Dr. Karen DeSalvo Talks I&D and SDoH


What it's like to be the only female leader in the room, and how digital innovation is advancing SDoH.

Karen DeSalvo, MD, MPH, MSc and Terry Stone

3 min read

It’s our first female-only episode of the Oliver Wyman Health Podcast. We’re taking this opportunity to spark conversation about what it means to be a female healthcare leader, and to also examine some of the latest advancements addressing social determinants of health.

For this episode and more, check out the Oliver Wyman Health Podcast page, featuring executive conversations on the business of transforming healthcare, available on iTunes, iHeartRadio, Soundcloud, Google Play Music, Stitcher, and Spotify. Or, just tell Alexa, "Play Oliver Wyman Health Podcast."

In this episode, Terry Stone, Managing Partner in the Health & Life Sciences division at Oliver Wyman, chats with Dr. Karen DeSalvo, a primary care physician, Professor of Medicine and Population Health at the University of Texas at Austin Dell Medical School, and former Acting Assistant Secretary of the US Department of Health and Human Services (HHS). Karen is also a keynote speaker at this year’s Oliver Wyman Health Innovation Summit. Karen and Terry share their stories and experiences regarding the lack of female leaders across the industry.

“When I started as a physician leader, my first big role in academics was to be the chief of general internal medicine,” explains Karen. “I was one of very few female leaders in the entire university.”

“There’s something very special about the intentionality with which women leaders support each other and have been increasingly focused on supporting the pipeline,” she explains. “Quite honestly, for the bulk of my career, my mentors have been male. Frankly, I never felt like my gender was an issue in the roles and responsibilities that I’ve had. I’m thankful for that inclusiveness my leaders and mentors had along the way,” Karen says. 

“There’s a lot of good will. Now we just have to get to the ‘how,’ not the ‘what,” she adds. “We’re learning we have to be a lot more deliberate about identifying and developing future leaders to support not only the pipeline, but each other in the work that we do.”

Another topic discussed was how to understand and address determinants of health. Karen says progress is being made after a stagnant transformation period.

“Nationwide, the leading causes of death and what’s causing life expectancy to decline relate to social issues – such as educational opportunity, job opportunity, hopelessness, and social isolation,” she says. “Five percent of high cost, high-need individuals drive half of all healthcare costs. But these people aren’t just medically complicated; they’re also socially complicated, just like all my patients across my career. This is a population health phenomenon.”

“There’s exciting work happening as systems dig into their high-cost, high-need population. Whether doing quantitative or qualitative data assessment, they’re learning it matters if somebody goes to bed hungry,” she says. “Everyone’s got a part to play in improving health. It’s done better when there’s not only cooperation, but in some cases, convergence across systems to be much more seamless in the opportunity to manage the health of people and communities, as well as things like data and financial risk.”

Recent notable policy efforts stemming from Washington aim to provide more flexibility to Medicare and Medicaid payers on the front lines to address social need. For example, by using Medicare Advantage dollars to pay for patients’ food delivery. “We’re beginning to see recognition after some time of people helping policymakers understand the siloing of funding is not helpful for the work that needs to get done on the front lines. The value-based care movement is really driving this.”

“One way social care and medical care are just beginning to think through how to reduce cognitive load for, say, a social health worker or community health worker on a team, is to help direct services. Some small-name and big-name companies are starting to consider using augmented intelligence to support the social side of healthcare to make addressing social need both downstream and upstream much more efficient and effective.”

Karen says one particularly interesting model to watch in this space where digital infrastructure supports the social determinants of health is the state of North Carolina – the first state where a public-private sector arrangement has come together to create a systemic approach to care delivery. This way, for example, patients can research on their own about what programs they’re eligible for.

“This systemic approach – a public-private opportunity – means a housing agency won’t have to be on five digital platforms to support the community. It’s about taking a two-in-one system and modernizing it, then creating a closed loop referral opportunity and also a Yelp-like opportunity where you can rate the social services providers. It’s an exciting choice.”

For this episode and more, check out the Oliver Wyman Health Podcast page, featuring executive conversations on the business of transforming healthcare.