Name: Jay Bhatt, DO, MPH, MPA
Specialty/Interests: Primary Care & Geriatrics | Public Health Innovation | Physician Executive
Education: University of Chicago (BA) | Philadelphia College of Osteopathic Medicine (DO) | University of Illinois at Chicago (MPH) | Harvard Kennedy School of Government (MPA)
Current Position: Executive Director of the Deloitte Center for Health Solutions (DCHS) and the Deloitte Health Equity Institute (DHEI)
About Dr. Bhatt:
Jay Bhatt, D.O., MPH, MPA is a physician executive, internist, geriatrician, public health innovator and widely quoted expert on the most pressing challenges and exciting opportunities in health care. These include cross-sector initiatives; the application of predictive analytics and informatics; using Medicare and Medicaid as opportunities to redesign the healthcare system; addressing the social determinants of health to lower costs, improve outcomes and eliminate inequities; technology innovation; and emergency preparedness. As a physician executive, Jay’s innovative initiatives have helped hospitals deliver safer, smarter and better care; made physicians and nurses more skilled and responsive to patients; and helped government across sectors impact health outcomes and the health of communities. These accomplishments have been informed by his earliest positions practicing internal medicine and geriatrics in underserved communities at the Erie Family Health Center on Chicago’s Northwest Side and as the managing deputy commissioner and chief innovation officer for the Chicago Department of Public Health. Through hard work and fresh ideas, he became a trusted community leader and eventually was able to bring the voice of those patients to the Illinois Health and Hospital Association (IHA) and American Hospital Association (AHA) as a senior executive. Jay earned a B.A. from the University of Chicago; a Doctor of Osteopathic Medicine (D.O.) from Philadelphia College of Osteopathic Medicine; a MPH in public health from the University of Illinois at Chicago; and a MPA in public administration from the Harvard Kennedy School of Government as a Zuckerman and Commonwealth Fund Minority Health Policy Fellow. Over the years, Jay has received many honors. He was an Aspen Health Innovator Fellow and a Presidential Leadership Scholar; was named to 40 Under 40 lists by Crain’s Chicago Business, the National Minority Quality Forum, MedTech Boston and Becker’s Healthcare, where he was a Rising Star; and received UIC School of Public Health’s Distinguished Alumni Achievement Award, the National Medical Fellowships’ Champions of Health Award and the American College of Physicians’ (ACP) Walter J. McDonald Award for Early Career Physicians. He was also named a leader in the ACP’s Resident/Fellow Membership and is part of the National Health Service Corp, a program aimed at reducing health workforce shortages in underserved areas.
Follow him on Twitter @bhangrajay, Instagram at drjaybhatt and LinkedIn.
1 | What do your roles as a clinician & public health leader entail today?
First and foremost, I’m a doctor for underserved communities focused on steering the vulnerable and impoverished towards a better future. I also communicate at scale about healthcare issues to the public, policy stakeholders, healthcare leaders, and clinicians to advance knowledge about critical issues facing our nation. Most recently, I’ve been providing expert commentary about COVID-19 to the public.
Clinically, I am a primary care internist and geriatrician, and I work at a federally qualified community health center. For context, community health centers were started across the country to care for people in underserved communities and do so without taking into consideration insurance and cost – in other words, they were initiated to serve those in the truest need regardless of their capacity to pay.
Accordingly, we serve a lot of folks on Medicaid, Medicare, and the uninsured and see commercial insurance minimally. We also partner with hospitals in the region and are able to provide care to folks who’ve developed relationships with the community health center and are in need of support. That’s one bucket of work.
I also work for an Accountable Care Organization (ACO) under whom I serve a population of folks on Medicaid. ACO’s host groups of clinicians who share responsibility in coordinating care for patients on Medicaid and Medicare – we work to design high-quality, equitable care models for vulnerable populations and older adults. Personally, I work in South Side Chicago and we’ve developed a really unique care model in which we are working directly with community health centers and safety-net hospitals and girding their delivery of care from different angles.
For many years, the healthcare system has operated around the goal of seeing as many patients as possible without much attention to outcomes specifically. Fortunately, things are changing.
The way we’ve structured care now – value-based care – is oriented around the primary care team delivering better outcomes for patients they see, coordinate, and manage. We also address social needs by working alongside policymakers to impart lasting social, economic, and environmental change at a systemic level.
Technology is particularly important to our model because it has empowered us with a 360-degree view of our patients and allows us to delegate care management at the practice level. As a result, we have highly reliable, customized workflows that empower clinical teams to work at the top of their game.
As a result of our model, we’ve been delivering top-outcome results for any Medicaid managed care plan in the state and we’re returning significant dollars to the members of the ACO to reinvest in their practices and communities, and for us to invest in pilot interventions and models to address more multifaceted social needs – such as housing.
This has been a huge focus recently, given that on average, people with unstable housing have a 27-year lower life expectancy than those with stable housing. We’re also working around mental health, substance abuse, and opioid addiction.
2 | What experiences crystallized your interest in medicine and your commitment to the underserved?
Personally, I am the son of two South Asian immigrants – my dad is a pharmacist in Southside Chicago and my mom is a factory worker.
I spent a lot of time being raised directly alongside my dad in a pharmacy setting – whether it was his own pharmacy, the retail environment (Walgreens) or the hospital. Ultimately, by spending so much time with him, I was able to understand and observe healthcare at various levels and environments and felt a growing sense of motivation and fascination with both science and helping people live better lives.
I saw firsthand how the medicines that my dad brought to people at their homes, given that some patients couldn’t make it to the pharmacy, made a world of a difference and imparted a huge sense of relief. I also saw how healthcare team members worked together to provide nutrition counseling, support patients with diabetes, and ensure that medications could be placed within the hands of patients, even if transport challenges or disabilities jeopardized one’s capacity to make it to the pharmacy.
These experiences were surely influential, but in college, I visited a barbershop and ultimately had my perspective shifted permanently. This shop was a popular joint among my college classmates, and when I visited, I saw several local black physicians setting up a clinic in the back. They said to visitors that if they’d like to get a haircut for free, they have to be seen by a doctor. This was an informal, but hugely impactful local intervention that has now been of service to hundreds of people.
These black physicians spoke about the obstacles and constraints they were forced to navigate professionally and personally – the lack of economic opportunity, the limited transportation, poor health, etc.
Eventually, I had the opportunity to work alongside these men and their families, and I came to realize that if you could effectively empower communities, even through a minor, informal local intervention, you could shift the trajectory of people’s futures for the better.
I also saw family members serving within medicine: my grandfather was the food and drug commissioner of India, my uncle a cardiologist, and I saw a lot of people engaged in healthcare and leveraging their position to help vulnerable populations achieve their highest potential in health, and as a result, achieve greater opportunity and eventually prosperity.
My experience serving alongside physicians within the four walls of a barbershop, alongside the insight I was gleaning from my father and family’s work, crystallized my interest in becoming a doctor and putting myself in a position to serve as an agent for social change.
3 | What led you to pursue primary care & geriatrics?
It was a priority to me to put myself in a position where I could serve patients indefinitely and forge longitudinal partnerships with each individual I cared for – this would ensure that my support extended beyond the duration of a singular visit.
Ultimately, there were four major factors that led me to primary care: firstly, primary care provided the opportunity I was looking for to develop such relationships with people and their loved ones. It put me in a position to treat a wide range of conditions and enabled me to advance public health and prevention. And lastly, it gave me an opportunity to serve within underserved communities.
I did think about becoming a cardiologist and an infectious disease specialist, but these specialties would have focused me in specific areas. I enjoy the broader medical landscape and the opportunity to serve in different directions.
I also trained as a geriatrician, an interest that was formalized by one experience in particular. I had a patient who ended up falling, breaking her hip, going into surgery, completing post-acute rehab, suffering an infection, and landing right back in the hospital.
What would’ve been a 24-hour treatment course evolved into 3 weeks of suffering that she didn’t need. I was able to see the challenges associated with transitions in care, as well as the unique hindrances facing elderly people, specifically their delay in healing.
Today, I’ve been fortunate enough to have worked with members of the John H. Hart Foundation and the Institute of Healthcare Improvement to create a model of care around the elderly and the aging.
4 | What were some of the most influential training experiences that broadened and strengthened your knowledge base?
I think the most influential learning experiences can be distilled down to the people I was fortunate enough to have come across. Over the course of my career, outside of my collaboration with doctors in the healthcare system, I’ve been able to work directly alongside those in a policy role, social workers, nurses, pharmacists, dentists, community health workers and I’ve learned a great deal from interacting with such individuals in different environments.
I also would attribute my time at the Harvard Kennedy School and University of Illinois School of Public Health as places where I honed my understanding of leadership and public health and started to glean insight into how I could fuse my understanding of these things and integrate them into my work for a more lasting impact on patients and the healthcare system.
My clinical training was complemented and enriched by each of these nonclinical experiences and interactions – by coming to appreciate how different folks went about different problems, I’ve been able to strengthen my understanding as to how policies and systems can be refined for lasting change.
Today, I’m able to think more critically about the conditions that result in illness and should be attributed for poor health outcomes in the first place – and by capitalizing on this growing understanding, my work has diverged into the various roles I now play.
5 | If you were to distill the major issues facing the US healthcare system to a few fundamental challenges, what would they be?
For one, we need to move towards a healthcare system that is oriented around health and not sickness.
Our system should be able to keep people healthy and shouldn’t be a measure leveraged only in the face of illness. Arranging such a system will take time, and it may require us to find a means of effectively incentivizing patients to act proactively and preventatively, but this frame of thought is becoming increasingly important.
Climate change is another issue that poses tremendous threat to our healthcare system and the wellbeing of society at large. For one, weather hazards pose threats to both the delivery of care and long-term energy efficiency. They impact the workforce, resource availability, and force hospitals and systems to incur costs that could otherwise be reinvested elsewhere in an area where there is much greater need. And most importantly, they pose a risk to environmental stability, which has major implications for our supplies and the sustainability of our healthcare system.
I also believe value-based care is of great importance. We were moving pretty quickly towards value-based care in earlier years, but our rate of progress has diminished and we need to do more on that front and accelerate the rate at which we approach that goal.
Fourthly, I think we need to continue thinking about unique care models for aging. Health aging is of tremendous importance – we see retail players, innovative practices, and a lot of different models emerging. We need to figure out how to make it easy for folks to achieve affordable, high quality, reliable, equitable care as they age.
6 | How does climate change threaten the healthcare system?
In developed nations like the United States, I think it is easy to overlook the tremendous threat that climate change poses towards the healthcare system, but its implications become increasingly apparent as you examine the challenges plaguing developing nations.
Firstly, for our healthcare system to remain effective and reliable, every effort needs to be optimized for sustainability. And to sustain the healthcare system as it exists today, and to sustain the changes that will surely be imparted on the system in the coming years, we need to strive for improved individual, environmental health, and planetary health – these three things need to be in harmony for sustainability.
Fundamentally, at the individual level, climate change will evolve to increasingly jeopardize the social and environmental determinants of health – this will manifest in compromised drinking water, clean air, sufficient food, secure shelter, and resources.
At a broader level, climate change poses a tremendous threat as we think about sustainability and energy efficiency. It is well established that climate change will culminate in a higher frequency and intensity of severe weather events, infectious diseases, and a host of other challenges that will cost resources to redress. Our healthcare system is going to have to adjust around this.
There are vulnerable populations in need of shielding. Communities are going to face infrastructural challenges and people will lose their homes. In the face of heat waves, we’ll need greater resources to sufficiently support people. We’ll need backup generators and routes through which we can efficiently and safely evacuate patients. Even today, there have already been incidences that have forced hospitals to shut down. In the face of the California wildfires, hospitals have had to evacuate patients and close their doors to people in need – as the threat of climate change exacerbates, these incidences may scale into something with much harsher implications for the healthcare system.
7 | How should we be thinking about combatting health inequity?
The root causes of inequity can be traced to our nation’s history, and the racism of earlier times has prevailed, both deliberately and inadvertently in the form of biases that still manifest today.
Challenges associated with education, income, housing, transportation, food insecurity, violence, and isolation fall upon communities unevenly, and they ultimately accentuate the inequities that are rooted in our history.
Moreover, inequity doesn’t just affect the victim. It affects society at large because it has a profound economic and social impact – tangibly speaking, about 23 trillion dollars have been lost in economic productivity as a result of inequities in the last three decades.
My colleague shared with me a parable that makes clear the fundamental challenge facing this nation. In the story, there are three kids playing along a riverbank, and they see people being dragged through the water downstream. One of the kids says “I’m going to jump in the water and try to save these people.” The other says “I am going to hang off the branch and try to pull people out.” The third person – who is a girl – says “I’m going to go upstream and find out why they are in the water in the first place.”
Ultimately, the parable lays clear the importance of focusing on removing obstacles to good health: poverty, discrimination, and inequity, and a host of other hindrances. We need systems that support people so that they can achieve their best potential for health and ultimately lead a more fulfilling life, and that means we have to go upstream.
Today, we treat people for asthma but send them right back to the environment that aggravated the issue in the first place – perhaps a factory. Then, they end up right back in the hospital. We need to go upstream and explore the root issue at hand and ultimately change the environment so that these triggers are nonexistent in the first place.
8 | What tangible steps can we take to redress inequity?
If we define health equity as a just opportunity for every individual to achieve their highest potential and wellbeing, we need to find a means of working to remove racism and implicit biases as barriers to achieving health equity.
They surely exist in the ecosystem. There is distrust, medical mistreatment, and lack of equitable access to care.
We need employers to understand the importance of driving towards health equity and lay clear the steps that must be taken for equity to be achieved.
There is an economic argument for this. If we can reduce the inequities across the nation, we’ll ultimately reduce healthcare costs greatly and the benefits will be reaped by the individual, the business, and the community broadly.
Today, ample resources are devoted towards mitigating the consequences of inequities – if instead, we were to invest these resources to prevent these issues in the first place, we’ll have the economic strength to focus on areas in greater need.
Life science organizations and public health organizations should work together to address common systemic changes that are needed to achieve health equity. We can take action at the community level and individual level, and value-based care models will be very important in this process.
We also need organizations to go through their own journey of addressing biases and improving cultural sensitivity and humility.
9 | Given the issues that the pandemic has laid clear, what should healthcare leaders be focused on today?
I am concerned about healthcare workers. The pandemic has been very challenging for my colleagues and individuals working across the healthcare system and delivering care in institutions and communities. I worry about our ability to retain these individuals.
We need to further support healthcare workers, their various responsibilities, and their work.
We also need to accelerate the path to value-based care.
We need to more greatly embrace technology: the inefficiencies facing the healthcare system today have a profound expense on resources and the wellbeing of clinicians and patients. That said, technology provides a means to achieve greater system interoperability, leverage predictive analytics, and use augmented artificial intelligence in ways that minimize bias.
These are just a few things that are of tremendous importance today.
10 | How does your model of care deviate from traditional care?
We know that community health centers do not have a significant Medicare footprint. They aren’t seeing a significant population of Medicare patients – mostly Medicaid.
If we look at the rising number of individuals that are coming to community health centers, those who are 64 or older have increased in the greatest proportion. Respectively, it is critical for community health centers to think about a Medicare strategy, and Medicare Advantage is one of those strategies that are important because it unlocks benefits and congregates of coordinated and integrated care that older adults can benefit from.
I’ve been working to develop a model of care that helps older adults achieve their highest potential for health in supportive living facilities, nursing homes, long-term care, and within the community setting. The model has been designed to help people progress forward, whether that requires virtual meetings or support within the home or clinical settings.
For example, we leverage technology, care coordinators, care managers, and other partners to reduce falls at the root level. We also provide support within the community through social workers to address food insecurity, housing and transportation; we’re able to connect these patients with mental health professionals, dentists, eye doctors, and given the comprehensive nature of the model, we keep people healthy and generate savings and returns in the long run. More importantly, we’re able to generate great outcomes.
11 | What disciplines and learning opportunities should physicians-in-training immerse themselves within?
To acquire informative experiences, I think students should partner with organizations in the community and try to understand the factors driving their work. They should also work directly alongside vulnerable populations and try to understand the nature of their challenges and their unique position.
Secondly, there should be specific resources you read regularly as your primary sources of information to keep yourself informed about the industry – whether that be Health Affairs or Modern Healthcare or Harvard Business Review, etc.
It’s also good to have a broad range – there are consulting associations you can collaborate with for learning opportunities, depending on the interests you have.
I would also advise students to partner with physicians and experts in the field delivering care or engaged in policy. Ask critical questions – what are we doing today? Why do we do things the way we do them today? How can we improve upon our processes today?
Asking questions is critical – you might come back to the same answers you’ve encountered before, but you might also end up with something different. Something that sparks more questions and guides your conversations in a manner that will be more fruitful to you.
12 | What new frontiers in medicine particularly excite you?
I’ve been thinking a lot about unique care models that bring different stakeholders together: there is retail, innovative primary care in community-based organizations, efforts to redesign Medicaid to go more upstream towards value-based care. Right now, there is an interesting model called DC (Direct Contribution) that is introducing some new things in Medicare. I think we’re also at an interesting inflection point with the Centers of Medicare and Medicaid Services – there is going to be interesting things coming from the federal government.
13 | What would you like to share with our readership?
Be curious and avoid judgment. Ask questions and make observations. Think about what the answers mean and test them against your thoughts and insights, as well as those of your colleagues and people impacted in the environment.
I’d also like to note that leadership is a practice. It can come from formal authority – a position – but it can also come from informal authority.
This requires that you build trust, relationships, and a reputation for doing certain things. You listen and act with emotional intelligence and empathy. Building skills in these arenas will cultivate a richer leadership capacity.
Lastly, you should have a regular cadence of writing, reflection, and reading diverse perspectives on the healthcare industry.