Corey Dion Lewis (00:02.154)
Hello, everybody. Thank you for listening to the Healthy Project podcast. I am your host, Corey Dion Lewis. As always, I have another great guest in the building, switching it up a little bit, still talking about health equity, but from a health tech lens. So I'm super excited about having this conversation. We spoke already, and I already know there's going to be a vibe. So I really appreciate.

Dr. Felix Manuel, excuse me, Chenea from DocSeminy here with me today. Felix, thank you so much for being here. I really appreciate it.

Félix Manuel Chinea (he/him/él) (00:39.607)
Hey Cory, thanks for having me on the show.

Corey Dion Lewis (00:42.418)
Yes. So, you know, before we get into the topic today, can you please tell the audience a little bit about yourself and what gets you up in the morning?

Félix Manuel Chinea (he/him/él) (00:52.063)
Yeah, I know you asked most of your guests this question, so I thought about my answer to this. And I think when I, in terms of, I'll tell a little bit about like my role or give an idea of like what I do. So I'm the head of health equity and inclusion strategy at Doximity, I'm a physician by training. I'm also a Puerto Rican military brat who mostly grew up in the Southeast, mostly in Georgia and North Carolina. I currently live in Durham, North Carolina where

here with my pup and my wife and we're setting in roots over here in the Bull City. So shout out to anyone else in the Bull City. In terms of what gets me up in the morning, I think three words come to mind, culture, community, and personal growth. In terms of culture, I think the thing that's giving me life this week and anyone who knows me knows that I'm going to say this, is the new Bad Bunny album. I think I've been like

relentlessly and absolutely consistently obnoxious about how much I'm listening to this album. It is so good. And that could be a whole separate podcast episode, but had to put that out there. That's really giving me life this week in terms of culture. I would say in terms of community and growth and personal growth, that's really been in alignment with my path in healthcare. I really

Corey Dion Lewis (01:51.742)
Okay.

Corey Dion Lewis (01:57.246)
I'm sorry.

Corey Dion Lewis (02:03.955)
All I can.

Félix Manuel Chinea (he/him/él) (02:20.895)
started this path because of seeing the way my family has navigated healthcare and seeing the opportunities for healthcare to do better around them and their experiences. As I grew and kind of my education increased around healthcare and like what the healthcare system is like, I started understanding a little bit more around the inequities that face the Puerto Rican community at a large and then also the Latina community at large as well.

all those inequities that are facing the community within healthcare and within the healthcare space. As I continue to kind of grow my understanding of equity and social justice concepts, I realized that these are systemic issues that impact all communities. Maybe sometimes they impact different communities in different ways, but when you drive down to the root of it, it's the same root problem that's affecting different communities in unique ways.

With that, I've kind of wanted to have a better understanding of what that looks like and developing a willingness to kind of better understand the system, approach it with humility, and then really engage with this ability to depersonalize ourselves from that system and ask ourselves, you know, what part of this really doesn't serve us and how do we change this? And I feel so attached to the current system and the way things operate.

I know that was pretty complex about what gets me up in the morning, but really it's about that kind of connecting with the community, understanding it, and constantly growing and learning these things to be able to do good work.

Corey Dion Lewis (04:04.542)
No, that's real. So what I love about the conversations that I have on the show and the reason why I love asking that question, I've asked it for years and don't plan on changing, that's the question that I ask everybody. It kind of fits in with the health equity conversations that we have because you mentioned that some of these systemic issues everybody's dealing with, but what's so interesting about it

is that everybody's feeling it, yes, but everybody's feeling it in a different way. You know what I mean? And it just makes the conversation so much more interesting because we can be going through the same thing, but it could affect me differently and my cultural views differently than it may affect you and your cultural views differently. You know what I mean? So that's why I love what we do here.

Félix Manuel Chinea (he/him/él) (05:01.195)
Yeah, no, I completely appreciate that and completely agree. I think as we think about like practitioners and those who are doing equity work in particular, it's really our job and kind of our experience and expertise to drive into understanding all the different ways it comes up for folks and then asking ourselves if there's like a root cause that's really related to all those things and how do we address that root cause?

Corey Dion Lewis (05:22.092)
Mm-hmm.

Félix Manuel Chinea (he/him/él) (05:28.579)
so that folks can really start feeling it. Because if we're just addressing how one particular community feels it, we can alleviate that for them, and it may come up again later, it may be just a superficial fix. And we need more upstream, more root cause solutions for folks to be more sustainable.

Corey Dion Lewis (05:39.403)
Right.

Corey Dion Lewis (05:49.954)
Yeah, absolutely. And that kind of leads into our conversation today. And we're discussing a little bit about, prior to this, diversity, equity, and inclusion, and health equity, and the differences, but also the similarities. So kind of my first question for you, coming from a health equity and health tech lens, how would you define?

DEI and health equity, and where do you see the intersections and divergences between the two in the context of health tech?

Félix Manuel Chinea (he/him/él) (06:29.623)
Yeah, I mean, I feel like I've answered this question in different spaces and I've heard other people answer it. And it's a fairly common question to bring up, but I feel like it keeps on needing to be answered. Like I think it's an incredibly important distinction to make that I think we still need to make. And so my take on it is, is that diversity, equity and inclusion are a set of principles. Each three separate words.

Corey Dion Lewis (06:46.136)
Right.

Félix Manuel Chinea (he/him/él) (06:59.107)
that mean three separate things, right? You have diversity, equity, and inclusion. And those are tools that we can use in different contexts. And so as we apply them to the workplace, that's kind of the traditional space in which we think of when we think of this like acronym, right? So when we say DEI, most of the time folks' mind goes towards like corporate DEI initiatives as a fuller business function.

and they lose sight of the fact that there are each distinct principles that can be applied separately or together, depending on the context and depending on the solution or depending on the problem that you're trying to solve. Now, as equity and inclusion applies to health, we start thinking about what health equity means. That's a little bit more distinct in the sense that with healthcare and anything having to do related to health,

comes clinical settings, comes clinical treatment and clinical outcomes measurement. And we need to understand that incredibly to be rigorous in the work that is healthcare. These are people's lives at risk when you're thinking about changing healthcare systems or in the way you practice or in the way you measure outcomes and making decisions based off that data. So having that clinical background, that clinical understanding or clinical research understanding

is important when applying equity and inclusion principles in the context of healthcare. And that's where we're talking about health equity. And with that comes the long history of medical research and academic medicine around the topic of health equity, that there's been so many other people to do this work, that's done incredible work around this space, kind of comes into play. So they both kind of come in with their own baggage where we hear these terms and we have...

preconceived notions of what it means, but I think it's also important to engage with kind of boiling it down to the terms and understanding where they started from. And then using that to understand all that historical context that have led up until this point that they've become unique functions and understanding that's why it's shaped the way it has and that's why it functions the way it does. Yeah, does that answer your question fully?

Corey Dion Lewis (09:24.97)
Yeah, it does. And I mean, do you think my follow up to that is do you think that there's so much confusion around DEI in health equity? Because there are people that when you say DEI, they just want to bring in health equity into that. Like, it's all DEI. And then there are people who separate it and say, well, no, there's, there's this, there's this constant like,

not like East Coast versus West Coast battle, you know, Biggie versus Tupac, but there's just like this, there's this thing there, right? And I wonder if it's just because they're, they are so similar in a way that it's just the lazy thing to do to just say they're the same or, you know, is it, is it more than that?

Félix Manuel Chinea (he/him/él) (10:13.911)
Yeah, I mean, I think some of those preconceived notions that I mentioned, it drives into how people see DEI and health equity. And it's more common to understand what DEI is in terms of how it serves people within the workplace. I also think as we think about health equity, right? Like, it depends on the context. If we're thinking about a hospital system that's trying to do health equity work.

Corey Dion Lewis (10:36.735)
Mm-hmm.

Félix Manuel Chinea (he/him/él) (10:43.171)
they can't just skip DEI. That's part of the health equity work. It's uniquely different, but it's also part of it. Because as we're thinking about applying the latest medical research, understanding health inequities, understanding how that translates into certain specialty care, and being cognizant of that when it comes to patient care at that particular hospital setting for their unique patient population based off their locality.

All of that is incredibly important when it comes to a health equity initiative, right? But you also need to realize that you can't do that fully authentically and sustainably unless you have a diverse healthcare workforce. And unless your healthcare workforce actually feels included in that organization as an employee. And so there opens up topics around conversations around diversity in healthcare workforce. How do you engage with that?

Is this hospital system connected to a medical school? What do you think about in terms of your recruitment pipeline from medical students to residents, to fellows, to attendings? And then how do you think about other health care professionals as well and engaging with what diversity looks like for them as well? And making sure that those employees and those staff members actually reflect the community that they're serving, because that is a component of it. And I think the other piece.

side of things is where folks want to engage in that part around the diversity of healthcare workforce and culture changing and forget about the health equity piece and the rigor that's needed around measuring outcomes and engaging with, you know, up-to-date research and understanding what health equity means in the particular context for, you know, cardiology outcomes or for diabetes outcomes in that given community.

Corey Dion Lewis (12:34.571)
Right. Because you can go to any workforce, and this is not just in the healthcare system, but there are people where the DEI work is important, they're doing great things, but they're also not considering that their workforce may have certain social determinants of health that they may need to be looking at through a health equity lens. And what can they do to improve that? And that's where I feel like, I guess for me...

Um, that's the, those are the differences. And I feel like some people are either focusing on DEI and saying that's going to fix this part, this piece. Does that make sense?

Félix Manuel Chinea (he/him/él) (13:12.503)
Yeah, no, it makes complete sense. Like, they're unique disciplines, and you have to invest in both.

Corey Dion Lewis (13:20.318)
Yeah, absolutely. Absolutely. So talking more about the technology piece, how does the role of tech and digital platforms like Doximity, how does that help bridge the gap between DEI and health equity? Or how can it?

Félix Manuel Chinea (he/him/él) (13:41.279)
Yeah, so I feel like it kind of relates a lot to what we just talked about right now, which is that there needs to be investment in both DEI and health equity for health tech companies. I can share a little bit about how we're doing it at Doximity to kind of give an example. So right now we call the work that I'm doing health equity and inclusion strategy. And those two words really reflect the internal DEI initiatives that we're doing.

and the external facing equity initiatives that we're doing that's more around the health equity piece. So inclusion strategy really reflects what we're doing around recruitment, around culture, around employee benefits, working with employee resource groups as well. And then the health equity piece really reflects how I'm working with product teams, our sales and marketing teams, thinking about business strategy, and we're a public company so really thinking about our social impact.

as a public company as well. Really thinking about how these functions apply to the context in which your company operates is incredibly important. And I think having that holistic approach where you build a system where you recognize the interdependency between DEI and health equity, and you also recognize how they're unique and where they connect and how they interrelate, and you allow one to benefit the other because

As we're recruiting to create more diverse teams, we need to make sure that we have a culture that truly values the lived experience of folks who come from historically marginalized backgrounds. And that culture needs to translate into those people being on those teams and being empowered to actually make decisions that shape our products. Because ultimately, if we wanna have a successful health equity initiative that improves how we serve historically marginalized communities, we need those lived experiences to shape our.

products to understand how those communities, what their needs are, and what they're looking for and what best serves them. So part of that is having people represented on teams and having those communities represented on teams.

Corey Dion Lewis (15:53.83)
No, I totally agree. And it brings up a story and I had this conversation maybe a few years ago. And pretty much, you know, they were talking about how there were certain health tech companies that did not do what you were just talking about. They did not employ diverse thoughts or diverse populations into their product, but they were selling them, they were selling these specific, this data.

to go to these, you know, underserved communities. But it was, it didn't fit. It was like, well, it'll just work. It'll just work out. It didn't. But there was no thought. And I feel like, you know, Felix, and definitely correct me if I'm wrong, but it sounds like what you guys are trying to do and maybe what others are doing, I can't tell you, I don't know.

But looking at technology through a health equity lens, the DEI lens and saying, okay, where did we go wrong? And a lot of these technologies came out really, really fast, but how can we take a step back and do these a little differently?

Félix Manuel Chinea (he/him/él) (17:03.427)
Yeah, I think, so there's a couple of other people in the health tech space that are doing this work similarly. I think one person that really comes to mind that I try to learn a lot from and model some of the way I do my work after is Dr. Ivor Horn, who's the Chief Health Equity Officer at Google. She does amazing work, and I really love to see what's coming out of there. But to your point around like, you know, how is this shaping the way health tech thinks about their product development?

I think, yes, there's ways we want to look at our current products and see how they can be better and to measure how they're actually working and engaging with communities and if it's actually serving them. There's also engaging with idea of health equity from the get go and understanding like what is the direction of health equity for a given product. So when we talk about health equity, I feel like the broad-based definition that most people say is like giving everyone the opportunity to live their healthiest lives.

What does that mean in a health tech context? And even in health tech, every tech company is vastly different. They're creating very different products that, you know, are solving very different problems. So health equity cannot mean the same thing at every health tech company. So really sitting back and understanding what is our mission here? What products are we building? What problems are they solving for?

Corey Dion Lewis (18:05.476)
Mm.

Félix Manuel Chinea (he/him/él) (18:30.655)
And what does health equity actually mean in that context? And to be more specific, so for Doximity, for instance, our mission is to help clinicians be more productive. And we have three main product lines. One is our news product where there's a newsfeed. We send out digest emails that give clinicians relevant information for their practice. And then we have our network line of products, which is really...

around what you think of as like a professional social media network with some tools that are found within there. And then the last one is our telehealth product. That one's a little bit more self-explanatory. But the way we think about these product lines in terms of health equity is first, you know, making sure we give relevant conversations, like really host relevant conversations around anti-racism and medicine, around health equity for particular specialties and make sure that is very specific to the needs

our clinician members. For our network, we wanna make sure that we're investing in a more inclusive medical network. Part of that is some things that we've come out as putting pronouns on profiles, adding name pronunciation features so we can really center in dignity and respect for our clinician members and really adding to that inclusive culture on the platform. And then for telehealth, you really wanna think about broadband access. You wanna think about the design of the product.

Are you taking digital literacy into account? Are you taking accessibility into account when you're designing that product? And how do you improve telehealth equity when it comes to that? So really being specific in terms of your products can be really powerful with doing this work. And I mean, can't have a strategy unless you're specific about it.

Corey Dion Lewis (20:17.634)
Right, right. Are there, what are some of the challenges? And what I mean by that is, I mean, some of these platforms, I don't know how long you've been at Doximity, but maybe some of these have been going, they've been up and running for a long time. And what are some of the challenges of a mature, already up-to-date, already going platform? And you're like, I know you guys love it, but we're going to add these things to that. What are some of those?

have there been challenges or has it been easy?

Félix Manuel Chinea (he/him/él) (20:50.935)
Yeah, I think when it comes to challenges for already existing products that have kind of been out there, so one thing that comes to mind is how there's organizations putting out equity, equitable design frameworks for product development, right? And some of these frameworks are really incredibly useful and it helps you kind of encapsulate what does equity look like centered into product development and design.

And one of the places that I think about in terms of one of these frameworks is Rock Health. They put out an equitable product design framework. And there's four main components of this. This is centering in the community, co-designing the solution, which is kind of encapsulating diverse teams, having diverse teams, developing the right product, which can include, you know, capturing the right data to be able to really question whether there's bias in your product development or in the product itself.

and then iterating on accessibility. Now, best case scenario, that's where you start product development from. But as you said, a lot of these companies are already developing products and it's really hard to fit already existing processes into a new framework, right? So how does someone in these positions try to actually center equity in the development of products and kind of build that out?

I think it has to be iterative and you have to find these opportunities to kind of like slowly, stepwise build it into the way these products are developed. And I think one example of this that we have specifically at Doximity is our Dialer for Free Clinics program. So we recently started or hasn't been as recent now. Now it's been over a year where we have a Dialer for Free Clinics program where we give our paid for Dialer Pro service for free to 100% free clinic.

There is about a thousand plus free clinics in the U.S. So that's kind of the opportunity there to support all of those thousand plus free clinics with telehealth. Now when this program first started, it was a handful of free clinics that we really wanted to support coming out of the pandemic where we used to offer our product for free and they could not afford the product. And now we're in a space where...

Félix Manuel Chinea (he/him/él) (23:12.651)
we realize how beneficial it was to them and we want to expand that program to offer it to more free clinics. In my role in better understanding this program itself and the opportunity that it gives us to improve our product, I really helped leaders understand that this is also a channel for feedback for us. This is clinicians and patients who practice in a free clinic setting.

that would not have been able to afford our paid for product otherwise, that have a particular context in which they're practicing and using our product, that they can give us feedback, we can build relationships with them, and that can change the design, the decision making, the features we prioritize in our product, and that gives us an ability to bring it back to that Rock Health framework to really center in the community, right, as we're building diverse teams to co-design that product.

and start filling in what that framework actually looks like for our telehealth product in particular.

Corey Dion Lewis (24:19.33)
Wow, so it's almost like it's a win-win-win. The patient gets better care, the clinic gets a service they couldn't afford, and you get the information you need to improve those products.

Félix Manuel Chinea (he/him/él) (24:31.863)
Absolutely, and when we're talking about these free clinics, most of these or a lot of these free clinics are serving predominantly black, Latinx, LGBTQ plus or immigrant communities. So there's a win on that side of being able to, support the telehealth strategy for those giving care to historically marginalized communities, absolutely. And as they're seeing benefit from our product, they can give us feedback around the areas that could be better. We can improve our product for them.

And a lot of times, those different changes and those different features that we prioritize will end up benefiting all of our clinician members that end up using our products, even for the paid-for service. So I think there's that aspect, and I learned this story from, or this anecdote from Annie Jean-Baptiste, who's head of product inclusion at Google, where she talks about the curb cut effect, where there's a cut at the curb when you cross the street, right?

That was designed specifically for folks in wheelchairs. But then when you think about who uses that and who benefits from that, it's all of us. Whether you're pushing a grocery cart or whether you're riding a bike or you're on skates. So there's something around that curb cut effect where you're designing solutions for a particular set of people who are considered historically marginalized or who are on the margins. That's not your default user, which is typically what tech teams design for.

Corey Dion Lewis (25:40.041)
Yeah.

Félix Manuel Chinea (he/him/él) (25:59.031)
that actually benefits everyone as a whole. So designing these solutions that center the experiences of those who are historically marginalized can actually bring out solutions that benefit everyone. And I think building out what that looks like is incredibly important in these roles.

Corey Dion Lewis (26:16.538)
Oh, that's amazing. Thank you for that. So this is my last question. I'm gonna give you some time to sit on this one. Bad Bunny, you love him. You made that very apparent. Bad Bunny and health equity. What are the similarities?

Félix Manuel Chinea (he/him/él) (26:23.151)
Yeah.

Félix Manuel Chinea (he/him/él) (26:29.986)
All right.

Félix Manuel Chinea (he/him/él) (26:35.363)
Oh my gosh, I love this question. Oh my gosh.

Félix Manuel Chinea (he/him/él) (26:43.743)
Okay, I got you. I got you on this one. I did, yeah. I was engaging with this kind of like thought the other day. So Bad Bunny actually recently hosted a pitch competition for Forbes 30 Under 30, where he actually listened to a group of Latinx like entrepreneurs who are trying to showcase what they're working on and what they're building, right? Ideas that they have.

Corey Dion Lewis (27:12.29)
Right.

Félix Manuel Chinea (he/him/él) (27:13.643)
And I read this article about, that was kind of like recapping the pitch competition that was sharing how other judges on the panel, so he was one of the judges on the panel, and other judges on the panel were actually, you know, measuring people on the numbers they were providing and their business, you know, acumen and the business plans that they had for very traditional methods of measuring what is the value and the likelihood of this idea actually like proving out.

And Bad Bunny completely flipped it on its head and was really focused on the energy and the passion of the person presenting and how bought into the solution that they're thinking about. And I think what I started reflecting from that was how much we think about success and the likelihood of success being rooted in how...

Corey Dion Lewis (27:53.038)
Hmm.

Félix Manuel Chinea (he/him/él) (28:11.959)
the current systems that have educated us and that we've always navigated. So it's what we know, all of us, it's what we know. And we engage with different strategies and new ideas, putting them through those past experiences of whether, is this the right solution? Is this going to work out? This is the way we should build out a strategy. And with him, he had this creative mindset of

Corey Dion Lewis (28:22.091)
Right.

Félix Manuel Chinea (he/him/él) (28:42.247)
I need the person to really be like passionate. I need them to have the drive to make this wanna work. And it's gonna open up something completely new. And I think we need more of that energy around health equity. I think there's a component of staying true to past research and past work that we need to continue moving forward and standing on those people's shoulders because they've done incredible work.

Corey Dion Lewis (28:50.347)
Mm.

Félix Manuel Chinea (he/him/él) (29:10.587)
And I think we need to look for the opportunities to be creative and do something new in a rigorous way where we're measuring outcomes. But we need to experiment. I think we need to be willing to kind of lean into there, take the past research, develop strategies of actual implementation so people can really see the benefits of this work and just put ourselves out there and rigorously test and be OK with it not working and changing.

from that and owning that when it doesn't work. Because that's something that we learn when we measure something and realize that it didn't work. That's a new learning that's important to have that we didn't have.

Corey Dion Lewis (29:52.978)
Yeah. Taking what we already know, but stepping up beside the box a little bit and not being afraid of whatever we're thinking not to work because that's going to lead us to the next thing that will.

Félix Manuel Chinea (he/him/él) (30:08.107)
Yeah. And I think when it comes to folks who are coming from, you know, black and brown communities, who are coming from historically marginalized communities, what I want folks to hear and kind of engage with is the importance of our cultures and like how our culture is important and is valuable and can help teach us different ways of operating in these spaces when you reach.

you know, your professional life or in academic settings, we can change these systems in a positive way. And there's ways that, you know, our family and culture can teach us what that looks like. And we can use those lived experiences to do that.

Corey Dion Lewis (30:55.138)
Awesome, awesome. Bad Bunny, thank you for the health equity bars. Um, Felix, thank you so much for being here, man. I really appreciated your time and your insight. For those that want to learn more about you and what you're doing, where can they find you?

Félix Manuel Chinea (he/him/él) (31:00.625)
Yeah.

Félix Manuel Chinea (he/him/él) (31:14.987)
Yeah, I mean, I'm on LinkedIn. Feel free to connect with me on LinkedIn. I'm also on Instagram, so feel free to connect with me there. That's where you can find me.

Corey Dion Lewis (31:25.39)
Absolutely. Well, again, Felix, thank you so much for your time and everybody. Thank you so much for listening to the Healthy Project podcast. I'll see you next time.

Félix Manuel Chinea (he/him/él) (31:35.427)
Thanks.