INTERVIEW
Addressing the opportunity gap Nathan Chomilo, MD, FAAP Department of Human Services DHS recently restructured Medical Directorship to now include two individuals. Please tell us about this shift.
specifically anti-racism. The pandemic has allowed conversations about the importance of a racial equity lens to be applied to all policy discussions and for decisions to be accelerated.
The move allows DHS to bring on regularly practicing physicians and providers who also have demonstrated experience in addressing health equity, health access, and better statewide integration of care. It is in line with the state’s commitment to address health disparities, particularly around substance use treatment, mental health access, and child and maternal health outcomes. Having a director focused on behavioral health and familiar with the nuances of care delivery as well as a director who is a practicing physician taking care of Medicaid patients regularly will allow these policy discussions to be more grounded in the impact on patients and their families.
Much of my early career focused on advocacy around early childhood, racial and health equity, and how health care systems can address the opportunity gap and structural racism. We have to shift how our health care system talks about disparities, how we structure payment and quality measurements, and how health care becomes a more just and equitable force. Medicaid plays a huge role by serving some of our most under-resourced communities. As one of the largest payers, it often sets policy that is followed by others. Roughly 50% of my patient panel is served by Medicaid or MinnesotaCare. I had been interested in how I could utilize my experience with early childhood advocacy, Reach Out and Read Minnesota, and Minnesota Doctors Health Equity to help inform state policy—but I was not ready to move into a full-time policy position and give up my clinical practice. This opportunity aligned with many of my goals and existing efforts. In addition, our Governor, Lieutenant Governor, and Commissioner have been very clear about addressing racial disparities in Minnesota, recognizing the importance of early childhood, and making equity a focus across all efforts.
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AUGUST 2020 MINNESOTA PHYSICIAN
Before accepting this role, I split my time as an internal medicine hospitalist and a clinic pediatrician. My schedule was one week of hospital medicine and one week of clinic pediatrics. I’ve now moved to a casual position with the hospitalist group and I’m doing one week of clinic pediatrics, then one week with DHS.
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What are some of the things that appealed to you about taking this new position?
Please tell us more about what your day-today activities are like now.
What were some of your initial priorities and goals?
Prior to COVID, my goals were: • Working to address the racial and geographic disparities we see in our state, particularly regarding maternal health outcomes; • Continuing the work my predecessor pioneered on addressing the opioid crisis through the opioid prescribing improvement program; and • Using Medicaid’s role throughout early childhood to better support the early childhood infrastructure and help decrease opportunity gaps that start as early as 18 months and lead to many of the disparities we see throughout life. I also have taught and given several Grand Rounds about structural racism within medicine. I aim to help facilitate similar conversations within DHS and to support efforts to make DHS an agency that not only values equity but
As Medicaid medical director, my days are a mix of reading to stay abreast of the ever-changing policy landscape and medical literature; meetings with my DHS colleagues and with other state agency colleagues, health plans, provider groups, and patient advocates; and preparing and delivering talks to help inform the broader public about the work I do and the work of Minnesota’s Medicaid agency. What surprised you most about your first six months?
The easy answer is COVID-19. There were few within public health or health care policy who saw in January the dramatic impact this would have. My initial plan was to spend a good chunk of the first six months getting to better understand our Medicaid agency functions at the state level, getting to know my colleagues at DHS and the work they are doing, and then starting to build toward my goals and the changes I hope to impact. COVID-19 accelerated some of my work and postponed other parts. It has been difficult to connect with and get to know all of the other leaders within the Medicaid agency due to both the difficulties of working from home and the extraordinary time and effort needed to address COVID-19—challenges that our whole agency has had to undertake. What are some examples of how the pandemic has impacted your work or changed your priorities?
It has given me the platform to push for an “equity first” lens in all of our work earlier than I had
