When Dr. Jaren Trost became senior medical director at Optum New Mexico, he looked out at the health landscape of the state and knew something had to change. In a poor state, many of the sickest were getting sicker. They had barriers to quality health care and were not going for checkups, filling their prescriptions, or answering providers’ calls. Some hadn’t seen a primary care provider in years.
Dr. Trost, who viewed his new position as an opportunity to lead with a servant mindset, wondered how he could help these people and make the biggest impact on New Mexico’s health care.
Knowing that our sickest members take up the majority of healthcare resources, he decided he’d start with the 37 sickest patients. And he decided that his method would be to hop in his car and visit each of them himself to see how he could help.
One of the first patients he visited was living on a mattress on her floor in the living room. Dr. Trost could barely walk into her house because there was feces and urine all around. He sat with her for two hours and talked with her about her medical, social, and psychological history and needs.
Another patient had six DUI’s, so he couldn’t get a driver’s license. Because he couldn’t drive, he couldn’t go to a provider.
A home on an American Indian reservation with a large extended family lost their mother two years prior. We had no idea the patient had died. The house also didn't have running water.
“One lady I saw had a bilateral blood clot,” he said. “So, I go in her house and her legs are swollen like tree trunks. I end up getting her in the clinic and she has bilateral blood clots. I come to find out that she ran out of her blood thinner medication, and she can’t reach the phone.”
“It breaks your heart. You see this stuff and it shouldn’t be like that,” he added.
What Dr. Trost learned is that many of these patients had simply given up. He also learned that his visits could give them a chance at better health – as well as hope…something in life to look forward to.
These same patients who wouldn’t answer their phones or return e-mail, he found, welcomed him with open arms when he showed up knocking on their doors with his stethoscope and backpack filled with medical devices and supplies.
Dr. Trost believes this is because he approaches each patient with curiosity, empathy, and courage. He asks a lot of questions to help him understand their situation. He then lets them know he understands where they’re coming from. And finally, he has the courage to say, if you work with me, we can we do this together.
On the flip side, these visits reaffirmed to Dr. Trost why he had become a doctor in the first place. He had been in training for 15 years and was starting to feel a little burned out. “I was starting to forget what my purpose is – what am I doing here, what am I doing on this Earth?” he said. “When I got in a car with my stethoscope, knocking on doors, it gave me a new paradigm shift on how to think about being a doctor and what I do every day. It reaffirmed my purpose. I would call my mom and call my girlfriend and say, ‘This is why I’m a doctor.’”
“I’ve always thought I could change the world,” Dr. Trost says. Steve Jobs used to say that the people who are crazy enough to think they can change the world are the ones who do.”
Dr. Trost is working to expand the program to visit the 100 sickest patients in the state. He’s asked some other providers to help.
He believes that visiting members in rural and marginalized communities of New Mexico adds a human face and touch that grows the Optum brand in a positive way. “The amount of human touch probably reaffirmed their belief in medicine,” he said. “Where you live shouldn’t determine how healthy you are, and if we can reach out to these people and help them get access to clean food and water and care, then we’ll make a difference.”
Dr. Trost believes virtual care can be a vital tool to help. “But there is no substitute for me sitting at your own dining room table, talking, listening to your heart and lungs, observing things like beer cans piled up in the trash or the smell of cigarette smoke, what kind of food they have in the fridge. You glean so much more in person that you can’t get on the video.”
As Optum New Mexico expands the program, he’ll do some things differently. He’ll schedule more follow ups, for example. But he knows the people he visited are in better shape than they were before they met him.
“Some people go through life without ever finding their perfect job,” he said. “For me, I’m literally in the community, driving around, talking to people. I’ve found something that matches my skillset perfectly.
And though he started small, he believes this method can be scaled to help many more patients’ lives. “Imagine if we did this on a grand scale with 100,000 clinicians?” he asks. He also believes this is the heart of the value-based care model. While fee-for-service takes care of what happens to a patient in the office…the visit, lab work, etc.…value-based care is making sure that patients are taken care of beyond the clinic. It’s following up to make sure the patient gets their subscriptions, checking in after they get discharged from the hospital, making sure they do their screenings and get the care they need.
“I put Optum and UnitedHealthcare on my back every day,” he says. “This is just the start. I’m going to change the world.”