Hi, everyone, and thanks for tuning in to
the Becker's Healthcare Podcast. My name is Lucas
Voss, and I'm very excited to be joined
by Trina Histon, PhD and VP at clinical
product strategy at Wolbot Health to discuss scaling
mental health support with health systems. Trina, thanks
so much for joining us today.
Lucas, it's a pleasure to be here. Looking
forward to today's conversation.
Yes. And it's so so interesting to have
you on. You've done so much work
in the health care space. You've been around
for such a long time. I briefly scanned
over some of your papers that you've done
on on overweight and obesity and a lot
of that work, and it's there's it's so
multifaceted,
which I love. You have such a deep
background in health care. Can you just give
us a little bit of an introduction to
yourself and and your work at Wolcott?
Sure. Sure. Happy to.
So I'm a health psychologist by background. And
as as you referenced, I've over 2 decades
of experience
in health care. And a lot of that
in health care was kind of building end
to end clinical pathways
for prevention and treatment. And I would say
the last 7, 8 years of my time
in health care before I joined robot health
and startup world was building and scaling a
digital mental health ecosystem
that deployed in primary care and in specialty
care. So in in doing that work, it's
really
translating the evidence base into care delivery and
doing that with methodologies
like human centered design and performance improvement. So
you're really thinking deeply about not just the
what you're deploying,
but where you're deploying it and who you're
deploying it with at both in the care
team side and on the patient side. So,
delighted to bring that skill set to what
about health where I really lean into clinical
enablement with our partners. So it's been it's
been great so far. Start up world is
different to health care, but I'm in my
happy place for sure. That's fantastic. And it
it like you mentioned, it's become such an
important part of the industry, I feel, like,
to be able to look to those new
solutions, to look to new developments, technology,
digital solutions, etcetera. I think that that's really
the way of the future. And you've mentioned
you've you've started to work with health systems
on this quite extensively.
One of the systems you work with is
Virtua Health.
What were the initial goals when you first
started that collaboration
and and sort of the objectives as you
were looking into how can we help patients?
How can we improve care?
Absolutely. Quick question. So I would say Virtua
Health for those who aren't familiar as a
health system in New Jersey. In fact, it's
Southern New Jersey's largest healthcare provider.
And when we started talking with the Virtua
team,
you know, we're thinking about primary care and
the primary care setting and patients coming in
to see their doctor. And, you know, one
of the initial sort of pain points not,
unfamiliar to pro perhaps most of health care
in the US was making a referral to
behavioral health and then having a wait list.
I think Virtua really wanted to explore might
there be other ways
that patients who might need support in living
better with
symptoms of anxiety, depression,
might there be other tools? And, of course,
in the last several years, digital tools have
become more and more common in deployments in
in primary care and specialty care. So the
initial pain point we were looking to solve
was those patients seen in primary care who
may get a referral and then they're on
a wait list. But I think we we
quickly then explored more deeply with the team
and,
you know, these tools are an adjunct to
care. So again, robot health, in adults, that's
the tool we've deployed with with the virtual
team can be that support that's 247 for
that patient.
So I think, you know, that was really
the initial discussion that we had with the
virtual team. But but as I'll explain later
on, we've we've expanded. So it's been tremendously
exciting, and they've been a great team to
partner with.
Lots of options. And I feel like, again,
that's that's where really those those digital solutions
can really fill some of those gaps, fill
some of those care gaps, and be able
to to truly make an impact on the
patient at the end of the day. And
I think that's what we want. That's what
we Absolutely. We're looking for help in the
moment. Mhmm. Yeah. To to supplement
to supplement and being able to help. I
think that that's really key.
Again, a lot of this is new for
a lot of folks. A lot of people
are might be hesitant.
There's all of these solutions, all of these
different companies that are doing this. What are
some of the challenges
in integrating a digital solution, especially if you
already have a built out infrastructure?
Sure. Sure. Great great question. I think, you
know, I feel that the work we've been
doing in partnership with Virtua really does, you
know, offer a blueprint for success. So
when we're we're the first sort of digital
mental health tool that Virtua is deploying.
And so we think of scale at the
beginning. So you're not just sort of adding
on and iteratively doing piecemeal, but you're thinking
of your end goal in mind. And so
we tend to implement in phases or or
kind of what we call internally crawl, walk,
run. And so, you know, when you're crawling,
you're learning, like, you're exploring something new. I
would say, you know, I think about the
ABCs of implementation. And so I I think
I've talked about the a, which was access,
which which is a pain point for many
systems in the US. And and I think
the b is not to be pity, but
it's it's beginning and being bold. I think
a lot of folks who might be hesitant,
you just you just have to take that
first step. And so what does that look
like? Well, we actually started in telehealth in
in primary care in VirTra. In fact, our
clinical lead, doctor Skrinsky leads leads that that
team.
And in doing that, like, the the c
of the ABC's is context. Deep understanding and
respect for
how patients move through their visits pre, post,
and after.
How doctors are spending their time with patients
kind of where's their attention going, what are
they holding space for, what are they listening
for. You know, we know from the literature
that on average primary care doctors might have
about 17 minutes and there are 6 to
7 topics that are usually covered in those
17 minutes. So there's a lot happening and
they're they're doing a lot and they're obviously
documenting in the EMR as well and and
Virtua use epic. So in the crawl phase,
you're really understanding,
you know, where might they be there'd be
good points to get robot in in a
patient's hands. What does the workflow look like?
So
making sure that you're not adding it undue
burden to the care team because we know
clinician burnout is very real and we know
that teams are doing more and more and
more, in in a visit. So we didn't
wanna be one more thing that adds burden.
So really listening for where are the opportunities
for us to deploy,
and really have that minimal impact on workflow,
but really lean into where there's already good
muscle memory on on different places in the
EMR that a doctor is going to provide
care. And so we really wanted to do
that in crawl and we sort of launched
in January
in telehealth and then quickly added some, what
I'll call more traditional primary care face to
face care,
sites in virtual health care footprint as well.
We learned a lot, you know, in those
first 15 to 20 patients in, how are
the conversations going, what quest questions do patients
have because,
you know, part part of the getting ready
is, you know, developing clinical training because
a lot of doctors, you know, they've obviously
deep expertise
in in their degree, but things like mental
health and digital mental health and and concepts
from cognitive behavioral therapy may not be something
they've had a lot of exposure to. So
making sure that they really are comfortable
with robot health and that they can talk
about it knowledgeably
in making the referral and that they get
to ask and answer all their questions. You
know, doctors are very discerning and and rightly
so. And so we had a lot of
great conversations to get ready and a number
of clinical trainings to get ready. And so
that would cover, you know, what robots is
for adults and, you know, who might be
a good fit for robots and maybe who
isn't a good fit for robots and then
how you make the referral.
And and I would say one of the
nice things Virtua has to,
if I think of kind of workforce of
the future and sort of care team configuration
of the future, they have also got,
technical consultants that support
telehealth. And I think these are newer roles
in in health care that we're seeing pop
up like digital navigators or care coordinators,
and they are really in a really nice
connection then between the care team and the
patient.
So in the crawl phase, you know, figuring
all those moving pieces
out, looking at how the flow of the
first, as I said, 10 to 20 patients
is looking and might there be anything we
need to optimize. And then we scaled quite
quickly across their primary care footprint
in the springtime and continue to to learn
as we go. In fact, you know, Virtua
made the decision to to bring in other
specialties because, you know, the other thing that's
happening in health care and I'm personally applauding
it is the recognition that the the head
is connected to the body. And so physical
health and mental health are are intertwined. And
and Yes. You know, if you're struggling
with your mental health, it's gonna impact how
well you might manage your diabetes or or
anything else of chronic conditions. So we've actually
launched another specialties like GI, like cardiopulmonary,
and and those care settings and and are
about to add some more because those specialties
we're recognizing, look, we we wanna really support
our patients and giving them tools to kind
of help them at at at 4 in
the morning. I mean, candidly, about 77% of
patients who are using robots in our virtual
deployment are doing so outside of traditional office
hours. So we can act as that digital
layer of support
that's available in the moment. And then, obviously,
we're adjunctive to care. So, those patients know
they can always go back to their, you
know, referring provider as well.
Yeah. And I think, again, that's what I
love about digital about these digital solutions and
specifically what you've mentioned with WoBot Health. Right?
It's it's ax we're also solving an access
issue. We're providing access to people that normally
might not have it or that might not
be able to get the help that they
need, and these digital tools are able to
do that in a way that's so much
more just inclusive for everyone. And I think
that that's such a key such a key
piece to being able to have a strategy
like this
for for health systems, I think. Absolutely. And
and Virtu the Virtu team exceed those opportunities
early. Yes. And and they want to avail
of them. So that's been, you know, such
a joy to to partner and think through,
okay, might we adjust any of the materials
for different specialties or or do we sort
of point to different parts of robot that
might be supportive in different ways for for
different kinds of patients. So they've they've just
really been very innovation mindset, which is wonderful.
I definitely really enjoy the partnership. And and,
you know, you're building the company, you know,
and now I'm on the other side, right,
that I wasn't healthcare and I'm in a
startup. But, you know, you move at the
speed of trust and you're building
relationships with folks every day. And so, you
know, our data is growing every day, but
you're learning from that. And then you're infusing
the learnings from data in the context of
say virtual health footprint. And then, you know,
you're continually, you know, moving and optimizing and
it's a dynamic process. But, you know, you
always want to keep at the heart of
it is, you know, you're being deployed
in in a clinically mediated way and it's,
you know but the relationship between a clinician
and a patient. And so we never take
that for granted and and really sort of
hold that that trust as well because we
are also supporting those patients.
Yeah. And and I think it comes back
to your your ABCs that you've mentioned earlier
in the conversation. Right? And I think the
the b here is really crucial. As you've
mentioned, you have to be bold.
You have to Uh-huh. You have to innovate.
You have to start. And I I think
that's such a key piece. And and looking
ahead
right now for you as you as you've
been in the industry for such a long
time, you've been on different sides of things.
Where do you see this going? Where do
you see the partnership with Virtua going? But
in general, also, how do you see this
overall evolving for other health systems as well?
Yeah. Yeah. Great question. I think there are
a couple things with Virtua. Obviously, we're we're
expanding into other specialties. So I think we're
gonna learn a lot as those mature and
evolve in terms of different types of patient
populations and and what's resonating with them as
as we are providing that support.
We're also doing a case study with Virtua.
So, you know, again, they're, you know, very
innovative, but they also want, you know, as
do we want to understand how are we
impacting
patient care, down the line. So really looking
at the context of the deployment in different
settings. So I would say keep your eyes
peeled for for that case study.
And if I zoom out to the whole
field, I mean, there are many big moving
pieces now happening in the US. So recently,
you know, with parity, you know, seeing how,
that's going to land with parity between mental
health and physical health.
Also, CMS will be releasing their physician fee
schedule final ruling
in early November. And that is, you know,
with the goal to supporting the deployment of
digital mental health. I'm personally very excited about
that because it kind of creates a a
strong reimbursement pathway.
So I'm excited that those big pieces are
moving. The other things I'm seeing also are
looking at more whole person care. And I
think Virtu have been one of the early
movers in this in terms of addressing social
determinants of health. And so both assessing it
but also addressing it. So I think in
healthcare and I can say this after 2
2.5 decades and, you know, a lot of
times you're assessing a lot of things, but
maybe you're not able to act on them
because there may not be something in place
to do something candidly. And, you know, I
think mental health might have been one of
those areas where that was challenging. But I
think again with digital mental health growing and
growing year on year, that's now becoming less
of an issue. But newer things like social
terms of health and what you need to
have in place to support whole person care,
I think there's tremendously
exciting efforts,
you know, underway and understanding, you know, the
assessment and also the deployment of solutions to
really support that human being. And we're part
of that story and that architecture. So we're
excited to to partner with our healthcare partners
and and lean in and see how might
we be part of that touch point for
that patient over, say, a 24 hour period.
What else can we do? So I'm excited
by all of that because the promise of
digital mental health, I think we're in the
the second era, if I can frame it
that way Mhmm. In the field. And, you
know, I'm excited for the future.
Absolutely. That sounds so fascinating. And we'll have
obviously, Trina, we'll have to do a second
podcast once the study comes out. Right? Absolutely.
Happy to come back and talk. Once it
comes out, we'll have to talk about the
findings. We'll have to talk about all the
interesting things that come out of that. Again,
thank you so much for sharing your time
today with our audience and your insights, certainly.
What a great conversation. Thanks for being here.
Thanks a million, Lucas. Take care. Thank you.
And I'd also like to thank WolBot Health
for sponsoring today's content. And to our listeners,
thanks for joining us today, and make sure
to check out other Becker's podcasts.
Have a wonderful rest of your day, and
make sure to tune in for the next
one.