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      Live from HIMSS with Alex Wendling

      Healthcare Rethink - Episode 20

      Joining Jonathan Wiik live at the FinThrive booth at HIMSS 2023 was Alex Wendling, Flow Core Specialist at the University of Virginia. In this episode of Healthcare Rethink, Wiik and Wendling discuss the intersections of health, economics, and policy, focusing on the implications of Wendling’s recent study with Utica University.

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      Jonathan Wiik:
      Alex, welcome to HIMSS. Is this your first HIMSS?

      Alex Wendling:
      This is Awesome. Thank you so much for having me.

      Jonathan Wiik:
      It's a little overwhelming I think, man.

      Alex Wendling:
      Yeah.

      Jonathan Wiik [00:00:30]::
      There's a lot going on here. We have a large FinThrive booth. We got a lot of traffic here and it's been busy.

      Alex Wendling:
      It's a massive location.

      Jonathan Wiik:
      Yeah.

      Alex Wendling:
      It took me a while just to get here.

      Jonathan Wiik:
      I think there's like a thousand vendors. There's a lot of people going on. I've been to eight sessions. It's been really, really busy. You flew in yesterday? Yeah?

      Alex Wendling:
      Yeah. I landed just this morning.

      Jonathan Wiik:
      Oh. Okay. It's been a long day. Well, I won't keep you too long. Thank you for coming out. You are at the University of Virginia and you helped with Utica on a study. Can you tell me a little bit about your role at UVA?

      Alex Wendling [00:01:00]:
      Yeah. So at UVA I've worked for the last 12 years in translational research and medicine, primarily in hematology, oncology, doing a lot of work in different applications of immunological research and currently working at a core facility where I assist different researchers within the university and their projects.

      Jonathan Wiik [00:01:30]:
      Awesome. Well, let's talk about that Utica study. This is exciting work, a lot of work in health equity. That's something FinThrive's very, very passionate about. We have a lot of data sets that we're leveraging to look at disparities in care, identifying social risks like housing, income, transportation, other social vulnerabilities. You said there were some key takeaways from that study and do you feel like there was anything that was compelling in the realm of just the study of the research itself or its application kind of to general society or?

      Alex Wendling [00:02:00]:
      Yes. So a little bit of background on the study is that we were looking at changes in economic stress factors pre and post the COVID-19 recession pandemic within a variety of six states about. It's an ongoing study, so we're still going through a lot of the data, but we've gone through New York and Virginia so far, and what we found is that despite a lot of the interventions that have been made in terms of things like the rent freezes, credit for child tax credit purposes and things like that, we're still seeing specific large populations are experiencing a lot of economic stress factors as a result, credit utilization increasing and stuff like that.

      [00:02:30]:
      And while it's not necessarily surprising to find out that single parents are experiencing these stresses a lot more than others, some minority populations, folks without graduate degrees, it's interesting to see that despite these interventions with one of the most liquid recessions that we've had, we're still seeing these strong impacts. We actually see differences in some of these populations between different states. We're still going through the data, so it's still going to be interesting to see how different states react differently for different demographics.

      Jonathan Wiik [00:03:30]:
      That's fascinating stuff. I was in a session yesterday where they talked about lifestyle vulnerability score and it talked about how patients live or patients, how people live check to check, and when something and like an adverse event happens, you go to the hospital or someone gets sick in the household, they have to actually go borrow, and that is amplified in areas of ethnicity. You know, so there may be in the Hispanic or African-American population that happens with a higher level of frequency and there's more barriers to accessing healthcare or even transportation to get there. And the study gets into some of that. Right?

      Alex Wendling [00:04:00]:
      Yeah. And in addition to that, childcare. It's very hard to take time off just to go to a doctor's appointment half the time or schedule one, in which case you can have somebody watching your kids or you don't need to go pick them up. And I think accessibility is going to be one of the key factors because we've seen in pretty much every state that we've looked at so far that the largest group that's impacted are single parents, which is very unfortunate that we don't have better daycare times and assistance that work better with parent schedules. So in addition to, not only access, I think when people do experience problems, they tend to push them back and don't even go to the doctor, don't take preventative care measures, and those tend to build up and the saying ounce of prevention is worth a pound of cure. That's very much applicable in these cases.

      Jonathan Wiik [00:05:00]:
      Yeah. I heard yesterday too that medical adherence is very impacted by that. So we're trying to help providers and payers associate that risk from studies like that at the state level to say, hey, watch out for these zip codes or these states. There's a high density of single parent households. That is not a question that's often asked in the clinical setting. I worked in a hospital, hey, are you single? It's something you'd ask somewhere else, but it's not, do you live by yourself or do you have a mechanism to get there? Those are not questions that are typically asked in a clinical setting, so I think that data's very, very powerful.

      Alex Wendling:
      Yeah.

      Jonathan Wiik:
      That's awesome. You shared the benefit of early intervention. Can you expand on that? So what types of early interventions do you think could occur based off those scenarios for people to get to where they need to be or to get into healthcare and get those needed services?

      Alex Wendling [00:05:30]:
      Well, as I've mentioned, so many people will then push off issues either frequently dental exams, just to get their teeth checked, and that causes so many downstream issues. Just having the availability to get there, so much of social determinants of health aren't necessarily just health issues, but accessibility, as you pointed out, public transportation, daycare services, and then of course cost, which can be taken to care of at the health side, but you need a whole lot of different groups collaborating together for that same common goal. I think that's going to be one of the hardest barriers to reach that.

      Jonathan Wiik [00:06:00]:
      Yeah. That's so, so true. You talked about stratification of health and just some of the outcomes that you saw in that report. So talk through some of those stratifications. Where did you see breaks specifically in some of the results from the Utica report? What were some of those layers of data that you saw?

      Alex Wendling [00:06:30]:
      A lot of it is going to be kind of overlapped between different populations, so you can use that information to then look at all the data sets that we haven't directly studied. So a lot of this data is from completely disparate groups and data forms that have been then joined together, done a lot of cleanup, so finding out different overlaps between these demographic data. Like as you pointed out, clinical settings don't have information like are you single? Do you have children at home? So being able to combine that information, we gain a lot more than just the sum of the individual parts, but I'd say the big stratification is being able to then continue to expand this work. Once we get more information from different states, we could see how state results differed and maybe look at the different policies that different states had in terms of unemployment benefits and stuff like that.

      Jonathan Wiik:
      That's good. Yeah. I think that's a good application of that data is to go back and look at the Medicaid population specifically and understand where there's gaps in accessing care or maybe over-utilization in some cases in the ED, where maybe primary care physician density is not there, and understanding those accessibility issues and barriers that exist. It's awesome. FinThrive helped provide a lot of the data for this report as an input. Can you kind of expand on what some of that data's role was in helping with the findings?

      Alex Wendling:
      Yeah. So as I mentioned, this came from a lot of different disparate sources. So this project was a massive collaboration between Utica, Robert Wood Johnson Foundation, and FinThrive, and we really couldn't have gotten a hold of all the dataset that's required. Having just the financial information doesn't tell us much, and FinThrive's contributions of the demographic data are what really allow us to target in on specific at risk population so that we can better identify these are the folks who are at need. Just having the economic information, we found income doesn't necessarily correlate, because as I pointed out, this was a very high liquid recession where stimulus checks that came through all of that muddles the data a lot, and it doesn't really convey the full story about who's experiencing these stress factors.

      Jonathan Wiik:
      Nice. That's awesome. How would you define health equity? What's your definition there? Just generally, it doesn't have to be from Utica or anywhere, but go ahead.

      Alex Wendling [00:09:00]:
      Not only just having access, but feeling safe within your healthcare provider. Feeling kind of recognized, understanding that my doctor is listening to my concerns, they're respecting my concerns about whether I'm having pain and or taking my feedback on treatment. Because sometimes it could be hard to convey what issues you're having and different things like that, respectful pronoun usage and stuff. I think that's where I kind of hope to see healthcare equity going and just everybody being on board with making sure people have access, can afford it, and feel comfortable going to the doctor.

      Jonathan Wiik:
      That's awesome. Where do you think this data's going? What's the next step? If you were to do another study or who would you like to pick this data up and make change in our country? What would you like to happen with it?

      Alex Wendling:
      I'd say probably the next big step for this particular data set is we still have a couple more states to go through, and we'll be able to then compare state to state responses and look at things like, we see that minority populations in New York are affected very differently than minority populations in, I don't know, North Carolina or somewhere.

      Jonathan Wiik:
      Totally. Yeah.

      Alex Wendling [00:10:00]:
      And then we can actually see how and where those locations are, if they're more rural, harder to get access to specific things like public transportation, and then see how those other factors, so it's going to be kind of an escalation. The data keeps stacking. We keep learning new things from it. The difficult part is knowing where to kind of stop with it at some point though.

      Jonathan Wiik:
      You bet. Well, Alex, thank you so much for coming today. My advice is to not walk around too much. It looks like you got some pretty comfortable shoes on. It's my eighth HIMSS. There's a lot going on. Jonathan Wiik here at FinThrive. Alex Wendling from University of Virginia. Thank you so much, sir. Really appreciate your time.

      Alex Wendling:
      Thank you so much for having me.

      Jonathan Wiik:
      And enjoy the rest of the show.

      Alex Wendling:
      Thank you.

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