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[00:02:00] Welcome to the Healthcare Nation podcast. Vincent, so glad to have you on the show today. I've looked forward to this for a while. You've got a lot in common. I mean, I could just starting with nursing nurse practitioner NYU, but there's a lot more than that that I want to unpack, including what you've been up to and in academia, research and health policy.

But I just want to start and jump right in and talk about your new role at the Institute for Policy Solutions at Johns Hopkins School of Nursing. Tell us a little bit about that. Maybe your journey and how you went from, let's say, the bedside into policy, academia, leadership, but, you know, Dean of the Duke School of Nursing.

And now into this, what I [00:03:00] would say, incredibly prestigious, very influential position. And so

So thank you, Rick, for having me on the show. It's actually an honor to be here. You know, it's interesting because my story is, it's a little unusual and I hope that listeners will Here but everyone's path is different. You know, I came to nursing much later in my career. I actually was heavily influenced by being born and growing up in the South Bronx.

And so, for me, Living in a community that was primarily Latino, about 70, 75%, and then also the remaining 25 percent being African American. That shaped, Rick, a lot of my thinking about health and around what at the time I didn't realize were inequities. And, you know, everybody was kind of the same in my neighborhood.

But as I grew up... And as I started to travel into Manhattan, I saw that people lived quite differently and really within a very short distance life look quite Profoundly, you know to be [00:04:00] honest, it looks better in many ways in many tangible ways and so You know, what I was initially drawn to was not nursing and not even health.

I was drawn to social welfare. I spent a huge amount of my career pursuing social work. And the reason for that was because I really liked the social justice. Focus of social work. And I really enjoyed, Rick, the idea of taking a particular case or a person, maybe it was a family, and then making it into a broader cause and seeing the connection between people and larger social issues, but with a very, very unique lens on social justice and sort of the ecology of what it that drives people to being in the circumstances that they find themselves.

I later moved into public health. I was sort of on a journey, Rick, and I was thinking, you know, how can I get to the issues that I really care about? And I was fascinated with epidemiology, the science of public health, and really thinking about distribution of [00:05:00] disease in populations and also how to develop community based interventions.

That would address the kinds of patterns that I was seeing in my own community in the South Bronx. And so I pursued that. And all throughout that process, I had this lingering... sort of nagging feeling of wanting to directly care for young people. My area initially was focused on adolescent sexual reproductive health.

At the time when I was working you know, in my twenties and thirties in the South Bronx, you know, there was a huge problem with HIV. There was a huge problem with sexually transmitted infections and unplanned pregnancies among young people. And so that captivated. My mind and my interest. And so later I pursued a career as a nurse when I started in nursing school, Rick, you know, many people will be surprised by this.

I actually was already a full professor. I'd been tenured at Columbia. I later went to NYU and became a full professor. I'd spent a decade in both of [00:06:00] those institutions 10 years at each and along the way, I took a sabbatical and said, I'm going to become a nurse. And what led me. Down that path was again, you know, really wanting to deliver services directly, healthcare services directly to young people.

I ultimately made my way to Duke to the School of Nursing where I trained in their HIV specialization and became a nurse practitioner. I later added on a psychiatric mental health component because I realized that much of what I was seeing was actually not physical, but was more within the realm of, of how people were feeling and what was happening sort of in their minds.

And I cared at the adolescent AIDS program in the Bronx at Montefiore Medical Center for young people at risk and living with HIV. So all that to say, Rick, that led me to nursing. I would say that I'm kind of a non traditional nurse in the sense that I still combine The clinical expertise of nursing with the deep commitments to [00:07:00] social welfare, that social justice lens, and I've continued to work with the public health, particularly in epidemiology focus.

I still work 30 years later in the South Bronx. I have projects right now that remain in the Mott Haven community. We still address a lot of the contemporary health issues that are happening in that community, and I think what I've tried more and more. Rick is to really use those projects as demonstrations of what health care should look like across our country.

A lot of what we do with our nursing and interprofessional teams that work in public housing in the South Bronx is that we bring care to people and we try to manage whatever it is that's going on, historical chronic conditions, but also the contemporary issues, you know, right now. We're wrapping up something called the Radix Up project, which is a way that we were able during COVID to bring COVID [00:08:00] testing and vaccines directly to families that were residing in public housing.

And so you might ask me some questions about that later, but I think in terms of models, what has deeply informed the way that I think about health is this commitment to social welfare, public health, and the clinical expertise of nursing. To me, that's a winning combination.

Yeah. So listen, I want to hear more about the new role, but I have to tell you, and I'd be remiss if I didn't say it. Look, we both grew up in New York and New York City. I was in Brooklyn. You're in the Bronx. That background that it's not even a microcosm. It's a macrocosm of just about everything that you could experience in life in a lot of ways.

And certainly the health care system there the challenges is. Whether it's a social determinants all the way up to inequities, and I think some of the incredible policy issues that are born out of those challenges, they take place in the city. And it's it is a testing ground in a lot of ways. But I really applaud the work [00:09:00] you're doing there and keeping it going, particularly.

Knowing how busy you are. So that means a lot. I know for the communities that you serve, but let's just I want to go deeper and double click, though, on on on the new role. Because for me, you know, when I think about your background, everything that is informed, obviously, your professional career, your personal story.

But now having what is an inaugural role at Hopkins, tell us what you're going to be doing. And I just want to also add, look, you're going to be based out of DC. So this is something where the level of influence and impact factor is going to be dialed up.

Sure. So thanks for that question, Rick. You know, I think for More than two decades, I've worked on sort of health issues in communities, and that's positioned me to really think broadly and systemically about how can we do things differently? You know, right now, what we're experiencing as a country is that we're seeing some pretty disturbing patterns.

And so here's would [00:10:00] lead me to the new role and to a policy focus. First and foremost, Rick, most adult Americans in our country right now have one or more chronic conditions. And those chronic conditions fall into a group of five or six that are fairly predictable and that occur over and over again.

And if you look at projections as to where we're going as a country, what we see is a pretty Dismal picture. So right now, the majority of adult Americans have at least one chronic health condition. That number is only projected to increase as we get to 2030, 2040 and beyond. What's even more distressing to me is really what's been happening with life expectancy.

We know that there's been a lot of attention in the media around reductions in life expectancy. from COVID and also from the opioid epidemic, which I customarily refer to as the polysubstance use epidemic. But to be honest, Rick, if we really pull back the curtain a little bit. What we'll see is that yes, COVID and polysubstance use did in [00:11:00] fact detrimentally impact life expectancy, significant reductions, but actually that trend was occurring prior to COVID and prior to the polysubstance epidemic.

There was a recent paper in the American Journal of Public Health that really shows. From the 1950s forward, in some segments of the population, we see that life expectancy has been stagnating or going in the wrong direction. And that is deeply troublesome, especially when we think about what typically people sort of compare the United States to.

It's not uncommon to hear that the United States developed country. You know, spends the most money in terms of health care relative to any other country in the world. And yet, when we compare ourselves to other developed countries, we have among The worst outcomes. What is not often discussed, and this is the part that I really would love for listeners to fully embrace, is that if you were to take, for example, certain geographies in our country, and I'm going to focus [00:12:00] on the southeast, although it's not only the southeast, in every single state in our country, I could find a segment or community where, where what I'm about to say might be true.

And so if you look, for example, to southeast, Life expectancy could actually be as low for certain communities as 57 years of life. And if you compare, for example, Mississippi to Bangladesh, what you'll find is that Bangladesh has a higher life expectancy than Mississippi. And so, again, I could go through many examples that actually we are on the wrong course, Rick, in terms of how we deliver care.

Right now, we have what I would call a fee for sick care model, where we are entirely incentivized by the by performing procedures for people that have already developed whatever the condition may be. And once they have diabetes or hypertension, heart failure, they then are on a trajectory of, again, using that term fee for sick [00:13:00] care, where we continue to stabilize, perform procedures manage that chronic condition and typically that is where the bulk of...

The expenses are being accrued in this very, very costly acute care model that really deemphasizes health promotion and prevention. I think the second thing I want to highlight is the distribution of our health resources have been suboptimal. And so this also is a major driver to why I'm seeking this position or why I'm now sort of starting this position at Hopkins at the Policy Institute.

We know that the major breakthroughs that we've made in terms of health care, that everybody doesn't have access to those services and to those innovations. And because of the poor distribution of health services and the unequal, unjust, unfair distribution, we see disparities. And I'm going to call them inequities.

And I'm intentionally making that [00:14:00] contrast between disparity and inequity. A disparity is just a difference that we see. Those differences can be clustered in certain groups. And inequity is a clustered difference, but that difference is driven by something that is unfair and unjust. And in my view, what I am really focused on, Is the inequities and really showing through the Policy Institute in order for us as a country to advance health, we're going to need to address the inequities.

A good example I'll use North Carolina, the state that I currently live in. So I'll take a contemporary issue with just to illustrate, you know, when we had the impacts epidemic in the United States. We saw that. There was a disproportionate burden of infection amongst certain segments and in North Carolina that was black men who have sex with men.

When we look at the distribution of the vaccine that was preventative vaccine that would [00:15:00] reduce the chances of having an active impacts infection. What we saw was that seven out of 10 vaccines went to non African American populations, where seven out of 10 of the infections. went to were among black MSM in the state.

That wasn't just North Carolina. When you look around the United States, what we saw was a total disconnect between the actual sort of, in this case, vaccine that would prevent infection and who was getting it. So

So real and vigilant. Let me feed it back. So the folks who could have benefited the most were not clear access issue for the group that would have had the best clinical return on having access to that.

Exactly. And that was because of the way that we distributed the vaccine. And the good news is that we corrected that as a country. But I think what I want to highlight, you know, Rick, for, for listeners, is that that would result then in a core message that would come out [00:16:00] typically from media that certain groups have this particular condition.

But what's not part of the deeper understanding of why that is, is because the distribution of the preventative vaccine didn't go to those communities. So the virus had no place else to go other than those groups. The last thing I'll say that leads me to the policy role is really a growing recognition, Rick, that only 20 percent of the variability in a given health outcome is tied to the clinical care.

So even as a nurse, or as a physician or any health care worker, we provided the best, perfect, optimal care. It would only be about 20 percent of the variability. 80 percent is rooted in the social conditions or what typically we call social determinants of health. 80%. And so the thing that's really striking to me is that most of my clinical training has focused on the 20%.

And it has not included the 80%. And part of what I'm hoping to do in D. C. is really [00:17:00] explain that we've got to do something about chronic morbidity and premature life expectancy. We've got to be critical about the distribution of our health resources, and that healthcare in the United States needs 80 and the 20.

The excellent clinical care and how do we improve the social conditions that people live in, how communities are living, how families are living in order to improve health outcomes. So that's, that's the promise of the Institute, Rick, and that's what I'm going to work on when I get to DC.

No, fascinating. And clearly, you've got the background. And as I said, the insights and experience. To be very effective in that. And I have to tell you, Vincent, you know, I hearken back to my own time, you know, practicing clinically. And I think I've said it even before on the show. One of the most important questions I would ask a client, a patient coming through when I was volunteering at the free clinic was.

Where did you sleep last night? It was much more indicative on the trajectory of their health, [00:18:00] you know, status and where they were going than perhaps a lot of the you know, physiologic parameters that we would get from the patient because it was immediate and, and I think there's, there's not enough insight and that speaks directly to the social determinants and I think a lot of the gaps you know, I, there's so many gaps whether it's Just in, in, in the disparity inequity access piece, but also I think in the technology side, but let me pivot for a second and ask you this.

Just given the current state of health policy in the US, how would you sum that up? And where do you start to address? The biggest issues that are in there. So what's the, you know, if you said, Hey, here's the state of the union for, for us health policy. You mentioned a few things there, but then where do you start?

Where do you start at the Institute?

Sure. What a great question, Rick. So let me first say, I think you must have received great training because that question that you gave about your clinical [00:19:00] practice is exactly the kinds of questions that we want all healthcare providers you know, to address when they see a patient or an individual.

So, you know, I just want to recognize that. I think, you know, we're, we're in a tough spot, Rick. You know, right now I think there's a lot, I think it's not unfair to say there's a lot of. Tensions that are operating at the federal level and even in many local sort of state and even city governments.

I think that what the Institute can do is first and foremost start with creating evidence that is bipartisan evidence that is rooted in nursing science and the science of whatever the issue is that we're pursuing. And then thinking about how we can develop partnerships. With sort of key decision makers and some of those partnerships will be in coalitions with other organizations or with groups that are working on similar issues and some of those Rick will be really the close proximity of the Institute will be located at 555 Pennsylvania, which is just steps from the nation's [00:20:00] capital, which really creates an opportunity where let's imagine Rick that you weren't elected official.

What we want is for the staff that work for those individuals. To say, hey, let's call Vincent and find out the latest evidence on what's happening on whatever the issue might be. And so, you know, the Institute will put out a series of briefs. The Institute will work in partnership with mobilizing groups that are committed to solutions.

And then also we will spend a significant amount of time actually cultivating relationships. So that while maybe not so apparent externally, we are the group that is providing the evidence. In terms of whatever the health solution is. I also want to say that one of, you know, our greatest aspirations, Rick, is to elevate, you know, the role of nurses not just because we think nurses matter, obviously we do, but I think because nursing is really an invisible solution to the kinds of [00:21:00] challenges that we're facing as a country, and for that matter, a world.

The nursing workforce is the largest segment of the health or public health workforce. By far, there's roughly 4. 3 million registered nurses in the U. S. There is no other health profession, even if you added them all up, physicians and other health professionals, they wouldn't equal the sheer size of what I'm going to call, you know, a health army, the nursing workforce.

And despite our size, and despite the fact that the largest, the lion's share of health services is delivered by nurses, too seldom are we asked about Solutions to the health issues that we face. And so what the institute will also do is elevate why nursing and the nursing workforce are the path forward in addressing the issues that we've been talking about today as part of our time together.

And so. Another place to start is to really show nurse led solutions. You know, one of [00:22:00] the things that we've been evolving is what we call the nurse led model of care, which is not a specific intervention. It's a set of principles by which nursing is able to improve access. clinical outcomes, and also better address the harmful social conditions.

And that nurse led model of care is the secret sauce that the Institute will pursue and sort of lead nationally at helping schools of nursing and other health professions to really think about how can we provide health care differently in our country.

Yeah, I want to pick up on the models of care piece. But first, I just have to tell you that from my perspective, the Institute serving as a source of truth. And what a lot of folks would call a post truth world, and I'm not saying that, by the way, it is what it is, right? But we just have to recognize that reality, particularly as it relates to you name it, whether it's a policy questions in health care.

It's [00:23:00] very, very important questions with respect to say, vaccines and efficacy. There's got to be voices out there, or at least the opportunity to tap into voices. That are the content experts that are really leading the science, the policy, and its translation. So. Again, I think the Institute's role in, in that sense, and, and of course, the proximity, it really is just, the value is incredible, and, and I, I commend everyone at Hopkins for putting it together and putting you in that role.

Let me though, just take that notion of new models of care and the nursing piece, which is. Obviously, a great focus of mine, and I want to unpack that a little bit of Vincent. Tell me about the model itself, what it means. I've always, and I'm clearly I'm biased here with my nursing background. I've always believed that that the the nursing role has not been valued to the extent it needed to be, and that persists [00:24:00] today.

And I, I also blame in large part a lot of the policy issues and, and even nursing itself, and not advocating like, say, PharmDs did in pharmacy and physical therapists, etc. But it's a new day and age, and things, I think, are changing at such a velocity. That the role of the different practice models clearly nurse practitioners and their role are going to play a big part.

But what does the model look like and what will it look like as we see this emergent of even the retail sector getting into the space?

So a couple of parts, Rick, to that question. I want to first say that I completely agree with you that nursing for too long has been largely invisible. And there have been a couple of important reports about nursing in the media. This is why shows like this are so important because it elevates the contributions that we've made as nurses to health in our country.

But those reports have shown that it's [00:25:00] unusual for nurses to ever be sort of, You know, quoted in the media as experts on any health related issue, and in those few instances where nurses are in fact asked their opinions, it usually is restricted to some issue in nursing, and it doesn't really go beyond sort of nursing in terms of health or public health.

And so, again, really want to recognize that every single time that a nurse, any nurse, is sharing their view, elevating their voice about our contributions. It's one step closer to the kinds of solutions that our country needs in addressing these health inequities in terms of the model. This is really cool stuff.

You know, what I love about academia is that my research team and I, we spent a lot of time. We're thinking through. Well, is there something here that is worth pursuing? And is there any evidence for this? And so we noticed that there were many nursing, I'll call them interventions, they were programs, they were particular ways in which nurses were addressing health [00:26:00] issues.

And there were hundreds. And so what we did was this very, very large scoping review, where we sort of looked at the past 20 years of a range of issues, but prioritizing the major conditions. that are causing the chronic illness in the vast majority of people in our country. And what we did is we wanted to deemphasize any one approach.

And so it's not X program. We looked at all the programs, we evaluated the evidence, but we were able to extract components. And surprise, surprise, Rick, there were certain things that were similar across the vast majority of the programs. There were these underlining principles that, You know, I call them components in the nurse led model, but they were ways that these programs were developed that actually were different than the way that more traditional medicine and healthcare delivery in our country is practiced.

So some of those things, I think this will resonate a lot with you and with, with listeners. We were [00:27:00] really struck by

the focus on whole person care. It wasn't a body part. It was a person. who had a condition, but there was a much broader context, and there was recognition in the vast majority of these programs that in order to help them with whatever the condition is, that we needed to take into account the entire individual, their circumstances, their family, their work, their community, their mental health, their physical health, and that condition.

There was also... A strong emphasis on really thinking about what we call locational flexibility. This was true across many of the programs. It wasn't just in the traditional sort of brick and mortar clinics, but we found nurses in a whole range of settings, right? And so schools, in substance use treatment facilities, in correctional facilities, out in communities, in the home.

And so we really saw there was a willingness. For this 4. 3 million, the sort of army of [00:28:00] healthcare workers called nurses to work in many different settings. And we saw that as being incredibly positive. Don't wait for people to come to you when they're sick, go to them and actually leverage the nursing workforce in communities where people are irrespective of whether or not they're sick because there's important prevention and health promotion work that can happen.

We saw that there was a real interest in cultural responsiveness. Many of the programs were developed for specific groups and so they tended to think about, well, what was different about that group? What was important in terms of the provision of care or the working relationship? And so cultural responsiveness was essential and it was definitely embedded among many of the programs.

We saw that there was an emphasis on family and community, more so than the individual. Again, much of healthcare is really about an individual patient. And in many of these nursing interventions, one of the themes [00:29:00] was This person is part of a family. However, that's defined and a broader community. And then in order for us to be effective, we've got to embrace that family and community.

There was emphasis on using technology. So many of the programs were telehealth, or they relied on technology that somehow brought I care to communities. And so again, you know, just using an example from my own work, you know, it wouldn't be unusual that we would bring point of care testing for something like Cove it directly into the home without technology that allowed us to collect the specimen process.

Get the result. Those were things that were very much synonymous with nursing nurse led models of care. There was also a deep clinical expertise. You know, nursing is typically valued as being the largest. You know, there's some data out there that says we're the most trusted for more than 20 years.

Nurses [00:30:00] have been identified as being the most trusted. But here's the thing, Rick, that doesn't often get identified clearly, that I really want to land on this. That nurses have clinical expertise. That is what makes nursing care effective. There is our specific aspects of what we do and these components combined that actually improve access, improve patient outcomes.

And address the broader 80 percent and 20%, even using an example of like what you said about the patient that comes in and you ask them about their, you know, their, their housing situation, their food insecurity, whether or not they have clothing, who is in their life that supports them. Are they lonely?

All of those questions that are going to help you to better manage their diabetes. That's nursing, and that's our model, and that's the solution to many of the issues that we're facing in our country. The last thing I want to share is I want to give a case example, there, there are several, but here's a case [00:31:00] example.

I've been really fascinated by Costa Rica, Costa Rica, Central American country much less economically much poorer than the United States, and yet their outcomes are much better than the U. S. In many ways, Costa Rica is an exemplar. If you look historically at what was happening in the country, there were, you know, many problems that we see in the U.

S. Today in terms of life expectancy and chronic conditions. But Costa Rica took a community perspective to health care. And what they did is they mobilize interprofessional teams. And so again, in our nurse that model. It isn't only about nurses. It's about nurses working side by side with other health care providers, all at the same level, all equally embracing the work and really delivering the care in communities to families in ways that we know, you know, who in that household You know, has whatever the condition is.

Do they have food? Do they [00:32:00] have electricity? Do they have adequate air conditioning? If the climate is too warm, you know, is somebody there expecting a child? Are there mental health concerns? Is there enough money to actually pay for whatever that rental? Property might be the monthly rent is their housing instability and all of those things coming together.

What Costa Rica saw was that they started to see improvements in chronic conditions and life expectancy because they were addressing the underlining drivers while they were going to people not waiting. for them to come into the clinic or an ER already sick. To me, Rick, that's the future, and that's the nurse led model.

That's what the Institute is going to elevate, and that's what we're hoping the United States writ writ large, will actually embrace. That nursing can be that workforce in partnership with others, like community health workers, to really bring this kind of care to the American public.

Yeah, you know, it's [00:33:00] something because when you mention that and so much of it is the social determinants. But also these externalities that we've isolated historically for years and looked at them as not part of the system where you're sick, you enter the system, hopefully you're, there's a remedy applied to you and you return to a state of wellness instead of looking at holistically the continuum, including housing, for instance, as As much of, as an influencer as whether you have good food to eat or medicine to take.

But I wanna Vincent, the, the, the, the nuances that I think in, in policy, I've always broke it down to the five Ps. So politics begets policy, policy influences the payer. Now I'm gonna get paid. Which really impacts the provider and ultimately the patient. And when I think about that, and even the, the, the model, which is, it's, it's more than aspirational because it's [00:34:00] actually practical.

And I think that means so much when you have something that's realistic and can, it can make a difference. But how do we get it through the policy process when we're thinking about. Politics when we're thinking about, let's just say Medicare, even the way we're reimbursed now, the less than adequate recognition we will have with new models.

Let's just think telehealth. It's been around for years. I wouldn't say it was a disruptor, but what happened, the pandemic accelerated it. How do we, how do we look at everything from lessons learned, say, through the pandemic, apply it to new payment models, so that what we're doing is we have a sustainable movement going forward, versus something where you're just sitting back and saying, I hope I get funded for this, or it's, you know, isolated to, say, an accountable care organization or some other very focused initiative.

Yeah. So Rick, what a great question. And I think you just went right to the issue [00:35:00] that is also important in terms of the nursing workforce. You know, too seldom are nurses trained in the issues that you're referencing. So how do we think about payers? How do we think about the politics, the economics of health care?

How do we think about systemic change? And so one of the things that the Institute you know, will certainly do, and this will be in partnership with the Johns Hopkins School of Nursing is really helping to lead on how the nursing workforce can better prepare. I'm going to address these kinds of issues.

We've got to do a couple of things. You know, one, we've got to come up with solutions that are evidence based. Having solutions that we can show will have an impact is kind of the first step. But we also know that there are many things that are out there. There's lots of evidence. That doesn't necessarily change policy.

There are many things that we know actually work. That actually don't get embraced at scale sort of nationally, but it is important to have a solution. Second thing [00:36:00] is that we need relationships, you know, believe it or not. This might be something that is unpopular to say, but it's the truth. A lot of policy is shaped by relationships by really having close contacts and connections with the people that are making the decisions, those trusted relationships and the ability to understand what they prioritize.

What they see as being important and then having that solution that is evidence based at the time when you can in fact, you know, kind of take you know advantage of a policy moment. There's an issue. There's a particular point in society where people are thinking about this and it becomes then acceptable to move this forward.

I think those are very important parts of this. I also want to say that, I think, Rick, the other piece is that we've got to be able to take an approach as nurses where we are thinking before we start [00:37:00] developing whatever it is that the solution is. Asking those tough questions about sustainability right now in our country, the largest payer, just as an example, is Medicaid.

Medicaid you know, has complex patients because it's a means tested program. You don't have Medicaid unless you economically fall below a certain threshold of income and because of the impact of income on health, we know that many of the individuals in the Medicaid program are experiencing chronic conditions and maybe in social circumstances that are quite complex.

So it's a great program to try to test a lot of these ideas out because if we can do it there, then we certainly can do it in other kinds of, you know, payer models, whether it be Medicare or private commercial insurance, etc. And so one of the things that I'm currently wrapping up at Duke, this is something that will be part of my Duke work, but it will continue at Hopkins, [00:38:00] is that we looked at the Medicaid program.

And this is the kind of product that would it would not be unusual for something like this to come out of the Institute. we partnered with a group called MONAT which is sort of National Global Health

and other.

Yeah, I work with them well and

So,

and for years, absolutely great

you know, it's. So, you know, we're not. So they work with us, Rick, on really thinking about how we could look at some of the initiatives and Medicaid transformation.

And if we were to sort of insert our nurse and model, which we've been talking about. Could we achieve improvements in a couple of core areas? Better management of patients with complex conditions. Better integration of a population level focus. Better focus on social determinants. And then also really dealing with behavioral health and the issues that are happening around depression, anxiety, and substance in our country.

Those [00:39:00] were four pillars. that are very important for Medicaid because a lot of the costs are tied to those issues. And so again, taking the model that I've laid out and then reviewing the evidence for how this approach, better use of the nursing workforce can save taxpayers money and can improve outcomes in people.

The last thing I'll say is that I recently had a partnership With Deloitte, which is an accounting firm. And some may be saying, Hey, well, why, why is a nursing school? Why is a nurse sort of partnering with an accounting firm? Well, Deloitte did some interesting work as part of their health equity Institute.

They modeled the cost of inequities and what was really striking about that, Rick, was that this wasn't the total cost of health care. This was the part of the expense that we pay as taxpayers and as a country for bad care for preventable bad [00:40:00] outcomes that if we did things differently, we wouldn't pay.

And that number right now, based on the estimates from Deloitte was 320 billion. 320 billion. With a projection by 2030, that would be close to 1 trillion. I mean, simply

staggering,

staggering. That's if we do nothing. And so what I'm trying to communicate is that we can't keep on going down the path we're going. We need solutions.

And part of what I think will happen with the Policy Institute is clear evidence, bipartisan perspective, Really looking for building relationships and then thinking about how to fit those solutions into existing opportunities. Medicaid is being transformed. How do we think about the nurse led model within Medicaid transformation?

And then elevating nurses. Because when these decisions are being made, Rick, and when [00:41:00] committees are formed, It is too seldom that nurses are part of those committees to offer solutions, and we have to change that. So that's kind of what I'm hoping will happen.

No, no, that was great. That's a fantastic very detailed summary. And I, and I'm sure I, for one, and I know my listeners, our listeners appreciate that one thing I wanted to pick up on was when you mentioned the relationship wise how important that is in on Capitol Hill. In the political realm, this is a highly charged environment at this particular time and place and space.

We know that when you think about Medicaid at the state level, you're dealing with politics at the state level. Medicare, obviously the federal level, a lot of political activity at different strata here. Do you see the institute being active at both the state level as well as the federal level? I mean, we know you're based obviously at Capitol Hill, but.

But there's so much activity in the nursing model of care with [00:42:00] Medicaid. can't see you be limited there. And I don't mean that just geographically, but what are your thoughts on

Sure. That's a great question. So I think my gut reaction to that, I haven't necessarily flushed all that out yet, Rick, but I think it's a, it's a fair question. And it's really important is that I think the Institute will have sort of a federal national perspective as sort of top line. However, One of the things that I know we're deeply committed to and something that I've been in conversation with Sarah Zanton, who is the Dean of the Hopkins School of Nursing, is the importance of it not solely being a Hopkins thing.

This isn't about Hopkins. This is about the issues that we've been talking about, which will require the nursing workforce throughout the United States. We envision as a school and as an institute that we'll have fellows at the institute, that there will be policy institute fellows that come from different geographic regions and part of what will be [00:43:00] important about the work that they do is getting involved in their state or even more local sort of policy issues.

For example, when I was living in North Carolina, I was very involved in scope of practice issues for nurse practitioners in North Carolina. Because of the limitations that are there that are not in other, you know, in other places, the majority of states actually have full practice authority, not true in North Carolina.

And so imagine if I had been not the director of the Institute, but a fellow that might be the project that I would work on, but the Institute would provide support and thinking through how to be strategic, the evidence. Testifying before state legislature, building relationships with key decision makers, trying to analyze, are there partners like certain payers or certain health groups that either support or the major opponents to whatever that changes [00:44:00] and then thinking about how to have a series of conversations.

You know, I will say, Rick, what's been really a learning curve for me and that I've enjoyed, you know, I have spent a number of years getting to know people who work specifically in the policy space and who hold sort of public office or staff members who support those individuals. And many of those folks, because I talk to people who agree with me and I definitely talk with people who don't agree with me.

And I think one of the things that I've learned is in those private conversations, people have been very candid about what the issue is. And oftentimes, They may or may not feel really strongly about opposing or supporting an issue, but they will make clear what is important to them. And they will say, you know, Vincent, we can't do that for this reason.

And so then my immediate question is, well, what is possible? And how could we get closer? And what are the things that [00:45:00] you see as being the priorities that we can be helpful with? And if not this issue, can we carve out? Another opportunity, because ultimately, Rick, what I'm interested in is developing those relationships around a series of issues because change takes a long time.

Yeah, and you know, it gets right back to that relationship side and the power of, of that connection. And I think the credibility that goes into an authentic. Relationship where, where you're actually speaking and seeking to understand where the other person is, is coming from. So that's the, I really, I appreciate that perspective and that approach, particularly also leveraging the fellows where you get, I think, individuals who are passionate about a particular policy issue or topic.

It's close to home for them, but you can support them academically, professionally, and even professionally. And it just serves everyone, which I think has been a model and an institute model, which I think has been something we [00:46:00] haven't seen enough of in nursing. So I, again, I commend you for that. Just a couple of quick questions to wrap things up.

We usually ask this. One would be when you think about the young folks that are the up and comers, The folks you're mentoring other individuals who are considering not only a career, I think in nursing, but levels of nursing where they can have influence and even beyond that professionally, what advice would you give in general to these emerging leaders in healthcare and the health sector?

I mean, I guess my my sort of top line advice Rick would be that nursing is an amazing profession and that no one should limit themselves. And assume incorrectly that there's only one way to be a nurse and that every nurse needs to be at the bedside. The truth of the matter is we need some nurses at the bedside, but we also need [00:47:00] nurses that will pursue policy.

that will pursue elected office. We need nurses that will work in journalism and think about reporting on health from a nursing perspective. We need nurses who will lead health care organizations. We need nurses across all different segments of society, even as entrepreneurs and working in the private sector at groups like CVS or, you know, Walgreens or other kinds of private.

Sort of, you know, sort of companies or initiatives. And so nursing is an amazing profession. We should not limit ourselves and we need nurses everywhere. That would be kind of a core message that I would offer.

Excellent. Listen, last question. If you had a magic wand and you could change, make an immediate change in the US healthcare delivery system. And you were limited to say payer or provider space or [00:48:00] direct patient care or any other area, what would it, what would it be? What would it look like?

If I had a magic wand there, and this is a great question, Rick, I would say get payers to reimburse health and prioritize health promotion and prevention. That would fundamentally change. U. S. healthcare.

Oh, Vincent. This has been a fascinating conversation. We've wanted to go deeper into care delivery, specifically with highlighting nurses as such an essential component of that delivery system professionally and so much more as you put out there. Hearing about the Institute is so exciting. You've got to come back.

Because it blends policy, healthcare delivery, the professional aspects, in this case nursing, with what's happening in the nation. And that's what this is about, the healthcare nation. So thank you my friend, and we will have you back soon, and all the best [00:49:00] of luck with the new institute. Stay

Thank you very much, Rick. It was a pleasure being on.