Could primary care at home unlock better health and lower costs for American families? Rebekah Gee, a physician and policymaker turned entrepreneur, joins us to talk about the big bet her company Nest Health is making on home-based primary care. It’s a model that makes sense for families and delivers results. In the first year of operations Nest doubled primary care visits, reduced ER visits, and increased childhood immunizations.

We discuss:

• The sound economics behind the Medicaid expansion in Louisiana
• What she learned from her mentor, astronaut John Glenn
• How to close the primary care gap for children and parents
• Whether ultra processed foods are the next tobacco

Rebekah shared about an exchange with Elon Musk on the short sightedness of Medicaid cuts:

“So Nest came out with our savings numbers. We put out some really good information about the health of children and the opportunities. And Elon Musk retweeted it. So as a result of that, we actually got a lot of press. But I wrote back to him and said, ‘I'm glad you like this concept. And just remember, don't cut health care for children because we'll be paying far more for that than you will ever save.’ ”

Relevant Links

• Read more about Nest Health
• Watch: Dr. Rebekah Gee on what entrepreneurs need to know about Medicaid
• Learn about Alaska’s Nuka system of care
• Evidence from the Nurse Family Partnership about the impact of home-based care

About Our Guest

Dr. Rebekah Gee is the founder and CEO of Nest Health, a technology-enabled whole-family primary care provider providing care at home and virtually to Americans who struggle to receive comprehensive care. Previously, Dr. Gee served as Secretary of Health for the State of Louisiana. In that cabinet-level role, she led the expansion of Medicaid. As Secretary, she was responsible for nearly half the state budget including Medicaid, public health, aging and adult services, licensure, sanitation, disability services, and a nearly 2,000 bed state hospital system. As Secretary, she developed a first-in-the-nation subscription model for the drugs that cure Hepatitis C that is being used as a national and international model for increased drug access and affordability.

Dr. Gee has served as an advisor to multiple Governors, presidential campaigns, and policy efforts at the state and national level. Her board service includes medical advisory support of public companies Select Quote and 3D systems. She has also served as a board member or advisor to Ready Responders, Ouva, Noble, NCQA, NQF, IHI, the Penn Center for Behavioral Economics, and the Duke-Margolis Institute.

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Whether it's the civil rights movement, marriage equality or even seatbelt laws, community organizing is how change happens in America. In this encore episode, Dr. Tony Iton shares a masterclass in how social, political and economic power shape health outcomes and how to meaningfully shift those dynamics when it matters most. Tony argues that reinvigorating democracy at the community and local level is where we should be doubling down. This episode was impactful when it was first released but is even more relevant and timely now.

We discuss:

• The ABC’s of health for all: agency, belonging and social contracts
• How California communities applied this framework to dramatically change school climate and reduce suspensions
• The role of narrative in shaping policy choices towards belonging or exclusion

Tony digs into why power matters in health:

“We're talking about essentially community-level power, what we refer to as community agency, and we basically theorized that if we could build social, political and economic power in a critical mass of people in 14 low-income communities that have documented health disparities, that we could improve the health status of those populations over a 10-year period… We weren't thinking that there was something that we needed to do to people. In other words, it wasn't like increasing access to healthcare or, you know, enhancing the quality of public health education. This was fundamentally about unleashing the power of communities to [determine how resources are distributed].“

Relevant Links

• Read about our UC Berkeley School of Public Health Social Impact Fellows (Tony included)
• Learn more about the California Endowment
• Visit Dr. Tony Iton’s website
• Read Dr. Tony Iton’s “Understanding How Health Happens – Your Zip Code is More Important Than Your Genetic Code” by Dr. Tony Iton, MD, JD, MPH and Robert K. Ross, MD.
• Order “Advocacy for Public Health Policy Change: An Urgent Imperative” which is co-authored by Dr. Tony Iton

About Our Guest

Dr. Tony Iton is a Social Impact Fellow and lecturer at UC Berkeley School of Public Health. He was the Senior Vice President of Programs & Partnerships at The California Endowment from October 2009 to June 2024.

Prior to his appointment at The Endowment, Iton served from 2003 as both the director and County Health Officer for the Alameda County Public Health Department. In that role, he oversaw the creation of an innovative public health practice designed to eliminate health disparities by tackling the root causes of poor health that limit quality of life and lifespan in many of California's low-income communities.

Iton also served for three years as director of Health and Human Services and School Medical Advisor for the City of Stamford, Connecticut. Concurrent to that, he also served as a physician in internal medicine for Stamford Hospital's HIV Clinic. In addition, Iton served for five years as a primary care physician for the San Francisco Department of Public Health.

Iton's varied career also includes past service as a staff attorney...

California is full of hardworking people—nurses, teachers, delivery drivers, baristas—who keep our communities running. Many of them live paycheck-to-paycheck, making too much to qualify for most government benefits, but not enough to afford the basics. For nearly 2 million Californians, Covered California provides a critical lifeline, offering access to affordable health insurance and now basic needs support. Dr. Monica Soni, Chief Medical Officer of Covered California, joins Claudia to talk about the program’s important and expanding role in the California landscape.

We discuss:

• What the working poor really need: breathing room in their budgets to afford healthy food
• Operating a startup within government
• How collaboration across Covered California, Medi-Cal and CalPERS – which together cover 45% of Californians – will drive faster and more aligned health improvement in California

Monica’s team uses experiments and user research to shape every aspect of the program:

“But I do think in our DNA is this idea of innovation. In-house, we have a research team that does randomized controlled trials. We're committed to hyper transparency. Almost all of our data is released. We stratify it by everything we can think of to really identify where there might be pockets of coverage that aren't there or outcomes that are suboptimal. And we do a lot of deep listening with consumers and with the community to help inform what we do.“

Relevant Links

• Read more about Covered California’s Innovative Program to Improve Population Health
• See the details on Covered California’s Data and Research tools
• Announcement of the launch of Covered Californians Population Health Investments
• More info on how Covered California uses email nudges for enrollment

About Our Guest

Dr. S. Monica Soni is the Chief Medical Officer, and a Chief Deputy Executive Director at Covered California, leading the organization’s Health Equity and Quality Transformation division. In this capacity she is responsible for health equity, health care strategy, medical policy, and other clinical operations to continuously improve not only the health services provided through Covered California’s contracted health plans, but also California’s delivery system.

She is a board-certified internal medicine physician with more than a decade of experience working in both inpatient and outpatient settings and continues to see patients. She is an Associate Professor within the UCLA Department of Medicine and the Charles R. Drew University Department of Internal Medicine, where she is committed to residency diversification and pipeline development.

Prior to joining Covered California, Dr. Soni served as Associate Chief Medical Officer within Evolent Health focused on the delivery of high-quality, cost-effective specialty care for the over 16 million supported Medicaid lives across the United States. During her time at the organization, she played a critical role in clinical informatics, provider engagement, value-based strategies and innovation. Dr. Soni also served as the Director of Specialty Care for the Los Angeles County Department of Health