We are excited to kick off "High Tech + High Touch Health Care" with the Jewish Healthcare Foundation as an on-going series of conversations exploring the future of health care.
We welcome Ellen Beckjord, PhD, MPH, who oversees Population Health for UPMC Health Plan and its 3.5 million members. She is an Adjunct Professor at Carnegie Mellon University’s Heinz College of Information Systems and Public Policy where she teaches Population Health Management. She is currently serving as Program Chair for the 2022 annual meeting of the Society of Behavioral Medicine.
Dr. Beckjord is a behavioral scientist and epidemiologist working at the intersection of population and digital health. She will talk about her work focused on the use of digital tools in clinical operations to achieve efficiency and impact in population health management.
Join us for what promises top be an informative and engaging conversation!
Transcription:
So good afternoon, everyone and happy belated Mother's Day. This is Audrey Russo, President and CEO of the Pittsburgh Technology Council. And I'm pretty thrilled because it couldn't be more timely in terms of the conversation that we're, we're having today. So before I introduce our guests, I just want to get a little housekeeping out of the way and extend some appreciation for those who make us who we are in trying to deliver relevant content and meet just amazing people who are doing incredible things, solving deep problems or building futures across Southwestern Pennsylvania. So Jonathan Kersting is with us. As always, he's vice president of all things, media and marketing and storytelling, and podcasts and radio and magazines, you name it, and he's gonna keep his eye on the chat, to see if there are questions and keep us engaged. As most of you know, this is very conversational, but we do have some questions that I will begin to ask our guests. And, you know, we'll have some fun as well as learn a lot. I know today, we're definitely going to learn a lot. And it might be a little bit emotional as well. So just enjoy your lunch, sit back, have some coffee, and we've muted your microphones, we do that on purpose, because we really don't want to hear some of the noise that's in the background. And this is not an opportunity for you to sell your wares. That's not what this is about today. This is just about focusing on our guests and the subject matter at hand. We have plenty of other opportunities at the tech council to do so. So I also want to give deep appreciation to Huntington bank, I believe, right? We have Huntington bank has been a sponsor with us, but also the Jewish health care Foundation, the Jewish health care Foundation, has done some pretty amazing things over the last at least 20 years. If you don't know them, we'll put their link out there. And this is part of their program called lift off pgh.org it will also be a part of their podcast. So the Jewish health care foundation is pretty passionate about ways of finding leading edge to you know, innovation across the healthcare industry. And that can mean lots and lots of things are one of the things that the President and CEO Karen Feinstein's pretty passionate about is not just safety, because safety is a is a very, you know, important piece of the work in healthcare, particularly over this last 15 to 16 months, we've seen such a huge need for things like contactless safety, you know, making sure that you know, everything in our environment, adheres to these new world of protocols. But Karen has always been interested in passionate about driving innovation, and not necessarily innovation that we think solves healthcare problems, but understanding ways to use innovation to apply to this market sector. And that's the cool part that we really loved about working with her and her team is thinking about different ways that technologies actually exist today. And what are the ways that they actually apply to healthcare, so I really can't thank them enough. So we're pretty excited about this series as well. So we're also excited to have Ellen backdoored. She is the Associate Vice President of population health and clinical transformation at UPMC. There's a lot we're gonna try to pack in here. We really only have about 30 minutes, but I know that you're really going to enjoy hearing from from Ellen and all the things that she's working on. So but we're really going to focus today in the fields of digital and maternal health. Okay, so you're probably wondering what what does that really mean? How does that matter to all of us, but guess what it matters to all of us, this work matters to all of us. So welcome, Ellen. I haven't seen her in a while. So it's good to see her face and that she's safe and sound. And before we ever start, I just want to say, first of all, thank you. And then second of all, how did you land in this role that you're in right now? Can you tell us just a little bit about your journey? Sure, I'd
love to and it's so great to be here and great to see you again, Audrey. Thanks so much for the opportunity to talk about this work that we're doing at UPMC health plan. So briefly, I'll say I'm a clinical health psychologist by training. And after I finished my training in psychology, I went on to get a master's in public health and landed at the National Cancer Institute. And I worked in a branch of the NCI called the health communication and informatics research branch, which was the branch at NCI that was doing a lot of work in in digital health, but this was a long time ago. So we're talking about things like how do people use the internet To find information about about healthcare, in 2005, I published one of the first peer reviewed papers on how people use email to communicate with doctors, right. So it's been a long journey. And so at that point, my research really started to focus on digital health and informatics. I'm from Pittsburgh, I'm a native of the South Hills, loved being an NCI but wanted to come back here. And so ended up working at RAND Corporation for a few years a great organization. And there, I had the chance to work with my colleague, Dr. Donna Kaiser, on a pretty large maternal child health project. Anyway, fast forward, spent some time at Pitt in the Department of Psychiatry worked at the Hillman Cancer Center. And six years ago, I was fortunate to join UPMC health plan where Donna Kaiser is as well as we'd worked at ran together, she came to the health plan before I did, and then when a position opened up that she thought I would be interested in reached out to me. And so it's been six years. And this is really a project that represents kind of coming full circle working with Donna and folks in the center for high value health care, again, on a project focused on maternal health. And in this instance, with a heavy emphasis on the use of digital tools.
So isn't that great journey, it's so funny that you can, you know, dial back and talk about email and doctors and you know, all the actual nuances of it all. But you know, what's even better is you've had a chance to work with your friends and colleagues. Yes, right. And then come back to Pittsburgh, not everyone gets a chance to do that. So that's, that's really special. It is. So work. So during the pandemic, right digital health, everything in tech has just accelerated people who had digital plans have like three year plans, five year plans, you know, they were, they were moving like snap, right? In the matter of weeks, people were just reacting to these plans, you know, in terms and then we also made major strides, I think, which will validate in terms of adoption. So we've seen recently, the strong push to bring behavioral health services into the digital world, we see that in tech in apps. And you know, you probably know more than we do in terms of the proliferation of all these apps. But UPMC has actually brought new services in this arena through UPMC. Anywhere care. So why don't you just talk about that, talk about the services, and then maybe talk about some trends that you've also seen in the space?
Sure, sure. So you're absolutely right, what's happened with respect to adoption of lots of different types of digital tools in the context of healthcare. We've seen huge acceleration during the pandemic, which I think we can probably attribute to the adage of necessity being the mother of invention, you know, we just but but you know, one of the things that will probably come up during this conversation is a huge function of these digital tools, is to help people connect authentic connection. And something that got taken away from us during the pandemic, was the ability to connect face to face in ways that we're typically used to doing. And so digital tools stepped in, to help facilitate those connections when we couldn't be together in person, but they have a value proposition above and beyond that, and even that value proposition of facilitating connection, it's going to remain true, even as social distancing measures ease up. But you're right, Audrey, we at the health plan now offer Behavioral Health Counseling on our anywhere care platform, which is a synchronous video platform, to our members through our EAP product and our Medicare and snip lines of business as well as most of our members in our commercial line of business. And so we're making sure that people have access to mental health treatments. And if you can't go to a therapists office, or if you don't want to, you can still receive high quality counseling through synchronous video. And, you know, mental health is such a huge area, we know that there. And we were just talking about this before the call there remains a lot of stigma. I think the stigma there are some some additional layers of stigma when we talk about women needing mental health services during the perinatal period during pregnancy and shortly after pregnancy. And we need to take a very that that stigma is multi dimensional, and we need to take a multi dimensional approach to addressing it. So one aspect of that is making psychotherapy and counseling extremely accessible from the privacy of your own home. And one way we do that is through offering our counseling services available through the health plan on a synchronous video platform and Covering, you know, the our behavioral health benefits now cover telehealth delivered psychotherapy to so just needing to address accessibility and convenience as one aspect of how we overcome barriers to receiving
mental health care. So what do you see what trends have you seen? And then I want to talk about the intimacy of a synchronous interactions. Sure.
So the the trends that we see, I think we've seen some trends towards more this is a case in point, talking publicly about the need for mental health treatment, the prevalence of both clinical and subclinical levels of emotional distress. There was a great Google Health blog recently, from May 6, where they talked about how there's been a spike in searches for Why do I feel bad? Hmm, it's been a spike across the world, in people searching on those words, why do I feel bad, and the blog does a nice job of explaining that anxiety and fear are normal reactions to a global pandemic. And the stage of the pandemic that we're in now, where we're here in the US and most parts of the US really emerging out of it is not without its challenges, either. But so there's, there's been a trend for more high levels of emotional distress among children and adults. And I think more public conversation about it, and a push to make services that help connect people to content or or actual real life people, peers and or providers to help more accessible. So again, as I, as I mentioned, the way we've we've done that at the plan and that other places are doing it is by making services available via synchronous video by making them available via mobile applications. So we have a mobile app at the health plan called RX well, where our members can connect with evidence based content around stress, anxiety, and depression, and then also lifestyle content, as well as assistance of a digital health coach. So and we know that in the market, you know, the the investment in digital mental health continues to just be enormous. So I think we're seeing you were tapping into an unmet need, we're tapping into a willingness of people to engage and a desire for them to engage in ways that are convenient, and that they can do privately. And I think that we're tapping into a way to make addressing these issues more convenient for folks. But I think we, we also need to remain mindful of the fact that taking care of your mental health takes time and resources, we should make that as easy as possible. But we can't, we can't, you know, right time out of the equation. So so we don't want to I think, go over the top of convenience towards assuming you know, it's this takes time and resources, but we should make it as easy as possible for folks.
Well, it's so interesting, because I definitely think obviously, the pandemic has exacerbated all this, right? You know, we've had time or home, you know, there's just all the complexities with schools and, and the vaccine, you name it at every turn, there's something but the intimacy of zoom, or whatever platform you want to use is actually quite effective. In, in, particularly in health, right. So it could be even, even apps that are related to exercise, but they're actually pretty intimate. So I feel like we moved into this world with not just amazing accessibility, but there's also a sense of intimacy, you know, it's just, you know, you and I, right, and we can have a pretty authentic exchange through zoom, despite zoom fatigue, right, despite all that, but you know, I imagine that there will be a day of real time access, and I'm hoping for, for behavioral health or mental health care, whatever it may be. And am I dreaming? I don't.
I don't I don't think so. But I love that you've used the word intimate. Yeah, because I think health is an incredibly intimate topic. And then if we don't treat it as such, or when we don't treat it as such, we really turn people off because it is extremely intimate. And I think that you're also exactly right, that there's something really qualitatively different about seeing one another face to face, right. Not that we can't deliver don't deliver great support via asynchronous chat, even via telephone and there's still of course a place for face to face. But I do think that we can we can really support authentic connection via that face to face synchronous video connection that that that is fundamentally different than doing without the synchronous video being able to see people idi.
So are we seeing an acceleration in telehealth for traditional healthcare services? Are we seeing that mental health services are growing in the same usage?
That's a great question. I know that with respect to using telehealth for physical health, you know, there was a huge spike at the beginning of the pandemic that is somewhat leveled off, but I don't think we're ever going back to pre pandemic baseline levels, we're still seeing higher adoption. I know that with respect to the the synchronous video behavioral health counseling services that we're offering at the health plan, we're seeing steady adoption of those and growing adoption. I don't know for sure how it sort of parallels physical health adoption, but my hope is that it will continue to steadily grow as people become aware of this being an option for a way to receive good psychological and behavioral health care.
So I mean, I'm hoping that even the field of psychology and social work etc, become more desirable fields again, you know, opportunities. So let's, let's talk about December, like if you can think back December UPMC, announced a new project. And that was to reduce barriers to critical behavioral health services for women, both during and after pregnancy. And you're really focused on, you know, developing tools for women who actually have limited access, right, in terms of care, but also about the barriers that exists, there's this whole thing that you're doing, and that, you know, how does, how do you do that with digital tools? How do you make sure that, you know, the stigma is eradicated around maternity leave, I mean, it seems like this is a big, big endeavor that you're taking on.
It feels big, and it feels so important. We know, here in Pittsburgh and in southwestern Pennsylvania. And you know, I don't know that anywhere is can say they've, they've they've gotten their arms around this in the way that we have to but we know that there are there are just completely unacceptable health disparities when it comes to maternal and child health outcomes between women of color and white women. And so this is one of many projects that we're engaged in to try to reduce that disparity. And so you're right, we're focused. This is a large project that's funded by the patient centered Outcomes Research Institute PCORI. It's being done in collaboration with partners at the University of Pittsburgh at UPMC. And really led by our Center for high value health care. It's a an initiative that's going to focus on pregnant women and new moms in our Medicaid population. Our health plan membership is it's written with respect to our members who are pregnant or have given birth in the past year runs between 20 and 24%. African American, we're actually going to make sure that a third of the women involved in this initiative are African American. And we've got a wonderful team put together that also includes folks from incredible community organizations like brown Mama's run. Yes, we'd love to talk about that. But But you're right, it's really looking at Okay, we have a set of maternity care management services that we offer our members that are intended to help support them as they navigate pregnancy and the first year postpartum. We know that behavioral health and mental health challenges occur during that time that are under addressed. So like many Pokorny proposals, this is a comparative effectiveness trial. So women will be randomized, and we're going to compare the effectiveness of three approaches, or maternity care management services as they exist and function well today, which include making sure we connect women with behavioral health resources, if that's something that they need. an arm that accompanies that with our mobile application RX well, where women can access services for depression, anxiety and stress management but in a completely self directed manner. And then finally, the third arm will be maternity care management plus the RX well app with the addition of a digital health coach who's a real live human being that is helping coach women using the RX well app and there's so much going on. Conversation completely, about how we think about the integration of human and digital support. We know there's a lot to be learned there, how much support is needed, by whom and when. So we hope that overall that this study will enhance our efforts to provide a deep level of support to our, to our new moms in our Medicaid product, and particularly to our moms who are African American, but also help us continue to understand and contribute to the evidence around how we understand the best ways to integrate human and digital tools in the context of healthcare delivery.
So like in the middle of COVID, the report comes out about Pittsburgh being the worst place for African American women to give birth in the middle of COVID. Right. And so you start this ad in, in, you know, in December, I guess, and really ramp up your passion, you connected with a group called brown mamas you mentioned that earlier. And who are these amazing women,
amazing women indeed. So brown mamas, if people are interested, their website is brown mamas.com. They are by their website, creating a lane for black moms there. And I don't want to speak for Muffy Mendoza, who is the head of this organization created it. But, but it's an organization that is completely dedicated to making sure that that that black moms have the support that they need from one another and from the resources that are available to them. You know, the something that stood out for me and the report that you're referencing, is in there, it showed exactly what you said that, that there are just enormous and horrible disparities in maternal and child health outcomes compared between white women and women in color. But it also showed that there was not a disparity with respect to engaging in prenatal care. And I think that's so interesting, because what it speaks, we have world class care available here in Pittsburgh. And we still have these disparities. So what is going on? Right, what is going on outside of the care delivery system? That where were some of the answers to these critical questions about how we better support and help women of color across the lifespan, but certainly during the perinatal period, and what part of why I'm so grateful that that Muffy Mendoza, and brown mamas will be a big part of this perform initiative, and part of what they're doing so MFI will be leading our stakeholder advisory board. And she'll be overseeing the execution of several community engagement studios, where we'll invite women from the community in to listen and learn from them about what's going on how we can help, how our clinical services and our digital tools need to be configured to feel relevant and supportive to them. So that we can really learn from this community about how to deliver care in a way that feels supportive and impactful. So for Jonathan's
going to grab a question, there's a great question chat that sort of makes a little bit of a right turn in terms of the topic at hand. So Jonathan, you want to grab it from Dirk.
Absolutely. Great to have you on the show today. Ellen, it's such a fascinating conversation need to have more of these. That's for sure. So Dirk wants to know, basically, is there anything of promise on the horizon in behavioral health help us overcome addictive behaviors?
Oh, certainly. Apps Absolutely. There. The field of digital health is, of course very big. And but there's a huge portion of it that is specifically dedicated to folks living with addiction disorders to overcome addiction to alcohol, and other substances. opioid is a big market there too. So the answer is yes. And it's very needed. And there's so much stigma around almost all behavioral health issues. Addiction is no exception, that some of the value proposition of digital tools and making evidence based services and support and peer support available to people in a way that lets them navigate that in a in a way that feels kind of safe and private, if that's what they need. I think that really applies to what's happening in digital health with respect to addiction. So there's
also in the beginning of jerks he talks about food science and food products. such thing and the marketing that is high chapter palates that we have addictive eating behaviors and you know, results in chronic disease. What about that? I know there's so much we can throw at you. But what about that piece? No, this
is Well, I mean, I, I was one I saw a chat pop up. And I saw that I mean, I think the marketing is engineered, I think the content is engineered, we could have a whole group, you know, I'll share that. That that some of how I think about our clinical services at the health planet, you know, is if I had if I was pushed to give a tagline, I might say something like American culture is trying to kill you. We're here to help you fight. Wow, I mean, so much about everything from how we eat, the way we live, that is really architected against health. And I think this is actually very relevant to this conversation about health disparities, even in the context of of perinatal health, because we know that it is harder, I think it's hard to be healthy in America, it's harder for traditionally underserved populations and people of color. And I often to on average, I would say and I would say that's because of the negative effects of systemic racism because of the negative effects of poverty. You know, there's a wonderful book called scarcity, why having too little means so much by by sheer fear, and more than a fan. I love I love that book. And what it really boils down to is, lots of people are living under conditions of scarcity and scarcity in three key areas scarcity of time, money and support. I think that one of the most critical ingredients to health is time, people need me, I think people need need money and support to be healthy too. But we need time to attend to our health. And when we are working multiple part time jobs, or we have to spend time worrying about whether we can keep ourselves in our family safe just because of the color of our skin. We're robbed of time that we could otherwise spend caring for ourselves and those we hold most dear participating in things like preventive health care. Right. So. So I think that that all this to say those certainly, you know, it's certainly a very big picture issue. But we don't live in a particularly health promoting culture. at UPMC, we're trying to address that and in a whole myriad of ways. And there are lots of ways I think that we can affect the micro environment of a person's experience through the use of digital tools to provide education support resources, as we navigate a macro environment. That is that is not particularly conducive to health and I would say is in fact a little hostile towards being healthy.
It's true, it's really hard. It's really hard for all of us to eat well. And think about food and think about our environment. And you know, we have like 412 Food Rescue that tries to address waste, yes. Right and, and eradicate waste and try to get food to the right places, what we saw what we saw during the pandemic, and what we continue to see from when we've had these scales on the show talking about food, and the demands on the food bank. And, you know, just the fact that this pandemic trip that and we're still seeing those kinds of food desert issues is, you know, I'm I worry and, and I worry about that. So how, how can we in our tech community, how can we be helpful to your work?
That's a great, that's a great question. I I'm thinking a little bit about I don't know if you're familiar with a relatively new initiative from Tom goats and Steve Downes called Building Ah, and you can get mine there, they're all about that they're sort of tagline is trying to build health into the operating system. And they just did a survey of modern American Life. showing what will not expect will not surprise anyone but but should concern all of us that modern American life is pretty unhealthy. And one example is we spend less than two hours a week with friends on average, and that's even through synchronous video that is an only a function of the past, right? You don't get enough exercise, sleep, etc. And they they're doing an interesting thing at building age where they're kind of grading different products and services around the degree to which their health promoting or health detracting. So, you know, there's such innovative, exciting work happening In the tech community around how to make health more accessible for everyone, I would say the ways that the tech community can help is to always think about how connectivity can be a vehicle for driving authentic connection, to think about how to make tech products and services, overwhelmingly available to traditionally underserved populations. Because if we're thinking through an equity lens, we know some people need more support than others. This isn't about equal offering. It's about equitable offering, right. And so, you know, I love 412 Food Rescue I love as you know, Pittsburgh is my hometown, I love seeing the myriad of exciting tech solutions that address everything from food chain, and food supply, which is such a driver, you know, all the way through pretty sophisticated niche markets within healthcare and consumer technology. It's all needed a tech isn't here to save us, I think it's here to help us save each other.
Well, on that note, that's pretty powerful. On that note, we're gonna wrap up, I think we've taken enough of your time, this is Elon backdoored, if people want to reach out, and they want to find out more about different ways to get engaged information, ideas that they have, what's the best way to do that?
The best way to do that would be to reach out to me on LinkedIn probably just messaged me on LinkedIn. I'm happy to share my contact information there. I'd be happy to talk and love connecting with folks on these topics. And thank you so much for the opportunity.
This was wonderful, really important. I know, we only like the tip of the iceberg. You know, there's so much to talk about. But thank you for your leadership. Thank you for coming back to Pittsburgh and sharing, you know, your journey and your passion around this. I think this is the this is the beginning. So again, thank you. Thank you, UPMC for leading this work, and the health plan as well. So Jonathan is what's on what's on record for this week. What do we have? Well,
Rumor has it Audrey that you're going to be at the easily Rebus stations
Morrow Yeah, I'm gonna be in an electric vehicle tomorrow. That's not about that
might be about the new flyer electric buses that are part of the fleet of the Port Authority and what that means for Pittsburgh and what that means for business opportunities. I'm really excited about this conversation.
That'll be great. Well, thanks again, Ellen. Thank you, everyone at UPMC and the health plan, really appreciate your time and stay safe.
Transcribed by https://otter.ai