January 2019: The Whole of What We Do


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Vol 2 Issue 1

Dear friends,

One of the most exciting observations I’ve made so far in 2019 is that the Upstreamist community is rapidly growing. And that news raises an important recognition: As our upstream mission builds momentum, we must remember that it’s not just individual, but also community needs that encompass our work.


This was a message I sensed keenly at the annual Health Tech 4 Medicaid forum hosted within San Francisco’s Glide Church a few weeks ago, and in a recent article in Health Affairs. It’s easy to fall into an individualistic worldview, one that sees moving upstream as all about optimizing individual clinical outcomes.


But even as we work to help individuals get their social needs met, it’s equally important to focus on addressing the economic and community-level conditions that drive those needs in the first place.


Just last week, I gave a presentation in Los Angeles to about 40 graduate students from across the health professions. I presented to them a story I’ve often told, that of Mrs. M., a 46-year-old mother of two who also cares for her frail, elderly mother. She works two jobs to make ends meet. I explained that she was admitted at a local hospital after she nearly fainted. Her type 2 diabetes was poorly controlled.


“What could have led to this woman’s hospitalization?” I asked. To my pleasant surprise, these young caregivers completely bypassed the standard response I so often get in healthcare settings: that Mrs. M. was “not compliant” with her treatment. Instead, they brought up social factors such as food insecurity that may have affected her health.


What’s more, the students understood that these upstream issues manifest at three levels: individual, institutional, and community. At the level of individuals, they knew that upstream factors show up as health-related social needs. When reflecting on the role that health institutions play, they discussed the importance of shared responsibility, of health and social integration. And when working at the community level, they saw that upstream care reaches into the realms of policy, power, and the distribution of resources — the broad social determinants of health.


This was a powerful moment for me. It was invigorating to realize that the age-old narrative that segregates the silos of individualistic medicine vs. communal public health is becoming obsolete. We can finally move past that either/or debate.


Now, as the upstream movement builds, we must continue to choose different narratives than the ones our silos have given us — whether in the norms of how we talk and think about patients, or in our thinking about providing care outside the walls of a clinic. Addressing the social needs of individuals is critical, but we must also address broader inequities at the community level.


In other words, we must embrace the full scope of what it means to be an Upstreamist.


I can’t close without noting that just as the community of Upstreamists grows, so does the crew here at HealthBegins. We’re excited to welcome to the team Read Holman. Read previously spent eight years in Washington D.C. bringing innovation and entrepreneurship to the worlds of public health and government at the federal level. He’s based now in Oakland, Calif. If you’re in the Bay Area, I’m sure he’d appreciate your reaching out to him.


Rishi Manchanda

More from The Upstreamist, the HealthBegins Blog:

New Hope, Timeless Values: What Happened When HealthTech 4 Medicaid Went to Church

The HealthBegins team went to San Francisco this month to join the 2nd Annual Future of Medicaid Innovation Forum. In a church with a historic past, we sat in fellowship with hopeful, determined entrepreneurs working to improve Medicaid through tech. Our post explains what we saw, learned, and will carry with us.

Key Lessons on Structural Racism & Health Equity: Highlights from the HealthBegins Webinar

Our webinar on healthcare’s role in fighting structural racism drew record-setting attendance and a passionate discussion. The conversation must not end there. To carry it forward and help catalyze passion into action, here is a summary of key lessons learned in the webinar. 

A Hospital Marketer Pushes Primary Care Upstream

Upstreamist in Action: As a community-relations specialist, Jessica Saunders knew the community around Dayton Children’s Hospital deeply. Then she used that closeness to the community, along with Upstream QI, to lead her hospital upstream.

Don’t miss our February webinar!


Better Upstream Strategic Thinking: Lessons from the Field
Wednesday, February 20 at 11 a.m. PST / 2 p.m. ESTA growing number of health plans, hospitals, and philanthropies are developing strategies to address upstream social determinants of health for Medicaid beneficiaries. We know that great strategies spring from great strategic thinking — but we collectively know little about the frameworks that these stakeholders are using to shape their approach to this complex transformation.This webinar, co-hosted with Blue Shield of California Foundation (BSCF), presents real-world challenges and insights from a series of case studies and offers recommendations for healthcare leaders who seek to improve the way their organizations think and act on the path upstream.

Register Here


  • Rishi Manchanda, MD, MPH, President, HealthBegins

  • Peter Long, PhD, President and CEO, Blue Shield of California Foundation

By the end of the webinar, participants will be able to:

  • List at least two challenges facing healthcare organizations engaged in strategic planning for social determinants of health
  • Describe at least three strategic frameworks used by healthcare organizations, as well as their strengths and limitations 
  • Outline a simple, stepwise approach to make upstream strategic planning more productive for healthcare leaders 

Cost: This webinar is free!

Can’t attend the live event? By registering, you will be able to access a recorded version of the webinar later.

Questions? Email us at info@healthbegins.org.

Have a topic that you’d love to see us cover in a webinar?
Please tell us! Email at info@healthbegins.org.

Upcoming Events: Find HealthBegins Here

LA County Department of Public Health Community Services Staff Conference
February 28 | Hacienda HeightsPublic health staff learn how to engage community partners on population-level upstream determinants.2019 AMSA Annual Convention
March 8 | Washington, D.C.

Physicians-in-training gather to explore and understand the future of healthcare.

2019 IHI Patient Care Summit
April 12 | San Francisco

Healthcare professionals explore how quality improvement methods can be used to achieve better outcomes in primary care.

Presenting powerful upstream results at an upcoming conference? Nominate yourself to be featured as a HealthBegins Upstreamist in Action at info@healthbegins.org.

Upstream Opportunities

If you have fellowships, events, or other opportunities you’d like us to share, please email us at info@healthbegins.org.

Upstream News

Curated highlights of happenings affecting upstream care. Links are not endorsements.

Reducing Infant Mortality Starts With Listening to Women in This City (Video)
PHB NewsHour

NQF, Aetna Join Forces Join Forces to Tackle Social Determinants
Modern Healthcare

Social Determinants of Health, Value-Based Care Key for Medicaid Success
Health IT Analytics

New York City Launches $100 Million Universal Health Insurance Program

Leading Health Care Organizations Declare Physician Burnout As ‘Public Health Crisis’
Harvard T.H. Chan School of Public Health

American Is Failing Its Black Mothers
Harvard Public Health magazine

Innovation and Opportunities to Address Social Determinants of Health in Medicaid Managed Care
Institute for Medicaid Innovation

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