Under Karen DeSalvo, Google Health has big ideas for bolstering public health

For Karen DeSalvo, MD, MPH, joining Google Health meant a chance to help improve health for just about the largest audience anyone could hope to reach.

After all, she noted, the company’s data shows that three out of four people go to Google in search of health-related information before they contact the healthcare system. There hardly could be a better platform on which to usher in innovations that make a large-scale impact.

“There are hundreds of millions of people asking us questions all the time, and we have to be ready for that,” said DeSalvo, who is Google Health’s chief health officer.

She views her job as the culmination of a path she embarked on starting in 2005, when she was residing in New Orleans as Hurricane Katrina struck. At HFMA’s 2022 Annual Conference, she’ll share insights from her career in clinical leadership, public health and policymaking as she receives the Richard L. Clarke Board of Directors Award, which recognizes individuals who make significant, positive contributions to the profession of healthcare finance or the financing of healthcare services.

The hurricane led DeSalvo to consider how she might shift from an academic healthcare role to a position in which she could more directly affect public health. She eventually served as health commissioner for the City of New Orleans and in high-ranking jobs at the U.S. Department of Health and Human Services (HHS).

She says she couldn’t ask for a better opportunity than the one she has now.

“Information is a determinant of health,” DeSalvo said. “It’s a nonmedical driver of health.”

She added, “How do we help people find the information they need so that they have that empowerment, that sense of agency?”

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Key steps on Karen DeSalvo’s path to Google Health

1. After graduating from Tulane University’s School of Medicine in 1992, DeSalvo stayed on campus and made her mark in academic medicine. Among other positions, she served as chief of general medicine and vice dean for community affairs and health policy.

2. DeSalvo said it was Hurricane Katrina in 2005 that first got her seriously thinking about changing course and moving to the front lines of public health. Inspired to go into public service, she eventually was named health commissioner for the City of New Orleans and served from 2011 until 2014. “You sleep with the phone by your head, with the ringer on,” she said.

3. The Obama administration came calling in 2014, offering the role of national coordinator for health information technology. DeSalvo had a few reservations because of her lack of direct experience with tech and IT, but she couldn’t pass up the chance to work in a job that would incorporate medicine, public health and technology in efforts to improve healthcare nationally. She later served as acting assistant secretary for health, which has more of a public-health focus.

4. After her departure from the federal government, DeSalvo spent time on the board of Humana and as a member of the Medicare Payment Advisory Commission. She currently serves on the boards of Welltower and the Council of the National Academy of Medicine and has co-founded the National Alliance to Impact the Social Determinants of Health.

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Collaboration over competition

Some legacy healthcare providers may wonder whether their market share or perhaps their very viability will be at risk if the strategies of disruptors such as Amazon or Walmart prove successful. But Google Health, another colossus with a name that resonates across industries, is not seeking to infringe on anybody’s turf, DeSalvo said.

The company has been making strategic adjustments in recent months. In 2018, Google Health was launched as a stand-alone unit under the leadership of David Feinberg, MD. But in the summer of 2021, after reflecting on lessons learned amid the pandemic, leaders decided the optimal approach was to weave health-related products and initiatives throughout the company, better linking them to services such as Google Search and YouTube. Google Health is now strategically embedded across the company.

Feinberg departed for Cerner in September, making way for DeSalvo, who had started with Google Health in 2019, to ascend to the lead role with oversight of “the development of inclusive research, products and services.” The job allows her to fuse her experiences in clinical leadership, public health and healthcare technology to spearhead efforts that promote health and wellness on a large scale.

DeSalvo wants to emphasize collaboration and trust more than competition. Specifically, Google Health hopes to establish partnerships across the globe with consumers, caregivers (i.e., providers) and communities.

Consumers. When people search for information on whether they may have diabetes, for example, Google Health wants to ensure they can immediately find a physician who speaks their language and takes their insurance and that they can schedule an appointment without having to navigate to a different platform.

“We think of consumers as partners,” DeSalvo said. “Building their trust is honestly job one for us.”

Caregivers. Google Health has developed software that supplements a provider’s electronic health record, allowing users to apply Google’s search capabilities to find relevant clinical information. A possible next step, DeSalvo said, is to overlay information about social determinants of health (SDoH) as they pertain to specific patients.

More broadly, the company hopes its AI and cloud solutions reduce the burden imposed by administrative tasks so that clinical and revenue cycle staff can “make sure they have plenty of cognitive load for the things that AI can’t tell them.”

Communities. Information from Google can help consumers find healthy food or green space, DeSalvo said. Google Health also hopes to partner with public-health agencies to ensure they have the tools and technology needed to improve community health, such as by using search data on symptoms to gauge the spread of COVID-19.

DeSalvo also is looking to use an equity lens to frame every aspect of Google Health’s strategy. Considerations range from the fairness of the company’s AI models to the importance of partnering with isolated communities and lower-income countries.

Overcoming obstacles to better health

As DeSalvo spent time in leadership positions with HHS during the last three years of the Obama administration, there were two big issues that stood out to her about healthcare policymaking.

One was the underrepresentation of “people with broad, lived experience in trying to figure out if they can keep the lights on in their ER or how they’re going to cover the shifts in the ICU because they have a nursing shortage, or what they’re going to do when their orthopedic surgeon retires, or how hard it is for women to have babies in their county on the frontier.”

Federal policymakers try to seek feedback from areas that may seem far away from Washington, D.C., DeSalvo said, but that input isn’t always forthcoming. While bigger hospitals and health systems have mechanisms in place for commenting on proposed rules or fulfilling requests for information, smaller hospitals also need to make their voices heard.

“That rural hospital in Nebraska has a lot to say, and it really matters,” she said.

The other issue that stood out to DeSalvo as a complex industry challenge involved SDoH.

“It took longer than I expected to help people speak a language about SDoH, to stop blaming the patients and the community and to recognize that healthcare doesn’t own it, but they’re a part of the solution,” she said.

She’s heartened by the strides that have been made in ensuing years but says plenty of work remains.

“I don’t want this to fall on the head of healthcare and have us medicalize the social determinants,” she said. “It really should be multiple parties working toward solutions.”

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See Karen DeSalvo speak at HFMA’s 2022 Annual Conference in Denver

When: June 26-29

Where: Colorado Convention Center

Pricing and registration: Visit hfma.org/ac22.

Virtual option: Registration for the virtual version of the conference offers access to all four general sessions featuring seven speakers.

Speakers of note

In addition to Karen DeSalvo, general sessions will feature Zeev Neuwirth, MD,  chief of clinical care transformation and strategy, Atrium Health; Joseph J. Fifer, FHFMA, CPA, president and CEO, HFMA; Kelli Harding, MD, MPH, author and assistant clinical professor of psychiatry, Columbia University; Aaron R. Crane, FHFMA, CPA, MHA, incoming HFMA National Chair and executive vice president, Seattle Cancer Care Alliance; D.J. Vanas, internationally acclaimed leadership and personal development speaker; and Joel Selanikio, MD, physician entrepreneur focused on the intersection of health and technology.

About the program

In-person attendees can earn up to 16 CPE hours and choose from more than 70 solution-focused breakout sessions spanning seven tracks: Accounting and Finance, Business Strategy, Cost Effectiveness of Health, Data and Analytics, Leadership and Workforce Development, Payment and Care Delivery Models, and Revenue Cycle.

Other attractions

HFMA’s Exhibit Hall will showcase the industry’s top vendors and offer lunch and educational sessions June 27 and 28. Evening receptions for attendees will take place June 26 and 27. Visit hfma.org/ac22 for updated news on the schedule of events.