FP’s Mission to Address Social Needs Rooted in Family Medicine

His drive to improve the health of patients and communities by addressing social needs, however, has its roots in family medicine and dates back more than two decades to his native Lebanon.

As a second-year medical student at the American University of Beirut, Choucair chose a one-month elective rotation in family medicine in the rural Beqaa Valley. He and two classmates were assigned the task of completing a community needs assessment in the agricultural area.

“We literally knocked on people’s doors and asked them about their health needs,” he said. “It was an eye-opening experience for me. It made me realize how important the conditions in a community are to the health of the people who live there. It also opened my mind to the promise of family medicine.”

Choucair will share his story as a main stage speaker during the National Conference of Family Medicine Residents and Medical Students, July 28-30 in Kansas City, Mo.

“I think it’s really important for people thinking about family medicine as a career to look at the continuum of what influences health,” he said. “Yes, family physicians do great work with their patients in the prevention and treatment of diseases and making sure people get the care they need and deserve. At the same time, family physicians have a great role to play in connecting what happens in the exam room with what’s happening in the community and understanding how social factors are impacting patients on an individual level and how to incorporate screening for social needs into how they deliver care.”

As a family medicine resident at Baylor College of Medicine in Houston, Choucair’s experience included a training track focused on immigrants and refugees and a program that cared for people experiencing homelessness.

“I found myself often talking to patients about where they were going to sleep that night, where they would find their next meal, whether they could afford medications,” he said. “All these conversations needed to happen before I could talk to patients about things like diabetes, blood pressure and asthma. As I treated more and more patients, it became clear to me that I needed to think upstream.”

After residency, Choucair practiced in federally qualified health centers in Illinois for a decade, including serving in medical director roles for programs focused on homelessness and HIV care. His upstream focus led him to ponder policy changes that could address the challenges that were affecting his patients’ health, such as food, housing and transportation insecurity. Choucair frequently spoke with Illinois State Rep. Greg Harris about those concerns, and it was Harris who suggested he might be able to make a difference in a new way when the city’s public health commissioner position opened.

“When I had the opportunity to jump into the public health department in Chicago, I didn’t think twice about it because I wanted to see how local government can influence health,” he said.

Choucair’s five-year tenure coincided with significant improvements for the city in areas such as breast cancer mortality rates, teen pregnancy and teen smoking. For example, breast cancer mortality among Black women decreased by 14% between 1999 and 2013, and the disparity in breast cancer mortality rates between Black and white women was reduced by more than 20%.

“When you focus your public health tools and engagement with health systems and community-based organizations, you can make a difference in disparities,” he said. “There is no one solution that helps solve a public health crisis. You look at the root causes, and you develop a broad approach that includes multiple strategies.”

In the case of breast cancer, Black women were being screened at lower rates than white women and waited longer for treatment after detection. Choucair said the city and its partners worked to make screening more accessible citywide and to shorten the time patients waited for follow-up care.

“We developed a plan with a task force that included multiple community-based organizations that have been working on this for a long time,” he said. “That collaborative effort is truly what has driven that reduction in disparities.”

At Kaiser Permanente, Choucair manages the health system’s community health portfolio, including medical financial assistance, charitable care, grants and community health initiatives. He is responsible for the care of more than 1 million Medicaid members and those dually enrolled in Medicaid and Medicare.

As part of his role with Kaiser, Choucair also oversaw the launch of the nation’s largest social health network, which will mark its third anniversary this year.

The health system, which has 12.6 million members spread across eight states and Washington, D.C., surveyed about 10,000 members in 2020 and learned that two-thirds of respondents had at least one unmet social need. Kaiser then worked with Unite Us, an outcomes-focused technology company that builds coordinated care networks of health and social service providers, to deploy an IT tool that connects it with thousands of community-based organizations to enable referrals to services. Patients can also access services through a self-service directory.

“We’ve created multiple capabilities that would allow people to tap into that social health network,” Choucair said. “I’m incredibly proud of its scale and scope and the timeline in which we were able to develop the network and get it up to speed.”

Choucair spent most of 2021 focused on his role as White House vaccinations coordinator. During his tenure, nearly 450 million doses of COVID-19 vaccine were administered nationwide. His efforts included coordinating the vaccination efforts of multiple federal agencies, including the CDC, Federal Emergency Management Agency, Department of Housing and Urban Development, NIH, Department of Veterans Affairs, and others, as well as working with local and state governments.

“My White House experience was probably the most of everything: the most rewarding, most difficult, most humbling, most challenging, most impactful,” he said. “When I immigrated to this country 25 years ago, I never thought I would be working at the White House and be in briefings with the president and the vice president.”

Choucair said when (then) President-elect Joe Biden’s transition team called and offered him the role of vaccinations coordinator, he immediately said yes.

“There is no way that when you’re called to serve during the most consequential public health threat that this world has seen in over a century that you would say no,” he explained. “I didn’t know what to expect, but I knew that I was going to roll up my sleeves, join an outstanding team and do everything we could to get this country vaccinated.”

Choucair visited a dozen AAFP state chapters during his tenure and is proud of the role family physicians have played during the pandemic.

“Family physicians stepped up to help answer patients’ questions, dispel myths and provide facts about the vaccine and played a huge role in getting so many people vaccinated and closing disparities in vaccination rates across the country,” he said.

Choucair said he heard from family physicians who testified at school board meetings, city council meetings and legislative hearings regarding masking and vaccinations in “places where public health was facing significant challenges.”

“Many physicians were yelled at and received threats, and yet they stood up and did the absolute right thing to help improve public health,” he said, “and for that I am so grateful. It’s that kind of perseverance and leadership that is always needed in health care.

"I’m proud of the folks who have engaged over the last few years, and I’m so glad I chose family medicine as my specialty. Family medicine is so deeply connected to public health that anyone embarking on this path will play a key role for public health going forward.”