Didier Choukroun of SPHERE Investments On 5 Things We Must Do To Improve Patient Outcomes for Underrepresented Populations
Medical provider referrals for exercise and lifestyle programs. Lifestyle and physical habits are preventive factors related to many SDOHs impacting patient health outcomes over time. Receiving referrals from a trusted medical practitioner has the power to motivate patients from underrepresented communities to not only change their behavior but also refer them to programs that can help make these habitual changes feasible for each individual.
Healthcare disparities continue to affect underrepresented populations, leading to unequal patient outcomes. Social, economic, and cultural barriers often hinder access to care, appropriate treatments, and equitable health services. How can we bridge these gaps and ensure that all patients, regardless of background, receive the highest standard of care? In this interview series, we are talking to healthcare providers, policy makers, community leaders, researchers, and anyone who is an authority about “How We Can Improve Patient Outcomes for Underrepresented Populations”. As a part of this series, I had the pleasure of interviewing Didier Choukroun.
Didier Choukroun is the Founder and CEO of SPHERE Investments (Strategic Public Health Equities and Real Estate), a pioneering investment firm based in Miami with a European presence. Under Didier’s leadership, SPHERE leverages advanced data analytics and an interdisciplinary team to drive investments that transform healthcare infrastructure and advance public health on a global scale.
Before founding SPHERE, Didier launched PIX Investment in 1995, a real estate advisory firm that later partnered with Lend Lease and became a leading investment manager in Latin America, eventually acquired by BNP-Paribas Real Estate. Earlier, Didier held leadership roles at Colliers International, Bouygues Immobilier, and Club Méditerranée, managing projects across Latin America, Spain, and South America. He began his career as a commercial attaché for the French Embassy in Cuba and currently serves on the Editorial Board of Population Health Management at Jefferson College of Population Health.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?
In 2010, I founded Flagler Healthcare Investments with a singular focus on healthcare real estate. Over the years, our company grew into one of the leading firms in this sector. While proud of Flagler’s achievements, I recognized the need to address health challenges beyond traditional healthcare infrastructure. This realization led to our transformation into SPHERE (Strategic Public Health Equities and Real Estate) in January 2024. Under the SPHERE name, we have adopted a new mission and vision, reflecting our commitment to invest strategically in the broader built environment and contribute to public health improvements.
Our shift was driven by an understanding that health outcomes are influenced by the environments where people live, work, and play. Social determinants like housing, education, and transportation are critical factors that affect health equity. SPHERE’s mission is to address these determinants by expanding our investments to non-traditional healthcare real estate assets and to include operations and technologies that impact public health.
Can you share the most interesting story that happened to you since you began your career?
One particularly transformative moment in my career began in 2014 when we went from being users of “Prime Healthcare Analytics” to owning it. Acquiring this former Konica Minolta subsidiary sparked our journey into healthcare data analytics and fundamentally changed how we approached healthcare real estate investment.
This acquisition laid the foundation for SPHERE Analytics, our proprietary platform, now one of the most innovative business intelligence engines in the real estate and healthcare sectors. By integrating advanced analytics, we shifted from relying on intuition and historical data to predictive and prescriptive business models. This approach helps us identify emerging trends, accurately predict future needs, and make informed investment decisions. The platform’s effectiveness owes much to our talented team of data scientists, physicians, and public health experts who drive innovation.
This strategic entry into data analytics has been nothing short of transformative, fueling our company’s growth and reinforcing our competitive edge.
Can you please give us your favorite “Life Lesson Quote” and share how it was relevant to you in your life?
One of my favorite life lesson quotes comes from Antoine de Saint-Exupéry, who said, “If you want to build a ship, don’t drum up the men to gather wood, divide the work, and give orders. Instead, teach them to yearn for the vast and endless sea.” This quote has profoundly influenced my approach to leadership by highlighting the power of purpose in motivating a team. I learned that inspiring a shared vision can drive people to greatness.
In my career, particularly during the transition from Flagler to SPHERE, this philosophy guided me to instill a sense of shared purpose among our team. We harnessed collective passion and creativity by encouraging everyone to focus on improving public health. This approach motivates and fosters innovation and ownership, enabling us to navigate complex challenges and achieve ambitious objectives together.
How would you define an “excellent healthcare provider”?
It is nearly impossible for any healthcare provider to be perfect in addressing every need but one who is “excellent” expresses humility and self-awareness, engages in continuous learning and improvement, and strives to ensure that all individuals, regardless of their backgrounds, receive fair and unbiased access to high-quality care. Healthcare providers who demonstrate strong communication skills, show compassion and respect for their patients and commit to serving as their healthcare fiduciary, building trust, leading to better treatment adherence and improved health outcomes. An “excellent” healthcare provider puts patients at the center of care, prioritizing their needs, preferences, and values, ensuring that care is clinically effective and aligned with the patient’s unique circumstances and desires. Excellence is not about doing everything alone. Well-organized, coordinated patient care stems from providers being able to work in a multi-disciplinary setting. Healthcare providers who also recognize the substantial impact of social determinants of health — such as housing, education, nutrition, and transportation — and can collaborate with other providers to address and mitigate these factors as a team can better improve health outcomes for every patient.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
We frequently share books and resources within the team to stay updated on key public health issues and to cultivate a shared mission to become better healthcare investors by guiding capital toward strategies that have the greatest impact on population health. The Price We Pay by Dr Marty Makary highlights the complex and often opaque practices in the US healthcare system that lead to high costs and distrust. It offers potential solutions and empowers readers to navigate the system more effectively. Another notable mention is Beyond the Wall by Dr. Zeev Neuwirth, which delves into key trends and innovations reshaping the U.S. healthcare system. The book highlights the shift of care delivery from traditional hospital settings into patients’ homes, positioning “the place of care” as “the place of need.” These changes challenge healthcare real estate investors and developers like us to reimagine the traditional healthcare infrastructure. Finally, An American Sickness by Elisabeth Rosenthal outlines many of the financial and political incentives that cause large players in the healthcare industry to prioritize financial gain over the delivery of compassionate care. These insights serve as a wake-up call to address the role investors play in shaping the system and help us better align our efforts toward improving transparency, affordability, and patient outcomes to contribute to a more equitable and sustainable healthcare system for all.
A few podcasts that are team favorites are ‘Turn on the Lights’ by Dr Berwick and Dr. Mate and ‘Creating a New Healthcare’ by Dr Neuwirth. These podcasts are platforms for in-depth discussions on critical healthcare issues, featuring expert insights. The thought-provoking discussions in these episodes offer valuable perspectives that help drive our business strategy forward.
Are you working on any exciting new projects now? How do you think that will help people?
SPHERE is advancing several key verticals. One example is our Senior Housing division, currently undergoing a transformation and led by our newest hire and graduate of the Yale School of Public Health, Rachel Diaz. Rachel has a background in health economics and social and behavioral sciences, and is particularly interested in social determinants of health — how factors like housing, education, nutrition, and transportation affect health outcomes over time.
Given Rachel’s public health background and SPHERE’s mission to create healthier, more connected communities, Rachel will be leading the newly formed SPHERE Generations: a non-profit organization bridging generational gaps, empowering individuals, and preserving community stories to leave a lasting positive impact on the spaces where we live, work, and play. SPHERE Generations will begin with two initiatives that foster intergenerational connections between seniors in our communities and youth from disadvantaged areas to create a powerful platform for mentorship, reflection, and personal growth. These initiatives will repurpose, rather than dismiss, the rich experience of our elders and ensure their histories are both preserved and amplified.
What are the primary barriers that underrepresented populations face when seeking healthcare?
There exist many socioeconomic and systemic barriers to securing quality healthcare in underserved communities, though financial barriers are among the most challenging obstacles to overcome. Factors like high out-of-pocket costs due to underinsurance, rising healthcare service prices, higher unemployment, poor wage growth, and a lack of access to timely transportation greatly hinder underserved communities’ access to quality care.
Moreover, institutional and interpersonal discrimination based on race, ethnicity, socioeconomic status, or sexual identity in healthcare settings erodes the quality of healthcare delivered to these communities while decreasing their trust and confidence in healthcare providers.
Cultural medical mistrust extends across racial and ethnic communities that have been historically mistreated, neglected, and subjected to unethical experimentation in Academic Medical Centers, government agencies, and other medical institutions. This bleak legacy continues to augment health disparities today. It has led to a decrease in health-seeking behaviors, especially for vulnerable Black and African-American communities who already disproportionately suffer from higher infant mortality rates, higher incidence and prevalence of chronic diseases, and health complications from associated comorbidities.
Language barriers and the fear of legal repercussions like deportation can further widen the healthcare access gap, deter residents who are undocumented from seeking necessary care or undergoing essential preventive practices that may save time and money, and prevent suffering in the long run.
Finally, cultural representation plays a significant role in patient receptivity to care. Patients who identify with their healthcare providers and speak the same language may be more likely to follow treatment advice and adhere better to treatment plans. Healthcare providers who are culturally insensitive and do not make genuine attempts at communicating effectively can drive patients away from care and health systems altogether.
How can healthcare providers build trust with patients from diverse backgrounds, especially in communities that have historically experienced medical neglect or discrimination?
1. Communication: Unbiased and clear messaging in their native language; asking more open questions and creating a safe space for patients to voice any concerns; avoiding assumptions and being sensitive to their cultural beliefs, practices and health literacy levels; embedding Community Health Workers and Patient Navigators wherever possible to help patients navigate complex health systems alongside a figure who acts as a “bridge” between community members and healthcare practitioners.
2. Campaigns: Campaigns that reflect the target population and are supported by news media, celebrities, social media influencers, faith-based leaders, and community organizations can effectively promote consistent messaging on the importance of seeking care, quench health misinformation, and build trust in healthcare providers. The success of past HIV/AIDS and malaria campaigns should be emulated. The COVID-19 campaigns, despite saving lives, faced poor and inconsistent messaging that bred distrust in healthcare providers, fueling misinformation and disinformation. This led to a decline in vaccine adherence, with uptake decreasing from 81% for the first dose to 70% for the second, and only 28% for booster doses.
3. Health clinics: Organizing neighborhood health clinics for underrepresented communities can raise awareness about prevalent health issues and encourage care-seeking. For example, while White women have higher rates of breast cancer, the mortality rate for Black women is 40% higher, and the highest among all racial and ethnic groups. Hispanic Americans are 70% more likely to have diabetes compared to their White counterparts, with Mexican Americans in particular showing the highest incidence for end-stage renal failure. Targeted community health clinics addressing these specific health disparities can help patients from that community identify with the issues, feel supported, and motivate them to seek appropriate care.
What role does cultural competence play in improving patient outcomes, and how can medical professionals be better trained to meet the needs of underrepresented groups?
The US is becoming increasingly diverse with ethnic minorities now comprising 40% of the population. Understanding cultural differences, norms and health beliefs of this growing segment are vital to maintaining trust, confidence and engagement with healthcare providers. Although US medical schools and accrediting bodies do emphasize cultural competence training for medical students, the implementation differs in its content, priority, setting and duration across the schools. In a cross-sectional survey of 118 US and 15 Canadian medical schools, very few schools (US = 8%, Canada = 0%) were found to provide specific courses to address cultural differences among patients. Training is usually contained within a larger course, mostly didactic and may be absent from students’ clinical rotations, where the training may actually feel more relevant and memorable. Cultural competence training should span the entirety of medical school and extend through residency, where opportunities for interaction with underrepresented groups are the greatest and learning through reflection and introspection are most impactful.
Moreover, a very small portion of healthcare education –be it nursing, medical or pharmaceutical– is focused on the social determinants of health (SDOH) despite SDOH impacting 80% of overall health outcomes. Healthcare is highly medicalized today due to a) a tunneled focus on quick fixes for patients’ clinical signs and symptoms and b) healthcare reimbursement models that encourage interventions over preventive care. Physicians and nurses are typically in a time crunch to treat patients daily, leaving them little time to fully consider socioeconomic factors affecting patients’ lives or customize care to their belief systems, living conditions, access to resources, and health literacy levels. That said, as value-based care takes shape across the US, clinical care will be more holistic and increasingly driven by SDOH considerations to improve health outcomes.
Can you share any successful strategies or programs that have been implemented to reduce health disparities and improve outcomes for underserved communities?
A successful strategy to reduce health disparities and improve outcomes for underserved communities has been the use of Community Health Workers (CHWs) in many African countries. CHWs, trusted members of the community who are not medical practitioners but receive some medical service training, play a crucial role in increasing vaccination rates, protecting against disease, and enhancing maternal-child health. For instance, in Rwanda, CHWs have been instrumental in distributing antimalaria services, providing maternal and newborn healthcare through home visits, providing contraceptives, and screening for malnutrition. In Ethiopia, CHWs in the Health Extension Program deliver preventive care and maternal-child health services in rural areas, such as distributing childhood vaccinations, aiding with family planning, and preventing and treating malaria, diarrhea, and pneumonia in children under five, contributing to significant improvements in maternal and neonatal outcomes. Finally, in Ghana, CHWs have helped guinea worm eradication, provided HIV/AIDS treatment and management, and expanded immunization coverage. Using CHWs as trusted liaisons between healthcare systems and communities improves access to care and addresses cultural barriers, leading to improved health outcomes in underserved populations over time.
How can technology and telemedicine be leveraged to reach underrepresented populations who may face geographic or financial barriers to traditional healthcare services?
Technology and telemedicine offer innovative solutions to improve healthcare access for underrepresented populations in a way that feels easy, approachable, and personalized. For instance, there now exist many digital health apps that track and analyze critical biometric data at a patient’s fingertips, such as Spanish-language phone applications that help Latines with diabetes track and identify patterns in blood sugar levels without having to visit an expensive clinic. There are also telehealth consultations like Better Help for those struggling with mental health who have limited access to transportation for in-person therapy, digital referral platforms like Unite Us that allow CHWs to track whether their clients received a recommended health service, and cell phone applications like Good Rx that connect users with physicians on-demand for antibiotic prescriptions such as those for common urinary tract infections — all from the comfort of home.
As a “healthcare insider”, if you had the power to make a change, can you share 5 changes that need to be made to improve patient outcomes for underrepresented populations? Please share a story or example for each.
- Having standardized EHR portals that contain all screening results, diagnoses, and prescriptions for an individual patient throughout their life course that can be accessed by the patients themselves and transferred across health systems. This will significantly reduce the time it takes for new physicians to catch up on a patient’s medical history, as it will be accessible by the patient regardless of the health system they’re in. It will also discourage repeat and costly examinations, screenings, and testings if the patient were to change providers or insurance.
- Community Health Workers (CHWs) & Patient Navigators (PN) at a 1:30 PN to patient ratio in every hospital. This will ensure all patients are adequately supported with varied and culturally-sensitive support ranging from translation services and appointment scheduling aid, better treatment adherence, to social service referrals, and more. This ratio will ensure all patients are paired with community resources to supplement any healthcare received with reasonable caseloads so as not to burn out CHWs and PNs.
- Centralized digital repository of all community resources that can be readily accessed by CHWs, volunteer organizations, providers, and patients, as well as community members (i.e., digital resource updating and displaying all community food pantries, health clinics, free screening and testing centers, free exercise programs and public parks). These community resources are necessary for many underserved, lower SES community members but are typically tracked via paper handouts and not often updated. Systems that keep track of these resources are usually costly and only afforded by large hospital systems that do not necessarily share compiled repositories with community members or volunteers.
- Produce prescription programs with prescriptions written by PCPs, who are shown to be the most trusted healthcare providers for many patients from underrepresented communities. Challenges accessing and consuming healthful foods are prevalent in communities with high rates of chronic illnesses, and many PCPs have begun to prescribe specific nutrition plans in addition to, or instead of, prescription medications. These prescriptions can be covered by Medicaid and Medicare to help afford healthful foods, which can often be more expensive than cheaper, processed foods with less nutritional value.
- Medical provider referrals for exercise and lifestyle programs. Lifestyle and physical habits are preventive factors related to many SDOHs impacting patient health outcomes over time. Receiving referrals from a trusted medical practitioner has the power to motivate patients from underrepresented communities to not only change their behavior but also refer them to programs that can help make these habitual changes feasible for each individual.
What specific steps can be taken to ensure that medical research and clinical trials are more inclusive of underrepresented groups, and why is this important for improving overall patient outcomes?
Several actions can be taken to ensure that medical research and clinical trials are more inclusive of underrepresented groups. First, it is crucial to set representative trial enrollment targets that mirror the incidence, prevalence, and severity of the condition or disease in the populations affected. This ensures that participants from the demographic groups most affected by a target disease are included in clinical trials intending to treat that disease. It also ensures trial findings are relevant and generalizable across many demographic groups.
Second, to be more inclusive pharmaceutical companies must identify and address barriers to trial recruitment and retention. This includes recruiting from diverse site locations, such as medical centers that serve low socioeconomic status (SES) and minority patients, and adapting trial protocols to be accessible to more patients. For example, one pharmaceutical company attempted to improve recruitment diversity in Alzheimer’s drug trials by partnering with community groups to spread awareness about the trials. The same company then implemented a new, lower-cost blood test to screen for target protein levels in the first stage of their trial instead of requiring PET scans as a screening measure. These blood tests are less invasive, less expensive, and more accessible than PET scanners for all participants, especially those far from hospitals with PET scanners.
Finally, systemic barriers should be addressed, such as the lack of coverage by the Centers for Medicare & Medicaid Services for clinical trial participation and employers not offering time off for participants outside of using sick days.
The importance of making clinical trials more inclusive cannot be overstated. When racial and ethnically minoritized patients are underrepresented in these studies, the generalizability of trial findings is put into question, and the likelihood of physicians prescribing related medications and referring their patients to similar trials decreases. A lack of inclusivity thus decreases patient access to potentially life-saving and life-enhancing treatments and causes patients from underrepresented backgrounds to lack trust in the treatments and view the results as less applicable to them. Ultimately, this underrepresentation can limit community health benefits and widen health disparities.
If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger.
A movement that expands access to quality healthcare and quality education for all — connected factors that not only advance the quality of life but have incredible community spillovers. By ensuring that everyone has the resources to prevent, diagnose, and treat illness and injury, we can ensure that every individual has access to their highest attainable standard of health. Better health aids in better academic performance — and pairing a clear mind with quality education increases the chances of an individual generating larger earnings over time. This increase in socioeconomic mobility impacts an individual’s lived environment and each of their social determinants of health — the conditions in which they live, work, and play. This is why SPHERE Generations exists: to interrupt a vicious feedback loop of poor health and educational outcomes by connecting community mentors to those who need them most.
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.
Didier Choukroun of SPHERE Investments On 5 Things We Must Do To Improve Patient Outcomes for… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.