WEBVTT 00:00:00.500 --> 00:00:01.944 So my freshman year of college 00:00:01.944 --> 00:00:04.694 I signed up for an internship in the housing unit 00:00:04.694 --> 00:00:06.894 at Greater Boston Legal Services. 00:00:06.894 --> 00:00:08.547 Showed up the first day 00:00:08.547 --> 00:00:10.863 ready to make coffee and photocopies, 00:00:10.863 --> 00:00:15.445 but was paired with this righteous, deeply inspired attorney 00:00:15.445 --> 00:00:16.914 named Jeff Purcell, 00:00:16.914 --> 00:00:19.379 who thrust me onto the front lines 00:00:19.379 --> 00:00:21.379 from the very first day. NOTE Paragraph 00:00:21.379 --> 00:00:23.144 And over the course of nine months 00:00:23.144 --> 00:00:24.157 I had the chance 00:00:24.157 --> 00:00:25.929 to have dozens of conversations 00:00:25.929 --> 00:00:28.713 with low-income families in Boston 00:00:28.713 --> 00:00:31.829 who would come in presenting with housing issues, 00:00:31.829 --> 00:00:35.113 but always had an underlying health issue. 00:00:35.113 --> 00:00:37.345 So I had a client who came in, 00:00:37.345 --> 00:00:39.663 about to be evicted because he hasn't paid his rent. 00:00:39.663 --> 00:00:41.951 But he hasn't paid his rent, of course, 00:00:41.951 --> 00:00:44.445 because he's paying for his HIV medication 00:00:44.445 --> 00:00:46.645 and just can't afford both. 00:00:46.645 --> 00:00:47.996 We had moms who would come in, 00:00:47.996 --> 00:00:49.379 daughter has asthma, 00:00:49.379 --> 00:00:52.264 wakes up covered in cockroaches every morning. 00:00:52.264 --> 00:00:54.237 And one of our litigation strategies 00:00:54.237 --> 00:00:57.012 was actually to send me into the home of these clients 00:00:57.012 --> 00:00:59.145 with these large glass bottles. 00:00:59.145 --> 00:01:01.145 And I would collect the cockroaches, 00:01:01.145 --> 00:01:04.163 hot glue-gun them to this poster board 00:01:04.163 --> 00:01:06.195 that we'd bring to court for our cases. 00:01:06.195 --> 00:01:07.473 And we always won 00:01:07.473 --> 00:01:10.195 because the judges were just so grossed out. 00:01:10.195 --> 00:01:12.344 Far more effective, I have to say, 00:01:12.344 --> 00:01:15.195 than anything I later learned in law school. NOTE Paragraph 00:01:15.195 --> 00:01:17.745 But over the course of these nine months, 00:01:17.745 --> 00:01:19.596 I grew frustrated with feeling 00:01:19.596 --> 00:01:22.562 like we were intervening too far downstream 00:01:22.562 --> 00:01:25.079 in the lives of our clients -- 00:01:25.079 --> 00:01:26.611 that by the time they came to us, 00:01:26.611 --> 00:01:28.779 they were already in crisis. 00:01:28.779 --> 00:01:31.595 And at the end of my freshman year of college, 00:01:31.595 --> 00:01:33.279 I read an article about the work 00:01:33.279 --> 00:01:35.061 that Dr. Barry Zuckerman was doing 00:01:35.061 --> 00:01:37.197 as Chair of Pediatrics 00:01:37.197 --> 00:01:38.597 at Boston Medical Center. 00:01:38.597 --> 00:01:41.664 And his first hire was a legal services attorney 00:01:41.664 --> 00:01:43.546 to represent the patients. NOTE Paragraph 00:01:43.546 --> 00:01:45.061 So I called Barry, 00:01:45.061 --> 00:01:47.664 and with his blessing, in October 1995 00:01:47.664 --> 00:01:49.729 walked into the waiting room 00:01:49.729 --> 00:01:52.595 of the pediatrics clinic at Boston Medical Center. 00:01:52.595 --> 00:01:53.928 I'll never forget, 00:01:53.928 --> 00:01:56.812 the TVs played this endless reel of cartoons. 00:01:56.812 --> 00:01:59.746 And the exhaustion of mothers 00:01:59.746 --> 00:02:03.278 who had taken two, three, sometimes four buses 00:02:03.278 --> 00:02:05.210 to bring their child to the doctor 00:02:05.210 --> 00:02:07.094 was just palpable. NOTE Paragraph 00:02:07.094 --> 00:02:08.342 The doctors, it seemed, 00:02:08.342 --> 00:02:09.861 never really had enough time for all the patients, 00:02:09.861 --> 00:02:11.111 try as they might. 00:02:11.111 --> 00:02:12.329 And over the course of six months, 00:02:12.329 --> 00:02:14.010 I would corner them in the hallway 00:02:14.010 --> 00:02:17.911 and ask them a sort of naive but fundamental question: 00:02:17.911 --> 00:02:20.396 "If you had unlimited resources, 00:02:20.396 --> 00:02:23.711 what's the one thing you would give your patients?" NOTE Paragraph 00:02:23.711 --> 00:02:26.411 And I heard the same story again and again, 00:02:26.411 --> 00:02:29.361 a story we've heard hundreds of times since then. 00:02:29.361 --> 00:02:32.926 They said, "Every day we have patients that come into the clinic -- 00:02:32.926 --> 00:02:34.627 child has an ear infection, 00:02:34.627 --> 00:02:36.560 I prescribe antibiotics. 00:02:36.560 --> 00:02:39.393 But the real issue is there's no food at home. 00:02:39.393 --> 00:02:40.894 The real issue 00:02:40.894 --> 00:02:43.128 is that child is living with 12 other people 00:02:43.128 --> 00:02:44.626 in a two-bedroom apartment. 00:02:44.626 --> 00:02:46.476 And I don't even ask about those issues 00:02:46.476 --> 00:02:49.227 because there's nothing I can do. 00:02:49.227 --> 00:02:51.065 I have 13 minutes with each patient. 00:02:51.065 --> 00:02:53.634 Patients are piling up in the clinic waiting room. 00:02:53.634 --> 00:02:56.319 I have no idea where the nearest food pantry is. 00:02:56.319 --> 00:02:58.667 And I don't even have any help." 00:02:58.667 --> 00:02:59.867 In that clinic, even today, 00:02:59.867 --> 00:03:01.553 there are two social workers 00:03:01.553 --> 00:03:04.284 for 24,000 pediatric patients, 00:03:04.284 --> 00:03:07.136 which is better than a lot of the clinics out there. NOTE Paragraph 00:03:07.136 --> 00:03:10.167 So Health Leads was born of these conversations -- 00:03:10.167 --> 00:03:11.351 a simple model 00:03:11.351 --> 00:03:12.866 where doctors and nurses 00:03:12.866 --> 00:03:15.084 can prescribe nutritious food, 00:03:15.084 --> 00:03:16.386 heat in the winter 00:03:16.386 --> 00:03:18.968 and other basic resources for their patients 00:03:18.968 --> 00:03:21.519 the same way they prescribe medication. 00:03:21.519 --> 00:03:23.500 Patients then take their prescriptions 00:03:23.500 --> 00:03:25.967 to our desk in the clinic waiting room 00:03:25.967 --> 00:03:29.784 where we have a core of well-trained college student advocates 00:03:29.784 --> 00:03:32.236 who work side by side with these families 00:03:32.236 --> 00:03:33.535 to connect them out 00:03:33.535 --> 00:03:36.751 to the existing landscape of community resources. NOTE Paragraph 00:03:36.751 --> 00:03:40.300 So we began with a card table in the clinic waiting room -- 00:03:40.300 --> 00:03:42.450 totally lemonade stand style. 00:03:42.450 --> 00:03:45.770 But today we have a thousand college student advocates 00:03:45.770 --> 00:03:50.070 who are working to connect nearly 9,000 patients and their families 00:03:50.070 --> 00:03:53.271 with the resources that they need to be healthy. NOTE Paragraph 00:03:53.271 --> 00:03:54.787 So 18 months ago 00:03:54.787 --> 00:03:57.572 I got this email that changed my life. 00:03:57.572 --> 00:03:59.987 And the email was from Dr. Jack Geiger, 00:03:59.987 --> 00:04:02.971 who had written to congratulate me on Health Leads 00:04:02.971 --> 00:04:04.270 and to share, as he said, 00:04:04.270 --> 00:04:06.906 a bit of historical context. 00:04:06.906 --> 00:04:09.856 In 1965 Dr. Geiger founded 00:04:09.856 --> 00:04:12.870 one of the first two community health centers in this country, 00:04:12.870 --> 00:04:16.021 in a brutally poor area in the Mississippi Delta. 00:04:16.021 --> 00:04:18.537 And so many of his patients came in 00:04:18.537 --> 00:04:20.687 presenting with malnutrition 00:04:20.687 --> 00:04:23.171 that be began prescribing food for them. 00:04:23.171 --> 00:04:26.422 And they would take these prescriptions to the local supermarket, 00:04:26.422 --> 00:04:27.520 which would fill them 00:04:27.520 --> 00:04:30.338 and then charge the pharmacy budget of the clinic. 00:04:30.338 --> 00:04:33.221 And when the Office of Economic Opportunity in Washington, D.C. -- 00:04:33.221 --> 00:04:35.056 which was funding Geiger's clinic -- 00:04:35.056 --> 00:04:36.255 found out about this, 00:04:36.255 --> 00:04:37.455 they were furious. 00:04:37.455 --> 00:04:39.204 And they sent this bureaucrat down 00:04:39.204 --> 00:04:42.155 to tell Geiger that he was expected to use their dollars 00:04:42.155 --> 00:04:43.621 for medical care -- 00:04:43.621 --> 00:04:47.021 to which Geiger famously and logically responded, 00:04:47.021 --> 00:04:49.446 "The last time I checked my textbooks, 00:04:49.446 --> 00:04:53.805 the specific therapy for malnutrition was food." NOTE Paragraph 00:04:53.805 --> 00:04:55.089 (Laughter) NOTE Paragraph 00:04:55.089 --> 00:04:57.788 So when I got this email from Dr. Geiger, 00:04:57.788 --> 00:05:00.154 I knew I was supposed to be proud 00:05:00.154 --> 00:05:01.821 to be part of this history. 00:05:01.821 --> 00:05:03.037 But the truth is 00:05:03.037 --> 00:05:05.029 I was devastated. 00:05:05.029 --> 00:05:06.370 Here we are, 00:05:06.370 --> 00:05:10.355 45 years after Geiger has prescribed food for his patients, 00:05:10.355 --> 00:05:12.370 and I have doctors telling me, 00:05:12.370 --> 00:05:16.437 "On those issues, we practice a 'don't ask, don't tell' policy." 00:05:16.437 --> 00:05:18.870 Forty-five years after Geiger, 00:05:18.870 --> 00:05:20.421 Health Leads has to reinvent 00:05:20.421 --> 00:05:23.256 the prescription for basic resources. 00:05:23.256 --> 00:05:26.421 So I have spent hours upon hours 00:05:26.421 --> 00:05:29.755 trying to make sense of this weird Groundhog Day. 00:05:29.755 --> 00:05:32.289 How is it that if for decades 00:05:32.289 --> 00:05:35.058 we had a pretty straightforward tool for keeping patients, 00:05:35.058 --> 00:05:37.655 and especially low-income patients, healthy, 00:05:37.655 --> 00:05:39.556 that we didn't use it? 00:05:39.556 --> 00:05:42.655 If we know what it takes to have a healthcare system 00:05:42.655 --> 00:05:45.154 rather than a sick-care system, 00:05:45.154 --> 00:05:47.187 why don't we just do it? NOTE Paragraph 00:05:47.187 --> 00:05:49.421 These questions, in my mind, 00:05:49.421 --> 00:05:52.487 are not hard because the answers are complicated, 00:05:52.487 --> 00:05:57.621 they are hard because they require that we be honest with ourselves. 00:05:57.621 --> 00:06:00.721 My belief is that it's almost too painful 00:06:00.721 --> 00:06:03.950 to articulate our aspirations for our healthcare system, 00:06:03.950 --> 00:06:06.688 or even admit that we have any at all. 00:06:06.688 --> 00:06:07.855 Because if we did, 00:06:07.855 --> 00:06:09.471 they would be so removed 00:06:09.471 --> 00:06:11.657 from our current reality. 00:06:11.657 --> 00:06:14.620 But that doesn't change my belief 00:06:14.620 --> 00:06:17.538 that all of us, deep inside, 00:06:17.538 --> 00:06:21.105 here in this room and across this country, 00:06:21.105 --> 00:06:24.021 share a similar set of desires. 00:06:24.021 --> 00:06:26.154 That if we are honest with ourselves 00:06:26.154 --> 00:06:28.455 and listen quietly, 00:06:28.455 --> 00:06:30.271 that we all harbor 00:06:30.271 --> 00:06:34.471 one fiercely held aspiration for our healthcare: 00:06:34.471 --> 00:06:36.571 that it keep us healthy. NOTE Paragraph 00:06:36.571 --> 00:06:39.888 This aspiration that our healthcare keep us healthy 00:06:39.888 --> 00:06:42.288 is an enormously powerful one. 00:06:42.288 --> 00:06:44.905 And the way I think about this 00:06:44.905 --> 00:06:47.089 is that healthcare is like any other system. 00:06:47.089 --> 00:06:49.655 It's just a set of choices that people make. 00:06:49.655 --> 00:06:51.456 What if we decided 00:06:51.456 --> 00:06:53.872 to make a different set of choices? 00:06:53.872 --> 00:06:56.904 What if we decided to take all the parts of healthcare 00:06:56.904 --> 00:06:58.706 that have drifted away from us 00:06:58.706 --> 00:07:01.172 and stand firm and say, "No. 00:07:01.172 --> 00:07:03.139 These things are ours. 00:07:03.139 --> 00:07:05.138 They will be used for our purposes. 00:07:05.138 --> 00:07:07.162 They will be used to realize 00:07:07.162 --> 00:07:09.093 our aspiration"? 00:07:09.093 --> 00:07:10.843 What if everything we needed 00:07:10.843 --> 00:07:12.988 to realize our aspiration for healthcare 00:07:12.988 --> 00:07:14.571 was right there in front of us 00:07:14.571 --> 00:07:16.455 just waiting to be claimed? NOTE Paragraph 00:07:16.455 --> 00:07:18.505 So that's where Health Leads began. 00:07:18.505 --> 00:07:20.189 We started with the prescription pad -- 00:07:20.189 --> 00:07:22.588 a very ordinary piece of paper -- 00:07:22.588 --> 00:07:26.556 and we asked, not what do patients need to get healthy -- 00:07:26.556 --> 00:07:29.574 antibiotics, an inhaler, medication -- 00:07:29.574 --> 00:07:32.357 but what do patients need to be healthy, 00:07:32.357 --> 00:07:34.904 to not get sick in the first place? 00:07:34.904 --> 00:07:36.755 And we chose to use the prescription 00:07:36.755 --> 00:07:38.537 for that purpose. 00:07:38.537 --> 00:07:39.739 So just a few miles from here 00:07:39.739 --> 00:07:41.523 at Children's National Medical Center, 00:07:41.523 --> 00:07:43.789 when patients come into the doctor's office, 00:07:43.789 --> 00:07:45.474 they're asked a few questions. 00:07:45.474 --> 00:07:48.138 They're asked, "Are you running out of food at the end of the month? 00:07:48.138 --> 00:07:49.704 Do you have safe housing?" 00:07:49.704 --> 00:07:51.773 And when the doctor begins the visit, 00:07:51.773 --> 00:07:54.606 she knows height, weight, is there food at home, 00:07:54.606 --> 00:07:56.222 is the family living in a shelter. 00:07:56.222 --> 00:07:59.106 And that not only leads to a better set of clinical choices, 00:07:59.106 --> 00:08:03.156 but the doctor can also prescribe those resources for the patient, 00:08:03.156 --> 00:08:06.822 using Health Leads like any other sub-specialty referral. NOTE Paragraph 00:08:06.822 --> 00:08:09.055 The problem is, 00:08:09.055 --> 00:08:11.254 once you get a taste of what it's like 00:08:11.254 --> 00:08:13.489 to realize your aspiration for healthcare, 00:08:13.489 --> 00:08:15.007 you want more. 00:08:15.007 --> 00:08:15.770 So we thought, 00:08:15.770 --> 00:08:17.371 if we can get individual doctors 00:08:17.371 --> 00:08:20.588 to prescribe these basic resources for their patients, 00:08:20.588 --> 00:08:23.305 could we get an entire healthcare system 00:08:23.305 --> 00:08:26.057 to shift its presumption? 00:08:26.057 --> 00:08:27.304 And we gave it a shot. NOTE Paragraph 00:08:27.304 --> 00:08:28.739 So now at Harlem Hospital Center 00:08:28.739 --> 00:08:32.525 when patients come in with an elevated body mass index, 00:08:32.525 --> 00:08:34.389 the electronic medical record 00:08:34.389 --> 00:08:38.189 automatically generates a prescription for Health Leads. 00:08:38.189 --> 00:08:39.655 And our volunteers can then work with them 00:08:39.655 --> 00:08:42.872 to connect patients to healthy food and excercise programs 00:08:42.872 --> 00:08:44.304 in their communities. 00:08:44.304 --> 00:08:45.438 We've created a presumption 00:08:45.438 --> 00:08:47.005 that if you're a patient at that hospital 00:08:47.005 --> 00:08:48.555 with an elevated BMI, 00:08:48.555 --> 00:08:50.789 the four walls of the doctor's office 00:08:50.789 --> 00:08:52.641 probably aren't going to give you everything 00:08:52.641 --> 00:08:53.823 you need to be healthy. 00:08:53.823 --> 00:08:55.223 You need more. NOTE Paragraph 00:08:55.223 --> 00:08:55.904 So on the one hand, 00:08:55.904 --> 00:08:57.601 this is just a basic recoding 00:08:57.601 --> 00:08:59.306 of the electronic medical record. 00:08:59.306 --> 00:09:01.024 And on the other hand, 00:09:01.024 --> 00:09:02.673 it's a radical transformation 00:09:02.673 --> 00:09:04.841 of the electronic medical record 00:09:04.841 --> 00:09:08.723 from a static repository of diagnostic information 00:09:08.723 --> 00:09:11.557 to a health promotion tool. 00:09:11.557 --> 00:09:12.674 In the private sector, 00:09:12.674 --> 00:09:15.294 when you squeeze that kind of additional value 00:09:15.294 --> 00:09:17.041 out of a fixed-cost investment, 00:09:17.041 --> 00:09:19.641 it's called a billion-dollar company. 00:09:19.641 --> 00:09:21.022 But in my world, 00:09:21.022 --> 00:09:24.423 it's called reduced obesity and diabetes. 00:09:24.423 --> 00:09:26.306 It's called healthcare -- 00:09:26.306 --> 00:09:29.289 a system where doctors can prescribe solutions 00:09:29.289 --> 00:09:30.839 to improve health, 00:09:30.839 --> 00:09:32.988 not just manage disease. NOTE Paragraph 00:09:32.988 --> 00:09:34.522 Same thing in the clinic waiting room. 00:09:34.522 --> 00:09:36.139 So every day in this country 00:09:36.139 --> 00:09:37.639 three million patients 00:09:37.639 --> 00:09:42.133 pass through about 150,000 clinic waiting rooms in this country. 00:09:42.144 --> 00:09:44.117 And what do they do when they're there? 00:09:44.117 --> 00:09:47.567 They sit, they watch the goldfish in the fish tank, 00:09:47.567 --> 00:09:50.050 they read extremely old copies 00:09:50.050 --> 00:09:52.333 of Good Housekeeping magazine. 00:09:52.333 --> 00:09:55.566 But mostly we all just sit there forever, waiting. 00:09:55.566 --> 00:09:56.917 How did we get here 00:09:56.917 --> 00:10:00.266 where we devote hundreds of acres and thousands of hours 00:10:00.266 --> 00:10:02.049 to waiting? 00:10:02.049 --> 00:10:03.266 What if we had a waiting room 00:10:03.266 --> 00:10:05.367 where you don't just sit when you're sick, 00:10:05.367 --> 00:10:07.233 but where you go to get healthy. 00:10:07.233 --> 00:10:09.750 If airports can become shopping malls 00:10:09.750 --> 00:10:12.716 and McDonald's can become playgrounds, 00:10:12.716 --> 00:10:16.149 surely we can reinvent the clinic waiting room. NOTE Paragraph 00:10:16.149 --> 00:10:18.183 And that's what Health Leads has tried to do, 00:10:18.183 --> 00:10:20.466 to reclaim that real estate and that time 00:10:20.466 --> 00:10:21.898 and to use it as a gateway 00:10:21.898 --> 00:10:22.950 to connect patients 00:10:22.950 --> 00:10:25.717 to the resources they need to be healthy. 00:10:25.717 --> 00:10:27.233 So it's a brutal winter in the Northeast, 00:10:27.233 --> 00:10:29.700 your kid has asthma, your heat just got turned off, 00:10:29.700 --> 00:10:31.867 and of course you're in the waiting room of the ER, 00:10:31.867 --> 00:10:34.399 because the cold air triggered your child's asthma. 00:10:34.399 --> 00:10:37.316 But what if instead of waiting for hours anxiously, 00:10:37.316 --> 00:10:39.516 the waiting room became the place 00:10:39.516 --> 00:10:42.000 where Health Leads turned your heat back on? NOTE Paragraph 00:10:42.000 --> 00:10:43.618 And of course all of this requires 00:10:43.618 --> 00:10:45.566 a broader workforce. 00:10:45.566 --> 00:10:48.733 But if we're creative, we already have that too. 00:10:48.733 --> 00:10:51.119 We know that our doctors and nurses 00:10:51.119 --> 00:10:52.466 and even social workers 00:10:52.466 --> 00:10:53.934 aren't enough, 00:10:53.934 --> 00:10:55.583 that the ticking minutes of health care 00:10:55.583 --> 00:10:57.001 are too constraining. 00:10:57.001 --> 00:10:59.050 Health just takes more time. 00:10:59.050 --> 00:11:01.849 It requires a non-clinical army 00:11:01.849 --> 00:11:04.533 of community health workers and case managers 00:11:04.533 --> 00:11:06.149 and many others. NOTE Paragraph 00:11:06.149 --> 00:11:09.299 What if a small part of that next healthcare workforce 00:11:09.299 --> 00:11:13.000 were the 11 million college students in this country? 00:11:13.000 --> 00:11:15.766 Unencumbered by clinical responsibilities, 00:11:15.766 --> 00:11:18.368 unwilling to take no for an answer 00:11:18.368 --> 00:11:19.950 from those bureaucracies 00:11:19.950 --> 00:11:21.883 that tend to crush patients, 00:11:21.883 --> 00:11:23.833 and with an unparalleled ability 00:11:23.833 --> 00:11:25.285 for information retrieval 00:11:25.285 --> 00:11:28.266 honed through years of using Google. NOTE Paragraph 00:11:28.266 --> 00:11:30.799 Now lest you think it improbable 00:11:30.799 --> 00:11:32.416 that a college volunteer 00:11:32.416 --> 00:11:34.199 can make this kind of commitment, 00:11:34.199 --> 00:11:35.766 I have two words for you: 00:11:35.766 --> 00:11:38.117 March Madness. 00:11:38.117 --> 00:11:42.084 The average NCAA Division I men's basketball player 00:11:42.084 --> 00:11:45.349 dedicates 39 hours a week to his sport. 00:11:45.349 --> 00:11:47.501 Now we may think that's good or bad, 00:11:47.501 --> 00:11:50.183 but in either case it's real. 00:11:50.183 --> 00:11:52.368 And Health Leads is based on the presumption 00:11:52.368 --> 00:11:53.750 that for too long 00:11:53.750 --> 00:11:56.300 we have asked too little of our college students 00:11:56.300 --> 00:12:00.065 when it comes to real impact in vulnerable communities. 00:12:00.065 --> 00:12:01.418 College sports teams say, 00:12:01.418 --> 00:12:03.483 "We're going to take dozens of hours 00:12:03.483 --> 00:12:07.367 at some field across campus at some ungodly hour of the morning 00:12:07.367 --> 00:12:10.183 and we're going to measure your performance, and your team's performance, 00:12:10.183 --> 00:12:12.349 and if you don't measure up or you don't show up, 00:12:12.349 --> 00:12:13.799 we're going to cut you off the team. 00:12:13.799 --> 00:12:15.687 But we'll make huge investments 00:12:15.687 --> 00:12:16.899 in your training and development, 00:12:16.899 --> 00:12:20.317 and we'll give you an extraordinary community of peers." 00:12:20.317 --> 00:12:22.132 And people line up out the door 00:12:22.132 --> 00:12:24.917 just for the chance to be part of it. NOTE Paragraph 00:12:24.917 --> 00:12:26.134 So our feeling is, 00:12:26.134 --> 00:12:27.617 if it's good enough for the rugby team, 00:12:27.617 --> 00:12:29.732 it's good enough for health and poverty. 00:12:29.732 --> 00:12:33.000 Health Leads too recruits competitively, 00:12:33.000 --> 00:12:34.481 trains intensively, 00:12:34.481 --> 00:12:36.450 coaches professionally, 00:12:36.450 --> 00:12:38.399 demands significant time, 00:12:38.399 --> 00:12:39.766 builds a cohesive team 00:12:39.766 --> 00:12:41.250 and measures results -- 00:12:41.250 --> 00:12:43.933 a kind of Teach for America for healthcare. NOTE Paragraph 00:12:43.933 --> 00:12:46.033 Now in the top 10 cities in the U.S. 00:12:46.033 --> 00:12:48.352 with the largest number of Medicaid patients, 00:12:48.352 --> 00:12:51.566 each of those has at least 20,000 college students. 00:12:51.566 --> 00:12:54.767 New York alone has half a million college students. 00:12:54.767 --> 00:12:57.816 And this isn't just a sort of short-term workforce 00:12:57.816 --> 00:13:00.066 to connect patients to basic resources, 00:13:00.066 --> 00:13:03.667 it's a next generation healthcare leadership pipeline 00:13:03.667 --> 00:13:06.117 who've spent two, three, four years 00:13:06.117 --> 00:13:07.618 in the clinic waiting room 00:13:07.618 --> 00:13:11.602 talking to patients about their most basic health needs. 00:13:11.602 --> 00:13:13.351 And they leave with the conviction, 00:13:13.351 --> 00:13:15.183 the ability and the efficacy 00:13:15.183 --> 00:13:18.966 to realize our most basic aspirations for health care. 00:13:18.966 --> 00:13:21.984 And the thing is, there's thousands of these folks already out there. NOTE Paragraph 00:13:21.984 --> 00:13:25.801 So Mia Lozada is Chief Resident of Internal Medicine 00:13:25.801 --> 00:13:27.216 at UCSF Medical Center, 00:13:27.216 --> 00:13:29.549 but for three years as an undergraduate 00:13:29.549 --> 00:13:31.182 she was a Health Leads volunteer 00:13:31.182 --> 00:13:34.184 in the clinic waiting room at Boston Medical Center. 00:13:34.184 --> 00:13:37.899 Mia says, "When my classmates write a prescription, 00:13:37.899 --> 00:13:39.917 they think their work is done. 00:13:39.917 --> 00:13:41.633 When I write a prescription, 00:13:41.633 --> 00:13:43.900 I think, can the family read the prescription? 00:13:43.900 --> 00:13:46.083 Do they have transportation to the pharmacy? 00:13:46.083 --> 00:13:48.533 Do they have food to take with the prescription? 00:13:48.533 --> 00:13:50.783 Do they have insurance to fill the prescription? 00:13:50.783 --> 00:13:53.466 Those are the questions I learned at Health Leads, 00:13:53.466 --> 00:13:55.216 not in medical school." NOTE Paragraph 00:13:55.216 --> 00:13:57.200 Now none of these solutions -- 00:13:57.200 --> 00:14:00.170 the prescription pad, the electronic medical record, 00:14:00.170 --> 00:14:01.317 the waiting room, 00:14:01.317 --> 00:14:02.485 the army of college students -- 00:14:02.485 --> 00:14:03.668 are perfect. 00:14:03.668 --> 00:14:06.168 But they are ours for the taking -- 00:14:06.168 --> 00:14:07.500 simple examples 00:14:07.500 --> 00:14:11.001 of the vast under-utilized healthcare resources 00:14:11.001 --> 00:14:13.916 that, if we reclaimed and redeployed, 00:14:13.916 --> 00:14:17.333 could realize our most basic aspiration 00:14:17.333 --> 00:14:19.117 of healthcare. NOTE Paragraph 00:14:19.117 --> 00:14:22.333 So I had been at Legal Services for about nine months 00:14:22.333 --> 00:14:25.066 when this idea of Health Leads started percolating in my mind. 00:14:25.066 --> 00:14:28.000 And I knew I had to tell Jeff Purcell, my attorney, 00:14:28.000 --> 00:14:29.419 that I needed to leave. 00:14:29.419 --> 00:14:30.382 And I was so nervous, 00:14:30.382 --> 00:14:32.916 because I thought he was going to be disappointed in me 00:14:32.916 --> 00:14:35.966 for abandoning our clients for some crazy idea. 00:14:35.966 --> 00:14:37.950 And I sat down with him and I said, 00:14:37.950 --> 00:14:39.833 "Jeff, I have this idea 00:14:39.833 --> 00:14:42.252 that we could mobilize college students 00:14:42.252 --> 00:14:45.186 to address patients' most basic health needs." 00:14:45.186 --> 00:14:46.767 And I'll be honest, 00:14:46.767 --> 00:14:50.066 all I wanted was for him to not be angry at me. 00:14:50.066 --> 00:14:51.533 But he said this, 00:14:51.533 --> 00:14:54.881 "Rebecca, when you have a vision, 00:14:54.881 --> 00:14:58.732 you have an obligation to realize that vision. 00:14:58.732 --> 00:15:01.833 You must pursue that vision." 00:15:01.833 --> 00:15:05.099 And I have to say, I was like "Whoa. 00:15:05.099 --> 00:15:07.116 That's a lot of pressure." 00:15:07.116 --> 00:15:08.515 I just wanted a blessing, 00:15:08.515 --> 00:15:10.066 I didn't want some kind of mandate. 00:15:10.066 --> 00:15:11.633 But the truth is 00:15:11.633 --> 00:15:14.416 I've spent every waking minute nearly since then 00:15:14.416 --> 00:15:16.200 chasing that vision. NOTE Paragraph 00:15:16.200 --> 00:15:19.382 I believe that we all have a vision 00:15:19.382 --> 00:15:21.283 for healthcare in this country. 00:15:21.283 --> 00:15:23.482 I believe that at the end of the day 00:15:23.482 --> 00:15:25.316 when we measure our healthcare, 00:15:25.316 --> 00:15:28.132 it will not be by the diseases cured, 00:15:28.132 --> 00:15:30.650 but by the diseases prevented. 00:15:30.650 --> 00:15:33.667 It will not be by the excellence of our technologies 00:15:33.667 --> 00:15:36.167 or the sophistication of our specialists, 00:15:36.167 --> 00:15:38.966 but by how rarely we needed them. 00:15:38.966 --> 00:15:40.450 And most of all, 00:15:40.450 --> 00:15:42.967 I believe that when we measure healthcare, 00:15:42.967 --> 00:15:45.650 it will be, not by what the system was, 00:15:45.650 --> 00:15:48.416 but by what we chose it to be. NOTE Paragraph 00:15:48.416 --> 00:15:49.483 Thank you. NOTE Paragraph 00:15:49.483 --> 00:15:59.733 (Applause) NOTE Paragraph 00:15:59.733 --> 00:16:01.000 Thank you. NOTE Paragraph 00:16:01.008 --> 00:16:10.331 (Applause)