Errol Pierre, Senior Vice President of State Programs at Healthfirst, Inc.
How will healthcare in 2049 be shaped by advancements in technology, access to education and the intersection of health and wealth? In this thought-provoking podcast episode, we have a captivating conversation with Errol Pierre, Senior Vice President of State Programs at Healthfirst. Explore the potential impact of AI, telehealth and local collaborations on the future of healthcare. Delve into Errol's insights on addressing disparities, fortifying social service programs and the crucial role of policy changes today for a healthier and more equitable tomorrow. Join the discussion as we envision a transformative healthcare landscape and consider the question: What interventions can we make today to shape a brighter healthcare future in 2049?
Errol Pierre is the Senior Vice President of State Programs at Healthfirst, Inc, the largest non-profit health plan in New York State, serving 1.7 million members. In this role, he is accountable for growth, profit/loss, sales and retention for the Medicaid, Long-Term Care, and Commercial product portfolios.
A Bronx, New York resident, Errol graduated from Fordham University with a bachelor's degree in Business Administration with a concentration in Finance. He later obtained a master's degree in Health Policy and Financial Management from New York University. In December 2021, Errol completed his doctoral degree focused on Health Equity. Lastly, he is an adjunct professor at New York University, Columbia University, and Baruch College teaching various courses in Healthcare and Business. In his spare time, Errol volunteers for numerous non-profit organizations as a board member of the Arthur Ashe Institute of Urban Health, and a member of the national 100 Black Men's Health & Wellness Committee.
Prior to Healthfirst, Errol spent over 10 years at Empire BlueCross BlueShield, which is the largest for-profit health plan in New York State serving close to 5 million members. Errol's career in health care started at Empire as an intern in 2003. Throughout his tenure, he held various leadership roles in Sales and Strategy, leaving the company as the Chief Operating Officer in 2019.
In 2020, he was acknowledged as one of the Caribbean-American "Power 100" by Carib News and was awarded for "Outstanding Community Service" by the Asclepius Medical Society. In 2018, he was recognized for with the Outstanding & Dedicated Service Award by 100 Black Men and the Home Award by the National Organization for the Advancement of Haitians. Errol is an avid traveler visiting over 35 different countries.
Errol added published author to his long list of accomplishments earlier this year when his book, The Way Up: How to Climb the Corporate Mountain as a Professional of Color (Wiley) became available.
Show Notes
Errol Pierre shares his background in the healthcare industry. [03:34]
How can the future of health care potentially be the best of times and the worst of times? [05:37]
Can AI-assisted diagnostics fill the gap of the healthcare’s workforce shortage? [10:43]
What are the potential issues around access and health disparities? [14:55]
How can we create access to new healthcare technologies that bridge inequities in the system? [18:31]
What will the role of the health insurance company be in 2049? [23:04]
Will we have a more consolidated healthcare system in the future? [25:43]
Can a local healthcare solution work for all subpopulations, including caring for the unique needs of transgender individuals? [29:20]
How can we ensure a brighter health care future? [31:39]
Transcript
Jason Helgerson
Hi. I'm Jason Helgerson, and you're listening to Health2049.
Errol Pierre 00:08
We have a habit to put money at the symptoms as opposed to the root cause. When we look at the root cause of why certain populations have worse outcomes and other populations, of why medicine is inefficient, there's such a strong correlation between health and wealth. And so where I would put my bets is ensuring that the next generation of Americans that come into this country, they are well educated to be able to get high paying jobs, increase the median income, increase the middle class. They have access to fresh fruits, fresh food, they can exercise, they can take care of themselves, they can build strong families. If we focus on those things, naturally, our health care costs will be lower.
Jason Helgerson 02:10
Prepare to be inspired by today's guest, Errol Pierre, a business executive leadership coach, healthcare strategist, public speaker, Professor and writer. With over 17 years of experience, Errol has dedicated his career to achieving health equity and empowering individuals to reach their full potential. Residing in the Bronx for the past two decades, a county known for its health challenges, Errol believes that health care thrives when it is rooted in local communities. He has made significant contributions to both for profit and nonprofit health plans in New York, while also teaching at Ivy League institutions and captivating audiences as a public speaker worldwide. His dedication to community work has garnered recognition from various nonprofits and business organizations. Currently, Errol serves as the Senior Vice President of state programs at Health First, the largest health plan in New York. Join us as we delve into Errol Pierre's wealth of knowledge and expertise in healthcare leadership and community empowerment. I'm Jason Helgerson, and you're listening to Health2049. And it's my pleasure to welcome Errol Pierre to the program. Errol, welcome.
Errol Pierre 03:24
Thank you. Great to hear you, Jason.
Jason Helgerson 03:26
Well, thank you for being our guest today. I'm hoping that maybe you could tell our audience a bit more about your interesting background.
Errol Pierre 03:34
Sure. So I started my career in healthcare accidentally. I ended up interning at a very large for profit health insurance plan, and found out that I was pretty good at solving complex issues. So stayed there for 10 years, changed different departments, product sales, strategy, business development and learned a ton working in the blues, that system before moving to one of the largest nonprofit plans in New York. That's how I came over to start with the implementation of the Affordable Care Act and so that was one of the best learnings ever, because policy was changing so much in Washington and impacting the nation and I had a front seat at those changes back in 2014 when the exchanges launched. So from there, I grew in different responsibilities at the company and now I'm serving as Senior Vice President of State Programs at Health First. You mentioned teaching, I'm teaching health economics at different schools and then also learning from students as well. So that's a little bit about my background. Then during the pandemic, I also wrote a book called "The Way Up" that really dives into what it takes for professionals of color to navigate Corporate America, as being sometimes the only person in the room of color and then also feeling like an other. I interviewed 11 executives of color as part of that process and it's a book, both for people of color that are trying to grow in Corporate America, but also bosses and managers and supervisors that have diverse teams and want to learn more about how to help their employees be successful.
Jason Helgerson 05:24
Great, all right, so with all our guests, we always start this conversation with the standard question, which is, what does health and healthcare look like in the year 2049?
Errol Pierre 05:37
That's a huge question and I had to think about how to slice and dice it. And I have remnants of a "Tale of Two Cities," the best of times and the worst of times, essentially. And I say best of times, because I feel like by then, technology will be even more amazing than it already is. And so I project that AI and tools around decision making will probably be doing like 75% of our health care decisions in medicine, meaning all the tools that we have, if you were at the starting phase of ChatGPT, but imagine that extrapolated all the way out to 2049 where diagnosis will be done very, very, very quickly. And computers will be right in the thick of things with a physician as they provide care, making decisions. I think hospitals, and the concept of a hospital will fully be at home, we see pilots of it now. But by then we'll absolutely see hospitals at home programs where someone can actually stay in their home, for even surgery, potentially, or stay in these sort of makeshift hotels that are built for surgery. So totally flip hospitals on his head on what we think about what they look like. And obviously, genetic mapping and precision medicine will definitely be in our future where we are now getting a pill that's designed for you, as opposed to generic medicine, which just speaks to amazing medicine, amazing solutions, amazing treatments for many, many Americans, which is amazing. That's the best of times. And then the worst of times, is that it's going to be a greater divide between the haves and the have nots. So all the positive things I just mentioned, which I think are just going to be so amazing for people to treat cancer, and to slow down what diabetes does to the body and hypertension, and being able to treat folks quickly and efficiently without human error or mistakes. And comparative research will be even better, so that treatments will be so good. The problem with that is I'm concerned about who will get access to all of that new technology and all that new health care. So the worst of times is that I think it'll be bleaker for the have-nots. If you think about the government programs, will Medicare be around by then and what will it look like? Will the age level be higher, maybe it'll be 75 years of age. Disparities that we have today, how much more will they exacerbate if we're treating people faster and better, and only a certain group of people are getting access to it versus another group of people. So I do think disparities will exacerbate. And then the part that scares me the most is, we're sitting on physician shortages. Granted, technology can assist with that, but that won't help all the way. But the biggest issue I see is the lack of diversity in the clinician population. So we have physician shortages today. Everyone knows about the nurses shortages today. Those will continue to exacerbate but on top of it will also be the disparities in physicians of color that are going to be serving a population because everyone projects that by 2050, we will be a minority majority country, meaning we will have more minority populations than non minority. This is going to probably be the Hispanic population that's going to be one of the biggest populations in our country. And do we have the workforce to serve them? That's my biggest concern. So best of times, worst of times. Jason, that's that's the way I could say.
Jason Helgerson 09:28
So there is a lot there. A very comprehensive vision of the future. Maybe just dive into a few aspects of it talking first and foremost about the workforce. The World Health Organization, projecting that by the end of the decade globally, will be 18 million healthcare workers short of what the demand is, and it's spurring a global conversation. I was at a meeting in Rome a few months ago, where it was a global conversation around the fact that we can't hire our way out of this problem, and now we need to automate. And you're clearly optimistic about what technology is going to be able to make possible. And whether it's the hospital and home model you talked about, or the power of AI-assisted diagnostics. Do you see a fundamentally different role for, say, physicians or nurses or sort of direct human to human care? Do you see that more of our care is actually provided, not by humans, but by machines, and is that maybe a way out of that workforce challenge that we already have today, and as you say, could get worse in the future?
Errol Pierre 10:43
Yeah, I do. So if you think about how inefficient our system is today, you feel you have a cough, you book an appointment today, you put in your information into some site where you can book an appointment online. You still show up to the doctor's office, they still ask you for the same information that you just submitted online, you have to fill out all these informations that ask for your name several times on the same piece of paper, the nurse sees you first and the doctor sees you, you get a script and you go to the pharmacy. Even though we're 2023, it's extremely inefficient how we do it, where with AI and technology tools and even advanced telehealth, that diagnosis can happen potentially in your home with all the devices that we can have that can tell if you have a cold or not. And so you don't have to go to the doctor to determine if you have a cold. So I think there's going to be way more tools that are diagnosing that you can do on your own, where what the clinician is doing is just validating what the computer has produced. So I think if we can get the low acuity diagnostic services out of those doctor's offices, that changes the way it is. I also think the way we live will change because we're also out of space in terms of housing. So today, we built these big apartment buildings. We start out with gyms in the basement and maybe there's a dry cleaner. I definitely think apartment buildings of the future for urban areas are going to include clinics. We already have Amazon Go stores where you can go into a store with no one there and leave and pay for a product. I think very similarly, there's going to be tools that can do diagnostics inside of a clinic where you don't need to talk to anybody for the low acuity things. For the higher acuity things I do think caregivers, family members are going to take a much, much bigger role, especially because the senior population is only about 17% of the US population today, that's going to exacerbate because we're keeping people alive longer. So maybe it's going to be say 25%, if not higher, by 2049. And so there's definitely going to be more family members, caregivers taking care of their family, maybe their mother, their father, sister, brother, etc, etc. And so they will now have tools enabled for them to provide care as well. So we already see the early days of CDPAS, which is big in New York, which is consumer directed where you can have a family member take care of you in the home. But think of that on steroids, where now you can diagnose your mother with technology tools to find out what things are happening and the drugs will get delivered to you. And you don't even see a doctor. I mean, some of these decisions, because the computer will be right so often that it'll just bypass the need for a physician. So I think we'll get there. And again, my biggest fear is who gets access to it. It's going to be who has money that it's going to get access to these types of tools.
Jason Helgerson 10:44
Yeah, so let's get right into that issue around access and health disparities. I think I'm a little more optimistic than you are around it in the sense that I think the unit costs on some of these things, the artificial intelligence tools, for instance, they'll be so low that they'll be inexpensive, that some of these things, the diagnostics you described, some of those things could be really very affordable, very cheap. In fact, at some point in your unit, the marginal costs will be close to zero. My worry is more on what you mentioned previously, the precision medicine, the medications uniquely designed for just you, branded types of things that are under patent that could be very expensive, but maybe talk a little bit more about the kinds of things that won't be as accessible or potentially couldn't be as accessible in your future world.
Errol Pierre 14:55
Yeah, so the way I think of it is COVID to me, it taught me a lot of lessons. When we had the COVID pandemic, we quickly set up ways for people to get vaccines, we set up a website, so you can book appointments. And what I saw firsthand working at Health First and working at a plan that serves the underserved, more than 1.2 million of our members are enrolled in Medicaid, so they're making less than $18,000 a year, was a website that was built for people who had a desktop, that spoke English and that were mobile and could use transportation to get to their sites to get the vaccines to the point where people that were outside of the city were taking vaccines from the locations that were inside the city. So people in Long Island or other areas outside of New York City were actually being able to book appointments for locations inside the inner city, where the inner city folks could not get access to it. And so to me, when I'm thinking that as as a microcosm of what's going to happen with the expansion of technology. Yes, those diagnostic tools might be cheaper, but I'm thinking about, Okay, what will be the device that has access that provides those services? And will that device be ubiquitous amongst everyone, despite their income? With AI, many of the jobs that low income individuals are working today, these are the cashier clerks, we're already seeing those jobs go away, so with AI, will be much more changes in how the job market operates. What happens to those folks? Where are they getting their income? Where are they living? What will they be doing it because AI is not just going to impact health care, it's going to impact all industries. And so many of the folks that are on Medicaid today, they are doing the labor jobs of keeping the United States working and afloat. But those jobs displace what happens to them whether they get their care. So I think those are the fears that I see. We have to make an intervention today to change the trajectory toward tomorrow. And the last thing I'll say, too, is embedded in all of this AI is already bias, unfortunately, because humans aren't perfect. So we're taking all of these decisions that have been made, 1000s of decisions are made every single day in medicine and these algorithms are taking all these decisions and obviously, some of them are wrought with bias and systemic issues. Those go into the decision maker, so to the degree that we can check those algorithms for bias, I don't know how we do it and offset it. The other thing is the exacerbation of it because the AI is going to be everywhere is the fear of people just missing out on care and the algorithm exacerbating the bias that's already existing in the system.
Jason Helgerson 17:57
So in terms of, let's stick with healthcare delivery and your concerns around exacerbating the inequity in terms of access that could be created by some of the new technologies, what is your prescription for that in terms of what do you think the government or providers or insurance companies could or should do between now and 2049 to help make sure that those inequities are not as bad as you fear they could be?
Errol Pierre 18:31
Yep, absolutely and if we make changes now, I think 2049 will definitely be much brighter. So things like policy changes that put money to where we need to get to. You know this better than me, our system is fee-for-service, so it drives behaviors that do us a disservice. We have to get off of this fee-for-service chassis as fast as possible. The hope is that in 2049, it is different because if it's not, the behaviors that we get from fee-for-service is more expensive care, more sick care, less preventive care, less focus on primary care, less focus on preventive medicine, that will not change unless we change the way we pay providers and incentivize them. So I think that's the first big thing we have to change. Two is our concept on funding social services. So we talk about social terms of health, we talk about health equity, we're early days of trying to screen everybody, but the problem is, if you screen everyone to ask them their needs, but there's no place for them to get those needs met, we didn't change anything. And so before we start screening folks for food insecurity and for housing issues, we have to fortify those resources to make sure that there are places where they can get food and not just food pantries, because those are sort of nonprofit band aids to help with supplemental food, but actually social programs, so programs like SNAP benefits, has to be totally changed to align with health care. Make SNAP literally a food as medicine program to say, actually want to give people food because that will help them be healthier. Instead of like, Oh, it's a social service program that we want to cut, say actually no, if I can invest in this program, I'll actually keep people healthier. So the food deserts that exist, they totally have to be upended for the purposes of people living a life of equality and basically have better health outcomes. The other piece I'd say, too, is, if we know we're going to be a minority majority country by 2050, based on all the demographic data that's out there from the US Census, we have to staff accordingly for that population. We have to start totally thinking about how we do recruitment. You brought up the fact that we can't hire our way out of it. If you add on top of it cultural competency, it's even worse, the disparities in the clinician population. So we literally have to train people about health in schools. It is not a class on taking care of yourself, it's being healthy. Probably when I went there was a health class. It's something that we train people today like what to eat, what not to eat, exercise to get, how to take care of yourself, that has to be ingrained in people today. So we have to change how we educate folks around that process. But then definitely change the trajectory of how hard it is or easy it is to get into healthcare delivery because we are so far from being able to handle what the population will look like in 2049 unless we make changes today.
Jason Helgerson 21:50
Right, I agree with you 100%. One of the underlying premises of this show is that 2049 may seem like a long time from now, but the decisions we make today will have a direct impact. One of our previous guests is the Vice Dean at Columbia School of Medicine, and is working on a project to transform the curriculum with the idea that the physicians being trained today will be in the heart of their practice in the year 2049. And so the reality is that the decisions we make today will have direct implications out there in 2049. We have no choice but to start thinking differently about all aspects of the system, particularly as you talk about the need for cultural competence, the need for recruiting and training individuals of color into the industry, into the space, all exceptionally important points. You're a senior executive with a health insurance company, so I'm interested in your thoughts on what the role of the health insurance company will be in 2049?
Errol Pierre 23:04
Yep, there's a question of what health insurance will look like, because there's a whole transformation of the payer space today. We have a payer in the country that's the biggest owner of physician groups right now. So payers are definitely changing what they look like. And I think that 2049 will see a much more blurred line between payer and provider. It's happening already, but I think we're going to get to a point where if health care is local, the government will probably get to a point where they'll provide money to someone who not only can pay claims, but also can deliver care, just from an efficiency perspective, so much more pay vitor approach with a population health lens where you say, I'm a hospital, I have a group of physicians and I can process claims and I can manage a population of members from a population health perspective, let me take over this population and be responsible for it and provide me the funds to manage it and let me live out my destiny. So it's going to probably be an ACO look alike, but on steroids, where you have a population health management process, where it's got to be bigger than just the hospital. It's going to have a merger or a consolidation of hospital provider, payer, all saying we're going to collectively take care of a certain population. The other thing I think that's going to happen from the payer space is the rates. I don't think by 2049 we can still have Medicare rates, Medicaid rates, commercial rates and keep these three different reimbursement rates separately and try to get some semblance of equal access for everybody. Part of the rates, that differential between some of the programs that serve our population, leads to the inequities. So if I get paid lower reimbursement, then it's going to be a longer wait time to see a doctor, if I get paid higher reimbursement, I'll see that patient sooner. So I think there will also be a blending of some of the rates across the different programs, just for the sake of consolidation and trying to get more efficiency out of the system. That's where a payer can assist in this by being a collaborator and the convener of different parties and socializing the data to all those different parties so they can make the best decisions on behalf of the patients.
Jason Helgerson 25:43
So I want to go a little bit deeper on this topic because I think it's a crucial one and your perspective is very interesting. How consolidated, do you see that future state? I mean, you describe the sort of super ACOs, which sounds to me like Geisinger or Intermountain or systems like that, Kaiser, a lot of them have systems of that type. We've seen them around the country, these integrated delivery systems which have a payer and provider, is that the kind of organization? I mean, how many of those do you see in the future? That would seem to imply to me a more consolidated healthcare system than even what we have today? Or am I misinterpreting that?
Errol Pierre 26:33
No, I think that you're hitting the nail on the head. When you become big and you don't have connections to the local delivery system, it's very hard to move the needle on patient behavior to either take costs out of the system, or to drive better outcomes. So like I said, health care is local, I believe that in my heart of hearts. You're going to need these local systems that know the community, know the populations, have the staffing that's there to enable this work to happen. But I think today, we still are in our silos. hospitals don't interact with community physicians, community physicians and hospitals and payers are never collaborating around their specific population. Everyone believes they own the member, the PCP says I own the member, the hospital says that's my member. And the payer says that's my member. The only way this is going to work is when all the bodies are collaborating around it. So I do think yes, Geisinger, Kaiser, you can see the recent acquisition with SCAN and Oregon, I think there's gonna be more models like that, Kaiser doing their acquisition in Pennsylvania. More models where you're saying, I need to be local in my area, but then for scale, I have to have many of these local groups together, so I can have scale in multiple parts of the country.
Jason Helgerson 28:02
It's interesting, because I hear you and I hear the benefit of the local approach and tailoring services to the needs of local populations. But we had a guest on the show in Season Two, who is the Chief Medical Officer for Plume, which is a virtual primary care provider for transgender individuals. And the argument they were making was that they wanted to build a health care solution tailored to the unique needs of transgender individuals, and that the traditional local health systems, talk about a lack of cultural competence, or even a lack of clinical competence to really meet the needs of that population. And the idea being that they wanted to build a platform on a national and international level, and develop just super expertise in serving the needs of that population. I'm wondering, do you think that the local solution is right for all subpopulations? Or are there potential advantages, particularly with new technologies and things like that with so many services being brought into the home that people or providers may not want to be able to have that opportunity to have solutions really tailored to the individual's unique needs?
Errol Pierre 29:20
Yeah, it's a great question. So absolutely, to expect every locality to have a high level of expertise to serve a transgender patient, is that going to happen? So the ability to have something that's national and cross cutting, especially from a telehealth perspective, definitely makes sense from just a patient perspective and then also just from economies of scale perspective, so I get that. The one thing I will say though, is telehealth can only go so far, at the end of the day, if this patient has to get seen, they are going to have to show up somewhere and what tends to happen is these local air areas have to be the jack of all trades master of none. So, health care is not local, because we think it should be I mean, health care is local because people can only go so far to get their services. When I spent time at a for profit plan, we used to provide ideas to some of these major employers that had employees all over the country, the idea of either medical tourism, but even the idea of domestic medical tourism to say, hey, New York might be expensive for this procedure, we'll fly the member to Wisconsin where they can get the same procedure with high quality, and it'd be a lower cost. And it never picked up, even though it was an offering. People still, even though it was more expensive in New York, said I still want to get my surgery in New York. And then the person in Wisconsin was like, I don't want to go to New York, to get by surgery in Wisconsin. So it's human nature that makes health care local, not the fact that the industry wants to be local. I think people just feel way more comfortable being able to walk out their door and take less than a 30 minute ride to actually see someone and speak to them. Now, can someone like you said telehealth, can there be a screen in the home and they can talk to someone? Yes. But when you actually have to get seen, it's gonna go right back to the local delivery system.
Jason Helgerson 29:21
Gotcha. All right. So a final question for you is, I think you've been very, very articulate on the need to make changes today in order to get to a better, brighter future in 2049. If you could wave a magic wand today, what change would you make that would help to ensure that brighter future in the year 2049?
Errol Pierre 31:39
Yeah, that's a great question. My magic wand, it has nothing to do with health care, honestly. So we have a habit to put money at the symptoms as opposed to the root cause. When we look at the root cause of why certain populations have worse outcomes than other populations, or why medicine is inefficient, again it comes down to this such a strong correlation between health and wealth. So where I would put my bets is ensuring that the next generation of Americans that come into this country, they are well educated to be able to get high paying jobs, increase the median income, increase the middle class, they can get jobs in an environment where we're going to have way more automation. So that's my biggest fear of what jobs will they have as automation happens, and they have access to fresh fruits, fresh food, they can exercise, they can take care of themselves, they can build strong families. If we focus on those things, naturally, our healthcare costs will be lower. And if you look at Norway, if you look at France, Germany, all of the things that they focused on, their percent of GDP spent on healthcare is still 10-11%, nowhere near ours at 18-19%. Where they are spending the money, that's much higher than health care as a percent of GDP, is on social services and spending the money on social services turns into an ROI on health expenses. So my magic wand would be to actually make our social service programs much more fortified and better than they are today. And that will actually solve root cause issues of why we have health care disparities now,
Jason Helgerson 33:33
Great, on that optimistic note, we'll bring this session to an end. And that was Errol Pierre's vision for health in the year 2049. As always, thank you for listening to help 2049. If you enjoyed what you just heard, please subscribe to us on Apple Music or Spotify, and share this podcast with a friend. Thank you and see you next time.
