Exploring Partnerships in Healthcare with Judith Kulich, Managing Principal - Patient Health & Equity and Americas West Region at ZS

[00:00:00] Hey, everybody.

[00:00:10] Salmarquez with the Health Matters podcast.

[00:00:12] I want to welcome you back to another episode here at the Las Vegas Convention Center 2023

[00:00:19] Health Event.

[00:00:20] Today, I have the privilege of hosting Judith Koolich on the podcast again.

[00:00:24] Judith, welcome.

[00:00:25] Thank you.

[00:00:26] Happy to be back.

[00:00:27] Oh, it's such a pleasure to to have you back and folks, I'll link up our previous

[00:00:31] discussion with Judith in the show notes.

[00:00:34] But for those that haven't had an opportunity to get to know her, let me just give you a

[00:00:37] quick intro.

[00:00:39] Judith is Z.S.'s lead for patient health and equity focused on partnering with clients

[00:00:44] across the healthcare industry to drive meaningful progress and health equity.

[00:00:48] She also serves as managing principal for ZES's West Region and as the environmental, social and governance program chair.

[00:00:56] Thank you, Sal. Happy to be back.

[00:00:58] And look, for those that haven't had a chance to meet you, can you share what is it that buyers your work in healthcare?

[00:01:04] chance to meet you. Can you share what is it that buyers your work in health care? Yeah, I've had the opportunity to be focused in health care for more than 20 years now. So it's

[00:01:09] been a long time journey here and long time passion. I think continuing to stay oriented on

[00:01:16] the patient. I spent much of my years in health care focusing specifically on product development,

[00:01:21] drug development, bringing products and medicines to market to reach the patients

[00:01:26] who need them most.

[00:01:27] These days, I've expanded beyond product development

[00:01:31] to more of a kind of the full journey of a patient experience

[00:01:35] and really focusing on patients and specifically health equity

[00:01:38] and addressing health disparities.

[00:01:40] So really keeping patients at the forefront has been what's

[00:01:44] inspired me and kept me

[00:01:46] going. And we don't seem to be short of problems or issues to try to solve. So long road ahead as

[00:01:53] well. That's for sure. Yeah. And a great call. And Judith, thank you for sharing that. In today's

[00:01:58] world, it's well understood that health is driven by much more than genetics and medical care. How are healthcare organizations expanding focus and adapting to address these broader drivers of health?

[00:02:10] At this point, we've spent the last couple of years educating on social determinants of health

[00:02:16] and increasingly re-raising awareness about the significance of these social determinants of health.

[00:02:22] It's commonly accepted that up to 70% of a patient's health

[00:02:26] outcome or a person's health outcome,

[00:02:28] I should say, is driven by things like gender identity,

[00:02:31] race or ethnicity, income, lifestyle, education, home,

[00:02:36] location, access to care, other diverse factors,

[00:02:39] and increasingly healthcare organizations,

[00:02:42] while historically centered on

[00:02:45] medical care are stretching the boundaries of what they consider

[00:02:49] and what they're trying to reach and how they're trying to

[00:02:51] affect the communities that we serve.

[00:02:53] It's very clear here at health that this week, the number of

[00:02:58] organizations that are really stretching to address directly

[00:03:01] these social determinants of health organizations can take steps on their own against some of the innovators here

[00:03:08] and specifically our startups targeting specific social determinants of health

[00:03:14] and looking for partners across health care to reach a broader audience

[00:03:18] and really drive impact.

[00:03:19] Organizations can have impact on their own, but we're seeing more and more

[00:03:24] that that organizations are also thinking creatively

[00:03:26] about those partnerships.

[00:03:27] How can I go beyond just providing services or just

[00:03:30] supporting access and reimbursement or just bringing

[00:03:33] drugs to market to really work with partners and extend

[00:03:37] in a much more broad reach and tackle these social

[00:03:40] determinants of health as well?

[00:03:42] Thanks, Judith.

[00:03:43] What are some examples and some partnerships you see doing this well?

[00:03:47] There's no two partnerships are alike, I don't think, is what I'm learning.

[00:03:53] And it's great.

[00:03:54] There's not a cookie cutter approach.

[00:03:56] We are seeing healthcare getting increasingly creative.

[00:03:59] And it's not easy.

[00:04:00] So, you know, we'll talk more about that over the course of this conversation.

[00:04:03] But some of the examples I'm seeing, some are pharma directly with organized customers

[00:04:08] and health systems. It's interesting. This is a tricky dynamic to partner versus one

[00:04:14] being kind of a provider and one being a customer. But we do see that those organized

[00:04:19] customers are keen to partner. We ran a study of organized customers across the United States and saw that

[00:04:26] 80% of health systems are either doing or planning health equity initiatives. Many are partnering

[00:04:32] with community-based organizations to extend their reach into the communities and build

[00:04:38] relationships through kind of trusted partners within the communities. But they're also keen to partner with pharma

[00:04:45] and with manufacturers.

[00:04:46] And only about 20% are actually working

[00:04:49] with manufacturers today on these initiatives.

[00:04:52] Those that they are working with,

[00:04:54] they tend to have a more positive relationship with.

[00:04:56] Trust can build perceptions, improve.

[00:05:00] And when you really have that aligned

[00:05:03] kind of set of objectives really oriented toward the patient

[00:05:06] that the strength of those relationships can grow and grow. But I mentioned no two partnerships are the same.

[00:05:12] Many are striving to form partnerships with community-based organizations as I mentioned to engage more directly with local patient communities.

[00:05:20] Patient advocacy groups are another great channel to get close to patients and really understand the voice of the patients and that is trusted partners. Universities and academic

[00:05:30] institutions, particularly when we're looking to stretch earlier to address things like diversity

[00:05:35] amongst our healthcare professionals or diversity in clinical trials. University and academic

[00:05:41] institutions are playing a bigger role there. Thank you for that. Yeah, some great examples, Judith, and I appreciate you highlighting those.

[00:05:49] It's just good to learn what's happening in the industry and how people are partnering for

[00:05:54] success specific to these issues of equity and access. Even organizations with perfectly

[00:06:00] aligned goals and missions could face resistance when forming an alliance. How could healthcare organizations and community partners

[00:06:07] overcome barriers to forge effective health equity partnerships?

[00:06:11] There's a few things here.

[00:06:14] One I mentioned was trust.

[00:06:16] I think that continues to be a dilemma, particularly I do a lot of work with pharma

[00:06:22] and biotech on the manufacturing side of things.

[00:06:24] And I wouldn't call it a barrier per se, but it is a hurdle.

[00:06:29] I think one way to overcome or to think about that is it takes time for one,

[00:06:35] and it will show, you know, proof is in the pudding, so it will show,

[00:06:39] it will see results over time and build trust over time.

[00:06:42] But you need to establish those relationships and start to show your commitment

[00:06:47] and again, orientation toward patients and can see benefits

[00:06:51] to kind of chip away and build trust over time. One

[00:06:55] opportunity for that is there's pharma has had a long history

[00:06:58] of philanthropic investments and donations toward nonprofits

[00:07:03] or community based partners. And it can be an opportunity maybe to build on those relationships

[00:07:07] that may be in place or partnerships that may have existed

[00:07:10] in a different form in the past,

[00:07:12] to build and show what a new style of partnership could look like.

[00:07:16] Similarly, approaching those partnerships with humility

[00:07:20] as we think about, looking at where you can add value versus the step

[00:07:24] on toes or versus duplicate efforts and really learning from the partners experience their local knowledge their insights and connections but thinking about additional value.

[00:07:36] Can I provide on top? Where should I really be leading versus where should I be following my partner's leads? It's a bit of a dance and it's not immediate, but looking at this really from view toward partnership.

[00:07:47] One other dilemma that we haven't talked much about,

[00:07:50] and I feel like it's often not talked about,

[00:07:53] but it very much can be a barrier

[00:07:55] is compliance considerations.

[00:07:58] And again, particularly as we're thinking

[00:07:59] about approaching partnerships from a pharmaceutical

[00:08:02] manufacturer perspective,

[00:08:04] often compliance becomes such a concern that it

[00:08:09] can kind of stop people in their tracks, stop the best of

[00:08:13] intention in their tracks. But we are seeing that by going in

[00:08:19] eyes wide open and working very closely with legal and

[00:08:22] compliance kind of advisors and experts within the firm

[00:08:25] from the beginning, you can establish those partnerships are really set up with the patient

[00:08:30] outcomes in mind with the best of intentions in terms of addressing health equity, health

[00:08:37] disparities or health inequities and really focusing on those results. It takes navigation and careful steps and agreeing upon

[00:08:47] kind of the balance of a value exchange

[00:08:50] and documenting the value that each partner is bringing

[00:08:53] and establishing mechanisms for measuring success,

[00:08:55] but it can be done.

[00:08:57] And it's nice to see that progress is being made there

[00:08:59] because even as recently as a year or 18 months ago,

[00:09:04] it would be kind of a show stopper in many cases.

[00:09:07] Thank you, Judith.

[00:09:08] Yeah, some of the themes are centered around compliance

[00:09:11] as a hurdle and also being able to have that trust

[00:09:16] and it takes time.

[00:09:17] And look, I would say you're an example of that.

[00:09:19] You showed up a year ago

[00:09:21] and your agenda was tech equity and equity and access.

[00:09:24] And here you are again,

[00:09:26] speaking about the same issues. So to the listeners and to me, that shows Zs is your

[00:09:32] commitment to this topic. And it's that thing that you're talking about showing up and going

[00:09:36] deeper on some of these. Yes, it's been an evolution that I think we've gone from everybody having

[00:09:42] really nice conversations, but relatively surface level to getting much more granular,

[00:09:47] much more deep, much more in the weeds on exactly what are we trying to do,

[00:09:51] exactly what kind of partners in this case may be viable options.

[00:09:56] And even though those partnerships can be kind of clunky or maybe it takes a bit

[00:10:01] of trial and error, kind of starting down the path with a few

[00:10:04] potential partners to find the right one.

[00:10:06] We are seeing positive breakthroughs

[00:10:09] and really positive progress where those partnerships

[00:10:11] with that kind of mutual value

[00:10:13] and that those aligned objectives are really struck.

[00:10:17] Progress can be.

[00:10:18] Thank you, Judith.

[00:10:19] How can organizations ensure they find value in partnership

[00:10:24] and that they're providing value to the patients

[00:10:26] they're serving and in particular what key strategies are essential to make this happen.

[00:10:31] I mentioned the specificity element. It's not enough to say I want to focus on lung cancer in

[00:10:39] the rural south. We need to get very specific about where with which patients, what step in the patient funnel am I trying to achieve or trying to address.

[00:10:49] So really getting very targeted about where are we orienting those efforts.

[00:10:53] There's one example, BMS and the Georgia Cancer Center's C-Care program and they're working with August University, specifically focused on smoking, lung cancer, education, screening, rural and urban African-American.

[00:11:08] So just getting very specific around where, who, what are those barriers or social determinants that you're addressing,

[00:11:15] and how can you kind of drive access and drive change. So one is level of specificity, I think really targeted focus and aligned objectives.

[00:11:26] I talked about what value does each partner bring?

[00:11:29] Write out the gates as you're establishing those partnerships.

[00:11:32] Who's bringing what to the table

[00:11:34] and what are you relying on the other partner

[00:11:36] to bring to the table?

[00:11:37] Because you need to make sure all bases are covered

[00:11:40] or perhaps figure out if you need to get someone else

[00:11:42] and bobs as well.

[00:11:43] So, you know, what's kind of that give and get that each partner brings to the table.

[00:11:48] And then really, how will you measure it? What is the type of impact that you're trying to see?

[00:11:53] What are the success metrics? How will you know if you're making progress?

[00:11:57] Some of these partnerships, the end goal is very long-term. But what are those kind of KPIs

[00:12:04] or early you can start to see to understand

[00:12:06] if you're reaching the right set of patients,

[00:12:08] if your impact is broader than what you could have yourself,

[00:12:11] how can you learn and also adapt over time?

[00:12:15] So how are you measuring those, that progress,

[00:12:18] what objectives are you setting,

[00:12:20] and how do you know that you're moving in the right direction?

[00:12:23] I think hopefully that answered your question in terms of some of the things that we suggest

[00:12:27] that organizations look for.

[00:12:28] Yeah, and very granular tips on how to make sure that chances for success in these partnerships

[00:12:36] is maximized.

[00:12:37] And so once success is achieved, how can organizations replicate success from one partnership to the next?

[00:12:45] Because as you said at the beginning, one partnership is one partnership, right?

[00:12:49] They're all different.

[00:12:50] A couple of things come to mind here.

[00:12:52] One is I talked about kind of understanding how you'll measure impact.

[00:12:57] Having a somewhat standardized approach to measuring impact across partnerships or across

[00:13:02] interventions you're running is important.

[00:13:05] Most organizations are not just running one partnership.

[00:13:08] Again, they're exploring different opportunities.

[00:13:10] They're engaging with different local,

[00:13:12] community-based organizations.

[00:13:14] And so, is there some mechanism to look kind of apples

[00:13:17] to apples across investments that we're making

[00:13:19] and across partnerships to understand,

[00:13:21] where is the greatest success and where is there not?

[00:13:24] There's a metrics we're establishing

[00:13:26] and working with many of our clients and partners on,

[00:13:30] which we refer to as patient outcome impact.

[00:13:32] So what is a collective set of drivers

[00:13:34] and information that you can look at?

[00:13:36] Not to necessarily understand revenue impact,

[00:13:39] because in many of these partnerships

[00:13:41] that won't be an appropriate metric to utilize,

[00:13:43] but actual patient outcome impact.

[00:13:45] And can we establish kind of a standard nomenclature and understanding and set of information that

[00:13:51] we're looking at to understand apples to apples, the success of each program.

[00:13:55] But when you do have those successful programs, one thing that's particularly tricky is very

[00:14:00] rarely are they national in scale or for sure international in scale, right?

[00:14:04] Many of these health equity partnerships, again, as we talked about being very localized,

[00:14:09] are super granular, are very community specific.

[00:14:13] And thus, you can't necessarily just learn and expand and scale.

[00:14:18] It's not necessarily the idea of a proof of concept or pilot that will scale within that existing partnership, but rather replicability,

[00:14:27] where you're looking to learn from an existing partnership

[00:14:31] that's working well and think about

[00:14:32] what can I kind of lift and shift?

[00:14:34] And are there other similar types of organizations

[00:14:37] out there in other communities, for instance,

[00:14:40] that we strive to reach,

[00:14:41] or maybe relevant to other therapeutic areas

[00:14:44] that we strive to reach, where relevant to other therapeutic areas that we strive to reach

[00:14:46] where we can learn from that one partnership and take that learning elsewhere. So that we're

[00:14:50] starting with a leg up, we're starting with a head start, and frankly, we're starting with some

[00:14:54] experience and kind of proof to show to our potential partners what can be done and where we've had

[00:15:01] success with others in the past. So kind of a more of a lift and shift rather than a scale per se, but to reach a broader

[00:15:08] audience.

[00:15:09] That's great.

[00:15:10] Yeah.

[00:15:11] That unique approach to each market we're serving is key so that lift to shift is definitely

[00:15:15] the right approach.

[00:15:16] Judith, this has been an incredible conversation.

[00:15:20] I'm always impressed with the commitment that you have and your organization ZS has for

[00:15:24] this topic.

[00:15:25] What would you say is a good call to action for our listeners today?

[00:15:30] One, I would say there is a huge appetite for collaboration. Again, if you're here today at

[00:15:37] health, you're seeing it firsthand. If you're not here today, trust me. It's amazing. The energy is amazing.

[00:15:45] And the number of folks out there looking for partners and continued

[00:15:49] focus on health equity amongst this audience is tremendous.

[00:15:53] So I would just say the appetite is out there.

[00:15:55] Partners are looking for partnerships and looking to expand beyond the

[00:16:00] impact that they can have themselves.

[00:16:01] So know that know that that appetite is out there and there's willing partners on the other end of the line.

[00:16:08] I would say know that partnerships aren't easy,

[00:16:10] they're clunky, there's the human factor

[00:16:13] and there's figuring out how to work together

[00:16:15] and there's of course again,

[00:16:16] kind of figuring out the right partners

[00:16:18] from a aligned objectives perspective,

[00:16:21] but they can be incredibly powerful.

[00:16:23] And the last point I would make is just there's no silver bullet to driving change in health equity. I wish it could be that easy, but it's not.

[00:16:33] But really through our collective progress and impact, we can make strides within our own spheres of influence and again by engaging partners even fluent So go out there be bold and know there's going to be

[00:16:46] some stops and starts. But you know, keep trying and keep

[00:16:50] pushing and we will make progress.

[00:16:52] That's great. Great call to action Judith. And thank you so

[00:16:54] much for the very thoughtful approach to health equity that

[00:16:58] you guys are taking and the insights that you've shared

[00:17:01] today. For anybody wanting to get in touch, engage more with ZS on this topic, where's the best place they could do that?

[00:17:08] They can find us on zs.com.

[00:17:12] You can reach out to me, Judith Coolich at zs.com.

[00:17:15] I'd be happy to speak with anyone on this topic.

[00:17:17] Amazing.

[00:17:18] Thank you, Judith.

[00:17:19] And folks, in the show notes, you'll find not only our previous episode with Judith,

[00:17:23] but also ways to get in touch with ZS,. as well as her to learn more and most importantly, do more.

[00:17:29] Judith, thanks for your time.

[00:17:31] Thank you.