Meet Lisa Fitzpatrick, MD

Gregg Masters  00:10  

This is PopHealth Week on HealthcareNOW Radio. Today's episode is sponsored by Health Innovation Media. We bring your brand messaging alive on the ground and now in the virtual space for major trade show conference innovation summits and webinars via our signature pop up studio connect with us at www.popupstudio.productions. I'm Gregg Masters Managing Director of Health Innovation Media, publisher of ACOwatch.com and your  PopHealth Week co -host with my partner co-founder Fred Goldstein, President of Accountable Health LLC, a Jacksonville, Florida based consulting firm. Our guest on today's show is Dr. Lisa Fitzpatrick, the founder and CEO of Grapevine Health. Grapevine Health's mission is to be on the ground, bridging health communications and demystifying health care for the community, deploying videos, storytelling and collaborative conversations between community and health experts. Grapevine Health improves health literacy and patient engagement. Dr. Fitzpatrick aka Dr. Lisa is a medical doctor who has worked at the Centers for Disease Control and Prevention. Her career has spanned research, clinical medicine, global health, community health education, and patient advocacy. Dr. Lisa recently served as the medical director for Washington DC's Medicaid program. She is also a clinical professor and professorial lecturer for the George Washington University School of Medicine and the Milken Institute School of Public Health. As a member of the Aspen Institute Global Leadership Network. She was selected as a 2017 Aspen Institute Health Innovator Fellow, Dr. Lisa has a Master's in Public Health from the University of California School of Public Health, and Master's in Public Administration from the Harvard Kennedy School of Government. So Fred, over to you help us get to know what Dr. Lisa and her colleagues are doing on the ground with Grapevine Health.

Fred Goldstein  02:13  

Thank you very much, Greg. And Lisa, welcome to PopHealth Week.

Lisa Fitzpatrick  02:17  

Thanks very much. It's nice to be here.

Fred Goldstein  02:19  

Yeah, it's a pleasure to have you, Dr. Fitzpatrick. And perhaps we could start as we typically do in the show, give us a little bit of your background and the work you're doing.

Lisa Fitzpatrick  02:26  

Sure. I'm an infectious disease doctor who trained in public health at the CDC, althoughmy career has traversed clinical medicine, academic research, I do a lot of community health advocacy, including health education. And most recently, I was the chief medical officer at DC Medicaid. But I left all that behind to start a company called Grapevine Health, because I think we have a problem with having trusted messengers and community. And because of low health literacy and lack of trust, people don't know where to turn for valid health information. And as a result, they the health outcomes are not great, especially in the communities, I'm working in, underserved communities. So it's been a really interesting ride. And we'll see what's next.

Fred Goldstein  03:18  

Yeah, and obviously, health literacy is a critical area is something we've talked about often on the show, and major difficulties in the United States, getting people up to the appropriate health literacy or bringing the providers and health care system down to an appropriate level. So what sort of services do you provide? 

Lisa Fitzpatrick  03:33  

Well, we're just starting, so it's a new company. But we hope to provide tailored health information, videos or health information content to Medicaid programs. Information that they can push out to their members digitally, to see if we can improve engagement, nudge people toward health behaviors, and help them understand how to navigate the healthcare system. So for instance, if a health plan is concerned about people with diabetes, who have frequent admission to the hospital, we can create video content that focuses on information about diabetes. So what's unique about our approaches, we want to incorporate the community member in the video. So it won't be typical content, you might see didactics or people giving information or lectures from doctors or subject matter experts. We want to demonstrate the knowledge already in the community and use that as a hook to further engage people in conversations about health.

Fred Goldstein  04:38  

There's a big question I know you've written about I was reading some of the blog posts on your site in regards to technology in the community. And there's really been this belief that the technology isn't there and oftentimes it hasn't gotten there. But in fact, there is quite a bit of technology you can leverage in the community, isn't there? 

Lisa Fitzpatrick  04:53  

Absolutely. One of our first research studies, I was assessing the availability or the prevalence of cell phone ownership among Medicaid patients and people in underserved communities and 99% of the people we spoke to had a smartphone, including people who are homeless. And I think this is because a lot of the health insurance companies and so social service organizations provide these cell phones to people, because for a lot of us, it's just nice to have a cell phone. But for the folks we work with, it's imperative because it's their lifeline. And this is the reason we're seeing such high prevalence of cell phone ownership. In addition, a lot of innovation is happening in the digital health space, but it's not focused on underserved populations. So that's an area we are very interested in bridging the gap so that people who are traditionally underserved also have access to digital health solutions.

Fred Goldstein  05:55  

And I know back in the day, when I was doing some high risk maternity programs in the Mississippi Delta, we heard very quickly from the young mothers to our community base staff, don't call, me text me, that's how I interact and prefer to interact. And so I know there's been a lot of growth in that, is that what you're looking at sort of a multi channel platform to reach the community?

Lisa Fitzpatrick  06:18  

So absolutely. But I think the the least common tech denominator is texting. And we want to start there. In fact, we already have, we have a Google number that we give to people who come to our events in the community and tell them you can use this number, if you have a question. So for example, if you went to the emergency department, and they gave you information, but you didn't really understand what they said, or what you have, or what you know what health condition they diagnosed you with, you can send us a text message and we can help you navigate for the Medicaid population. But texting absolutely, everybody's texting, and they don't like to download apps as much as you would think.

Fred Goldstein  06:58  

Right? That's, that's fascinating. And who's sort of who do you have on the back side? Obviously, you're a physician, well trained, you've got an MPH from Berkeley and public health and a master's in public administration from Harvard. Who else do you have helping to provide you obviously, you can't do all this by yourself to build this out?

Lisa Fitzpatrick  07:16  No, absolutely not. So I actually have a co-founder, his name is Dr. Neil Sikka, and he's on faculty at the George Washington University. And he's a emergency room physician, but he also is the head of their innovation and transformation department there in the emergency department. And he's very interested in digital solutions and improving digital literacy. And had launched a program called the Help Desk and what they do there, they're also they were also doing a lot of community outreach, and realizing that people would be really interested in engaging with digital health solutions, but they weren't as proficient as some with using the phone. And because of their technical assistance, that we're providing people on the spot, they learn, we need to create strategies to provide support for our underserved population. So we thought it'd be a great idea to work together on this. We also have someone who runs all of the outreach events. And outreach is really a critical component for us. Because trust, our currency is trust, I think there's so much health information out there. People need to know where their trusted sources are. And so we do that by being out in the community where people are. So having someone in charge of outreach is critical for us. And then we also work with interns right now a lot because interns provide a lot of technical capacity, because we are at the beginning stages of this and are looking for funding to find full time staff members. So it's really a work in progress. So we have what we also have a very supportive advisory board with a lot of skill sets. We have a lawyer on our board, healthcare strategists, we have a couple of tech people. So we're slowly building but you're right, it's, it takes a village.

Fred Goldstein  09:11  

It really does. And I've seen some of your unique videos you've done an education and some of the pictures of the work in the community. I think it's fascinating You know, you're taking out the these models, organs, etc. On some of the pictures and talking to community about it. How has that been received as you do things like that?

Lisa Fitzpatrick  09:26  

You know, people love that, we've we've beta tested those videos with community members just to obtain feedback and get their reactions to it. And people are asking for more. So this is the video production, including Dr. Lisa on the Street will be an integral part of the work we do not just for the health plans, but for other organizations. We're looking to partner with the organ models. They're really inviting. They invite people in and everyone has a body and we often don't think About our organs so when when people see we have this organ model out in the community, it immediately draws them in. And we can start, you know, it's the gateway to lots of conversations. It also puts people at ease. We laugh a lot when we talk about the organ's, and I think it helps us build trust by having that visual for people, we also have a skeleton, people like to, you know, look at the skeleton and say, Oh, that's where my elbow is. So I think what's unique about that approach, or the approach we use with the on the street and the visuals and the hands on, and it's something that people don't see very often, there's so much health information, but it's hard for people to consume it when it's a newsletter, or a pamphlet or a website. But you make it real for people when you're out in the community with them, helping them to identify, oh, look, that's your liver, or that's your heart. So and it's also a lot of fun for us.

Fred Goldstein  11:02  

Yeah, I think that's fascinating. And the pictures were great. You know, it really shows these people like you said, they're laughing, they're having fun they're smiling is it isn't holding them up. And I also I know you were at the CDC as well. And it was interesting we did a couple years ago, we did a show similar to this with some folks on health literacy. It was actually a webinar and we we had somebody from the CDC. And they said, similar to what you said, obviously, that we've known for 30 years that handing out pamphlets doesn't work, but we still do it. And you're taking this newer approach, and getting some really unique responses and results. And I like the fact that you've mixed this technology approach with being in the community, because I think oftentimes we forget in population health, that a lot can be accomplished by a local individual down in the street, who lives there and knows that community to help out.

Lisa Fitzpatrick  11:50  

I think that's critical. And I think it's an overlooked strategy, because people don't realize the value of being on the ground with people. I'll give you an example. One of my neighbors has a physical condition, and he's often in the emergency room. So I talked to him about his visits to the hospital and what he thinks about it. And he tells me things like, well, I don't believe what they said, I only went because I couldn't breathe, even though he couldn't breathe, the information they gave him didn't resonate with him. So he didn't believe what they're saying. So for instance, they told him, your heart is weak. And he said, well, I'm short of I was short of breath. So why are they talking about my heart, and I had to explain to him how breathing is linked to the heart. And I think these are the opportunities we have to see to help people, we have to use language they understand we have to connect with them on their level, and frankly, you know, in a non-judgmental way, because so much so many of the experiences people have in healthcare are so full of judgment bias. And being in the community on the ground with people. I think it helps you connect in a way folks aren't used to but they welcome they welcome having you here in the community. And sometimes I wear my white coat, and that's a little that's a little surprising to people. Why is it doctor walking around ina white coat? So, yeah, you know, there's different strategies to get people's attention and let them see, okay, you're human. And the connection is really important. So yeah,

Fred Goldstein  13:27  

I think it's fantastic. And you touched on an interesting issue. You mentioned briefly this issue of bias. We're dealing right now with the COVID-19 pandemic. We're seeing the disparities in outcomes and infections, etc. How are you seeing that? And what should we be doing?

Gregg Masters  13:44  

And if you're just tuning in, you're listening to PopHealth Week on HealthcareNOW Radio. Today's episode is sponsored by Health Innovation Media. Our guest today is Dr. Lisa Fitzpatrick, the founder and CEO of Grapevine Health.

Lisa Fitzpatrick  13:57  

Yeah, I'm so glad you brought that up a lot of my time and attention over the last few weeks has been to try and address some of the misinformation because there's so you know, it's everywhere. And what I'm saying is, a lot of people being confused, distrustful because there's so much conflicting information. So for example, the challenge the public has was understanding models is playing out on the ground as distrust and they keep changing the story. So why should I do what they say or believe what they say? So, you know, social distancing is challenging to begin with, to get people to so to actually, social distance consistently is a real challenge. But if you add to that, the lack of trust or broken trust, I think, from miscommunication and conflicting messages, it's really difficult to to see this implemented, especially in the end. I I live in the community I'm serving. So I have a different perspective. I'm also hearing a lot about how the communication went wrong in the beginning, around black people not being susceptible to Coronavirus. And I think even though that reportedly started out as a joke, it did take hold because the people we were seeing in the media, were affluent white people. And if you're looking at that as a person living in an underserved community, and then on the grapevine you're hearing oh, well, we can't get Coronavirus, you can, you can understand how the confusion might happen. And then finally, just hearing a lot of confusion about whether or not you should go and get tested. And I understand that because I think everybody's confused at this point about testing, because the messages were so incredibly confusing in the beginning. And even now people don't know, well, should I go get a test? Or shouldn't I and people are avoiding the hospitals and healthcare institutions because they don't know if they should go or they're afraid to go. So lots of misinformation, but also just lots of confusion. 

Fred Goldstein  16:11  

And so what are some of the things that are you doing some unique things around that some of the things you tried to do to counter that

Lisa Fitzpatrick  16:16  

There are a couple of groups I check in with weekly one is a group of seniors and we talk, we have a Zoom conversation every Tuesday afternoon, not only does that help me keep my ear to the ground, it helps me to help them reduce anxiety, because a lot of them are also confused. And being in the house is challenging for a lot of the seniors who are used to being very active. But I also have been connecting with a couple of our social service organizations, whether through volunteering, or just going out to see if there are people, homeless people, for instance, who might need some support. There are so many people we're not hearing about who are suffering right now, not necessarily from COVID, but from the effects of of what's happening. And so in addition to that service, I'm out just trying to listen and direct people to resources if I can. And then finally, I'm trying to be on social media. Although this was challenging for me, I don't love social medi,a that's where people are paying attention. So I I conducted a couple of Facebook live sessions letting people ask me questions about COVID and Coronavirus. I think that's really important, you know, for people who understand the science and people who understand infectious diseases to be in these spaces, helping people to understand this information. So now I'm trying to dominate one of my interns is going to help me on Instagram, do the same thing. But I think just you know, trying to be a voice for credible, trustworthy and simplistic information so that people have a resource.

Fred Goldstein  17:57  

Yeah. And I think you've done a masterful job with it. That's because I remember seeing one of those early videos you did, explaining the virus and the and the, you know, coming in through the nose and the mouth and the lungs and all of that, 

Lisa Fitzpatrick  18:10  

Oh okay

Fred Goldstein  18:10 

Which is very well done.

Lisa Fitzpatrick  18:12  

Where did you see that?

Fred Goldstein  18:14  

I've tried to remember where you had it posted up? I can't remember if it was in LinkedIn 

Lisa Fitzpatrick  18:17 

Oh wow

Fred Goldstein  18:17 

Or somewhere or Twitter so far.

Lisa Fitzpatrick  18:21  

Okay, yeah, that's great. People are watching. Yes. So I need to make a lot more of those. Because people have sent me questions. I'm getting a lot of questions about quinine, and whether or not quinine will prevent COVID. And that's because there's a doctor on YouTube who's telling people they need to be drinking talk tonic water, because quinine will prevent COVID. So you know, in the back on the in the background, I'm, you know, doing some research and trying to figure out where is this misinformation coming from? Because I think you can help people understand if you explain why and how

Fred Goldstein  18:55  
It's fascinating some of it as you talked about, some of it's because the message changed so much that you don't really necessarily trust the message. And then you see something else coming across the transom on social media say, Oh, this guy says doctor says you do this. And I guess that's really been a difficult situation for us all to deal with. 

Lisa Fitzpatrick  19:13  

Absolutely. And the modeling, I just think we when when projections are changing based on modeling, whoever is announcing these, particularly the state and federal leaders need to explain to people so that they understand modeling what why why the modeling is happening, and why the projections keep changing, because I think people don't understand that if you don't have solid or good verifiable data that goes into the model in the beginning. It's hard to know if your projections are going to be accurate, and I think people don't really quite understand that.

Fred Goldstein  19:52  

I assume that would be one of the things to sort of cover in the health literacy training program over time is understanding at least enough to make some sense of Why these things occur? And without having a PhD in statistics or something? How is it going in the DC area right now?

Lisa Fitzpatrick  20:08  

Well, you know, we're being told our surge is happening in June. And again, that's based on modeling. So who knows? We could very well be in our surge right now. And I think people are waiting for a surge like New York had. And I think that's probably not right. Every state is not going to experience what New York is experiencing, I think the best we can do is follow the numbers. But if we could increase testing, not just here, but I think, across the US in places where you're not seeing a lot of cases, try and acquire the testing to conduct case finding, so that you can isolate the cases do the contact tracing. And really, I mean, that's how you stop the spread of Coronavirus. You really have to implement public health strategies. And it seems to me that a lot of places of states are being too passive about this. And I think that's why it continues to be scary for people as they're sitting in waiting for the surge to happen, when they may be a missed the surge right now. Hard to know,

Fred Goldstein  21:15  

As we've watched this, as we talked about earlier around the disparities, etc. Do you think that this may be the point where we finally opened up enough that people recognize we need to put more focus on these social determinants of health and we really want to fix this stuff, but we're gonna reach that point where we make that transition? And might this be it?

Lisa Fitzpatrick  21:34  

I am very skeptical. You know, I think we we have, I think it's a flash in the pan like Katrina, like other things, it's, it's going to be a blip on the radar, I really want to be wrong about that. So we've known about these health disparities for decades. And we have a lot of data substantiating these health disparities. And generally, what we do is we convene, and we write reports, and then we move on to the next thing, while the information is really compelling. Is it really any different than what we learned during Katrina? Or is it really that much different than, you know, the the conversations we have all the time about? How is it that in America, black women have such higher death rates in pregnancy and the perinatal period? Like why is maternal morbidity, so much higher? These are all related to the health disparities we're experiencing in this country. And while there are, you know, solutions here and there and in good faith effort, developed approaches and interventions for this, we still have a national problem with health disparities. I'm not optimistic that this will change. I think, even I don't know if you saw my, my blog about we're not all in this together. I think that sentiment, or we're not all in this together is the same reason that when this pandemic is over, we will gradually get right back to where we were before when it comes to these things like social determinants of health. Because social determinants of health is not a new phenomenon. It's been around for a long time, but now people at least are paying attention and recognizing that these social issues are really influencing health outcomes. But what are we really going to do about it? Are we going to facilitate payment for social determinants of health? And what does that look like? I think, regulators, policymakers, funders are concerned about what happens if you open up that floodgate and say, okay, all community health workers can be reimbursed, you know, you can bill for a community health worker, or you can bill for someone who works in a food pantry and so on. So I, while I would love to see our conversations progress toward supporting these things, since the social determinants addressing racism, bias and health care. I'm skeptical.

Fred Goldstein  24:02  

I think that's, I think I'm gonna have to agree with you, although it's just so sad, where we really need to do something. We've had enough studies, we've known about this for long enough, it's time to actually do something and work to fix these issues. And I was hoping if this thing isn't big enough to get us to switch and do something, then what's it going to take? It's just an unbelievable thing to be thinking about right now. I really appreciate getting you on Dr. Fitzpatrick. It's been a fascinating discussion. I'd love to have you back on later and talk about where you've gotten to as you continue this mission you're working on. So thank you so much for joining us this week.

Lisa Fitzpatrick  24:42  

Yes. Thanks so much for having me. I enjoyed talking to you.

Fred Goldstein  24:45  

Yes. And with that, I'll turn it back to you, Gregg.

Gregg Masters  24:47  

And thank you Fred that is the last word of today's broadcast and want to thank Dr. Lisa Fitzpatrick, the founder and CEO of grapevine health for her time today. For more information or to follow Dr. Lisa's work. At grapevine health go to www.grapevine.health.co or email them via info@grapevinehealth.co for PopHealth Week, my colleague Fred Goldstein and HealthcareNOW Radio. This is Gregg Masters saying stay safe everyone.