Latest / Becker’s Healthcare Podcast / Joanne Armstrong, MD on Expanding Access and Personalizing Women's Healthcare

Transcript

Joanne Armstrong, MD on Expanding Access and Personalizing Women's Healthcare · Becker’s Healthcare Podcast

• 0:02
  - Every health system executive right now is being
• 0:04
  - asked to do something that has no useful
• 0:06
  - precedent,
• 0:07
  - make durable technology decisions in an environment that
• 0:10
  - looks meaningfully different every six months.
• 0:13
  - The pace isn't slowing,
• 0:14
  - the vendor landscape isn't getting simpler, and the
• 0:17
  - cost of missteps keeps rising.
• 0:19
  - Becker's eleventh annual IT and Revenue Cycle Conference,
• 0:23
  - The Future of AI and Digital Health, exists
• 0:25
  - for exactly this challenge.
• 0:27
  - Here, you'll find more than 2,500 executive level
• 0:30
  - attendees,
• 0:31
  - 600 plus speakers, and four days of sessions
• 0:34
  - built around the questions leaders are actually wrestling
• 0:36
  - with.
• 0:37
  - How to scale AI responsibly,
• 0:39
  - how to protect increasingly complex systems,
• 0:42
  - how to wring more performance out of the
• 0:44
  - revenue cycle, and how to make tech investments
• 0:46
  - that hold up over time.
• 0:48
  - Join us September fourteenth through the seventeenth at
• 0:51
  - the Hilton Chicago.
• 0:53
  - You can register on our events page at
• 0:55
  - beckershospitalreview.com
• 0:57
  - by clicking on the events tab in the
• 0:59
  - upper right.
• 1:00
  - Welcome to the Women's Leadership Podcast hosted by
• 1:03
  - Becker's Healthcare. My name is Paige Twenter. I'm
• 1:06
  - an editor at Becker's Healthcare, and I'm so
• 1:08
  - thrilled to be interviewing doctor Joanne Armstrong today.
• 1:11
  - Thank you so much for joining me. Before
• 1:13
  - we dive in, doctor Armstrong, I'd love to
• 1:15
  - have you kinda introduce yourself and tell us
• 1:17
  - a bit about your background.
• 1:19
  - Great. Thank you, Paige. Thanks for inviting me.
• 1:22
  - So I am the chief medical officer and
• 1:24
  - vice president for women's health,
• 1:26
  - and personalized medicine at CVS Health. By way
• 1:30
  - of background,
• 1:31
  - I've had a long career both in,
• 1:35
  - sort of the implementation of policy
• 1:37
  - now through CVS Health. And I also have
• 1:39
  - had a long career as a practicing obstetrician
• 1:42
  - gynecologist
• 1:43
  - in many different settings from academic to community
• 1:46
  - health centers,
• 1:47
  - all different patient population types. I'm currently a
• 1:50
  - professor of OB GYN at the University of
• 1:51
  - Texas in,
• 1:53
  - Houston. From a CVS,
• 1:55
  - perspective, really my role is
• 1:57
  - to think about to drive strategy and innovation
• 2:01
  - and how we,
• 2:03
  - use all the capabilities within CVS Health to
• 2:06
  - really improve
• 2:07
  - access for women's healthcare quality and bring this
• 2:10
  - at a national scale.
• 2:12
  - And we have this, enormous set of capabilities
• 2:15
  - to do that because of the types of
• 2:18
  - businesses,
• 2:19
  - that we,
• 2:20
  - that we have in this space.
• 2:22
  - Some of those include about a thousand
• 2:25
  - primary care clinics in the form of MinuteClinic
• 2:28
  - and, they provide
• 2:31
  - both episodic and longitudinal women's healthcare services.
• 2:35
  - We, within Aetna,
• 2:36
  - there are about 23,000,000
• 2:38
  - Americans who get their health benefits through Aetna.
• 2:40
  - About 200,000
• 2:42
  - deliveries a year.
• 2:44
  - Our coverage for that is provided within Aetna.
• 2:47
  - From just a retail clinic perspective, we have
• 2:50
  - about 9,000
• 2:52
  - of those and
• 2:54
  - 85% of Americans live within
• 2:56
  - about 10 miles of the CVS,
• 2:59
  - retail space. So it's really a large space
• 3:02
  - when you think about
• 3:03
  - closing gaps for care in women's health, making
• 3:06
  - care more accessible,
• 3:08
  - more affordable,
• 3:10
  - really across the, across The US healthcare
• 3:12
  - ecosystem.
• 3:14
  - And then something that's really important in our
• 3:16
  - environment is about 70% of the 300,000
• 3:19
  - colleagues
• 3:20
  - who work at CVS are women.
• 3:22
  - And we use those,
• 3:24
  - you know, not used, but we work with
• 3:26
  - women in our own,
• 3:28
  - you know, in our own company to sort
• 3:29
  - of understand what the needs are, to think
• 3:31
  - innovatively about how we deliver
• 3:33
  - solutions to close some of the gaps that
• 3:35
  - women experience and to help overcome some of
• 3:38
  - the unique challenges that women have in their
• 3:40
  - receipt of health care services.
• 3:42
  - 70%
• 3:43
  - of women in the workforce, that's that's amazing,
• 3:46
  - I think.
• 3:48
  - So, obviously, you know, you mentioned,
• 3:50
  - obviously, CVS sits at the intersection of pharmacy
• 3:53
  - benefits,
• 3:54
  - insurance with Aetna, retail health with the 9,000
• 3:57
  - locations, and then, of course, the Minute Clinic,
• 3:59
  - or primary care clinic. So how is CVS
• 4:03
  - translating or you and your role translating clinical
• 4:06
  - insights
• 4:07
  - from women's health into
• 4:09
  - measurable
• 4:10
  - outcomes
• 4:11
  - that, you know, employers or health plans can
• 4:14
  - actually act on?
• 4:16
  - Yeah. So I I think it starts with
• 4:18
  - sort of understanding what is women's health.
• 4:21
  - Sometimes folks think that it's, restricted
• 4:23
  - to sort of a smaller
• 4:25
  - I won't call it a niche area, but
• 4:27
  - a smaller area of pregnancy, say, in infertility
• 4:30
  - care. But it's really much larger.
• 4:33
  - And we start by looking at the data.
• 4:35
  - I'm
• 4:36
  - trained in epidemiology. I'm a little bit of
• 4:37
  - a data geek, so I like to think
• 4:39
  - about health care this way. You know, what
• 4:41
  - what is the size?
• 4:43
  - Who are we actually talking about? So in
• 4:45
  - health care, we first from a cost perspective,
• 4:48
  - we spend about about,
• 4:50
  - $5,000,000,000,000
• 4:51
  - or so in
• 4:53
  - both direct health care services
• 4:55
  - and wellness services. Women influence about 80% of
• 4:59
  - that either directly receiving these services or coordinating
• 5:02
  - them for their family. So there's it's just
• 5:04
  - a it's a very large space.
• 5:06
  - Within it when you think about what that
• 5:08
  - space is it is you know traditional women's
• 5:11
  - health as we talk about
• 5:13
  - but there are areas of health care services
• 5:17
  - that are either dominantly experienced by women in
• 5:20
  - fact they are the major you know, the
• 5:22
  - the dominant person who experiences these conditions. Those
• 5:25
  - things include things like,
• 5:28
  - migraines,
• 5:29
  - even obesity,
• 5:32
  - behavioral health needs. And then there's these other
• 5:34
  - services that are
• 5:35
  - that are differentially expressed in women. And when
• 5:38
  - you think about both, you know, exclusively experienced
• 5:41
  - conditions,
• 5:42
  - disproportionately experienced conditions,
• 5:45
  - and conditions that are differentially expressed, it's really
• 5:48
  - a large,
• 5:49
  - body, right,
• 5:51
  - of clinical opportunity.
• 5:53
  - When we think about the gaps that women
• 5:56
  - have
• 5:57
  - some of those are access that are unique,
• 5:59
  - right? Access gaps, we have all sorts of
• 6:02
  - care deserts of all types maternity care deserts
• 6:06
  - you know, genetics care deserts,
• 6:08
  - primary care deserts across The United States. So,
• 6:10
  - a lot of people have real challenges getting
• 6:12
  - health care services.
• 6:14
  - There's also an affordability
• 6:16
  - issue. Women have particular,
• 6:18
  - challenges there just because of the amount that
• 6:20
  - they make and the disproportional burden they have
• 6:23
  - for caring for families.
• 6:25
  - So, we need, you know, when my team
• 6:27
  - leans into thinking about
• 6:29
  - how we close access gaps,
• 6:31
  - how we lean into the unique challenges and
• 6:33
  - the unique solutions for women. So really thinking
• 6:36
  - about how do we use telephonic health, right,
• 6:39
  - which increases access immediately. And we've done some
• 6:42
  - tremendous work in behavioral health, telephonics,
• 6:45
  - all of the primary care services and MinuteClinics,
• 6:47
  - the ones that can be delivered telephonically.
• 6:50
  - We worked in developing those,
• 6:52
  - to overcome access. So we think about telephonic,
• 6:55
  - we think about digital,
• 6:57
  - delivery, and we think about retail health delivery
• 6:59
  - of services. And it turns out women are
• 7:02
  - about 1.7 times more likely to use these
• 7:04
  - services
• 7:05
  - than men, you know, if they are available.
• 7:07
  - So we really lean into that.
• 7:09
  - And then the last, piece that we lean
• 7:11
  - into is sort of education,
• 7:14
  - and how do we talk about services so
• 7:16
  - that people
• 7:18
  - are, are hearing it, right, so that they're
• 7:20
  - not stigmatized
• 7:22
  - and that they sort of build their own
• 7:23
  - power agency to sort of, receive healthcare services
• 7:27
  - that they need.
• 7:28
  - So those are, you know, when we think
• 7:30
  - about these are the pillars of how we
• 7:32
  - try to,
• 7:33
  - really address the unique needs of women, those
• 7:36
  - are the three pillars that we design around.
• 7:39
  - One thing you, mentioned that I wanna ask
• 7:42
  - more about definitely is, you mentioned telephonic and,
• 7:45
  - obviously,
• 7:47
  - digital delivery of care
• 7:48
  - and how that's improving access. What metrics
• 7:51
  - are you all using
• 7:54
  - to define, you know, increased access?
• 7:57
  - We actually directly,
• 8:00
  - you know, evaluate the number of people that
• 8:02
  - are using these services. So we we start
• 8:04
  - with the creation. Right? We actually start with
• 8:06
  - what is the landscape need for this,
• 8:09
  - what solutions are in place,
• 8:11
  - where can what's the white space, how can
• 8:13
  - we close these gaps. And then we work
• 8:16
  - with our colleagues and the resources across our
• 8:18
  - company
• 8:19
  - to develop solutions. We may be working with
• 8:22
  - MinuteClinic,
• 8:23
  - as I said, for primary,
• 8:25
  - care, including those services that can be delivered
• 8:27
  - telephonically.
• 8:29
  - We work, with our Aetna colleagues to create
• 8:31
  - benefits that are available telephonically
• 8:34
  - or even, with, you know, our Caremark colleagues
• 8:37
  - for some of the,
• 8:38
  - some of the solutions that they have. And
• 8:40
  - then we, you know, we design, we develop,
• 8:43
  - we put these into the market, and then
• 8:44
  - we use a number of tools to make
• 8:46
  - sure that the people we serve, you know,
• 8:48
  - have access to those.
• 8:49
  - And then we measure the impact of it
• 8:51
  - directly, how many people are using these services.
• 8:55
  - From
• 8:56
  - a business point business standpoint, I just wanna
• 8:58
  - talk about women's leadership and
• 9:01
  - health care industry, specifically. Where do you see
• 9:05
  - the most consequential
• 9:06
  - gaps right now in that space? What is
• 9:09
  - it cost organizations
• 9:11
  - in concrete terms if those voices are missing
• 9:13
  - from benefits design or clinical program development?
• 9:18
  - You know, I I think it's really important
• 9:20
  - to have women at the table to talk
• 9:22
  - about women's health. When you directly experience it,
• 9:25
  - including, you know, the challenges, the gaps, and
• 9:28
  - what the receipt of services look like, it
• 9:30
  - changes the conversation.
• 9:32
  - We and I can tell you, like, personally,
• 9:34
  - I experience that if I'm in a room
• 9:36
  - talking to benefit managers that are women versus
• 9:39
  - men. It's a different initial understanding of what
• 9:42
  - we're talking about. But overall, regardless of who's
• 9:44
  - hearing, we know that women have said that
• 9:47
  - they need more
• 9:49
  - benefits and personalized benefits
• 9:52
  - to meet their unique needs.
• 9:54
  - We know from
• 9:56
  - just now in a benefit environment
• 9:59
  - about 70%
• 10:00
  - of healthcare benefit leaders
• 10:02
  - recognize the need for more personalized benefits for
• 10:05
  - women.
• 10:06
  - And so that's one of the things that
• 10:08
  - we are kind of responding to creating those
• 10:10
  - so that they make sense. And then then
• 10:12
  - there's some data around the specific ones that
• 10:15
  - women need.
• 10:16
  - Menopause, for example, and midlife care is something
• 10:19
  - that is very topical right now. And some
• 10:22
  - of the data that we have from there
• 10:23
  - are the impact for employers is significant. There's
• 10:27
  - about,
• 10:28
  - 1.8
• 10:29
  - billion dollars of lost productivity
• 10:32
  - in this. About twelve, thirteen percent of women
• 10:35
  - say that they have left the workforce,
• 10:37
  - because of the inability to manage the symptoms
• 10:40
  - and which of menopause and midlife care which
• 10:42
  - are really, can be very disruptive and very
• 10:45
  - problematic.
• 10:46
  - So we have worked, you know, in that
• 10:48
  - environment to, meet the needs of women.
• 10:51
  - And it's a, you know, it's an interesting
• 10:53
  - space because of the large size of the
• 10:54
  - demographic
• 10:55
  - and the long duration, you know, twelve or
• 10:58
  - fifteen years of this life transition.
• 11:00
  - So it has real clinical importance, but it
• 11:02
  - also has workplace and productivity
• 11:05
  - importance.
• 11:06
  - And, of course, financial importance for these for
• 11:09
  - any organization.
• 11:10
  - Right? Financial.
• 11:12
  - Right.
• 11:13
  - We only have a few minutes left, unfortunately,
• 11:16
  - for our,
• 11:17
  - podcast today. Is there anything we haven't talked
• 11:20
  - about yet that you think would be remiss
• 11:21
  - if we didn't mention?
• 11:24
  - I I think what's important when when women's
• 11:26
  - health is that women, you know, they they
• 11:28
  - there are a lot of gaps. We talked
• 11:30
  - a little bit about menopause, but when we
• 11:32
  - think about common chronic disease, you know,
• 11:36
  - obesity,
• 11:37
  - migraines, autoimmune disease, these conditions, about seventy percent
• 11:41
  - of them,
• 11:42
  - are experienced by women. So we need more
• 11:45
  - personalized solutions for them. They become an enormous
• 11:48
  - cost issue. Right? These are among the most
• 11:50
  - costly,
• 11:51
  - conditions that employers face,
• 11:54
  - that,
• 11:55
  - patients face and we really don't have solutions,
• 11:58
  - for women. So we are working with a
• 12:00
  - range of partners inside and outside, CVS Health
• 12:04
  - to think about, like, how we personalize this,
• 12:07
  - what we can move forward. I'll just give
• 12:09
  - you one quick example.
• 12:11
  - We, in Caremark,
• 12:13
  - we, have a weight management,
• 12:16
  - program,
• 12:17
  - to address really some of the issues that
• 12:19
  - go along with this epidemic of obesity.
• 12:22
  - We just did some research that identified that
• 12:24
  - about seventy eight percent of the people who
• 12:27
  - use that weight management program are female
• 12:30
  - and
• 12:32
  - the majority of those, actually seventy seven percent
• 12:35
  - say that this really accelerated during menopause. When
• 12:37
  - you think about a weight management program
• 12:40
  - and you were thinking about personalizing it for
• 12:43
  - women, you need to bring these two clinical
• 12:45
  - conditions together. Weight management and obesity
• 12:48
  - to think about what are the solutions, right?
• 12:51
  - How do you understand it? What's the role
• 12:53
  - of hormones?
• 12:54
  - What's the access issue for hormones?
• 12:56
  - So that that in that particular case it's
• 12:59
  - you know, it is personalized to them so
• 13:01
  - that the solution is more than just, you
• 13:03
  - know, GLP ones which are important
• 13:05
  - but over the course of a lifetime,
• 13:08
  - right, we need to think about how wellness
• 13:11
  - plays into that and what does it mean
• 13:12
  - for each subset of the population you're talking
• 13:15
  - about and if that population tends to be
• 13:17
  - dominantly female and a dominant age band then
• 13:20
  - you need to personalize solutions to it So
• 13:23
  - I just use that as an example of
• 13:25
  - how we bring
• 13:26
  - like, clinical thought leadership
• 13:29
  - into,
• 13:30
  - really in into a benefit design and a
• 13:33
  - benefit access issue, that ultimately serves women and
• 13:37
  - serves employers.
• 13:39
  - It's almost or it is like the recognition
• 13:41
  - of,
• 13:42
  - the intersectionality
• 13:44
  - of different patient groups, like you were saying
• 13:47
  - before, like the overlap of,
• 13:49
  - weight loss program participants
• 13:52
  - who, are going through menopause.
• 13:54
  - Right? So it's
• 13:56
  - I I I guess I'm just copying you
• 13:58
  - on what you're saying. I I just I'm
• 13:59
  - interested in, like, that personalization
• 14:01
  - aspect and that design.
• 14:03
  - Yeah. No. So that that is it that
• 14:05
  - is it. And we talk about access. We
• 14:07
  - talk about affordability, and we talk about personalization.
• 14:10
  - And those are actually the three pillars that
• 14:12
  - we, you know, that we program around. What
• 14:14
  - is the access gap? It's wellness issues that
• 14:17
  - are personalized to women. Right? How do you
• 14:20
  - deliver it? Telephonically,
• 14:22
  - retail health, you know, enabled?
• 14:24
  - And then how do you talk about it?
• 14:27
  - How do you make sure that you are
• 14:28
  - responding to the actual real issues that people
• 14:30
  - have so that they can stay on their
• 14:32
  - wellness journey?
• 14:33
  - Well, thank you so much, doctor Armstrong for
• 14:36
  - joining us on the, you know, Becker's healthcare
• 14:38
  - podcast today and sharing your insights. I really
• 14:40
  - appreciate it. That's all the time we have
• 14:43
  - today, unfortunately, but thank you again. Thanks for
• 14:45
  - inviting me.