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‘Leveling the Playing Field’ with José Pagán

This interview with Dr. José Pagán is part of a larger series of interviews where we discuss the intersection of healthcare and technology with subject matter experts from Adhera Health’s Advisory Board.

Dr. José Pagán is a professor and health economist; he has spent his career understanding healthcare delivery and payment systems, leading research, implementation, and evaluation of healthcare delivery and payment projects. His expertise in population health management, healthcare payment and delivery system reform, and the social determinants of health has led him to a chair position at the Department of Public Health Policy and Management in the School of Global Public Health at New York University, as well as chair on the board of NYC Health + Hospitals; he is a former Robert Wood Foundation Health and Society Scholar, and was elected last year to the National Academy of Medicine. We were elated when Dr. Pagán joined our board of advisors because of his impressive skillset, experience, and values. This month, we conducted an interview to help you understand why Dr. Pagán’s expertise is so valuable to the work we do at Adhera Health.

Adhera Health and Dr. Pagán know the importance of access to care. It’s a primary reason why Dr. Pagán pursued a career in public health.

Making the Business Case for Public Health Interventions

“I’m interested in, ‘how do we improve access to care?’ How do you increase health insurance coverage? How do you make sure that people get the care they need?” said Dr. Pagán. “And a big component of it, of things that improve health, are not connected to the healthcare delivery side, but they're more social and behavioral factors. And public health gets into that, you know, how do you focus on prevention? How do you improve health so that you don't need as many clinical interventions as people may think they need?”

“As an economist, I do work on showing the business case for a given program. And public health is a perfect place to study that because you lose something that prevents something into the future. A lot of the work that I've been doing applying economics to public health is around this issue of making the business case for public health interventions that may matter and that are difficult to pay for. For example, if you help someone manage their diabetes or manage their hypertension, the benefits you see are way into the future… The behavioral aspects of chronic disease management are incredibly important.”

As Dr. Pagán said, by focusing on prevention we can avoid future healthcare costs – this relates to Adhera Health’s adaptive self-management programs. Through digital programs, we’re able to improve self-management behaviors for both family caregivers and patients, offering constant, personalized support and education, leading to better future health outcomes, fewer interventions, and therefore lower healthcare costs.

Measuring Health Disparities is Essential to Advancing Health Equity

“Everybody should have access to equitable high-quality care. That's incredibly important. As human beings, as a social justice issue, that's really important. There is research work that I've done where I've looked at communities that have, for example, some people with some access to care, and others that don't have access to care. And it turns out that you have a stronger healthcare system in your community if everybody has access to care. So, it's not only because it benefits individuals, it's also because it benefits society and our communities to have systems of care that take care of the whole population in your community.” Dr. Pagán’s research demonstrates that a strong healthcare system involves the inclusion of all individuals. And he argues that health systems are already moving in a more inclusive direction.

“They want to make sure that they provide care to everyone, and they're developing systems to track that information. And the reason they're doing it is because they understand the importance of it, in terms of how to keep the whole population healthy, not just one segment of the population.” The future of health systems relies on providing equitable care to all.

Policies have been implemented to reduce or even eliminate health disparities to attain health equity. Despite these policies, chronic conditions such as diabetes, cancer, and mental health issues, among others, remain prevalent across disadvantaged populations compared to the majority (Williams et al., 2016). Measuring health disparities is essential to advancing health equity and Dr. Pagán knows this.

“I use economic models and tools to show: this is the health pathway of someone that has diabetes and, because you have it under control, you prevent the foot amputation or you prevent somebody from going blind. This is how much you may save in the healthcare delivery system in terms of hospitalizations, emergency department visits,” said Dr. Pagán.

Providing and Receiving High-Quality Care Relies on Health Literacy

As we look toward the future of healthcare, it’s easy to envision the power of digital tools in reducing healthcare costs. Adhera Health’s research has provided evidence of the effectiveness of personalized digital programs in their ability to improve the mental wellbeing of patients and their family caregivers, improving treatment adherence, and leading to better health outcomes.

Dr. Pagán’s perspective aligns with the Adhera Health vision: using science and real-world data to create evidence-based programs that improve the quality of life for both patients and their family caregivers. Now, as an advisor for Adhera Health, Dr. Pagán is making the case for Adhera’s own adaptive self-management application.

An important aspect of Adhera’s highly personalized digital programs is their ability to educate the user. By utilizing observed and reported user behavior, the AI-based recommender system offers interventions and personalized recommendations. Through education, family caregivers and patients can develop skills to better self-manage their conditions and improve their lifestyles.

Dr. Pagán has spent time studying the effects of health education/health literacy on different populations, including the effects of health literacy and breast cancer screening among Mexican American women in South Texas, as well as the impact of community diabetes education.

“Being able to consume information about your health is critical.” Dr. Pagán said. “It's also important because when you go receive health services of any type in any system, you need to understand, for example, how a piece of advice for a given drug or a given treatment is going to impact you... For anybody to be able to follow advice, they need to be able to understand the information that is provided to them. And so, health literacy is critical to be able to provide and to be able to receive quality high-quality care.”

The Adhera Health vision involves helping individuals all over the world through health education and recommendations. In this sense, health literacy is a huge part of what makes the work Adhera Health is doing so important. Through personalized recommendations and education, users can understand exactly what they should be doing for their specific needs in real-time and improve their health literacy. With our adaptive self-management platform, we have the potential to change lives all over the world.

“Being able to have tools and technology platforms that allow for better communication between health systems, patients, providers – any tool that sort of like facilitates that, any tool that empowers the patient or empowers a person to take care of their health – whether it is somebody with cancer that is undergoing treatment or somebody that is trying, for example, to manage their diabetes or hypertension, or mental health issues, or whichever aspect that you can think of – those tools, I think that is what a lot of people need.” As Dr. Pagán says, the digital aspect of adaptive self-management makes things interesting because it offers a larger reach, and impact, and “…you also have data so that you’re able to manage patient populations.” And with more data, these systems can become more advanced.

As we continue to look for digital and human solutions to empower individuals with chronic conditions and caregivers to live healthier lives, we are confident in the future of Adhera Health because of skilled advisors like Dr. Pagán that will help guide our vision. His expertise in understanding health systems is invaluable, and his passion for health equity aligns with Adhera Health’s principles.

“Tools that sort of like, level the playing field, for lack of a better term – tools that allow people with different languages or different educational levels and different levels of health literacy – that allow everyone to be able to meet them where they are at and provide the information that they need, are critical.” – Dr. José Pagán.