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. If you'd like to listen to more podcasts from Becker's Healthcare, you can visit beckershospitalreview.com.