California is the latest state to address healthcare affordability through cost growth targets. Elizabeth Mitchell – President and CEO of Purchaser Business Group on Health – Joins us to discuss the nuts and bolts of the 3% cost growth target recently adopted by the state. Healthcare affordability is a big issue across the country. More than half of us skip or postpone care due to cost and medical bills are a leading cause of bankruptcy. Reining in medical costs is also how we’ll free up resources for what we know works to build health in America: prevention, addressing the social drivers and fostering health in communities.

We discuss:

• Two proven strategies to reduce healthcare costs: advanced primary care and effective specialty referrals
• Why better consumer “shopping” is not the path to healthcare affordability
• How price transparency gives employers new tools to negotiate, and reveals troubling facts about purchasing intermediaries

Elizabeth reminds us how troubling it is that we don’t have clear prices in a sector that makes up 20% of the economy:

“The idea that you can't find out what something is going to cost before you agree to it is outrageous. Name any other industry that refuses to show you a price. It is incredible to me that we are still fighting about transparency when it is 20 % of the US economy. I mean, this is a multi-trillion-dollar industry who feels no accountability to show pricing. So, I just think it is incredible that we do not have meaningful transparency yet.”

Relevant Links

California’s Office of Health Care Affordability sets cost growth target

Federal hospital price transparency requirements

Purchaser Business Group on Health (PBGH) website

PBGH white paper on advanced primary care

US Department of Labor clarifies the fiduciary responsibilities of self-insured employers purchasing healthcare

About Our Guest

As President and CEO, Elizabeth Mitchell advances Purchaser Business Group on Health’s (PBGH’s) strategic focus areas of advanced primary care, functional markets and purchasing value. Mitchell leads PBGH in mobilizing health care purchasers, elevating the role and impact of primary care, and creating functional health care markets to support high-quality affordable care, achieving measurable impacts on outcomes and affordability.

At PBGH, Elizabeth leverages her extensive experience in working with health care purchasers, providers, policymakers and payers to improve health care quality and cost. She previously served as Senior Vice President for Healthcare and Community Health Transformation at Blue Shield of California, during which time she designed Blue Shield’s strategy for transforming practice, payment and community health. Mitchell also served as the President and CEO of the Network for Regional Healthcare Improvement (NRHI), a network...

The scope, scale and timeline of what California is trying to do with CalAIM is truly breathtaking. Two years after the launch of the ambitious program, which offers integrated medical and social care for California's 15 million Medicaid members, Dr. Palav Babaria joins us to discuss how it’s going and what comes next. Dr. Babaria is a primary care physician who leads quality and population health management for California’s Medicaid program, Medi-Cal.

We discuss:

• Which community supports are used most, or least?
• One of the big learnings from CalAIM: the enhanced care management models that work for adults dont work for children
• How Medi-Cal is leveraging health plans as the organizers of social care because that’s where the members are
• The soon-to-be-released population health management service will address two big issues: standardized and equitable approaches to identifying high risk members and integrating state level benefits data, like for WIC

Palav reminds us that CalAIM was built through listening:

“Not everyone may know this, but CalAIM was generated from a statewide listening tour. Our previous state Medicaid director went around the state and literally asked communities… rooms full of plans, members, providers, what do you need from Medi-Cal that isn't working today? [The] smorgasbord of recommendations is what turned into CalAIM … Listening to the community and responding to the community's needs is in the core DNA of this program.”

Relevant Links

• Listen to our related episode “Reflecting on Year One of CalAIM with Jacey Cooper”
• CalAIM dashboard
• Population health management policy guide
• California and other states require managed care plans to reinvest in local communities
• NY waiver summary

About Our Guest

Dr. Palav Babaria was appointed Chief Quality Officer and Deputy Director of Quality and Population Health Management of the California Department of Health Care Services beginning in March 2021. She was formerly the Chief Administrative Officer of Ambulatory Services at Alameda Health System. In that capacity, she operationally and clinically oversaw 26 specialty clinics, four large primary care FQHCs, specialty and integrated behavioral health, and is responsible for all outpatient value-based payment programs. Prior to that role, she served as Medical Director of K6 Adult Medicine Clinic. She also has over a decade of global health experience and her work has been published in the New England Journal of Medicine, Academic Medicine, Social Science & Medicine, L.A. Times, and New York Times. Her areas of interest include ambulatory transformation in resource-limited settings, shifting to value-based care, and issues of gender in medicine. Babaria received her bachelor’s from Harvard College, as well as her MD and Masters in Health Science from Yale...

To achieve whole person care, we can try layering new social services on top of medical care. But Dr. Rishi Manchanda believes we should move further upstream and ask, what will it take to actually improve health in communities? From founding Rx the Vote to HealthBegins, Rishi is committed to building community social capital in America.

We discuss:

• Why he created HealthBegins, which is now halfway to its goal of transforming equity in 250 communities by 2025
• How California is making practice transformation a foundation of whole person care
• Rx the Vote and the important role of health organizations in voter engagement
• Kaiser Permanente's health, housing and justice initiative

Rishi thinks all public health students should study and know how to shift the political determinants of health:

“I think we can recognize there's ways to… get the dollars out the door, get the services out the door, get the access that we need while [also building] local governance. And I think that's what I see as a really interesting opportunity for us in California… There are opportunities here for public health schools, including Berkeley, to [help] public health students… understand the political determinants of health and then understand their role [to]... address them and improve them.”

Relevant Links

HealthBegins website

Rishi’s book The Upstream Doctors

Rishi's TEDx Talk: "What Makes Us Get Sick? Look Upstream."

New collaborative community health planning model in California

Policy requiring California Medicaid health plans to invest 5-7.5% of profits into local communities

California Medicaid investments in practice transformation

Kaiser Permanente's health, housing and justice initiative

Oregon CCO model

An interview with Rishi Manchanda

About Our Guest

Dr. Manchanda is Founder and President of HealthBegins, a social enterprise that provides training, clinic redesign, and technology to transform health care and the social determinants of health. Dr. Manchanda is a dual board-certified internist and pediatrician, a board member of the National Physicians Alliance, and a fellow in the California Health Care Foundation’s Healthcare Leadership Program. He is the lead physician for homeless primary care at the VA in Los Angeles, where he has built clinics for...

June 18th is “Maya Petersen” day in San Francisco, in honor of her work building disease models that guided the region through the early days of COVID and saved countless lives.

With projects spanning from developing HIV prevention strategies in East Africa to shaping new Medicaid models in California, the UC Berkeley epidemiologist is building a future where local public health leaders have the tools and data to ask and answer complex policy decisions in real time. Now that’s a world I want to live in.

We discuss:

• How much better our pandemic response would have been if Public Health had access to integrated and linked data
• Her work to bring sophisticated data tools to the point of decision in East Africa
• How California is building population management infrastructure

San Francisco’s Director of Health, Grant Colfax, taught her an important lesson about showing up and helping:

“I remember… saying, ‘You know what? You really need to find somebody who's an expert in this, I'm not an expert in this.’ And he said, ‘Okay, Maya, but if you're gonna find me someone it needs to be in the next 24 hours, because I need help.’ And it was just a reminder that, you know, you're not always going to be an expert, sometimes you just need to show up, do your best… be clear about your uncertainty and communicate well, and that can be… a big service”

Relevant Links

Local Epidemic Modeling for the San Francisco Department of Public Health

San Francisco’s COVID strategy

Multi-sectorial Approach to HIV in East Africa

Maya Petersen Day in San Francisco

Maya’s UC Berkeley page

About Our Guest

Dr. Maya L. Petersen is Professor of Biostatistics and Epidemiology at the University of California, Berkeley. Dr. Petersen’s methodological research focuses on the development and application of novel causal inference methods to problems in health, with an emphasis on longitudinal data and adaptive treatment strategies (dynamic regimes), machine learning methods, adaptive designs, and study design and analytic strategies for cluster randomized trials. She is a Founding Editor of the Journal of Causal Inference and serves on the editorial board of Epidemiology. Her applied work focuses on developing and evaluating improved HIV prevention and care strategies. She currently serves as co-PI (with Dr. Diane Havlir and Dr. Moses Kamya) for the Sustainable East Africa Research in Community Health consortium, and as co-PI (with Dr. Elvin Geng) for the ADAPT-R study (a sequential multiple assignment randomized trial of behavioral interventions to optimize retention in HIV care).

Source: https://publichealth.berkeley.edu/people/maya-petersen

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For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email

If there’s one thing politicians do little of these days it’s change their minds. But, that’s exactly what North Carolina’s General Assembly did in 2023. Ten years after the ACA was passed, and in a historic bipartisan move, they changed their minds and voted to expand Medicaid. NC Secretary of Health & Human Services Kody Kinsley joined us to talk about what it took to get this done and how it’s been going so far.

We discuss:

• How to get stuff done in a politically divided state
• One move that would dramatically increase access to healthy food in America - automatically enroll all Medicaid beneficiaries in SNAP
• Why NC Medicaid has gone deep on peer to peer support for prenatal care and mental health
• The importance of building a better narrative about the role and value of public health

Kody points out NC’s strategy of investing in community organizations is creating both health and economic opportunities:

“75% of our community based organizations are minority or women owned throughout those 33 counties. So, this isn't just about getting good access to what drives health in the long run. This is also about building that infrastructure and having a financing model that sustains it that is in the balance, a good value for the taxpayer.”

Relevant Links

NC enrollment dashboard

Crisis warmline

Healthy Opportunities pilots

“NC Launches Additional Phone Support for People Experiencing Mental Illness or Substance Use Disorfer” [RELEASE]

About Our Guest

Kody Kinsley serves as North Carolina’s Secretary of Health & Human Services, overseeing a department with over 18,000 staff and a $38 billion budget. With experience centered on health policy and operations, Kinsley worked on digital healthcare transformation, national education and labor policies, and served as COO and CFO of the U.S. Treasury.

Secretary Kinsley’s three priorities for the department include: Investing in behavioral health and resilience, improving child and family well-being, and building a strong and inclusive workforce. Under his leadership, North Carolina expanded Medicaid and received the largest investment to bolster the mental health system in over a decade. Kinsley grew up in Wilmington, earning his bachelor’s degree from Brevard College and his master’s in Public Policy from the University of California at Berkeley.

Source: https://www.ncdhhs.gov/about/leadership/kody-kinsley

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For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email claudia@theother80.com and follow us on twitter @claudiawilliams...

One thing is clear from the last four years: public health leaders need to seriously upgrade their skills in communication and partnering. In this episode Anne Zink, who is stepping down as Alaska’s Chief Medical Officer, brings us a master class in both topics. Guiding the state through COVID she inspired both a Facebook fan group and the hashtag #ThinkLikeZink. Take a listen and you will see why.

We discuss:

• How we might have avoided the politicization of COVID
• Partnering with Alaska’s tribes to get vaccines to every corner of the state
• The ways her background as a fine art major, mountaineer and emergency medicine doctor shapes her leadership approach

Anne is committed to breaking the silos between medical care and public health:

“Public health is population health and if you want to make a difference … public health and health care have to be braided together. We need to not think about this in terms of separate systems, but we need to think in terms of patients and to get there, public health is that key chief strategist for population health and needs to be at the table.”

Relevant Links

NPR Story on #ThinkLikeZink

Article on the Five Reasons Dr. Zink is crushing it as a crisis communicator

An interview with Alaska’s top doctor

Article on the rural Alaskan towns leading the country in vaccination

Case study on the partnership between public health and tribes for vaccine distribution in Alaska

Information on the Watson Fellowship

About Our Guest

Anne Zink grew up in Colorado and moved through her training from College in Philadelphia to Medical School at Stanford and then Residency at the University of Utah. As a mountaineering guide she had fallen in love with Alaska and after residency in Emergency Medicine became lucky enough to call Alaska home. Not only does she love the people and the place, but also the medicine. She quickly became involved in helping improve systems of care as the medical director of her group, then in her hospital and with state and federal legislation, including state legislation to improve care coordination, opioid addiction treatment options, and integration between private systems and the VA, DOD, and IHS facilities and more.

Dr. Zink became Alaska’s Chief Medical Officer in July 2019. In all the work she does, she strives to create work environments, policies and practices that are data-driven, foster collaboration and build system efficiencies that put patients first. Zink was a visible public presence in the early months of the pandemic,...

Today’s guest is Susannah Fox, author of Rebel Health: A Field Guide to the Patient-Led Revolution in Medical Care. The book is a deep dive into the expert network of patients, survivors and caregivers who are charting a new path of innovation and research. It is for anyone who feels alone, forgotten or lost in the shadows of suffering as they navigate a new diagnosis. But, it’s also for anyone working inside healthcare who is fed up with the status quo.

We discuss:

• How patients – like those first affected by long COVID - accelerate solutions by making invisible problems visible
• That data liberation is often the foundation for patient rebel movements
• The pop up peer groups forming in Amazon reviews
• A framework for understanding, and embracing patient expertise: seekers, networkers, solvers and champions

Susannah reminds all innovators to talk with people living with rare and life-changing diagnoses:

“If you are going to try to understand the intersection of healthcare and technology, you need to put down your clipboard – which is the classic status symbol of a survey researcher – and get out there and just talk to people. Talk to people especially who are dealing with rare and life-changing diagnoses, because those are the people who are going to use technology in ways that we can't even imagine.”

Relevant Links

Susannah’s book Rebel Health

Susannah’s blog: Wow! How? Health

Patient-Led Research Scorecards

An article about how patient-led research could speed up medical innovation

A story about Tidepool Loop receiving FDA clearance

OpenAPS and #WeAreNotWaiting

Hugo Campos’s TedX talk about not being able to access his cardiac device data

Graphic used by Sarah Riggare to show the time spent in self-care for Parkinson’s disease

About Our Guest

Susannah Fox is a health and technology strategist. Her book, Rebel Health: A Field Guide to the Patient-Led Revolution in Medical Care, was recently published by MIT Press. She is a former Chief Technology Officer for the U.S. Department of Health and Human Services during the Obama Administration, where she led an open data and innovation lab. Prior to federal service, she was the entrepreneur-in-residence at the Robert Wood Johnson Foundation. For 14 years she directed the health portfolio at the Pew Research Center’s Internet Project where she helped define a new market at the intersection of health, social media, and patient engagement. Fox currently serves on the board of directors of Cambia Health Solutions of Portland, OR, and Hive Networks of Cincinnati, OH. She is an advisor to Alladapt Immunotherapeutics, Archangels, Article 27, Atlas of Caregiving, Before Brands, Citizen, Equip Health, Faster Cures, and the Lemelson Center for the Study of Invention and Innovation at Smithsonian Institution. Fox is a...

We'll be unpacking lessons from the COVID 19 pandemic for many years to come. Dr. Tomás Aragón, who leads public health for the State of California, joins us to discuss what he learned guiding America's most populous state through this challenging and disruptive period.

We discuss:

• That public health’s deepest power lies in the ability to help diverse groups reach consensus under great uncertainty
• How California redeployed an army of census workers to support the COVID response
• The biggest opportunities to use AI for public health
• Three great book recommendations: “How Emotions Are Made” by Lisa Feldman Barrett, “High Conflict” by Amanda Ripley and “Fifth Discipline” by Peter M. Senge

Dr. Aragón shared insights about leadership:

“The other thing is to really appreciate the importance of human psychology. It is so incredibly important … You're going to come up against people who are going to “resist”. I don't think of it as resistance. I just think they're being human. That's just all it is. People have variability in how they process information … And so rather than seeing things as resistance, you really just see it as part of the diversity of ingenuity that exists in an organizational culture.”

Relevant Links

Dr. Tomás Aragón’s UC Berkeley Public Health profile

Dr. Tomás Aragón’s GitHub blog

Article on Bay Area pandemic response: The epidemiology and surveillance response to pandemic influenza A (H1N1) among local health departments in the San Francisco Bay Area

“How Emotions Are Made” by Lisa Feldman Barrett

“High Conflict” by Amanda Ripley

“Fifth Discipline” by Peter M. Senge

About Our Guest

Dr. Tomás Aragón, MD, DrPH, has served as the director of the California Department of Public Health and the State Public Health Officer, since January 4, 2021. Prior to coming to CDPH, he was the health officer for the City and County of San Francisco and director of the public health division. Dr. Aragón has served in public health leadership roles for more than 20 years (communicable disease controller, deputy health officer, health officer, community health and chronic disease epidemiologist), including directing a public health emergency preparedness and response research and training center at the University of California, Berkeley School of Public Health.

Connect With Us

For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email claudia@theother80.com and follow us on twitter @claudiawilliams and LinkedIn.