Gregg Masters 00:08 This is PopHealth Week on HealthcareNOW Radio. Today’s episode is sponsored by Health Innovation Media. We bring your brand messaging alive on the ground and now in the virtual space for major trade show conference innovation summits and webinars via our signature pop up studio connect with us at www.popupstudio.productions. I’m Gregg Masters Managing Director of Health Innovation Media, publisher of ACOwatch.com and your PopHealth Week co-host with my partner co-founder Fred Goldstein, President of Accountable Health LLC, a Jacksonville, Florida based consulting firm. On today’s show, our guest is Kistein Monkhouse MPA, CEO and founder of Patient Orator, a digital health startup empowering chronically ill underserved patients with effective communication tools and healthcare resources. We discuss a range of topics in the social determinants of health domain from implicit bias and healthcare decisions to empowerment and shared decision making, as well as Kistein’s documentary film, Humanizing Healthcare, a narrative-driven, emotionally paced documentary about healthcare experiences in the United States, the film explores deeply rooted systemic issues across the healthcare ecosystem, and the barriers they present to people at each touchpoint in care delivery. For more information, go to www.filmfreeway.com/humanizinghealthcare or for the app, www.patientorator.com. So with that introduction, Fred over to you help us get to know Kistein.
Fred Goldstein 01:51 Thank you so much, Greg, and Kistein, welcome to PopHealth Week.
Kistein Monkhouse 01:54 Thank you for having me, Fred.
Fred Goldstein 01:56 It’s a pleasure, Kistein. It really and thanks so much for joining us. That was we had a fantastic conversation about a week ago, and I’m so glad to get you on the PopHealth Week . So why don’t you give our audience a little bit of your background?
Kistein Monkhouse 02:07 Sure. So my name is Kistein Monkhouse. I am the founder and CEO of Patient Orator and producer of a short documentary titled, Humanizing Healthcare. First and foremost, I love healthcare, because it is the only industry that I can think of that touches all of humanity. Therefore, it has a capacity to bring us together as a society as a collective. And as individuals. I think that COVID-19 has highlighted its importance. My background is that I am a public administrator, I specialize in public health. Most of my experience in healthcare has been on the front line, I worked as a nursing assistant in college, and I later became a care coordinator prior to founding Patient Orator . In the nursing assistant role what I saw was firsthand how silos impacted patient experience in that the patient’s voice were left unheard. And I also saw that the healthcare workers were restricted based on a limitation in time, and the great burden of documentation that they face. And so from a system standpoint, each stakeholder were at friction with the other. So the patient’s being at friction with the nurse. And there’s been at friction with the MD D and the MD at friction with the administrator. And so it continues. But on the flip side of that is my experience in working with underserved populations, which expose me to a different set of frictions in the healthcare settings or in healthcare ecosystem that is related to the issue of resource limitation and the lack of care coordination and poor patient experience based on where a person lives, their race and their income. And so eventually, I was overwhelmed and had this voice telling me that I needed to do something because I was morally conflicted about the fact that I couldn’t do more for the patients that I was caring for. And I ultimately made a decision, which I thought is an ethical decision to help bring the issues of poor patient experience of caregiver experience and also bring the voices of folks from the frontlines in those in policy to speak openly about disease and illness, not only from the problem standpoint but also from that of what are the solutions and how do we address these issues. And that really is the birth of Patient Orator, which was originally intended to be a place to amplify voices, patient voices, through video discussion.
Fred Goldstein 04:42 So you start Patient Orator and what is Patient Orator now and what have you created with that?
Kistein Monkhouse 04:49 And so one of the things that’s happened is, as I was building this story Bank of stories from all across the United States, I became ill and I found myself on the receiving end of the very thing that I was advocating for which in essence is equitable health for all. In my case, I was left undiagnosed and untreated for chronic pain issues for over a course of three years. And during that time, I was seen by over seven different specialists before I was actually treated, this experience truly opened my eyes to the importance of not only documenting these issues, surrounding poor patient experience around in poor health outcomes, but also creating practical solutions to address these issues. So in 2019, I had a lightbulb moment that brought me to realize our new mission, which is around empowering, underserved chronically ill patients to better communicate their symptoms, to better improve their health literacy, and to connect them to those services that will help them achieve optimal health through a mobile health app. And we’re currently in private beta of and so there’s a lot that is being developed as we speak.
Fred Goldstein 06:06 That’s fantastic. So the issue you really felt was the ability of an individual to better tell their story to their physician? Is that fundamentally where this is going?
Kistein Monkhouse 06:18 Yes, one of the things that I saw was patients, sometimes there’s all kinds of dynamics within these healthcare settings, a lot of which are systemically at play of deeply rooted racial issues. And I’ll get into that when I speak about the documentary. But there’s a lot of different dynamics at play. And sometimes, again, going back to restrictions around time, the lack of interoperability within the settings, resource limitation, patients are really limited in how much they can communicate and and how well they communicate. And on the other side of that, see in the clinicians having these barriers, how do you help a patient to tell their stories effectively when they’re in those settings. So it doesn’t matter what race class or gender they are, they’re able to effectively communicate what the problem is, so that the clinician can treat them appropriately.
Fred Goldstein 07:10 It’s really fascinating. I know, when we’re doing our Medicaid disease management programs, that was, you know, one of the glitches we saw is with these lower socio-economic groups was that there were sort of the two sides that you mentioned to their story, the one side of being able to communicate effectively. And the other side is to be able to take the time and hear and respond to that appropriately. And we see problems on both sides of that today. And I guess that’s sort of what you experienced in your three years journey with your pain issue.
Kistein Monkhouse 07:40 Yeah exactly with my issue, I didn’t realize that it was ongoing for three years. Of course, it wasn’t until I was in a crisis that I realized, holy cow, it’s no one has been paying attention to me. And luckily for me, I googled, I gain the help that I needed, and was able to be treated. But in my own self-awareness, I look back on the encounters that I’ve had, including the trip that I had to go to the emergency room. And I question How was it that I was communicating to the physician versus the aide versus the nurse or the respiratory therapist, whomever I was encountering, there was different ways in which I was communicated. And every time I spoke to someone else, I would share a different piece of my story that I might not have mentioned, to the other, the other party. And so those are things that I examined as to going back to that light bulb moment of, are we communicating in a way that fosters this environment that is just so restricted around time and all these other things? Are we communicating as patients effectively when we’re encountering in these settings?
Fred Goldstein 08:47 How are you seeing that you mentioned early on the the COVID issue? How are you seeing that play out in these various communities in terms of COVID? Obviously, we’re seeing much poorer outcomes for those in the lower socio-economic groups. Is this a piece of that?
Kistein Monkhouse 09:02 So a little piece, I think, first and foremost, Patient Orator’s app is going to solve for some of the issues of health disparities, but it won’t fall for all of the problems. So I’ll use my aunt, for example, who lives in Brooklyn, and she had started experiencing COVID-19 symptoms, and she went to her local emergency room, she had expressed very clearly that she had an issue, that the symptoms that she was experiencing align with what was instructed to be symptoms to look for, and she was turned away from her emergency room because she was not critical enough. And so when you look at where she’s located, in comparison to someone with more money or people that are wealthier, and the experience that they will encounter is it will be two different experience. Where as even though she communicated very clearly, she did not receive the help that she needed, because of the issue of access because of the issue around limitation in resources, etc. And so some of it is being played out around, yes, the patient should be communicated more effectively or addicted learn to communicate more effectively. But then we still have those systemic things, the systemic barriers that really regulate the quality of care patients will receive,
Fred Goldstein 10:22
right. And that really gets to the social determinants of health, which this is one of the pieces. And when I talked about the issue of if that’s part of the problem that’s going on, it wasn’t from a patient perspective, that they’re not doing it right, but that the system is able to communicate effectively with them. And there’s been this ongoing discussion about whether or not this should be something that the health care says really brings that level of education down to where the patient needs it at their appropriate level. So really fascinating. And how are things going in New York? Right now?
Kistein Monkhouse 10:53 Well, it’s from from my understanding, having family and friends that lived in New York City, I know that there’s an increase in testing sights. So that’s very good. From a resource standpoint, I think having having the testing available is one of the major steps in which we can help to bring these numbers down for people that are diagnosed or for people to be even diagnosed. And so those are some some key things that I think is really good. I think also there is this saying of New York to New York is a community unlike no other community that I’ve ever experienced. And I’ve traveled all around the country in times of stress and crisis. It’s just this amazing feeling to see people come together and be a part of the solution rather than a problem. And so for everyone who has been abiding by social distancing, and practicing social distancing, I’m really really, really impressed and really grateful for for what we’re doing as a collective.
Gregg Masters 11:56 And if you’re just tuning in, you’re listening to PopHealth Week on HealthcareNOW Radio, our guest is Kistein Monkhouse, CEO and founder of Patient Orator a digital health start up empowering chronically ill underserved patients with effective communication tools and healthcare resources. Kistein is the producer of Humanizing Healthcare, a narrative driven, emotionally paced documentary about healthcare experiences in the United States.
Fred Goldstein 12:23 That’s great. It really is part of it’s also part of your Humanizing Healthcare documentary. So can you talk a little bit about that documentary? How did that go on what made you decide to do that? And what?
Kistein Monkhouse 12:36 Yes, so Humanizing healthcare is inspired by my experience on the frontline. Having seen high hospital readmission rates among poor folks and people of color around witnessing abuse in healthcare settings, and knowing that we all care about sick and health care, but we’re operating in silos. So the film itself is a narrative driven, emotionally paced documentary about healthcare experience in the United States, it explores deeply rooted systemic issues across the health care ecosystem, and the barriers that they present to people at each touch points in care. It was produced by myself. So everything you see is 100% of reflection of my experience on the front lines, like I mentioned before, and it really highlights the patient, the frontline healthcare workers, the policymakers and just everyday Americans as they navigate the healthcare system. And what you’ll also see is the emergence or what you’ll also learn is the emergence of institutionalized healthcare within the United States. And America is really calling for Humanizing Healthcare. As a person, it is my belief that every single human being have a voice that matter. But as we navigate the stressors of our own lives of our work, in addition to navigating the societal pressures of expectations, and other things that may come along our path, we become apathetic to other people’s experiences. And I saw this firsthand in working with nurses working in nursing homes, rather, with patients that were being abused, where the workload was an issue because administrators prioritize cost savings over the safety and well being of not only patients but those that care for them. And ultimately, when you watch Humanizing Healthcare, you will learn you will feel and you will be equipped with some tools to take some steps to better your patients. To be able to be an active participant in your care, or whether you’re a provider to have the perspective of the other person who might be the patient or even even be more aware of how health plans work or any or any of those instances, for example. And, in essence, the film talks about things that you will learn at healthcare conferences. And these are some uncomfortable conversations around bias in medicine and highlighting how healthcare costs impacts patients of diverse backgrounds. In essence, it’s really a tool that brings awareness to social determinants of health, true storytelling.
Fred Goldstein 15:32 Yeah, it’s really great. I happen to watch the whole thing, it was very well done. I can’t imagine how much time it took you to actually do that. And perhaps we can get into that a little bit. And also notice, you had Dr. Lisa Fitzpatrick on there, who we had on the show a few weeks ago, as one of the people you interviewed. And obviously, she’s in a similar space trying to solve these problems. It’s also fascinating. You mentioned this when we were on the phone call that where are the conferences have discussed this stuff? And yeah, I just thought that was so true. In healthcare, we have all these big conferences, how many of them really get into these issues that are really fundamentally impacting individuals health?
Kistein Monkhouse 16:10 That’s a very valid question. And I don’t know if it was a statement, but I can tell you last year, I must have went to over seven different conferences, if not more, and I can recall, there was a social determinants of health panel at HIMSS. And they spoke about access and how, where people live, work and play impact their ability to access healthcare. And I remember that very distinctively, because I was immediately drawn to that kind of conversation and discussion. But I don’t recall other places that facilitated these conversations. And I know for a fact that I haven’t seen any conference where we had or were, the organizers had a people really describing from from a very humanistic standpoint of how these these these these silos, and these issues, impact their experience to obtain health, and from really using that diverse perspective. And so what you just brought up with, it was excellently fitted.
Fred Goldstein 17:10 Thanks. And so for your your film, where do people go to find that?
Kistein Monkhouse 17:14 Sure. So the film can be rented on Vimeo and it is available worldwide, until you essentially type in Humanizing Healthcare and it will pop up producer is Kistein Monkhouse and you can also find it on the Patient Orator website, which is patientorator.com.
Fred Goldstein 17:34 That is great. And I would recommend people watch it, it really was very insightful. And you really talk to people throughout the system, like you talked about from patients, to physicians to policymakers. And it really does open people’s eyes as to what’s going on. And in terms of that, you mentioned nursing homes as one of the things that was a sort of draw drew you into this. And you also mentioned the issue of nursing homes and costs and controlling costs. And we’ve seen what’s happening right now in COVID, particularly in the nursing homes is this really one of the underlying causes of why we struggle with that group, and they’ve been so battered by this illness.
Kistein Monkhouse 18:13 I don’t have the answer to that. But I what I do know is that if people have loved ones living in in or residing in long term care settings, that really I would just say check in on your loved one. And don’t leave them isolated. Oftentimes abuse is something that is very common, but it is not being spoken of what COVID-19 did was brought it to the forefront the issue around let’s say, for example, cost savings, prioritize safety and well being that I spoke of earlier. That’s a real thing. And what it results in is patients of not having the quality of care that they should be having. And again, COVID-19 brought that forward. But it’s really our individual responsibility to not depend on the system itself to autocorrect. But to correct them by making sure that we’re doing our job, our diligence and calling and finding out from our loved ones, or getting to know who the nursing staff is, being an active participant in your loved ones care. I think it’ll be it’ll be it’ll make a huge difference, at least from a very micro level.
Fred Goldstein 19:23 And getting back to your the app you talked about. It’s in beta now, what exactly does it or will it do once it gets released out? And how does that work? Sure.
Kistein Monkhouse 19:33 So what it will do is it will help patients navigate their storytelling, it will help them track their symptoms, it will help them store their symptoms securely. And really there’s there’s no existing app in this space that is addressing the issue of social determinants of health and literacy by addressing illiteracy and communication. So we’re really looking at addressing whose causes of health disparity from a holistic standpoint, ensuring that the patient knows how to tell their story effectively, they have a place to securely store, track and record their symptoms, that they’re improving their literacy. And that they are connected to those resources that they need.
Fred Goldstein 20:20 And as you take this message out, you’ve talked about this broader message includes the app, Humanizing Healthcare, are you finding receptivity? Are there places where people are willing to listen? Is it health systems or employers or other groups,
Kistein Monkhouse 20:33 I think people are more receptive now that COVID happened, which is a shame, really, and when when we look at the spending in the US $35 trillion in 2018, alone, and I think there was a study that was done that shows that 68% of patients had at least one challenge, or one social determinants of health challenge, which may be financial, housing, security, transportation, food, etc, etc, I think that there should be incentives around solutions that are solving these problems. So value based care be an increase in across the healthcare ecosystem is great. But we also need to look at folks like myself, that are developing tools for communities that we’ve worked in our our ourselves are part of. Receptivity should be there. But yes, there is more receptivity now because of COVID-19. And, and I am very enthused about solving these issues.
Fred Goldstein 21:39 Yeah, as am I, I think it’s unfortunate that COVID-19 is brought this to the fore. But I think it’s given us as much bigger voice regarding this. And I think you meant 3.5 trillion for the annual spend in the US, which is certainly a lot of money. And I know, we got involved in discussion last week on this issue of value based care, and whether that’s where we can find the funds for helping with social determinants of health, are you seeing more interest, beginning to come around in terms of either shifting money or finding money to help solve these problems?
Kistein Monkhouse 22:11 Yes. And so there’s a lot of a lot of call for innovation right now, even as we speak, to solve these issues. COVID-19 really expose these underlying issues in regards to healthcare disparity. And I love to see that that health systems that the payer is for everyone is really trying to solve for these underlying issues. And I think it will take a collective effort in order to really address these issues. So I’m very appreciative of the fact that there’s an uptick in technology and spending around solving for social determinants of health.
Fred Goldstein 22:48 So where are you going out to? To take your message? Who are there certain groups you’re talking to, or places you’re targeting? As you try to move this along, both from the, you know, perspective of your company, your film, and just the broader issue? Obviously, it’s, it’s embedded in you other places you’re going out to?
Kistein Monkhouse 23:09 Yes, so I am really looking at the folks who are already in the space solving for these issues, and who may be a complement to the technology that I created. And also looking at the payer system, the provider system, looking at the communities that will ultimately benefit from the product itself. So there’s, there’s a wide variety of stakeholders that I’m approaching as a startup, I think the first place that I’ve looked at was really the the key players that are already in the ecosystem.
Fred Goldstein 23:41 And did you as you start this company up, did you have some funding angels or others help you out to get this going? Have you just bootstrapped this? Where are you with that?
Kistein Monkhouse 23:52 I think we know we I bootstrap. No one wrote me a check and said, Hey, Kistein, we want you to solve for social determinants of health because we’re passionate about this issue. And we know that it’s important. No, I took that upon myself, because it is not right that people are being turned away from from hospital settings. So because of where they live, that people don’t have access to food because they live in a food desert, or an area that has a food desert. It these things are just, they’re not right. And no one is going to solve for them. Because there’s they’re well, up until very recently, there was really no incentives around solving for these issues. And so I took it upon myself, because I felt a calling and I heard a voice say, you have to fix this. And from there on out, it’s really taking steps to first prove that, Listen, I know what I’m talking about the data points to the fact that if we address these issues that will have better health outcomes, and the journey has not been easy. It’s constantly having to talk to people who don’t understand if they seriously don’t get it as to why this solution will help or any other solutions in this area will actually help to address the issue of spending and improve population health. But I continue to do it because there are patients and caregivers who looked at the application and said, I would pay you money for this right now. And that says that there is a need. And because there is a need. And because I’ve experienced the discrimination, as a patient and the unequal access to care, I will continue to work towards this solution. However, if there is an angel investor out there that’s listening.
Fred Goldstein 25:40 Yeah,
Kistein Monkhouse 25:40 I invite you to reach out.
Fred Goldstein 25:45 Well, maybe somebody will listen to this show and do it. Kistein, I think you’re fantastically oriented, a great space, obviously, you’re mission driven. It’s a critical area for this country to solve. And I just want to say I appreciate the efforts and the and the true passion you bring to this.
Kistein Monkhouse 26:02 I thank you so very much, Fred. I know when we spoke privately, I was amazed and impressed and just wanted to learn as much as I could from you as someone who’s been around and has been doing this work. And I think it takes an army of people who have been doing the work and people who are energized now. That one to solve for it. And it will also take a lot of change in minds and hearts. And hopefully we can as a collective do that.
Fred Goldstein 26:31 Absolutely. And I can tell you from both Greg’s perspective and mine, we’re happy to get on your train and try to help move this thing forward. So Kistein, I want to say thank you so much for joining us this week on PopHealth Week. It’s been a pleasure.
Kistein Monkhouse 26:43 Thank you so much for having me. It’s truly my honor.
Fred Goldstein 26:46 And back to you, Greg,
Gregg Masters 26:47 and thank you, Fred. That is the last word on today’s broadcast. I want to thank Kistein Monkhouse, CEO and founder of Patient Orator and the producer of the documentary film Humanizing Healthcare. For more information on the app, go to www.patientorator.com and follow Christine’s work on Twitter by @patientorator. Finally, do check out the documentary film Humanizing Healthcare at www.Filmfreeway.com/humanizinghealthcare. For PopHealth Week, my colleague Fred Goldstein and HealthcareNow Radio This is Gregg Masters saying stay safe y’all will get better together if we toe the line on social distancing, proper hygiene and by all means wear those masks when in public and do hold space for our collective healing. We have lots of work to do in pursuit of that more perfect union.