The Future of Healthcare: “Our system favors those with economic means; we need this to change” with Dr. Sandhya Gardner

Equality of care for every patient: Our system favors those with economic means. We as healthcare leaders need to be funding, promoting, and designing companies and innovations that target and prioritize underserved populations and flip the model. Focusing on initiatives that support lower income and underserved patient populations and rewarding entrepreneurs and providers who choose […]

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Equality of care for every patient: Our system favors those with economic means. We as healthcare leaders need to be funding, promoting, and designing companies and innovations that target and prioritize underserved populations and flip the model. Focusing on initiatives that support lower income and underserved patient populations and rewarding entrepreneurs and providers who choose to support these communities with things like tax and loan forgiveness are examples of steps that could advance this effort.

Asa part of my interview series with leaders in healthcare, I had the pleasure to interview Dr. Sandhya Gardner. Dr. Sandhya Gardner is the former Chief Medical Officer of Relias. She joined Relias in December 2016 with the acquisition of Advanced Practice Strategies (APS), a Boston-based healthcare education and technology company where she served as Chief Content Officer. Prior to her role at APS, Sandhya was as a practicing physician, specializing in Obstetrics & Gynecology. She worked in private practice in the greater Boston area for over 10 years, serving a diverse population of women of all ages, demographics, and needs. The relationships that she fostered with her patients and the impact that she was able to make on their health remains one of the greatest privileges of her life. Sandhya earned both a BS in Psychology and her M.D. from Brown University. She completed her Obstetrics and Gynecology residency at the University of Massachusetts. She is a board-certified physician and Fellow of the American College of Obstetricians & Gynecologists. Sandhya spends her free time with her husband and two children. They all share a passion for travel and sports.

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

My interest in a career in healthcare, specifically being a physician, began early on in my high school years. I spent a summer with my aunt between my sophomore and junior year shadowing her at the hospital where she was a practicing OBGYN. I observed my first delivery of a beautiful set of twins that summer, and though it was many years ago (will not elaborate on how many years!), I remember it vividly. I knew then that I wanted to commit to a career in which I could provide care for women and their families during a vulnerable but joyous time in their lives, and have the unique privilege of bringing life into the world.

My transition out of clinical practice to working in the healthcare learning and technology space happened about 8 years ago. Through my years in practice, I saw significant variation in what clinicians knew and in the way they were caring for patients. I also recognized that there were real opportunities to improve patient outcomes across healthcare if we could begin to address some of these gaps. This ultimately led me to Relias.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

I was sending out an email to my team from my phone, and was typing away to get the communication out quickly. I signed my name and must have missed the “n” in my first name. I didn’t double check it and the signature I ended up sending was “Sad human” instead of “Sandhya”. I heard about that one for a while. Lesson learned: take time to proofread!

What do you think makes your company stand out? Can you share a story?

The mission. “Relias strives to measurably improve the lives of the most vulnerable members of society and those who care for them.” It is incredibly compelling that Relias embraces a dual mission of supporting our members along with the healthcare providers who are working so hard to take care of these individuals in their time of need.

There are many meaningful stories from our clients, but I will share one that stands out for me given my background as an OBGYN. It involved a hospital Labor & Delivery client. They used one of our clinical education products that teaches obstetrical providers how to perform difficult deliveries of infants that are unable to clear the maternal pelvic bone during birth. A provider encountered one of these rare events and was able to apply one of the surgical techniques that she learned from our course to safely deliver a newborn and avoid any complications to both baby and mom.

After this, the client sent us a letter expressing profound gratitude for the work we were doing, and let us know how it was positively impacting patient lives and helping to make healthcare safer. These are the kinds of stories that have and continue to motivate me and the other employees at our company.

What advice would you give to other healthcare leaders to help their team to thrive?

Remember why you are doing this, and who you are doing it for. The opportunity to improve healthcare and patient and provider outcomes is a privilege, and we have the potential to bring value and impact across our globe. Keeping this at the forefront can help you overcome the day to day difficulties and roadblocks that we all encounter, particularly when trying to innovate and introduce disruptive technology and products into the healthcare market.

Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

  1. Lack of focus on healthcare quality and outcomes. The fee for service model of care still predominates. Hospitals are slow to take on risk and providers are not consistently incentivized or enabled to shift to value versus volume.
  2. Access to healthcare. This is a broad issue with a number of drivers. One example is poor data management and use of technology in healthcare. Data driven and automated patient scheduling and telemedicine are two examples of advancements that are helping to alleviate suboptimal patient access to care.
  3. Lack of healthcare equity. Given how much the US spends on healthcare each year compared to other wealthy nations, it is astounding and unacceptable how much inequality there is. Social determinants like income level, availability of transportation, and zip code are coming into the spotlight, and there is an increasing awareness of how Social Determinants of Health impact patient health and the quality of healthcare being delivered.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

  1. Hospitals/Providers need to more aggressively move to the value based care model (Example: Taking on a large % of the financial risk such that compensation is based on the quality of care delivered and healthcare outcomes versus the traditional fee for service model)
  2. Invest in improving patient access (Example: Provide telehealth resources in ER’s, particularly rural and critical access hospitals that often have inadequate access to behavioral health or medical specialists)
  3. Focus on healthcare outcomes (Example: measure and share data on hospital, department, and individual clinician performance. This kind of transparency and emphasis on outcomes creates awareness and a culture of accountability and can help to change behaviors that undermine quality)
  4. Create a delivery system that promotes Integrated Care & Care Coordination (Example: Behavioral health, Physical health, and Social determinants need to be considered holistically if we expect to sustainably improve healthcare outcomes. Simply treating a poorly controlled diabetic patient in DKA (Diabetic ketoacidosis) without understanding why the patient did not take his/her insulin is inadequate. Taking the time to identify and address root causes (such as a lack of transportation to keep medical appointments or a recent loss of a job and income resulting in an inability to pay for medications) should be part of how we provide care for every patient.
  5. Provide the same quality of care to every patient. (Example: maternal mortality rates in the US continue to rise while other developed nations are on the decline. These rates are disproportionately higher in African American women- anywhere from 3–4x the rate of Caucasians women. This kind of variation in care and outcomes needs to be called out, the drivers understood, and the issues addressed).

Ok, its very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

1 & 3) Value based care adoption & focus on healthcare outcomes: The hospital or health system administration needs to be willing to take on the financial risk and motivate their providers to get on board. Leveraging compensation/bonuses for providers; and using practice and provider performance analytics tools to show providers where they are falling short and where they are excelling with respect to care cost & quality and patient outcomes (and creating a culture of transparency and accountability in doing so) are possible strategies to accomplish this. A majority of providers want to do the right thing and practice at the top of their game. Shining a light on areas of variation and opportunities for improvement, using actionable data, is very powerful and motivating. Communities and leaders should also be highlighting hospitals that are excelling in these areas as a way to promote them and encourage laggards to adopt.

2) Patient Access: Investing in telehealth resources in critical access emergency departments so that patients have access to the right specialists and consultants required to provide them the highest quality of care. This would also have an impact on avoidable readmissions.

4) Integrated care delivery: One concrete step is educating staff on the value and the strategies to accomplish this; e.g., providing online training for your clinical staff to show how integrated care improves patient experience and outcomes and how they can tactically deliver this in their practice settings.

5) Equality of care for every patient: Our system favors those with economic means. We as healthcare leaders need to be funding, promoting, and designing companies and innovations that target and prioritize underserved populations and flip the model. Focusing on initiatives that support lower income and underserved patient populations and rewarding entrepreneurs and providers who choose to support these communities with things like tax and loan forgiveness are examples of steps that could advance this effort.

As a mental health professional myself, I’m particularly interested in the interplay between the general healthcare system and the mental health system. Right now we have two parallel tracks mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?

I am a proponent of integrated care and holistically treating the patient, not the traditional parallel track approach. Treating physical health issues without addressing the mental health component (or vice versa) is short-sighted and doesn’t address the whole patient and their complex needs.

One strategy is to provide education and training for healthcare providers on the value and improved results that collaborative care/Integrated care and other patient-centered care models bring. Another step is to provide telehealth services in care settings where access to specialists may be limited. One example is to use telehealth in rural or Critical Access Hospital emergency departments to access mental health providers for patients presenting with a behavioral health diagnoses on top of their presenting medical diagnosis. Being able to show the improvement in outcomes that integrated care models can deliver is an effective way to move from the parallel track status quo to a more holistic approach.

How would you define an “excellent healthcare provider”?

A provider who treats his/her patient as they would their own family member; always keeping the best interest of the patient at the forefront. The ideal provider is skilled, open, honest, and humble. They consider all aspects of the patient from medical and behavioral health diagnoses to social determinants of health and the life stressors and motivations of their patient.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“Ever tried. Ever failed. No matter. Try again. Fail again. Fail better.”

By Samuel Beckett

I learned the quote when my older son was in 4th grade. I have since used it to encourage, console, and guide my two boys (10 and 14) through many of their early life challenges. It exemplifies the grit that it takes to succeed. And while I didn’t have these exact words while I was growing up, I consistently used the message behind this quote to push me forward.

Are you working on any exciting new projects now? How do you think that will help people?

N/A (Not in a position to share new projects through this venue).

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

Cutting For Stone by Abraham Varghese is one of my favorite books. It is an epic tale that spans continents, cultures, and race; and is story about love and betrayal. It is about the struggles of a young surgeon and how his complicated family story helped to shape him, yet not define him. Finally, the real essence of the story is about how the character uses the joy that comes with being able to heal others, to ultimately heal himself.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger.

I would want to inspire a movement to eradicate hunger. If we could eliminate how much food is wasted in certain parts of the world and re-purpose and re-distribute this, along with creative technological advances in farming and food creation…perhaps we could find a way to feed the world.

How can our readers follow you on social media?

Dr. Gardner isn’t on social media, but you can follow Relias on Twitter: @Relias.

Thank you so much for these insights! This was so inspiring!

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