Revolutionizing Healthcare: What 25,000 Patient Interviews Reveal ft Natalie Davis

[0:00]  we really want doctors to be thinking about you know better quality Care instead of quantity we had one woman say to us like healthcare feels like you're going down the cafeteria line in high school and like you get SCH slopped Health Care on from one person they tell you to move on and they schlop more Health Care on and like you don't really have a say you have to just like keep going down and we thought what a great analogy for our feif for service Health Care system that really is just treating you as like the person down the assembly line um and then when we talk to people are like okay well this there is a movement to do this sort of Healthcare differently we need to Center patients more on it but it's called value based care like what do you think about that people and it was the worst performing messages we've ever had people ha that was going to be my question I was like does value mean value as in like I'm getting more services for cheaper and then cheap means bad in my mind like what does that mean what is value

[1:04]  all right guys welcome back to a brand new episode of the heart and hustle podcast now I'm incredibly excited because I have another amazing guest sitting across this digital table with me I have Natalie Davis who is the CEO of United States of care Natalie welcome to the show thank you so much I'm so glad to be here so Natalie we like to kind of get these things started we're going to learn a lot about your heart and hustle today specifically in the work that you've been doing I want to tell everybody about kind of what I said before we started getting uh going here today is the hand toand combat in interviewing people about their preferences and what it means to truly meet them where they are in their Healthcare Journey so you said that you guys have um done over 25,000 interviews across different demographics asking patients what they want out of healthcare that equates to over 5,000 hours of time spent with people hearing

[1:52]  it from their mouth why did you guys choose to take that specific approach to learning what people want in healthcare yeah it's one of my favorite parts of the organization it's what definitely sets us apart and is our unique value ad um to to improving our health care System when we started this organization about seven years ago we wanted to prove a theory that we had um coming out of when I was working in the Obama Administration on healthcare.gov and other issues that if you got away from the politics of healthcare people actually agree on more than they disagree of what they want out of the Health Care System what they want their experience to be um so we had this Theory and then we had to prove it and so building out that strategy um to really go out and talk to people about their Healthcare experiences what do

[2:40]  they love what do they hate what um what makes them angry what language do they use where would they want to see targeted changes do they want a big blowup to the system do they want targeted changes um we really wanted to go out and authentically listen is what we say and so there's a lot of work that's done in politics and um and in advertisement where you have an idea you go out there you put it in front of people and you like kind of know they're going to like it or you're going to get some good stats on it some good polling results um but we call that lipstick on a pig and we definitely have used that sort of um approach before when we're really close to passing legislation over a line and you really want to get the numbers to show people support this but that's not what we wanted to do as the basis of our organization we want to go out and listen to people and so um years ago we started out by talking to people

[3:29]  and just asking the same five questions um what's the first word you think about when you think about Healthcare um I wish Healthcare worked more like blank we had a couple of those questions and I brought those to kitchen tables in San Diego to a Red Hot and Blue and Texas to uh the Love Park in Philadelphia and and to really understand okay if we didn't bad people to the answer what would we hear and that work is continued like I said like you said we've engaged 25,000 people every single state 5,000 hours and are building um what I call the mapping the human experience of the healthcare system and then we use that to drive change it's not just so we can understand people but it's so we can go out and um advocate for policy change so we can talk more about we can Center

[4:18]  people's needs in a conversation that often just feels like it's about the Health Care system and not people um we can change that kind of narrative um we can build policy recommendations that others can run with and make um um make happen but for us we didn't feel like there was an advocacy organization that's just for the people and just there for healthcare and making sure healthare can change so I'm glad you started out with that it's something we're super proud of um we hope to you know increase our data by 50% every year and and really continue to get a pulse of pulse of the people as we call it when I sit across this table with amazing people who are having such a gigantic impact I have to ask myself the question was this the plan from the very beginning like when we're in fifth grade our teachers ask us what do you want to be when you grow up and we say an

[5:04]  astronaut or a firefighter a professional baseball player but did you always say that this was going to be my path early or did that change along the way um I have you met people that have been on the path that they started in fifth grade and I've met a couple and that is an anomaly right that's the path that we all think but everybody else says you know I did everything and I was brought to this moment which made so much sense yeah you know I think um no this is not I I came to Washington DC actually um to be a museum curator so even if we're going back like two decades um I didn't come to DC to work on health policy I came to really understand the intersection of society and individuals how do they interact and how does that show up in art and came here and realized that nobody leaves the amazing Museum jobs in DC and I needed a different path and thankfully a lot of my interests were in healthcare but I

[5:50]  say looking back and I've had a coach that's helped me realize recently like what has been the theme of what I've been interested in um what I've been paid to to do what I do on my own free time what people praise me for and you know I solving problems breaking down things and questioning things and then Building Solutions and I've come to learn that that's kind of the definition of an entrepreneur I never felt worthy of what I think is like one of the coolest things which is being an entrepreneur but it really has been something that I've um that has stayed with me I think since early on um I just didn't have necessarily a topic when we came to DC my husband and I um you know I started while I was doing policy work in DC on Healthcare I started a flower company

[6:37]  because I realized that I wanted to do my own wedding flowers and I found a wholesaler and then I started doing other friends weddings and um one was featured in Essence magazine it was a beautiful wedding and then started doing um table um table uh flowers for fundraisers here in DC and so it was a really fun way before I had kids and had time to kind of scratch that entrepreneurial itch and then of course starting a nonprofit I'm one of the co-founders of this organization and um have I think that's been the through line even working in the government we don't think of that as entrepreneurial necessarily but they're serving really hard problems and coming up with new ideas on how to do so and working on healthcare.gov um I think there's nothing more entrepreneurial in the moment of creating a brand new way

[7:24]  people can enroll in Insurance um and doing it through such an amazing platform like the federal government how did you so we've talked about a lot of stuff right we're museum curator then we recognize we're going to be an entrepreneur so we start taking on different Ventures but then the big elephant in the room becomes Healthcare right so why so many people choose to stick away from this space specifically because of how slow this ship turns to make changes that people actually want so how did you think about approaching this challenge a little bit differently through the lens of saying okay if I invest my energy and time into solving this problem we're actually going to get a substantial result out of effort and time yeah it's a good question I haven't thought about an answer so specifically to like to that question I think I mean Healthcare is the basis health is the basis of like literally our lives and our bodies um and anything we want to do

[8:13]  with these lives and bodies whether that is through friendships through Rel you know romantic relationships through work through fun um and the idea that something like that could hold you back um from living a life uh however that may show up in the body that you have I think it just to me it felt like such an important almost no du issue to work on and you know I think there are times where it's important that Healthcare and other huge industries that impact our lives do move slowly I think you know there's times where it's good that policy and Congress and the administration and states can move slowly to make sure we're not using having huge disruptions to healthcare um and then I think you know what I wanted to do and what a lot of us wanted to do

[9:01]  with building this organization was say there are times we need to move faster and they or we need to move slower but either way we need to be centering the conversation on the people that matter most which are us patients these people these humans with bodies that need to um live the best lives that we can and so um I think my foray into Healthcare especially if we look at healthcare.gov that felt very fast I mean that was a huge and Innovation that was changing Healthcare very quickly it's enrolled millions and millions and millions of people in a brand new program a brand new way um and I look for those kind of entrepreneurial moments and a lot of the policy work that we do knowing that it does take time to craft and Advocate and pass new legislation but but sometimes that's done so we can make sure we get

[9:48]  it right but let's just Center let's the way we do Healthcare we should be doing an entrepreneurial way more of a human- centered policy approach um to change so there's a a famous saying it says you know the person who has their health has a thousand problems right the things that we want in life can't get the new car I've got a leaky faucet things like that but a person who doesn't have their health only has one problem and that's getting their health back in line yeah so what are some of the perspectives about what you learned in this journey if you will on the perception of healthcare and then what do people actually want are there core pillars that we find that are commonalities on all the people you've spoken to yeah it's a a great question so um there are some core kind of things that we've learned as we've um kind of mapped out The Human Experience in

[10:34]  healthcare and one is that um affordability being able to afford your healthare is the most important thing for people um to it it wakes them up in the middle of the night it decides if they're going to go to an appointment or not if you talk to people even if the entry conversation is about maternal Health if it's about mental health it's about anything the almost the first thing people say is yeah but if I I always worry I can't afford it um I lost my job during this you know a public health emergency and I don't have insurance so I can't afford health care during a public health emergency um and and so affordability is the number one issue that we hear from people that's why it's the number one issue that we work on in States and Congress across the country to make sure that we can make that make it more

[11:22]  affordable for people um some of the other nuances that we hear are that people um really have come to not trust the Health Care system because they don't believe that their needs are at the center um there's a real skepticism that other people are making money off of your back and you have to carry all the weight um there's a real skepticism that I don't feel like my doctor is always able to spend enough time with me um the back you know their back is to me or I don't know maybe they're getting money from this Pharma company to prescribe me something and they're not actually first like listening to my Healthcare needs and prescribing lifestyle changes or other ways that I can um I can be help be healthy and so there's kind of this distrust of the system itself um I

[12:12]  think we've seen some of that play out over the last um couple the last month or so with the murder of the um United CEO um and and while that should never be the case I believe I think many people believe it was a cultural moment and the cultural reaction is something we can't ignore which is that people really feel like this is another Finding they're going at this alone the healthare system is not meant for them they have to figure it out on their own um maybe they're too dumb or too smart or too sick or too healthy to pick the right he insurance plan to make the appointments they need to make to follow up to coordinate their own care I mean people this is too much um and and people kind of feel like they they know the system's not there for them but they also feel like a personal failure um and one of our goals of the organization is

[13:00]  to show that there are things people agree on and these are collective kind of um concerns and needs um and that that's where we can Center Center um our efforts and so at the very beginning in our kind of core research we after really hearing some themes from people um we went back and said okay we're going to find these shared values what is a value framework where people can say they agree on these things need to be changed and there are four things that people want out of a Health Care system that works for them number one is they can um afford their healthare so it gets back to the affordability issue um number two is people want Dependable coverage as their life changes and um you know that means that their insurance is there if they get cancer if they have

[13:47]  a baby if they lose their job during a pandemic um people don't feel like it is right now and if the idea of coverage being there for you really resonates with people number three is people want personalized care and for them that means getting health care that meets their own needs for their own body their full body not just an elbow versus their mental health um in a place where they want it so is at school in the community Etc virtually um and then lastly and this is one that like you know people usually laugh at is people want a healthcare system system that's easy to understand and navigate uh you know enough said on on how people feel with that one and and we brought back those four goals back to the public brought 75 different policy Solutions and said Force rank these talk

[14:35]  to us about these and and there are 12 that kind of Nest under those four values that look like anything from reducing the cost of prescription drugs to increasing support for employee for people that get insurance out of their not from their employees to better maternal Health better mental health um more care in the community and virtually U maybe this idea of like a care navigator that will come with you to an appointment there was one woman who's a wheelchair user and she was like if my family members can't come to an appointment with me I have to rely on a tech to lift me up for my mamogram and that's not comfortable I don't feel secure can I have someone that comes with me from the Health Care system that knows me and can help listen to the results help me navigate it so um it's

[15:24]  not these aren't like radical ideas um and I we really see them as a place to Cent where we drive change whether you're an entrepreneur whether you a policy maker an advocate um these are what we heard from people across demographics um politically race ethnicity income that they really want fixed were you surprised by hearing these four kind of pillars emerge right we talk about affordability we talk about dependability we talk about personalizing we talk about easy to understand when based on kind of your Outsiders perspective in healthcare did you have some of these same quals I guess with the overall healthare system that maybe you didn't understand Healthcare maybe you felt that it wasn't affordable or Dependable when you were going into this process of surveying so many people oh gosh I mean I I definitely feel that as a as a a patient

[16:11]  and as a mother and as a daughter um my son just last weekend we had to go to the ER because he was in diabetic um uh acidos keto acidosis um and we just learned at that moment he has Type 1 diabetes and so all of a sudden we're you know a whole new world of healthcare is opening up to us and that's from the ER Bill to the amazing texts that are helping us with the technology that he has so um when we when we first were starting this you know we were a startup organization a nonprofit and we were trying to figure out our own insurance and how we were going to take care of our employees um when I started at the Obama Administration my husband and I were both working um the same son he was born um months prematurely and was in the NICU for a month and we chose who was

[17:01]  going to become the stayed home parent because my job had Insurance uh through the government and so you know you kind of yeah I mean totally as an individual you try to navigate this as best you can with the information you can and um and it's kind of unbelievable to me how much you have to be your own self- Advocate to fit to to make it through all four of those goals um it's it really does at times feel like the system isn't there to to to help you so I don't I'm I'm trying to remember if any of these surprised me I think I was just so excited yeah getting this information yeah yeah man I mean I just think about the element of of trust right if you come to somebody in a moment of insecurity of Doubt right you need to lean into a trusted resource and I wonder why so many people don't trust

[17:48]  the healthc care system and I want to kind of reverse to the points that we were making yeah I mean every single year we hear more and more people unfortunately having a difficult time navigating the Healthcare System yet the Optics of Healthcare in general is you know optim puts up record profit numbers this year and it seems like there's a disconnect from the messaging that we see in the media compared to the personal human Centric experience that other people understand where do you think this started right that separation between the human and the organizational Optics of kind of what Healthcare is supposed to mean oh it's such a great question because this was not the world that our grandparents grew up in right this is also not the world that often our parents I was born in 1990 came from and like navigating these complex Health environments and not having a trusted relationship with your doctor it just seems like this has been coming over the last couple generations and times and

[18:35]  you know decades or when do you think this really kind of started yeah I think um I think a couple of things I think our population uh has ballooned into such a larger um amount of people with more diverse needs um we're living longer we are looking for more and more treatments more and more ways to stay healthy longer um and that a lot of that comes with cost if we're looking at the new you know weight loss drugs the zic ETC um the federal government has a huge question in front of it is it going to pay for these drugs for people uh and so I think it it kind of became intrinsically interconnected with the cost that it cost the government um the cost that it costs insurers or hospitals

[19:25]  to maintain and I think it also became a really attractive place to to build companies that you hope could make a lot of money um and um I think it's you know if you go to some of these huge Healthcare com conferences where people are creating new apps and new um companies and I don't think there's necessarily anything wrong with that I think it just has become very very flooded with um ideas and for the most part most people are looking to make money off of those ideas and I think it just um got quite quite mixed up um when we put together demographic changes um then the desire and need for new Innovations to stay healthier longer and this kind of view where you could um see Healthcare as a place to to make um

[20:13]  profit I have I have a simple question about time and this is a really interesting one because you know based on the data and the research and the conversations that I have I hear that on average your doctor spends about five minutes with you in the actual care environment right if we're talking about like a check up a primary care visit that same doctor spends about 15 minutes documenting that interaction because it's vital for them to be reimbursed for the service that they just delivered to you patient interaction 5 minutes documentation 15 minutes if you change the incentive you would change the outcome of that interaction so why do you feel like doctors are being held captive I guess with golden handcuffs to say I have to document for 15 minutes which equates to me being on my computer asking Natalie so that's is still consisting with you okay sounds good like where do you think we can kind of

[21:01]  switch up that I would say consumer Centric experience because it seems so opposite to everything else that we experience in our daily lives yeah I think that's right and it's what's interesting is so there's a concept of what's called value based care and health care and how um we and that has been a bipartisan issue across uh political across um administrations from Obama um others that were thinking about this beforehand through Biden through Trump um and on and the hill and in States um and it really is looking at how do we change the incentives so providers are giving the best quality um uh care and with the best outcomes to people um and it has change there has been a lot of changes as we think about that sort of movement to more accountable Health it has also come with a lot of reporting requirements a lot of like a doctor can prove they're doing

[21:49]  well by filling everything out in an EMR we have emrs that are locked down which can't be shared among others um patients are responsible whether they say you know say so or not we're still responsible for bringing that information even it's just in our head from Doctor to doctor um and you know I we our organization has kind of realized that the way we have talked about this concept of value based care the way we've constructed the policy really has been about provider um incentives and provider reporting to make sure that we're giving better outcomes and and there might there is definitely some some goodness there and there's definitely too much there um what it has we' felt like we've missed and when we talk to people across the country is like okay but if you're going to build this Better Health Care system with different incentives how would you

[22:37]  do that around the patient um and what matters most to the patient in that and and the number one thing that we heard from people is time they want more time with their doctor if we are going to incentivize doctors to care and give good outcomes patients want more time they want um to be seen as a whole body and not just like I said their elbow or their knee surger but like how is their mental health impacting their back pain and how can they then go out and get PT instead of maybe back surgery and so this idea of more holistic kind of Whole Health full body um and they really want doctors to be thinking about you know better quality Care instead of quantity we had one woman say to us like healthcare feels like you're going down the cafeteria line in high school and like you get slapped healthare on from one person they tell you to move on and

[23:24]  they shlop more Health Care on and like you don't really have a say you have to just like keep going down and we thought what a great analogy for our feif for service healthare system that really is just treating you as like the person down the assembly line um and then when we talk to people are like okay well this there is a movement to do this sort of Health Care differently we need to Center patients more on it but it's called value bed care like what do you think about that people and it was the worst performing messages we've ever had people ha that was going to be my question I was like does value mean value as in like I'm getting more services for cheaper and then cheap means bad in my mind like what does that mean what is value it means exactly that people talked one woman was like I don't buy value bacon I don't want value heal exactly well we've been talking about value based care for decades and a way to sit and they're like and what does

[24:13]  value even mean and who's deciding the value I want to decide the value for my health and so we have companies out there that are doing value based Kidney Care and it's like I think people think you're getting a cheap kidney like I Walmart Kidney Care yeah exactly and so um we said okay well what would you call this and it was Patient First Care they want to be at the center um and even the idea of incentives actually really piss people off they're like why do you have to pay a doctor extra to give me better care like isn't that their job isn't that why go they go to school and so you know money really is tied up in so much of so much of healthcare and in some ways policy makers we've done it to ourselves by calling it something like value based Care by focusing on incentives by talking about the cost curve and um the Medicare trust fund all

[25:02]  important stuff but in the meanwhile people really feel like none of that conversation has to do with the health that they need the healthcare they need it sounds like messaging has been targeted at those who are providing the health care services rather than the recipients of it and that just seems completely opposite of consumer Centric Care today or consumer Centric world that we live in in general that's right and and and we're not here just for like good messaging exactly but um but good substance underneath it and so like if you you go to our website you can see that work on Patient First Care as we call it and not only do we talk about like the the frame of of Patient First Care and what matters to people most um but the policy principles that should stand up behind that and so if we're building Patient First policy principles for changing our healthare system this

[25:49]  is what that would look like um and that's all to the end of making sure that we're Paving a path for policy to change like if we're doing good message testing it's so good policy passes good laws pass um and that's kind of the the recipe that we work on and then we go out and pass them Well here here's a recipe for let's say creating a more personalized right Healthcare experience one of the biggest challenges if you're integrated into Healthcare in and in any fathom or any factor is you're recognizing that we have huge staffing issues nursing shortages doctors you know certifications of docs who are coming out of medical school that number continues to decline so is there a way for us to start thinking about the other human that we're kind of all developing today in

[26:36]  the world of like AI is there a a Synergy or a collection between using digital team members to gather information for us that makes it readily available to enable the patient to go into the healthcare environment better prepared and feel more personalized what's kind of your two cents on AI in the healthcare space yeah I mean it is definitely everywhere right and I think if you're in the AI Healthcare conversation you realiz izing where we're we're calling what was just like digital health or other things like AI but then there are real advances happening in in healthcare and and our goal um actually this past summer was to go out and talk to the public about like do they know AI is coming to healthcare what does that mean for talk about trust what does that mean for their trusted relationship with the health care system or their their provider more likely um what scares them what interests them and

[27:24]  then what changes across demographics and um we say there are some people that self-reported at least that they do know that AI is in healthcare um and often they knew that from um watching the news that was the biggest source they had of kind of understanding Ai and Healthcare um the more people knew about AI or self-reported knew about AI then we saw a correlation of their comfort of a AI being in healthcare um but then we went with five use cases that we're kind of seeing out in the marketplace right now you know anything thing from back office um to support ambient listening um to actually support during like a surgery um and it became clear and it was really wild it was across demographics almost the exact same like it was very very very little um demographic difference um

[28:13]  people you know if they where they had Comfort it was usually like in back office admin sort of support and then the closer it got to their own care the more nervous they got um for it um and what that tells me is the healthcare system has a long long way to go of building trust with people with AI and we've seen over and over again that we wait too long to build to let people know about Innovation that's happening in healthcare and all of a sudden we just plop it in there and we expect them to be fine with it and my real concern is that we aren't taking the time as a Health Care system to really understand what are the use cases people care most about and how do we bring them along on this journey so that when we are asking people to you know do an AI diagnostic before they show up and um or ambient

[29:03]  listening um that that we're doing that hard work I think deoe had a survey out asking Health System Executives their priorities right now in Ai and of the five they listed every single one of them I think listed in educating consumers or patients on AI is the least important um they have right now and I think that's just a big mistake I think we're gonna huge yeah and we're going to really take a step backward on progress that we could be seeing but we have to be taking the time and um interestingly the one really interesting fact finding that we had with that and you know we're seeking support to go out and and do more listening towards these research questions but one was um there were times in the the survey that people uh black people and Hispanic people

[29:54]  actually had higher degrees of interest in healthcare making in in AI making Healthcare delivery better for them and we weren't able to ask why in this research study so like we're like chomping out the bit to go out and do that you know our hypothesis is that people of color recognize that the healthcare system isn't meeting their needs it's not it definitely doesn't have their needs centered and maybe AI would make that better you know there's all sorts of questions we would ask under there of like do people know about how algorithms are created and and such and but maybe they maybe they do and maybe they still feel like a you know AI would would be better than some of the ways they're treated the Health Care System right now I mean naturally I go from the place of thinking about you know stigma towards Health Care in different segments of our population and demographics right if you don't feel

[30:41]  like even from a position of being able to raise your hand and ask a question of a trusted resource is challenge because that's part of your culture right we don't talk about those things outside the house maybe this is a digital front door that people can access to get good trusted information from some a trusted resource that they can lean out to yeah AB absolutely and we just got to do the work to to get there right I mean we've been in rural um counties especially in South Carolina but in Colorado and others and there's a real there's a real lack of providers like you said um and they aren't getting as good of care as everybody else AI has a real or virtual care in Ai and you know a real opportunity to really Bridge some divides if we care about getting those into the right places there people talked about that they didn't feel like

[31:27]  they could go in their little local town they couldn't go to the Addiction Center or they couldn't go to a mental health center because everybody would see them going I mean so they don't and there's real ways that this could could help My worry is that we're just not focusing on patients let alone those that are often Left Behind yeah I mean it seems like once again if we change the incentive we change the outcome because I think about naturally of course and this is a big process for me in 2014 I started a tella Health company right and so we were starting to go out and say hey guys doctor CEO of the hospital system there's going to be a future for a virtual interaction the biggest instance that stopped our initiatives from moving forward was not that our patients aren't going to like this but I'm never going to be able to get my docks to adopt this which in itself seems a little bit

[32:13]  backwards from how we need to kind of attack the future we need to educate the population to make sure they're comfortable with this tool and then when they come into an environment that they've been educated about they understand how the technology directly impacts them and their overall journey in the healthcare system seems like just like right like we've made it clear why this is important to them yeah to to the goals they have for their health and the healthare system I agree man so here's a question for you I want to switch gears a little bit and talk about how we build a team around such an important initiative right so recognizing that being a museum curator right and starting your own flower shop was it just wanted to be okay okay all right well you know and then we pivot into saying hey you know I'm going to be a part of this organization we start up a nonprofit I Ascend through the organization from an adviser to being a CEO so how have you been able to cast a vision right as a leader of the

[33:01]  organization to find other highly talented people to get behind this mission that you guys are actually kind of you know pursuing yeah um we have the best staff we've had the best staff that have worked here since the you know over time and that are here now and the people that have helped shape the organization and I think one of my core attendants is really hiring it's kind of I know a lot of people say this but like hiring everybody hiring people that are smarter than you I you know I am not a policy wonk but I've hired the best policy people to do the policy wonk I started our community engagement work but I'm not a researcher um and so for me making sure that we are hiring the best talent and they know that they are coming in there to build um the strategy and seeing how that all ladds up to the

[33:48]  overall organizations's um mission is is really critical and really allowing people if they as they've here is to build out what are those strategies for the work that they're doing our State team it would be a disaster if I built the if I built the strategy for our state advocacy work our team that is out in States uh who have worked at in the state advocacy space should be doing it and so I think really building the building the team of experts and letting them run all towards you know our our overall okrs for the organization has been really key and then you know something we've really really been focusing on is then how do do we maint retain that amazing staff um and for us that means like great benefits um and as

[34:36]  a nonprofit We can't pay the best people could go and get you know better high paid jobs but they're Mission driven and so making sure that we have unlimited vacation time which we still have to force people to take we close between Christmas and New Year's we close um on Fridays in the summer uh we have a sabatical plan that I took my sabatical this past uh year I was a fifth employee to take sabatical and really making sure that as we think about what is diversity Equity inclusion the idea of inclusion means people to us that people are showing up as the full self whatever they feel comfortable showing at work but they also have a life outside of work and those all of that is supported um through through our work and you know I think maybe as somebody who is kind of creative and more of entrepreneur

[35:23]  letting the team build those things under you know within their expert is um something I at least look to the team to do and I I hope I believe they feel supported in doing that as well do you ever have feelings of like insecurity or impostor syndrome right trying to have such a huge impact in the space that you didn't naturally come from yes oh my God all the time uh uh and you know it's actually interesting I um I had a media coach a couple of years ago when I first stepped into this role my board chair is very supportive of making sure that I was ready to do this and part of that was being a media coach and a lot of those insecurities came out um because when you talk to the media you have to be confident you have to you can't say I think this or maybe that like you have to say things definitively and you have

[36:10]  to come with a presence and um and have some uh Charisma you know the first time we were doing uh uh this is all virtual because it was during the pandemic and she was like all right Natalie we're going to pretend like you're starting this webinar 54321 and I like went back I like froze shoulders back and um just started like saying my script and she's like what happened to you like you're very you're very fun you move your hands a lot like what happened and I'm like well I thought I should be professional and she's like you have the wrong definition of profession professional like that's changing now and um that honestly was one of the first times that it's helped me kind of push through imposture syndrome of having someone coach me of showing up with confidence and um and building that then under you know as you get winds under your belt

[36:59]  and um you realize what you can control and can't control and um you know getting the coaching that I need in lots of different ways from our team and from others I think has really helped as much as possible with them imposture syndrome and and I'm trying to you know as lovey I J Jones says like not even think of that concept anymore because it means you don't belong in the room that you are literally in um and so I'm trying to abolish even that concept from for myself but I totally feel it do you Keenan do you have that when I first got into the space right in 2014 or I was 24 years old so I'm a young guy going into these Hospital Systems I would dress up with a suit and tie button up slacks nice shoes and things like that now I go into meetings right with the current type of fit that I have because one thing that I heard from a

[37:47]  mentor it's you know confidence does not come from shouting affirmations in the mirror but having a stack of undeniable proof that you are who you say you are behind you and if I were to lean on any element of your story The 25,000 interviews the 5,000 hours spent means you have the information Advantage so we're not just hypothe you know we're not just hypothesizing or talking about ideas in a vacuum but rather you've got the information Advantage about what the people want and so being able to come into a conversation like this and articulate what people are looking for based on the conversations you've had superp power yeah that I love that that quote and I thank you for saying that and I you know it's funny when I started that part of the workout people including people in our organization are like what the hell are you talking about you're going to go and talk to people and you think they're going to agree on

[38:34]  stuff like what uh and you know I really was taking lessons from Human centered design and from other ways that you Center the patient you know person um but that was those were scary times it was not only a new organization but it was also like this really New Concept that nobody really understood what I was talking about but now we do have the data and we do have unique IP and we have a dat database and and we've impacted the lives of millions and millions of people through the legislation work that we've done in States and in Congress so let's go let's go just to to say very simply so I want to talk a little bit about what what's the future going to look like what are we thinking about 2025 2026 what are some of the initiatives what are we trying to accomplish what are we trying to impact yeah so we're going to out there talking to people combing our data that we already have to make sure that

[39:21]  we're continuing to find insights um and talking to people across the country we launching an initiative called pulse of the people which really is there to uh routinize our data collection our conversations with people make a public use um website where people can find these insights on their own um and use that to drive a narrative um uh in the next you know two years four years six years about what matters most to people as I think about an election that's only that's two years away and then you know presidential election that's four years away I want to make make sure that we are having a conversation across the both political parties of what do people actually want and what are solutions to get us there and I don't think either side right now really have the ideas

[40:10]  that are going to meet the needs of people and the expectations that people have as we're coming up on elections I know we haven't even inaugurated our new president so I know I'm I'm I'm looking um already towards the next election um but but that's important in future planning there's a lot of work that this Administration and Congress wants to do to make health care more affordable in some ways and and we're here for that we've done a lot of that work in the state level and we want to bring that up to the federal level and show where we can make an impact to make Healthcare more affordable um we also have concerns about a lot of um ways that we're worried Healthcare could go backwards and and people will lose coverage and lose affordability um and so we're going to be working closely on that um you know really defend people's

[40:58]  access to affordability and um and making sure we don't go backwards um you know I think there's a real interest in this uh Administration on what is it what is health and prevention and wellness look like and we want to bring that science-backed you know uh responsible way of thinking about health um matched with our what we hear from people and making sure that that that view is represented um and then we are working in um you know we're we're hoping to work in states to really expand through our Women's Health Project expand the benefits that women need after they are no longer pregnant as we've talked to women and I have four kids I felt the same way after you have the baby or you aren't pregnant you're you aren't the one that people are are catching up on

[41:45]  and and and and your insurance isn't there to give you the support you need that year postpartum and so a lot of work that we're doing in states to make sure Healthcare is more affordable includes making sure women have what what they need after they are no longer pregnant um so we're going to have we got a lot of work to do um really excited to to come and talk to you about that to to really talk about the amazing work our team does and um all towards making that you know more patient centered healthc care system well knowing that we have leaders like you that take their heart and their hustle so seriously to be able to impact everybody right is so important and I feel so much better knowing that we have amazing leaders and organizations like United States of care out there that are prioritizing these things so important you know Natalie we have a tradition

[42:32]  here on the podcast where our previous guest wanted to ask you a blind question oh gosh so their question was what does innovation mean to you ah I love that Innovation to me means finding a problem to solve asking constantly asking questions on why things are the way they are how things can get better not assuming any answer or way we've done it before matters and then delivering that that as a as a solution that you iterate over time I love that well Natalie it's easy to understand why you are on the show you are the definition of heart and hustle and I just want to thank you for everybody who's been tuning in watching and listening today thank you so much for coming on the show with us we really appreciate it oh I

[43:19]  loved it thank you so much all right that's a wrap