Heroes of Healthcare
Heroes of Healthcare

Episode · 3 weeks ago

Providing Affordable Care With Population Health Outreach

ABOUT THIS EPISODE

How do you provide healthcare to someone who can’t afford it, is unable to travel, or lacks any trust in health practitioners? From mental health to discrimination, COVID-19 exposed the flaws and disparities that exist in healthcare, leaving many to look for solutions to these problems.

In today’s episode, Dr. Alexander Salerno, Physician at Salerno Medical Associates LLP, gives a glimpse into his early career in medicine and the selfless ways he and his team are improving the health of urban communities through population health outreach programs and affordable healthcare.

Join us as we discuss:

Community focused health programs

Providing care in HUD housing.

The disparities in healthcare 

To hear this interview and more like it, follow Heroes of Healthcare on Apple Podcasts, Spotify, or wherever you listen to podcasts.

Listening on a desktop & can’t see the links? Just search for Heroes of Healthcare in your favorite podcast player.

Answer screenings, diabetes, hypertension, hypertensive heart disease, these are scary words. So how do you combat fear? Is through knowledge, and so that's the educator part, and you have to educate in a way to people get it and you have to be talking not at people, but two people. You're listening to heroes of healthcare, the podcast that highlights bold, selfless professionals in the healthcare industry focused on transforming lives in their communities. Let's get into the show. Hi, I'm Olivia and on today's here is of healthcare podcast, we are joined by Dr Alexander Salerno of Salerno Medical Associates. Dr Salerno gives us a glimpse into how he chose to pursue a career in medicine and the selfless ways he and his team are improving the health of urban communities through population health outreach programs and by providing affordable, comprehensive healthcare at Salerno medical associate clinics. Dr Salerno Truly eaves. All patients deserve empathy and understanding, and he's made it his mission to positively impact the lives of anyone within reach. Welcome to the show, Dr Selerno. Thank you so much for having me. Well, it has been a couple of months since the two of us have connected and had our original introductory call. What has been going on in your world? How is your summer going? Um, summer is pretty good. Um, as I was mentioning, actually, for the first time in my career, I'm going to be taking a sabbatical for two months, ten weeks Um, just kind of focusing on building myself back up after these last two years. I just kind of feel weathered and worn and I always said I don't want to be, you know, the apathetic physician. Um, you know, one of the things that just drives me is I love what I do. So I need to kind of recharge my batteries and come back out of this like better and stronger as we hit the fall. That's remarkable and I think it takes a lot for you too recognize that you are. You know, your body needs this as well as you're deserving of this time for for your sabbatical. Do you have any plans while you're you're going to be away. You know, it sounds kind of Cliche, but I'M gonna do mind, body, soul, you know. So it's gonna be meditation, it's gonna be Yoga, cardiovascular and strength training, it's gonna be lots of reading and webinars that I've like stockpiled up and, you know, again, I just want to not feel, you know, old and stale and, Um, nutrition. That's going to be big nutrition supplements, Um. So it's I actually think it's gonna probably be harder than seeing patients because I'm going to try to be so strict about it and I don't want to waste a moment of the day, of the week, of the month and I just want to accomplish a lot and just do things with like my wife, like try to go to, you know, events and museums and shows and, you know, road trips into the country three or something, just try to be normal again after two years of anything but normal. No, I think that you are just making such a smart move to to do the Sabbatical and I'm sure your wife is very happy that you're you're taking this time for yourself and at least you can go on this journey with her, Um, and and she'll be able to be your support as you mentally recharge and physically recharge. Yeah, I don't think anyone could have expected these last two years. I mean, you know I mean thank God. It seems to only happen every hundred years or so right. So hopefully there won't be another type of COVID UH event Um, in the next hundred years. We need about fifty years to recover well, and I would love you've been in medicine for a long time and it has deep roots in your family and I'd love for you to maybe give the listeners a little bit of a backstory for that and then work our way into in your medical career, have you seen anything like covid anything close? Yeah, Um, well, a little bit about my background. So I am a physician, second generation. My Mom and dad were physicians and I was an only child growing up. So, Um, I was always at their side. So I used to do housecoals with my dad back into seventies and carry literally his doctor's bad into people's kitchens and get served cookies and pasta and all sorts of good treats and got my cheeks pinched a heck of a lot, I got to tell you that. Um, and you know, I would do hospital rounds with them as well. I would play underneath my mom's desk, unbeknownst to her patients, with my little matchbox cars as a little kid, and I used to just literally memorize her dictating charts and I remember one time distinctly my mom, I guess, had a brain Fart, if you would, and she forgot where she was in the dictation, but I knew the sequence and I kind of blurted it out and she started laughing hysterically. But I mean it was just, you know,...

...it's how I grew up. I grew up around medicine my whole life and so, you know, my mom was family practice, my dad was a surgeon and I'd have breakfast with my dad every morning at around five in the morning and, you know, just so I could see him, because I know when he left in the morning. You never knew when he was coming back with his our schedule and things like that, and so, you know, it's just it's just been, you know, part of me and who I am. I guess. You know, I didn't want to do medicine actually, you know. So, Um, I actually was anti medicine. I thought I was going to do law and Um my dad got sick in Um and we were at N Y U in New York City, big, you know, intense medical center, and he had a serious neurosurgery operation and it lasted I think like twelve hours. I've never like been that long in a waiting room in my life. And so when he recovered, it was a very long recovery. Took about two years. And so we were on the other side of defense. Now we were no longer a physician family, but we were a patient family. and Um, and at this point, you know, I said it was so I was around twenty two years old at the time and Um, I just was shocked at how medicine was being delivered to my dad, who was a patient. Now, after having seen so long on my mom and dad delivered medicine. So it kind of made me change directions. Um, and I had to go back to college because I graduated, I had no premed so I had to go back and take two years of Pre Med and Um, I didn't really want to wait around because I know it's very competitive and difficult to get into schools. So I basically just packed my bags and went to Granada and Um, I did medicine offshore, which was the most amazing experience among experiences, and to see a different culture and different everything. And, you know, Um, and I don't regret it and I think it turned out pretty good so far. So I'm twenty years into my career and I probably have another ten or fifteen to go. My Dad worked till he was eighty nine years old. So, Um, I don't know if I'll have that much gas in my tank to eighty nine, but Um, definitely probably to my mid sixties and then we'll see. then. That is such an impressive backstory. And you mentioned when Your Dad was hospitalized, the patient care wasn't what you were expecting. Was it worse than you were expecting and had seen throughout your childhood? Yeah, it was awful. I mean it was like, and we're talking like a prestige center here, and we're talking, you know, Neurosurgical Department here, which was, you know, one of the most difficult post graduate studies in medicine is neurosurgery. and Um, you know, I guess you use the word empathy, but you don't really know the word empathy, and so that really lacked in the in what I saw with the residents and the fellows, you know, and Um, it just it wasn't there the communication, the bedside, you know, mannerisms. Obviously these are not things taught in medical school and residency, but they are very much a defining characteristic of this profession. And so, you know, seeing that with my dad, you know, I just and my mom the way they did it. I was like this, this doesn't make sense, like what's wrong with this picture? And so I mean, you know, it sounds again kind of Corny, but I felt compelled to continue my parents and what they did and to demonstrate that health care is science, but it is also compassion, it is art, it is you know, it is about people taking care of people and you know it's not always a formula and it's not always just a you know, like some standardized algorithm that you spit out, because we're not treating algorithms. You know, we're using algorithms, but we're treating people. Well, I know any anyone who's listening to this who has had a family member who has been sick or they themselves have been sick, hearing you say that, you know, you believe that doctors should have that empathy and compassion. I know that it goes a long way and you're right. Unfortunately, sometimes it does fall to Um Science and it's it's you know, that piece of it is removed and it's a lot of patients who have interacted with you. I know that they are better because of it and and that is something that they probably weren't expecting and it was Um, you know they are, they were calmer and their delivery of health care was was better because of you. Well, I think it's because, you know, the upbringing to my parents gave me, and you know, the apple doesn't fall far from the tree and I had a really damn good tree and my mom and dad so well, and the fact that your dad was a surgeon until eighty nine years old.

How long did your mom practice? So I pulled my mom out right before covid she was kicking and screaming. So Um, you know, she wanted to, you know, continue to work and it was just too dangerous. You know, my mom is now also eighty nine. So Um. So she practiced up until like probably Um, part time at that point, but still part time. But Um, you know, now it's just two and a half years out. She's she's just she's not happy about it, but she's not practicing right now. Well, it is remarkable that they've had such long careers. And I know you say that you only want to go into your sixties, but I have a feeling you'll probably follow in your parents food stuffs, at least from a part time standpoint, and continue. Time will tell. Time will tell. Well, in your twenty years, as well as just being around health care your entire life, have you ever seen anything like covid? No, just on TV, like a movie, like with Dustin Ha From and write dot virus that came over and you know, I was just like it really was surreal. I mean I was afraid. I mean I definitely had fear because, you know, it was a invisible enemy and you had no idea and none of us knew anything about it. Right. We were trial and error. And where we were in week one, I mean I would literally remember every morning starting the day with a huddle and our protocols and parameters changed from the previous day and I mean it was just, it was just, it was constant energy. I mean just energy. Seven you didn't you couldn't accept fatigue, you couldn't accept fear Um, but you were feeling both, you know, and you didn't know where the light was at the end of the tunnel, you know, like it actually the closest thing I could say it reminded me of was nine eleven. and Um when I because funny story or not funny story, but my first day of my professional career was nine eleven. So I started uh, nine eleven, two thousand and you know, one I was driving to my mom's office first day at work and her office was positioned such a way that you could kind of see the New York skyline. So we saw these black smoke coming up and the waiting room was empty and the entire office was on the sidewalk, patients and staff, and I was just glued to the waiting room TV. And you saw one tower go down, you saw another tower go down, you saw the Pentagon and you started hearing all this thing like we were being targeted everywhere. And I mean and you didn't know when the light was at the end of the tunnel and where we over after the Pentagon flight going down, where we over after the flight going down in Pennsylvania. Was it done yet? was there more to come? You know, and then hearing just constant sirens, siren sirens going off. You just didn't know when it was over. And so same thing with covid like you just didn't know, like is it? Are we hitting the peak today? Are we hitting the peak tomorrow? Are we hitting the peak next week? Are we getting a vaccine? Do we have a therapeutic you know, like like, who's going to come into my door today and be crashing, you know, with a blood oxygen level of which was happening all the time. And how are we going to protect the staff? I mean, I was like I had an obligation, obviously, to my community Um, but I also add an obligation to my staff. And you know, we have about three hundred people in our practice and they're young. I mean you're talking about kids, like people in your twenties and thirties. You know, where do you get the preparation for this? I mean, and you know, I mean it was hard. It was hard, you know, uh, but you know, we got through it as a team. Well, and you were clearly moved by the past two years and and uh, there are so many heroes that were so own in you, and you are certainly one of those heroes, Dr Salerno, and we just greatly appreciate just your undying devotion to help just bring patients care throughout these this this this trial. Um, do you think that there is light at the end of the tunnel now? Oh, for sure. I mean obviously we have therapeutics, we have vaccines, we have greater factors, you know, new vaccines like Nova vacts coming out with the vaccine, hopefully in the next six to twelve months. I mean, Covid is here to day. It's the new flu, right, so it's going to be fluent covid each season, and I mean we were losing people to the flu, right, every year fifty sixty people would die to the flu, but I mean certainly not the numbers and not the devastation that covid did in the beginning. Thank God it's coming down. I mean each new virus is maybe more infectious, but it's not nearly as legal. But Um, you know it was. It's we're definitely in a better place, but it is the new norm, you know. Yeah, and throughout your career you also participated...

Um health care in the military. Did can you tell us a little bit about that and and did any of your military experience prepare you for for such a disaster as Covid? Ironically, I'm probably not ironically? Yeah, I mean it definitely. Did you know a pound of preparation is better than a ton of treatment, as they it's both saying goes and not applied to covid and the war on Covid if you would so, you know, chain of command, quick reaction, communication, UM, applying historical perspective. But history was twenty four hours, not twenty four years. Um, that definitely had a lot to do with it. I mean, I think, you know, I volunteered back, you know, back and I guess it was I think with the air force and it was in the reserve. and Um, you know, it sounds again kind of Corny, but my mom and dad were immigrants to this country. And Um, my dad grew up doing a great depression, so he knew hunger. My mom came to this country when she was in her twenties, escaping uh Europe and the war. She lost her father and her uncle Um to the concentration camps and Um she came to this country. Her winter coat was an army blanket and she came here at age twenty four, not knowing anyone in America, and America, you know, accepted her and took her in and she became a physician and so, you know, again, it sounds kind of Corny, but I felt like I should get back to a nation, in the country that, you know, gave the opportunities to my two parents and without them there would not be me. So, Um, so I did that and Um, it was amazing. Like you know, you you, you learn structure, you learned chain of command, as I mentioned, you learn processes and procedures, you learn cool under pressure. Um, and boy dad came handy with covid every single day after day, after week, after month. Um, I mean there was a challenge, like you know, as you know, in the beginning there was no supplies, we couldn't get anything, you know, and we had to really become inventive. So we went to automobile shops to get paint overalls and, you know, paint masks and construction masks, and you know, we we, we really just we had to become very creative. I mean it was we were not prepared for this as a country, you know, and it was challenging. I mean challenging and, as I said, it was scary. Do you think that you, as a physician, and other physicians out there who we're dealing with COVID. Are you better now because of it? You would hope so. I mean, bit ripped off the band aid on a lot of infrastructure problems. It ripped off the band aid on public health, or the lack of public health. It ripped off the band aid on you know, we turned to the federal government all the time to help us, when you know, sometimes the federal government can't help us, not three million people in fifty states at the same time. You know. So, Um, you know, you have to really again. It sounds Corny, but you turned to your neighbor and you turned to the people, you know, boots on the ground, and you know, we did amazing work, for the first time in twenty years, with politicians, I mean politicians and physicians like the P and p. You know, they came together, and Mayor Warren of Orange and Mayor Baraka, I mean, I think they were scared too. And you know, politics aside, didn't matter what side of the aisle you you know, you stood on. Everyone was getting this and so we all came together and worked really well. Um. So I hope, you know, we can learn from this about Um, the importance of public health, about clear communication, about multidisciplinary teams coming together walks of life. Um, you know, and I think obviously it ripped the band aid off about mental health. They ripped the band aid off about disparities and care and outcome. It ripped off the band aid that. You know, it's not a one size fits all when it comes to diabetes, hypertension and nutrition. In our country we still are a country of haves and have nots Um. You know, more is not better, but better is better. Um. So I hope we build this momentum. But you know, sometimes I think we still have a bit of a hangover from covid and we may be still a little bit dazed and confused. But I hope we hold not to something about this at all, you know, moving forward. Well, I'd love to hear a little bit more for you to tell the listeners. Selenium Meta Coal Associates is your company. Can you talk a...

...little bit more about what that is? So, you know, I always like to say my meetings it's not about to me, it's about the week. And so it's not my company. Um, it's our company. I mean we're not like a KA books or anything, but still, Um, we are a team without a doubt and I always kind of like say, uh, you know, I may not have a big family because right now it's just basically me and my wife, but my extended family and the new DNA of my family is my practice. And so one of the things I'm most proud about is that I have a group of people that I've been with me like ten, fifteen, twenty years and we are a strong core and that's something that you can't model, that's not something you can cut and paste and I think that's really what defines us. So we are a tight knit clan. We we we disagree, but we don't disrespect Um, you know, we we listen and we work well together. I try to be available to everyone in our company. Um, you know, my my one of my I'll call him my cousin, his sister is my chief operating officer. So we try to bring like close knit family into it as well to run it like a family business. It's a family business. It's not a medical practice. It's not this big conglomerate. I'm not worried about size, I'm not worried about anything. I'm just worried about, you know, continuing the tradition started by my parents and for us to be, you know, the whole ideas our family taking care of your family all the time. That's remarkable. And what patient population does Lerner medical associate serve? So we always have been in the urban area. My mom was in New York her whole career. My Dad was in east orange. They started their practices prior to the race riots when New York was on fire back in the sixties. A lot of people left right but my parents actually stayed and continue to stay, and so we we that's where we are. We're basically in urban areas and, Um, I think that's where healthcare needs to be delivered. You know, it's not concierge medicine, it's not, you know, nip and TUK medicine. It's just, you know, really medicine, primary care, prevention, population health, all those kind of buzzwords. But it's just trying to educate. My Dad always said we're not healers, we're educators, and so, you know. And one of the pastors I've worked with in my non for profit, you know, told me something that really kind of changed how I approached patients and populations. He said fear is an emotional sin. and Um, and it's true because if you think about it, I mean I fear stuff. You fear stuff. When you we fear stuff, we never make a rational decision. Do it. Like I fear taxes, and I mean when I see in here from my accountant, I'm running to the bathroom all the time. You know. So Um. So imagine if I'm talking to a person that, you know, is scared of medicine, scared of doctors, scared of you know, I don't want to. You know, if it ain't broke, don't fix it right. And now I have to talk to them about cancer screenings, diabetes, you know, hypertension, hypertensive heart disease. These are scary words. So how do you combat fear? Is through knowledge, and so that's the educator part. And you have to educate in a way to people get it. And you have to be talking not at people, but two people. And so that's kind of back to my my experience when my dad was a patient and seeing how these fellows were talking to him. I don't think they knew he was a doctor. I'm glad they didn't know he was a doctor because it was enlightening to me to see how they were talking to him, and that lack of talking to someone, but at someone, not listening to someone seeing beyond the person in front of you, Um, was what really resonated with me and made me make a career change. Well, I'm glad you did. And you have a couple of different non for profits that you run presently. So you have the Urban Health Initiative program and the Community Healthcare outreach program I'd love to touch and highlight both of them. So could you tell us about the urban health initiative program first, so to kind of Relabel it? Um, their population health programs, right. Um. So you hip, Urban Healthcare Initiative program is a non for profit like true, five and one, c three, with the board and minutes and quarterly meetings and all this. And then shop, which stands for community healthcare outreach program and the one that started it all back in two thousand one called shop, which stands for seenior healthcare outreach program these are our population health programs. Um. So you hip was a program that I started, Um, I don't know, like probably, I think I want to say twenty, twelve, maybe eleven, and it started out of frustration...

...because I saw that I one couldn't touch as many people as I wanted to touch. Two that a lot of people didn't believe the message because they didn't believe the Messenger. And so seeing the disconnection with healthcare with the community, a lot of times I was like, how can I deliver a better message? How can I redeliver or re transform the team, the healthcare delivery team, and where can I give a message that it would have the most impact? And so that's where I started talking to different folks in the community. I actually started going to a couple of Baptist churches Um in in Newark, and you know, that was kind of like what's wrong with this picture, like, you know, at a Baptist Church on a Sunday um but seeing some of the path susters and deacons and how they have their finger and the pulse of the community. I mean talk about seriously having your finger on the pulse of the community and the trust of the community, and that's key trust. I was like, Oh my God, this I mean they have to be part of the healthcare team, they need to preach diabetes, they need to preach hypertension, to chronic kidney disease, vaccinations, dementia, HIV, depression. They have like end of life. And so I met a reverend, Pastor Owens, from the Messiah Congregation. He's my age, amazing speaker, I mean really amazing speaker, like I just sit and listen to him like God, I wish I could speak like this. and Um, I was like I approached him with the idea and he was new to New Jersey. He came from Cleveland, not Cleveland at Dayton, Ohio. He would be insulted if I said Cleveland. And so he was new to New Jersey and new to East Orange, New Jersey. and Um, obviously this was a new program and his he really was big in healthcare. So every pastor, I understand, has their own missions. Some people do food kitchens, some people do you know, Um, you know, just other ways of giving back and strengthening community. Pastor Owens, he wanted to focus on health and wellness so his parishioners can live better, because he was, I guess, getting tired going to the hospital and giving last rights to a lot of members and seeing the effects of diabetes and hypertension. So I started talking with him and you, hip was born and it was like he and I starting with his Messiah Congregation. He's actually president of our board right now and, Um, we actually now had dinner the other day. We're like, what can we do next with you hip? So we're gonna start doing podcasts on on cool eye concepts, because obviously one of the things covid demonstrate to us is zoom. You could touch a lot of people with zoom. You could touch a lot of people with telemedicine at works, Um. So it's not like you don't need brick and mortar to have an impact. So so you know, you hip is knowledge is power. Um. It's faith based medicine. Um, because diabetes affects Baptists and seven day adventists and Muslims and, you know, everyone equally. Um, it's about where if you come to a building to heal your mind and soul, you should heal your body and go for the whole trifecta. And you know, we we created the seven pillars of wellness, like seven days of creation, and each pillar is a topic. Like I said, depression and dementia is one of them, HIV and infection is another one, hypertension, it goes, you know, diabetes and so forth and so on, and it's about knowledge is power, you know, and, as I mentioned earlier, you know fears and emotional sin and changing the Messenger, Um, from doctors and white coat syndrome dealing, you know, two pastors and Deacons and people within the community that truly know the community better than we do, Um, and try to swing the pendulum from reactive medicine to proactive medicine. So that was you him and then Um, the first population health program that I mentioned shops, senior health care, Ridge program. So funny, when I joined my mom and dad in two thousand and one in your offices, there was no room for me. So Um, you know, and none of the patients wanted to see me. They only wanted to see my mom and dad because they were yeah, they remember me under the desk playing with matchbox cars. So it's like there's no way, junior, you're taking care of me, because I remember you like underneath your mom and dad's desk, so playing with matchbox cars exactly. So it was tough. So in the beginning I needed to find ways to work. So I would see occasionally some of my mom's and dad patient and,...

...you know, they were coming to us and they were pretty sick. Like, you know, maybe heart failure that got a little bit out of control or maybe diabetes that got a little bit out of control. So I was like, you know what, why did it take you three months to come to the office? And you know, and it would often be transportation, whether my knees hurt, couldn't get an appointment. So I was like, well, you know what, I have nothing better to do. Where do you live? And I'll go see you. And so I started doing house calls Um in two thousand and one, like my dad did in the nineteen seventies. So full circle. And in the urban area a lot of seniors live in Hud housing, and so I'd go to a senior tower. It could be twenty stories tall and studio and bedroom apartments and I would just ride the elevator all day long and I would see my parents patients. But then I'd start seeing everybody, you know, because they, you know, swooned. The building manager, security, social service would say, there's a doctor in the building if anyone's interested in seeing a doctor, and so I started really just doing house goals and not doing office hours for several years, and so it became a huge program in the urban community. and Um and it still existed this day. I've transitioned it now to nurse practitioners, but it still exists today. Um. And the final program that I started chop, community health care outreach program so this was another frustration. A lot of the things I do I do out of frustration because I'm just so like, if it doesn't make sense, my Scorpio stubbornness will will get the best of me and so I will just figure it out. So, Um, I really got we we know about people, Brown and black, of color and disparity of health care access and health care outcomes, and it is very true. But I think the greatest discrimination when it comes to primary care access is patients with mental health. Unfortunately, their primary care access is restraints in an emergency room, to a Gurney or in a prison. Um, where they're. Unfortunately they are not because they intentionally did something wrong, but because of medical reasons they're in a prison. And and I started doing some research and reading and I was like wow, I mean the amount of reactiveness in primary care outcomes and primary care management and B H Behavioral Health Patients is insane. and Um, and I was like again, it makes no sense. Um, so I through you hip, and one of an our accountant of the time of you hip, who deals with only not for profits, introduced me to a gentleman by the name of Bob Davidson, who is the Essex County Director of Behavioral Health, and I had a lunch with him, and this was also probably eight nine years ago, and just the two of us were at lunch. It's like, I've got a facility. It's an outpatient facility, Monday through Friday, eight to four, nine to five. I don't have much space, but if you want to come, you know you're welcome to come. So that not much space. Was a janitorial closet, I'm not hidding. So it was an upgrade from being under the desk too. Yeah, it was. So they converted, you know, the janitorial closet to a very small, you know, one person shop, Primary Care Office. And it made sense, right, because you have people who are there in program right, the schizophrenics, bipolar, PTSD, and they're there eight to four. So talking about captured population right, and again, only treating above the neck and nothing below the neck, and you're talking about a population at big and alcohol abuse. I B D a smoking obesity, lack of nutrition. So you know, the medications that we use to treat P H lead to obesity, which lead to diabetes, which lead to chronic kidney disease, which leads to cardiovascular disease. So you're talking an avalanche of problems. But yet they're under one roof from eight to four, five days a week. You know how easy it is to see patients under one roof? I mean it's like it's the easiest thing in the world. Yet why aren't we doing it? You know, and I learned that, unfortunately, you know, at least then, and I think it's starting to change the way these programs have been structured, you know, and and funded through federal programs. The initiative is not to pull patients out of the programs to go across town to see and get primary care because the programs that's called a time out and during the time out they can't build and they're not being compensated. So I was like, okay, well, let's let's flip the switch and I can come to you. So you're not going across town, you're not sitting for hours...

...in a waiting room, you're not getting a bunch of prescriptions and you don't know what to do with right. I mean, imagine giving ten referrals to a patient that schizophrenic. How is that ever going to be connected? It's not. So I mean here we are adding to the problem, not solving the problem. In medicine we're supposed to solve problems. So so this, I think, chopped to me, was probably pretend and it's not like there yet because again we're dealing with, you know, reimbursement issues of how the the government and programs pay these these B H centers. But if they really start, you know, approaching the clients and the constituents as a whole and not a part, and increase accountability that, you know, we need to take care of all of the patient and not just above the neck the patient, I would quickly see that you're going to redefine population health in this country like hot knife through butter and it's going to be amazing. But we got to get there with policy and you know, and and so sometimes politics work, like it did with covid on a local level, with me and the mayors and and and civil servants, and then sometimes it doesn't work when it comes to the people. I guess making the rules in Congress and Senate and, you know, not really being in the trenches to understand the problem before making the rules. So it's a challenge but it's great. I mean. So those are the three population health programs. Um, they all kind of Um, you know, lean on each other and and and spawned from each other and Um, you know, health care should it's not like the field of dreams. You build it and they will come. Health care should be consumer centric, not patient centric. It should be where the people are, not where you are. And, like you know, it should be somewhat decent. Like would you go to a terrible restaurant with terrible food and terrible service? So, but you know, sometimes healthcare gets insulated from consumer economics of customer service, service with a smile. The customers always right. It's got to be easy, it's got to be friendly, it's got to be clean, it's got to be inviting, it's got to make sense and Um, you know. So sometimes we get again caught up in the algorithms and we forget at the end of the day, where people treating people. And you know, the golden rule treat others as if you'd want to be treated. So I mean I would never go to a restaurant where to give me lousy food and service. You know that, and so why would I want to go to a hospital or a clinic or a provider and I'm getting Lousy Service? It makes perfect sense. and Dr Silerno, you are quite the inspiration creating these population health programs from the ground up, and you can tell just just what a heart you have to make lives better of those around you, and especially people who need it, and meeting patients where they are. Um It doesn't happen often enough. And just these programs themselves. I hope that listeners are inspired and other people who maybe have the same hard as you do to to do something that can help will also think of you know, maybe reach out to you or think of ways that they can go and create similar programs in their community to help with from the population health standpoint. Yeah, I mean, if you think about it right, behavioral health centers or throughout the country. So right then and there, imagine if you just bring primary care into every behavioral health outpatient program in the country. Think about how much you can move the needle. And then think about like the network when it comes to faith based medicine. I mean every Baptist, seven day adventists, I mean the seven day eventist religion is like the IBM of religion. I mean they are so structured and so strong that if you implant, you know, health care Um, you know Um program in in in these congregations, because they all have also their sister congregation, they do get competitive. You know, they are competing at the same time, a healthy competitiveness. You again, can really just redefine so many healthcare obstacles and remove them, you know. So it's it's you know, it they I mean we've been, for lack of better words, Beta testing it in New Jersey now for over a decade and it works. So, you know, I don't think it's any different in Houston or Minneapolis or New Orleans or anywhere else like that. You know. So I'm hoping that maybe programs like this can kind of get traction. It's all about traction, right, and and we go from there, you know. Yeah, well, and I think that we all have people in our lives that we look up to and, you know, similar to doctors, these these pastors. If you are a religious person, whomever you're, you're going to you know, see each week you trust with...

...they tell you. So if they are giving you advice, uh, and and telling you, Um, people to see you, know, to to get your health care looked at, more than more likely than not, you're gonna listen to that person and you're gonna do what they're telling you. So that that certainly helps. Definitely. I mean I've seen it, you know. So Um, you know, when Reverelon's talks, people listen. So that's good. Well, I'm glad that you're giving them a platform and and it's in improving the health of of everyone that they're talking to. In turn. In December, so learn no medical associates produced a white paper about the mental health crisis. Can you walk us through your findings? So, um again, you know, based on the Chop Program and the work that we did with Bob Davidson at the prospect house in East Orange, New Jersey, we had a lot of data, Um, you know, leading up to covid. Of course, covid took us all offline for a while, but we had a lot of data and it was impressive data. Um. So again it worked. We we brought primary. Initially was just like me and then it was you know, an expanded primary care team. Bob Davidson saw, you know, how well we did that. He was able to get funding and he created an F Q hc lookalike and he actually built an addition to his clinic. So we went from a janitorial closet to a three room clinic with a waiting room, two bathrooms, a triage station and an exercise room. And so you know, and and so it works. So you know, we expanded. So I partnered up with a hospital system, R W J Newark at Israel, and they provided us a patient navigator. So what we would do is Um in the room. I'm seeing Mrs Jones. Mrs Jones is a smoker. She's more of the obese. She's never had a paps Mare, she's never had a mamo. She needs a colonoscope, she needs a lung cancer of screening because she's a, you know, two pack per day smoker, because you know these patients smoke a lot. So I'll go to my patient navigator. My patient navigator would preregister the patient at the Behavioral Health Center, arranged transportation to bring the patient from the center straight to the Mammo Department and back, so we avoid high stress areas, right, like patient registration areas in hospitals. That's a high stress area, right. You don't want to do that. So so this is what we did and it really worked. And so we were able to close gaps in care. We were able to do value based medicine. We really scored high with the players because all of a sudden we swung the pendulum from reactive to proactive. Um We integrated, you know, above the neck and below the neck, primary care and psychiatry into one. Because you know, you're saying you get two doctors in the room, you get six opinions. Right, but that wasn't really the case in this particular one because we were voluntarily working together. And you know, again, the doctor great drugs now to treat sophrenia and bipolar, but they lead to waking. We have great drugs that COMEBAT waking. So you could get one shot a month or one shot a week for schizophrenia and you could get one shot a week for weight gain. And so you promote weight loss. And what a great one to punch, you know. So, and then what we also noticed? You know, there's something called annual you know, an annual wellness visit, which we do each year for every patient, regardless of age, and in the annual wellness visit there is a depression screen and an anxiety screen scale that you do and we noticed that our patients, after years of seeing us and seeing where, in their backyard, working with their case manager, working with their psychiatrists, working in their four walls, they got to realize we're not, you know, prison wardens and we're not emergency and folks that are going to be restraining them. And so their depression numbers and anxiety numbers on the scales we're going down, especially because they realized, wow, it's not so bad to get primary care. Mammograms aren't that bad, pneumonia vaccines aren't that bad. You know, Um, you know, going for you know, your colonoscopy, you know, is a little bit discomforting, but it's not as terrible as colon cancer. You know, Hepatitis C can be cured, latent TV can be cured and we saw a lot of that right. Um. So it really again keep saying it's swung dependulum from reactive to proactive, from fractionated to integrated, from you know, Um, you know, just services under one roof, as as opposed to services under ten roofs and and ten time outs right, and that's not good for the facility when they're all struggling with funding and they have all these time outs. So we did this white paper and, Um, you know, unfortunately, though, I'm not a politician, I don't have lobbying power, and so I just sent this white paper to as many people that I can find on the Internet and I haven't gotten any feedback...

...yet. It's been like six months to a year. So Um, I don't know. I mean, you know, I just keep doing what I do and maybe, you know, the white paper will fall across somebody's desk as bathroom reading and they'll be like, Oh wow, we got to figure this this out a little bit better and here's potentially an algorithm. So we'll see. But that was the white paper and you know, Um, again, it was a great team effort with the Chop folks. I have a really amazing executive director in population help that we recruited and she really knows how to wear all the right hats and so she put us together for us and she converted, you know, medical charts and too relevant what I think should be public policy. You know because you know public policy should come from real life events. You know, because there's the problem and here's the formula that has been tested to work, rather than some formula coming from some you know, mb a guy sitting at some executive desk and some power somewhere. Yeah, it makes perfect sense to me and you're showing the results of thinking of things this way and providing medical care and kind of a combined way, just the impact it's making. So we will be sure to make sure that that your white paper, Um, there's a way for listeners to read it and anyone who comes across our podcast. I think that with all of your stories that you've had and everything that you've your parents have encountered over the years and you've encountered throughout your medical career, I think that you're doing your own podcast makes a ton of sense and I will certainly be a listener for that. I know it will be extremely entertaining as well as just informative. Well, that's one of the things on my sabbatical that I'm working on. So let's let's hopefully I can figured that out, because I'm not, as you can see, very uh, tech savvy. Just trying to get my Mike to work on this. UH, today event was a challenge, but but we'll see. But I definitely I feel like I have some I've met some great people and we have some good things to say and it's been time tested and proven. And you know, Um, you build a great society. I read once on education and healthcare, and so I do think that we need a little bit more attention and heir to the ground and with our educators and our healthcare providers if we want to be that great society, which I think we may have lost our way a little bit over the last you know whatever, ten years or twenty years. But you know, we are, as my dad said, we are the problem, but we are also the solution. We are the architects of what we build and what we destroy, and no one else. So politicians, physicians and pastors should come together and we can maybe make a great society. I think so. And you really mentioned you've got to take ownership of it, and I'm very impressed that you are taking ownership of your own health and you are going on this at article. But if we are looking at our families and we're trying to to help them, what are some signs of declining mental health or even physical health that we should maybe look for in our loved ones and let them know they need to to see someone. I mean, I think number one is if you start noticing that your appearance is changing. You know, they're not, you know, showering, they're not, you know, dressing, they're not like, you know, just doing normal what we call activities of daily living. If they're losing weight, if they're if there's changes in their sleep cycle, if they're not normally as engaging and as engaged as they used to be. Um, you know, these are all signs that something is kind of brewing above the neck. And and you know, and so again it's it's it's not just to say, Oh, you know, they're having a moment and they'll work their way out of it, especially because, again, after Covid, covid ripped the band aid off on mental health and Um, you know, it was always there. It just, you know, for for you know, for whatever reason, we weren't talking about it. You know. So I think now we ripped the band aid off and we have to talk about it and it's not taboo. That's the other thing, right. Mental Health is very taboo. Um, you know, God forbid you talk about it. That means you're a weakling and you know you're you're soft and you know you're not. You know, gonna be. You know you're gonna be chastised in some way. So we we kind of have to just remove the ignorance, Um, you know, and understand that. You know, mental health is a disease, no different diabetes. And we've accepted diabetes and we know it's a disease and we know that their medications and lifestyle and modifications to manage that disease. Well, there is the same for depression and anxiety and o c d and everything else that goes with it. So, you know, we can continue to ignore it and look what happens, or we could just address it, Um, where it is, you know, and it's it's you know, anyone can address it, you know, and and get to...

...the right folks to help treat it, whether if it's a counselor or a psychologist or a psychiatrist. And again, you know, with you know, covid, some good things came out of covid. One was the you know, the idea of telemedicine works and it can bridge care regardless. If you're you know, what's it code you're in, and that could be primary care and that could be specialty care, and that's certainly, certainly, if there's anything tooled for telephonic healthcare, it's behavioral help, because you don't need a stethoscope, you just need a mind in an ear and a map. And so so I i. You know, I think we're in a position that we can really do a lot in the years to come because of, you know, what we learned from covid and as a result of covid Um, and it starts in your own backyard and in your own living room, um, because if if it doesn't get addressed there, oft forbid. You can see how it can man nfs. Absolutely it can, and I'm excited to you know that the heroes of health care team. Anyway that we can support chop shop you hip. We certainly want to do so. And it's wild to me that so much time this has flown by. I could sit here and have you for a lot longer, um, but hopefully we can touch base with you once you get back from your sabbatical and hear what ideas have flourished. It come from that and get an update on your podcast. Um, afterward. Um, but before we round out the show, Um, we always like to end and and talk about who your health care heroes are and you named an abundance of different people throughout kind of your health care journey. But who are some people that you might want to call out? Um. Well, obviously I did mention, you know, my parents, because I think you know healthcare and being a physician it defines you as a person and not just as a professional. It's not a nine to five job. Um. I think unfortunately some young your generation, physicians go into it for lifestyle and it's not. It's not a lifestyle job. That's that's working in a hedge fund or, you know, doing something else. You know, but this is about selflessness and it defines you. And you know, my dad said everything would be taken away from me by your education and character, and that's very important when it defines as a as a health care provider. But I think also, like, as I mentioned, you know, it's people outside of health care, because you learn about people and you learn about circumstances not just from the you know, that closed circle that you work with. You know. So, uh, I mean you know, I've learned a lot, believe it or not, or believe it, from social workers that you know, from building managers, Um, from pastors and Deacons, Um, from funeral directors in the last couple of years. Um. So I just you know, at the end of the day, uh, you know, medicine is a science, but it's also an art and it's not a one size it's all approach. And you know, another thing my dad said. He said, you know, at the time patients get better, you know, regardless of what you do. Five percent a time you help them and five percent a time you kill them. And so, you know. So I definitely think that, you know, just because I'm a doctor doesn't mean diddally. You know, I can learn so much and I try to learn so much by listening and just watching again, you know, just by spending a Sunday a couple of times at a Baptist congregation and understanding the community that I'm in. Yet I wasn't really in it, because you're not really in it if I'm just restricting myself to four walls and a small circle of people. So, UM, so I don't have one hero. I have many heroes and I would like to say have many people that I learned from. Well, I'm I'm grateful and I know that the reach of patients that you've seen over the years and that you're you're the doctors that are oociated with you have seen over the years. They're all I'm thankful that Your Dad had a neuro surgery scare when you were twenty two years old, because if it wouldn't have been for that, none of this would have happened. So so there is a blessing out of it, Um. But, Dr Selano, again, thank you so much for joining us today. We have Um. It's been a pleasure having you on the call and we look forward to touching base with you in a couple of months after you are sabbatical. Thank you so much. It was a pleasure being with you folks as well. Today. You've been listening to heroes of healthcare. For more, subscribe to the show in your favorite podcast player or visit us at heroes of healthcare PODCAST DOT COM.

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