DGTL Voices with Ed Marx - Empowering LGBTQ+ Healthcare (ft. Justin Ayars, JD)

Episode Date: July 3, 2024

On this episode of DGTL Vocies, Justin Ayars, JD, shares his personal journey, experiences, and the mission of equalityMD, a healthcare technology company focused on LGBTQ+ healthcare. The conversation covers topics such as inclusion, LGBTQ+ representation, the impact of historical figures, and the importance of cultural competency in healthcare. Justin also discusses the challenges of entrepreneurship and the significance of resilience.  Takeaways The importance of cultural competency in healthcare and the impact of historical discrimination on the LGBTQ+ community. The challenges and rewards of entrepreneurship, emphasizing the need for resilience and inner strength. The leadership lessons and inspiration drawn from diverse experiences, including history, music, and personal heritage. The significance of empathy and allyship in closing the gaps of inequity in healthcare and social care.

Thanks for tuning to Digital Voices Podcast, where we chat digital transformation, challenges and opportunities across healthcare and life sciences. And now, your host, Ed Marks. Hey, it's Ed here. Welcome to another edition of Digital Voices and another exciting episode, of course, because I believe that they're all exciting. But I want to welcome Justin Ayers to Digital Voices. Welcome, Justin. It's a pleasure to be here. Hey, we're going to cover a lot of different ground here, but one thing for sure, we talk about inclusion all the time. And we're going to talk quite a bit about LGBTQ plus, making sure that everyone has access to equitable health care. And so we're all humans and that's what matters most.

So we're going to dive into that. But first, how we first met, I've just been following you, Justin. And, you know, I appreciate your advocacy that you have for people and the heart that you have for people. I was like, I want to talk to that guy, and I want to help share his message to the world. So that's sort of how we first met up. But as I was doing my research, I found out that you're in some Liberace movie or something. Tell us a little bit about that. It's always stranger than fiction.

Yes. My dad was Liberace's musical director and conductor for 13 years. He left Elvis Presley to do a contract with Liberace. So as my mother says, your father went from the king to the queen. And so he didn't, Liberace obviously didn't have any kids. And so the only straight member of his inner circle was my dad. And so my mom and dad had two kids, myself and my brother, both came out to be gay later on. And the joke was, did Liberace make you gay?

Nature nurtured. That's all just silly. But there was a German film crew in 2018, early, 2017 even, putting together a documentary based on the lives of people who were working with Liberace during Liberace's life. He died in February of 87, who were still alive and be able to tell their stories of working with him in their own words rather than having some elaborate movie scripts like Matt Damon and Michael Douglas did,

which was a great work of fiction if you enjoy that. But that documentary is done by a German filmmaker. It's called Look Me Over, which is one of the famous say Liberace used to say. And it still hasn't been released yet, but I got to fly to Vegas for a week, reconnect with my dad after 13 years, and consider myself a movie star. Yeah, right. Yeah, I know.

Once that movie's released, this podcast, it already have a lot of listeners, but it'll triple, for sure. People would be like, hey, Justin, was on digital voices. Justin, tell us about songs on your playlist. Now, this might be an interesting answer, given your sort of musical background vis-a-vis your dad and some of the influences. It's by classical musicians. So I grew up at eight years old, my mom said, what do you want?

We were living in D.C. at the time, and I said, season tickets to the Kennedy Center Pops. What eight-year-old asked for that? But then she also made sure I was raised on her favorite genre, classic rock. So my first concert outside Liberace was Eric Clapton. It's kind of hard to go down up from there. but I love pretty much anything Madonna likes or put out.

I know that's cliche, but I'm also big into like 90s, early 2000s punk rock, Green Day, Deschuala, Velvet Revolver. But I love a recent song I heard recorded by Kylie and Danny Minogue, sisters. I think it was 2016 called 100 degrees. It's also known as Feels Like Disco. Disco never died. And so I love that. I love Gloria Gaynor, never can say goodbye. But I'm also big into movie music, particularly movie themes from Alan Silvestri's Back to the Future to his Avengers movies, but also James Horner and Jerry Goldsmith, who did a lot of the Star Trek movies, but also recently Hans Zimmer, particularly his take on the James Vaughan theme.

But my favorite, I think I'd have to say as an entrepreneur, is Frank Sinatra's That's Life. Ah, yeah, I can't go wrong with old blue eyes. and I try not to mention my youngest son in any of these podcasts, but it just comes up when we talk about music because you mentioned movie soundtracks. So big movie coming out in June or July called Twister, and the number one song coming out of Twister is one that my son wrote and produced.

Wonderful. That's the Twisters. That's the sequel to the, I think, 1996 blockbuster. Yeah. So it's called Hell or High Water. It's actually, if you listen to the words, it's pretty powerful. Hey, what about your life message or mantra? Are there words that you sort of live by help guide you? It gets down to very philosophical. I love Henry David Thoreau's idea of living deliberately.

And that's a lot to say within just two words. It encapsulates the idea of remaining constantly curious and listening actively and thinking critically. And I think that those ideals along with the Star Trek, mantra, which I'm a Star Trek geek, thanks to my mom, of just looking up at the stars and wondering what if. And that all drives it back home to my North Star, which has always been curiosity. That's awesome. Yeah, and you can tell from your background, which you're about to get into, because I completely skipped over it on purpose, because I want you to tell your story. But I will say, yeah, you're our first trial lawyer or former trial lawyer on digital voices. So it's going to be so excited. So share it with us your story. You can start

back as far as you want, as personal as you want, all the way to today and tell us about what you're doing. And we're going to talk a lot about what you're doing today with EqualityM.D. Just briefly, when Liberacea died in 87, my dad had already worked with all the stars from the Rat Pack to Elvis. And so he'd already done the biggest thing he could in terms of music and pop culture. So we moved back east to D.C. where my mom's family is from. And they helped create the CIA back in 47. So growing up, I was either going to serve with a gun for God and country. or put on some sequins and go on stage and razzle dazzle with some jazz hands.

I was the black sheep that went to law school, and both sides of my family said, what the hell are you doing? When most sane families would say, my doctor's going to, my son's going to be a doctor or a lawyer. And so I went to law school and had a great clerkship and then wanted to do energy litigation, but that was when the Great Recession was just starting to kick in. So an offer I had was rescinded, and I'd take a job in Northern Virginia defending insurance companies in health care cases, and that is not what I wanted to be doing. But it was a paycheck, and I eventually had to find alternative employment, as a lot of

young attorneys had to do at the time. I then realized I'd always had this entrepreneurial bug, especially after living abroad and teaching history abroad, which really informed everything I do now. And the path of being an entrepreneur is really about relationships and trust. And so I jokingly say, been building a quality MD mind. life without meaning to simply by showing up giving first and being my authentic self. And in so doing, I've created a vast network of social capital built upon meaningful relationships that I've nurtured and cultivated over the years.

And in activating those relationships, and some of them are with nonprofits, some of them for-profits, some of them are just social media influencers. It's allowing us to turn those into channel distribution partners for equality MD, which is an LGBTQ healthcare technology company, and we're delivering inclusive affirming telehealth in the mental health primary health and urgent care spaces along with prescription delivery. So those most vulnerable, particularly LGBTQ members who've been overlooked or endured systemic discrimination from within the healthcare community for generations. No, that's great.

And yeah, that really tells the story how Quality MD came about and about the mission and vision. Have you seen improvements? Because I don't know, right? I can't directly relate. Has things improved over the last several years? And how far do we still have to go to close the gaps that are there? It's a long road. In 2016, the NIH declared the LGBT community to be what they call a health disparity population.

And what that means is that according to their textbook definition, the community has endured historic lack of access. to care, and also they suffer from unique health care concerns. And what they left off, which I found very interesting, was systemic discrimination from within the health care community itself, which is why there's historic lack of engagement. So you can imagine why there's people not willing to go to the doctor when there's a whole generation of people who lived through the AIDS crisis of the 80s and 90s, and everybody just ignored them.

So that is still on top of people's minds and the element of trust between that patient and provide a relationship is critical. So what we're doing is, in a sense, serving as a trust bridge to a community that's been historically marginalized, particularly in health care, and reshaping how they perceive and receive care. The impact it's having, I think a lot of good companies, whether they're startups, entrepreneurs, or Fortune 500 companies

or nonprofits, are really doing good work. The one silver lining of the pandemic was it put bright spotlight on all these health care inequities that underserved communities have been enduring for generations. And then so people would have speeches on different health care equity topics at health care conferences I went to agnosium. But at some point, you have to get off the diocese and start actually doing something. And so the question is, who's doing something and who's doing it authentically rather than just

checking the rainbow box or rainbow washing their medical brand? And there are two companies that are doing well. They're considered competitors. I consider them collaborators, and they do wonderful work serving transgender patients, a population that accounts for about 4% of the broader LGBTQ community. So we're focusing on our the mental and physical health for the other 96%, and some of the trans patients were actually sharing and sending and referring them over to those other two entities, because that's all they do, and they do it very, very well.

And that's, I think we're changing things. Patients love what we're doing because they can finally come out and be their authentic selves. The providers are receiving cultural competency training that's evidence-based by scientists. It's not just LGBTQ-friendly because what the hell does that mean? And that patients feel safe coming out and that's unusual. And many of them had not seen a doctor since rolling off their parents' plan, which is incredible. And the vast majority are seeking mental health issues. as 80% of our community says mental health is their primary health care concern.

On the flip side, providers are loving it because finally they've been wanting to serve this community because they know health disparities exist and they want to bridge some of those inequities. But they don't know where to find these patients, let alone how to communicate with them in such a way that will change their behavior to have them come in for even just a basic physical. So it's still an ongoing battle because we have to change hearts and minds and that doesn't happen I applaud you for what you're doing, and we need definitely more allies and others to keep fighting this fight and closing that gap. When Chris Ross and I wrote a book on patient experience, you know, we included focus groups made up of all kinds of patients that were not like us

so that we made sure that all their issues were addressed as well. It was kind of shocking that because, you know, again, I couldn't relate directly. So I had to hear their stories. It was quite quite shocking. So I applaud you for what you're doing. And I think it's incumbent upon all of us to be doing something. So just along that line, I want to ask you a couple questions. One is going to be about what patients can do to become their own healthcare superheroes. But what can, what else can, you know, talking to our audience, what else can we do as healthcare leaders to make sure that these inequities go away and we close the gap? So are there some proactive things like you said, and I loved it because I think you're right, just putting up a rainbow, it is not the solution.

But what are some things that, like a tangible one or two things that leaders should be doing that maybe we are doing so well today? I majored in political science at William and Mary, and I've always said that one of the biggest national security concerns that no one's talking about is public education. That translates to health care as well. The trainings that exist, the cultural competency trainings in particular, that exist from organizations like the federally funded National LGBTQIA Health Education Institute out of the Fenway Institute in Boston

is the gold standard for becoming culturally competent understanding the unique histories and health care concerns that our community has. And if you're looking at it from whether you consider DEI to be an ugly word or a positive word, if you're just trying to serve more people more authentically meeting where they are, the LGBTQ community is a great place to start because we represent every other underserved demographic on earth,

from racial minorities to military veterans to neurodiverse, you name it, we're there. And I've often been approached by people saying, why don't you serve everybody? I think, well, not everybody has the same challenges. And you have to, as the old saying, when it comes to writing, write what you know. Well, our entire team has lived the problem we're solving. So we really know what we're doing, but we've also conducted extensive research. 32,000 patient surveys over 350 in-person patient interviews, working with Cedar Sinai,

UC Berkeley, and the National Research Corporation. We really know our patient. And that's a huge win for us in addition to the massive social capital we've enacted so that I've been building this company my entire life without even real life. Yeah, so one thing, obviously leaders can't do. If they know this gap exists for them, they can reach out to you and you can provide a lot of help and further assistance and give them some great ideas. And we'll put all your, yeah, we'll put all your information in the show notes for sure.

What about one or two ways that LGBTQ plus patients can become their own healthcare superheroes? Because as we know, the system fails, fails them. So what are one or two things they can do? Understand if you are insured, what that means. Because oftentimes you don't realize that your plan doesn't cover certain things you think it did until it's too late. and that leaves many underinsured, particularly when it comes to mental health and even some companies still don't accept telehealth or telemedicine as a reimbursable expense. So you're paying these high deductibles or high premiums, you have to meet certain deductibles,

and then you have to pay for a visit with a co-pay on top of that, and then pay a prescription on top of that. So it adds up very quickly, which is a disincentive for any person to go seek care because it's expensive. So to take control is to really understand what your insurance does give you and what it doesn't. And even if you have the premium plan, you still might not like the provider you're assigned based on your employer's in-network provider because you have no choice in the matter. Your employer is going to pick whatever insurance company rolls through town with the best rate every year. So you might get a new PCP every year for 10 years. So you have no continuity of care. You're starting from ground zero every year, and they have no idea, nor do they give a crap about your LGBTQ identity, which when you're doing to talk about other identities, racial minorities, military veterans, et cetera.

If you can get that, right, sexual orientation, gender identity, the rest kind of falls into place, and that's based on what we've seen and what reports you're saying. So it really comes into knowing what you have and knowing, more importantly, what you don't have and knowing what options are out there like Equality MD to at least explore and make a more informed data-driven decision. Love it. Yeah. And that actually goes right along the lines of what we wrote in the book as well. And really empowering people. Yeah, to realize you have more control than you think because I don't think the system's ever going to fully serve everyone the way that should. You know, just for whatever reason. I'm not going to go there, but for whatever reason. So we also have to take what we can do ourselves and sometimes make stuff happen for ourselves. And so we empower people like you're doing. So I love it. I love to talk about leadership because, Justin, you're clearly a leader formally and informally. And so I want to go down that route. But before we get there, you mentioned your mom had a, she loves Star Trek. So, yeah, tell us about Star Trek and how you apply Star Trekian lessons to everyday life. I love that question because people, some know I like Star Trek.

They don't know how much I really like it. And I love Gene Roddenberry's vision. Even just looking at the bridge in the 1966, 67, 68, it was so diverse. You had a Russian at tactical. You had a Japanese American at the helm driving the enterprise through space. And we were at Cold War with the Russians, and we had just bombed Japan twice with nukes. And then we had an African-American woman. And civil rights had just barely passed.

And so Gene Roddenberry, he was told, he actually wanted to put a black man on the bridge, and he was told no. And he said, basically, F you, I'm putting a black woman up there. Because he was just inspirational when it comes to the idea of infinite diversity with infinite possibilities, and you can't enter the future if you fear diversity. And he even wanted to put gay characters on the show, but back then he couldn't. So the idea of the diversity of, of, of individuals, of thought, but more importantly, the idea of exploring space is really an exploration within.

And you need to be able to do both. You need to be able to sit in that captain's chair, make the hard choices. But importantly, know that you're never alone. Captain Kirk, Picard, Janeway, you name it, they were surrounded by people who were smarter than they were in many different areas. And that's how they succeeded. It's never a solo journey. and I've been trying to do that in my entire life and whatever endeavor I undertake. Don't forget on the original USS Enterprise, you also had a Klingon.

When you go out into space and discover new species, but yes. You know, Jesse, it's so obvious now that you articulate it, I never put it together, but it probably shaped maybe because of the way I am today and how I look at things, but you're right.

That, that, the leadership of the, Star Trek of the Enterprise. It was completely diverse in a time where, yeah, it was completely counterculture. And it showed how they can all work together and everyone had their strengths. And yeah, there are so many good lessons there. Yeah, that's a great, that's a great answer. And man.

The late great Nichols, the late great Nichol Nichols, before she died, she did several interviews. Google YouTube, Nichelle Nichols and how she met her biggest fan of Star Trek. Martin Luther King, Jr. And the long and short of it is she was going to retire after the first season of Star Trek ended to go do something on Broadway because her passion was Broadway musicals. And so Gene Roddenberry said, no, you need to meet your favorite fan. Turned out to be Martin Luther King. Martin Luther King had heard word from Gene that she was going to leave the show.

And he said directly to Michelle Nichols, you cannot leave the show. And she said, I don't know why I can't. I want to be a Broadway star. And he said, you are in Americans' homes in their... living rooms in their TVs once a week as an equal on the bridge of some spaceship traveling through space. Do you know what Gene Roddenberry is trying to do? And she said, I'm going to go back to Star Trek. Oh, I love it. Oh, my gosh. Getting goosebumps. I'm definitely going to look that up. You are the first trial lawyer on digital voices, as I mentioned. How is your experience

as a trial lawyer? How does it shape your leadership? Tremendously. First, I should say my experience as a trial attorney was first and foremost shaped, not just by my undergraduate experience at Wayne Mary in utilizing a well-stamped passport as the best education one can receive, but I was a history teacher at a naval boarding school in rural England, and I learned more from my kids than I ever could have taught them. And taking that into the trial room proved invaluable. Three trial strategies that I still use to this day, deference. If your opposing counsel makes an argument that is completely antithetical or torpedoes your position, it can. acknowledge it and give credit where credit is due, even if it hurts you.

It's a sign of professional respect and that you know the landscape that you're in in RK, self-care. Another one is if you were asked a question, you don't know the answer. Just say, I don't know the answer. Saying I don't know, but I'll get back to you, is actually a sign of strength rather than trying to be asked your way through something. And third, utilize silence as a tool. when asked a question, if I pause for five beats, even ten, everyone was hanging on my next word. But it also gave me time to really think critically, not about what I was going to say. And as Thomas Jefferson said, never used two words when one will suffice.

So say as little as you can and make it as impactful as possible, which is the exact opposite of what I'm doing right now. But at the same time, I use those lessons of deference, of respect when it comes to acknowledging that I don't know something and the power of silence. Excellent. And I love the deference one. I think it requires a lot of humility, and I think that's what's missing in a lot of leadership. Where do you draw inspiration? I draw it from, this is going to sound corny, but I've always said that I have the mind of a philosopher, the heart of a potent. the spirit of Starship Captain and everything I do, Curiosity is my true North Star.

That just flowed out of my fingers one day, maybe five, six years ago, doing one of the applications I do ad nauseum for something or other, and it stuck because that's who I am. And where do I draw inspiration? History. Not just military history, but art, music, philosophy. What can I learn from those that came before, no matter where they were? and it could be a Hollywood star or a singer from the 30s. I draw inspiration from the strength in leadership of various starship captains.

But I also draw strength from my grandfather, who was a, well, he was active in the CIA. I'll say that during some very high-profile times, now deceased, but also my mother, who has been a rock for me growing up and ensured that I was exposed to various things from playing in the church handbell choir competitively. Competitive handbells is a real thing, and it is fierce, to just appreciating music. And I even wrote a paper in college history of Western Europe about how music influenced the fall of the Berlin Wall and the reunification of Germany. So I think having that interdisciplinary approach to everything is a really powerful thing to draw upon, that wealth. wisdom from everything that came before and appreciating it for what it was and what it wasn't.

Yeah, I think it's a great point. So for listeners who are parents, especially young children, expose them to, given that wide breadth and depth like you received, you know, the art, the music, everything, the sports, sometimes I think we get too fixated on sports. I love sports. And that becomes the end all be all. But if you can give this well-rounded, you know, life to your kids, I think it's really important like you received.

What about the hardest decision you ever had to make? That's an easy one. To remain an entrepreneur. It is not something for the faint of heart. You have to be so comfortable being uncomfortable. It's really not meant for everybody. A lot of people get into it and get out because they don't realize it or they think they can handle it. The fact of the matter is most can't, and that's okay.

if everybody could, our economy would be vastly different than it is today and maybe not in a good way. But for those that can, I hate to use the phrase, tough it out, but you never tough it out alone. You always surround yourselves with those who can support you. And I would not be an entrepreneur, this being my 15th year in so doing, but for the lessons I've learned, the times I've fallen flat on my face, and boy, did that hurt. But I learned from it, and I had people to help pick me up. But you have to have that inner strength. And so that's where I draw from those childhood experiences of baseball, of church choir and handbells,

to traveling abroad and seeing myself and my country from the perspective of other people in other cultures, from living and working abroad, from being a trial attorney. People say I've worn ridiculous number of hats, but really it's the same hat, just different colors. really look at it and the lessons you take from it and apply. Because as Gene Rodenberry said, we're all basically aliens living on a strange planet and spend most of our lives just trying to communicate with each other. And I think that that's really what it's all about. So remaining an entrepreneur was the hardest decision.

And it is every day still. But one I don't take lightly and one that I enjoy. Yeah, resilience. That's what you're really describing. Yep. I'm going to ask you two surprise questions. Rapid Fire. those would be really easy for you.

If someone said, I'm not giving you any context, there's no qualifiers. So someone said, hey, what country should I travel to? What would be your top two choices for that person? For anybody, and I don't know them, I'd say, go wherever the hell you want. Just get a passport and go. My personal favorites, I'm a total anglophile,

so I'd say London. It's an easy first stop because they speak English, although Winston Churchill said England and America, two great nations divided by a common language, so there's that. And then I would suggest Italy or Greece because of the ancient cultures and sort of seeing not just from architecture and art, but the history of how great civilizations rose and fall and see if there are any lessons to be learned from a business standpoint, but from a standpoint of American geopolitical stance in today's current climate. Favorite Star Trek captain. Tough, but I'd have to say

John McPacard, because he has the boldness of Kirk, the softness of Janeway, the stick-to-itiveness of Cisco, but he does it with such class, such style. He can eviscerate his enemy

and then have a hot cup of Earl Grey Tea. Yeah, I love it. I've been confused at the airport like three or four times, actually, if I was, I can't remember his name. Patrick Stewart? Yeah, Patrick Stewart. It's kind of funny.

I was like, that's a nice compliment. I would take that. It's a nice compliment in terms of the guy is fit and he's chiseled and all that kind of stuff, but he's like 20 years older than me. But I was like, if I could look like that, 20 years, dang, I'll take it. I did name, so our firstborn son, his nickname was number one. And, and, and, well, that's, my mom calls me number one son. Yeah, I had to modify it a little bit when we had five kids because, you know, I didn't want them all to get mad.

Like, oh, he's number one. Yeah, of course. First board. Yeah. And then we named one of our dogs. I mean, I think it's a compliment. But we did name one of our dogs, Riker. So anyways, anyways, I love it.

It was a great dog. Anyways, Justin, you're awesome. That's why I wanted to connect with you and have you on the show. We talk about a lot of things from the top, just about a lot about music and you're growing up. Very interesting parental heritage and the things that you're, you're you're, you were exposed to. And then we talked about equality MD and really the important work that you're doing. Thank you so much for doing it. And we need to make everyone who's listening an ally to help close those gaps of inequity when it comes to health care and social care.

And then finally, a lot about leadership and Star Trek. What did we miss or is there anything you want to double down on? I give you the last word. Thank you for that. I think I'd like to double down on the fact that I would like people to give equality MD a try, even if they aren't a member of the community, we found that many people who are allies enjoy what we are able to offer simply because the level of empathy is elevated because our providers have to undergo cultural competency training, not just checking a rainbow box. And if you have friends, family, colleagues that might benefit from this at $79 a month for 36 virtual healthcare visits a year and that includes your prescriptions being mailed to you, it's a great deal for those

who are uninsured, underinsured, as well as those who have insurance, but looking for more LGBTQ affirming care outside their covered network. And it's a bargain, but we're making sure that we deliver quality care in a responsive way that meets our people where they are. Yeah, that's awesome. Like I said, we'll put the Quality MD in our show notes so people can easily find you. Justin, again, thank you so much for being part of Digital Voices. Thank you for having me. It's been fun.

Hey, that wraps up another edition. I told you it would be awesome. And thanks for listening. I know you have a lot of choices. Thank you for listening to Digital Voices podcast with Ed Mart. If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review.

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