Sunday, May 10, 2020

THE FIRST STEP… Beyond the Pandemic





Timidly, humans begin to look out toward the streets. The most terrible days of the fear, tribulation, anguish, and mourning wrought by the COVID-19 pandemic caused by the coronavirus appear to be behind us. As I write this article, the "official" global figures count almost 3.5 million people infected—suffering in the most absolute solitude, a million more who have recovered, and 250,000 who died alone, anonymous, without mourners or the rites of funerals.

All humanity has lived through an unusual and unprecedented situation of closing ourselves in, compulsory seclusion, confinement on a global level, quarantine, and social isolation—the most effective remedy to prevent contagion, to preserve and care for the invaluable gifts of health and life.

This is, without a doubt, the largest health crisis of our time, which overturned all our daily routines and "normality" and tore down all our certainties, security, and traditions. This crisis created a suspicion among us, shook our ideas of solidarity and brotherhood, and of being together, close to each other, and produced a still incalculable global economic slowdown, which is manifesting—first and foremost—in the terrifying number of unemployed people.

No one doubts that this pandemic is a milestone in the history of humanity and a turning point for our way of life, of being and living on this earth. During these days, we all wonder how to get back to what is being called the “new normal.” And although humanity has experienced earlier plagues and pandemics, this pandemic is the one during which we happen to be living. It is about this pandemic that I share here some brief reflections that, being realistic, positive, and hopeful, I hope to mitigate the exaggerated optimism that says that—following the pandemic—the world will be “new,” “distinct,” and radically “different” from what we have known, as if by some magic, the virus will turn us into better human beings and cast away the fatalistic pessimism of those proclaiming disaster, chaos, catastrophe, and death.

First of all, let me summarize—in addition to what I already mentioned above—other realizations and lessons that the pandemic leaves us. Suddenly, we are discovering the uselessness of the thousands of things that we had considered important and the usefulness of those that count: a life with meaning, with direction, with values… because the pandemic makes us confront the reality that nothing else matters when we do not have health or life.

Likewise, the pandemic teaches us that there is no economy or any other area of life in society if we do not have health and life, fundamental values of human existence. For the same reason, too, the pandemic suddenly and crudely revealed to us who is who in society. Who is socially useful and who is useless: because today a hospital’s stretcher-bearer or a restaurant’s delivery driver is more important to society than a soccer player, movie star, or a shoddy, chattering politician to whom we give such worship and platitudes. … Suddenly, health personnel and science professionals—to whom we give so little and no social recognition—were on the front lines of society in the fight against the pandemic.

We also learned about the planetary and ecumenical condition of human beings: that we are deeply and universally together in good and in evil. Quite literally, when someone sneezes in China, there is a fever at the other end of the earth. And, for the same reason, nothing that interests one human being can be alien to the rest of humanity or leave them indifferent. As Pope Francis has continually said, during these days, “no one is saved alone.” We all share the same “common house.”

We learned that although goodness and altruism have not disappeared and have manifested themselves these days in a thousand initiatives of solidarity with the most vulnerable in society, they coexist with the forms of unconsciousness, selfishness, corruption, and evil manifested these days, especially in the lack of cooperation and carelessness in not protecting others against infection, and in the theft of government aid meant for the poorest among us.

Politically speaking, if there was anything that exposed this health crisis, it was the insufficiency and shortcomings of the much-publicized "globalization" and of governmental institutions to face it. Society has tried to solve a global problem with local measures. Large cracks and structural flaws have been discovered within societies, exposing failures through which thousands of forms of structural inequity and injustice cannot go on.

We are also aware of a total absence of world leadership. The United States lost the opportunity to exercise it and those of us who dreamed of a new multilateral world order suddenly woke up, literally “distraught,” without a north, aimless, disoriented. ...

All this gives rise to the danger that—under the pretext of the pandemic— abusers in certain regimes and governments will, in turn, take advantage of collective fears to trample and violate human rights, and civil and individual liberties, by implementing—for example—emergency rule, curfews, states of emergency to legislate, greater police and military intervention to contain the population on the streets, etc. This is a danger that would, unfortunately, lead to new forms of autocracies, authoritarianism, populism, totalitarianism, dictatorships, protectionism, isolationism, nationalism, and xenophobia, which would revert achievements and successes we have already attained in societal life and our democracy.

Curiously and painfully too, society experienced this pandemic largely without the spiritual company of religious institutions. In societies already openly atheistic in relationships and social structures, each human being has had to solve alone—in personal and intimate confinement—the most distressing and fundamental questions about the meaning of life and the proximity of death and what lies beyond.

But this is not the end of human life on earth, nor can it be the end of trust, solidarity, and hope. This crisis must give us all a new and different attitude towards life and others. This crisis may represent an opportunity for the governments of the world to apply new paradigms in all fields of societal life: family, health, education, work, housing, public services, etc. ... This immeasurable crisis is a unique opportunity to adjust human and social values, to right the road. ... Now is not just for beating the virus, but also for overcoming our vain and arrogant failures—both human and global—that have been laid bare by the pandemic.

This crisis urges us all toward new forms of international cooperation and less harmful and healthier forms of globalized solidarity for all so that we can deal with present and future crises such as hunger, wars, climate change, etc. … all themes that involve the entire human family.

From the pandemic, we learn that the health-economy tradeoff is false. That, from now on, the public good requires that the economy be placed at the service of our collective health. ... How we solve and manage the lessons that this pandemic leaves us will depend—in large part—on the near-term future of humanity. The virus will not end economic inequality, nor will it end the animosity between leaders and the led. The virus will not miraculously work a mutation into the human spirit. Yes, from now on, fraternal solidarity, equal opportunities, honest work, and trust—without fear or anguish—in ourselves, in others, and in our institutions will save us.

May we have a vaccine soon! May the joy of life return! May the next pandemic be that of solidarity and fraternal love! “Light is the task where many share the toil,” said Homer. And “a journey of a thousand miles begins with the first step,” said Lao-Tse. Well ... Let's take the first step!

Thursday, May 7, 2020

SOMOS INNOVATION—the post-DSRIP future






As our city, our state, our nation and our world are struggling with the coronavirus pandemic, I first of all want to express my gratitude and admiration for your work on the frontlines of caring for coronavirus victims and protecting New Yorkers across the board. May you and your staff stay safe—and know you have the support of the entire SOMOS organization.

As you know, the DSRIP program formally concluded on March 31, 2020. It is a great disappointment that federal and state authorities opted not to renew the program’s mandate despite DSRIP’s many achievements. However, SOMOS will continue it groundbreaking work on behalf of the city’s poorest patients through SOMOS INNOVATE. It’s with an eye on that new chapter that I have drafted these notes.

The following draws on the recommendations and observations found in a report produced by the Helgerson Solutions Group (HSG), which earlier this year completed a strategic audit of SOMOS, precisely to map out its post-DSRIP future. HSG’s founder and principal is Jason Helgerson, the former New York State Department of Health Medicaid director and visionary behind DSRIP. He and this team know the health-care landscape intimately. It is a landscape being radically transformed by the Value-Based Payment (VBP) model and SOMOS INNOVATE will be our doctors’ guide and advocate.

As such, the HSG report proclaims that SOMOS INNOVATE is “about more than just being a VBP innovator. … SOMOS has the potential to revolutionize health and social care … and being a light in the wilderness for physicians and physician groups around the country.” As pioneered by DSRIP, the VBP model, a move away from the traditional Medicaid  fee-for-service payment formula, allows networks of independent physicians to bypass hospital systems and “contract directly with insurers (or the government) and take control of the total health care dollar and the flexibility those payment models offer to revolutionize care.”  With SOMOS INNOVATE at their side, our doctors can continue “to rise up and take control of their own destiny.”

SOMOS INNOVATE will continue the transformation of health care for New York City’s most vulnerable patients by continuing to “institutionalize cultural competence, empower patients and address the true root causes of bad health and social outcomes.” The fact that so many of our doctors share the same cultural background as the people they serve makes for “an exceptional closeness to their patient base, something that is very hard to achieve and harder to replicate by other organizations.”




To strengthen its clout and grow our network of providers, SOMOS INNOVATE will aim to engage other IPAs. It will also put a premium on partnerships with Community-Based Organizations to address Social Determinants of Health, a critical component in providing patients with comprehensive, wholistic care. Such care has the power to improve “community happiness” by “fully embrac[ing] the health, social and economic needs of the community.” It’s a model of care that revolves around the neighborhood-based primary care physician as trusted community leader.

To stave off competition, SOMOS INNOVATE will consider establishing “creative partnerships” with hospitals which might otherwise make access to specialty care more difficult. It will also pursue VBP contracts with Managed Care Organizations that would welcome SOMOS INNOVATION as a hospital competitor.

SOMOS INNOVATION has been operational for some time and continues to implement a rapid development strategy. The SOMOS Board of Directors appointed 20-year health-care industry veteran Dan McCarthy as CEO of SOMOS INNOVATION. An expert in value-based care, Dan has spent the bulk of the past year building up the organization and putting in place his management team.

The time is now, says the HSG report: “SOMOS is on the right side of health-care history. After years of delay, the health-care world is finally starting up really embrace value. New York State and Medicare are continuing their push to get virtually all providers into the VBP arrangement.” The goal is to position SOMOS INNOVATION on the forefront of publicly funded health-care innovation, state-wide and even nationally.

Achieving that objective will be critical if SOMOS INNOVATION is to succeed in enabling its doctors to remain competitive in a time of rapid change and in the face of the potential challenge of the Big Four—Apple, Google, Amazon and Microsoft—entering the arena of “technological innovation that will revolutionize the provision of many health-care services over the next decade,” stresses HSG.

In the form of robotics and Artificial Intelligence, “technology may replace as much as 80 percent of what doctors currently do and SOMOS will need to stay ahead of that curve on their physicians’ behalf.” A premium must be put on building “productive partnerships between doctors and machines.” Increasingly sophisticated technology will free up doctors from “routine tasks so that they can re-focus their time and attention to supporting their patients psychologically and helping them understand—as well as act upon—their medical condition.” Surely, this increasingly intimate attention paid to patients will be essential for delivering optimal value-based care.





Among the technological tools of the future will be smartphone apps that allow for 24/7 monitoring of patients. There will be sharp growth in the kinds of “wearable technology, biometric sensors as well as apps,” all working in sync to create an “Internet of the body.” “Doctors in the future will prescribe apps” allowing for patients’ self-diagnosis. Overall, technology will drive a “long-term shift from managing sickness to preventing it.”

The report says that in future, doctors may well be “dispensing their advice through chatbots, instant messaging and video calls instead of sitting in an office with a line of patients to see them.” Noting that SOMOS doctors “already excel at some of the inter-relational aspects of the job by virtue of being in, and of, the community in which they serve,” they will need training in acquiring a “new basket of skills” “to make the pivot to a more interpretative and context-providing role on its own.”

HSG notes that telemedicine, remote patient care, will have a $130B market share by 2025; and “the healthcare artificial intelligence market is projected to reach $19B by 2026.” All that innovation means that “the future of medicine will be more precise, personalized, participatory and preventive. These attributes align perfectly with SOMOS’ existing values.”

Indeed, helping and training our doctors “plan and prepare for the technological disrup4tions of the future” will be a hallmark of SOMOS INNOVATION. It is part and parcel of its overall commitment to empower our providers to offer the best possible care to New York City’s most vulnerable patients, and to bring about lasting reform of publicly funded health-care delivery.