Conversations with members of the Harvard and Radcliffe Class of 1992.
Hosted by Will Bachman.

Episode: 99

Somava Saha, Founder WE in the World, Better Ancestor in the Making

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Show notes

Somava Saha’s interest in medical school began late in her career. She studied molecular biology in her fourth year at Harvard, but she eventually enrolled in the Berkeley UCSF joint MediCal program. There, she learned about medicine from the perspective of people and cases, as well as the economics of medicine and the history of healthcare and public health. She also completed a master’s thesis with the Bahai Community Health Partnership in Guyana, South America, where she worked alongside community health workers, villagers, and teachers to create conditions for collective healing. Somava explains the approach taken and how it led to significant health improvements, such as 90% reductions in malaria rates and elimination of acquired developmental delays. 

 

Getting to Know the People Who Experience Homelessness 

Somava also talks about the impact the Spare Change newspaper and getting to know the people experiencing homelessness in Harvard Square had on her and her career. She started to get involved in programs like Phillips Brooks House, and food recovery programs. By listening to the stories of people who were homeless, Somava found that there was an incredible wealth of human potential and people with enormous gifts to offer one another and others in creating communities. This experience taught her how to value the knowledge stored in stories, how to connect people’s stories with policies, and see the gift in others as valuable tools for creating better change. 

 

Community-driven Change

Somava talks about her time at Harvard Medical School and the Cambridge Health Alliance. She learned about the importance of community-driven change and how it can build social connections and change systems. During her residency training, Somava learned about the differences in structures and systems. She also encountered the challenges of supporting patients who had recently been assaulted. She talks about the process of collecting evidence and how this experience led to her belief in a model of seamless care that demonstrates true dignity and cultural competence is an important model to follow. She realized that the presence or absence of money does not determine whether systems work for people and communities experiencing inequities. Instead, it is the choices we make as a society and how structures and systems are designed to create a sense of dignity.

 

Leading a Community Health Center

Somava talks about leading a community health center in Revere, using the same lessons and methods as her life at Cambridge Health Alliance. Over the next two and a half years, the center became known as a national model, and she became elected as the next president of the medical staff. Somava went on to become the Vice President leading the care transformation in Massachusetts. The transformation focused on designing a system that works for people, giving dignity and agency, and valuing all workers based on their expertise, talents, gifts, and contributions. This transformation was chosen by the Assistant Secretary for Planning and Evaluation as one for innovative and effective transformations in the country.

 

Designing a Health System that Works

Somava realized that health doesn’t happen when someone goes into the doctor’s office, but rather throughout life, leading to toxic stress and harmful outcomes. This led her to propose the 100 million healthier lives initiative, which built a global network across 30 countries and over 1850 partners reaching over 500 million people. In three and a half years, the network improved 738 million lives. She also founded Well Being and Equity in the World, focusing on changing the underlying conditions and root causes that perpetuate harm in people’s lives, holding back their potential throughout their lifespan.

 

A Progressive Medical Clinic Model

Somava explains what made the Revere Clinic a progressive model and offers an example of how it worked for patients. The clinic created high-functioning teams to cater to the needs of the community, ensuring longer hours and safety appointments. The clinic recognized the importance of community members, such as medical assistants and receptionists, who could play a larger role than their technical capacity. Revere changed its financing model to focus on improving health and connecting with people throughout the year. They focussed on quality of care over quantity, building relationships, and supporting the patients. These approaches are just a few that were incorporated and prioritized preventative care, chronic disease management, and provided more time and coaching for individuals to work on their health and well-being goals. 

 

Creating Well-being Initiatives

Somava has worked with over 500 communities across the nation, including black, indigenous Latinx, and other communities, to create wellbeing initiatives designed by people closest to the problems. These initiatives saved over 60,000 years of life and helped communities of color, expunged prison records, and fed and housed the community back in their homes.She emphasizes the importance of understanding that those experiencing inequities have enormous gifts to offer the nation and that it is a loss is when we prevent them from expressing their genius.

 

A Mission to Advance Well-being

Somava’s mission is to advance intergenerational well-being and equity based on racial and economic justice. She talks about methods employed to create pathways for intergenerational health building and community building, including the Well Being in the Nation network, which connects the dots across organizations and provides support in multiple ways. Many of their initiatives and frameworks have been adopted by organizations and federal agencies.  The most important part of their work is building community, and building change agents who can create better change. They have worked with organizations like the Robert Wood Johnson Foundation, the CDC, and the Surgeon General to build capacity in the public health system and to create a network of change agents.

 

Influential Harvard Courses and Professors

Somava mentions professor Diana Ecks on World Religions, and courses Lessons Learned from the Weimar Republic, Medical Anthropology

 

Timestamps:

05:17 Healthcare, poverty, and social connection

10:18 Homelessness, poverty, and healthcare

18:11 Improving healthcare systems for marginalized communities

24:05 Transforming healthcare through community-centered approaches

28:45 Healthcare system redesign for better patient outcomes

36:43 Improving diabetes care through patient-led groups

40:56 Trusting patients’ knowledge for health and wellness

46:07 Building collective leadership for health equity

 

Links:

Website:  https://weintheworld.org/

 

Featured Non-profit:

The featured non-profit of this episode is CAPE, recommended by Melinda Hsu Taylor who reports: “Hi, this is Melinda Hsu from the class of 1992. And this week’s featured organization is the coalition of Asian Pacific’s in entertainment. They’re a group that’s been around for about 30 years in Hollywood, fostering and Amplifying Voices from the creative side from the industry talent side, all from the Asian Pacific Islander native Hawaiian community. And I’m very pleased to have been involved with many of their outreach programs and the Asian American writers brunch, as well as the mentoring program that they have through not just the cape writers fellowship, but also the showrunner incubator, which I’m helping launch this year. And I hope that you will look up their website which is Cape usa.org To find out more about the work they do the initiatives and also the screenings and the kind of like programs that they do to let people know about what films are coming out and how to support them and how to get involved with all of these things. And now here is Will Bachman and this week’s episode.”

To learn more about their work visit: CapeUSA.org

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Transcript

 

  1. Somava Saha

SPEAKERS

Somava Saha, Will Bachman

 

Will Bachman  00:00

Good. Hello, and welcome to the 92 report conversations with members of the Harvard and Radcliffe class of 1992. I’m your host will Bachman. And I am excited to be here today with shoma Shah shoma. Welcome to the show.

 

Somava Saha  00:16

Thanks. Well,

 

Will Bachman  00:19

there’s shoma. Talk to me about your journey since graduating from Harvard.

 

Somava Saha  00:25

Well, you know, the funny thing is, the first thing I did was spend another year at Harvard. So I was in a bachelor’s, master’s, combined tracks, so I hang out for another year, to enjoy that sweet feeling of that fourth year, plus, I spent a lot of time really figuring out what mattered to me and who I was about, and it was one of the most transformational years of my life. So you know, in that year, I remember while I was at Harvard, I spent a lot of time looking at and speaking with and hearing the stories of the men and women on the streets of Harvard Square, who sometimes slept there sometimes did it, you know, asked for help at there. And in that last year, as fair change ticker began creating and running small businesses to sell a spare change and newspaper that educated all of us about experiences and policies of homelessness, and on the other hand, helped. Those who were experiencing homelessness have a sense of agency and purpose and resources with which to live their lives. So for me that year was a really powerful one, both in terms of, you know, getting to experience school, and that extra year at Harvard, getting my master’s, before shifting on to graduate and medical school, but then to spend that extra time seeing a very different way in which one could create change.

 

Will Bachman  02:13

And then, were you already planning on going to medical school talk to me about kind of what happened then?

 

Somava Saha  02:21

Yeah, I actually wasn’t I had planned to go into graduate school until a little bit late in the game. In the fall of my senior year, I had really planned to sort of hedge my bets, like I took the MCAT. But I didn’t apply until that fall. And for me, I remember. You know, that was a, it was at the time to finalist for the Howard Hughes and was really going down a bio, medical molecular biology path and loved molecular biology, love learning about how genes worked, and vile things worked at levels that you couldn’t see. But right in front of me were women and men that I couldn’t see. And what I could see was that, you know, there were people here in the US, in the wealthiest country in the world, outside the wealthiest university in the world, there were people sleeping on the streets, just as there were in my as in my, from my home country, where I grew up until I was eating in India, and in Kolkata. And it struck me remember this moment of realization, where I realized that, you know, on the one hand, we had collectively embarked on the Human Genome Project, this was going to be the most incredible time for the sciences, especially the biosciences, we were going to make amazing discoveries about how our genes worked, and what they could do and how we could create medicines and vaccines that would be life saving, in fact, my senior Prach See, my master’s thesis was about developing a vaccine against leukemia. But on the other hand, there was a super simple technology called housing that had been developed 1000s of years ago, that still didn’t seem to be reaching everyone. And I really had no reason to think that the technology that the biotech that was developed with AI there, and you know, at the time, I was taking a lot of courses related to things like medical anthropology from Arthur Kleinman, and the understanding sort of the philosophy of world religions how civilizations occur and take place. And, you know, it struck me that there were choices that we make as societies that Determine how we treat or that there are systems in place that lead us to make choices that leave people in India and lead people in the US without simple something as fundamental to human health and well being as housing. And I became really interested in how you shift that. And so to pursue that, I ended up doing sort of a, a shift, I played late to medical school, and fortunately, was caught into the Berkeley UCSF joint MediCal program, where I spent the next five years first learning about medicine from the perspective of people and cases, but also got a master’s in which which had two parts. One was understanding things like the economics of medicine, the the history of health care and public health and how that got set up. It was couched within the School of Public Health, and you really understood things like community organizing, but also how health systems got set up. And then the other part of that was about getting to do a master’s thesis. And mine ended up being with the BI Community Health Partnership in Guyana in South America, in the second poorest region in the second poorest hemisphere, watching, and over the next set, next three years as I got to walk alongside community health workers, villagers and teachers with a with a fifth grade education who created in, you know, supported by a tiny little program that will leave that the indigenous people in this place. That was, seems so poor in terms of economic resources, but was so wealthy in the way in which the community work together, believe that, that the indigenous people in this region were noble, that they had gifts that were needed for the healing of the world, and that the process of development could be created in a way that was not about those who had something, giving something to those who didn’t. But it was about fundamentally walking alongside and journey in which you each helped to create the conditions for each other’s operation for collective healing in the world. And, you know, I can tell you what happened out of that, in terms of, you know, there were 90%, reductions in malaria rates, elimination of acquired developmental delay, across whole regions, community health workers, became valued and pay things that, you know, would rival any health improvement anywhere across the world. But at that, what I came to the real gift of my education was getting to watch that and to have the context, both from Harvard and from the Berkeley UCSF joint MediCal program to be able to understand it. And over time over the rest of my career, to be able to put methods to it to begin to show apply it and other contexts to learn how to teach those methods and how to accompany other communities reaching his nations and being able to create change differently.

 

Will Bachman  08:26

I want to dial back a year or so, to your it seemed like your fourth year of Harvard is when you really started to get to know, people experiencing homelessness in Harvard Square, if I understood correctly, talk to us about the was that were you? I imagine that might have been something deeper than you know, chatting with people on the street, were you writing services? Or were you volunteering or helping involved in some program and tell maybe tell us one story about one particular person you got to know you know, as a as a human and not just you know, someone that you know, asking for asking for spare change? Can you tell us a little story about that, but that period about what shifted for you? How did you get involved in that? And it seemed like that was a transformative period view.

 

Somava Saha  09:21

Yeah, it was. So I started getting to know people experiencing homelessness from the first year on so when I got there, I just actually didn’t understand why there were people sleeping on the streets in the wealthiest country in the world outside that wealthiest university in the world. I totally understood why they were there. Why people lived in shanty towns and on the streets in India. I had no idea why they were there. The only way I knew to try to understand Understand and and maybe the other thing that I noticed was nobody looked people in the eye people walk past them. And that seemed to cause a delay. poverty of social connection that wasn’t about well, it was about human dignity. And so when somebody would ask for change, if I had any time at all, at the very least I would look someone in the eye and say, Thank you, or no thank you, or whatever I did. But mostly I would say, could if I had any time at all, I’d say, could we have a meal together. And often over a meal, we I would get to hear the stories that people had. And what I got to know, was Caroline, and what happened to her and her two kids as a black mother who had been left behind, or I got to know. wrestle a veteran, I got to know, Jacqueline, over time, the men and women of the streets were not just people with names and whose stories I knew they were people who, you know, if I was walking home late at night, I would literally get passed on from one person to another because they didn’t want it to be sure it was safe walking home. And, you know, I think I think in this country, we make such assumptions about people who are poor, being people who don’t have anything to give people who have no resourcefulness and no contribution. Instead, what I found were a group of people who had experienced hardship, who had fallen through not just a social safety net that was about not having food and housing, but about losing that sense of social connection, that losing that sense of family and community over time, and what it meant to help build that and how powerful that was for people and to be seen to be known to be acknowledged, and also how much they had to get to me. So yes, you know, I did get to, you know, by the end of my, my, my second year, I was working with Phillips, Brooks House and food recovery programs, and working to support people to have food and things like that. You know, and say more about that. But I think watching spirit change as a newspaper, a franchise that was run, led by people who had experienced homelessness as a newspaper. And that was set up as a in a franchise model to help those who are experiencing homelessness to not just tell their story, but to educate everyone and to have a means to an income. But to have a way of helping everybody to become educated about why people were experiencing homelessness, the policies that had led to that, as people took people out of mental health facilities and treatments said that they could get community care, this was in the 80s. under Reagan, but without building any community supports for people, what it meant for people who had been veterans who had given their lives, in some cases and lost so much tours, who didn’t have the support they needed, what it meant to be a lawyer who may have fallen into alcoholism or a system engineer. What I found were, was this incredible wealth of human potential, and of people who had enormous gifts to offer one another and to offer others in creating communities. So for me that last year was more about that. Haha, that was about myself. I think everything up to that was about helping me shift from someone who saw myself largely as having a gift to do technical things because I was, you know, always going to do something in the sciences, something like that, to understanding how to value my ability, my ability to listen to stories to understand that the ability to connect people’s stories with policies and my ability to see the gift in others are also things to be valued and could be used as a path to creating better change.

 

Will Bachman  14:43

Amazing thank you for sharing that, that context and what what initiate all this I want to make sure we get to up to the present of your work with with the wind Network. So so keep going with your story. Talk to me about your time at the med school and Cambridge Health Alliance and then onwards.

 

Somava Saha  15:09

Sure, so I went from college ended up as I mentioned at the Berkeley UCSF program where we learned what happens if we see people differently and create different ways. If we create change differently in a way that the asset pays that’s community driven, that builds social connection and changes the system in a way that goes things. So I went from there to come back to the Boston area to to Harvard for my residency. And my first job out of residency was that Cambridge health lines and the GI Bill, or will I go by? Well, that’s what I just wanted to confirm. So we’ll I swear was going to be one of these people who didn’t stay in Boston. And here I am, like, decades later, working at Harvard as faculty and creating change. Technically, I now live in in New Hampshire, Pelham, New Hampshire. But, you know, I was one of those people who had I had, I could see that there was a whole world out there that was creating amazing change. But I got the opportunity just start a new Community Health Center at in revere at Cambridge Health Alliance, which again, was one of those encountering Cambridge Health Alliance. In my, in my during my residency training was one of the most transformative pieces because I was in med peds residency, which means that I was training to be both an internist and a pediatrician was a couple boards that as a result of that, but in that you rotate through something like 11 hospitals, least I did, at the time at the Harvard Med peds program. And so when you what you what you see is that, you know, what they’re what’s different between different structures and systems. And at, you know, places like some hallowed institutions in the Harvard system that are pretty large that were making at the time, $300 million a year or more in revenue, you would hear these announcements at night that would say, would any x hospital employee fluent in Spanish come to translate for a person in the emergency room. And you this was common, you know, in these huge hallowed institutions that were creating amazing biomedical breakthroughs, and which are filled with incredible, incredible people, like truly incredible people. And I knew I was honored to be there and to be working in that. But then I went over to Cambridge Health Alliance on a rotation for pediatrics and I, you know, one of the things that I’d encountered in some of these other institutions was the incredible the unfortunate, terrible experience of for, for the patient and for the clinician of having to, you know, support someone who had recently been beaten, raped. And it’s a difficult painful procedure for the person and for can feel, in the process of collecting evidence, it can be several hours, the person who’s doing it often a resident usually doesn’t, has not done that before been trained to do that they’re sort of learning on the job. They have to get it right. Otherwise, you’re not collecting the right evidence. We now know that many of these rape kits sit in just basements of emergency rooms are never proper. non emergency rooms are police departments that are never processed, which is a heinous crime in and of itself. But all that aside, the experience is a really challenging one. So I remember being sent had been through that with somebody with several several times and other institutions where I was the person on call when someone was cavemen who needed a rake. And I remember being paged at Cambridge Health Alliance, which that year I think they cleared like $100,000 Like there was this tiny little, you know, community driven institution whose goal was mission was to improve the health of the community. And I remember being paged down on us Saturday morning to see a Brazilian 16 year old girl who had been raped on my way down, just thinking, how can I make this better for her and thinking how hard this was going to be for her and her family, without a translator and without support and with learning how to do it. And when I got down there, what I found was not only a Brazilian Portuguese translator for myself, there was a Brazilian Portuguese speaking sexual abuse nurse who knew how to do the procedure for the all the collection, my job was just to check her medically, but the person who really knew what they were doing today, with kindness and professionalism and incredible competency, she was connected hurt, she and her family had a translator, just for them, so that they could ask and be supported what they need are met by victims of violence professional, again, who was Portuguese speaking and connected to victims of violence program the next day, she got her prophylactics that was the most seamless example of person and culturally did not just competent, but care that was designed with true dignity and, and whole person and cultural competence. And it really demonstrated that. And I became interested, as someone who asks these questions. No, why is it just just as I would ask, I would wonder why people are experiencing homelessness not just in India, but also in the wealthiest country in the world outside the wealthiest university in the world. I became interested in how why is it that there’s a there would be overhead requests for translators and institutions that were clearing 300 million a year, and this incredible model of seamless care on a weekend in an institution that was clearing 100,000 A year and it you know, those experiences along with what I’ve seen about system transformation in Guyana convinced me that it’s not the presence or absence of money that alone or primarily defines whether you will have systems at work for people and communities experiencing inequities. It has to do with the choices we make as a society and the way that structures and systems are designed to create that sense of dignity or not. And so I became really interested in how we do that. So after grad, you know, while I was playing, and sorry, that was a really long story, I know. But uh, you know, I remember being on call and applying to be part of one of these. Two, actually applying for an open position at Cambridge Health Alliance. And I had planned to get out of Boston, so it wasn’t really planning to take the job. But when I thought that I would do is use it to understand why the system was designed, the way it was designed, it was, was, in retrospect, was like, wow, that probably could have wasted a lot of people’s times. But little did I know that in asking the questions and an understanding how and why the system was the way it was. I was given the opportunity to lead a new community health center that will they were starting in northern in Revere. And so my first job at a residency was to start this Community Health Center. And I didn’t know a way of going about it without applying the very same lessons, methods and approaches that I had seen in my life Cambridge Health Alliance, that sorry, and in Guyana, I work to apply those at Cambridge Health Alliance. I revere. And over the next two and a half years, that community health center and with a lot of support from lots of people, David Bora. David us there, there are tons of people who really clear the way and I think, represent real examples of how how leaders can support emerging, Emerging Women of Color leaders. I mean, they really not only didn’t feel threatened, but really encouraged and supported and mentored and provided the support I needed to grow. But in two and a half years, we were able to help. I think revere Family Health Center became known as a national model. And then we I think I became elected the next president of the medical staff, and then began to help grow lots of other EHRs who to have the same knowledge and skills because they didn’t think they were particularly special to me was just a different way of creating change. And then over time, and then in the next couple of years as seek as Massachusetts health care reform happened, and Cha went through its own transformation went on to become the vice vice, the Vice President leading the care transformation, even as we shifted our into our financial model, and we were able to show again in about three years that we could move health outcomes for a safety net population of 100,000 people above the national 90th percentile, while taking 10% of cost out and improving joy and meaning of work. But it really went back to the same methods of saying how do we design a system that really works for people that gives dignity and agency? How do we value all of the people working along that line from the community health workers to medical assistants and receptionists not judge them based on their level of education, but but value them based on their lived expertise, their talents, their gifts and their contributions, while building competencies and pathways for professional development, that transformation over time became known, was chosen by the Assistant Secretary for Planning and Evaluation as one for innovative and effective transformations in that country. And I could quickly see that, while we could redesign primary care flipper payment, entire business model of health care and achieve better outcomes, it wasn’t going to be enough. If we didn’t understand that health doesn’t happen when someone goes into the doctor’s office, that happens all through life as those same factors that lead some people to be on the streets or not have enough growing up. But that, in fact, causes toxic stress that can increase one’s risk of dying by 14, four that can prematurely age you and give you a chronic disease and mental health and other outcomes that are not only incredibly toxic and harmful for you, and take 1010 2030 years off your lifespan, but in fact, is incredibly toxic for our economy, in terms of runaway and wasted health care costs. And so I became really interested in how we changed that. And that led me to go to IHI where I proposed some that the 100 million healthier lives initiative, which built a global network of apps across 30 countries, over 18 150 partners reaching over 500 million people ask well, how might we have we know we don’t know? How might we use an audacious goal like 100 million people reaching 100, helping to help 100 million lives, people live healthier lives? How can we make learn what it takes to get there and in three and a half years, this collective network of incredible change leaker leaders from school teachers in Scotland to people working on the incarceration system, and reentry to people working on birth outcomes and chronic disease outcomes showed that there were some there were solutions possible that could improve those outcomes by 50%. or more, in fact, the network, collectively, they improved 738 million lives when we stopped counting three and a half, three and a half years later. The problem was that you could in some cases, you could see that they weren’t going to be sustained changes. In other cases, what you’d see is another 730 million people take the place of the first set, because while the lives of some of those people helped one on one had changed. Nothing about the system that was creating harm had changed. And that’s what really led me to this the place I’m in now, which is about it’s how I founded well being an equity in the world. Are we in the world? whose purpose is to? Not is to yes, we want to help the people in front of us today. But how can we change the underlying conditions and the root causes that are perpetuating harm in people’s lives that are holding back their potential all through their lifespan, in a way that creates the conditions for all of us to be threatening? Sorry, that was really long. Well,

 

Will Bachman  29:46

wonderful answer. So I want to I’d love to hear so many different eras. I’d like to go, let’s dial back to revere told me it became a national model. Give me a little bit more like specifics to help me understand some of the specific things, you know, ways that that was different than a, you know, a different facility might find somewhere else. So, you know, in terms of payment in terms of staffing in terms of, you know, the services delivered, like, get me inside a bit a little bit and talk to me about what was distinctive about what you built.

 

Somava Saha  30:32

Like, you just say, yes, all of those when I want to be a pain in the neck instead. So here’s what you would experience if you were a person at Revere. So this clinic took care of predominantly, so 80% people would be on public insurance. So we would also have family members from our public officials and others, some was truly known as an outstanding place to get care. And the reason for that is because people knew you. And then we had created high functioning teams that could take care of our community, we organize the way in which care was delivered to meet the needs of our communities. So that meant that we would have longer out like, we would stay open till eight, because people often didn’t come in during the workday, it meant that a whole bunch of our slots were held for safety appointments, so that you could pretty reliably get in not just to your primary care doctor, but also to mental health professionals. When you were in crisis, like, immediately, you could, there was a you didn’t just have a doctor, you had a care team that cared about you. And that was in relationship with you to do that. And this was a safety net system that was the poorest paid system in the state of Massachusetts, we didn’t have a lot of extra money. But what we understood was, and this was really based on what I learned in Guyana, is that people who are from the community, like medical assistants and receptionists can play a much larger role than we usually give them credit for. Usually, we treat them like checker inners of her front desk, person and vital signs takers, we think of them only in their technical capacity. That because we could see that these were people who brought a depth of lived experience from knowing what was really going on in the community, that we believe that they could be trained, they could be caregivers, and that instead of having these are all of the people that I had some I’ve had, I’ll be my patients, instead of we could be for that group of people, their team, and free to do create by changing our financing model so that we basically our job was to keep people well, that meant that and we stopped thinking about the visit as the only time things happened. And instead the whole year, as an opportunity to improve, connect with people and improve their health, we began to see, you know, we began creating innovations that, you know, before you got to a visit, you’d have a lot of things done by the time you got there. It really focused on prioritizing what you needed for all of the things that you might need for preventative care, chronic disease management wouldn’t be done. And there would be much more time and and supports for coaching for you to be able to work on your priorities and goals in terms of your own health. And well being when you had different models of care. I’m sorry,

 

Will Bachman  33:46

when you change the funding model. Could you talk about that? Was it a value based care thing? Or was it? Yeah,

 

Somava Saha  33:55

yes. So we could see that the more the fee for service model of care, really didn’t reward that basically supporting you to do high volume care, rather than high quality care. And it wasn’t that you couldn’t do high quality care, but the incentives of the system drove you to see more and more people and in less and less time with less tension. In fact, if you did more in a visit, you probably wasn’t weren’t gonna get rewarded for that. And so that in that whether you want it to or not, that’s that’s a system that drives you. So we said if the system doesn’t serve our patients, and we’re not doing all that well in terms of reimbursements in any way, what if we flipped our business model? So we proposed and worked with pair by pair? This was while it was at as a it was a vice pres sit there at Cambridge health plans, we flipped our payment model. And our Cambridge Health Science Health Alliance re contracted pair by pair to go to either global payments or shared savings for a lot of its work. So we went from zero to 60%. global payments are shared savings in five years. And in the meantime, underneath that we, we made things like in our EMR easier to do the right thing. But we also did things like if something really wasn’t working for someone, we would give people the chance to just take that visit, offline, as we would put it to just hear what mattered to the patient, what was really going on in people’s lives. And that sounds so simple. But whether it was that and build care plans with the person, whether it was that or whether it was, you know, reaching out between visits, or whether it was doing group visits for things and or Shared medical appointments for things like diabetes and heart disease were in mental health and addictions care where you weren’t just getting clinical care, that technical thing we do, but you were getting a community of people who could help solve problems with you were our patients became our best teachers of one another. What we could do was create a care system where we knew where people how people were doing, we supported people all through the year in their health, and well being goals, through planned care teams that would reach out and connect and support people all through the year that come in to get the care they needed. We provide support, we’ve provided supports and navigation and really expanded the team to include nurse nurses, pharmacists, care partners, social workers. And in doing that actually created a more cost effective model for getting to much better health outcomes, while preserving relationships.

 

Will Bachman  37:08

Interesting, give me an example of maybe one type of, you know, health condition, perhaps diabetes, or, or you pick one, and compare the more traditional model of treating that, and what your clinic would would do instead, you know, in terms of more preventative or more, you know, making sure people were, you know, like taking their medications or getting exercise or whatever it was like how, what helped me get into the understandings and the specifics of how that manifested itself. For one condition.

 

Somava Saha  37:55

Sure, so it, and I will tell you, this is pretty far from the work I do now, though, it’s a part of it. The so if you were, let’s say, a person with newly diagnosed diabetes, I’ll give you an example of Henry, who was a machinist, and who, you know, you newly diagnosed diabetes, and he didn’t know how to take care of it. So he, he was diagnosed, he came in, he’d be Yeah, and there would be somebody who might be a diabetes care partner, who’s a nurse who knew who knows a lot about diabetes, who’s there to really sit with you for as long as you need to help you get educated about how to take care of your diabetes, how to do your blood, sugar’s, et cetera. But more than that, you would be invited to join a diabetes Shared medical appointment group. So instead of learn being, and managing your diabetes on your own, or seeing the doctor on your own, you might see, you might come to a series of visits. And in those visits, you’d be going one person at a time, you’d be reading a book called living with diabetes that was written by patients, for patients had really practical tips. But as you went person by person saying what you needed other patients would help you figure out how to solve that, where can I buy the cheapest brand of low carb milk? How do I shop and prepare a meal? So we would do things like supermarket safaris and help have people put in their carts, what they thought they should put in and the nutritionist would be there in that visit, helping people understand how to make better choices. And what we learned was, you know, for example, for Portuguese speaking people, instead of book nobody had anything that had a package in their cart. That meant that they were largely people were eating need fresh fruits and vegetables. And so we were doing all this education about how to read the label, which was really irrelevant and unhelpful. And so we needed to learn how to create a different kind of cheat sheet or guide for people as they did that. People might trade recipes with one another. And above all, they would coach each other. And so while somebody would, people would set goals, and these groups, these groups ended up being as impactful in terms of your diabetes outcomes as being on major diabetes medications, like the same reduction in you’re seeing improvement in your diabetes control. But more than that, it helped grow patients and communities that you would never think of as this is a champion person, to being people who really own their diabetes, doing things like playing diabetes, bingo, or helping to coach one another. And I’ll still never forget that, you know, that goal setting for diabetes looks so different. There was a woman who had had diabetes for 13 years, and she had had sugars in her for hundreds for five hundreds, the whole time, she was having multiple medical issues. As a result, she was in this group where her big issue was, her kids had left her home. And she was really lonely. And the other people in the group could tell her something that I never would have had the courage as a doctor just saying, which is, what they said was, hey, you kind of need to move on, like, your kids are not going to come back home, and you need to, like you need to get a life get your own life. So in like week two, they said that which you know, a doctor could never say that, but other patients can say that to each other. And so by when it was time for goal setting, and week four, which is like what you so typically would go through one of these group visits, these visits would be co led by patients with diabetes, etc. But by week four, when it was time for goal setting, she decided to set her goal of getting a boyfriend. And so and I swear, well, I was like, I’m like, as a doctor. I’m like, oh my god, it’s going to take like years to get this woman’s sugar’s under control. But this is what she said she needs to do. And it’s been 13 years. So what’s another month or two, whatever. And so the group went, they they made a plan, they helped her think about a plan. And her plan was she was gonna go to her church and get a boyfriend. That was her her whole plan. I swear to you, she comes back to group three months later, and her sugars are within six months, they’re in perfect control. She’s gone to church, she’s met her boyfriend, seriously. And then it wasn’t that she didn’t know what to do. It’s that she didn’t care enough about herself or her life to do it. And, you know, that was the very last time I stopped believing that, that I let myself believe that people didn’t know what they needed for their own health and well being. And I think that that experience of trusting what people knew supporting them, and creating the conditions where people could be the greatest assets in each other’s health and well being in the context of the last several years of the pandemic. That meant working with over 500 communities across the nation and black, indigenous Latinx and other communities to create not vaccine programs, but wellbeing initiatives that were designed by people closest to the problems and those people, those trusted community members found the most creative and innovative ways to keep their friends and neighbors safe. They kept over a million and a half people. Well put 60,000 years of life back and communities of color, got prison records expunged, and hundreds of 1000s of people fed and housed the the community back in our communities. And I think that, that understanding that those who experience inequities, whether they’re on the streets of Harvard Square experiencing homelessness, whether they’re in our diabetes clinics in this little Community Health Center in Revere, or whether they’re in our communities across the country, that people have enormous gifts to offer our nation and that our loss is not in what we give to people who experience inequities. Our loss is when we prevent those who are some of the most resourceful, creative, brilliant men and women In our nation, what happens when we don’t create the conditions for people to express that genius in the world?

 

Will Bachman  45:09

Amazing. I love that story that illustrates the approach about getting a boyfriend, probably not someone, something that you were trained to prescribe. Tell us a little bit more. And I know we’re kind of coming up close to the top of the hour. But I’d love to hear a little bit more about the way in the world. Well, being an equity in the world that you’ve found, it could tell us a little bit more about that organization. Sure.

 

Somava Saha  45:38

So we in the world, our mission is to advance intergenerational well being an equity on a foundation of racial and economic justice. And I think a more shorthand way of seeing that is that we’re working to build a movement of better ancestors of people who can see and know and own, what has built with the strengths, but also the challenges of our past. Understand how that affects our present as well as what what’s happening in the present, and then works together with others in powerful and practical ways to create a better future. And that gets enacted in incredibly powerful ways. As I mentioned, the pandemic be built something called communities rise together, bringing together black, indigenous Latinx, and older adult networks, those reaching the people who are experiencing the greatest inequities in our nation and, and supported bending a federal pipeline of resources to support them, to create their community to create wellbeing, and health in their communities. That meant barbers and farmers and community organizers and Meals on Wheels workers at people got called in to be the public, we brought the public back into public health, and connect them to one another to be part of a shared and collective movement that created a club, in our communities across political contexts and others, what we’ve been doing so there’s basically four things we do one is we build frameworks, tools, amplifies stories, and narratives that help us see and create change differently. We help build will come alongside those, we’re creating real demonstrations on the ground, create real change. And that might mean entirely rewiring how people do mental health and addictions and diverting from incarceration in Delaware, or that could mean funding community health workers differently in Rhode Island. And it could mean building some civic capacity in rural communities in Illinois, or it could mean creating pathways for intergenerational wealth building and community building in the south of Texas so could really be diverse in across the nation as well as working in in other countries with changemakers. Second, third part of what we do is build strategic networks like the can, we like the well being in the nation network that is about doing that, and connecting the dots across organizations that are seeking to do that, that can make things a new norm. So an example of that was we helped to amplify that the vital vital conditions framework as well as that became integrated into the excuse me into the federal plan for long term recovery and resilience is now adopted across 47 federal agencies, we advanced the health equity framework for the CDC and helped we facilitate the process for building our nation’s population community measures called the well being of the nation measures. And finally, we grow community of changing we really grow a community of change agents. And both part of that is important. On the one hand, that is like growing, growing leaders who know how to create better change, because there’s no one organization that’s going to do it alone or no one change leader. It’s really what we can do together. It’s why your name is literally we in the world. We serve as a national program office for Robert Wood Johnson Foundation, in building collective leadership to address structural racism in health care, as an example, but also work with the CDC and other agencies to build a capacity of the public health system. Work with the Surgeon General to partner with businesses and to help them grow Are there leadership and creating the role of business, for example, in creating health well being inequity. So, but the more other more important part of that isn’t just about that capacity building, it’s about, about building community. And so last week, we brought together people over 250 or so changemakers gathered together in St. Louis, hosted by some of our partners in St. Louis, and showed and built their pathways that they needed to build, that both helped people feel that sense of joy and possibility and resilience in a moment of our nation’s history that can bet feels fraught for many, and instead built this network of, you know, that’s grounded in what it looks like for us to engage in both generational healing ourselves, to create generational healing in the way in which we create change. And in actually working together to change the policies and systems that can create a path for long term change so that we have a nation where everybody can participate, prosper, thrive and contribute to the well being of others.

 

Will Bachman  51:19

Wow, what an incredible organization. I’d love to hear more about it. I know that we’re going to close to the top of the time that we had scheduled. So I want to close with a question about college. Are there any courses or professors or activities you are involved in, you’ve already touched on some that continue to resonate with you?

 

Somava Saha  51:46

Oh, my gosh, so many. I mentioned an x ray survey of world religions. But lessons learned from the Weimar Republic actually loved my distribution requirements. So much. Medical Anthropology has ended up being some of the most powerful and useful for me, because it was the first time I learned that you could go, you could take a balcony view to the process and systems that were going on and understand culturally how you interpret something that’s happening, that we see a science and also understand what systems are in place that do that. So those are three of the ones that I would say, were really powerful, but Mesoamerican, there’s just so many.

 

Will Bachman  52:40

Inshallah, for listeners that want to learn more about the work that you’re doing and your organization. Where would you point them online?

 

Somava Saha  52:47

I would point them to me in the world.org, that’s w e i n, the th e world work,

 

Will Bachman  52:55

and we will include that link in the show notes. Shoma. Thank you so much for joining and sharing your incredible journey with us.

 

Somava Saha  53:06

It’s been a pleasure. Thank you for having me. Well,