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.