Dr. Anish Mehta of Eden Health: In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System

An Interview With Luke Kervin

Meet patients where they are. Even in their home. Doctors rarely have insight into the whole picture of their patient’s lives. From their office, they only get a small glimpse of what the patient chooses to share with them. A move towards home-based or virtual visits allows doctors to evaluate the whole person, including things like nutrition, exercise, mental health, hygiene, even family members that are involved in patient care. Having a complete view of a patient’s life may even change their recommended course of action. This byline examines the benefits of home visits, and, by proxy, virtual care.

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.

As a part of this series, I had the pleasure to interview Dr. Anish Mehta.

Dr. Anish Mehta, MD, MPP, is the Medical Director of Care Transformation at Eden Health. Dr. Mehta is driven to create innovative ways to care for patients and believes strongly in the power of technology to lower the barriers created by traditional healthcare. He earned his MD from Case Western Reserve and completed his training in internal medicine and Brigham and Women’s Hospital after earning a masters in public policy at the Harvard Kennedy School.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?

My interest in the medical field started young as my mother is a primary care physician in Ohio. I attended Case Western Reserve for medical school where I helped start a student-run, free medical clinic. At the time, I was also doing a lot of advocacy around expanding Medicaid in Ohio and getting people signed up after it expanded. I saw firsthand how the complexities of health insurance can be a big barrier to getting the care they need.

This led me to receive a Master’s in Public Policy from the Harvard Kennedy School before I was in residency for internal medicine at Brigham and Women’s Hospital. Since then, I’ve worked passionately to find ways we can improve access to care — whether that is by making health insurance easier and less costly, or by finding new ways to deliver care like telemedicine, home-based care, or other methods outside of a traditional healthcare setting.

I am now the Medical Director of Care Transformation at Eden Health, working alongside our primary care physicians to find the best way to leverage virtual and in-person care. I am also an assistant clinical professor at Mt Sinai, where I deliver care and teach medical residents.

Can you share the most interesting story that happened to you since you began your career?

I worked as a home hospitalist at the beginning of my career. With the help of a nurse and some really cool technology, I delivered hospital-level care to patients in their homes as an alternative to them being in the hospital. I was traveling to my patients’ homes every day while they were ill, so I got to know their families, their home situation, and their personal lives really well. One interesting story from this time was that I took care of a patient with a really debilitating gout flare. The patient had a history of gout, but they had turned their diet around, exercising more and eating healthy. So they were devastated when they had another flare, this time involving multiple joints and worse than any they’d had before. When I got to their home, I saw that the patient was indeed eating right, there was no alcohol or red meat in their fridge, mostly healthy foods and vegetables. However, I also saw that they were taking protein powder and creatine powder supplements to help build muscle. The patient thought that this was healthy, but protein and creatine supplements can cause gout flares, which no one had told them. More importantly, no one had thought to do a close review of the supplements that the patient was taking in addition to their medications. This really highlighted the importance of asking the right questions and getting to know your patients.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

This is not really a mistake, more of an unexpected diagnosis. I took care of a patient who was admitted to the hospital with chest pressure, lightheadedness, confusion, and just feeling really off. We did a full workup and couldn’t find anything wrong, but we admitted them for monitoring because of the sudden onset and acuity of the symptoms. The patient’s daughter later came in to see her in the hospital, and we’re all in the room explaining what’s going on. As we’re talking, we could see the daughter’s face turn beet red. The daughter turns to the patient and asks — “Mom, when you were in my apartment earlier, did you eat any of those brownies in the fridge?” The patient admits that she ate one or two…and all of a sudden the daughter bursts out laughing. “Those were weed brownies…you’re high!” It was a lesson that you should always try to talk to the patient’s family to get a history in addition to the patient!

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“In God we trust, all others must bring data.” — W. Edwards Demming

For me, this perfectly illustrates the fact that we must be constantly bringing data, measuring results, and collecting feedback in all the care that we do. Providers can’t just go with a gut feeling — we need to put data behind it. We should be leveraging all the technology we have at our fingertips to measure data at a population level and combining it with the real-time feedback collected on a personal level to make sure what we are doing is actually making the difference we want.

Are you working on any exciting new projects now? How do you think that will help people?

Right now my biggest, most exciting project is around care transformation which I break down into 4 buckets:

1. App optimization: I work closely with our product team, optimizing our app to help increase patients’ engagement with their care. We are developing an individualized primary care plan for every patient based on their demographics and clinical needs, and we are building systems to help patients stick to their plan.
2. Provider training and continuing education: We want to maintain an academic environment within the clinical team. Since much of our team works virtually, we have created remote learning sessions, virtual rooms, and other ways for our teams to learn and discuss important developments in clinical care. By creating this environment, we want to continue to build a close-knit team of providers who can trust and lean on each other.
3. Decision support: We are creating clinical pathways to help guide treatments, and then to have those pathways integrated into our back-end technology.
4. Clinical innovation: I’m particularly excited by this area where we are starting to explore ways to close the gap between what you can do in person and what you can do virtually.

How would you define an “excellent healthcare provider”?

For me, an “excellent healthcare provider” is someone a patient can trust and have a relationship with. This provider is someone who listens more than they talk and can help a patient meet their goals without the patient feeling judged.

Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?

A few examples of where we have seen the US healthcare system struggle are:

First, An under-investment in primary care and an over-investment in specialty care: The pandemic was the biggest healthcare need in our nation, but primary care providers did not have the resources to respond. In fact, many practices closed, people even lost their jobs as healthcare systems struggled to stay afloat because elective procedures stopped. In a time when we most needed primary care, the system didn’t support it. More money should be reserved for primary care because it should be the front line for healthcare in this country.

Second, the Mental Health Crisis: The pandemic changed all of our lives forever in a profound, many times tragic way. We are seeing what many have described as a ‘collective trauma’ as a result and our system is not set up in a way to help people deal with this. There is still such a stigma around mental health and a lack of resources to help. In reality, mental health is completely tied to physical health and should be treated as such. With care methods like collaborative care, a primary care provider can help to bridge that gap both destigmatizing mental health and increasing access.

Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.

I think we did a great job of transitioning millions of patients to virtual care. While it wasn’t perfect at first, the entire system did a remarkable job at changing the way we administer and receive care. Providers quickly made whatever tools they had work for them and the government loosened virtual care regulations. We had a patient who was coming in weekly for therapy and at the onset of the pandemic was extremely worried about what might happen. However, they were able to quickly transition to virtual therapy and build an even closer relationship with her therapist with more ways to communicate because of it.

Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

1. Meet patients where they are. Even in their home. Doctors rarely have insight into the whole picture of their patient’s lives. From their office, they only get a small glimpse of what the patient chooses to share with them. A move towards home-based or virtual visits allows doctors to evaluate the whole person, including things like nutrition, exercise, mental health, hygiene, even family members that are involved in patient care. Having a complete view of a patient’s life may even change their recommended course of action. This byline examines the benefits of home visits, and, by proxy, virtual care.
2. Take a collaborative approach to care. Recent studies have shown that more than 80% of patients with medically unexplained symptoms seek psychosocial treatment in a primary care setting — but only 10% will follow up on a referral to a mental health provider that is not co-located. By taking a collaborative approach to care — we can help patients have a single, longitudinal care journey. With collaborative care, primary care physicians are trained to ask behavioral health questions and work with a team of mental health professionals to treat any potential issues that come up. Building a dedicated care team for patients not only improves patient satisfaction but helps build trust & reassurance, and leads to better outcomes.
3. Create a new medical doctrine: first, listen to the patient. Right now it can take thirty minutes on the phone to book an appointment that is not for two weeks. Then when you finally see a doctor, it can be a short 15-minute appointment which results in a referral to a new specialist. The moment you leave the office, you’ve left with more questions than answers and have to start the process all over again. Doctors have financial and administrative pressures to see more patients in less time, and as a result they lose the opportunity to actually sit down and talk to the patient, to listen and observe–which is often more telling (and more assuring to the patient) than sending them off to another practitioner. I’d like to see more doctors have the opportunity to have dialogue with their patients. Patient-centered care means joining the patient on their journey, not just getting them to their destination.
4. Remove cost as a barrier to care. When patients are sick or have a problem, the cost of care is always top of mind. There are many services that are supposed to be free that patients are concerned about cost so they may not engage in — like the COVID-19 vaccine, birth control, preventative care, cancer screening. High-deductible health plans are not a solution, but in fact, decrease access to care and make cost an even greater barrier for many. We need to make the system simpler, and more affordable for all individuals — especially when it comes to preventative care.
5. Reimburse for healthcare based on outcomes that patients care about and that matter. There is a reason why your doctor’s appointment might only be 15 minutes long — today doctors have pressure to see as many patients as possible. This is not how patients like to be treated or how doctors like to administer care. So we need to move away from a fee-for-service model and instead reimburse for value. This way we are delivering care that delivers better outcomes for the patient.

Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?

I think we can do three things. First, reduce the cost of medical training. Everything from the applications to actual tuition is so expensive that it’s simply not accessible to too many. Next, we can increase the number of residency spots available in the United States. And finally, we can diversify the workforce with advanced practice clinicians and other professionals. PAs, NPs, and nurses can all help increase access to care

How do you think we can address the issue of physician diversity?

We should start building the pipeline early to build interest in medical training among underrepresented groups starting in middle and high school. Then, we can re-evaluate admissions criteria for medical schools to ensure that the standardized tests and admissions criteria are not inadvertently biasing against underrepresented groups.

How do you think we can address the issue of physician burnout?

We need to allow physicians to spend more time with their patients and get to know them better. We can do this by reducing the non-clinical work that they are doing and moving away from a fee-for-service model. We should also give physicians more of a seat at the table to actually make decisions and have their voices be heard. Physicians are the ones that actually deliver care to patients — so their opinions on how to deliver that care must be considered.

What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

I think we can as a society do two simple things that will help manifest the changes I mentioned. First, invest in health. For corporations, this means not only bringing on the best health insurance but also providing better ways for employees to receive care that actually results in better health outcomes. Communities should invest in making healthcare more accessible to underserved communities. This can come in the form of education, free clinics, or any number of other activities. Individuals should invest in preventative care — putting their health as a priority before issues arise. And for leaders, this means actually investing in collective health and realizing that the system we have now is broken. Investing in a value-based system will create more affordable healthcare that delivers better outcomes.

Second, destigmatize mental health. Much of this comes from education — communities must educate and talk about mental health, its connection to physical health, and the benefits everyone has from caring for it. Corporations should acknowledge that mental health plays a large part in the productivity and happiness of their employees. They can bring on solutions that help employees manage their mental health and train managers on how to talk to their employees about it. Leaders should make getting mental health support easier, providing more insurance coverage and educating the public on the importance of it.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

I would love to move towards a value-based health system. Right now, we are incredibly burdened by the cost of care — doctors are not able to treat patients the way they were trained to, patients don’t receive the care they need, and the cost of care continues to rise. Moving in the direction of a single-payer, value-based system will help us achieve these goals and fix what I think we can all view as a broken system.

How can our readers further follow your work online?

Follow our work at Eden here:

LinkedIn: https://www.linkedin.com/company/eden-health/mycompany/

Twitter: https://twitter.com/EdenHealthInc

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.