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