sickle cell
The walls of Michael Smith’s office are covered in paper. Framed diplomas, certificates from his medical experience and other regalia fill the room.
Smith’s resume is long, and he’s gained plenty of honors across the 50-plus years he’s been on the earth. But it is his work that lets him sleep well at night, a journey made up of many steps all headed toward one goal – helping others.
“I think it’s the feeling that you are really making a difference,” Smith said. “Everybody wants to feel like they are making a difference. Having a sense of purpose is critical to finding peace in the world.”
Classic City beginnings
Smith grew up in Athens, two generations removed from sharecroppers, studying in Clarke County Schools. Later, he enrolled at the University of Georgia, with plans to enter the veterinary medicine field. During his bachelor’s degree program, a question from a fellow Alpha Phi Alpha member led to a change of course.
“A very good friend, a fraternity brother who was older, asked me, ‘There are so many people needing good doctors, have you thought about becoming a medical doctor?’” Smith said.
After earning his bachelor’s Smith applied to the Medical College of Georgia, matriculating through the program before enrolling in the University of Kentucky’s general surgeon training, where Smith broke a barrier and made history as the first African-American surgeon to train at the school.
After completing his training in Lexington, Smith returned to Georgia, practicing vascular surgery for a year in Atlanta before receiving an offer to train in cardiovascular surgery at Mount Sinai in New York, one of the nation’s leading cardiovascular programs that had recently opened a heart transplant program at the time.
There were still a few stops in his journey to a more extended time of practice. He spent time in a cardiothoracic research fellowship at the University of Massachusetts, which led to a cardiothoracic residency where he remained with the Minutemen. After his time in the Bay State, he returned to Atlanta.
Shifting focus
Smith practiced for a number of years in the state’s capital, working his way to chief of cardiothoracic surgery at Atlanta Medical Center (formerly Georgia Baptist Hospital). Focusing on heart and lung-related issues, he learned about a statistic he wanted to change.
“I learned that African-American men in Atlanta had the highest death rate of lung cancer in the nation – 134 per 100,000,” Smith said. “So we started the first lung cancer early detection program in the state of Georgia. It became part of the International Early Lung Cancer Action Program (IELCAP), and now, the United States Preventive Services Task Force uses CT Scanning for early detection of lung cancer based on the research we were a part of years ago.
“That was exciting. And that was a health equity issue. I saw in it the chance to do something about the high death rates with minority populations and disease.”
With the pursuit of equity as his focus, he learned of other populations in need.
“I learned that Jehovah’s Witnesses were being denied heart surgery because they, religiously, cannot accept blood,” Smith said. “I knew it was possible to perform open-heart surgery without giving them blood; I had read several articles and heard of people who were doing it. So we decided to start a bloodless cardiovascular surgery program, the first in the state of Georgia, and we were very successful. For a year-and-a-half, two years, we were the only group in Atlanta doing this heart surgery.
“I spent quite a bit of my time in the cardiovascular space looking at clinical investigation opportunities and health equity opportunities.”
Others saw his efforts in the field, too, and they weren’t looking for someone to fill shoes in the operating room. Smith made a jump, transitioning into physician-led managed care. He took a position in New York as a Medical Director for the Heritage Provider Network where he received training on the other side of care. This first role formed a skillset that led him to leadership roles in the managed care space, including stints leading Medicare work with Anthem, as the chief of clinical strategy for government business at Cigna and ultimately as the deputy chief equity officer at CVS.
“All of it seemed to be a great alignment of things that I enjoyed,” Smith said. “I loved managed care and knew the importance of value-based care – paying doctors to keep you healthy versus paying doctors to treat you when you are sick. Much of what I spent 12 years doing in managed care was building those value-based models; we built 42 of those when I was at Anthem with the help of some very talented people.”
Everybody wants to feel like they are making a difference. Having a sense of purpose is critical to finding peace in the world.
Blending talents
His latest venture combines his experience and passion. With some financial backing and help from talented partners, he launched Marti Health, a holistic, community-based digital care hub to promote patient wellness last year.
The hub’s first task – sickle cell disease. With more than 3 million people worldwide affected by the disease, it presents numerous challenges with regard to both delivery of care and treatment regimens. However, rather than seek a one-size-fits-all approach, Smith and his crew took the time to listen to those who were dealing with the disease.
“The sickle cell population started telling us, ‘this is what the problem is, and this is how we see solving it; if you are really trying to help, this is how you can help,’” Smith said. “We used that to build a minimally viable product for delivering a care-coordination platform that helps meet their needs.”
That platform offers four distinct features for the sickle cell community. First, it collects all of a patient’s medical, behavioral, functional and social determinants of health data and allows that data to be shared to any customer-designated place, doctor, nurse or caregiver, which provides the entire care team with realtime information on how that patient has been treated in the past and evidence-based recommendations for caring with them in the present.
“Nobody had done that for the sickle-cell before,” Smith said. “The data shows that if they present to the emergency round with that plan of care, and the doctors that treat them use that information in the management of their sickle cell disease, they receive pain medicine sooner, they are less likely to need to be hospitalized, and they have less long term damage from their sickle cell crises.”
The platform also provides asynchronous communication, which allows patients to seek the help of a dedicated team of trusted sickle cell care providers at anytime from anywhere with an internet connection. It also provided a single, curated source of evidence-based knowledge regarding the disease to allow patients and providers a place to become better informed about the illness. Additionally, it gives a virtual meeting space for those who want to fight the injustices of sickle cell to communicate and come together.
But that’s not all. With the help of three seasoned sickle cell healthcare providers in the state of Georgia, he is bringing a value-based model to the management of sickle cell disease, rewarding providers for keeping patients healthier, longer. All of these providers have been treating patients for more than 20 years, joining a system built for change and hope.
“We are building what will be Georgia’s first community-centered, sickle-cell specific, value-based, specialized medical home,” Smith said.“We hope to launch that in July; we’ve gotten a lot of positive feedback. It’s been an exciting journey in these eight months, an exciting roller coaster ride.”
The sickle cell population started telling us, ‘this is what the problem is, and this is how we see solving it; if you are really trying to help, this is how you can help.
“It’s an amazing disease”
The roots of sickle cell disease can be traced back thousands of years to another illness. Malaria, a deadly mosquito-borne disease caused by parasites, is commonly found in areas of the Southern Hemisphere, including Africa, South Asia, South India and Australia, and its impact includes changing the fate of the Roman Empire as the Romans were unable to capture areas because of the disease.
At one point in time, a single gene mutated in one individual, allowing them to no longer be susceptible to death from malaria, explained Smith. This gene mutation was passed through generations, protecting some from disease but causing problems for others.
“They thrived, they had children and some of their children passed on that gene,” Smith said. “Ultimately people who had this one gene would have children with individuals who also inherited one gene, resulting in offspring with two mutated genes. And when you get two genes, that’s when it’s bad. Two copies of that gene in your hemoglobin causes your cells to form these chains, these polymers, and the cells become C-shaped cells instead of these nice round, soft cells.
“Those sickle-shaped cells are chewed up by the body, causing anemia or they cause clumping – the C-shaped cells to clump together – and it causes patients to not have blood flow in those critical parts of the body. If you have two copies of this gene, you have a life of acute and chronic pain.”
Along with pain, disease-holders also suffer from damage to organs — including the brain, kidneys, bones and others — and hearing and vision loss along with the possibility of premature death; half of sickle cell patients die by the age of 50, according to Smith. People of color make up most of the near-130,000 patients in the U.S., and those with the disease have to face a fragmented healthcare system along with cultural and clinical ignorance about the disease.
“Many doctors have not seen a lot of sickle cell patients,” Smith said. “They don’t know how to deal with sickle cell patients. They think they are all drug-seekers when they come into the hospitals complaining of severe pain because they don’t look sick. What you don’t see about this population is they are treated as drug-seekers and asked to leave the hospital when they complain. What they are really seeking is equitable, compassionate care.”
Once we prove that we can actually improve the outcomes and advance health equity, we are going to look at the next special needs population and see how to make things more equitable for them.
A chance to reach more
Through the process of starting Marti Health, the sickle cell community has taught Smith a plethora of information, but one thing that stands out is insight into the phases of a sickle cell disease crisis. It has changed the way Marti Health is approaching the coordinated care model.
The first cycle in this process, known as the prodromal phase, takes place when early occlusions of vessels occur with little damage. When left untreated, this process cascades rapidly through three more phases, each more painful and damaging until eventually growing into a full-blown vaso occlusive sickle crisis.
With a cardiac surgical background, Smith was used to acting quickly – every second and minute counts when you are dealing with the heart. Heart attacks don’t generally present with a prodromal phase. Sickle cell disease is different; this first phase lasts around three days.
That’s 4,320 minutes. Or more than 259,000 seconds. In other words, a lot more time to do something.
“If someone told me that a patient was going to have a three-day warning opportunity before a heart attack, I would tell you we could eliminate most heart attacks,” Smith said. “That just doesn’t happen with cardiovascular disease. If we can improve the use of appropriate medication where needed, if we can educate patients on the prodromal phase and how to mitigate it, we think we can reduce a huge burden of illness on the population.”
It’s not just sickle cell Smith and his team wants to tackle. Once they figure out the ropes for sickle cell, the team wants to bring a working model to similar diseases like lupus or cystic fibrosis.
“We think this is a tremendous opportunity to level the playing field for people who have special needs in this country,” Smith said. “We’re starting with sickle cell because I think there is a real need, but once we prove that we can actually improve outcomes and advance health equity, we are going to look at the next special needs population and see how to make things more equitable for them. I think that is a tremendous opportunity.”
Smith has always been one to make the most of every opportunity, gaining experience at every stop of his academic and professional journey to help him craft Marti Health. As he prepares to launch the platform, the joy he finds in helping others is shown through his work.
“My daughters ask me all the time, ‘Dad, what do you do for a living?’ And I say, ‘I work with smart people to try to solve big problems to make the world a better place. That’s a pretty neat job description, and I am fortunate I get to do it.”
