Cyrus Batheja (00:03): I think that there’s enough resources for us to be able to achieve that in the United States, for everybody to have dignified housing. And I think it’s important, because it acts as a base for people to then start to establish themselves, find purpose in their life and feel like they’re a part of the community.
Nacole Riccaboni (00:23): As a first-generation immigrant, Cyrus’ perspective on breaking down barriers in health care is grounded in his own lived experience, which makes it a very compelling and awesome story.
Cyrus is a nurse who believes that housing is a key determinant of health, and he says it’s not as simple as putting a roof over someone’s head. It’s about putting people on equal footing and creating a solid foundation for their health.
Cyrus’ first health equity project was a family business that provides dignified housing for Medicaid’s most vulnerable patients. What an amazing thing. Later in his career at UnitedHealth Group, Cyrus got to show on a much larger and bigger scale how impactful it is to provide people experiencing homelessness with a place to live.
Cyrus’ story is all about progress over time. When it comes to health equity, he told us, “We don’t have to have all the answers today, all at once. It’s a process that can span our entire nursing career.”
My name is Nacole Riccaboni. I’m a critical care nurse working in Florida and your host for SHIFT Talk season two. SHIFT Talk is a podcast that brings nurses together to talk about the challenges we’re facing on and off the clock.
This season, we’re interviewing nurses who are working to ensure that all patients can have access to the resources and care that they need to be healthy. And that’s called health equity, by the way.
We’re going beyond the clinical and looking at the social factors that impact health, from a person’s zip code, to their health, to even their job and even structural racism. No health care provider knows more about nurses’ lives than nurses, right? We can really make an impact here, folks.
This podcast is brought to you by SHIFT, an entertaining nursing community for today and tomorrow’s changemakers. SHIFT is sponsored by the Robert Wood Johnson Foundation. Follow us on Instagram at @shiftnursing. And for more amazing stories and real talk about nursing, head over to shiftnursing.com.
One final note: This episode was recorded in July, so please keep that in mind as you listen to this great conversation. Now let’s dig in.
Welcome to the show, Cyrus. Can you introduce yourself to our listeners and give us background on who you are, what you do and everything about what makes you you?
Cyrus (02:48): Sure. Yeah, I’m happy to do that. Thanks, Nacole, for having me on the show today. Really excited to take the time to meet with you and tell a little bit more about who I am, my story.
My name is Cyrus Batheja. I have a two-year degree in nursing. I’m really proud of that. I always say it was one of the most challenging degrees. And so an associate’s degree in nursing and then also a bachelor’s degree in nursing. I’m a registered nurse and also a licensed public health nurse in the state of Minnesota.
I have an MBA, master’s of business administration, with a focus on finance, and then went on and did a doctorate in education with a focus on critical pedagogy, social movement construction at the University of St. Thomas, which is also located here in Minneapolis, where I have been since about the age of five.
Moved to Minneapolis from the U.K., from a small place where I was born, just outside of a place called Watford in England in a place called Carpenter’s Park. Currently, from a work perspective – should we dive into that?
Nacole (03:55): Oh yes, please do.
Cyrus (03:56): Okay, perfect. I’m using my nursing, my public health background but also my business background and my focus on social movement construction at a company called the UnitedHealth Group. We’re a Fortune 5 company. We’re the largest health insurer under the name UnitedHealthcare, which many of the listeners might be familiar with.
I work there currently as the National Vice President of Enterprise Transformation and Health Equity. I’ve recently had the opportunity to lead our government programs divisions in building out our health equity strategy and thinking about, “How do we integrate health equity across our business?”
I also am here in the Twin Cities in Minneapolis, St. Paul working with my wife. We own and operate a supportive living service business, where we actually provide people with special needs, vulnerabilities and high levels of care housing and services with a really unique approach that we’ve customized over the last 20 years.
Nacole (05:02): Nice. Now, let’s circle back regarding your family immigrating here. What kinds of challenges did you face when you came to this country?
Cyrus (05:09): Yeah, that’s a great question. A lot of the things that I’m working on today, the challenges that I see with the folks that we support in the community here locally and in Minneapolis, St. Paul, as well as at a national level, it seems to be a lot of similarities.
So I think your question resonates for me on a few different levels. Like I said, Nacole, came to the U.S. from the U.K. in 1985. Seems like it was just yesterday. We actually came here on a business visa.
So we didn’t have a green card. That’s like permanent residency, which allows you to live freely and things like being able to get a job or having different kinds of government supports like tuition support from the government or financial aid, those sorts of things – even Medicaid, Medicare support, Social Security. Your permanent residency, or really your citizenship, provides you with access to all of those things.
Well, when we came over, we came over on a business visa that allowed my dad to operate his business. My mom wasn’t allowed to work. I could go to school, but that was just about it. So we lived off the little bit of savings we had.
The family who invited us over actually owned a chain of motels in the heart of Minneapolis. They allowed us to stay in that motel for a few months – from what I remember, it was probably about half a year and store my dad’s wicker furniture in the basement of one of the motels.
And so, we lived in this motel room, really kind of basic. There was no income from my dad’s shop. And so it led my mom to cleaning the motel rooms and really doing it for pennies on the dollar. The family who had called us over, we came to find out later, really had ulterior motives on inviting families from all around the world, particularly India, to the U.S. and then exploiting for their savings and other things, being able to have cheap labor and that sort of thing.
So my mom was making a very little bit keeping a roof over our head basically. And then they took all the furniture that was in the basement or was my dad’s inventory. I remember that too, already barely being able to make it, and then the little bit that we did have them having to fight over it.
When you don’t have immigration status, people don’t really want to listen to you either. And you live in fear. You live under the radar, and you don’t want to cause any disruptions. And they kind of knew that, and that was a way that they took advantage. My folks ended up breaking up. I do blame a lot of it on the social challenge, all of the stress that came with the uncertainty and financial challenge.
My dad ended up moving back to England, so my mom became a single mother with really no status in the U.S. Obviously, with my dad’s business visa, that was a non-option at that point. I was about 10, 11 years old at this point. When my dad moved, he left us with about $5,000.
Right before my dad left, we met a really great immigration attorney and they had said, “Hey, there’s a nursing shortage in the U.S. And if you would be willing to go back to school and become a registered nurse… ”
Now keep in mind, my mom was in her mid-forties or she was in her early forties at the time, probably 43, 44, right around there. “If you’re willing to go back to school to become a nurse, that could lead to a path to a green card and you guys being able to stay in the country and work freely.”
To us, a green card was always our dream. We used to literally pray and wish upon stars, I remember, that one day we would be able to achieve equal footing. Most of my life, I just felt like I was not an equal. I didn’t know what was going to happen. I didn’t know if I was going to be able to stay or if we were going to go, what tomorrow would bring.
Nacole (09:04): Can you tell us a little bit about your own experiences as you went through nursing and at the bedside?
Cyrus (09:08): Yeah. Yeah, happy to. My mom went through nursing. I joined her, watched her go through that program as a young teenager growing up. Ultimately, I never thought I was going to be able to go to college. But when my mom was able to afford to pay for me to go one class at a time, I went through the same nursing program that my mom did and went to Normandale Community College.
It was funny, some of the faculty, some of the instructors actually remembered me as the little guy who used to accompany my mom to class and sit in the back of the lecture halls or in the biology lab, run around the student center. Once I got in and started to work on getting to that nursing degree, things really changed for me in my life.
My mom ended up getting her green card. She was sponsored. She worked in a skilled nursing facility, and they sponsored her to get a green card. And then I went into practice in a skilled nursing facility as well. And both my mom and I were honestly pretty disappointed with what we saw when we finally made it.
Nacole (10:12): Now, what type of issue did you face, you and your mother, when you both were at the skilled nursing facility?
Cyrus (10:16): It was really just being disappointed with the cost of the services that were being provided. We were able to have visibility. We moved into management and were able to see. We were disappointed with the quality of services, so the quality of the housing and how staff were being treated, people not being paid a living wage, particularly the nursing assistants who we were depending on.
We had worked so hard to get our nursing licenses, and that was really our footing in the U.S., and we weren’t going to give it up. Seeing nursing assistants having to work multiple jobs and falling asleep in patients’ rooms. I remember distinctly it happening to me and my mom in totally different settings where we’d walk in and nursing assistants would be sleeping.
And for good reason, because they had just done an overnight at another facility. And then they were picking up their next shift. And they had to do it at different facilities because of labor laws. But they were basically working around the clock and barely being able to keep food on the table for themselves and their families.
And a lot of them similar to us – immigrants. Part of the challenge that we faced was seeing how much corporations were making in health care, not being satisfied with what was being delivered to the patient from a quality standpoint and then seeing staff mistreated and not really having a fair shot.
Nacole (11:39): Oh, god. Well, that’s a terrible experience. Now, you went from skilled nursing to starting your own business. Can you talk a little bit more about that?
Cyrus (11:48): Yeah, happy to. I think the background and context that I provided is important, because those lived experiences of being a first-generation immigrant, being exploited, just being able to see my mom persevere through all of the challenges of being a single mom, being a first-generation immigrant and not having access – we were laser-focused on making a difference, on making an impact.
Right around that time, my now wife, my girlfriend and I and my mom had come up with an idea that we could take the little bit of savings that we all had and license a single-family home to provide services to people in our community.
And really do it the way we felt would best provide really dignified housing, housing that we would be proud to live in, improve the quality of housing, work with staff and be able to support staff in a much better way, provide them with a true living wage, make them equal. And then be able to deliver services in a way that we thought would be most meaningful and particularly having a focus around relationships with the people that we serve.
So we bought a small plot of land in a really rural part of town where we could afford, designed the home to be able to allow us to live on the property but at the same time provide care and services in the upper level. So there was a lower living area for us and then the upper area for our residents.
My wife worked full-time with my mom and got that going. I continued to work in mid-level management at the assisted living nursing homes. And then eventually, my wife and I went out and did the same thing. We bought our own single-family home, licensed it, and continued to develop. And we still own and operate both of those homes. My wife, myself, my two kids, our pets live with four residents.
We occasionally have some changeover but for the most part have been pretty stable and provide services with a particular focus on people with significant challenge – behavioral, health, social challenges has been our niche area. People who can’t find stability in placement, who have been rejected many times by other homes for different behavioral health challenges. So very community-focused.
Nacole (14:09): Nice. Now, Cyrus, can you tell us why you consider housing to be so important in achieving health?
Cyrus (14:14): Yeah. I think not only housing, Nacole, but more importantly, dignified housing. I think that a lot of times we think just throwing a roof over somebody’s head is going to fix things.
And it is super important to have shelter. If you think about Maslow’s hierarchy of needs, shelter is important. But if it’s not dignified, if you don’t feel like you have equal footing, then it’s really hard to thrive. And so for me, the focus has really been around providing high-quality housing, really housing that I would feel comfortable living in or that I would feel comfortable with my family living in.
I think that there’s enough resources for us to be able to achieve that in the United States, for everybody to have dignified housing. I think it’s important because it acts as a base for people to then start to establish themselves, find purpose in their life, and feel like they’re a part of the community.
I’ve done a lot of work inside of UnitedHealth Group to understand at a population health level what’s happening. One of the things I did was really looked carefully at people experiencing homelessness and what their health care trends look like in comparison to people who are stably housed.
And Nacole, what I came to find in doing that evaluation is that people experiencing homelessness are driving significantly more utilization. So they’re in and out of the ER more frequently, they’re being admitted to the hospital more often, they’re having extended lengths of stay when they are in the hospital. It’s harder to discharge. Health, it comes with stable, dignified housing. Your life trajectory, your life expectancy and quality of life comes along with housing.
Nacole (16:05): What type of community-based initiatives and programs were you involved in for UnitedHealthcare?
Cyrus (16:11): Yeah, so started back in 2009. But what I’ve really focused in on is gaining deeper understandings of subpopulations and subsets of the community. Similar to what we’ve done with our home, really focusing in to understand the needs, wants and desires of the community.
So for example, working with a population in Brooklyn, New York who were struggling with adolescent well checks and other measures and looking more carefully at why there was a gap in that particular community not having the same levels of engagement with the health system and care as the rest of the population.
And finding that some of the things we were doing there were really not culturally sensitive. So thinking about health equity and disparities, the community that I identified was specifically Hasidic Jews in Brooklyn.
And thinking about ways for us to align with them involved shifting from our traditional thinking, maybe incentives for things like Subway, which is a non-kosher food, to focusing in and providing incentives for going to the doctor, having the adolescents go to the doctor and giving them incentives for a kosher pizzeria.
And we knew that that kosher pizzeria was a place that they hung out. It was kind of an anchor for those adolescents. That’s where they liked to hang out. So when we aligned an incentive that made sense, it was helpful.
My own experience and what mattered to me and was important – our community business, and then thinking about it at a national level and being able to apply that thinking and logic to make relationships in that community and then breakthrough on helping to meet specific needs of this community of Hasidic Jews and thinking about health equity and disparities a little differently.
Nacole (18:09): Now, going back to the housing programs, did you partner with hospitals or health care providers in your programs or no?
Cyrus (18:16): Yeah, we did. We’ve got a really robust network of hospitals and health care providers within our pre-established network. And so, using the data, Nacole, I was able to identify which hospitals were most frequently being utilized by the individuals experiencing homelessness. The one thing that you know about super-utilizers is where they’re utilizing.
Because of the nature of us being an insurance company, we were paying the bill. We’re a payer. And so was able to focus in and build relationships with those particular health systems so that when these folks experiencing homelessness would show up, many of the docs and the folks in the ER knew these individuals by name. I mean, in some cases, we saw individuals going into the ER over 50 or 100 times a year.
I remember one particular patient had over 365 visits to the ER in a single year. I get questions from some of the executive team around, “How is that even possible?” And after helping him to find his way into dignified housing and wraparound trauma-informed services and supports, we got to know him pretty well.
And he’d be like, “Hey, it was super hot in Arizona, in Phoenix, where I was. After one ER would kick me out, I’d just head down to the other one. They’d bring me in, and I’d get a meal and some water and that sort of thing and be able to be off the streets and the heat.”
And so, yeah, we built a lot of partnerships like that and the docs, the providers, the nurses, so appreciative of us being able to find a meaningful way to help. Because all they wanted to do was help. They felt like their ability to do that was cut off because they couldn’t provide housing.
I mean, they could provide great medical services and support, but housing was kind of – even the social workers, it was tough to be able to support people. And so the housing program that I developed really focused in on helping to partner with health systems and providers in getting their most vulnerable patients to the right type of housing.
Nacole (20:26): Yeah. I’m an acute care nurse practitioner, and I see a group of 15 people about every other week. And like you said, they’re just like, “I needed something. I know I can come here.” And they come back over and over again. If you don’t find that why, this cycle continues. It will keep going.
Cyrus (20:44): Yeah. I don’t want to paint the picture though, Nacole, that it was only for social needs. When you live on the street – I worked in this space for quite a long time, like the last four years, and really studied it. And when you live on the streets, your health suffers significantly.
And so many times it was justified. Their diabetes would be out of control, and they’d pass out or they’d be severely dehydrated. So there was a lot of really good medical reasons why they were utilizing the ER, ambulance, being admitted.
Nacole (21:16): Did you see better outcomes regarding the patients’ decreased visits and things like that?
Cyrus (21:22): Yeah. So we looked at it, and this is where my doctoral work was really helpful. I used a mixed-methods approach. I’m a really big believer in not only looking at things through numbers but looking at things through lived experience as well.
And so we saw some really great outcomes. We saw outcomes related to reductions in ER utilization, in hospital admissions, in bed days. We could look at the total cost of care of individuals and saw that decrease. We saw that drop off significantly.
And it actually was the way in which I was able to build the business case to scale the model, because it was less costly for the community, for the federal government, for us to pay for housing rather than to have that individual live on the streets and continue to super utilize. Not only was it making the health system work better with the providers and their experiences, but also it was saving a lot of money and time.
And then one other thing. So that’s more quantitative, like dollars and cents and numbers-oriented. But from a qualitative standpoint, we examined folks. We asked them, “Can you tell us about your experience? Do you feel more connected to the health system? Do you feel like you have purpose?”
And the feedback we got from the individuals we were able to help was very positive, like off the charts as far as their experience with the health system and feeling like they could contribute back to the community. So that was another way that we were able to measure it.
And then the third way we were able to measure it was by looking at the community itself. The EMS, emergency medical services, so the police and fire department and the neighbors in the community, they came to us and said, “Hey, you guys are delivering a ton of value.” We helped hundreds, thousands across the country in doing that.
Nacole (23:21): Your story is so filled with all these different components of how you help people, whether it’s United or your skilled nursing facility experience. My question is, as you look back on your career, what advice would you give newer nurses who are at the bedside and want to understand health disparities and health equity?
Cyrus (23:38): I’m going to provide my thought more from my own experience, Nacole, and what we’ve talked about here. So sometimes the biggest challenges in your life could be the greatest points of opportunity, and we miss it.
I think back on those challenges I faced as a kid and being a first-generation immigrant to being in a nursing home and feeling like I was being undervalued and just not having equal footing. Really thinking carefully about how you may be able to take some of those experiences and apply them to new solutions, to ways of doing things differently.
And sometimes that’s daunting. But what I found to be effective was really just small steps, crawl, walk, run. It just starts with that first step, whether that’s taking on the risk of going back to school to become a nurse like my mom, or sell your home and try something different. If you believe in something, you can achieve it. Thinking about where you see things that aren’t working or where you could make them better and then taking a risk, taking a step.
Nacole (24:46): For sure. And your story is an example of just that. You took a bad situation and transformed it into something amazing that’s helping millions of people.
Cyrus (24:54): Thanks, Nacole. I appreciate you saying that. On my most stressful days, I elevate myself through gratitude, gratitude to the people who did support us, who held us up, that immigration attorney, my mom, the community college, just so many along the way that I can think about. They embraced us at our most vulnerable. And so I have a great amount of gratitude for the nursing community more broadly.
Nacole (25:20): Cyrus, thank you so much for this enlightening interview and sharing your background and your projects and just everything that makes you who you are. This interview was amazing.
Cyrus (25:30): Thanks, Nacole. Hey, it was a real pleasure and honor, and thanks for having the time with me today.
Nacole (25:41): Thanks for listening to SHIFT Talk. This podcast is brought to you by SHIFT, an entertaining nursing community for today and tomorrow’s changemakers. SHIFT is sponsored by the Robert Wood Johnson Foundation. The views expressed in this podcast are of the guests and hosts only and do not necessarily reflect the views of the Robert Wood Johnson foundation.
To learn more about our guests and to hear more awesome nurses talk about the important issues we’re facing right now, visit our website, shiftnursing.com. And please subscribe, rate, and review SHIFT Talk wherever and however you get your audio content. Until next time, stay safe and keep being awesome.
