Partner Spotlight with Dr. Andrey Ostrovsky
Health equity is a fundamental goal of healthcare policy, and achieving it requires significant policy changes that address the underlying social determinants of health. In this interview, and our first Agile Six Partner Spotlight, we talk with Dr. Andrey Ostrovsky, a physician and healthcare policy expert who formerly served as Chief Medical Officer of the U.S Medicaid program. Andrey shares insights from his partnership with Agile Six and the American Board of Family Medicine Foundation on payment and social risk factors in healthcare. He explains how the workshops they conducted have led to actionable policy changes at various levels. Join us as we explore the path from workshops to policy change and the evolving landscape of healthcare equity.
Meet Andrey Ostrovsky, M.D.
A little bit about myself: I'm a pediatrician. I practice medicine two Fridays a month, just enough to get my fill, before returning to work on system issues. I am the managing partner of Social Innovation Ventures, where I invest in diverse founders trying to close health equity gaps. I also find time to work with good friends like Dan Levenson with Agile Six. He and I worked together back at CMS, and we've continued our work together since leaving CMS, focusing on similar issues from the outside and helping our friends at the federal government continue the good work they're doing.
Tell us about the partnership with the American Board of Family Medicine Foundation and Agile Six.
A: I feel very fortunate to be connected with such amazing people who are trying to make a positive impact in the United States. Specifically, I had the pleasure of meeting Dr. Bob Phillips and Dr. Andrew Bazmore from the American Board of Family Medicine Foundation, who were working on innovative ways to measure social risk. They developed the Social Deprivation Index, which uses publicly available data such as census tract data, to map out and quantify how socially compromised a particular neighborhood may be.
As we discussed their work, we began to consider the idea of incorporating social complexity into the way healthcare is reimbursed in the United States. We wanted to operationalize the concept of social determinants of health and actually allocate funds towards addressing social risk factors. We spoke with friends in the government, including those at CMS, and found a real interest in pursuing this idea. Our government friends couldn't convene and run this initiative, so they asked if we could do it.
I reached out to Agile Six for help, and they graciously agreed. Together, we facilitated two workshops in 2022 – one focused on Medicare Advantage and the other on Managed Medicaid. We invited impactful leaders from across the United States, at a national and state level, including consumers and providers, to participate in service design workshops. The result was a template for how we might be able to actually pull this off.
Who participated in the workshops?
A. We wanted to ensure that all interested parties were represented in the workshop, including patients, consumers, and beneficiaries. We had consumer advocacy groups and actual consumers of healthcare present. We also had a range of healthcare providers, including physicians, PAs, NPs, and community-based organizations. Insurance carriers were also present, with chief clinical officers from four of the largest health insurers in the country participating. Additionally, we had payer representatives from more regional and nonprofit plans to ensure a wide range of representation in the payer space.
Our government friends, including those from CMS, AHRQ, and ASPE, were also present as they play a critical role in setting policy and overseeing insurance carriers. To keep the size of these groups manageable and ensure a trusted environment, we capped each workshop at 20 people. The workshops were intimate, and everyone was on a first-name basis. We applied the Chatham House rule, meaning no comments were attributable to any one person.
During the workshop, we had professional facilitation from Agile Six, which was crucial to the success of the event. The day was hands-on, with participants designing, drawing, creating, and iterating, while also providing feedback to one another. The result of this collaboration was quite special, and we even had a paper published in Health Affairs, which is the most prestigious journal in the country.
Takeaways from the workshop addressing social determinants of health.
Incorporating social risk factors into payment: The group concluded that incorporating social risk factors into payment is crucial, and it should be done using a combination of individual and community variables.
The ethical issue of collecting data without taking action: Patients shared their personal experiences of filling out surveys about social risk factors only to have nothing done with the information they provided. This was a wake-up call for clinicians, policymakers, and insurance companies to not only collect data but also take action and close the gap in social needs.
Equipping medical providers to address social risk factors: Most medical providers are not equipped to address social risk factors and almost none are paid adequately to do so. Non-clinical providers or care team members, such as barbershops, may be more trusted and better equipped to address social needs, but there is a significant gap in infrastructure building that needs to be filled.
Empathy building through co-creation: The process of designing solutions for addressing social risk factors involved empathy building and co-creation among providers, payers, and government officials. This allowed for more honest and productive discussions, rather than hiding for fear of an audit.
Professional facilitation created a safe space for honest and productive discussions among stakeholders, leading to actionable solutions
Overall, to be able to get to the vision or the North Star of not only paying for and addressing medical needs, but also paying for and addressing social needs.
Why do you think the workshops were so successful in getting everyone to open up and share their ideas and experiences?
A: Effective facilitation and guidance on setting expectations were key factors that contributed to the success of the workshops. The organizers received guidance from Agile Six and their partners on how to invite people to the workshop and create an open and collaborative environment. They also created a friendly atmosphere where people felt comfortable sharing vulnerable information without fear of retribution. The facilitators modeled behavior that encouraged contribution from everyone, including regulators, insurance companies, providers, and consumers. The follow-up process was also important to keep everyone engaged and ensure that feedback was captured accurately, which led to the synthesis of artifacts that could be shared publicly and used to shape policy moving forward.
Were the people there the policymakers and changemakers?
A. They sure were. We had senior leadership from across the federal government and private sector, there were senior leaders with meaningful P&L responsibilities, policy decision-making authority, and green or red light responsibilities. There was enough representation from different geographies within the US, as well as from organizations that interact with different populations and subpopulations. Therefore, the authority and representativeness were present in the 20-person workshop as much as possible. The findings from these workshops have already started to make their way into policy, with an ASPE Report that changed the narrative on how they communicate about social risk factors and payment adjustment. This is a big deal and already shaping policy.
What surprised you the most about the findings from the workshop?
A. One surprising finding was the ethical issue of collecting social risk data without addressing patients' social needs. It's almost unethical to collect information around social risk factors from beneficiaries if you're not going to address those gaps.
Another surprising finding was the willingness among insurers to forego short-term profit gains and instead focus on the long-term sustainability of the healthcare system and what is best for the consumer. Community variables were seen as an important countermeasure to individual variables.
The workshop also drew a line in the sand on where healthcare dollars should be spent on addressing social determinants of health. Housing insecurity was discussed, and some clever ideas suggested using existing piping, such as HUD, to funnel those dollars instead of passing them through an insurance company, which could be inefficient.
Does this workshop stand out to you in any way compared to others you've done in the past?
A: The caliber of people who participated in these workshops was probably the most influential group I’ve helped to convene and facilitate. While it is still too early to see the long-term effects of the workshop, the ASPE report already references the work they have done. Additionally, colleagues across Medicare, Medicaid, and CMMI who participated in the workshop are starting to rethink and incorporate the findings into their approach to addressing social risk factors through payment. The workshop also resulted in a research paper being submitted for peer review, which found interesting associations between the social deprivation index and 30-day readmissions. These findings can be used as a quantitative policy instrument. Overall, there is a potential long tail of repercussions from these workshops that could lead to significant changes in policy and healthcare delivery.
What role can civic tech companies like Agile Six play in improving healthcare outcomes, particularly in addressing social determinants of health?
A: Companies like Agile Six can play a crucial role in driving change and improving healthcare outcomes by providing resources for change management, human-centered design, lean management, quality improvement, and digital transformation. These tools and techniques are essential for policymakers who have legislative or regulatory imperatives, but want to ensure that the fulfillment of their vision is done proactively, iteratively and co-designed with the end-users who will be impacted by the policy.
While the federal government is not equipped to have all these skill sets internally, partnering with external partners like Agile Six can bridge the gap and bring in the necessary expertise. With their deep knowledge of policy and core skill set around change management, digital transformation, and design, companies like Agile Six can help the government co-create policies that address social determinants of health while being responsive to the needs of the people they serve.
What are your thoughts about the importance of the government's role in addressing social determinants of health, and what do you envision as the future of healthcare policy in this area?
A. Social determinants of health should move from being a buzzword to being a core pillar of how dollar flows move through the healthcare system. It is important to tie it with behavior change so that healthcare providers address social risk factors just like they would address other health concerns. Patients should have access to the resources and tools to address social risk factors.
The federal and state governments need to adapt dollar flows to address social determinants of health. It is also important to humanize the technical aspects of policy redesign and payment redesign so that policymakers understand the impact on each user. The skills of design, digital transformation, and service design are important and impactful in this regard.
In the future, healthcare policy in this area will likely involve a more human-centered approach to address social determinants of health, with a focus on behavior change and access to resources. The government's role in addressing social determinants of health will continue to be crucial in weaving dollar flows and adapting policies to improve healthcare outcomes for all.
Tell us about the outcomes of the workshops.
A: The findings from the workshops were codified into a 19-page white paper, which detailed the methodology used to gather information and design the future state of payment and social risk factors. This white paper was then distilled into an academic work published in Health Affairs, a journal with broad reach among policymakers, providers, and payers. The findings have also impacted policy discussions across CMS and state Medicaid programs.
Unanswered Questions and Future Research
While the workshops yielded many insights, there are still unanswered questions that require further research. Arnold Ventures, CommonWell Fund, and all of our other funder friends, we have a great opportunity here to take this to the next stage of implementation. Who knows what else comes out of this work? That's why it's all publicly available. We want to be super transparent about it. If there are folks listening who are using the findings from these workshops, please let us know. Give me a shout. You can find me on LinkedIn or Twitter. Give Agile Six a shout or our friends at the American Board of Family Medicine Foundation.
How important is it to find the right partner?
I get approached all the time by government contractors. They want to use my name for this or my subject matter expertise for that. For me, it just comes down to brand alignment. If I'm going to put my name out there and my brand, especially discussing contentious topics or using my network to bring in influential people, I need to know that when I'm not looking, that partner is going to have the same value set as I have. Maybe that means foregoing the most profitable thing in the interest of doing the most correct thing, or maybe not even looking for an immediate growth opportunity, but rather knowing that there's a sense of paying it forward.
Also, simple brand recognition is that if you're creating value and doing good work, you're going to get business thrown your way eventually. Unfortunately, that's not common with contractors working with the government. Most contractors are very transactional, have growth goals, and if you're not achieving those growth goals, you have so-called difficult conversations. I credit Dan a lot with this. I'm always pushing Dan, like, 'Hey, how about this cool idea? What if we do this?' And he's like, 'No, we'll grow too fast.' I'm like, 'What are you saying? The investor in me always bristles at that. But he's right. It's not about growth for growth's sake. It's about finding work that's meaningful, not overloading a workforce that is working hard but also has a great work-life balance. It's just to create value, create value, create value, be human, and have a good time. If that's not the brand of whoever I'm working with or investing in, that's not worth it. I've worked hard to build my brand to where it is today.
Dr. Andrey Ostrovsky Shares His Final Thoughts
I think the one thing I would say is that there are currently a number of layoffs happening in the tech space, with companies like Google and Facebook letting people go. Perhaps this is a good time for talented tech professionals to consider applying their skills to improve government services and care for the most vulnerable populations, such as veterans and those in poverty or marginalized for other reasons. While I don't represent Agile Six, I suspect they are hiring.
If this spotlight piqued your interest in a career with Agile Six, explore our open roles.
Agile Six Partner Spotlight
This partnership between Dr. Andrey Ostrovsky, the American Board of Family Medicine Foundation, and Agile Six addresses social determinants of health and improving healthcare outcomes. It also highlights the importance of effective facilitation, collaboration, and human-centered design in policy-making and healthcare delivery.
Dr. Andrey Ostrovsky's contact information: LinkedIn Twitter
Arnold Ventures - https://www.arnoldventures.org/
Commonwealth Fund - https://www.commonwealthfund.org/
American Board of Family Medicine Foundation - https://www.theabfm.org/ABFM-Foundation
Disclaimer: This blog post is a summary of the interview with Dr. Andrey Ostrovsky. To access the full audio interview, please visit the top of this page.