Making Healthcare Culturally Competent w/ Gaurang Choksi, CEO & Founder, Violet

What if better care starts with more trust and understanding?

In this episode of CareTalk, Violet CEO Gaurang Choksi joins John Driscoll to explore why care can’t be one-size-fits-all and what happens when providers actually understand the identities and experiences of the people they treat.

Drawing from his journey as a gay immigrant and early leader at Oscar Health, Gaurang shares how culturally competent care leads to stronger relationships and better outcomes for the patients who’ve long felt unseen.

🎙️⚕️ABOUT GAURANG CHOKSI
Gaurang is the Founder & CEO of Violet - a platform dedicated to helping the healthcare industry connect underserved communities to culturally competent care, by building a new standard for identifying cultural competencies within providers. Violet's proprietary system for benchmarking cultural competence uses a variety of disparate data about each partner provider (e.g. training history, professional experiences, identities, etc.) to identify and showcase culturally competent providers. Prior to building Violet, Gaurang spent 4 years building insurance and technical products at Oscar health, a health insurance startup build from the ground up. He is also queer and an immigrant, with a passion for making healthcare more inclusive for the medicaid population.

🎙️⚕️ABOUT CARETALK
CareTalk is a weekly podcast that provides an incisive, no B.S. view of the US healthcare industry. Join co-hosts John Driscoll (President U.S. Healthcare and EVP, Walgreens Boots Alliance) and David Williams (President, Health Business Group) as they debate the latest in US healthcare news, business and policy. 

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Transcript

John: 0:07

Welcome to Care Talk. I'm America's home for incisive debate about healthcare, business, and politics. I'm John Driscoll, the chair of the Yukon Health System, and today we have Gaurang Choksi from Violet Health. Gaurang. Welcome. Thanks for having me, John. I'm excited for our conversation.

Gaurang Choksi: 0:25

Well, first question is why call it Violet? It's a very personal mission for the work we're doing. Uh, lesbians in the 18 hundreds used to wear violets to really denote their sexual orientation, and I'll share a lot more about why I started the company. But as a gay man, really having access to quality care that's trustworthy has always been near and dear to my heart. So we chose, we chose Violet because it really represented our mission well.

John: 0:50

And so how big a challenge is it for folks who are, um, you know, not from a traditional sexual orientation to necessarily access the healthcare they need, the advice they need? Uh, how big a problem are you trying to solve? It's

Gaurang Choksi: 1:07

massive. Uh, John, the reality is our healthcare system wasn't really made for humans. Every single patient, all of us we're all people. We're all humans. Our healthcare system just isn't serving us, and I'm preaching to the choir here, but I personally built a health plan for many years called Oscar, and one of the things that I saw building Oscar was people would always call in and say they want a doctor that's like them. Whether it's a new mom or an expecting mom saying, Hey, I want to work with a provider that actually shares my identities. Or whether it's a person of color, a veteran, a gay man like myself. People look for people that really understand them, and the reality is our healthcare system. Wasn't actually.

John: 1:54

I, I, I couldn't agree with you more. I think our many cases, our healthcare system was designed to make contact and generate a bill. I, I, i, I, it's, it's, it's frustrating and yet there's so many good, caring people in the middle of it. But maybe to tell me a little bit about, more about your origin story. What, where, where did you, uh, grow up? Well, how did you get to Oscar? I love the, the Oscar team. The Oscar, you know, health. The, the revolutionary digital first, uh, uh, healthcare team that Mario and, and, and Josh and others kind of built up. I, but how did you, what, you know, you, you, you weren't born there. How, where, where'd you grow up and how'd you get to Oscar?

Gaurang Choksi: 2:35

Yeah, it's a, it's a great story, or at least I like to think it is, but I myself grew up in India, so my whole family actually moved to the US in 2001. And I've always been really mission driven. Uh, when I first moved to the US my family and I all grew up on Medicaid, so literally both my parents gave up their professions. We restarted life, Medicaid, and I got to see firsthand as a teenager just how difficult it was navigating the healthcare system as non-English speaking immigrants. And then more so just being a gay man as I actually came out to myself and my peers. Was challenging. It was finding doctors that were actually affirming, in the simplest words, I wanted to find doctors that could actually advocate for me, and it was so difficult to find. And so I had just graduated college and I was. Initially I thought I was going to start an insurance company similar to what Mario and team did, because why? Why

John: 3:29

would you ever start an, in having been an insurance executive, you should have called more of us who've tried to innovate within, you know, the, the, the old empire.

Gaurang Choksi: 3:41

Yeah. Well, I got to learn first him. So I joined Oscar in the first hundred hundred employees and by Mario, Oscar cofounder investors. What I loved about building Oscar from scratch was we did everything. We rebuilt everything. And so I always say healthcare is death by a thousand paper cuts. And a lot of my peers from Oscar, we chose paper cuts that were personal to us to really fix. And for me that was personalized healthcare. How do we really help everyone get the care that we need and networks you have access to?

John: 4:13

And, and so you at, at Oscar, what were you doing?'cause Oscar really was a, an attempt to. An insurance business, a health insurance business. Truthfully, that was much more focused on, uh, deep personalization and digital first, digital forever engagement. So you could measure and monitor everything that it, it, it was initially obviously based on built around the Affordable Care Act subsidies and the expansion of the market, but it, but I think the novelty was the extraordinary technical stack that was built up. And you know, now it's, it's, I think thriving. It took some time, but where did you work there and, and what did you do?

Gaurang Choksi: 4:57

I, I held a few different roles. So when I started my career at Oscar, I was specifically in technical operations. So essentially product and operations and really thinking through what is the tech stack that they actually had. And it was a really amazing journey 'cause they rebuilt everything from scratch. Claims. I believe right now the number is 98 or 99%. Their claims are auto, which, uh, working in operations. Our insurance product design. And so then

John: 5:30

what's, what kind of provoked you to, to start Violet? You know, one of the things the backstories here is that, that many of our listeners may not realize is I think that Oscar has spawned 20 or 30 startups from folks who are graduates from Oscar. Oscar had a long, slow journey to. Public market success. Um, but that, but, but is succeeding quite, quite, quite, quite nicely right now. But through that period, drew a lot of innovators like yourself into the company that have now starting digital businesses that'll hopefully help us get to a better healthcare system faster. But what was the trigger that made you decide, okay, I'm gonna, I'm gonna leave the mothership and start your own company?

Gaurang Choksi: 6:18

It was honestly seeing all of the customer and just feedback we were getting from our concierge teams. So outside of my day-to-day jobs at Oscar, one of the things that I'm really proud of was I led their LGBT Affinity Group and John, it was fascinating leading the LGBT Affinity group at a health insurance company. What we got to see was lots and lots of data of what were our LGBT members actually saying. And what we heard over and over again was people were calling in and saying. I don't feel safe with my doctor. I want a doctor that looks like me or shares my identities. Of course, the challenge becomes, in our country we don't, but even if. What we wanted was

John: 6:59

in every, in every element of diversity, it's a very, sadly, much of, much of the, the, the healthcare system looks like me, talks like me, acts. It just, it's not, it's the nature of a system that grows slowly and is, and is and is calcified a bit because of the, you know, the, the, the structure of the way we make doctors and the limits we put on immigration. Um, so you, you're hearing that feedback and. But it's a pretty big step to then go out and, and start your own company. Other than providing, you know, an environment where people could be seen and connected in a, in a way through people like them, however defined what, what else, what else motivated you to jump and start your own company?

Gaurang Choksi: 7:48

Growing up in a small village in India and then moving to the US gave me a very unique perspective. I like to think, and maybe this is projecting a lot of immigrants share this perspective, which is I've already made it the fact that I get to be in America, to me, that's such a huge privilege and I already feel like I've already made my wildest dreams come true. And so building a company just felt like the right thing to do, specifically when it's doing something that I deeply believe in, which is ultimately helping people find trustworthy care.

John: 8:19

And, and, and the no, I I, my grandparents are immigrants and so I definitely identify like, well, you don't, when you realize how far you've, that your family has come, the distance to go, the risks associated with entrepreneurship look a lot less daunting 'cause the, because of the distance you've already run and it's much, be even much, much greater coming from a small village in India. So when did you start Violet and what, what was the, the sort of the founding, the founding theme.

Gaurang Choksi: 8:47

In 20, uh, literally two months before covid. Uh, in hindsight, maybe not the best timing, but we couldn't really predict it. The

John: 8:55

timing wasn't great, but if you could have predicted that you would've had one heck of a put, put one heck of a, a, a long, a, a long, a long put trade on.

Gaurang Choksi: 9:03

Exactly. No, but I, you know, I feel very lucky. We bring some amazing colleagues, um, team members that came from Oscar as well. But in 2020, we started the company and really the idea was one core idea, which is if we credential or verify providers that are doing phenomenal with many different communities, we can then build systems that really align incentives. What I mean by that is if you know what doctors are doing really well, working with black or brown patients or LGBT patients or veterans, you could use the data to both build better relationships, but do savvy things like pay those doctors more or make sure a network is actually the right network for the people it's there to serve.

John: 9:43

And how do you, how do you measure that go wrong in a, in a way that, um, doesn't create a new set of biases? It's an interesting that every, every, every set of preferences has embedded in it. A potential bias or misdirection, unintentional, um, or it could be, you know, a, a, a direction that you do intend.

Gaurang Choksi: 10:04

Yeah. My team and I spent a lot of time thinking about this. The reality is, as a startup, we're going to an industry that represents 20% of our country's GDP and saying, trust us. And what we work hard to do is earn the trust, not just of every provider we work with, but earn the trust of payers, of policymakers, and ultimately patients. So the way our technology works is we really think of ourselves almost like a credit agency, but for cultural competence. And so every provider has a profile and in there we collate lots and lots of data and we show them. So we actually show them with claims data that we know that 80% of their patient panel may be gay men, or we know that hey, 92% of their patients are actually black or brown or belong to the Asian community. And this is all insights that they really appreciate that the providers are the ones in the driver's seat. So the providers can go in and do more trainings. They could go in and actually say they've already built other expertise, maybe because of volunteer work or other educational work, but ultimately we're doing a deep dive in their experiences, which allow us to then actually structurally show what communities they're doing phenomenally well with. And then to really our work, what we are. So we have the privilege of working with leaders like UnitedHealthcare, like ance, and what we specifically are doing is building business cases, showing that when patients are given an option, option to choose, a trustworthy patient is not just going to preventive care faster. They're actually getting better faster. And so that's what we get really excited about. And how effective has it been? It's been really amazing. Um, so a lot of our early research came through direct relationships with partners at One Medical or Eden Health. And the beauty of starting with Digital Health Partners is they were very, very collaborative and very transparent. And so for Ed with Eden Health, for example, well, and

John: 12:00

they, and they, and they could actually get access to the data in a, in a structured, clean way. Exactly.

Gaurang Choksi: 12:07

And so with Eden Health, our huge focus was on looking at, for the providers that earned a violent badge and completed our educational collections, did they actually deliver higher quality care? And what we saw was the providers that did our program, which was more than 85% of their provider base, they not only were actually able to attract the clients they wanted to attract, we saw that they were able to get hypertension and diabetes more in control in their patient panels.

John: 12:34

Wow. And I mean, those are, those are being, just to be clear, those are the two of the most important pervasive categories of chronic illness.

Gaurang Choksi: 12:43

Absolutely. And I don't mean to be reductive, but really what we think a lot about is we've created systems of positive reinforcement. We're not saying every provider has to be an expert with every community. What we're saying is providers are just know some communities better or worse than others, and it's okay. Let's. And then ultimately by recognizing it to patients, we're helping people build better relationships, and those relationships translate to better communication and better outcomes.

John: 13:15

But really what you're building is a reference set of tests regarding the ability to influence care, the test, whether in how the doctor or clinician sees. Makes the patient feel seen in a warmer, connected, more comfortable way is a, can directly result in better care and better influence on how the patient cares for themselves. Is that basically the right way to think about it? Absolutely.

Gaurang Choksi: 13:53

Um, I'll share a brief anecdote. We do a lot of, right now on our platform, we have about 70,000 providers across the country, which is a lot. We do a lot of surveying and one of the things we hear is 75% of the providers stay there more confident just speaking to identities. Now, as a gay man, all throughout a health disparity, gay men in America have 20 times the of colorectal. If my doctor can't say. Speak to sexual orientation. It's unreasonable to ask that provider to then teach me about health disparities that affect gay men, and specifically guide me on what preventive services I need, and so I violate. What we're really proud of is when we combine clinical education on how to eradicate disparities with just helping people should understand how to speak to identities, how to say the word black, a.

John: 14:57

Gosh. It's just that element of being seen, it has that big an impact. That's wild. Absolutely. So you're not saying that. We need because I, we, I made this argument that we need ma many more female doctors to take care of females. Many more black doctors take care of black. The folk folks of color need to, we need, we desperately need that level of, of, of growth if we're going to actually care, um, effectively, because you see it in all of the, um. The unseen obstacles that lead to less access, less care, and actually, frankly, poor outcomes. Even if you hold, um, income in class constant. It's just, it's remarkable. But I think what you're saying is there's an unlock in recognizing people as, as who and what they are, even without necessarily having grown up in or close to their shoes. Is that what you're saying? We need both.

Gaurang Choksi: 15:55

I think. Uh, I sincerely believe as a country we need to acknowledge the reality that our clinical workforce just doesn't represent the country, and that's a systematic failure and we need to do better. But at the same time, I also think we need to create technology and systems where a provider, even if they're not LGBT, but if they spent their whole career, let's say, working with the. Community. We need to recognize that. And that principle applies to every community. You know, if a provider has spent two decades working at the VA or working at a system that was predominantly catering to veterans, to me that provider deserves recognition because they've already built that skillset and understanding how to serve veterans. So we think about that across all communities and identities.

John: 16:44

Interesting. And so then how did who, who pay, what's the business model guard? Who pays you? How do you grow?

Gaurang Choksi: 16:52

Yeah. We are very intentional about how to align incentives. You know, as a company, I think I shared this earlier, but we're asking the whole industry to trust us. It's everyone from the providers to payers, to provider organizations and patients and policy makers in that mix. The way we monetize is we work with health plans and care delivery organizations of. And essentially they play, they pay a platform fee and then they pay a shared savings for any cost of care improvement

John: 17:23

that you've gotta really believe you're gonna drive shared savings if you're gonna keep, make your bottom line grow.

Gaurang Choksi: 17:28

We do, but we, you know, John, share something. A lot of our growth has specifically come through the Medicaid line of business because what we're seeing is whether it's a blue state or a red state, everyone cares about cost containment and population health. HMA. Just put out this great state of state summary report highlighting what governors are talking about. Every single governor out there right now is worried about maternal health equity. They may not use the word health equity, but we can see from a population health perspective, every single person is talking about maternal health outlooks.

John: 18:02

Yeah, no, they've gone from talking about equity to quality, and I'm okay as long as we make some damn progress, but we've been, we've been going the wrong direction for a while. I'd like equity most, but more importantly, I, I, I, I, I, we, we absolutely have to have better, better outcomes. And so who would, who would buy your stuff? I mean, are, so it's health systems, health plans, and then how

Gaurang Choksi: 18:26

does it work? Great question. It's predominantly health plans and then a lot of regional or, uh, care delivery organizations will join us because they learn about us. They want the approach. Essentially a health plan brings us in and then they'll offer us to their whole network. And so immediately what we give to the health plan is real time analytics where they could actually see if they're across Colorado County, by county, what are the city, what are the counties where there's communities that just can't get access to quality care. And then what we do is we turn around and the whole network gets access to the Violet platform, both for earning the badges or the verification, but also for clinical education. And what's been really amazing is in some markets, the health plans even pay the facilities more if they become verified. And so this is, uh, with UnitedHealthcare, they were the first ones to roll this out, but we're really incentives across the board.

John: 19:22

And, and they would do the United Plan, which it comes in for a lot of. Obviously a lot of criticism because of the nature of the, what they do is putting you in place because they want to do what they want to improve health outcomes.

Gaurang Choksi: 19:38

Ultimately, every single

John: 19:40

I really wanted, I really wanted to underscore that, that this is an investment by United Health Group in finding a different angle to identify how to improve health outcomes, which is, which is, you know, quite, quite, quite thoughtful of them.

Gaurang Choksi: 19:53

I. I keep going back to this concept of trust, but really what we're asking for is a lot. We're asking providers to trust us in our verification. We're asking payers and health plans to trust us that we could improve outcomes. We're asking the, the facilities that the providers work for, for their providers time, and ultimately to every listener. You know, we're asking every single time. We're doing the upfront homework and legwork to really make sure we rightfully earn that trust through and through.

John: 20:30

So is there, just, I guess one final question, Gaurang, is there anything about Violet that you'd want people to know who had already heard about you but weren't quite sure how you fit in the healthcare system?

Gaurang Choksi: 20:44

Like every founder, uh, book a call with us, get to know us. I'm a big believer in relationships, whether it's. And, and really so much of life is just working with people that you deeply value. And so if you've heard about us before and you're interested in learning more, go to our website, book a call. We're excited to get to know you and to share more about our work.

John: 21:06

Gaurang, thanks so much. Um, and that's it for, uh, A Care, another episode of Care Talk. If you like what you heard or you didn't, we'd love you to subscribe on your favorite website.