Innovating Healthcare Access: The Importance of Storytelling, Mental Health, and Health Tech

[00:00:00] Joy Rios: Hello there and welcome back to the HIT Like a Girl podcast. My name is Joy Rios and this is a show that we get to talk about the complicated world of healthcare and trying to understand its 30,000 piece puzzle where each one of our guests essentially gets to bring in their expertise and share their piece of the health IT puzzle with our audience.

Today I am very excited to bring a new guest, Vanessa Villaverde. And I would like to ask you to introduce yourself, please, Vanessa, please tell us about your piece.

[00:00:37] Vanessa Villaverde: Hello, Joy. First of all, thank you for saying my name correctly. I think that's few and far between that I get to hear that.

So thank you. As you said, I'm Vanessa Villaverde. I'm the Senior Program Investor at the California Healthcare Foundation. We're an organization dedicated to improving healthcare delivery and outcomes for the people of California, especially those in low income and underserved communities, which is very personal to me.

Along with 60 incredible colleagues, we engage in research, policy, analysis, and grant making to advance meaningful and measurable change. Unlike many of my colleagues, I focus on how to supplement and expand access to care immediately through private sector innovation or purpose and program related innovation investments.

Together, my colleagues and I are on a mission to design a more equitable healthcare system with an incredible philanthropic organization led by Dr. Sandra Hernandez. So I'm thrilled today to be talking to you about my particular pieces. As there's so much work to do to address the gaps in care that exist today.

And as you often say on your show, healthcare is complicated. With my own puzzle pieces, I've lived the last couple of decades as a policy entrepreneur. And now aspire to be an investor within community working alongside innovator workforce who are using both tech and trust to reach communities. I get to do this through catalyzing investments in grant making into the ecosystem, which I'm excited to talk more to you about.

[00:02:00] Joy Rios: Okay, so you're hitting some things that are close to my heart. I am one, a California native, and I have plenty of family that have, that use the medical program to support their health care. So when you're talking about tech and trust, can you tell me more about that? And what kind of investments have you guys made and what kind of technology and how does that build trust?

And also, how do you get that information out to the right people who need it? All of that is. It's complicated in and of itself. So it's a big job.

[00:02:30] Vanessa Villaverde: You're exactly right. It's complicated, but maybe just at first as a starting framework for your global listeners, let's set the stage a bit on the context for California and the areas in which we invest.

California is amongst the most populated states in the United States. Currently there are 39 million residents today, more than a third of which are reliant on our state Medicaid program, which is called MediCal. So our economy here in California is one of the largest in the world. So if we were a country compared to the other countries, we would be ranked fifth largest, the first being United States, then China, then Japan, then Germany, then us, California.

So our state's overall workforce is driven by sectors like technology, entertainment, agriculture. Everyone has heard of the famous hubs like Silicon Valley and Hollywood, but also our famous hub of Central Valley known as America's salad bowl and feeding people globally. So we have a wide range of workforce that causes a wide range of healthcare needs.

So when we talk about the landscape of healthcare innovation in particular, where we look at the California Healthcare Foundation to invest, we're talking really about filling in gaps in care to an incredibly diverse population. So our healthcare innovation landscape and where we look to grow solutions is largely driven by the gaps in care.

And this gets to who are the founders and which are the solutions that are designed to close those gaps in a trusting way. Keep in mind, what we're seeing here in California is exactly what the world is seeing in terms of gaps. We're seeing an aging population, we're seeing growing chronic care needs and a significant mental health care crisis.

What is particularly challenging within California is not those big bucket solutions, but it's bringing those solutions and navigating through federal, state, and county policies, designing approaches for the regionally and linguistically diverse populations, and then also to support a severe provider workforce shortage that we have here, and I know other places are dealing with broadly.

So the short answer to your question is we look for the solutions that are able to navigate all of those incredibly difficult and challenging barriers that exist to innovation today, but are showing traction through tech enabled, trust based platforms across California.

[00:04:53] Joy Rios: One way of thinking about barriers, huge challenges, right? You've got cultural, you've got language, you've got like all the different settings within California, environments in particular. Those are also opportunities, right? So maybe one way to reframe a big barrier, and this is my own self talk, is also just to be thinking of there's a lot of change, good change that is ripe to be made there.

And so based on some of the barriers that we see, what are some of the opportunities that you guys have been invested in and perhaps seen growth or good change happen as a result of that.

[00:05:35] Vanessa Villaverde: You're exactly right. In the tech and product world, we talk about these places where technology and products have not gone as white space where the white space opportunity is to create something new and engaging.

And frankly, in an overall health care system that has not engaged with many of our populations, specifically not engaging with women, as we're talking about on the podcast, in communities of color. In particular demographics that don't have business hours to go see a doctor between nine to five working or they're in school. All of that costs our overall health care systems per hhs's estimate 451 billion because they have not engaged in these communities or what's being lost on quote unquote health disparities 21 of that by the way is because they're not reaching the latinx population. And so that's an area that I care a lot about You And represents California.

So going back to the question of absolutely there's opportunity, and this is where the incredible founders that I get to see every day are focused on building. So by ethnic composition, California is made up of nearly 40 percent Latinx population, 36 percent non Hispanic white, 15 percent Asian, and 6 percent African American.

We're incredibly diverse. So when we think about where there's opportunity. Frankly, there's a lot of opportunity in building solutions that are designed for populations that have historically been left out of the system. And from a tailoring perspective, that means getting more lived experience in the founder population.

One example is Latinx population. I know you're Latina. I'm Latina. We are not a monolith and oftentimes there's an assumption that we all speak the same language, have the same heritage, have a similar job, and therefore just giving us language access is enough in terms of personalization and tailoring.

But the reality is that's not true. There are so many spoken languages within our culture, particularly California is home to over a hundred indigenous languages. Our migrant farming community, which is housed and settled into Central Valley, is the backbone of our agricultural economy, and it is an opportunity for us to serve them through MediCal.

And there's further opportunity to serve them even better with solutions designed by founders in this space. Finally, you talk about the geographic diversity in California, we have beyond rural and urban, we have solutions that have to come about in coastal markets, mountain markets, forest, desert, and yes, central agricultural regions, which means the barriers around trust look different.

In the rural markets, we have less doulas, for example, than in our urban markets. So when we think about services that are offered to women during pregnancies, the solution has to be designed and tailored for different kinds of licensure levels and different kinds of clinical leaders in those markets.

So there's ample white space to think about. leveraging your personal understanding of how to design for a community for you. I think you and I both happen to be from and near border communities. Border communities grow up extremely empowered to take care and treat a lot of services in our home. For years, these have been unreimbursed services and treatments in our home.

But as the reimbursement market, or as dollars have moved to in home care, so have solutions and tech enabled abilities to grow care in these new kinds of settings. These are the things I'm excited about because this means that founders who innately know that is an option or grew up with those options can now make commercializable businesses.

[00:09:21] Joy Rios: That idea of being able to reimburse for in home care, like I am experiencing right now a lot of community care. I have a broken ankle audience. Just so you know, the recovery is not that fun, but it's been beautiful to see how people show up for me. And in the ways that I'm like people, somebody is walking my dog right now.

Somebody is bringing over food to me later on this afternoon. And somebody is also driving me to and from my doctor's appointment on Saturday and none of that's reimbursable. They're doing it out of the kindness of their heart, which I really appreciate. But there's a conversation to be had there around those are the types of services that a patient needs and how can we get more reimbursement to them?

That's a policy question. And do you get involvement in some of the tech that is being brought to market, like seeing some of that actually addresses some of those challenges. And then my other underlying question. It's sidelined to that. And so again, sorry, not sorry, but like people that are working in the central Valley, when I'm thinking about agriculture, they're either access or knowledge of a lot of tech is likely on a really low basis.

And so sometimes what could that look like in increasing trust in. Sometimes it might just be helping them get an email address or helping them download a particular app onto their phone, and I'll let you just simmer on any of those. I'd love to hear what you have to say.

[00:10:53] Vanessa Villaverde: I'll start with the policy side and then I'll get into the solution side.

So I built my career first in policy and started off as a presidential management fellow. It just so happened they needed translators, particularly to communicate the impact of the Part D program, which America was digitizing for the first time the enablement of the prescription drug program at the federal level.

And we were initiating these low income subsidites so that people could get their access to medications when they were previously getting their access to medications under state Medicaid programs. So over a decade long career enacted. At least 10 major pieces of legislation that shifted policy, in other words, policy changes over time and in reaction to things that are tested and incubated as innovation at the localized level.

I now fast forward, have a seat front row in a philanthropy organization that is very much active in informing policymakers and incubating innovation and then gets to have an input and show the kinds of innovation that's working in a population like ours, so that policy can be changed, not just in our state, but more broadly because, as we talked about earlier, California is such an incredible microcosm of the rest of the world.

So on the solution side, we have investments right now into critical need areas, supporting some of the most critical needs that we are facing as a country. California, unfortunately, has high mortality rates, particularly in black birthing equity, and we immediately made an investment into an organization called Mommy, who has an end to end platform in women's health.

Now, you may have heard, but just a few months ago, CMS CMMI launched a maternal health program through their innovation models where they're going to allow something like 14 states to innovate and identify what are the additional services women need, not just in a prenatal postnatal home care situation, but also through the transition.

And really excited to have the kinds of companies that we invest into as part of these broader innovation evaluations to showcase the kind of supports that women need. Because yes, they're still learning that even though we create 100 percent of the population, that we don't get all the services that we need.

Another great area that we've invested into is community health. So going into your personal story of what you're going through right now, you're right. Once upon a time, especially in our cultures, people do it for free. People do it because they have each other's numbers. They are tracking each other, whether they're going to church or not.

They're finding out who is sick and needs in home care. And that has always happened. In ways that haven't been reimbursed and in communities where there's not a lot of financial resources That often happens in new creative ways people take turns And so now what i'm excited about is that the health care system is actually not only recognizing that but incorporating that information and data into the rest of the EMRs, EHRs, such that we can understand value based care involves more than just what happens inside the four walls of a hospital or provider office.

It will impact you, an example who just got hurt, it will impact your ability to recover more quickly, to have that kind of in home care and resources to support your overall health and wellness. So we invested into a company called PairSuite, which is a tech enabled company that is offering community health workers the ability to standardize their care and also to connect that care back to clinical EMRs, such that you can track what kind of services, what kind of Z codes are being used overall to have a longitudinal record of particular patients.

So there's lots more examples and I'm happy to get into those in the area of mental health, in the area provider workforce that we are investing into right now. But the second aspect of your question is, are we also investing into places where policy will change?

And the answer is absolutely. The policy is an ever moving target. And part of the complication is that a lot of people, especially right now, who are entering the founder community and building early stage companies are doing so because they want to build impactful, meaningful companies. They're not necessarily coming from legal backgrounds or even business school backgrounds.

A lot of medical entrepreneurs who see the system not working and want to design differently. So that means that all of these new founders entering the market need additional information around how to do it in a reimbursable way or in a way that keeps them viable and keeps their doors open. And so we're spending a lot of time making sure that information around CalAIM, which is our innovation waiver that allows for reimbursement of a lot of community supports and serves our vulnerable populations.

That people understand exactly what they can get reimbursement for and that they can build and design their companies in ways that, yes, are meaningful, impactful, and also can make sure that their mission is supported by revenue and they can continue to grow.

[00:16:01] Joy Rios: That is such a great combination of being able to support specifically like founders because a lot of times I think people will identify a problem and have a solution for it.

But if there's not a direct line to how they can get reimbursed for those services, it is hard to stay in business. And so I love the conversation that you're bringing up, which is just around the impact that policy can have. I think that it's not necessarily a sexy topic to talk about because, and it's something I nerd out about a lot, because I just think when you think about grand change and what impact a policy can have on either a national scale or at a community level, that is actually what ends up being the driver of change. And I think with your experience that you've had at CMS and also what you're seeing now can you take a minute to just talk about, can we nerd out a little bit on the impact that policy has had on some communities?

[00:16:56] Vanessa Villaverde: Yes, happy to and special shout out to everyone that I worked with at CMS who was part of implementing the Affordable Care Act because I think that was the first time in my life that career long government policymakers were co collaborating with industry that came in wanting to have a say in what these private sector innovations look like, particularly in Medicare and Medicaid.

Elliot Fishman and Andrea and team back at CMS, you've done amazing work and it's great to see this continue to come to life. On the nerding out part, the Affordable Care Act, of course, everyone talks about the mandates for coverage, but the real sexy part for me was new expenditure authority or new dollars available for innovation.

And with the expansion of the CMMI office or the Centers for Medicare and Medicaid innovation, suddenly payment models or dollars available to test what innovations could work in Medicare or Medicaid were available. And they were structured such that you had to prove to the office of the actuary that this particular innovation had a chance of returning some of the investments made into it.

So said another way in a world in which that innovation or potential waiver didn't exist, how much did care cost? And in a world in which you added, let's say, in home care services or enhanced medication therapy management or so many of the implementation models that are existing today, what could it look like in a few given scenarios?

What is the evidence that says that caring for somebody in your home will keep them from coming back into the ER for readmissions? And so over time, we created a systematic process within government that looked very much like a venture capital, which means you had to take a bet that a particular kind of intervention would change the world.

And if you lost that bet, what would that look like? And if you won that bet, what would that look like? Except from a policy perspective, it created an on ramp to innovate and an ability to review over historical period of time how different states chose to innovate. So it created a fostered way of a public private approach, such that every state got to design slightly different, using their own resources, what their particular programs could look like.

And then at a macro level, take those learnings over a view of several states and build in some flexibilities. In other words, potentially deregulate or potentially apply new expenditure authority or new dollars such that this could continue to work. So in other words, health care has to be local, but we don't have a system that allows for an extreme amount of local financial flexibility to reimburse new and different ways.

I'll give you another example. I'm in my 40s and I talked to people who believe that they don't need to go to the doctor, they need to go to CrossFit. And in their communities, that is the center of gravity for health care and wellness, but there is not financial flexibility right now for CrossFit to be your doctor.

We have to design a system that frankly works for the way everybody accesses their health care and wellness needs.

[00:20:15] Joy Rios: I love also that with the California Health Care Foundation, it sounds and seems like you're actually carrying out and carrying out some of the initiatives that have that were driven by CMMI.

Is that a fair statement to a degree? And maybe that's a huge stretch.  

[00:20:32] Vanessa Villaverde: It could be. I will fully acknowledge that I might be influencing that a little bit since I come from the CMMI world and then came in to the organization California Healthcare Foundation has a long legacy of working and supporting the diverse medical leaders throughout the state and has been around much longer than CMMI necessarily.

So the organization themselves, they work with academic researchers, policy makers, clinicians, medical schools throughout the state and through those deep plugged in relationships, I've been able to identify where there are gaps. and what kind of information needs to be shared ongoing. That said, we're very much in a time in which the organization is supportive of innovative ways to fill in gaps now.

California has amongst some of the worst provider shortages in the country, which means that while we are absolutely working on pipeline programs, upskilling programs, and working alongside some incredible community based organizations throughout the state. We are also finding innovative companies to fill in those gaps, and I look at them as supplemental or in tandem to all of our nonprofit work as well.

[00:21:45] Joy Rios: That's incredible. I think that they are really lucky to have you on board to be able to bridge those gaps and identify those gaps. It's really incredible. And I will share with any of our listeners that if you have an opportunity to binge listen to the podcast series that you guys have created that it essentially identifies all the many of the organizations that you've invested in.

It's called Making Waves in Health Tech and is available on all podcast distribution channels. Is there anything you'd like to share about that particular initiative? Because I binged it and loved it and was super inspired. And I'm just, all listeners should be hearing about it.

[00:22:28] Vanessa Villaverde: Yeah. A special thank you to Ilda Martinez and Janet Boakye for making that podcast along with the production team. And so it was really the vision of both of them to storytell around what it means for founders with lived experience to design companies that are innovative not only impactful to their communities, but navigating through the intense difficult policy and reimbursement environments that you have to navigate to work and serve the safety net population.

So I think that I'm increasingly learning that in order to make Healthcare speak translatable to everyone and equalize access to this kind of information. We have to tell it in simpler ways. And I know you and I can nerd out about policy, but the reality is everybody feels what it feels like when you have to decide between food and going to the doctor.

It's unaffordable, right? So how do you access care in ways that you need it when you need it in its simplest form? And the only way we can get this information out into the streets is storytelling. I'm super excited to see more podcasts focus on simplifying the story behind company building, particularly company building in healthcare.

There's lots of episodes on the podcast that I love. Some of my favorites are Hazel Josh talks about his son, Gabriel, and I also have a son, Gabriel. And we talk about how our kids, we saw them needing mental health services, particularly during the pandemic, and it never even dawned on me that having my child access services at school would ever be an option, but in the state of California, it is, and Hazel is doing incredible work across L.A. County.

There's lots of storytelling that is happening on that podcast that is both inspiring and hopefully can normalize this idea that impactful companies can also be venture backed. We do not only co invest with foundations or philanthropy. We co invest with companies that are also getting capital from private sector venture.

And that's because we see that if it works in California or if it works within a particular population, then it's scalable. And it's scalable across states and other zip codes. A great example is Care Academy. Helen from Care Academy. This is a program to upskill and certify the training of caregivers, largely because a policy changed here in California that required this mandated standardized training.

So her company was born. But guess what other states are figuring out that. Caregivers need to be part of the medical system and they also need to have standardized care. So she's been able to scale across the country and so I'm really excited for you guys to hear the podcast. It was a labor of love and you will hear the incredible voices of Ilda and Janet Bawachi who was our health equity fellow and is now doing great work at the California endowment.

[00:25:21] Joy Rios: You guys did a great job. I mean that from the bottom of my heart. And I, and because I'm just, I learned about the mental health care, the one that you're talking about, in Spanish language. And I'm just thinking about culturally of just like getting across the divide of having a lot of folks that are Spanish language, even being open to getting mental health care services, and then having the access of it to it within their their own language too. Of just how much power, how empowering that is and how powerful that is for not just an individual, but their families and their communities. And so it's really neat to have a little bit more understanding of the seeds that get planted and like what grows from that.

And so the ripple effect I love being able to see again. Conversation to myself, too, of just the tiniest action can have a really big difference. And so I'm grateful for all the work that you and the California Healthcare Foundation are doing. And I would like to ask you if people would like to get in touch, if they would like to have pitch or have them.

You guys consider their organizations to invest in or if somebody just wants to send you a nice thank you email, how would you recommend that they get in touch with you?

[00:26:33] Vanessa Villaverde: So in terms of how to get in touch with me, I welcome emails at vvillaverde@chcf. org. I also recommend that you sign up for the California Healthcare Foundation blogs.

We send out information about the companies that we invest in real time so that you know where we are investing. We are also actively creating front doors. In other words, if you need information on how to grow your company in California and particularly within the safety net, stay tuned this fall. We are creating a partnership with UCLA, Center of Price Entrepreneurship, and we are making this information available to everyone that wants to build, particularly in the LA County area.

So I'm really excited about the upcoming ways in which you can not only engage with me and the organization, but also serving the safety net and in the state of California.

[00:27:25] Joy Rios: Love it. Vanessa, thank you so much for your time today. Thank you for sharing your expertise with our audience and it's just been such a pleasure having this conversation.

[00:27:33] Vanessa Villaverde: Thank you, Joy.

[00:27:35] Joy Rios: Thanks for listening. You can learn more about us or this guest by going to our website or visiting us on any of the socials with the handle HIT Like a Girl pod. Thanks again. See you soon.

Again, thank you so much for listening to the HIT Like a Girl podcast. I am truly grateful for you, and I'm wondering if you could do me a quick favor. Would you be willing to follow or subscribe to this podcast or maybe leave us a rating or review? Or if you're feeling extra generous, would you share this episode on your Instagram stories or with a friend?

All those things help us podcasters out so much. I'm the show's host, Joy Rios, and I'll see you next time.

I'm the show's host, Joy Rios, and I'll see you next time.