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Is Louisiana a healthy state? How does geography affect health care? Why are community health programs important? How is health care affected by socioeconomic status?
Yvens Laborde, MD, chief community medical officer and medical director of global health education at Ochsner Health joins for a new episode of the AMA's “What Keeps Me Up” series, where we talk with health care leaders about one thing that’s keeping them up—and what they’re doing about it. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Yvens Laborde, MD, chief community medical officer and medical director of global health education, Ochsner Health
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. We're back with another episode in our new "What Keeps Me Up" series, where we talk with health care leaders about one thing that's on their minds right now and what they're going to do about it.
My guest today is Dr. Yvens Laborde, chief community medical officer at Ochsner Health in New Orleans. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Laborde, thanks so much for joining us today.
Dr. Laborde: Thank you. It's a pleasure to be with you.
Unger: Dr. Laborde, the chief community medical officer is a brand new role at Ochsner and you're the first one to step into this position late last year. So tell us, what's been keeping you up since then and why?
Dr. Laborde: That's an easy question. Unfortunately, the fact that Louisiana has been ranked 50th by the America's health rankings in terms of our health status is a reason why I've had so many sleepless nights recently.
Unger: That's not a great statistic, and that obviously means that you and the folks at Ochsner have your hands full, obviously no shortage of work that needs to be done to address these kinds of issues. How do you take on a challenge like that? What are your top priorities for the year?
Dr. Laborde: It is a tremendous challenge, and what we've tried to do is prioritize our interventions based on the major structural drivers who are actually leading to us having these poor health outcomes. As you know, 80% of our health outcomes are really driven by non-medical and social determinants of health. And so our significant focus at this point in time with our healthy state initiative is to focus on how we can address these social determinants to improve the health outcomes of the state.
Unger: Talk to us a little bit more about some of your specific goals, and how you're trying to prioritize your efforts, especially around data to drive decision making?
Dr. Laborde: Yeah, one of the things that we've actually used is actually use the data from the America's health rankings, but also from our community health needs assessment. And so one specific point of information is the fact that the premature death rate is significantly high. That's one of the factors have actually driven our poor health rankings.
And so that also has been driven by the incredible number of chronic conditions, cancer, obesity, smoking. And so we try to use a data-driven approach by trying to understand specifically what are those drivers and then implement interventions. Effective interventions to drive them down.
Unger: When you follow kind of a data-driven approach like that have there been any surprises that would have maybe gone undiscovered otherwise?
Dr. Laborde: Well, yeah. I think one of the things that we focus on primarily is to understand how does geography impact our data. And so we found—obviously there's a significant correlation between the environment and the geography where actually patients actually live and the nature of their outcomes. So having understood that, we use that data to really focus our areas of intervention.
So we like to think of the idea that we like to actually provide the right intervention for the right community, within the right context and at the right time.
Unger: All four of those things need to work together. I'm interested to hear more about your health equity work because that is so central to advancing your goals. Is there a program that you're particularly excited right now about at Ochsner?
Dr. Laborde: Yes, absolutely yes. As you know, I'm deeply involved in academics. And so one of the things that we've actually implemented is the AAMC competency-based approach to teaching health equity and we want to do that across the learning continuum. And so we want to teach our medical students, we want to teach our residents and also our learners, for them to understand how incredibly important it is to master the science of health equity.
So that we can actually use that to address disparities, because disparities are one of the major drivers unfortunately as well of our poor health outcomes. And one specific example of us applying this competency-based approach is often times it's said that race is a social construct as opposed to a biological construct, and it's oftentimes used as a proxy.
One of the things we're implementing is to no longer use the race and ethnicity as the first line in the clinical presentation of patients, and apply that and use that more in the history and the social history but avoid using it as the initial presenting statement when we clinically present patients on rounds.
Unger: Now, one thing we hear from a lot of health care leaders, particularly those that are involved in health equity initiatives is just how important it is to work with community partners. Because it's such a big job that a health system on its own can't get that job done by itself. Tell us a little bit about how you work with community organizations to help meet your goals? And maybe give us an example of what might be a good successful community partnership?
Dr. Laborde: Yeah, that's a good point. I mean, given the fact that 80% of the factors that actually impact health outcomes are not health care related. And so, this really requires a collective community approach, and so we've actually partnered with our institutions or schools or universities. We partner a lot in the community, specifically with our—as I said with our schools, but typically our faith-based communities.
Because we think it's really important that a lot of the health that takes place takes place outside of the hospital, it takes outside takes place outside of the clinic. And so once we understand that, it's really important that we identify and partner with community-based institutions who can actually work with us to address some of these social determinants of health.
And one specific example that I can share with you is the fact that we've established partnerships with a number of the faith-based institutions within our service area, to the point where we oftentimes partner with them to provide services and try to provide access in one really simple example in terms of—as I said cancer and chronic conditions or a significant issue for us.
And so we will actually identify a particular area which is a high index area and then we'll go to that particular area and use the church itself to provide care. So in terms of screening, we've done cologuard testing, provided the cologuard kits at the testing, and actually have done even PSA of prostate cancer screening at the site after sermon.
Unger: Wow. That's a lot of value from that particular Sunday morning then.
Dr. Laborde: And we're able to set them up for continuity of care with our clinics because we typically have clinics within those service areas.
Unger: What a great example. In addition to the kind of community work that you do, Ochsner also works closely with the AMA on a whole range of issues. Tell us about how the AMA has supported you in your new role?
Dr. Laborde: Oh, the AMA has been an incredible resource for me, professionally, and but also for Ochsner in general. And so, it's a resource that I often use—as you know you have your Center for Health Equity, which is part of the AMA, and then Dr. Aletha Maybank, who's a colleague that I've actually referred to and have turned to for guidance in terms of how to implement some of our health equity centered interventions.
And so for me, the AMA and our partnership has been really critical and me being able to work hard to achieve the goals that this significant role has placed in front of me.
Unger: Now speaking—
Dr. Laborde: So thank you.
Unger: You're welcome. And it's great to work with you in partnership. Dr. Laborde, when you think about your role that you just kind of referenced in your organization, it's new and how important it is to work with the community, do you think that other health systems are going to follow Ochsner's lead and create a position like yours in the coming years?
Dr. Laborde: Absolutely yes. Because given the trend of value-based care, equity-focused care and community-centered data-driven care, you really do need to have a position like that to ensure that number one, that we address the social determinants of health. But more importantly do that through the lens of equity.
Because ultimately, we want to ensure that everybody, irrespective of their zip code or genetic code has the opportunity to achieve their optimal best health. And this role in roles similar to them will be critically important for us to achieve that goal going forward.
Unger: Dr. Laborde, thank you so much for joining us today. And we wish you the best in your new role, and to say thank you to the folks at Ochsner for all the work they continue to do and important issue. To support the AMA's health equity work and everything we do for physicians and patients, we encourage you to become an AMA member at ama-assn.org/join.
That wraps up today's episode, and we'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please, take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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