Gabriel Seidman of the Lawrence J Ellison Institute for Transformative Medicine: 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

I would emphasize the importance of task shifting, or reallocating healthcare tasks from physicians to other healthcare professionals, including allied health workers. My research has shown that task shifting could lead to significant cost savings in health care systems in developing countries without negatively impacting health outcomes, and the same approach has worked in the United States. However, we currently have a patchwork of laws that vary state-by-state on what services different healthcare professionals can perform. Expanding task shifting by standardizing its practice and ensuring appropriate quality control measures are in place could help expand access to care, especially primary care, prevention, and wellness services.

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 Gabriel Seidman.

Dr. Gabriel Seidman currently serves as Director of Policy for the Lawrence J. Ellison Institute for Transformative Medicine of USC. In this role, he leads efforts to amplify the impact of the Institute’s research and clinical work by engaging with and influencing external partners, including governments, other research institutes, think tanks, the private sector, and civil society. Gabriel has worked on health systems topics across North America and Africa, and he holds a Doctorate of Public Health from Harvard T. H. Chan School of Public Health.

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 work focuses on how to maximize the population-level benefits of health care and health technologies. I actually never had an interest in practicing as a clinician, and I hate working in a lab, so you might say that a career in healthcare was somewhat unexpected. I first developed an interest in public health by learning about the social, political, and economic factors that contributed to the spread of the HIV/AIDS epidemic, both in the United States and in Sub-Saharan Africa. These two parallel histories, where cultural forces led to devastating health outcomes for entire populations and also major transformations in the health sector, exposed me to the powerful ways that policy can literally have life-or-death consequences. Since then, I’ve had the privilege of working on a broad range of projects related to societal forces that impact health outcomes, from malaria treatment in West Africa to diabetes management in Ontario, and now COVID on a global scale. I love how I can work on diverse projects with a wide range of topics that always have a recurring theme of making health systems work to drive impact at scale.

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

Seeing the reactions of my friends and family to the pandemic over the last year-and-a-half really sticks out for me because it feels like the culmination of a lot of other experiences I’ve had in my career. I’ve worked on topics like epidemiological modeling, health systems management, and public health policy for a long time. My friends and family have always known what I do at a high level, but we rarely ever go into the details. I know that when I’ve gone abroad for projects, it feels to them like my work is very “far away” and unrelated to their daily lives. But now I regularly sit around the dinner table talking about topics like contact tracing, herd immunity, and vaccine boosters. All of a sudden public health feels very real, and people in my circles really understand how and why they personally benefit from investments in public health. I’ve found it very personally validating and humbling to work in this field during the pandemic, and I hope that this effect of COVID-19 on our broader awareness of the importance of public health long outlasts the pandemic itself.

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?

I started studying French while working in Rwanda for a summer. During one of my early lessons, I tried to say “I am hungry, so I would like a sandwich,” but because of my terrible accent, I said, “I have a lot of wives, so I would like a sandwich.” (For any Franchophones reading this, I meant to say “J’ai faim,” but instead I said “J’ai femmes.”) After several minutes of utter bewilderment, my French teacher, who did not speak any English, finally understood the mistake and laughed so hard that we had to take a break from our lesson. I turned beet red when I realized my mistake. A couple years later, I worked work on a project exclusively in French for several months despite only having intermediate-level proficiency, and it was a real challenge, but I managed to get through the project. These days, I fortunately only have to work in English, but I often find myself working with subject matter experts where I don’t know all the details of their work. I treat these interactions like conversing in a foreign language — I make sure I’ve got enough of the vocabulary to have a conversation, and I don’t beat myself up too much if I make a mistake every once in a while.

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

My grandfather, who was a hospital administrator and one of my mentors, helped teach me to play chess when I was very young. He used to tell me, “You always want to play chess with people who are better than you, otherwise there is no way that you’ll improve.” I try to bring that mindset to my professional life by surrounding myself with people who have more experience than I do and who know more than me. That allows me to treat every professional experience I have as an opportunity for learning and growth.

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

The Ellison Institute recently partnered with two other organizations — the Tony Blair Institute and scientists at Oxford University — to launch the Global Health Security Consortium. COVID-19 has laid bare some major gaps in our global ability to respond to emergencies. This Consortium aims to close some of those gaps by working at the intersection of science, medicine, and politics in a lean and agile manner. Our approach is to act as a non-sovereign voice that can influence political leadership using deep scientific and policy expertise. For example, our research found that the global community could reduce the time to achieving vaccines at scale around the world by 18 months by strategically sharing doses and prioritizing certain populations.

How would you define an “excellent healthcare provider”?

For me, an excellent healthcare provider is someone where the clinician-patient interaction doesn’t begin and end during the appointment. I’m currently in the process of starting a monoclonal antibody for an autoimmune condition, and I have to continually keep my specialist informed about the latest research on treatment options and nag them to fill out the paperwork I need to get insurance coverage. To me, that does not feel like an excellent provider. By contrast, my primary care provider checks in with me periodically between visits for updates on how I’m doing and has gone out of her way to develop a personal relationship with me. That makes me feel like she’s treating me like a person, not just a medical condition, and having a holistic picture of how I’m doing helps her provide better care and resources for my health.

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?

The main point I’d like to make is that public health is a public good. The healthier the people around you are, the better off you are. The pandemic exposed this reality at its most extreme, because the level of virus circulating around you had a direct impact on your chances of getting sick, and the number of people taking up hospital beds in your area had a direct impact on whether you could get treatment if you needed it. In my opinion, the biggest challenge that faced the US healthcare system from the beginning of the pandemic was our collective inability to come to terms with the nature of public health as a public good. We had such vast and different ways of understanding what the pandemic meant for us as a country that we had a very patchwork, inequitable, and uneven response. Even today, the vaccination rates by state vary widely, with official CDC data showing many counties above 70% vaccination rate, and others below 30%. We never had a single US healthcare system response to the pandemic because we never had a single narrative or understanding of how the pandemic would affect all of our lives and livelihoods. At a population level, that means that we’re still seeing avoidable deaths and illness.

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.

Before answering this question, you should know that I have a bias here. Both my mom and stepdad are essential workers in grocery stores. I think we have to credit the essential workers as heroes of this pandemic as well, because they risked their lives to make sure the rest of us had everything we needed to get through this time. The pandemic highlighted a very interesting paradox, where the workers we consider most “essential” also often face some of the lowest pay and greatest barriers to accessing care.

Focusing more explicitly on the formal healthcare system, the speed-to-market of COVID vaccines was remarkable. Pharmaceutical companies shrunk a process that typically takes ten years into 11 months. I think we will start to see a paradigm shift going forward, not just in what biomedical technologies we use for vaccines (like mRNA), but also in how we fund and conduct pharmaceutical R&D and manufacturing planning to bring products to market. The fact that the CDC also rapidly set up a direct-to-consumer post-marketing surveillance system with V-SAFE to monitor vaccine safety after their emergency approval will hopefully set a precedent for monitoring real-world outcomes for other vaccines and medicines going forward. By the end of June, the V-SAFE database had nearly 60,000 patients enrolled in the 12–15 year age range, which shows our ability to gather real-world data rapidly and at scale.

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.

First and foremost, we need a renewed focus on health equity in everything that we do. I don’t think of that as a single change, but rather an approach that informs all the work needed to transform medicine and healthcare going forward. The pandemic highlighted major racial and socioeconomic disparities in health outcomes; reductions in life expectancy in 2020 from COVID were 3x-4x greater for Black and Latinx people than they were for White people. These disparities reflect much deeper inequities in the public health, health care, and social systems, and we need systematic and vigilant efforts to address them.

Beyond that overarching priority, I would propose several specific changes to improve the healthcare system:

• Incentives and systems for tracking health outcomes: Because of our fragmented care delivery and data infrastructure in the US, it is extremely difficult to track patients in a longitudinal manner to understand how their health progresses over time and how they respond to treatments. I can talk about my own care as an example. As I mentioned earlier, I’m in the process of starting a new medication for an autoimmune condition. I have had this chronic condition for three years and will for the rest of my life. Because I’ve moved several times, I’ve seen a number of different providers around the country for my treatment. There is no simple way for me to integrate and share with researchers the treatments I’ve received and how they have affected my health. Now that I’m starting a new medication, I would be interested in joining a patient registry to help support research on patient outcomes for people living with my condition, but my physician doesn’t participate in this registry, so I have no way to do that. Providers, patients, and researchers should have incentives to longitudinally capture health outcomes and other patient data, and the systems to do so seamlessly. These systems should integrate data at multiple levels — from a patient’s genome to their zip code — to draw meaningful insights about their care and learnings for others. This issue of outcome tracking and sharing also applies to the research community. For example, despite federal rules for clinical trials sponsors to share data within one year of completion, fewer than half do. From a health equity perspective, having more robust incentives and systems in place could also help make sure we have sufficient, quality data from specifically underrepresented and harder-to-reach communities.
• Incorporating social determinants of health work into our healthcare system: Very often, the root causes of a person’s health issues sit outside the traditional purview of the healthcare system — access to affordable housing, food, energy, social support, transportation, etc. No pill or blood test will solve those issues. I love some of the innovations working on novel approaches to address these issues. For example, we saw rideshare companies (in partnership with the White House) donate rides for COVID vaccine appointments, specifically for low-income and vaccine-hesitant communities. Another initiative I recently learned about from a colleague — integrating access to legal services into primary care through medical-legal partnerships (MLP). One randomized-control trial found that MLPs increased infant vaccination rates and reduced infant visits to the Emergency Department by 25%, a statistically significant finding.
• Higher levels of insurance coverage: According to HHS, 30 million people in the United States still lack insurance coverage, and this lack of coverage disproportionately affects people of color, low-income individuals, and young adults. Fortunately, we have seen a nearly 7% drop in the number of uninsured since 2010, but a nearly 1% increase in the number of uninsured since 2016. With ten years’ worth of data on the impact of insurance coverage expansion, we now have a growing body of research that demonstrates how health insurance improves a wide range of health outcomes, including self-reported overall health, maternal and neonatal health, noncommunicable diseases and cancer, and overall mortality. I hope that we don’t reach a plateau in insurance coverage levels across the country.
• An accelerated commitment to global health leadership: In 2003, the US’s leadership in combatting HIV/AIDS via PEPFAR (President’s Emergency Plan for AIDS Relief) effectively turned the tide of that pandemic, and in 18 years, it has saved 20 million lives. More recently, the Biden Administration’s commitment to sharing COVID vaccines globally, including 500 million Pfizer vaccines by June of next year, reinforced the US’s leading role in global health. Global health programming is a strategic investment that builds diplomatic relationships, grows economies, and makes the world safer and healthier.

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

There are lots of proposals out there for addressing this challenge. I’ll focus on two. First, bringing care online with telehealth services is critical. We saw massive expansion of telehealth during the pandemic, and the recently released draft of “Cures Act 2.0” puts a focus on how to expand telehealth to improve patient health going forward.

Second, I would emphasize the importance of task shifting, or reallocating healthcare tasks from physicians to other healthcare professionals, including allied health workers. My research has shown that task shifting could lead to significant cost savings in health care systems in developing countries without negatively impacting health outcomes, and the same approach has worked in the United States. However, we currently have a patchwork of laws that vary state-by-state on what services different healthcare professionals can perform. Expanding task shifting by standardizing its practice and ensuring appropriate quality control measures are in place could help expand access to care, especially primary care, prevention, and wellness services.

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 don’t see a distinction between “individuals,” “communities,” and “leaders.” Some of the most important changes in healthcare have come from patient advocates and the communities they work with. For example, coming back to where we started this discussion, community organizing by HIV/AIDS activists in the 1980s and 1990s revolutionized the way that the FDA conducts clinical trials and gives patients access to drugs. Advocacy in the cancer community has taken a similar approach to increase funding for research, and more recently, community activists have come together to protect insurance coverage for people with pre-existing conditions. Leadership will always come from patients who recognize how policy decisions can mean the difference between life and death for them.

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. :-)

In 1948, the World Health Organization defined health “as a state of complete physical, mental and social well-being.” I would like to see a world where every individual and community has access to the right resources at the right time needed to achieve that level of health. I should add a caveat that I’m very much a pragmatist and a planner, so as soon as I laid that out, I immediately start thinking about what it would take to get there. Universal access requires insurance coverage and healthy living conditions. Selecting the right resources at the right time requires data-backed and evidence-informed decision-making, plus the right market conditions to make those resources available and affordable. I could go on and on about what it would take to make this work, but I’ll stop there and just say if any readers have thoughts or ideas about how to make this a reality, I’d love to connect!

How can our readers further follow your work online?

I’m brand new to Twitter and still figuring out how this thing works, but you can follow me @SeidmanGabriel. Or, better yet, reach out on Twitter to start a conversation. You can also follow the Ellison Institute for Transformative Medicine at @UscEllison and check out our website: eitm.org

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