Deena Shakir is an investor who is obsessed with expanding access to the basic health services people need and often can’t access: pediatric care, community health and women’s services. Her journey to investing passed through policymaking, journalism and big tech and her early techno optimism has given way to a much more nuanced and pragmatic view. She is able to see the big opportunities for impact hiding in plain sight.

We discuss:

• The two obvious megatrends hitting healthcare: GLP1s and AI
• And the not so obvious opportunity: doing basic things better
• How Dobbs was an accelerant, not a deterrent, for investments in women’s health
• Why Public Health is great training for healthcare founders

Deena is excited about “asset light” investments that combine new care models – like community health workers – and technology:

“There are some things that won't change. And there are things that hopefully tech can help to navigate. And so these asset light models, these models that are leveraging under leveraged care workers – like community health workers that are providing culturally competent care – and at the end of the day, that are improving metrics and outcomes, are the ones that get me excited.”

Relevant Links

Lux Capital

Jonathan Haidt article in The Atlantic titled “Why the past 10 years of American Life have been uniquely stupid”

President Obama’s Cairo speech

ARPA-H Sprint for Women’s Health

Health companies Deena mentions that she invests in:

Waymark

Summer health

Maven Clinic

About Our Guest

Deena's investments span stages and sectors, and include women's health, digital health infrastructure, health equity, foodtech, and fintech. Above all, she seeks out extraordinary, often underdog, founders on a mission. Prior to Lux, Deena was a Partner at GV (formerly Google Ventures), led product partnerships at Google for health, search, and AI/ML, and directed social impact investments at Google.org. Deena also served as a Presidential Management Fellow at The U.S. Department of State under Secretary Clinton, where she helped launch President Obama’s first Global Entrepreneurship...

Government systems often take a lot of flack for their (sometimes) built-in inability to take risks and make big bets. So, what would it take to encourage the government to take those big, risky moonshots? For Health, that’s the role of ARPA-H – to fund new ways of improving health by investing in people with big ideas. We sat down with ARPA-H Director Renee Wegrzyn at Aspen Ideas Health to talk about how it’s going and what comes next.

We discuss:

• Why ARPA-H is personal for President Biden.
• How ARPA-H’s special authorities – from flexible hiring to novel contracting – are its secret weapons for speed and scale.
• The critical role of Program Managers – single decision maker driving the vision and execution of each $50-$200 million initiative.

Renee says ARPA-H gives her the ability to direct funds into areas that are sometimes left off the list of “must haves” for innovation:

“...one of the only top down things I've done as a director is said, ‘Why aren't we funding more in women's health? We don't have any program managers in the pipeline that want to exclusively focus on this’. But I think we all inherently understand that women are underrepresented in almost every aspect of health. So I asked our [Program Managers].. who wants to raise [a] hand and pick a topic that is really either unique to women, or is disproportionately affecting women that we can do a sprint and invest around. And so I got six Program Managers to come up with topics, everything from Women's Health at home, to brain health, to understanding and quantifying pain – and through the Investor Catalyst Hub we have worked with investors to understand what kind of convincing scale do we need to get to for you to be the second investor. And we competed this across the country.”

Relevant Links

• About ARPA-H
• ARPA-H Health Equity Factsheet
• The Minor Consult Podcast Episode
• ARPA - H Timeline
• Youtube Conversation with New Yorker writer
• White House FAQ Sheet on ARPA-H

About Our Guest

Dr. Renee Wegrzyn is the first director of the Advanced Research Projects Agency for Health (ARPA-H), appointed by President Biden on October 11, 2022. Previously, she was the Vice President of Business Development at Ginkgo Bioworks and Head of Innovation at Concentric by Ginkgo, where she focused on synthetic biology for combating infectious diseases like COVID-19.

Wegrzyn has experience with DARPA and IARPA, the models for ARPA-H. At DARPA, she used synthetic biology and gene editing to enhance biosecurity and the bioeconomy, managing programs like Living Foundries, Safe Genes, PREPARE, and DIGET. She received the Superior Public Service Medal for her DARPA work. Her career includes leading biosecurity and gene therapy teams in private industry, developing immunoassays and diagnostics. Wegrzyn has served on various scientific advisory boards, including those for the National Academies and the Air Force Research Labs. She holds a Ph.D. and a bachelor's degree in applied biology from the Georgia Institute of Technology and completed...

The US is living through an affordable housing crisis - in fact, we are short millions and millions of affordable housing units. During the pandemic, homelessness flattened with an influx of resources to help keep people housed. But, those resources have long expired and now we are seeing an uptick in homelessness across the country. Jeff Olivet, the director of USICH (United States Interagency Council on Homelessness), says the problem is complex – but the math isn’t. We need more affordable housing.

We discuss:

• Biden’s proposed budget, which includes guaranteed vouchers for every low income veteran and person aging out of foster care
• The new frontier; pairing emergency response such as shelters with robust prevention strategies
• How prevention starts with helping families through periods of financial crisis
• What happens when heat crises turn deadly for people who are homeless

Jeff reminds us that the people affected most by the affordable housing crisis are those who have experienced trauma and domestic violence:

“50 years ago, we still had domestic violence, we still had addiction, we still had mental illness, and we didn't have perfect systems to address that – but we had enough housing for everybody, and we did not see homelessness on the scale we see it today. So when we're responding to homelessness, it's critical to individualize support for people to make sure they have access to the care they need in terms of health and mental health and recovery and all of those important things. But if we don't solve the underlying structural stuff, the lack of affordable housing, the ongoing discrimination that people of color and LGBTQ people face in jobs and trying to buy a home or rent a home in the criminal legal system, in education, if we don't solve that underlying stuff, we're gonna keep seeing homelessness for a very long time to come.”

Relevant Links

Jeff Olivet testimony to Congress on strategies to reduce Veteran homelessness

Federal actions to increase housing supply and lower housing costs

HUD-VASH vouchers to support homeless veterans

USICH guidance document for healthcare

Article about the SCOTUS ruling

About Our Guest

Jeff Olivet is the executive director of USICH. He has worked to prevent and end homelessness for more than 25 years as a street outreach worker, case manager, coalition builder, researcher, and trainer. He is the founder of jo consulting, co-founder of Racial Equity Partners, and from 2010 to 2018, he served as CEO of C4 Innovations. He has worked extensively in the areas of homelessness and housing, health and behavioral health, HIV, education, and organizational development. Jeff has been principal investigator on multiple research studies funded by private foundations and the National Institutes of Health. Jeff is deeply committed to...

California is the latest state to address healthcare affordability through cost growth targets. Elizabeth Mitchell – President and CEO of Purchaser Business Group on Health – Joins us to discuss the nuts and bolts of the 3% cost growth target recently adopted by the state. Healthcare affordability is a big issue across the country. More than half of us skip or postpone care due to cost and medical bills are a leading cause of bankruptcy. Reining in medical costs is also how we’ll free up resources for what we know works to build health in America: prevention, addressing the social drivers and fostering health in communities.

We discuss:

• Two proven strategies to reduce healthcare costs: advanced primary care and effective specialty referrals
• Why better consumer “shopping” is not the path to healthcare affordability
• How price transparency gives employers new tools to negotiate, and reveals troubling facts about purchasing intermediaries

Elizabeth reminds us how troubling it is that we don’t have clear prices in a sector that makes up 20% of the economy:

“The idea that you can't find out what something is going to cost before you agree to it is outrageous. Name any other industry that refuses to show you a price. It is incredible to me that we are still fighting about transparency when it is 20 % of the US economy. I mean, this is a multi-trillion-dollar industry who feels no accountability to show pricing. So, I just think it is incredible that we do not have meaningful transparency yet.”

Relevant Links

California’s Office of Health Care Affordability sets cost growth target

Federal hospital price transparency requirements

Purchaser Business Group on Health (PBGH) website

PBGH white paper on advanced primary care

US Department of Labor clarifies the fiduciary responsibilities of self-insured employers purchasing healthcare

About Our Guest

As President and CEO, Elizabeth Mitchell advances Purchaser Business Group on Health’s (PBGH’s) strategic focus areas of advanced primary care, functional markets and purchasing value. Mitchell leads PBGH in mobilizing health care purchasers, elevating the role and impact of primary care, and creating functional health care markets to support high-quality affordable care, achieving measurable impacts on outcomes and affordability.

At PBGH, Elizabeth leverages her extensive experience in working with health care purchasers, providers, policymakers and payers to improve health care quality and cost. She previously served as Senior Vice President for Healthcare and Community Health Transformation at Blue Shield of California, during which time she designed Blue Shield’s strategy for transforming practice, payment and community health. Mitchell also served as the President and CEO of the Network for Regional Healthcare Improvement (NRHI), a network...

The scope, scale and timeline of what California is trying to do with CalAIM is truly breathtaking. Two years after the launch of the ambitious program, which offers integrated medical and social care for California's 15 million Medicaid members, Dr. Palav Babaria joins us to discuss how it’s going and what comes next. Dr. Babaria is a primary care physician who leads quality and population health management for California’s Medicaid program, Medi-Cal.

We discuss:

• Which community supports are used most, or least?
• One of the big learnings from CalAIM: the enhanced care management models that work for adults dont work for children
• How Medi-Cal is leveraging health plans as the organizers of social care because that’s where the members are
• The soon-to-be-released population health management service will address two big issues: standardized and equitable approaches to identifying high risk members and integrating state level benefits data, like for WIC

Palav reminds us that CalAIM was built through listening:

“Not everyone may know this, but CalAIM was generated from a statewide listening tour. Our previous state Medicaid director went around the state and literally asked communities… rooms full of plans, members, providers, what do you need from Medi-Cal that isn't working today? [The] smorgasbord of recommendations is what turned into CalAIM … Listening to the community and responding to the community's needs is in the core DNA of this program.”

Relevant Links

• Listen to our related episode “Reflecting on Year One of CalAIM with Jacey Cooper”
• CalAIM dashboard
• Population health management policy guide
• California and other states require managed care plans to reinvest in local communities
• NY waiver summary

About Our Guest

Dr. Palav Babaria was appointed Chief Quality Officer and Deputy Director of Quality and Population Health Management of the California Department of Health Care Services beginning in March 2021. She was formerly the Chief Administrative Officer of Ambulatory Services at Alameda Health System. In that capacity, she operationally and clinically oversaw 26 specialty clinics, four large primary care FQHCs, specialty and integrated behavioral health, and is responsible for all outpatient value-based payment programs. Prior to that role, she served as Medical Director of K6 Adult Medicine Clinic. She also has over a decade of global health experience and her work has been published in the New England Journal of Medicine, Academic Medicine, Social Science & Medicine, L.A. Times, and New York Times. Her areas of interest include ambulatory transformation in resource-limited settings, shifting to value-based care, and issues of gender in medicine. Babaria received her bachelor’s from Harvard College, as well as her MD and Masters in Health Science from Yale...

To achieve whole person care, we can try layering new social services on top of medical care. But Dr. Rishi Manchanda believes we should move further upstream and ask, what will it take to actually improve health in communities? From founding Rx the Vote to HealthBegins, Rishi is committed to building community social capital in America.

We discuss:

• Why he created HealthBegins, which is now halfway to its goal of transforming equity in 250 communities by 2025
• How California is making practice transformation a foundation of whole person care
• Rx the Vote and the important role of health organizations in voter engagement
• Kaiser Permanente's health, housing and justice initiative

Rishi thinks all public health students should study and know how to shift the political determinants of health:

“I think we can recognize there's ways to… get the dollars out the door, get the services out the door, get the access that we need while [also building] local governance. And I think that's what I see as a really interesting opportunity for us in California… There are opportunities here for public health schools, including Berkeley, to [help] public health students… understand the political determinants of health and then understand their role [to]... address them and improve them.”

Relevant Links

HealthBegins website

Rishi’s book The Upstream Doctors

Rishi's TEDx Talk: "What Makes Us Get Sick? Look Upstream."

New collaborative community health planning model in California

Policy requiring California Medicaid health plans to invest 5-7.5% of profits into local communities

California Medicaid investments in practice transformation

Kaiser Permanente's health, housing and justice initiative

Oregon CCO model

An interview with Rishi Manchanda

About Our Guest

Dr. Manchanda is Founder and President of HealthBegins, a social enterprise that provides training, clinic redesign, and technology to transform health care and the social determinants of health. Dr. Manchanda is a dual board-certified internist and pediatrician, a board member of the National Physicians Alliance, and a fellow in the California Health Care Foundation’s Healthcare Leadership Program. He is the lead physician for homeless primary care at the VA in Los Angeles, where he has built clinics for...

June 18th is “Maya Petersen” day in San Francisco, in honor of her work building disease models that guided the region through the early days of COVID and saved countless lives.

With projects spanning from developing HIV prevention strategies in East Africa to shaping new Medicaid models in California, the UC Berkeley epidemiologist is building a future where local public health leaders have the tools and data to ask and answer complex policy decisions in real time. Now that’s a world I want to live in.

We discuss:

• How much better our pandemic response would have been if Public Health had access to integrated and linked data
• Her work to bring sophisticated data tools to the point of decision in East Africa
• How California is building population management infrastructure

San Francisco’s Director of Health, Grant Colfax, taught her an important lesson about showing up and helping:

“I remember… saying, ‘You know what? You really need to find somebody who's an expert in this, I'm not an expert in this.’ And he said, ‘Okay, Maya, but if you're gonna find me someone it needs to be in the next 24 hours, because I need help.’ And it was just a reminder that, you know, you're not always going to be an expert, sometimes you just need to show up, do your best… be clear about your uncertainty and communicate well, and that can be… a big service”

Relevant Links

Local Epidemic Modeling for the San Francisco Department of Public Health

San Francisco’s COVID strategy

Multi-sectorial Approach to HIV in East Africa

Maya Petersen Day in San Francisco

Maya’s UC Berkeley page

About Our Guest

Dr. Maya L. Petersen is Professor of Biostatistics and Epidemiology at the University of California, Berkeley. Dr. Petersen’s methodological research focuses on the development and application of novel causal inference methods to problems in health, with an emphasis on longitudinal data and adaptive treatment strategies (dynamic regimes), machine learning methods, adaptive designs, and study design and analytic strategies for cluster randomized trials. She is a Founding Editor of the Journal of Causal Inference and serves on the editorial board of Epidemiology. Her applied work focuses on developing and evaluating improved HIV prevention and care strategies. She currently serves as co-PI (with Dr. Diane Havlir and Dr. Moses Kamya) for the Sustainable East Africa Research in Community Health consortium, and as co-PI (with Dr. Elvin Geng) for the ADAPT-R study (a sequential multiple assignment randomized trial of behavioral interventions to optimize retention in HIV care).

Source: https://publichealth.berkeley.edu/people/maya-petersen

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For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email

If there’s one thing politicians do little of these days it’s change their minds. But, that’s exactly what North Carolina’s General Assembly did in 2023. Ten years after the ACA was passed, and in a historic bipartisan move, they changed their minds and voted to expand Medicaid. NC Secretary of Health & Human Services Kody Kinsley joined us to talk about what it took to get this done and how it’s been going so far.

We discuss:

• How to get stuff done in a politically divided state
• One move that would dramatically increase access to healthy food in America - automatically enroll all Medicaid beneficiaries in SNAP
• Why NC Medicaid has gone deep on peer to peer support for prenatal care and mental health
• The importance of building a better narrative about the role and value of public health

Kody points out NC’s strategy of investing in community organizations is creating both health and economic opportunities:

“75% of our community based organizations are minority or women owned throughout those 33 counties. So, this isn't just about getting good access to what drives health in the long run. This is also about building that infrastructure and having a financing model that sustains it that is in the balance, a good value for the taxpayer.”

Relevant Links

NC enrollment dashboard

Crisis warmline

Healthy Opportunities pilots

“NC Launches Additional Phone Support for People Experiencing Mental Illness or Substance Use Disorfer” [RELEASE]

About Our Guest

Kody Kinsley serves as North Carolina’s Secretary of Health & Human Services, overseeing a department with over 18,000 staff and a $38 billion budget. With experience centered on health policy and operations, Kinsley worked on digital healthcare transformation, national education and labor policies, and served as COO and CFO of the U.S. Treasury.

Secretary Kinsley’s three priorities for the department include: Investing in behavioral health and resilience, improving child and family well-being, and building a strong and inclusive workforce. Under his leadership, North Carolina expanded Medicaid and received the largest investment to bolster the mental health system in over a decade. Kinsley grew up in Wilmington, earning his bachelor’s degree from Brevard College and his master’s in Public Policy from the University of California at Berkeley.

Source: https://www.ncdhhs.gov/about/leadership/kody-kinsley

Connect With Us

For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email claudia@theother80.com and follow us on twitter @claudiawilliams...