Sonia Sarkar, Chief of Staff of Health Leads

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Mark Masselli: This is Conversations on Healthcare. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret the president had some pretty strong words for the
D epartment of V eterans A ffairs , and the trea tment delays at the Phoenix VA hospital
which led to 40 preventable deaths , and the president saying last week that he will not
stand for any misconduct to the nations VA Hospitals.

Margaret Flinter: Well he called the allegations of patient delays for c are and cover up
of these mishandled cases akin to dishonorable conduct and said that any VA
employees who manipulated medical records will be held accountable. Now there is a
comprehensive review under way some 26 VA hospitals across the country where
si milar issues have arisen. N ow the President is continuing to support VA secretary
Erin Shinseki and he knows that many of these issues are systemic and long standing
and it can’t be pinned entirely on the most recent VA secretary.

Mark Masselli: You kno w Margaret while so many new initiatives have been launched
at the VA like the blue button initiative to make medical records easily accessible for
patients and providers like . I t’s still large diverse patient population with a heavy burden
of complex med ical behavioral health and social issues and with the influx of additional
veterans over the past decade were the strain on the system has only increased.

Margaret Flinter: Well I think you are right Mark. But you know the White House has
been doing muc h to improve the lot of veterans with the joining forces campaign to
strength the military families with incre ase d support systems and including in behavioral
health and education and employment opportunities. I think a real commitment to the
cause of vet erans and their families and I suspect that this targeted review of the
underperforming VA hospitals in the long run will strengthen the VA.

Mark Masselli: I think you are right. Our guest today has been in the trenches of care
delivery in clinics aroun d the country especially where populations are underserved in
social conditions are negatively impacting health outcomes.

Margaret Flinter: Sonia Sarkar is the Chief of Staff of Health Leads, an organization
that partners with healthcare organizations an d seeks to assist their patients in
eliminating the social determinants that leads to poor health, lack of access to decent
nutrit ion, poor housing, unemployment . T heir organization is yielding some very

interesting results around the country in terms of improved outcomes for patients by
helping patients meet some of their basic needs.

Mark Masselli: We look forward to hearing from Sonia as well as Lori Robertson
Managing Editor of factcheck.org who stops by to correct another misstatement about
health p olicy in the public domain.

Margaret Flinter: And no matter what the topic you can hear all of our shows by going
to chc radio.com.

Mark Masselli: If you have comments please email us at CHC radio or find us on
Facebook or Twitter because we would love hearing from you.

Margaret Flinter: We will get to our interview with Sonia Sarkar in just a moment.

Mark Masselli: But first here is our producer Marianne O’ Hare with this week’s H eadline
news.

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Marianne O'Hare: I am Marianne O’Hare with the se Healthcare Headlines . A one - year
reprieve for hospitals and practices trying to get up to speed with meaningful use of
electronic health records the centers for Medicare and Medicaid announced that
practices in hospitals struggling to graduate from Sta ge I to Stage II of meaningful use.
We would get another year many practices complaining they were experiencing delays
with implementation of the 2014 standards. The one year delay will give these practices
more flexibi lity according to CMS officials. 7 healthcare workers who were exposed to
the second American represent with symptoms from the M iddle E astern MERS virus
had been cleared to go back to work . The clinicians including one physician had the
exposure to the patient. They were clear to go back to work after test determined they
weren’t carrying the virus , but they will continue to be tested. Speaking of viruses
should testing patients for HPV replace the typical Pap Smear. The thinking is testing a
woman for presence of HPV virus , the primary cause of cervical cancer will provide an
earlier window into those at risk. Opponents of the HPV testing were in many women
who carry the HPV virus never present with cervical cancer so with a necessarily worry
many women. Ther e is an effort under way t o develop interim guidelines for how to use
the HPV test for cervical cancer screening. Those guidelines group say could come as
early as this summer and another reason to tuck your toddler in for a decent night of
shut eye, a recent study shows the direc t correlation between insufficient sleep in
toddlerhood and belly fat later on and a study released in a general pediatrics Boston

researchers looked at a thousand children between the ages of 6 months and two
years. They measured the body mass index or B MI of all these children at the age of 7
and found those who would receive less than optimal sleep had higher BMI’s and more
important precursor to poor health later on to more belly fat. According to the National
Sleep Foundation the optimal amount of sl eep for toddlers is 12 to 14 hours a day
including the nap time. The study shows that a 7 year old who got less than 12 hours of
sleep between the ages of 6 months and 2 years had 36% higher odds being obese
than the child who got more sleep as a small ch ild. I am Marianne O’Hare with these
Healthcare Headlines .

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Mark Masselli: We are speaking today with Sonia Sarkar Chief of Staff of Health Leads
at National Organization dedicated to build ing a different kind of healthcare which
addresses all p atient ’ s basic resources needs as a standard part of quality care.
Ms . Sarkar co - founded health leads of Baltimore side serving as a program coordinator
as well as on the national board of directors. She has worked for the Baltimore City
Health Departmen t as a Mayoral Fellow and is also recipient at the rotary cultural
ambassadorial scholarship. Ms. Sarkar is found in board members for the Boston
Young Healthcare professionals and health works foundations young professionals.
Ms. Sarkar has a numerous d istinctions and including being named a young global
shaper by the world economic forum. She earned her BA and Masters D egree in public
he alth at John Hopkins University. Sonia welcome to conversations on healthcare.

Sonia Sarkar: Thanks so much for ha ving me.

Mark Masselli: Yeah you know everyone is talking about social determinants of health
but actually Health Leads is doing something about it and in a difficult environment
because the healthcare industry is really not designed or equipped to addre ss the many
causes of poor health leads in the population like diet and housing and transportation.
Tell us about Health Leads . Share with our listeners more about your organization.

Sonia Sarkar: Well one of the challenges of our current healthcare sy stem is that it isn’t
designed to deliver health. Every day we have physicians and other members of the
clinical team across the country who are prescribing antibiotics for example only to
discover that the real issues isn’t in the food at home or that th e family is living in a car
and then the situation of course the patients return back to the healthcare system with
yet more serious illnesses that are even more expensive to the healthcare system so
hopefully really it is born of conversations that are fo und there back only had with
physicians that what was done Boston City Hospital in the mid 90s when she was a

Sophomore in college and in this conversations and in (inaudible 06:58) we heard
clinicians tell us again and again your everyday patients that co me to the clinic waiting
room and they present with the health issues but I know that the underlying factors the
reality of their patient flies and hopefully it is really based on the idea that you can do
something about that. In the clinics where we oper ate the physicians and the other
members of the clinical team can prescribe basic resources that patient see to the
health facing like food, heat, childcare and the patients can then take that prescription
into the clinic waiting room where our well - traine d core of college student advocates
who work side by side with them to connect them out to the existing landscape with
community resources.

Margaret Flinter: Well Sonia isn’t certainly the very popular TED Talk that your founder
Rebecca only did but in i t she talked about building a team of elite volunteers as elite as
anyone in college sports too I love that analogy and said that these college students
could be mobilized all across the country with p artner healthcare organizations, you
begin your career with health leads as one such volunteer in Baltimore while a student
at Hopkins tell us about these elite volunteers.

Sonia Sarkar: There what we are really looking for as someone with passion about not
just serving patients but really looking at the lar ger picture of help serving that patient
could create a larger change within the healthcare system and specifically the question
that we o ften get is why college students you know why have you chosen this co hered
of folks who are pretty professional and wh o haven’t yet embarked on their careers. We
are looking for folks who are sort of cohesive in their retrieval of information on behalf of
patients. This is a generation that is growing up on Google and know how to track down
any phone number of any food pantry and any community. the reason that e are really
looking at this cohered is because you are capturing folks sort of time and their
developments where everything really makes a last thing impression and these
advocates go on to become alumni who have a very distinct impression of how
healthcare should be delivered. When they end up at a clinic or hospital 5 or 10 years
down the line , they look around and they say I want to be able to provide care for my
patients so they are actually responsive to the social factors in their life and that’s really
what we are looking for in those advocates that we choose. They are people who
become those future champions.

Mark Masselli: Pull the throttle a little more on that, the process that goes on. Again it’s
t he provider who is prescribing the food and the health and the childcare and then the
patients out with the health leads advocate and how does that all work for the patient?

Sonia Sarkar: Well one of the things we have been really intentional about doing is
looking at the core elements of the patient experience, the connect workflow I am
thinking about how to appropriate that for the cause of health. One of the things that we
want to be careful not to do is add a lot of extra things on to with already go ing on within
a busy clinic and so we looked at things like the prescriptions had, a screening tool that
you might get when you first walk into the clinic. Integrating data about patients social
needs into the electronic medical record and we said okay ho w do we re - appropriate
those for the purpose of connecting patients out to resources and so when I was an
advocate at the Harriet Lane Clinic which is a pediatric clinic at the John Hopkins
Hospital in Baltimore. I remember one of the cases that I encount ered was mom who
would come in because of the pediatrics clinic and you are talking to your pediatrician
about how her son had just been to the emergency room for the third time that month
due to lead poisoning I mean the fact that she was unable her kids to really escape from
that environment and what was key about that encounter is that physician had in front of
her a screening tool that the patient had filled out saying yes I need help finding safe
housing and then the physician was able to make a seamle ss referral to health leads
where I was able to sit down with the patient, hear her story and talk to her about what
she was experiencing and from that we were able to jump right in and get the family
access to about her for lead abatement as well as addre ss the whole host of other
factors like access to healthy food that was really impacting the family at that point in
time.

Margaret Flinter: Well Sonia I understand you have been getting quite a bit of attention
for your client connect program which is a digital platform that facilitates the search for
resources, what’s different about what you are doing with client connecting, how is it
helping patients in any sense of metrics or outcomes from that program?

Sonia Sarkar: For us client connect to really represents taking advice that as a
physician or a nurse or social worker give us in the clinic and making it actionable so
technology of course is something that can accelerate the encounter between our
advocates and the patients so last year we served 11 ,400 families utiliz ing the client
connect database. This year we will serve just a little bit over 14,000 and one of the
things that has been really incredible to see is the huge improvements in efficiency that
we have been able to gain through deploying this technology platform so just a quick
example of average intake time for a client has been cut in half from 20 minutes to 10
minutes which then allows our advocates to serve more patients in less time. We did an
hour long side by side comparison of ou r student advocate using client connect versus
our prior resource system and found out they are able to update five times more
resources than their peers so plus the technology platform serves multiple purpose of
everything from making that encounter reall y easy and efficient but also has a lot to do

with creating the data and generating the analytics that we are going to need in order to
really make the case for this work going forward.

Mark Masselli: We are speaking today with Sonia Sarkar, Chief of Sta ff of Health Leads
a national organization dedicated to building the different kind of healthcare in this
country which addresses all patients basic resource need s as a standard part of quality
care. Sonia you are one of our country’s young leaders and yo u have gained atte ntion
from lots of organizations about your work in the sort of global health space. You are
rotary ambassador scholarship recipient brought you to Costa Rica. You have worked
with the world economic forum groups of young as they call t hem global shapers . T ell
us how you have connected those back to the work that you are doing at Health Leads
or how it’s helped build your thinking process.

Sonia Sarkar: One of the things that we think about a lot at Health Lead s is how do we
examine w hat best practices (inaudible 13:19) either into the massive healthcare very
specifically and the global healthcare that we can then bring back and operationalize
with our population as well , and there is a great patient power that partners in health
often uses that really resonates with our work which is that giving drugs without food is
like washing your hands and drying them in the dirt and I think this concept is one that
has been a poor part of a lot of global health programs for de cades. The idea tha t you
really have to grapple with, the social contacts that patients are living in before you can
really make traction on health outcomes so we have done a heath phases apply the
same concept to many of our neighborhood here in the United States. When you look
at global health programs that have been very successful often what they are doing is
expanding the definition of healthcare provider, healthcare products, h ealthcare place or
in some cases healthcare payment and hopefully it has also latch on to loo king at the
expansion of each of those definition s and the United State Healthcare’s have done
whether it’s looking at a lay workforce, to work with patients, whether it’s expanding the
products of healthcare to give on the medical care to addressing socia l needs as well or
whether it’s looking at the place where healthcare is administered taking it out of the
exam room into the community and in the clinic waiting room so there have been a lot of
great innovations and a let them learn from the global health care that we have really
been able to apply to our work as well.

Margaret Flinter: Well Sonia as I listen and become soak sided by the work that you are
doing think about the size of the college student population and the need for the service
all across the country the two words that really are first in front of my mind are scalability
and sustainability and my guess is that it’s really philanthropic or social investment or
social investment bond kind of model of sustainability and I am curious what your

thoughts are about future sustainability to really reach much deeper into that market and
also penetrate more deeply across the country.

Sonia Sarkar: Yeah. Health Leads ultimate vision is that the healthcare system
addresses patients basic resource nee ds a s a standard part of quality care and so what
we are either focused on is thinking about the different levers that we have to plough it
in the healthcare system to make that vision a reality , and so we are not just interested
in serving patient after p atient although that this course is a core part of our work but we
are also thinking quite a bit about what we would take that a healthcare system to come
and accept this as a standard part of care and an underlying piece of that is of course
demonstrating the value to the healthcare system and to healthcare institutions
specifically moving the needle on patient social needs so currently Health Leads is
funded to accommodation of philanthropic dollars as well as earn revenues from our
partner healthcare ins titutions and three quarters of health leads partner institutions pay
some or all of the cost of the program and what we have been working very closely with
our partners on is trying to show that health leads can have an effect on metrics that
really matte r to healthcare institutions especially given the larger trends that play within
the healthcare system so one example of this is we recently launched an evaluation at
an academic medical center here in Boston and that’s looking at the impacts that health
l eads could have on patient satisfaction. Now that more and more patients especially
we are looking patients are getting covered under the Affordable Care Act. They are
starting to gain an agency see around where they could receive their care and as a
res ult healthcare institutions are really trying to understand how do we build the loyalty
and retention amongst that specific patient population so that they come back and one
of the elements of building that loyalty is ensuring that patients are actually sa tisfied with
the services that they are getting and that it meets their needs so I have just one
example of how we think about long term sustainability within the system it’s building
this case and providing prove plans to our partners and to other stakeho lders within the
healthcare system that this is something that can really become a cor e part of care
delivery.

Mark Masselli: So pulling this little there so value added proposition that will hopefully
influence from private payers to Medicaid in the lik e. We will walk back a little and talk
about the educational system and what you are doing on there because you really have
to establish it as a model of care and all of us have been thinking long and hard about
how you refrained the work of primary care. How are you thinking about integrating it
right in to the medical schools and trying to embed this into the next generation?

Sonia Sarkar: Absolutely well one of the great assets that we have at health leads is
our core of 4000 alumni who graduate from the program and go out into the system with

a very distinct point of view on how social determinants should be talked about and our
alumni are just one example I think of many of the stakeholders in the healthcare
system. They are starting to be in a con versation about how primary care and other
elements of care should be redesigned so what we have done at health leads is which
really taken a look at the different movements that are being made on care delivery
models and said how can we integrate into the se efforts that are already taking place so
a great example of this is the movement towards patient centered medical homes for
example which is not something that is necessarily new , but certainly something that
has gained increasing resonant over the past couple of months and we said okay for
patients centered medical home for an institution to qualify at the level III version of
being PCMH institution which then allows them to get the maximum amount of
reimbursement for patients. They have to show that t hey actually track their patients
social needs and have some sort of inventory of community resources that they can
refer those patients out to and often when we talk to institutions that are thinking about
this that can seem like a really complex process how do you go about doing that needs
assessments and building those resource database so Health Leads has worked with 6
of our current healthcare institutions partners to enable them to apply for that PCMH
status and we are saying that enabling them to mee t that one criteria really goes a long
way in how they think about the program being integrated into the rest of their clinic
workflow.

Margaret Flinter: We had been speaking today with Sonia Sarka r, Chief of Staff of
Health Leads a national organization dedicated to building a different kind of healthcare
one which addresses all of patient’ s basic resource needs as a standard part of quality
care. You can follow her on twitter by going to @sarsonia and learn more about their
work by going to healthleads usa.org. Sonia thank you so much for joining us on
conversations on healthcare today.

Sonia Sarkar: Thanks so much.

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Mark Massell i: At Conversations on Healthcare, we want our audience to be truly in the
know when it comes to the facts about h ealthcare reform and policy. Lori Robertson is
an award - winning journalist and managing editor of www.FactCheck.org, a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce the level of deception in U.S.
politics. Lori, what have you got for us this week?

Lori Robertson: Well there is a new viral email going around that claims under the
Affordable Care Act Medicare will not pay anything for seniors receiving observation

cares in hospitals. Not true. Medicare will pay a significant por tion of observation care
after co - pays and deductibles. Nothing has changed because of the healthcare law.
This is email is written in the form of a letter from a senior gentleman from Mesa Arizona
who gives his name as only Roger. Roger says that two d octors confirmed his claim
about Medicare and observation services but his claim is false. Doctors can place
patients under observation to determine if they should be admitted or discharged , a
decision that’s normally made in 48 hours. Admitted in patien ts cost or covered under
Medicare Part A after deductible is met for the year but observation care is treated as
help patient care covered under Medicare Part B. Cost of observation care are covered
too after a co - pay and deductible are met. But seniors receiving observation care as
outpatients could end up paying more than those admitted as in patients. Also follow - up
care at a skilled nursing facility is only covered under Medicare if the senior was with a
hospital in patient for at least three nights. These are legitimate issues for seniors. The
use of observation care in hospitals says increase in recent years leading to higher than
expected cost for some. The Non - Participating Center for Medicare Advocacy has been
tracking the observation care iss ue since at least the year 2000 but it has nothing to do
with the Affordable Care Act and that’s my F act C heck for this week. I am Lori
Robertson , Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from th e country's
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, e - mail us at
www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.

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Margaret Flinter: Each week conversations highlight’s a bright idea about how to make wellness a part of our communities and our everyday life’s. Smo king continues to be
the number one preventable cause of premature death in this count ry leading to over
440,000 deaths per year , and while quitting remains a challenge to most smokers the
tobacco industry continues to spend b illions of dollars on promotio n and lobbying. A
new study released by the International Tobacco Control Policy Evaluation Project shows that putting graphic warning labels on the outside of cigarette packs leads to significant reduction in the number of s mokers .
Dr. Geoffrey Fong : T here are some images of a dissected brain that has a bloody spot
that apparently is something from stroke. There is one that has a heart on it that reminds people about the relationship between cigarettes and heart attack.

Margaret Flinter: Dr. Geoffrey Fong of the University of Waterloo in Canada conducted
the study analyzi ng Canada’s Smoking Cessation on the year 2000 when Canada
began ordering that a third of the cigarette pack be reserved for graphic images of
diseased hearts and blackened lungs thro ugh 2009.

Dr. Geoffrey Fong : And what we found was that there was a sh arp decline in the
smoking rates after the warn in g labels compare d to before and we compared it to that
same period of time in the United States where there was no change in warning la bels
and it showed that the decline in smoking rates after the warning labels in Canada were
much greater than for that same period of time in the United States.

Margaret Flinter: Based on the Canadian numbers Fong and his colleagues estimate
that a simi lar program in the US would lead to a dramatic reduction in the number of
smokers here as has been shown in Canada and other countries around the world who
have initiated a similar practice. Placing graphic images of body parts that have been
damaged and diseased by smoking, providing a visual deterrent to regular smokers
under graphic visual warrantee young people considering smoking something that could
potentially lead to millions of Americans quitting and very likely prolonging their lives
now that’s a bright idea.

Margaret Flinter: This is Conversations on Healthcare. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.