me, certainly as I think about my path in healthcare. Um, I have become an emergency medicine physician. Um, you know, so much of what I think about on a day-to-day basis has been affected by the clinical care that I was able to offer, and frankly, the limitations of that care. I mean, you know, I chose the ER specifically because It's really hands-on, but it's, I talk about it as being literally and metaphorically on the ground floor of the hospital. And so everything comes in, right? Society comes in through the door. All of our social ills come in. And it's hard to escape what is happening in our societies when you work in the ER, which means every single day my limits, both as a human being and as a doctor, were kind of tested. And that has very much stuck with me as I kind of go through my professional career. Aside from that, you know, I'm married to a pediatric hospitalist. She reminds me every day what's truly important and valuable. And a focus on kids is just so critical. And she does that in her own career. And then, as I mentioned, we have 2— they still seem young to me, but they don't really seem young to themselves anymore— teenage daughters. And they definitely keep me humble because there's not a whole lot that I can do that impresses them.

Right. Yeah, teenagers have a way of doing that. So what part of India were you born? Where, what city?

I was born in a village in Rajasthan, India. So the state is Rajasthan. The village was called Beemal. It's really small. It's where my dad and my grandfather were born, actually literally in the same hospital. I'm sorry, literally in the same home. There was no hospital. So yeah, that's where I was born. And then we emigrated first to Detroit. when I was 4 years old.

Yeah, no, that's very cool. My wife has a similar story, but she's from Himachal Pradesh, but not too far from Rajasthan, right? It's north part of India. Yeah. So, that's super cool. So, tell us a little bit about Elevance Health. So, it was formerly Anthem, but for those that don't know much about Elevance Health, tell us sort of the mission and vision.

Yeah. So, Elevance Health has had a long history as Anthem, as Amerigroup, other organizations. We sort of undertook a major rebranding, sort of creating this corporate structure around Elevance Health, but we still have the Anthem names and brands attached to us. WellPoint and Carelon as well is sort of our new services organization. Overall, you know, we are a health benefits and services company. So, we directly insure, you know, let's call it at this point, 45+ million Americans. Across all lines of business. And then we have the health services company called Carelon that offers services to millions upon millions more. So I think net-net, we serve over 100+ million Americans through our entire footprint. We're national in scale. And I think what's really important to me and important to my role is that we really work to take care of members in all walks of life. So that means Medicare, Medicaid, commercial, the individual marketplace. It very much ties into our goal of being a trusted partner in health for, you know, a lifetime. And so that's really important when you think about our footprint. I think it makes a lot of business sense, but frankly, it's key to our mission.

Yeah, I like that. I know I want to dig into that a little bit when we talk specifically about your role. And before we get there, you know, because obviously I'm super into digital transformation, we're called Digital Voices. Curious, one or two ways that Elevance Health leverages tech to improve experience?

You know, being a digital-first company is actually really important to us. Again, when you think about that geographic and that membership footprint, we need digital in order to scale so that members are still getting what we aim for to be a very personal experience with us, but again, at a scale that we can achieve so that it's efficient and effective for the member. So that shows up in a wide variety of ways. So one example that's sort of close to the work that I do that's important to me is we think it's really critical when you think about addressing whole health and being a lifetime trusted health partner, we want to assess our members' social needs and work to address them. Well, again, I can try to get on the phone with a member, you know, one of our associates can try to get on the phone with a member But we also know that some members like to be able to do this on their own. This is a really sensitive topic, right? Talking with another human being, one who you don't know, may be really challenging for them. And so what we did is we also created a self-screening tool in our app. It's called Sydney, that allows a member to screen for their own social needs and then can get pointed in the right directions to get those needs assessed and addressed. Again, my goal is There should be no wrong door for engaging with our company when it comes to an area that's so critical like social. And so I would love to engage, you know, on the phone. I'd love to engage in person. We do that as well. But, you know, where the member might want a more digital avenue, that needs to be available to them to meet our scale purposes, but also hopefully to meet members wherever they are. So that That sort of digital capability was really important to me. Of course, you know, we are working on digital solutions across our entire business. We're working on really building on the new kind of generative AI solutions. We'll always be digital first, but I think that example is so relevant to me because it's so personal in some sense.

Yeah, no, I love that. And just for the record, you brought up GenAI before I did.

So I didn't say it. Yeah, that's fair enough. Fair enough. We do talk about it a lot.

No, that's awesome for sure. You need to lever all the available technologies, and it's great to hear that you're digital first as an organization. So let's jump into your role a little bit. So that's another thing that sort of attracted me to you and talking to you is the role of Chief Health Officer. Can you name one or two of your favorite aspects of that role?

I have to tell you, I never, you know, I've been here now 3 years. I did not contemplate coming to a company like this until this role kind of found me. And I credit our CEO, Gail Boudreau, a lot. She really innovated the concept of this role. And the idea was to really have a chief clinician that moved beyond the traditional chief medical officer role and was really focused on whole health outcomes. It ties in directly to our whole health strategy, which really starts with and puts health equity at the center. We can certainly talk more about that. But, you know, I think what she was looking for is a clinician leader that would help to create and drive that whole health strategy that would keep it front and center, and would not have some of the more traditional CMO roles that I think are extremely important, but would— and hopefully this role would kind of augment that. So that's really the vision that captured my attention 3 years ago. It's certainly the thing that I care about most as I've I've had the opportunity to be in the role. And I do think, and I say this because I didn't create it, but I do think this is going to become an industry standard. In fact, we've seen a couple of other of our peers create and recruit their own chief health officers. I do think it's an important role because it gives an opportunity for a mission-driven clinician to be at the table sitting with the entire senior leadership team focused first on health outcomes above all else. And when you think about the power of that, the importance of that, I can, I can completely see this becoming a normalized role in the industry.

Yeah, I would agree with you. And I think it's brilliant and super innovative. Because like you were alluding to, not that there's anything wrong with the traditional CMO role, but oftentimes, they became so burdened by administrative things, and they didn't have the time to focus sort of on this whole health concept. So So kudos to you all for sort of trailblazing that. Tell us maybe one or two things that you all have done to improve outcomes addressing disparities and social equity, because that, again, that's why, you know, you're very passionate about this focus area in particular. So I'd love to hear maybe one example on something that you've all done.

Yeah, I'd love to. I think there's a multitude of things. So look, I talked about our whole health focus, and what that means for us is really pulling together physical, behavioral, and social health in the sort of understanding the whole health of a member or of a population. I think the concept is really important because, as you know, too often in healthcare, we actually tend to fragment health. We think about a person's health in terms of conditions or diseases or organs. But there's so little that actually pushes us as an ecosystem to put that entire picture of health together. We are working to do exactly that, right? That whole health is our answer to healthcare value and affordability. We believe that if we address whole health, we will intervene on issues earlier, and that will stem both poorer health outcomes for a member down the line, but also unnecessary, wasteful, low-value healthcare utilization that everyone also cares about. So that's the sort of the North Star for us. And then, of course, health equity is at the center of it. And we've adopted the Robert Wood Johnson Foundation definition of health equity, meaning that everyone has a fair and just opportunity to optimize their health. And I think that's an incredibly important motivator for whole health itself. So there's a couple of things immediately when you think about where we are as a healthcare ecosystem that this whole health approach demanded. I think a great example is maternal health. We all know maternal health outcomes are highly disparate. African American women, you know, have much higher rates of morbidity and mortality than their white counterparts. in maternal outcomes. And so this became an area of focus for us literally for the last few years, such an area of focus that we actually have created a maternal disparity measure. We actually, we track a nationally known measure, severe maternal morbidity and mortality, and it is on our enterprise dashboard that gets reported to the board. And so we have a very specific goal around reducing disparities in maternal outcomes. as an equity and as a whole health issue. And so that is an example of something that we focus on literally every day. It's cross-enterprise, and we try to bring multiple solutions to bear, including new case management programs, new digital interventions, as well as even implicit bias training for our network OB-GYN physicians. So that's such a critical thing. And then I will say, you know, structurally what we have really worked to do is embed health equity in everything. We call the program Health Equity by Design. One of the things that we tried to do is actually work in all of our Medicaid plans because just the incredible relevance of equity to that population. We set out to achieve health equity accreditation for our Medicaid plans. So we have 21 Medicaid plans. We worked with NCQA. NCQA actually has 2 levels, 2 different levels of health equity accreditation. And over 2 years, we got all of our plans to the highest level of health equity accreditation. Now, there's no magic there to that, except that it necessitated a few things. First, that we would have an infrastructure supporting health equity built into those plans that would— that we would collect more information and data, some directly from our members, to better understand disparities today and health inequities today in our network. Third, that we would really think about and create best practices that we would then universalize across our system. So I'm really proud of that work. It has put us on a pathway to sort of ever improving in equity. I'm proud that, you know, 90-plus percent of our Medicaid members today are in a plan that has the highest level of health equity accreditation. And we are working very purposefully this year to get that to be 100%.

Nice.

I want to bring that thinking to the other lines of business, right? I mean, Bring it to Medicare, bring it to commercial, have the same infrastructure and thinking around health equity. It engages my team every single day. And it is, it definitely, when I wake up in the morning, feels like the work worth doing.

Yeah, no, that's an awesome, awesome example. And I certainly understand a little bit about it based on where I previously served in the C-suite at a healthcare organization. So tell me, I'm gonna raise it up a little bit, not specific to your position, but as an executive, How do you balance the needs of providers and members? Because that was always a challenge for me as well. It's like, you want to always have this perfect balance of, you know, all the providers that serve the patients and the patients. And sometimes the third sort of leg in that stool was internally, right? Your internal stakeholders. It's hard to balance all that. What are some ways that you try to do that?

Yeah, so it's a great question. And, you know, I, you obviously were a leader in a delivery system, a big, important one. And then I've been a practicing physician. I do think in my heart that if you, if we sort of collectively physician, provider, and plan kind of focus on the member, a lot of our interests instantly get aligned. I mean, where we often get unaligned is where sort of the member gets lost, right? Then it's very easy to kind of go our separate ways. If we think about, okay, what does it take? I think the sort of concept of whole health immediately resonates for physicians. I think many physicians, especially primary care practitioners, don't have enough resources to focus on the whole health of their patient. They have very brief appointment windows. They can get at a couple of topics. They're not able, maybe even not well equipped to get at behavioral health or social issues. You know, as I've talked to physicians in this role, quite a number of them, and I understand this, almost feel sort of like an ethical quandary around asking about social needs. We're not trained to do that. That wasn't part of my med school training. It isn't still today, unfortunately, the part of many medical school training programs. And so they don't feel well equipped to do it. But then if they find out that someone is food insecure, what are they going to do with that? Right? So you have to— I think in order to stay aligned around the patient, we've got to solve— for these kinds of quandaries. So a few things help, I think. First, value-based contracts. Put in the contracts what matters to us most. Let's agree to it. Of course, that's quality outcomes. It's equity outcomes. It's addressing social needs. Let's just agree to what those factors are. And that way, we'll be aligned around the patient/member. I think second, giving providers more tools, right? So we are really taking a care enablement approach with our providers. Let's get them more data. Let's get them access to more resources and infrastructure. If I want a physician to ask about food insecurity, then I really want to give them a program to address those needs so that it's not sort of this ethical black hole for them. So let's enable them to do better, to succeed in these value-based contracts that will keep us aligned. And third, I think there are more things that we as a plan I mean, one of the things that really attracts me to this space is that ultimately we are accountable, right? I mean, a, you know, the total cost of care comes down to us. We are held accountable by regulators, both at the state and federal level for our quality and other outcomes. We are accountable. And that means also doing more directly with our members. So I push that vision a lot internally, like let's have more engagement with our members. The physician is clearly critical. But there's no reason why we only have to go through the physician, right? We can engage the member, we can really figure out what their needs are, and then make sure that we are leveraging all of the available resources, including our physician network, to get those needs met.

Yeah, I love how you centered it all on really the member and the patient. And I think, I think you're right, if we can get everyone to always focus on that, I think the other things become more manageable that we, that we work through and find that right equilibrium or equal balance. You're a great leader as well. So I want to jump into some questions around leadership because a lot of our listeners are leaders themselves or aspiring leaders. And it's always great to hear other people, you know, and what their experience has been so we can learn from them. So how do you continue to evolve as a leader? So you're already a senior leader, but I bet there's some things that you still do to continue to evolve in your capabilities? Oh yeah.

I mean, one thing I've really valued is just being in a community of peers. So I always look for, in every job, like, who are the peers that I can learn from and work with? So there's a similar kind of a community of chief medical, chief health officers in our industry. I take a lot of time to sort of engage my peers in, you know, obviously permissible ways and just learn from them. Hey, you know, bounce ideas off of each other and share stories and best practices and especially mistakes and flaws that we sort of can learn from. So that peer group is really important to me. I do frankly learn a lot from my colleagues here. I mean, again, we have— I mean, one of the great things of working in an organization like this is there are a ton of experts. And there are people that have been in this industry for a lot longer than I have been who are really moving the ball forward on a day-to-day basis. I feel that way about Elevance Health. I felt that way at CMS, at NQF, like literally everywhere that I've been. And so there's a lot of opportunity to learn from peers. And again, how should I do this? You know, get counsel and advice.

Yeah.

What roadblocks am I gonna run into? And sort of take away the best that I can from those discussions. You know, one thing I'll say very specifically is in my last role at the National Quality Forum, I had the opportunity to be in the top job, right? I was the CEO of that organization. And man, like everybody says it, but until you're there, you don't really experience it. That's a very lonely job.

Yeah.

There's less opportunity to learn from others, right? Because you don't have the same set of peers that you do, you know, in even a very senior executive role. At least you still have peers in those roles. And so, you know, that's a lot more learning experientially and frankly making mistakes in public and learning from those mistakes. When I was thinking about this job versus sort of staying, and I was really happy in that last role, it was great. I loved the organization. I loved the whole quality enterprise. So it was a tough decision to move. But frankly, one of the things that I thought about was, Now that I'm sort of attuned to the challenges of a CEO, now that I kind of better understand them on a much more personal level, it's not theoretical for me anymore. I would love to just watch another great CEO do their thing.

Yeah.

And it felt like the right sort of next step in my career was to obviously in a much, much larger organization. And Gail is a fantastic CEO. She leads a massive enterprise. But there are things like I am very attuned to now watching as she sort of operates and makes decisions, that has definitely informed me. I'm probably, you know, not certainly not immediately, but like ready to kind of reapproach the CEO job sometime in the future. And I know everything that I've kind of experienced now is going to play into that. So a lot of it is, you know, is experiential. It's learning by doing and learning by watching others. But it's almost knowing the right questions to ask once you've had the chance to be in that uncomfortable personal experience.

Yeah. Yeah, that's good stuff. And I always just want everyone to just hear, you know, how other leaders like yourself are still growing and aspiring to learn and different ways that you do that. So thanks for sharing. Now, on the top, you know, your dad being a physician and you were able to follow him around. Where else do you draw? And I'm sure it was very inspirational. Where else do you draw inspiration from?

I mean, like I sort of said earlier, I am reminded all the time of patients that I had the chance to take care of. I'm like both specific patients, literally I can picture them, both the things I was able to do for them as well as frankly the mistakes that I made and sort of groups of patients, right? The, I can't describe to you if I just close my eyes and try to recollect the feeling of powerlessness that an ER doc can have when someone is uninsured or can't get in to see a primary care physician or can't buy their medications. And those are things that are very, very hard to, you know, address for an individual clinician. When I think about the, again, the very fortunate kind of career path I've been on and the roles that I've had, a lot of them have been predicated on this idea of addressing those patients and those issues. And so that is 100% everyday inspirational for me.

Yeah.

I wanna rectify some of the challenges so that the ER docs behind me don't ideally experience what we all experienced. I mean, this is not one place, it's not one practice, it's not anything. It's just these are the problems endemic to American healthcare. And I think if I say this when, you know, every once in a while I have a chance to teach a class to medical students or residents, and I tell them, you know, it is so enormously powerful to think about your clinical life and then extrapolate from it and externalize it and think about the bigger challenges that you're facing that you could help to address. I mean, that is what gives truly, I think, a physician insight into their patients' lives, but also the influence to make change. And so that is, you know, frankly, constantly inspirational for me. I will share very briefly just this one story. When I was in the pediatric ICU in residency, I took care of this just incredible little girl who had a genetic disease that caused spinal muscular atrophy. That's what the disease is called. And she was in and out of the hospital all the time, and I was admitting her to the PICU and she was teaching me about her disease because it's uncommon. She was so well knowledgeable about it, old enough to communicate all of that information to me. Her mom was incredible and it was like they were doing the admission for me, but I was going to take care of her. And she ended up celebrating in that admission her birthday and her family was there and it was just this incredible loving family. And she had pneumonia and she was gonna get better and she was gonna go home, but ultimately she still had this genetic disorder and she was going to die from it. And they all knew that. And then it was gonna be an early death. And I saw, it was just, I will never forget that family. I'll never forget that patient and how personally impactful it was to see just a, such a closely knit family dealing with this incredible disease. Earlier, like last year, the first gene therapy came out for exactly that disease. And my team writes the medical policies for the things that we're going to cover, like new gene therapies. And so we were discussing it, the medical policy came across my desk, and of course, instantly I could see the face of this patient. And I thought, my God, like, this is a chance to help the next one like her.

Yeah.

And so, yeah, patients, patients are constantly the inspiration.

Yeah. No, that's a great story. And, you know, clearly, I think all our listeners picked up on it. I knew it already. You're a great person, a great leader, working for a great organization, doing good things for, for what was it, 100 million Americans, I think was the, was the total. And look, we covered a lot of areas, everything from The Cure and Friday I'm in Love. So definitely playing that as soon as we're done here. And talked a lot about Elevance Health and what you do as an organization, but more specifically, your role as a Chief Health Officer. And you gave us some great examples. I especially love the one on maternal health. And then we talked about leadership and how you recognize that you need to continue to grow and evolve and just sort of where your inspiration is from. So we covered a lot of stuff, but did we miss anything or is there a point that you want to double down on? I give you the last word.

Now, Ed, I appreciate the opportunity to be on. It's fun. I got to— these are questions I don't often ask myself or really get to answer like this. So it was great. I appreciate the introspection. I do think we covered a lot of ground. I don't have a lot more except I'll just return to the beginning, which is stay focused on people, stay focused on patients, and just be nice to each other. Even in disagreements, just be nice to each other because at the end of the day, you will run into the same people over and over again.

Yeah, yeah, for sure. That's a great way to wrap up this episode of Digital Voices. Thank you for listening.

Thank you for listening to Digital Voices podcast with Ed Marx. If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review. And most importantly, thanks again for listening.