“I think that there are 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 part of the community.”
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As a first-generation immigrant, Cyrus Batheja has a perspective on breaking down barriers in health care that’s grounded in his own lived experience — which makes it very compelling. Cyrus — an RN — started his career in skilled nursing and today works for the largest health insurer in the country, creating programming that promotes health equity. He believes that housing is a key determinant of health. And he says it’s not as simple as just putting a roof over a person’s head. It’s about putting people on equal footing and creating a solid foundation for health.
Outside of his day-to-day role as a nurse, Cyrus started addressing disparities and health inequities directly when he founded an organization with his family that provides dignified housing for Medicaid’s most at-risk patients. His family continues to own and operate Batheja Supportive Living Services today. Later in his career, he joined UnitedHealth Group, where he still works in an executive role. At UnitedHealth, Cyrus has been able to show — on a much larger 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 Nacole, nurses don’t have to have all the answers today. It’s a process that can span our entire nursing career.
Cyrus shares his first-person account of barriers facing immigrants in the United States: “When you don’t have immigration status, people don’t really want to listen to you. … And you live in fear.”
A roof. A job. An education. Tangible things many citizens of the United States take for granted but that are much harder to come by for immigrants, including Cyrus and his family. They moved to the United States in 1985 with a visa secured by his father’s small business. Due to their immigration status, his mother was unable to work. They were housed in a motel room owned by the family that sponsored them. Cyrus was allowed to attend school, but the family’s rights really didn’t extend much further. When his business failed, Cyrus’ father returned to England. Cyrus and his mother stayed but faced uncertainty about their future and many financial challenges. Things turned around only when his mother found nursing.
Like mother, like son. Cyrus shares how his mother became a nurse and inspired him to follow that same path: “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.”
At the encouragement of their immigration attorney during a United States-wide nursing shortage, Cyrus’ mom went back to school to become a nurse. Nursing was the path that would lead to a green card and, finally, a feeling of security for the (now) family of two. We know moms have heroic instincts to begin with, but Cyrus’ mom truly deserved the cape she donned. Having had a front-row seat to her education, Cyrus took an interest in nursing and followed in her footsteps as soon as he could afford to. He worked hard to overcome the financial barriers to pursuing higher education, taking just one class at a time. We loved the story of this family nursing duo — and this part was only the beginning!
Cyrus shares his first glimpse into an inadequate health care system — and his plans to improve it. “Being a first-generation immigrant and not having access, we were laser-focused on making a difference. On making an impact.”
Cyrus and his mother both started out in skilled nursing, and they were shocked and disappointed at the high cost of services, the comparatively low quality of care and how staff members — who were both overworked and underpaid — were treated. Many of the staff, particularly nursing assistants, were also immigrants. And a number of them had to work in multiple facilities just to earn a living wage. To some, it seemed like this was just the way it was, but Cyrus and his mom weren’t satisfied with the status quo. And so, this is how the next chapter of their shared story begins.
How Cyrus built a business that promotes equity through addressing housing as a key social determinant of health (SDoH): “I think [housing is] important because it acts as a base for people to start to establish themselves, find a purpose in their life and feel like they’re a part of the community.”
Cyrus says it’s not just about putting roofs over people’s heads; it’s about providing dignified, high-quality housing. Cyrus’ first health equity project was founding a family business that provides dignified housing for Medicaid’s most at-risk patients. Together with his mom and his wife — a super trio in our eyes — Cyrus invested in a small home, which they converted into an adult foster care facility. They focused on people with significant challenges, including behavioral health issues and severe disabilities. Over time, one house turned into two, and Batheja Supportive Living Services has now been in business for two decades.
What Cyrus accomplished in his next chapter at United Health Group: “What I’ve really focused on is gaining deeper understandings of subpopulations and subsets of the community, similar to what we’ve done with our home.”
To illustrate what he means, Cyrus shares an anecdote about a population of Hasidic Jews in Brooklyn for whom he was trying to support healthier habits. Instead of giving adolescents incentives for Subway sandwiches, for example, they selected a kosher pizzeria where the teens hung out. It was all about offering community-specific and culturally sensitive care — not just in this community, but in all the communities Cyrus’ programs have reached across the country.
How Cyrus partnered with providers to make a housing-first program a success: “The providers, the nurses, were so appreciative of being able to find a meaningful way to help … Their ability to do that was cut off because … they couldn’t provide housing.”
Based on his own lived experience, Cyrus really views housing as a foundation of health, and he was instrumental in standing up a housing-first program at United. He looked at the data and identified unhoused, previously incarcerated or otherwise struggling Medicaid patients who would benefit from stable housing and wraparound services. Often referred to as “superutilizers,” these were individuals who were visiting the ER more than 50 times a year out of pure necessity. We were really impressed with the way Cyrus’ team partnered with hospitals and health care providers, collaborating to find the unhoused individuals and offer them a place in a housing program.
Cyrus on the positive impact of social determinant of health-informed, evidence-based care models: “I’m a really big believer in not only looking at things through numbers, but looking at things through lived experiences … we saw some really great outcomes.”
Cyrus’ hard work paid off. His programs resulted in reductions in ER utilization among program participants, as well as hospital admissions and the numbers of inpatient days for those who were admitted to the hospital. He looked at the total cost of care for Medicaid patients the program housed and proved that it had decreased significantly through providing preventive care, including housing. But Cyrus didn’t just look at the quantitative data — he also looked at the qualitative data: what the patients were actually saying. And they were happy. They felt more involved in the health care system.
Cyrus shares lessons for nurses at the beginning of their careers: “What I found to be effective was really just small steps. Crawl, walk, run.”
Although he learned from his own lived experience struggling with some of the social determinants of health and obtaining access to the health care system, Cyrus’ main message is applicable to everyone. When we see a problem, particularly as nurses, often we have a desire to solve it as quickly as we can. And that can be overwhelming, particularly when you’re dealing with issues as massive as equity. Cyrus encourages nurses to take it one step at a time. He says that it’s all about progress over time. You don’t have to have all the answers on the first day or even today, he tells us. It’s a process that can span an entire nursing career.