and meetings other events of note with a
bow as a way of settling ourselves and
also showing some respect to the people
that we’re about to engage with so
you’re welcome to join me I can’t do
anything without starting with the bow
its kind of now part of who I am so
please join the few wheels Thanks I
became an AIDS activist and care
provider by accident I realized that
most of the meaningful moments of my
life post professional and personal were
accidental that I think for me is the
definition of what it means to be a
social entrepreneur I’m not sure that’s
textbook or if the business school down
the road would teach it that way but
that’s the way that I’ve looked at it I
became a social and political activist
when I was young I was a teenager in
Cleveland at age 16 I managed to take a
semester off from high school to work on
a political campaign to help Carl Stokes
become the first african-american mayor
of the northern American city right
after that successful campaign I had
what was a politically unsuccessful but
pretty meaningful opportunity to work
for the Eugene McCarthy presidential
campaign which took me to Chicago to the
infamous convention in 1968 where I
started out living in the Hilton Hotel
actually as a 17 year old with the
national campaign staff but ended up for
the last half of the convention on the
streets with the tens of thousands of
demonstrators who had arrived in Chicago
to bear witness to a corrupt political
system and I have to say that I felt
much more at home on the streets than i
did in the hilton still the case i think
for the most part at 19 at brandeis
university i was a member of students
for a Democratic Society SDS for those
of you who can date yourself fighting to
end the war in Vietnam it was at that
point that I realized that while my
social justice passion
was strong that I was feeling uneasy
with who I was becoming as a human being
as I was becoming a more of an adult if
only mindfulness and awareness practice
had been invented then I would have I
might have been able to do something
about it but what did happen which was
typical maybe of another accident is
that my Jewish Marxist and now Zen
professor at Brandeis mentioned to me
that there was a Tibetan a guy named
chögyam trungpa rinpoche who himself
was only 10 years from having escaped
from the political turmoil in Tibet who
was beginning to teach in the West and
that what was interesting was that his
teaching was very pared down at that
point to work with meditation or
contemplative practices came with a lot
of other bells and whistles so there was
lots of there’s lots of chanting there
was lots of dancing which is not
something that I was so great at fairly
foreign there was a lot of non English
which made it very difficult but in the
case of trungpa rinpoche who became my
teacher in 1970 and who I worked with
until his death in 1987 his teaching was
in English and his work was very much in
the world first book in 1969 was called
meditation in action and that actually
says it all that there was a way to
actually create develop a contemplative
practice to work on issues of
mindfulness awareness and compassion and
also to be in the world and to be
engaged in a world that was suffering
and in need of healing so that was kind
of the background that ultimately
brought me in the early 90s to yonkers
new york just up the road as the
president of the grayston foundation a
nonprofit social enterprise that worked
in the areas of homelessness we built
hundreds of units of housing for
homeless families we have child care
centers we had an economic development
projects and we built an hiv/aids health
center and housing program aids today is
still in
epidemic I think we have to remind
ourselves of that yes it’s changed to
some extent it’s a chronic disease now
more than an acute disease it isn’t the
death sentence that it was in the 80s
and the 90s the reality is however that
there are millions of people around the
world who are still struggling with this
particular disease and as an epidemic
carried some of the sort of common
elements that other epidemics had that
basically disproportionately impacted
people who lack secure housing who
lacked access to health care who had
problems with food security those sorts
of things but it also was a very
different sort of epidemic in that when
people years or centuries before
contracted smallpox for example they
weren’t typically blamed for their
condition but in the case of hiv/aids
what happened was or at least many of us
found was that lifestyle and morality
actually became the disease and HIV
became the delivery vehicle people were
actually blamed for their own condition
and that was the the fundamental
attitude that was held universally by
many many people now the reality is that
there are caregivers who set aside any
judgment and provided care its as
population of people who were struggling
with this with this disease they were
doing that care within a dysfunctional
system however the people that we worked
with for example use the emergency room
as the primary gateway to healthcare now
as opposed to no health care at all the
emergency rooms seem pretty great on the
other hand for any of you have had the
opportunity to be in an ER for any
reason you understand that if that’s
your primary gateway to care the
dehumanizing elements are just all over
the place so we knew that there was a
problem that was a question of what we
could do about that new york state
decided in the 90s that it was spending
tens of millions of dollars on providing
aids healthcare and wasn’t seeing either
healthcare results and certainly seeing
huge expenses and made a decision that
people living with AIDS low income
people living with AIDS should enter
into the managed care system now we were
able to argue we and other non
profits for a long time that the
conventional managed care systems ones
that are HMOs that are still around
today we’re really not set up in any way
to be able to address the complexity of
the disease that people living with AIDS
had because after all they had both HIV
disease but also in many many cases had
issues of mental illness of substance
use and so there was a sort of broad
struggle of a number of things that they
were dealing with including homelessness
and other sort of non-medical if you
will conditions the state agreed for a
while and then said well why don’t we
try something we’re going to issue a
request for proposals to create
something new a new kind of HMO a
special needs plan or costs nip and
basically see if we can build something
from scratch using Medicaid resources
and there were hundreds of millions of
dollars of those resources to do
something in a different way now the
state’s view was that the big hospital
systems were going to propose the snips
that would be successful because after
all that was the system and that was
where the care was being given but they
made a decision that seven nonprofits
graistan being one could come together
and be invited to be the respondents to
this RFP as well the reality was they
didn’t think it was going to work but
the optics played well in Albany because
all of the legislators in the Department
of Health concise e were giving
community-based organizations that
apparently know this population better
than the big hospitals they’re giving
them a chance to step up we decided to
come together and actually respond to
that invitation now we didn’t know much
about running an insurance company but
we figured that we built a homeless
family housing development for example
I’d have to find twenty different
sources of funding that’s a whole other
story about whether or not that’s really
an effective way to deal with the issue
of homeless mythos that was the reality
we were also becoming increasingly
socially social entrepreneurs our
partners at housing works that some of
you may know have run thrift stores
throughout New York City and have a
bookstore cafe just down the road that
I’m sure many of you know well in the
case of graistan we have a bakery and I
keep saying we
now even though I’ve been gone for 20
years because that’s the nature of
that’s what happens when you get into
this world Grayson has a bakery hires
chronically unemployed people from
yonkers if you’ve ever eaten Ben &
Jerry’s fudge brownie ice cream or fudge
brownie yogurt you’ve helped contribute
to what is today a ten-million-dollar
social enterprise in Yonkers that is
made i figured last night 120 million
pounds of brownies that’s a whole other
conversation about whether that’s a good
product but nevertheless but we figured
we were actually able to look at
creating this insurance company as well
in 2003 a Medicare the HMO that I’m
talking about was licensed and we began
to do business ah the first year we had
60 members about eight hundred thousand
dollars in revenue this was an insurance
company and I’m sure most of you are not
insurance company executives but
probably could figure out that for the
amount of money that wouldn’t buy a
two-bedroom co-op probably anywhere in
New York City that was not a sustainable
model for an insurance company but as
tenacious nonprofits that we were we
kept going I was the CEO of a me to care
for a while my cash flow management
often involved my taking the checks that
were supposed to go to the doctors that
we were working with and putting it in
my desk drawer and forgetting where it
was for a couple of weeks until we had
some more cash in in hand that sort of
thing today a Medicare is serving 6200
people in New York City is a 325 million
dollar social enterprise and what’s most
important is it’s having a real impact
on the health care outcomes of the
people that is serving when we open the
doors we decided that we did not want to
create just a slightly better insurance
company we didn’t want something that
was a little bit improved from the
existing system so we had a certain
number of demands if you will or
requests as the state put it one was
that we could take a look at non health
related causes of illness and so for
example we believe that homelessness was
very much a symptom of P
i HIV disease and that not addressing
homelessness and not addressing the
issues that are come from that would
mean that we were losing an opportunity
to really address the broader health
care needs of our clients and so we were
able to start using Medicaid dollars to
actually provide the kind of case
management that would find housing for
people that would find child care that
would find security we asked our doctors
who were in the network that we put
together to uh meet new clients in a way
that they were not used to historically
so certainly they got their healthcare
history there at medical history but we
also asked them to talk about things
like experience of domestic violence
experience of unemployment and poverty
because again the view being that unless
we knew the full picture of who we were
serving it would be impossible for us to
actually bring about reasonable health
care outcomes and more most important i
think and maybe relevant to our
conversation today is that we also said
that there are other non traditional
therapies that we think actually makes
sense for this population because this
is a group of people that we felt needed
to come together to be humanized to come
together in community and to have access
to the kinds of resources that frankly
we privileged people easily could access
but for the most part was completely
foreign to any of the people that we
were serving in our HMO and so we were
also able to use our resources for art
therapy and music therapy and dance
therapy and importantly to many of you
for yoga and meditation uh and that was
basically something that was completely
new to the population that we were
working with but created the kind of
community that is resulted today in very
positive health outcomes for the
immediate care members and without
getting into lots of details the one
statistic that’s worth noting is that
the average member of a Medicare today
who has entered into care is showing a
seventy-five percent drop
in the amount of virus that they’re
carrying in their body because of the
fact that they’ve now got a
comprehensive approach to caregiving and
that’s a big deal with lots and lots of
ripple effect and so the model has
proven itself in in that way amita care
is an insurance company that does not
look to say no to claims which is very
atypical of insurers amita carrots
claims managers are out there to
encourage care providers to make claims
by actually providing real service and
by doing so um engaging with the client
with the member in a way that’s
completely new from any way that they’ve
been they’ve engaged before as a company
in Medicare is also engaging in the same
way we have members on the board of
directors of the HMO so people living
with AIDS sitting at the board table
because we don’t think that wisdom is
limited to the privileged people that
are actually in charge of these
organizations the member advisory
councils advise on policy on new
programming and the reality is that they
are coming together as a group of people
who have now been empowered I’d like to
just show you a couple of people
involved with immediate care hear their
voices they can say it much more
[Music]
my jug use increased all I want to do is
get high you know so that’s what I did
when you feel alone you have no one to
turn to with yourself now when you find
out there’s other people I care about
you that makes a big difference they’re
free and they’re a great way to get
together have fun and enrich your life
in body mind and spirit yoga believes
that our body has a tremendous capacity
to heal it’s really helped in my just my
eight allowing me to keep up with
day-to-day activities they will accent
very um challenging and I can’t afford
to to go to a yoga class like that
unless it i made a caregiving a
opportunity to cover their yoga class is
raising hope it gave me a little more
confidence in myself it’s a good feeling
to to create suddenly know I had this
time it’s a fun activity to do things
are and enjoy yourself can be
intimidating to really open up our don’t
have to talk you could just create the
dancing makes me feel free free of my
illness being free of everyday life and
stress
[Music]
uplifting it makes to feel alive one of
the most important aspects of my class
is that you feel welcoming that there’s
a place for you makes me feel very good
at my body’s lose its moving parts and
listening to the drums and beat and Abby
please awesome probably could have just
limited the whole session to that I
think you get you get the point I will
close in saying that the exciting
opportunity i think is that there’s a
recognition that HMOs like a medicare
actually can play a very important role
in the broader reformation of our health
care system and it’s being looked at now
as a model to deal with behavioral
health with aging with other chronic
diseases a long way to go there’s much
to learn about what to do right but the
tenacity I think of the people that have
been running this organization now for
the last 13 years built on mission and
compassion and a lot of stubbornness I
think is something to be looked at and which we can be quite proud of thanks