The Future of Health is Culture-Centered Care
Dan Miller, founder and CEO of Spora Health, believes health inequities are a product of poor design. The staggering health inequities and disparities that Black Americans face are driven by a number of deeply entrenched systems, and some of them are present right in the doctor’s office in doctor-patient interactions.
Dan’s own experiences and those of his loved ones inspired him to examine how the relationships healthcare providers build with their patients can impact health outcomes. By putting cultural competence at the center of their care model, Spora is creating a new paradigm for care with trust and empathy at its core, leading to more positive experiences and better outcomes for their patients. Their curriculum for training doctors on culture-centered care has been so effective that they’re now making it available to external clinicians, employers, digital health companies, and provider networks around the country.
We sat down with Dan to learn about what inspired him to start Spora, what it means to offer culturally competent care, and how building a trusted brand is a critical part of the patient experience.
What inspired you to start Spora?
I was thinking about problems that I was uniquely positioned to solve within digital health and was meditating a lot on my lived experience, my relationship with healthcare broadly, and issues that affect the lives of me and my loved ones. I spoke to some family members and learned about some of the really negative experiences they had in managing their healthcare.
When I was in middle school in New Jersey, my great-grandmother came to live with us towards the end of her life because she wasn’t comfortable with her caretakers. I became her caretaker after school on days I didn’t have practice. That was a solution born out of the necessity to make our great-grandmother comfortable towards the end of life, but it wasn’t the right solution. There should have been a more culture-centered, better-aligned option for her to have access to.
Spora was born out of asking myself the question, “what if we put the culture of the populations we serve at the center of everything we do?”
Why are you starting with primary care?
Primary care is the first major touchpoint folks have with the healthcare system, so the relationship that providers have with the populations they serve is very important. They are the quarterbacks of healthcare, triaging patients to specialists and different parts of the system. Because that’s where the relationship starts, primary care is the best intervention point to begin addressing a lot of the inequities and disparities in healthcare for folks that look like me.
What are the biggest drivers of health inequity?
There are a ton of drivers that exist upstream that we can’t control as a practice. We focus on the many inequities and disparities that show up in the appointment setting that we can control for.
Those include things like trauma-informed care, which recognizes how populations that have been exposed to traumatic healthcare experiences make health decisions. We educate doctors on ways they can change their behavior when they are in an appointment with a patient.
Other examples are verbal and nonverbal communication styles. Empirically, when white providers interact with Black patients, they talk more during the appointment. When they interact with white patients, they tend to talk less and listen more. This leaves objectively less time for Black patients to ask questions and discuss treatment options. It also means Black patients leave these encounters feeling less of a connection with their primary care provider, which leads to lower rates of medical compliance and follow-up and, ultimately, worse health outcomes. That experience is something that we can control for and which can have really positive outcomes on our patients’ lives.
What does it mean for a provider to offer culturally competent care?
Culture is at the center of Spora — it’s our brand, tone of voice, and representation in our providers. I wanted to push that thinking forward and ask what it could look like as a care model, so I came up with a thesis of care called “culture-centered care.”
No accrediting body in the US requires health equity or cultural competence training. One of the forces that’s perpetuating inequities and disparities in our system is that we’re not helping our doctors understand that by incorporating these skills into their practice in an evidence-based way, they create behavioral change.
We created the curriculum to educate all of our doctors, and it’s now available externally for other providers as well through The Spora Institute. That means helping them better understand determinants of health and lived experiences of our populations, how they show up in clinical encounters, and how that changes the way symptoms may present in different populations.
We have positive data points that this is working. The Spora Institute has a 96 NPS score. Our doctors are demonstrating a 96% knowledge gain when we assess them for attitudes, behaviors, and their clinical ability to address these issues. This is creating a markedly better experience for our patients — they are giving us an 85 NPS score. The industry average is -1.
About 70% of our doctors are folks of color. The remaining 30% are not, but they’re still able to provide high-quality culturally competent care for our patients, and our patients still love the experience.
Why did you start The Spora Institute?
Large provider networks and practices kept asking us for our curriculum. We used our platform as a sandbox to make sure it worked. We’re there now and super excited about the outcomes we’ve been able to drive. Now we’re offering versions of the Spora curriculum for clinicians and non-clinicians alike, and selling that externally to employers, HR and benefits teams, digital health companies, and provider networks.
Why is brand an important part of Spora? How does that change the patient experience?
Brand is everything. I’ve been Black for 36 years now, and I know my community. Building trustworthy environments is what’s required to swing the pendulum back from a very stark, bland healthcare system to one that’s rich with culture and community, understanding the environments that folks inhabit, and how that informs their healthcare decisions.
There is no shortage of services that have been targeting Black folks for decades, and there is often a high degree of skepticism for us. You’ve got to come correct as a brand in an authentic way. I strongly believe that we would not have been as successful as we have been over the last few years if we didn’t show up for our community and build an authentic relationship with the folks that we serve. As we expand to other populations, we’ll be looking to take a similar approach, because they deserve it.
Where do you see the healthcare industry moving as it relates to hybrid care?
Telemedicine is great for many use cases, but often we still need to manage care in person, and there will definitely be more demand for hybrid models from patient populations. We are seeing subsets of our population interested in seeing providers in-person. They tend to be our older patients that have rooted behaviors in driving to the doctor’s office and low adoption rates for new technology.
It’s really important for us to learn first before we start to build out solutions. The evolution of hybrid care models will need to consider the needs of folks at a population level. A hybrid model could include remote patient monitoring with patients using devices in their homes, a traditional brick-and-mortar experience, or a provider coming to the patient’s house and treating them at home.
Right now, we’re listening closely and trying to understand our patients’ expectations for in-person care depending on where they live — behaviors might be different in Florida versus Virginia or Texas. I’d urge other telemedicine and hybrid care providers to do the same so we can continue to provide high-quality experiences instead of trying to create a cookie-cutter model.
We’re in a transformative moment for healthcare. What are you most excited about?
The emergence of culture-centered care as a category, which I believe is the next phase of patient-centered care. Patient-centered care has been a concept for decades now, but it’s not moving the needle enough to decrease inequities and disparities in different populations. I’m excited and inspired by the innovative care models that are coming up and are culture-centered for their populations — Tia, Folx, Kiira, and Plume are other examples. There is more differentiation than ever for patients, but we need more alternatives in the market for patients to have enough solutions for their unique needs.
CB Insights released their top 150 digital health companies for 2021, and there is no category for culture-centered or population-specific. The market doesn’t know how to assess companies like ours, but that will change over the next few years. As we have more outcomes data and time-series data, this new category is going to become a focal point.
Who inspires you?
I’m inspired by the folks that I’m in the trenches with, who are trying to create a better future and are betting their livelihood and precious time on this planet to build better systems for others. Other entrepreneurs, for sure, but also other policymakers and folks that are beacons of change for good.
Interested in learning more about Spora Health? Visit their website here.
