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Your Women's Health Strategy Is Labor and Delivery and a Mammogram, with Priya Bathija · The Clinical Realist

• 0:00
  SPEAKER_01: I'm Dr.
• 0:00
  SPEAKER_01: Stermat, and this is The Clinical Realist, the show about what actually breaks when healthcare tries to modernize.
• 0:06
  SPEAKER_01: Not the pitch deck version, the version where the workflow fails at 2 a.m.
• 0:10
  SPEAKER_01: and somebody has to document around it.
• 0:12
  SPEAKER_01: My guest today is Priya Bethesia.
• 0:14
  SPEAKER_01: She's a lawyer by training, spent 18 years inside hospital law and policy, and a lot of it is at the American Hospital Association, where she built health equity and maternal health programs at national scale.
• 0:24
  SPEAKER_01: So in 2022, she left to found New Health, where she now advises hospitals and health systems on women's health strategy, what to build, what it returns, and which of the 400-point solutions in their inbox are actually worth the pilot.
• 0:36
  SPEAKER_01: She teaches health law at Ohio State and even hosts the Women's Health Playbook.
• 0:40
  SPEAKER_01: So Priya, thank you so much for being here.
• 0:43
  SPEAKER_00: Hi, thanks, Sarah.
• 0:44
  SPEAKER_00: I'm excited to have our conversation today.
• 0:47
  SPEAKER_00: And um I've been looking forward to this for a long time.
• 0:51
  SPEAKER_00: So thank you for having me.
• 0:52
  SPEAKER_01: Of course.
• 0:53
  SPEAKER_01: Well, let's do something different.
• 0:56
  SPEAKER_01: Let's start with what the board's talking about today.
• 0:59
  SPEAKER_01: So when a health system CEO says that they have a women's health strategy, what do they usually mean and what's missing from that sentence?
• 1:08
  SPEAKER_00: Yeah, so in, you know, to generalize for health systems across the country, and you and I both know that one health system is one health system.
• 1:17
  SPEAKER_00: But um generally speaking, when health systems talk about their women's health strategies, they are focused on labor and delivery and maternity care.
• 1:27
  SPEAKER_00: Um, they are really focused on making sure that women have great experiences when they are delivering babies.
• 1:35
  SPEAKER_00: And as we know, in the United States, um, we have a maternal health crisis.
• 1:41
  SPEAKER_00: Our maternal mortality rates are worse off compared to all developed nations.
• 1:46
  SPEAKER_00: So when we're thinking about labor and delivery, we are seeing hospitals really focus in on how can they improve quality, how can they improve patient experience, how can they make sure that when women show up they have a positive delivery experience and a positive delivery, right?
• 2:07
  SPEAKER_00: It really should be the happiest time in a woman's life.
• 2:11
  SPEAKER_00: Unfortunately, women have lives that far exceed the pregnancy phase of life, right?
• 2:19
  SPEAKER_00: There are women who never have children, there are women who live full lives before they have children or decide to have children, and then of course, this lengthy period of life that happens after.
• 2:32
  SPEAKER_00: And there are conditions that impact women differently only and disproportionately.
• 2:41
  SPEAKER_00: And so when we think about what a women's health service line or women's health strategy should be, it really should be incorporating all of those conditions across a woman's full life.
• 2:56
  SPEAKER_01: That's interesting.
• 2:58
  SPEAKER_01: You know, I think for me, just like you, when I hear the strategy term, I think LD and I think mammography, and then they wipe their hands, the checkbox is checked.
• 3:08
  SPEAKER_01: Yeah.
• 3:09
  SPEAKER_01: But is the underinvestment though a values problem or is it a math problem?
• 3:14
  SPEAKER_01: Do the economics just not work or are we just measuring them wrong?
• 3:17
  SPEAKER_00: So I think it's a mix of things.
• 3:19
  SPEAKER_00: You know, you've likely heard, you know, women's health is under-researched, underfunded, um, misunderstood.
• 3:27
  SPEAKER_00: And I think those are all very real problems.
• 3:30
  SPEAKER_00: If we're not researching these conditions that are happening only to women, differently and women or disproportionately to women, by nature in a medical system, there is less focus on that, right?
• 3:42
  SPEAKER_00: We don't know what we don't know, and we don't train clinicians on these issues because there's no research to back up the training, right?
• 3:50
  SPEAKER_00: And so that leads to a part of it.
• 3:53
  SPEAKER_00: Um, another piece of it is like I think society has placed a lot of value on women during the childbearing years, and not necessarily in the other phases of life, even when those phases of life actually impact their ability to have children, right?
• 4:13
  SPEAKER_00: And so we see some of society's structure show up in how decision making is made, and quite honestly, how these services are reimbursed and paid for, right?
• 4:25
  SPEAKER_00: So there's a lot of discussion now in the women's health space about how certain procedures that are performed on women's anatomy are reimbursed at up to 30 to 40 percent less than similar procedures performed on the male anatomy.
• 4:42
  SPEAKER_00: And so when that happens, whether conscious or not, it drives decisions, right?
• 4:48
  SPEAKER_00: So not only are larger providers like hospitals strapped to figure out how to best handle women's health with lower reimbursement rates, clinicians are also being reimbursed less if they choose to take a path that focuses on women.
• 5:05
  SPEAKER_00: And that inadvertently creates its own set of challenges.
• 5:09
  SPEAKER_00: So we have a lot of things that are leading into this.
• 5:13
  SPEAKER_00: My premise in the work that I do is that there are many ways to impact women's health.
• 5:20
  SPEAKER_00: I actually have a chart of strategies and it's 35 different strategies of ways that hospitals can start to improve women's health.
• 5:27
  SPEAKER_00: And it's not big stuff.
• 5:28
  SPEAKER_00: It's not like let's invite let's invest in a whole AI strategy, let's invest in a whole telehealth strategy.
• 5:34
  SPEAKER_01: Well, what's surprising on that?
• 5:35
  SPEAKER_01: Like, is there something on that list that I would be surprised about?
• 5:38
  SPEAKER_00: I mean, I don't think you would be surprised about it, but I think people in general are surprised at how easy some of this could be if we chose to make it so, right?
• 5:48
  SPEAKER_00: If we chose to actually educate women at every point along the way, for example, we could start by educating young girls about menstruation.
• 5:58
  SPEAKER_00: That's when they become a women woman, that's when they start interacting with the healthcare system in a different way.
• 6:05
  SPEAKER_00: Um, that's when they begin to trust or not trust healthcare providers.
• 6:10
  SPEAKER_00: So, what if we actually had hospitals and health systems do some education for um, you know, younger girls about menstruation?
• 6:19
  SPEAKER_00: What's normal, what's not normal, what may be a sign of endometriosis?
• 6:23
  SPEAKER_00: What should you be looking for in this phase of life?
• 6:27
  SPEAKER_00: Rather than what we do right now for girls, which is oh, here's a tampon and a pad.
• 6:32
  SPEAKER_00: This is normal.
• 6:33
  SPEAKER_01: You're gonna die every month.
• 6:34
  SPEAKER_01: Good luck to you.
• 6:35
  SPEAKER_01: Yes, we'll see when we have babies.
• 6:37
  SPEAKER_00: Yes, exactly.
• 6:38
  SPEAKER_00: And and the other thing, Sarah, talking about babies is like the entry point for women right now in healthcare, generally speaking, again, is when she is pregnant with the baby.
• 6:49
  SPEAKER_00: Not when she's thinking about having a baby, not in that zero trimester or the three months before she gets pregnant.
• 6:56
  SPEAKER_00: It's it's after she's pregnant, it's when she shows up to check if she's pregnant and then begins the perinatal phase, right?
• 7:04
  SPEAKER_00: And what if we could flip that?
• 7:06
  SPEAKER_00: What if we could get women to think about their health differently before they have their babies?
• 7:13
  SPEAKER_00: Now, what if we could actually, you mentioned mammography.
• 7:17
  SPEAKER_00: What if we actually educated women on what was going to happen during their mammogram?
• 7:22
  SPEAKER_00: What it actually meant if they're called back for a second round, what it actually means when you show up to get a breast ultrasound, what it means when you show up to get a needle biopsy.
• 7:34
  SPEAKER_00: What if we actually gave women that information before they show up and let them get comfortable with what is gonna happen?
• 7:43
  SPEAKER_00: Their experience would be so much more positive.
• 7:46
  SPEAKER_00: They may be more willing to come have these tests, which means earlier diagnosis can lead to better outcomes.
• 7:53
  SPEAKER_00: So when we think about what can be done, it doesn't have to be super huge investments.
• 7:59
  SPEAKER_00: It can be things like creating educational resources, sending a text to a patient with a link that says, here's what's gonna happen, or, you know, create a little bit more time.
• 8:12
  SPEAKER_00: Bring in another provider or nurse or social worker that can provide some of this information to patients when they're actually in the office getting these tests ordered.
• 8:22
  SPEAKER_00: So I think there's a lot of different ways, and I think the surprise comes, not that there are a lot of different ways, but that really everyone has an opportunity to take a step forward to do one thing better than they were doing before.
• 8:37
  SPEAKER_01: And I think that sometimes folks think, oh, well, it's just the right thing to do, but that's hard to make a business case about.
• 8:44
  SPEAKER_01: But well, when you talk about things like mammography, if we get more people in to have their mammogram, we have ROI based on imaging, then we have the referrals for surgery, we have the referrals for other pieces.
• 8:55
  SPEAKER_01: So now we're actually building an entire business model around the procedures and referral system from mammography.
• 9:02
  SPEAKER_01: And so that's not small money, that's a real business.
• 9:07
  SPEAKER_01: And so instead of thinking of this as you know a moral piece to move forward, actually it's it's a business decision.
• 9:15
  SPEAKER_01: Do you want to take 50% of the population and bring them into your organization and put them into the mammo and make it happen?
• 9:22
  SPEAKER_01: Well, here's a good way to do that.
• 9:24
  SPEAKER_00: Well, and Sarah, it it's real money.
• 9:26
  SPEAKER_00: It's not just us having a conversation about money.
• 9:29
  SPEAKER_00: Deloitte has done an analysis of how much hospitals are leaving on the table from not doing preventative screenings for women and men, right?
• 9:39
  SPEAKER_00: And they're leaving billions on the table by not having programs that adequately screen and get women to the services that they need.
• 9:50
  SPEAKER_00: Another area where there is a real ROI is midlife, right?
• 9:55
  SPEAKER_00: So there's a lot of conversation now about menopause.
• 9:58
  SPEAKER_00: But if you actually have a midlife program that creates time to listen and support women as they go through perimenopause, menopause, and postmenopause, you're creating a relationship that allows that woman to feel comfortable coming to you for all of her follow-up care.
• 10:17
  SPEAKER_00: So again, that includes mammograms, it includes DEXA scans, it includes GYN procedures, it includes anything else that they might need from a health system because they actually trust that clinic and that provider to refer them to the right place.
• 10:34
  SPEAKER_00: Okay, so everyone can do their own math on what that means and what that could mean for their ability to build loyalty and brand recognition with women as patients.
• 10:48
  SPEAKER_00: The challenge comes, hospitals and health systems generally are not thinking about women as consumers.
• 10:55
  SPEAKER_00: And it's a missed opportunity because women utilize on average 10% more healthcare than men.
• 11:02
  SPEAKER_00: Women are the decision makers for their family when it comes to healthcare.
• 11:06
  SPEAKER_00: So when they're making decisions, they're not just making them for themselves, they're making them for their kids, their spouses, and a lot of cases their parents, right?
• 11:14
  SPEAKER_00: So they are the most important consumer.
• 11:17
  SPEAKER_00: And that's just in terms of the decisions they're making.
• 11:20
  SPEAKER_00: Think about it just generally from a population health perspective.
• 11:24
  SPEAKER_00: They're 51% of the population and they're birthing 100% of our future.
• 11:28
  SPEAKER_00: So if we're not treating them as the best customer we have in healthcare, we're missing a huge opportunity.
• 11:39
  SPEAKER_01: I think it's interesting to see companies like MIDI that are just killing it.
• 11:44
  SPEAKER_01: And, you know, a lot of the services they provide are covered by insurance, but there's also a lot of self-pay, which is just an amazing opportunity from a healthcare perspective for hospital systems to build out.
• 11:55
  SPEAKER_01: So if you don't have it, your patients are gonna get it everywhere else.
• 11:59
  SPEAKER_01: And ultimately, they're gonna decide where those referrals go and they may not be back to you.
• 12:03
  SPEAKER_01: So you're essentially making it happen.
• 12:06
  SPEAKER_01: Goodbye.
• 12:07
  SPEAKER_00: Yeah, 100%.
• 12:09
  SPEAKER_00: And Sarah, the other sort of downfall that I think hospitals and health systems need to be aware of when women seek out treatment outside of their universe, they have gone, right?
• 12:21
  SPEAKER_00: So yes, they've gone, and their future referrals might not come back.
• 12:25
  SPEAKER_00: But more importantly, like they now have a separate medical record that's sitting over in another third-party place that isn't connected into their primary care, that isn't connected into their OB, and it is certainly not connected into the hospital infrastructure.
• 12:43
  SPEAKER_00: So when that woman comes the next time because she has a challenge or an issue, that lands up in an urgent care, in an ER, in a hospital setting, in a physician office, somewhere, and that information isn't connected.
• 12:59
  SPEAKER_00: And we know that if we're talking about hormones, that impacts a woman's full body and health.
• 13:05
  SPEAKER_00: Everything, right?
• 13:06
  SPEAKER_00: Everything.
• 13:07
  SPEAKER_00: If she's over here getting hormones or a GLP one from a virtual care provider, and you have no information on that, that's not a good place to be in terms of where we want to be when we're improving care outcomes and experiences.
• 13:23
  SPEAKER_00: And if there are any negative consequences by chance of what's happening over here in a silo, that's gonna show up on your door anyways.
• 13:32
  SPEAKER_00: So it makes sense not only from an ROI perspective, but from that connectivity perspective, to be the care provider for women during these phases of life or to work with companies like MIDI or Electra to connect the dots, right?
• 13:51
  SPEAKER_00: Because not every hospital or health system has the resources or the number of trained providers they need to do this, but there are opportunities for real partnership and connection so that we move in the right direction.
• 14:06
  SPEAKER_01: So, Priya, I know that we've talked about AI quite a bit, and you've heard on my podcast and what I talk about, you know, thinking about it from a health system perspective and the advantages and also some of the things that aren't going so well with AI.
• 14:18
  SPEAKER_01: But when we think about AI strategy for women's health in particular, I know in your frameworks, you talk a lot about the consumer, the actual patient.
• 14:27
  SPEAKER_01: When you think about AI for the patient, where do you see the most benefit there?
• 14:31
  SPEAKER_01: Or maybe some opportunities that aren't going to work out very well.
• 14:34
  SPEAKER_01: And the other piece I want to know is who should pay for it?
• 14:37
  SPEAKER_01: Should the hospital systems be investing in AI for their consumers?
• 14:41
  SPEAKER_00: Yeah, so I think there's a lot of ways.
• 14:44
  SPEAKER_00: From a clinical perspective, I think there are really great use cases out there on how AI can be used to look at research and to come to a diagnosis faster.
• 14:59
  SPEAKER_00: So, for example, with endometriosis, it can take up to seven to ten years for a woman to get a diagnosis.
• 15:07
  SPEAKER_00: What if we could scan research quicker, align symptoms with what women are facing, and get to a diagnosis much faster?
• 15:16
  SPEAKER_00: Certainly, women would feel relief, certainly they would get on a path to treatment much quicker.
• 15:22
  SPEAKER_00: So we're seeing a lot of opportunities there to dig through things and come to a diagnosis more quickly.
• 15:29
  SPEAKER_00: We're seeing a lot of AI use around monitoring of patients and babies.
• 15:35
  SPEAKER_00: Um, so when we think about maternal health, like different ways to improve outcomes by using AI to monitor what is happening with patients, what is happening to their babies when they're in their body, out of their body, which can lead to better outcomes and a um for the whole family.
• 15:53
  SPEAKER_00: Um, and then what I'm finding most interesting is the conversations that we're having on my podcast, the Women's Health Playbook, and that consumer angle to utilization of AI.
• 16:06
  SPEAKER_00: So we've heard throughout our first season, which was about a doctor's visit and what do women need to do to prepare to find a doctor, what they need to bring into a doctor's appointment, how they actually have conversations with their care teams, what do they do in follow-up.
• 16:24
  SPEAKER_00: We're seeing that AI can be a really powerful tool to help them better frame their family histories, to better frame the symptoms that they're seeing, to better understand how to describe things to their doctor in a way that saves time in a very short appointment.
• 16:44
  SPEAKER_00: We're seeing ways that patients can use AI to better understand documentation that they get from their doctor.
• 16:51
  SPEAKER_00: So, for example, if they get a readout of the symptoms that they're having, the potential diagnoses, they may not understand that readout, but they can put that through AI and they can get a better understanding of what is happening.
• 17:05
  SPEAKER_00: We're also seeing it be a really useful tool for patients to understand their medical bills, right?
• 17:12
  SPEAKER_00: What are they being billed for?
• 17:14
  SPEAKER_00: What do those CPT codes mean or those billing codes that make their way onto that paper mean?
• 17:20
  SPEAKER_00: And what if they disagree with them?
• 17:22
  SPEAKER_00: What how can they raise their questions?
• 17:26
  SPEAKER_00: Um, AI can help them build out emails or scripts for conversations with the billing department.
• 17:32
  SPEAKER_00: So we're seeing a lot of these ways that from a consumer perspective, AI could make this better.
• 17:39
  SPEAKER_00: Now, from a clinical perspective, I think it's on the healthcare system, whether that is providers or payers, to figure out how to pay for some of that AI around diagnosis and treatment.
• 17:52
  SPEAKER_00: But when it comes to this user-friendly AI, I think the question's out on who benefits from that.
• 18:01
  SPEAKER_00: But one of the things that I think is really important for health systems to be aware of is how individuals are using AI at every step along the way to make the experience better on their end and to invest and pay for the training that is needed to have their clinicians support that, right?
• 18:25
  SPEAKER_00: So in this women's health space, we've had a lot of conversation around how do you bring AI into a doctor's visit without throwing off your doctor or challenging your doctor or making it seem like you don't trust your doctor, right?
• 18:42
  SPEAKER_00: So I think there needs to be training on the patient side, which we're doing with our podcasts.
• 18:47
  SPEAKER_00: And I think there needs to be training on the clinician side as to how to have productive conversations about what comes from AI.
• 18:55
  SPEAKER_00: And I think it's no different than when we tried to have productive conversations about what came from Google searches or WebMD searches.
• 19:02
  SPEAKER_00: We're just in this newer layer of it where information is democratized at an exorbitant speed and rate in comparison.
• 19:11
  SPEAKER_00: And so I do think long-winded answer, it is on health systems to train clinicians to be able to have those productive conversations so that patients feel heard.
• 19:26
  SPEAKER_00: We acknowledge the nuance between what actually happens in people's bodies and what AI may feed out, and we get to a good result for the patient and the clinician in the short amount of time that clinicians have to have these conversations.
• 19:40
  SPEAKER_01: I love that.
• 19:40
  SPEAKER_01: So for me, you know, I see patients, I have to see patients this afternoon, actually.
• 19:44
  SPEAKER_01: But um, I did a house call a week or two ago for a clinical research patient who had metastatic breast cancer.
• 19:51
  SPEAKER_01: And I was just there for the clinical trial pieces of it, but she had all these questions about her most recent skin, about her, you know, chemo drugs, et cetera.
• 20:02
  SPEAKER_01: And so I was there and I was able to actually interpret those for her and help her understand better.
• 20:06
  SPEAKER_01: But when I was Googling some of these newer chemo treatments, that again, I don't do oncology, I have no idea, but I know so much that when I Google something, I can tell you what is reputable information, et cetera.
• 20:19
  SPEAKER_01: And she said, Well, how did you how'd you figure that out?
• 20:23
  SPEAKER_01: Because I looked online, I just have no idea.
• 20:25
  SPEAKER_01: And I think the digital literacy piece is really important here because those user-friendly systems need to actually exist.
• 20:34
  SPEAKER_01: They need to somehow be able to be utilized in a proper fashion, like you mentioned, with the providers, with the actual healthcare organizations, but they also need to have that cultural context, that digital literacy context, because my 65-year-old plus white lady in rural upstate New York is gonna have different needs, expectations, and assumptions than my inner city, different language, different whatever patient, too.
• 21:00
  SPEAKER_01: And so I think one of the things that we still probably miss is that we treat all women the same as opposed to recognizing there's lots of different kinds.
• 21:12
  SPEAKER_00: Yeah.
• 21:13
  SPEAKER_00: And Sarah, we're actually doing an episode that's gonna be released um later this month.
• 21:18
  SPEAKER_00: It's August of 2026 if you're listening.
• 21:21
  SPEAKER_00: Um but it we interview a journalist, uh women's health journalist, Megan Rabbit, who has written the book, The New Rules on Women's Health, and we specifically dive into her chapter on how to use digital tools, right?
• 21:37
  SPEAKER_00: So, how do you Google like a physician?
• 21:41
  SPEAKER_00: How do you Google essentially like a healthcare journalist, right?
• 21:45
  SPEAKER_00: So she gives all these tips and strategies, and I forget the name of the term, but there's one term that she uses where you open up several screens on your laptop, right?
• 21:57
  SPEAKER_00: And you start fact checking what You're seeing and what you might get from a Google search or an AI search engine, and you verify that other known experts and leaders in the clinical space are saying the same thing.
• 22:12
  SPEAKER_00: And you do this before you go into your doctor, before you have a conversation, so that you know if the information you've got is of value, right?
• 22:21
  SPEAKER_00: You take a video that you see on TikTok and you go and you fact-check it laterally across different resources to make sure that it's actually the truth.
• 22:32
  SPEAKER_00: And you do that not just for your own healthcare, but you do it every time you think of hitting share on Instagram or TikTok and you're spreading that information further.
• 22:42
  SPEAKER_00: Um, so it's a really interesting conversation.
• 22:44
  SPEAKER_00: And I do think everyone's coming from a different place.
• 22:47
  SPEAKER_00: And I don't think that in healthcare as a whole, again, generalizing, um, we don't take that reality into consideration.
• 22:56
  SPEAKER_00: Like I've done a lot of work in my career on digital health equity and actually making sure that when we design these really great tools or that we think are really great tools, that patients can and will use them, right?
• 23:09
  SPEAKER_00: That they're not just, it's not just about putting something in Spanish, it's about making it fit within a culture that speaks Spanish.
• 23:20
  SPEAKER_00: It's not just about designing a fancy app, it's about making sure that people have Wi-Fi or Bluetooth access to be able to use and transmit their information to get the care that they need.
• 23:34
  SPEAKER_00: Um, so there's a lot of layers to this, and I think sometimes we're so excited to have something new, to have technology work in these wonderful ways.
• 23:45
  SPEAKER_00: Um, but we have to pause.
• 23:47
  SPEAKER_00: We have to pause before we implement things.
• 23:50
  SPEAKER_00: We have to pause while we're designing them, while they're being rolled out.
• 23:54
  SPEAKER_00: We just need to make sure that they're actually being used.
• 23:58
  SPEAKER_01: I think the metric selection is really important because a lot of times we're measuring something and it shows up great on the dashboard, but it doesn't actually indicate that we're doing the right things.
• 24:09
  SPEAKER_01: And when we disaggregate the data, and again, by cultural groups, by zip code, whatever it is, there's usually someone being left behind.
• 24:17
  SPEAKER_01: And you know what?
• 24:18
  SPEAKER_01: That doesn't mean don't use a tool.
• 24:19
  SPEAKER_01: It means is your organization okay with leaving that group behind, or do you want to actually remediate that in some fashion?
• 24:27
  SPEAKER_01: Because we need to be intentional and honest about it, as opposed to just saying, oh, well, overall, all women are doing great.
• 24:33
  SPEAKER_01: You're like, well, are all women doing great?
• 24:35
  SPEAKER_01: And are we okay with that?
• 24:37
  SPEAKER_00: Well, and I think that data stratification is so important, like collecting the right data, collecting it for all populations, and then stratifying it by the ones that you really want to pay attention to or to find out which ones you should pay attention to is really important.
• 24:55
  SPEAKER_00: Um, I have given some presentations and speeches and educational sessions in the past two years, and I always ask the audience, how many of you are stratifying data by sex?
• 25:08
  SPEAKER_00: So, how many of you are looking at what is happening differently between female and male?
• 25:15
  SPEAKER_00: And most people are not.
• 25:17
  SPEAKER_00: And if they raise their hand, they say they're doing it for maternity care, which does not apply to men.
• 25:23
  SPEAKER_00: So it's been really interesting to have that conversation and to see lights go on, right?
• 25:31
  SPEAKER_00: Because even when we've had this conversation in healthcare around data stratification, it's all been about real and soji data.
• 25:37
  SPEAKER_00: And we forget, like we go so quickly to race, ethnicity, language, that we forget that like gender and sex, right?
• 25:47
  SPEAKER_00: We for we forget that we could just divide it that easily.
• 25:51
  SPEAKER_00: And I did have one healthcare leader tell me in a conversation, well, we can't do that.
• 25:57
  SPEAKER_00: We don't we don't collect data.
• 25:58
  SPEAKER_00: And I looked at her and I said, You Bill, what are you talking about?
• 26:05
  SPEAKER_00: Which doctor's appointment have you ever gone to in your life where you have not answered whether you are male or female?
• 26:12
  SPEAKER_00: We collect that data like from every single patient all the time.
• 26:19
  SPEAKER_00: If you had to tell me one piece of data that I know everyone is collecting consistently, it'd be that one.
• 26:26
  SPEAKER_01: It's that it was I was at a doctor's appointment today for myself, and I think I filled that out as a new patient at least 10 times.
• 26:34
  SPEAKER_01: Yeah.
• 26:35
  SPEAKER_01: And so I hope they know now, but you know, it might not go in the system properly.
• 26:39
  SPEAKER_01: Who knows?
• 26:40
  SPEAKER_00: It might not, and you're always gonna have anomalies and nuance.
• 26:44
  SPEAKER_00: But to to say that you can't do it or that you don't have that data, I think, is somewhat of a cop-out when it comes to stratifying bisex.
• 26:56
  SPEAKER_01: So let's think about this from an executive perspective.
• 27:00
  SPEAKER_01: If a system has budget for one thing next fiscal year, what's the highest return move in women's health that you see today?
• 27:07
  SPEAKER_01: And what's that seductive one they should absolutely skip?
• 27:10
  SPEAKER_00: Okay.
• 27:11
  SPEAKER_00: So I think the best investment depends on the organization and the resources that they have available.
• 27:20
  SPEAKER_01: Set a cop out.
• 27:21
  SPEAKER_01: Come on, Priya, help me out here.
• 27:23
  SPEAKER_00: But you've got to look at the data.
• 27:24
  SPEAKER_00: It's true.
• 27:25
  SPEAKER_00: You've got to look at the data and you've got to look at what is happening in your community because not every community needs the same thing.
• 27:33
  SPEAKER_00: And I think that's really important in this work because if you say you want to take on women's health, it can be really, really overwhelming.
• 27:41
  SPEAKER_00: But start with who is in your patient population?
• 27:45
  SPEAKER_00: Do you have a lot of younger people versus older people?
• 27:50
  SPEAKER_00: And that will direct you into the right area.
• 27:53
  SPEAKER_00: Like I have talked to health systems where their birth rates are declining.
• 27:56
  SPEAKER_00: Birth rates are declining across the country.
• 27:59
  SPEAKER_00: Certain parts of our community, it has been more drastic, of our country, it has been more drastic than in other places.
• 28:05
  SPEAKER_00: And you wouldn't want to go into a community that has decreasing birth rate and spend all of your money on perinatal and maternity care programs.
• 28:17
  SPEAKER_00: You would want to say, okay, we have some of that, but if we're gonna try something new, perhaps we meet our patients at midlife because that's where a majority of them are, and we have gaps, right?
• 28:30
  SPEAKER_00: So it's not, it's what your patients need, it's where do you have gaps in your system?
• 28:35
  SPEAKER_00: Not everyone has the same gaps, right?
• 28:38
  SPEAKER_00: Some communities have really excellent clinicians that help women through perimenopause and menopause.
• 28:44
  SPEAKER_00: Others just don't.
• 28:46
  SPEAKER_00: And then it's filling it in, filling in the gaps on what are the right solutions?
• 28:51
  SPEAKER_00: Do you build by or partner to get them?
• 28:54
  SPEAKER_00: Do you partner with a midlife care provider like MIDI or Electra?
• 28:59
  SPEAKER_00: Do you build a team and roster yourself by training your clinicians on these topics?
• 29:05
  SPEAKER_00: Um, what do you do?
• 29:07
  SPEAKER_00: Like that is totally dependent on what the data shows you and what resources you have available.
• 29:12
  SPEAKER_00: So, yes, it sounds like a cop-out, but I think if every health system were to run and create a midlife clinic, or if every health system were to say, I'm gonna buy the state-of-the-art mammography machine, it might not meet the needs of their patients.
• 29:28
  SPEAKER_00: And I'm I'm talking now with one hospital that has no labor and delivery.
• 29:32
  SPEAKER_00: They're trying to find a front door to just get women into the into the hospital, into the community to know they even exist.
• 29:41
  SPEAKER_00: And in that case, maybe a good strategy is around preventive care.
• 29:45
  SPEAKER_00: Maybe that works for the numbers and the resources and what's available to their community.
• 29:51
  SPEAKER_00: It may not make sense to build a full midlife clinic.
• 29:54
  SPEAKER_00: It may not make sense to invest in an endometriosis expert when there is such a basic starting point.
• 30:02
  SPEAKER_00: So yeah, sorry it's a cop-out, but there is a lot of shine in the women's health space as well.
• 30:09
  SPEAKER_00: Um, there are a lot of startups.
• 30:13
  SPEAKER_00: Um, I can't keep up with the number of startups that are out there.
• 30:17
  SPEAKER_00: I think I know a lot of them that are designing really excellent solutions and they need the support of health systems because they can't build and grow on their own forever.
• 30:28
  SPEAKER_00: Um, I think those are great ones to look at.
• 30:30
  SPEAKER_00: I think there are some that are just out there floundering.
• 30:33
  SPEAKER_00: They want to solve a problem, they don't necessarily know how, they don't have opportunities to test it, grow it, it may not pan out to actually improve outcomes.
• 30:43
  SPEAKER_00: So there is some shine that needs to sort of be avoided, but I think you do your research and you pick the right partners that make sense for what you need to accomplish.
• 30:55
  SPEAKER_01: So when you're assessing a strategy team, the executive team, the organization for readiness to move forward with a women's health strategy, what do you think is probably the one thing that will make them the most successful?
• 31:08
  SPEAKER_01: Um, as an example, like when I am evaluating the next women's health product or startup, I look at specific things and I know if we're gonna be successful or not within five minutes.
• 31:20
  SPEAKER_01: So when you're doing this assessment with delivery systems, what's the thing that you're seeing the most that says, yeah, you guys aren't gonna win here?
• 31:29
  SPEAKER_00: Yeah, I think it's the willingness to learn what is taking place in women's health, the willingness to understand the breadth and scope, the willingness of leaders to sit down and say, Oh, this is what other health systems are doing to tackle this.
• 31:47
  SPEAKER_00: How can we implement something similar, but in a way that works for our community?
• 31:53
  SPEAKER_00: Um, that willingness to accept that everything doesn't need to be done today and to put together a plan that is stepwise over two years, five years.
• 32:05
  SPEAKER_01: Well, you want to actually make a plan and actually execute it.
• 32:09
  SPEAKER_01: Hold on.
• 32:10
  SPEAKER_01: I think this might be a new thing for many people in healthcare.
• 32:13
  SPEAKER_01: It's it's you know, let's let's make sure they all get this one.
• 32:16
  SPEAKER_01: We'll put it in the show notes.
• 32:18
  SPEAKER_01: Absolutely.
• 32:19
  SPEAKER_00: Yeah, so I think it's that I think it's that willingness, right, to learn, to understand, and to grow in a way that can be sustainable.
• 32:29
  SPEAKER_00: Because if you try to do everything all at once, it's not gonna be sustainable.
• 32:34
  SPEAKER_00: And I think, you know, the number one sort of leave behind I give to hospitals that I'm working with is pick something that you can win on and have that be the first thing that you do and make it something that you can win on fairly quickly because that will help get the speed and the momentum you need to continue building and growing.
• 33:02
  SPEAKER_00: And so if you identify, for example, that you know, women need remote patient monitoring at home throughout their pregnancy and in the first year postpartum, find a partner that can help you bring that in.
• 33:16
  SPEAKER_00: Find the patient, the clinical champions that will help you do the change management you need in your organization and get that up and running and start to show how many women you are helping, how outcomes have improved, how you've brought patients in quickly when they've had challenges or alarming numbers.
• 33:37
  SPEAKER_00: Show that, and then you get to build the bigger things.
• 33:43
  SPEAKER_01: So to kind of wrap up our discussion on this one, what's the thing you believe about women's health that most of your peers in this space would argue with?
• 33:54
  SPEAKER_00: I don't think we can do it in silos.
• 33:57
  SPEAKER_00: Um, I've had a number of conversations with startups in my work about what they're building, how they're building it on their own without partnership of hospitals and health systems or partnership of payers, and it's all direct to consumer.
• 34:18
  SPEAKER_00: And I don't think that that is sustainable.
• 34:23
  SPEAKER_00: And when we think about how some of these startups are being funded by venture, the goal is to grow very quickly, and that doesn't always align with the time it takes to build relationships with hospitals and health systems and payers.
• 34:41
  SPEAKER_00: But that doesn't mean it is something you shouldn't do.
• 34:45
  SPEAKER_00: I think you absolutely have to acknowledge that it takes time to build these relationships, and that's just something you have to plan around, right?
• 34:55
  SPEAKER_00: You need to have your direct-to-consumer strategies to keep the business going, to get the evidence that you need, but you also need to be investing time in building relationships with these right partners so that everything gets connected in a way that makes sense for the patients that you're serving and the outcomes that you want to achieve over time.
• 35:17
  SPEAKER_00: Now that's sort of the startup side.
• 35:20
  SPEAKER_00: On the hospital and health system side, I think they need to learn how to move quicker.
• 35:25
  SPEAKER_00: I think that there are steps that they can take to implement these things at a quicker pace.
• 35:30
  SPEAKER_00: I think they can be more transparent in the communications that they have with startups to level set about time and red tape that needs to sort of be addressed in the partnership process.
• 35:45
  SPEAKER_00: Um, I don't think this is a one-sided thing.
• 35:48
  SPEAKER_00: Like any relationship, it is two-sided.
• 35:50
  SPEAKER_00: And so I truly believe that if we are gonna advance women's health, we have to take the innovation from this startup space.
• 35:59
  SPEAKER_00: We have to take the funding that we're getting from VC, and we have to connect it to the actual places where people are showing up to get care and to the infrastructure system we have that is paying for that care right now.
• 36:14
  SPEAKER_00: And if we can't figure out how to do that, it's not gonna really move forward in a meaningful way.
• 36:21
  SPEAKER_00: But each part is important, each part is a really valuable part.
• 36:26
  SPEAKER_00: And I go to conferences on the hospital side where they think they're the most important part.
• 36:31
  SPEAKER_00: And I go to conferences with VC and startups, and they think they're the most important part, and really we all need each other to sort of move forward.
• 36:39
  SPEAKER_01: Well, Priya, thank you so much for your time today.
• 36:42
  SPEAKER_01: You have kind of reframed everything into a thought process that I definitely want to dig into myself, and I love it.
• 36:49
  SPEAKER_01: So for anyone who wants to go deeper, where they where can they find you?
• 36:53
  SPEAKER_00: Yeah, so I um am in a lot of places on the internet.
• 36:58
  SPEAKER_00: So um for me personally, LinkedIn is the best place to find me for my company New Health, which is NYO Health.
• 37:07
  SPEAKER_00: Um, we have a website, newhealth.com.
• 37:09
  SPEAKER_00: Um, and then for the podcast, you can listen to the Women's Health Playbook wherever you listen to podcasts or um catch it all on women's healthplaybook.com.
• 37:19
  SPEAKER_01: I love it.
• 37:19
  SPEAKER_01: So that's the clinical realist for today.
• 37:21
  SPEAKER_01: If this changed how you think about what your data is and what it isn't telling you, share with a person on your leadership team who owns the AI roadmap and the women's health roadmap.
• 37:29
  SPEAKER_01: I'm Dr.
• 37:30
  SPEAKER_01: Sarah Matt.
• 37:30
  SPEAKER_01: We'll talk to you soon.