Latest / Becker’s Payer Issues Podcast / Addressing Food Insecurity through Innovative Programs: Dr. Crystal Clark, the CMO for the Community Health Choices Program at UPMC Health Plan

Transcript

Addressing Food Insecurity through Innovative Programs: Dr. Crystal Clark, the CMO for the Community Health Choices Program at UPMC Health Plan · Becker’s Payer Issues Podcast

• 0:00
  Hello everyone. This is Jacob Emerson with the
• 0:02
  Becker's Pay Your Issues Podcast. Thrilled today to
• 0:04
  be joined by a very special guest. Doctor.
• 0:07
  Crystal Clark is the Chief Medical Officer for
• 0:09
  the Community Health Choices Program at UPMC
• 0:12
  Health Plan. Doctor Clark, thank you so much
• 0:15
  for taking the time to be with me
• 0:16
  on the podcast today.
• 0:18
  Oh, thank you, Jacob. I'm happy to be
• 0:20
  here.
• 0:21
  So doctor Clark, tell us a little bit
• 0:23
  about yourself. What's your background in terms of,
• 0:26
  your career background in health care, and what
• 0:29
  it is that you're doing today at UPMC?
• 0:33
  Sure. I I'm a internal medicine physician by
• 0:36
  training,
• 0:37
  and I've been
• 0:39
  a physician executive. So leadership roles in health
• 0:42
  plans and hospital systems
• 0:45
  and in some government agencies for the last
• 0:48
  15 years, but I started off as a
• 0:50
  internal medicine physician taking care of adults in
• 0:53
  the community and in the hospital,
• 0:55
  mostly in urban settings
• 0:58
  and transitioned into more executive roles after I
• 1:01
  realized that while I enjoy taking care of
• 1:04
  patients,
• 1:05
  I was really interested in the things that
• 1:08
  drive,
• 1:09
  healthy
• 1:10
  outcomes, and,
• 1:12
  chronic disease
• 1:13
  was one of the issues that really kept
• 1:15
  me up at night. How do we improve
• 1:17
  that? How do we decrease
• 1:18
  the rates of chronic disease in so many
• 1:20
  of our patients and and Americans? And so
• 1:24
  I transitioned into more leadership roles, more training
• 1:27
  and quality,
• 1:28
  information technology,
• 1:31
  health equity,
• 1:32
  and,
• 1:34
  transitioned then to UPMC,
• 1:37
  in a role for a specific type of
• 1:39
  insurance program
• 1:41
  called Community Health Choices,
• 1:43
  which doesn't just provide
• 1:45
  traditional health insurance for medical things like appointments
• 1:49
  and prescriptions and things like that. We also
• 1:51
  provide for a good portion of this particular
• 1:55
  contingent of Pennsylvanians.
• 1:57
  We also provide in home support, so personal
• 2:00
  attendants,
• 2:01
  medically tailored meals, transportation, things of that nature,
• 2:04
  because
• 2:05
  we realize that some,
• 2:08
  folks need
• 2:09
  social supports as well as traditional medicine
• 2:12
  to get well or or try and get
• 2:14
  to live their best life. So
• 2:17
  that is,
• 2:18
  the role I'm in now,
• 2:19
  with UPMC.
• 2:20
  It
• 2:21
  it actually is,
• 2:23
  I think, a perfect fit for me,
• 2:25
  from my journey
• 2:27
  in in trying to achieve equity for for
• 2:29
  all people.
• 2:30
  Absolutely. It sounds like it. And it really
• 2:32
  sounds like you're providing wraparound
• 2:35
  health care to to those populations that you
• 2:37
  serve.
• 2:39
  In that vein, Crystal, I wanna talk with
• 2:41
  you, about an issue that we hear about
• 2:44
  so often nowadays from health plans, from health
• 2:46
  systems,
• 2:47
  a social determinants that they are constantly looking
• 2:50
  for new ways to address, and that is
• 2:53
  food insecurity.
• 2:54
  I know this isn't an issue very familiar
• 2:56
  to you in terms of the work that
• 2:58
  you do. So
• 2:59
  let's level set for a second, and if
• 3:02
  you wouldn't mind explaining to our audience,
• 3:05
  what is food insecurity in terms of what
• 3:07
  does it look like on the ground,
• 3:10
  among the population that you serve, and and
• 3:12
  just how pervasive of an issue is it
• 3:14
  today?
• 3:16
  Well, it's a it's it's a really big
• 3:18
  issue, Jacob. Let me just first define it.
• 3:21
  So
• 3:22
  food insecurity
• 3:23
  is defined as the lack of consistent and
• 3:26
  dependable
• 3:27
  access to nutritious foods
• 3:29
  that are necessary
• 3:31
  to maintain optimal health.
• 3:33
  So
• 3:34
  consistent and dependable
• 3:36
  access to the foods you need to stay
• 3:39
  healthy.
• 3:40
  The term food insecurity
• 3:41
  is
• 3:42
  relatively new, 1995
• 3:44
  or so, started by the, USDA,
• 3:47
  but it it's been an issue for as
• 3:49
  long as we can remember.
• 3:51
  You know, you can remember hearing peep people
• 3:54
  talk about,
• 3:55
  chicken soup when you're sick or making sure
• 3:58
  that you eat well to help you recover.
• 4:00
  So we've we've known the relationship between good
• 4:03
  food and good health for quite some time,
• 4:05
  but the federal government got in the into
• 4:08
  this to really take us to the next
• 4:11
  level,
• 4:12
  define it,
• 4:13
  fund it, monitor it, pull together partnerships
• 4:17
  because it's become such a a big issue.
• 4:19
  So so let's talk about the size of
• 4:21
  it.
• 4:22
  About one out of every 8
• 4:25
  American adults experience some type of food insecurity.
• 4:29
  So at some point in their months,
• 4:32
  they either have,
• 4:34
  inadequate food or significantly
• 4:36
  inadequate food to last the entire month.
• 4:39
  And when we looked at this data
• 4:41
  in a survey done by the, Census Bureau,
• 4:44
  it was a specific household study done in
• 4:47
  2023,
• 4:48
  they found that,
• 4:50
  about 12%
• 4:52
  of Americans
• 4:54
  in this survey
• 4:55
  sometimes or often did not have enough to
• 4:58
  eat in the preceding week.
• 5:00
  So you say, well, 12%,
• 5:02
  that's not great, but that means 88%
• 5:04
  of Americans
• 5:06
  do. They do have enough food.
• 5:08
  Well, 12% in the US represents about 28,000,000
• 5:12
  people.
• 5:13
  So the percentage is small, but the impact
• 5:15
  is huge.
• 5:17
  So it's it's a really, really important issue.
• 5:20
  The last thing I would say, Jacob,
• 5:23
  is when we've looked at
• 5:25
  overall health and and I I think this
• 5:27
  is a really important point.
• 5:30
  Many times, we think a person's health is
• 5:32
  dependent
• 5:34
  on their access to high quality health care.
• 5:37
  And make no mistake. It is very important.
• 5:39
  At UPMC, we know
• 5:41
  that good medical care can make the difference.
• 5:43
  Our our our logo is life changing medicine.
• 5:47
  But the data also tells us when you
• 5:49
  look at a person's overall health and wellness,
• 5:53
  only 20%
• 5:55
  is determined
• 5:57
  by the access to good medical care. The
• 6:00
  other 80%
• 6:02
  is driven by
• 6:04
  their access to a health physical environment, their
• 6:07
  access to healthy food, their access to employment,
• 6:11
  their access to good education, what we call
• 6:13
  the social determinants of health.
• 6:15
  So
• 6:16
  if you are interested in life changing medicine
• 6:19
  like we are at UPMC,
• 6:21
  you have to continue to give, you know,
• 6:23
  world class care, which we do, which will
• 6:26
  be responsible for about 20% of our patients'
• 6:29
  overall health and wellness, but then you have
• 6:31
  to partner with other organizations
• 6:33
  to help address that other 80%
• 6:36
  that allows to drive the the rest of
• 6:38
  the goal home of of optimal health.
• 6:40
  Absolutely. And that's such a great way you've
• 6:43
  phrased that earlier,
• 6:44
  Crystal, in terms of 12% of Americans experiencing
• 6:48
  food insecurity or not having enough access to
• 6:50
  the food they need. But but to your
• 6:52
  point that that represents a very large amount
• 6:55
  of people, 28,000,000
• 6:56
  people. And and I assume a lot of
• 6:58
  those are in are in Pennsylvania as well.
• 7:01
  So so Crystal talk to us a little
• 7:03
  bit about, you know, we we've heard critics
• 7:05
  say to us before, it's not the role
• 7:07
  of health systems or health plans,
• 7:09
  to be addressing social determinants. That it's it's
• 7:12
  up to government policies or the private sector.
• 7:14
  So what would you how would you respond
• 7:16
  to that? Why is it such an important
• 7:17
  issue
• 7:18
  for UPMC
• 7:20
  specifically, to be addressing these social determinants?
• 7:24
  Well, I think it's
• 7:26
  you can come at this many different ways,
• 7:28
  Jacob.
• 7:29
  You know?
• 7:30
  I think that having access
• 7:32
  to the food that you need,
• 7:35
  to live a healthy life is a human
• 7:37
  right.
• 7:38
  In addition,
• 7:39
  we've looked at the the data. We look
• 7:42
  we we watch the televisions. We talk to
• 7:44
  people.
• 7:45
  When we don't help people achieve,
• 7:48
  optimal
• 7:49
  diet and
• 7:51
  feeling like they have what they need to
• 7:53
  be healthy, it manifests itself in other ways.
• 7:58
  So more chronic disease, for example,
• 8:01
  food insecurity, believe it or not, is tied
• 8:03
  to obesity. It is not the primary driver,
• 8:06
  but it is a factor. Because when you
• 8:09
  have
• 8:10
  small amounts of income and you're trying to
• 8:12
  preserve your ability to feed yourself and feed
• 8:15
  your family for months,
• 8:16
  you often pick low cost items that usually
• 8:19
  are not the healthiest calories.
• 8:22
  And so you tend to actually gain weight,
• 8:25
  unhealthy weight,
• 8:27
  because you're food insecure.
• 8:29
  We know that in children who don't have
• 8:31
  adequate nutrition,
• 8:32
  they can't concentrate in school, they're fatigued,
• 8:35
  so their educational
• 8:37
  progress is compromised.
• 8:39
  And we know that people who,
• 8:42
  are food insecure,
• 8:43
  you know, often can't maintain employment, again, because
• 8:47
  of fatigue and energy levels and concentration.
• 8:50
  So
• 8:52
  it's it it's the the evidence is out
• 8:54
  there that this is
• 8:56
  everybody's
• 8:57
  problem. And if we don't address it as
• 9:00
  a entire nation,
• 9:01
  we end up paying the price for it
• 9:04
  in some way or another.
• 9:06
  Absolutely.
• 9:07
  No.
• 9:08
  Amazing insights, Crystal, that this is just a
• 9:10
  trickle down effect if you do not address
• 9:12
  the root of the problem. And in that
• 9:14
  vein, what are some of the efforts that
• 9:16
  UPMC is doing to address the root of
• 9:19
  this issue, to to take on food insecurity
• 9:22
  in in your communities?
• 9:24
  So UPMC,
• 9:26
  has been
• 9:27
  in the food as, as medicine space for
• 9:30
  quite some time.
• 9:31
  We started years ago,
• 9:34
  with a
• 9:35
  prescription for wellness program
• 9:38
  where our primary care providers had the ability
• 9:41
  to actually write a prescription
• 9:44
  to patients saying exercise
• 9:46
  or eat healthy diet or use more fresh
• 9:48
  vegetables
• 9:49
  and fruits.
• 9:50
  And the literature has told
• 9:53
  us when that type of discussion comes from
• 9:55
  the physician,
• 9:56
  the uptake is better. So we have we've
• 9:59
  been doing programs like that for quite some
• 10:01
  time, but then in 2019,
• 10:04
  we launched something called the Center For Social
• 10:07
  Impact
• 10:07
  within UPMC,
• 10:09
  within our another center called the Center For
• 10:11
  High Value Health Care.
• 10:13
  And the point there was,
• 10:15
  why don't we find out and
• 10:18
  what it takes
• 10:19
  to do exactly what you asked me? How
• 10:22
  do we partner with organizations
• 10:24
  that serve our members
• 10:26
  with us
• 10:27
  and see if we pull together, can we
• 10:30
  really make a dent in some of these
• 10:33
  issues that are
• 10:35
  impacting our members. Because, again,
• 10:37
  we can give them world class medical care,
• 10:39
  but if we're not taking care of unemployment
• 10:42
  and food insecurity,
• 10:44
  those things will will overshadow
• 10:46
  and collapse
• 10:48
  all the good that we've done as far
• 10:50
  as helping folks access,
• 10:52
  good health care.
• 10:53
  We've tried to
• 10:55
  think about our our food
• 10:57
  program that we're thinking about,
• 11:00
  called Nourish
• 11:01
  in 3 major buckets,
• 11:04
  availability,
• 11:06
  accessibility,
• 11:07
  and adequacy.
• 11:09
  So let me just just talk about that
• 11:11
  for a minute.
• 11:12
  Availability.
• 11:13
  So the distribution
• 11:16
  and transportation
• 11:17
  of food. How do we make sure that,
• 11:20
  our members
• 11:21
  have the availability to get the food that
• 11:23
  they need?
• 11:25
  So accessibility.
• 11:26
  So reduce the cost burden
• 11:29
  and then adequacy that the food that they
• 11:31
  do have access to or we help them
• 11:33
  get access to
• 11:35
  is medically and culturally appropriate so they can
• 11:37
  actually
• 11:38
  use the food that they've been given.
• 11:41
  And
• 11:42
  in the in that vein, we've had some
• 11:45
  programs that I'd like to just highlight briefly.
• 11:48
  So for the availability
• 11:50
  in our, community health choices program, for example,
• 11:54
  we provide home delivered
• 11:56
  meals.
• 11:57
  So folks who have physical impairments, need personal
• 12:00
  attendants in the home, they often can't cook,
• 12:04
  or they may be able to manage with
• 12:07
  some supports,
• 12:08
  but around mealtime in the evenings or things
• 12:10
  like that, it's a problem. So we
• 12:12
  actually partner with, meal delivery,
• 12:15
  providers
• 12:16
  and provide home delivered meals for those members.
• 12:19
  And it it makes all the difference in
• 12:20
  the world, and we can ensure those deliveries
• 12:23
  are on a consistent time basis. So, again,
• 12:26
  the person now knows
• 12:28
  food is going to come on a certain
• 12:30
  day. I know how much food I will
• 12:31
  have. I know how to store it. It
• 12:34
  just requires me to heat it up. So
• 12:35
  you're taking away the anxiety
• 12:37
  and you make sure that they have access
• 12:39
  to nutrition.
• 12:41
  For the accessibility
• 12:42
  to reduce
• 12:43
  costs of accessing some of this food.
• 12:46
  We have, a healthy shop healthy card that
• 12:49
  we give for our special needs members,
• 12:52
  which is a a $500
• 12:54
  annual allowance to
• 12:56
  use for healthy food and over the counter
• 12:59
  products that might support,
• 13:01
  health and nutrition.
• 13:02
  We have a UPMC neighborhood
• 13:05
  center,
• 13:06
  which is a,
• 13:08
  an actual physical location that we opened up
• 13:10
  in East East Liberty section of the city,
• 13:14
  that it's for the entire,
• 13:16
  neighborhood.
• 13:17
  It serves our members, but it also serves
• 13:19
  all members of the community.
• 13:20
  And that is a one stop shop for
• 13:23
  all things,
• 13:24
  that impact on the social determinants of health.
• 13:27
  So within that building, we have a food
• 13:29
  pantry,
• 13:30
  and people can come and get actually get
• 13:32
  food bags of food and leave.
• 13:34
  We have,
• 13:35
  folks that can help register people or enroll
• 13:39
  people in the supplemental
• 13:41
  nutrition assistance program or SNAP. Used to be
• 13:43
  called food stamps. So we have individuals there
• 13:46
  every day that can help people enroll and
• 13:49
  things like that. So that's another example of
• 13:52
  how we're trying to improve accessibility.
• 13:54
  And we also partner with community based organizations
• 13:58
  that provide community health workers that actually go
• 14:02
  out into the community. So everybody doesn't have
• 14:04
  to come to us.
• 14:06
  We actually go out into the community and
• 14:08
  help talk to people about
• 14:10
  SNAP and things like that and help them
• 14:12
  enroll so they can get these additional dollars
• 14:15
  each month. It's not a huge sum, but
• 14:17
  it's it's really important it can make a
• 14:19
  difference or make a bridge in adequate food
• 14:22
  for a month. And then for the adequacy
• 14:25
  so, again, this is making sure that
• 14:28
  the food that you get is appropriate for
• 14:30
  your health conditions, is appropriate culturally.
• 14:33
  We do something called medically tailored meals. We
• 14:36
  have organizations,
• 14:38
  food vendors
• 14:39
  that have nutritionists on board, design healthy meals
• 14:42
  that can be delivered,
• 14:44
  across the entire country if necessary,
• 14:47
  or
• 14:48
  our members who have food sensitive conditions. So
• 14:51
  some with kidney disease or some with heart
• 14:54
  failure where salt and,
• 14:56
  sugar and and and electrolytes have to be
• 14:59
  monitored carefully to keep people in, in in
• 15:02
  the best control that we can.
• 15:04
  We have and we have many more programs,
• 15:06
  Jacob, but that's just an example
• 15:09
  of some of the types of programs and
• 15:11
  and where we're trying to target our efforts
• 15:15
  to meet the needs, of food as medicine,
• 15:18
  for our members.
• 15:20
  Wow. I mean, clearly so much innovative and
• 15:23
  impactful
• 15:24
  work going on across the UPMC enterprise. So
• 15:27
  I really do appreciate you giving us an
• 15:29
  overview of that, Crystal.
• 15:30
  Before we go, what else are we missing?
• 15:33
  Any final thoughts you wanna offer or bits
• 15:35
  of advice you'd like to share while you
• 15:38
  have the attention of a lot of health
• 15:39
  plan leaders from all over the country?
• 15:42
  Well, we're really excited, Jacob,
• 15:44
  because our governor and our secretary of health,
• 15:48
  doctor Valerie Arcush,
• 15:50
  were trying to
• 15:51
  kick off additional
• 15:53
  services,
• 15:54
  through state funding
• 15:56
  to do things like help people reenter when
• 15:59
  they've been incarcerated,
• 16:01
  to expand the coverage of children continuously until
• 16:05
  the age of 6, insurance coverage,
• 16:08
  but also in this new group of offerings
• 16:11
  that the governor and the secretary are trying
• 16:14
  to get off the ground
• 16:16
  is medically tailored meals for for folks who
• 16:18
  have serious medical serious mental illness.
• 16:22
  That's a huge, huge thing.
• 16:25
  We know,
• 16:26
  that in addition to housing and medical care,
• 16:29
  again,
• 16:30
  helping people with serious mental illness
• 16:33
  maintain adequate nutrition, some stability there
• 16:37
  can really make a difference in their recovery
• 16:39
  or at least their sustained,
• 16:41
  recovery. So we're pretty excited that Pennsylvania
• 16:45
  and our leaders are really pushing forward with
• 16:48
  important projects like this.
• 16:50
  Absolutely. It sounds like a lot of really
• 16:52
  amazing
• 16:53
  things on the horizon.
• 16:54
  Doctor Clark, thank you so much for taking
• 16:57
  the time to be with us and for
• 16:59
  sharing your insights and impactful work with our
• 17:02
  listeners. We truly appreciate it. Thank you, Jacob.
• 17:05
  If you'd like to listen to more podcasts
• 17:07
  from Becker's Healthcare, you can visit beckershospitalreview.com.