Hello, I'm Jacinta Gauda.
Welcome to our conversations with the 2020 winners
of the Robert Wood Johnson Foundation Award
for Health Equity.
In our conversations, the award winners share their stories
and discuss the important work of systems change.
I think you'll find their stories to be informative,
insightful, and inspiring.
Today our conversation is with Dr. Maurice Lee.
Maurice is the founder of the Arizona Safety Net.
Let's learn more.
Maurice, congratulations on your award.
Let's talk a bit about closing systems gaps
to achieve health equity.
Now you saw opportunities to close these gaps
and you formed the Arizona Safety Net.
Tell us a little bit more about that.
It goes way back.
So back when I was in residency and running a free clinic
out of a YMCA.
And I was a resident at the time
and thought I could do anything
because that's what residents do, right?
And we were seeing patients really treating
about everything that we could, but every once in a while
we'd get stuck where we really needed
either a specialist to give us the next step
of what we can do
or maybe start something and then have us take over again.
So I actually just reached out
to every single clinic that offered care to the underserved,
whether it was, I'm sorry, the uninsured, whether it was
on a case-by-case basis or that's what they were there for.
And really got their buy-in,
got to see what resources they had,
what resources they didn't have.
And then we kind of put a directory together
on what clinics had what so
that we could all start referring within each other.
Maurice, let's stay with this a little longer and talk
about the making of the Safety Net
and making those critical connections between primary
and specialty care.
What I really tried to do in the beginning was try
to paint a picture that when it comes to uninsured patients,
we're all the same clinic.
So they're going to all of our clinics.
They're seeing all of us, why not coordinate that care
and make it the best that we can.
So it took a lot of individual meetings.
And then after about five or six months of meeting
with all the different people we finally met up
I think it was in October of 2015 as one group
and were able to discuss what it would look like
if every primary care was sharing all
of the different specialty services that they had.
And to get that coordinated.
Maurice it sounds like painting the big picture
is important as well
as building trust and connecting through shared values.
Let's turn our attention
to the physicians on the front line.
When we spoke earlier
you explained how systems gaps can be frustrating
for physicians and even lead to burnout.
Help us to better understand this impact on physicians.
There is a lot of,
a lot of burnout and a lot of frustrations that people have.
And unfortunately the patient ends up getting labeled
in a lot of the cases.
So, you know, I've heard a lot
of physicians within the Safety Net, so yeah
we just wish we had this, but we don't have it.
And like, it's right here, just do the referral.
We can get it done or let me know
and we can start recruiting the right people for it.
So it's really a win-win.
People talk about the triple aim
which is, you know, cost, quality and patient satisfaction.
But I really think it anchors, not just the physician,
but if you have a happy office that really
loves what they're doing and
they get a lot of
just chicken soup for the soul when they go to work,
they're going to be a lot more willing
to take the extra steps and help the patients
as opposed to labeling them as noncompliant
or other issues that we see in medicine.
Thank you for these important insights.
You know, you bring such a commitment
to the communities you serve
especially those who are uninsured.
What drives you in this direction
to bring about systems change?
This is the only work that I've ever really wanted
to go into.
I've never really wanted to do anything else.
And I'm not saying medicine, I'm saying
working with people that are kind of, you know,
the underdog, they're down.
I wouldn't say they're down and out.
That's a really weird way of saying it.
They just don't have someone out there being
their cheerleader, being their advocate.
Let's talk about outcomes.
The Arizona Safety Net for sure has made a difference.
What I can say is that the Safety Net now has between
40 and 55 individual clinics that encompass
about 11 different health care systems.
And that's all within the Phoenix Metro area.
It's really had a big transformation in the type
of care that the uninsured is getting.
The care went from what I've seen people say,
"well, they're uninsured,
this is the best we can do" to actually evidence-based care.
You know, in our clinic, we were able to see, I guess
that diabetes is one of the most common diagnosis,
one out of every five visits.
And I think that A1C is, the controlled A1C was at 92%
of our population.
Our hyper, the people that even with hypertension
their blood pressure is,
95% of the people with hypertension,
their blood pressure was controlled.
I believe it was 88% of people, women were up to date
with their breast cancer screenings.
It was in the very high nineties.
It was actually 99.7% of our women for cervical cancer were
up to date with that.
Colon cancer screening, we're at 92.3%.
So, and then are all of our vaccines were
between around 92 to 97%.
Maurice, as you well know, last year
COVID changed everything.
Talk to us about how this impacted your work
and the lives of your patients.
Did you do anything differently?
Yeah, yeah.
We completely changed everything.
So when, when Covid came around, we, our population
we knew from the beginning that our population
was going to be disproportionately affected.
So we, we didn't, we weren't the ones that were trying
to say, oh let's wait until someone makes us do this or that
immediately we went to telehealth.
We were able to partner through the National Association
of Free Clinics and CVS to become a testing site
for the uninsured.
So we, and since we had already built this community
we just shared it with the Safety Net.
All of a sudden we were
in our tiny clinic we were doing around 125 tests a day.
So our clinic turned into a call center.
We still had our medicine that we were doing mostly
via telehealth and we'd bring people in if we needed to.
We brought them in for medicine,
we brought them in for labs.
But other than that,
the clinic was being used as a staging center.
And we were the one place where uninsured patients could go
for COVID-19 testing.
So it really, it really transformed everything.
Incredibly proud of what they were able
to pull together for that.
Wow, you face these harsh realities head on.
Can you tell us about any
of these practices that have now become the norm?
I had my own thoughts that
my social history is so robust when I'm talking to patients.
I know my patients, right.
Everybody says that I know my patients.
I really felt like I did.
And I really felt like once the patient was
in their home and I was a guest in that process,
I felt like they were truly in the driver's seat there.
So post COVID, I still want to do virtual visits
even if the patient can come in.
Maurice, thank you for our conversation today.
you have shared a lot and we have certainly learned a lot.
And as we bring our conversation to a close
are there any thoughts that you would like to leave us with?
If you can institutionalize whatever change
that you're trying to make.
So make it a part of the culture, make it a part
of a contract,
make it the way that the clinic runs.
When you have your systems change
or your institutionalization, your culture change
don't make it an uninsured thing, make it a patient thing so
that everybody is treated the same as opposed to, well
our uninsured patients we'll treat this way.
We didn't go from canoes to submarines overnight.
That was a very incremental change.
So, my advice would be, or my lesson learned, I guess
would be that things are doable as long
as you stick with it.
You know, again, I'd like to thank you guys for recognizing
that the work that people, that people are doing out there
it's, I guess it's hard work.
It's fun work, but it is good to get recognition.
I know a lot of people were very happy to hear
that the work that they were doing here got recognized.
And it is special.
I think we really are doing the right thing here.
So we should keep doing it.
On behalf of the Robert Wood Johnson Foundation,
thank you for your belief in the dignity and rights
of all patients and congratulations on your award.
Thanks.
Thank you for joining us for this conversation.
And you are invited to more conversations
with the 2020 winners of the RWJF Award for Health Equity
and you can learn more about all of the winners at RWJF.org.
I'm Jacinta Gauda and thank you for watching.