Transforming Healthcare: Lessons from the Front Lines

How former caregivers are helping revolutionize their former professions

COVID-19 marked the beginning of an era that put enormous strain on staff supporting the pandemic response. The good news is Dr. Anthony Fauci announced that we are finally emerging from the pandemic phase of the COVID crisis as hospitalizations and infections remain consistently low. After more than two years of meeting the challenge day in and day out, healthcare professionals deserve our appreciation during National Hospital Week more than ever.

?I’m honored to work alongside professionals leading the field in creating better and more efficient healthcare. Every day I see breakthroughs, from expanding access to treatment for Medicaid members to implementing new collaborative clinical models. Our team is finding solutions to today’s most urgent challenges. Many of our colleagues have special insight into the challenges faced on the front lines of clinics and hospitals, having worked there themselves. I recently had the privilege of speaking to a few of them to try and get a view into their world. I’m inspired by their work; and I hope after reading their stories, you’ll recognize a healthcare worker making a difference in your life.

?Crushing barriers to care in the mountains??

When Lisa Angelos, Pharm.D., joined our team last March, we gained the unique perspective of a seasoned pharmacist with firsthand knowledge of challenges Medicaid members face when seeking treatment. She told me how her experience as a pharmacist informs her work to minimize care gaps among the Medicaid populations in the West. “I work with the Utah Medicaid team, helping provide care to the Medicaid population here.

We provide support for prior authorizations, ensuring accessibility and?provide?software as a service.?There have been a lot of changes we've had to make in regard to COVID, since circumstances are in a constant state of flux. Some of the current projects I’m most proud of involve addressing the care gap among the large numbers of uninsured people in Utah. Both the governor and local Medicaid team are committed to making sure this population is able to receive COVID-19 testing, vaccines, visits with providers as needed, and new-to-market antiviral medications,” Lisa explained.?

?Lisa’s work comprises a main part of Change Healthcare's mission. We prioritize ongoing modernization of systems and services to support changing needs in real time. Today’s society and healthcare marketplace depend on an ability to pivot seamlessly. We take great pride in anticipating trends and responding with innovative solutions. New studies continue to confirm the pandemic’s disproportionate harm to economically vulnerable and minority communities. We are responding to this need by connecting Medicaid members and the uninsured to lifesaving care.?

?Breaking in to get healthcare?

Miriam Burnett, M.D., has seen a lot in her years serving communities as a physician, medical director, and professor. While working as the medical director of a county jail in Atlanta, Miriam witnessed a shocking phenomenon that changed the trajectory of her career. Former and first-time inmates were cycling in and out of the prison system voluntarily. Incarceration offered shelter and healthcare access, neither of which could be found on the street. Recalling the moment, Miriam said, “These were people in such desperation; throwing bricks into windows, waiting for the police to come get them so that they could go to jail and be able to see doctors. Determined to find a solution to the urgent need for medical services among underserved metro-Atlanta residents,?Miriam?took matters into her own hands. Recruiting several other primary care doctors as partners,?Miriam?and colleagues began seeing needy patients for free. Later the colleagues, after securing support from a hospital to supply ancillary needs, opened a free clinic in a neighboring town.

?After 22 years directing care at both the county jail and the internal medicine practice where she saw her own hospital patients, Miriam relocated from Georgia to Pennsylvania for a new position. Leveraging her solution-based work style as senior medical director for appeals, Miriam oversaw a restructuring of siloed Medicare, Medicaid, and commercial insurance departments into a single bucket. “It allowed us to streamline efficiency so that?the?nearly 60?doctors?reporting to me were able to cross back and forth between the three systems. We had better coverage and better utilization of our workforce than ever before”. Miriam now serves as Change Healthcare’s senior medical director for payment accuracy. Outside of work, she plays an active role in volunteer?activities focused on increasing care equity.?

Miriam’s work breaking down barriers between healthcare professionals who work in the same space from disconnected buckets syncs perfectly with our mission to accelerate transformation in U.S. healthcare. Our platform exists to eliminate inefficiency rooted in inefficient communication between providers, payers, and consumers.

?Staying current with medicine

Jeff Barkin, M.D., is someone who takes common sense solutions to structural problems and applies them in real life. As a practicing psychiatrist, Jeff saw a need for increased cooperation between neurologists and psychiatrists, two disciplines that often overlap but are rarely co-housed. Reflecting on the path that led Jeff to his role as associate chief medical officer of pharmacy benefits solutions at Change Healthcare, he comments: “I worked in a neurology group and brought psychiatry to that group in the early 2000s as it was becoming clear that a ‘disease factory model’ made sense. A lot of neurology patients had psychiatric problems and a lot of psychiatric problems overlapped with neurologic problems, so I established a center and brought other psychiatrists on board. Around that time, I was having difficulty gaining access for Medicaid patients to certain medications. Over the years, I really began to appreciate the evaluation of treatments. And now with my role at Change Healthcare, we evaluate the efficacy of a certain medication. It’s an exciting time to be doing this work because medications are undergoing radical changes: we're seeing a number of new, innovative treatments. I also have a clinical practice where I treat patients with psychiatric problems across a range of diagnoses. By practicing medicine, I never lose that firsthand understanding of the difficulties that doctors and their patients undergo.”

Like Jeff, our team often maintains their private practices or serve through volunteer or board positions at hospitals and NGOs. This ongoing engagement keeps us up to date and in the loop, a critical condition for implementing solution-specific reform.?

?Perspective as a physician

Laureen Biczak, D.O., started her healthcare career in Portland, Maine, as an Infectious Disease specialist. As an osteopathic physician, she provided primary care as well as infectious disease services to patients practice for eight years, and also served in various roles throughout the hospital, including being a member of the Library Committee, chairing the Infection Control Committee, and being elected to Senior clinical positions including the Chief of the Department of Medicine and Chief of Staff. She also served on the Pharmacy and Therapeutics Committee of her local hospital as well as the state-wide Maine Medicaid Drug Utilization Review Board. ?Her part time clinical practice of infectious disease continues to this day.

Her time connecting the dots in pharmacy and therapeutics led to a career as Medical Director for Maine Medicaid, where she went from serving hundreds of patients per month to guiding care at the population scale. That work led to Laureen joining Change Healthcare, where she could grow that reach even further negotiating and making drug recommendations on behalf of multiple states for the good of their Medicaid patients.

Ultimately, Laureen said her background in the clinical setting gave her the perspective on how Medicaid and drugs are distributed and utilized, and now that helps her with getting patients what they need in the end. “That's what our jobs are about, being good stewards of the healthcare dollars that are available and making sure those dollars are used wisely to serve the Medicaid patients that rely on them. So that's why I love coming to work every day.”

Celebrating changemakers

I enjoy working alongside leaders who are connected with the state of play in their respective areas of expertise. Happy Hospital Week, everyone. Don’t forget to thank the caregivers and innovators building a better future for every single one of us.