What You Should Know:

– TruLite Health, a pioneer in health equity solutions, and Mayo Clinic, a global leader in medical care, today announced a groundbreaking collaboration to address disparities in medical outcomes and costs for diverse patient populations.

– This partnership marks a significant step forward in the fight against clinical bias, a pervasive issue that disproportionately impacts the health of Black, Latinx, and other minority communities.

Quantifying the Impact of Bias

Clinical bias has a staggering financial and human cost. A TruLite study revealed that individuals with one of seven chronic illnesses who are Black or Latinx incur approximately $5,300 more in annual healthcare expenses compared to their White counterparts. Truity™ aims to tackle this disparity head-on by ensuring all patients receive equitable care regardless of their background.

Truity™: AI Championing Fairness in Healthcare

TruLite’s revolutionary software, Truity™, identifies and mitigates clinical bias within electronic health records (EHRs). The platform analyzes patient data and suggests personalized interventions for clinicians, care teams, and patients themselves. These interventions address social and behavioral factors that often contribute to unequal healthcare outcomes, particularly for Black and Latinx populations.

Mayo Clinic: A Powerhouse Partner

Mayo Clinic brings its vast expertise and resources to the table. Their physicians will provide valuable feedback on Truity™, helping refine the user experience and workflow to maximize its effectiveness in clinical settings. Additionally, Mayo Clinic has a financial interest in the technology, demonstrating its commitment to advancing health equity solutions.

This partnership goes beyond software:

• Virtual health equity coaching: TruLite offers virtual coaching programs to empower patients and advocate for their healthcare needs.
• Partnership with Morehouse School of Medicine: TruLite collaborates with Morehouse to address the specific healthcare challenges faced by Black communities.

“This collaboration with Mayo Clinic represents a critical milestone in the fight for health equity,” says Dr. Alan Roga, Founder and CEO of TruLite. “Mayo Clinic’s expertise and commitment to patient care, combined with TruLite’s innovative technology, will allow us to reach a wider audience and make a real difference in people’s lives.”

What You Should Know:

– Buckeye Health Plan and Cityblock are teaming up to provide integrated, community-based care to approximately 10,000 underserved Medicaid recipients in the Cleveland-Akron-Canton area.

– The strategic partnership promises to redefine healthcare delivery for vulnerable communities, prioritizing whole-person health and tackling barriers to access in Ohio.

Building Bridges, Improving Outcomes

Buckeye is a leading Ohio Medicaid managed care plan serving over 428,000 members, offering primary care through its extensive provider network. Cityblock’s model integrates clinical care with social support, addressing factors like food insecurity and housing that impact health outcomes. As part of the partnership, Buckeye will connect Cityblock providers to members who haven’t seen their primary care physician in a year, promoting preventive care and chronic disease management. Cityblock’s 24/7 wrap-around services provide virtual, in-home, and clinic-based care, extending access and convenience.

This partnership holds significant promise for improving healthcare access, equity, and outcomes for thousands of Medicaid recipients in Ohio. By combining Buckeye’s reach with Cityblock’s innovative model, this collaboration paves the way for a more holistic and effective approach to healthcare delivery, prioritizing the needs of underserved communities.

“We’re thrilled to partner with Cityblock to further address the physical, behavioral, environmental and social factors that impact health,” says Dr. Brad Lucas, Buckeye Chief Medical Officer.

What You Should Know:

– Socially Determined, the leading social risk analytics company, and Uber Health, the healthcare platform for seamless benefit coordination, have announced a partnership to empower individuals and families facing common healthcare challenges.

– The strategic joint effort focuses on connecting vulnerable Medicaid, Medicare Advantage, and commercially insured beneficiaries with critical supplemental benefits like transportation, food delivery, and medication delivery.

Targeting the True Drivers of Health

It’s no secret that health is influenced by more than just medical interventions. Social determinants of health (SDOH), like food insecurity, transportation barriers, and lack of social support, play a significant role in well-being. Socially Determined’s expertise in identifying and analyzing these SDOHs, combined with Uber Health’s comprehensive platform for delivering supplemental benefits, creates a powerful solution for addressing these challenges head-on.

Targeted Support for Improved Outcomes

This partnership goes beyond simply providing access to resources. By leveraging Socially Determined’s sophisticated social risk data and analytics, healthcare organizations using Uber Health’s platform can now:

– Precisely identify individuals with the greatest needs: Utilizing real-time data on social determinants of health like food insecurity, transportation barriers, and lack of social support, they can pinpoint those who would benefit most from targeted interventions.

– Align available benefits with eligible members: With access to patient benefit data, healthcare providers can confidently match patients with the appropriate resources covered by their insurance, ensuring effective utilization of existing benefit structures.

– Empower engagement and address daily challenges: By removing the everyday hurdles of transportation, food access, and medication availability, patients and families are empowered to focus on their health and engage more effectively with their healthcare journey.

– Enhance access to healthcare and food resources: This partnership extends the reach of healthcare beyond the clinic walls, ensuring communities have equitable access to vital resources that contribute to overall well-being.

– Improve health and healthcare outcomes: Ultimately, this collaborative effort aims to break down barriers to care, leading to better health outcomes, reduced healthcare costs, and a more empowered healthcare experience for vulnerable populations.

“For years, our payer and provider customers have utilized our social risk analytics to better understand and address the challenges their members and patients faced every day. And now we’ve developed purpose-built analytic models designed explicitly for Uber Health’s key benefits that immediately help identify those individuals with the greatest need for each benefit,” said Trenor Williams, Co-Founder and CEO at Socially Determined. “Once our payer and provider partners know who needs assistance and what specific challenges need to be addressed, they require a partner to help mitigate those risks and eliminate those barriers. Uber Health’s knowledge, approach and ubiquitous network provides the perfect partner for our analytics and allows our customers to drive measurable, improved outcomes and member experience.”

One of the most pressing and often overlooked challenges in healthcare today is how to reach and effectively treat dually diagnosed patients — commonly, individuals who grapple with both mental health problems and substance use issues. According to the Substance Abuse and Mental Health Services Administration, more than one in four adults living with a serious mental health issue also has a substance use issue. The unique challenges these individuals face, along with the impact of social determinants of health, present formidable obstacles to their recovery. 

Mental Illness and Substance Use Disorder: A Common Comorbidity

The relationship between mental illness and substance use disorder (SUD) is profound: people who suffer from mental health disorders are more likely to turn to drugs or alcohol as a coping mechanism, inadvertently leading to substance use problems. Conversely, individuals with substance use disorders may experience heightened anxiety, depression, or other mental health issues as a direct result of their substance misuse. The cycle is vicious and self-sustaining.

Mental health conditions and substance use can exacerbate each other, creating a complex and intertwined web that entraps many individuals. A “one-size-fits-all” approach to treatment is insufficient when confronted with the intricacies of dually diagnosed patients. It’s not merely a matter of addressing mental health or substance use in isolation, but understanding how the two interact and developing a comprehensive treatment plan.

Unique Challenges for Dually Diagnosed Patients

The challenges that dually diagnosed patients face are multifaceted and can impede their access to behavioral health services and hinder their chances of successful treatment. These challenges include: 

Stigma: Dually diagnosed patients often suffer from a double burden of stigma. Society stigmatizes mental health issues or substance use problems separately, but the stigma intensifies when both conditions are present, discouraging individuals from seeking help and making them feel like societal outcasts.

Complex Clinical Needs: Treating dually diagnosed patients requires a high degree of clinical expertise. The interplay between mental health and substance use is intricate, making it challenging for healthcare providers to deliver effective care without a nuanced understanding of both conditions.

Fragmented Care: The fragmentation of health care services poses a significant barrier to dually diagnosed patients. Many healthcare systems are designed to address either mental health or substance use, leading to disjointed care. This fragmentation not only diminishes the quality of care but also deters patients from engaging effectively with the healthcare system.

Related to this is the need for coordinated care. Dually diagnosed patients require integrated and coordinated services, but these services are often siloed, with mental health professionals and addiction specialists working independently. This lack of coordination can lead to conflicting treatment plans and poor patient outcomes.

Social Determinants of Health

It is essential to recognize that the challenges faced by dually diagnosed patients extend beyond the clinical realm. Social determinants of health — i.e. where people are born, raised, learn, worship, etc. — play a pivotal role in shaping an individual’s initial access to care and their subsequent outcomes within the health care system. Addressing these social determinants is a vital component of reaching and supporting dually diagnosed patients.

Access to Care: Economic disparities and geographical barriers can limit access to behavioral health services. Dually diagnosed patients from disadvantaged backgrounds often find themselves trapped in a cycle of limited access and inadequate care.

Housing and Stability: Stable housing is a fundamental determinant of health. Dually diagnosed patients who lack housing stability face additional challenges in obtaining the support they need. The link between homelessness and substance use is well-established, making housing interventions crucial.

Support Systems: Strong social support is essential for individuals facing dual diagnoses. Dually diagnosed patients often grapple with strained relationships, isolation and the loss of social support. Reconnecting them with supportive networks is vital for their recovery.

The Role of the Health Care Continuum

To improve the behavioral health outcomes of dually diagnosed patients, a paradigm shift is imperative. The entire healthcare continuum, from payers to primary care providers to specialty behavioral health services, must come together to address this crisis comprehensively.

Integrated Care Models: Health care systems should adopt integrated care models that bridge the gap between mental health and substance use services. This means creating multidisciplinary teams that collaborate to provide holistic care.

Training and Education: Healthcare professionals need enhanced training and education to understand the unique needs of dually diagnosed patients. They must be equipped to recognize the signs, employ appropriate assessment tools and deliver effective interventions.

Community-Based Services: Expanding community-based services can improve access to care for dually diagnosed patients. This includes outreach programs, crisis intervention and peer support initiatives tailored to their needs.

Reducing Stigma: Healthcare organizations should actively engage in anti-stigma campaigns to reduce the societal prejudice surrounding mental health and substance use. Normalizing conversations about dually diagnosed patients is essential for encouraging them to seek help.

Advocacy and Policy Reform: Advocacy efforts should target policy reform to ensure that behavioral health services are equitable and accessible to all. Policymakers should prioritize the needs of dually diagnosed patients in health care reform initiatives.

Access to Timely Care: Perhaps most important is ensuring that these patients have access to the care they need when they need it. Currently, people suffering from SUD face wait times that can average more than three months for an initial visit to a mental health care provider. New solutions from third-party vendors are addressing this challenge head-on, utilizing a combination of technology and human expertise to connect people with care quickly. Health plans should embrace these solutions to solve the access problem for their members.  

The Solution

The current crisis of dually diagnosed patients demands a holistic and empathetic approach. The challenges they face, both within the healthcare system and from social determinants of health, necessitate a coordinated effort from all facets of the healthcare continuum. Only by addressing the unique challenges of dual diagnosis and eliminating the obstacles to care can we help patients recover and regain control of their well-being.  

About Dr. Bernard DiCasimirro

Dr. Bernard DiCasimirro, D.O., is the Chief Medical Officer of Lucet, a leading provider of behavioral health solutions and services to commercial health plans, government agencies, and other sponsors of care. Before Lucet, Dr. DiCasimirro was the medical director for PerformCare, spent over four years as an Optum/United Healthcare associate medical director, served as the primary psychiatric consultant for the Pennsylvania Bureau of Program Integrity, and has experience extending to correctional psychiatry as the statewide psychiatric director for the Pennsylvania Department of Corrections. Working in all levels of psychiatry and substance use care for more than 25 years, Dr. DiCasimirro is board-certified in general psychiatry and licensed in Pennsylvania, Iowa, Arizona, Arkansas, Kansas, Missouri, the District of Columbia, South Carolina, Louisiana, and New Jersey. He holds a Bachelor of Arts from Franklin and Marshall College in Pennsylvania and graduated with honors from Des Moines University, where he obtained his D.O.

By providing scaffolding to help build psychological flexibility among young people, we can not only support good mental health for life but reduce the mounting cost of mental healthcare.  

Mental health is the defining public health crisis of our time. According to the CDC, 42% of high school students felt so sad or hopeless that they could not engage in their regular activities for at least two weeks in 2021, an increase of 50% from 2011. The amount who seriously considered suicide soared to more than one in five, a 38% increase from 2011, and one-in-10 attempted suicide, a 25% increase from 2011. That means an average classroom of 30 has three students attempting to end their lives each year.  According to Pew Research, mental health is parents’ largest concern for their children, with 40% of parents being extremely or very worried about it.

To help reverse this devastating trend, healthcare systems need to shift “upstream” and focus on preclinical early intervention and prevention, as opposed to the current “downstream” reactive approach which only addresses issues after they’ve evolved into major disorders requiring acute treatment. On average, approximately 50% of lifetime mental health problems are established by age 14 and 75% are established by age 24. Unfortunately, healthcare systems globally are ignoring this reality and spending 90% of mental healthcare investments on acute mental healthcare treatment for adults, such as inpatient psychiatric care as well as hospital and emergency services.

This “downstream” approach is detrimental, inefficient, and exorbitantly expensive. It causes demand for treatment to outstrip supply and results in reactive treatment options that are condition-centric, episodic, and place-based. Healthcare systems are so heavily focused on (and overwhelmed by) the extreme instances requiring acute care that they are failing to find broader solutions to tackle the root of the problem.

We need to be proactive, shift upstream, and provide mental health support before people reach a critical breaking point. We need to support people during, not after, the 11 years it takes, on average, for initial mental illness symptoms to develop to the point of receiving traditional treatment.

Pre-clinical interventions are being vastly overlooked as the market struggles to address critically ill people. The lack of support for mental health issues until they become severe and urgent has created an enormous overlooked segment of the youth population that isn’t receiving help, but should be: the “missing middle.” This is the majority, roughly 60%-80%, of youth who are experiencing an emotional challenge, but they don’t have a mental health diagnosis, don’t think their issues are serious or ongoing enough to warrant a diagnosis and therapy, and aren’t facing an urgent crisis.

These are the young people who mask their problems, keep their heads down and just keep going. Often, they don’t recognize the severity of their struggles or don’t think medication or therapy would help, or don’t feel comfortable discussing the issue with parents or school counselors. Regardless, the “missing middle” needs far more support than they are currently getting. When left unchecked, mental health challenges often escalate and culminate into more serious problems. Prolonged exposure to stress, anxiety, and depression exacerbates each issue and increases the risk of people developing high acuity problems or having a crisis. Preventative upstream support not only builds healthier and more resilient young people, it also reduces healthcare costs by saving money on acute and chronic treatment down the line. Every $1 investment in prevention and early intervention for mental illness yields $2 to $10 in savings in healthcare costs, criminal and juvenile justice costs, and low productivity, according to a joint analysis by the National Academies of Sciences, Engineering, and Medicine.

Early intervention is particularly important because youth is the golden window of time during which environmental exposures have a pronounced impact on brain development, including the regulation of fear, stress, emotions, thoughts, and actions. We need to give young people the resources they need to build mental resilience and emotional coping skills during their early years to become healthier and higher-functioning adults.

Meeting young people where they are and where they feel comfortable

Successful upstream intervention with this generation of youth will require providing equitable access to behavioral health resources where they feel safe and comfortable. 

This means minimizing exposure to stigma by providing an anonymous digital platform where young people can privately and independently seek mental health support, which is not commonly available. In 2022, Pennsylvania began providing 150,000 students with access to Kooth’s anonymous digital mental health platform, and the user feedback demonstrated the importance of this anonymity; despite 65% of students feeling like they needed professional support, 63% did not feel comfortable speaking to friends or family about their mental wellbeing. If we want to help as many young people as possible, it’s imperative to give them equitable access to emotional health long before a diagnosis, which is generally not the case today.

It’s also imperative to make free, universally-accessible, and immediate support available 24/7. We heard time and time again from the Pennsylvania students that when they need help, they need it now – not in several weeks after they’ve obtained a diagnosis and scheduled a therapy appointment. 

The three primary reasons that Pennsylvania students are using Kooth are:

• 45% – To get mental wellbeing help that doesn’t require going to a counselor
• 59% – To get mental wellbeing help anytime/anywhere needed
• 62% – To connect with other people experiencing something similar

Finally, young people thrive when they have a sense of autonomy. We should give them the ability to address their mental health alongside their peers at their own pace – dipping into and out of a wide range of resources at their own leisure, with low commitment, minimal requirements, and no restrictions or funnels, except when people need to be referred to licensed therapy or other formal treatment. Young people need the chance to be themselves and don’t want to be commanded or controlled. We should encourage and facilitate them  to browse through and explore useful resources like therapeutic content, articles, stories from their peers, synchronous messaging and drop-in chats with mental health professionals, and forums moderated by licensed clinicians. 

Healthcare systems are very capable of providing this relevant, preventative support upstream, rather than only prioritizing acute mental healthcare treatment for adults. Society desperately needs it. 

According to the National Institute of Mental Health (NIMH,) mental health issues are costing the U.S. $467 billion per year, and they predominantly start with the youth, even though the nation’s spending on mental health does not remotely reflect that. Despite 70% of public schools reporting an increase of students who are seeking mental health services since before the COVID-19 pandemic and 76% reporting an increase in staff concerns about their students exhibiting symptoms such as depression, anxiety, and trauma, only half of school districts said they were equipped to provide needed care. As a result, the entry point for young people into the mental healthcare system is tragically often the emergency department. 

The majority of young people cannot be neglected just because their mental health challenges haven’t escalated or appeared. Instead, we must focus on enabling the youth to build psychological strength during their early years to create a more sustainable healthcare system and more importantly, a resilient, healthier, and higher-functioning population.

About Bob McCullough

Bob McCullough, PhD, is the vice president of Clinical Strategy for Kooth Digital Health. An associate professor of psychology at Missouri Baptist University and a licensed clinical social worker, Bob has extensive leadership experience in healthcare organizations including Cigna and Magellan Health, and behavioral health strategy experience at SilverCloud and ComPsych. He holds a master’s degree in social work from Washington University in St. Louis and a doctorate of philosophy from Newburgh Theological Seminary.

Hospitals, health systems and group practices nationwide are finding value and effectiveness by partnering with an outsourced care guidance resource to extend clinical staff and strengthen care management support. The addition of a structured and highly scalable care guidance program that goes beyond mere navigation efforts provides a unique solution as a service proposition to comprehensively address many of the operational and financial challenges that directly affect the entire provider ecosystem. 

An Extension of the Clinical Team Beyond Mere Patient Navigation

Modern care guidance is an evolution of patient navigation that combines a systematized assessment to support disease-specific clinical conditions with a tech-enabled, human-led solution. Care guidance serves as an extension of a hospital’s clinical team to support a range of service lines and support activities. 

When properly designed and implemented, care guidance supports a myriad of clinical and non-clinical functions, including facilitating pre-and-post-discharge and continuation of care. While care coordination usually includes a limited set of commonly performed tasks like scheduling follow-up appointments, helping patients understand what the next step in their clinical journey should be, care guidance goes deeper into social determinants and the life factors that can impact a patient’s ability to stay on track. 

An effective care guidance program depends on specially selected care guides who work to establish a peer-to-patient connection with patients and their families. This human-led approach builds trust, enhances a patient’s ability to communicate and helps to uncover issues that pose barriers to care. The support of care guides then works to resolve these issues and assist patients in the ongoing process of their care. However, while the human touch is vital, care guides are unlikely to meet efficiency goals without a technology platform that goes beyond logging into structured workflows and barrier resolution pathways.

As healthcare organizations experience the profound financial impact of nurse shortages, care guidance is providing an innovative and efficient solution. It provides truly effective supplementary support services, functioning as a lower-cost extension of clinical teams and freeing up labor, time and resources so that nurses can focus on high-value clinical tasks.

A successful care guidance program delivers a strong return on investment (ROI) by improving efficiencies, reducing time and resource allocation, and helping overutilized clinical care teams focus on truly clinical items, all while improving patient satisfaction and retention Care guidance is of especially high value in alleviating non-clinical tasks and of its ability to help identify and solve barriers embedded in the social determinants of health that have an outsized impact on the patient care continuum. When a guidance program is properly deployed, it functions to promptly identify and resolve non-clinical issues patients experience before they become clinically problematic and costly. 

Value of a Technology-Enabled Care Guidance Resources 

A technology-enabled care guidance resource offers the most effective patient activation solution. It seamlessly integrates with a health system’s care management team to reduce clinical resource use, improve patient experience, advance health equity and enhance value-based care and reimbursement.

The right mix and integration of human and tech elements support personalized and meaningful peer-to-patient relationships and personalized communication, providing patients and their families with the connected support they need to stay on track and engage in the management of their condition throughout their care continuum. 

Integrating care guidance with information technology can significantly enhance the efficiency and effectiveness of healthcare services. By leveraging these technologies, care guidance programs become more agile, patient-centered and efficient. They facilitate quicker responses to patient needs, streamline administrative tasks and ultimately improve the overall patient experience within the healthcare system.

Collaborative Function of Care Guidance

Collaboration between provider teams supports a triad of care coordination and management. Hospitals and their clinical staff receive the extended support they need from a dedicated care guidance service.

• Reach and manage more patients, maintain their continuity of care.
• Remove non-clinical tasks from the workloads of nurses and clinical staff.
• Perform follow-ups and monitoring, conducting follow-up tasks and ensuring that potential issues and barriers are proactively identified and resolved.
• Schedule appointments, screenings, preventive care and annual wellness visits.
• Find financial resources, such as assistance programs, to alleviate medical costs.
• Arrange transportation and other logistics that enable a patient’s ability to receive care.
• Ensure compliance, adherence and medication management. 
• Reduce unnecessary service utilization and avoidable readmissions.

Addressing Social Determinants of Health and Resolving Barriers to Care

As healthcare organizations prioritize to deliver equitable, patient-centric care they must consider the full spectrum of a patient’s condition, including non-clinical factors and socioeconomic characteristics that influence their ability to access, receive and adhere to care.

Care guidance takes into account the role of social determinants of health (SDoH), with personalized services provided by skilled and trained care guides that recognize these non-clinical factors that influence an individual’s ability to access care and adhere to treatment. It’s this “human touch” that supports patients who are at-risk based upon SDoH characteristics.  These patients frequently require amplified levels of activation and monitoring that cannot be addressed within the typical hospital’s resource capacity and clinical scope limitations. 

SDoH are categorized by socioeconomic, education, cultural and environmental domains. Sub-standard conditions among these domains are shown to perpetuate patient health disparities, contribute to their unmet resources, services and transportation needs and widen health inequities, especially affecting those with chronic health conditions.

When non-clinical factors, which account for 80% of patient issues, are not promptly addressed and effectively resolved, they can lead to:

• Health deteriorations
• Excessive rates of clinical service utilization
• Extended hospitalizations and readmissions
• Higher total cost of care

Care guidance programs have proven to be effective in supporting disadvantaged and underserved patient populations who are at-risk for these complex health challenges. 

Data Captures Provide Strategic Insights

Optimally, care guides are equipped with scalable, technology platforms that provide structured workflows and use evidence-based disease and condition-specific protocols to proactively identify and resolve practical and non-clinical barriers experienced during the care journey. A patient activation platform that augments a hospital’s care management workflow and automates protocols helps uncover both non-clinical and clinical issues and barriers. With this technological support, care guides ensure that non-clinical issues get promptly resolved and clinical issues are immediately escalated to proper clinical care teams. 

An effective care guidance platform captures SDoH data and disparity-related barrier resolution, exceeding the capabilities of typical electronic health record (EHR) systems which are not specifically designed to facilitate the kind of resolution workflows that are needed to address health equity and SDoH issues. A specialized platform facilitates operational improvement by seamlessly exchanging relevant insights for each patient population. 

How Information Technology is Utilized in Care Guidance:

• Resource Allocation: Data analytics help healthcare organizations allocate resources effectively based on patient needs, optimizing the patient navigation process.

• Machine Learning and AI: AI algorithms analyze patient data to offer personalized recommendations for treatments, lifestyle changes and support services.

• Interoperability: IT systems communicate across different platforms ensuring the smooth flow of patient information between healthcare providers and navigators, improving coordination of care.

• Data Analytics: By analyzing patient data, IT systems predict potential health issues, allowing providers to intervene early and prevent complications.

• Measuring Outcomes: Collect data to measure the effectiveness of their services, including patient satisfaction, adherence to treatment plans and health outcomes.

• Continuous Improvement: Based on collected data, patient navigation programs can be improved to better serve patients’ needs.

Data analytics within the platform provide insight into non-clinical issues, identify probable SDoH risks and facilitate personalized communication. AI and machine learning anticipate patient needs based upon condition-specific protocols that enable care guides to deliver an unprecedented level of vital, just-in-time communication. Led by this intelligence, care guides provide patients with the information they need to engage in the process of their care and empower each consumer to receive a better understanding of their treatment plan and options. 

Why More Health Systems Are Considering Care Guidance Programs 

Care guidance is now becoming a “must-have” addition to the service line portfolio of health systems, hospitals and provider organizations. It is at the nexus of managed care priorities where care guidance represents an innovative approach to connected care, advancing heath equity and delivering high-quality care.

A well-designed, scalable care guidance program offers a cost-effective, connected care solution, aligning with the “Triple Aim” goals of improving care, enhancing population health and reducing costs. Patients receive personalized, equitable care, clinical staff can focus on their core tasks and hospital administrators can improve financial and operational performance. This is where care guidance presents the most value and opportunity.

About Craig Parker, JD, CPA

Craig Parker, JD, CPA, CEO, Guideway Care, a company that partners with healthcare organizations to deliver on the promise of health equity through its unique combination of highly trained Care Guides and its patient activation platform. Craig Parker has a history of building innovative healthcare companies with business models that improve care delivery and provide better experiences for all involved. Before taking the helm at Guideway Care, Craig served as a senior leader in healthcare companies working in the patient experience and provider efficiency spaces. In his role as CEO, Craig serves as the company’s chief evangelist, spreading the message that Guideway Care’s services improve life for patients and providers alike.

What You Should Know:

• Pair Team, a virtual and community-based primary care solution connecting Medicaid’s highest-risk patients to high-quality care, today announced its expansion into seven new California markets: Fresno, Merced, Monterey, Los Angeles, Santa Cruz, San Joaquin, and Stanislaus counties.
• This move enables the company to further improve access to California Advancing and Innovating Medi-Cal (CalAIM) care benefits by reaching a larger number of patients, providers and community health partners.

Pair Team Expansion to Improve Accessibility to Healthcare by Reaching a Larger Demographic

CalAIM represents a lasting commitment from The California Department of Health Care Services (DHCS) to overhaul the state’s Medicaid health care program, Medi-Cal, making it more fair, organized, and centered around individuals. Despite the positive impact of the initiative on enhancing care accessibility, primary care providers (PCPs) and community-based organizations (CBOs) face challenges participating in the new care model due to insufficient funding and essential resources.

In response to these challenges, Pair Team has focused on seven new markets, addressing their specific needs for increased access to CalAIM programs. For instance, Los Angeles County, with its 2.7 million Medi-Cal members, includes some of the most high-needs individuals across the nation. Moreover, Central Valley counties in California consistently grapple with systemic access issues for Medi-Cal beneficiaries, especially concerning the availability of primary care physicians.

Pair Team actively breaks down barriers to care by collaborating with local clinics, shelters, food pantries, and other CBOs. Through a comprehensive artificial intelligence-driven platform, the team delivers services such as virtual urgent care, medication management, grocery delivery, and housing navigation, catering to the complex needs of their patients. Acting as an extension of safety-net organizations, Pair Team provides a multi-disciplinary care team comprising community health workers, behavioral health specialists, and nurses. Empowering their partners with essential tools, Pair Team facilitates increased access to high-quality care for a broader range of patients.

“Over 13 million Californians — one in three — rely on Medi-Cal for their health care coverage. However, many face barriers in receiving care including lack of transportation, housing and mobile phone access,” said Neil Batlivala, CEO and co-founder of Pair Team. “Health care is a basic right for every American and shouldn’t be more difficult to access for any one person. It’s our mission to bridge the care access gap, and this expansion enables us to do so for more Californians. We’re excited to continue bringing care to those who need it most alongside our innovative partners in these communities.”

What You Should Know:

– Arcadia (arcadia.io), a data platform for healthcare, today announced a partnership with WellSpan Health to improve the Pennsylvania health system’s performance in Medicare’s Shared Savings Program.

– This strategic partnership aims to leverage Arcadia’s data analytics platform to connect WellSpan Health’s 220 patient care locations and provide actionable insights that support the healthcare network’s value-based care journey.

Improving WellSpan Health’s Value-Based Care Performance

Benefits of the partnership for WellSpan Health include:

– Connect, normalize, and distribute data: Arcadia’s platform will integrate data from WellSpan’s 2,600 physicians and multiple EHR instances, providing a comprehensive view of patient data.

– Enhanced value-based care analytics: The platform will improve the accuracy and completeness of analytics across various contract types, including Medicare Advantage, commercial, and self-funded employer plans.

– Identify and close risk and quality gaps: Arcadia’s insights will help WellSpan identify and address gaps in care for its nearly 240,000 value-based patients.

– Improve care coordination: Risk stratification and modeling will enable WellSpan to improve the efficiency and effectiveness of care coordination.

– Manage referrals: Optimize quality while reducing unnecessary utilization and cost through better referral management.

“By leveraging data-driven insights and actions, healthcare organizations can meaningfully optimize performance in value-based care,” said Michael Meucci, President and CEO at Arcadia. “We’re thrilled to welcome WellSpan Health to our community of high performers who continue to lead the way in improving clinical and financial outcomes.”

During Diabetes Awareness month (November) – and every month – someone is having a limb amputated due to diabetes every three-to-four minutes here in the United States. These patients often come from traditionally underserved populations, including Black and Latinx communities, that disproportionately experience the clinical and economic burdens of diabetes.  

Getting ahead of rising patient risks can greatly improve quality of life and reduce the incidence of complications from diabetes, such as preventable foot ulcers.  It can also help cut spending by $9,800 to $14,000 per patient each year. 

America’s health plans have a major opportunity to pull back the curtain on health disparities, and take a hard look at what we can do to make preventive care a priority for all patients with diabetes.

Understanding the true size and scope of minority populations living with diabetes

Today, many analytics and risk stratification initiatives are built by using diagnosis and service codes to place individuals into defined disease buckets that end up prioritizing one disease state over the other without creating a full understanding of cause and effect. 

For example, people with open diabetic foot ulcers, which often indicates poorly controlled diabetes, are more likely to experience additional issues, including being 30 times more likely to have a lower limb amputation, eight times more likely to be hospitalized for peripheral vascular disorders, and about two times more likely to be hospitalized for renal failure, congestive heart failure (CHF), pulmonary edema, chronic obstructive pulmonary disease (COPD), or a heart attack.

As a result, we think of downstream spending on cardiovascular disease as the primary cost driver – not diabetes – and allocate our dollars accordingly. That leaves the needs of the rising-risk diabetes population unaddressed and inaccurately minimizes the costs associated with this small but very high healthcare spend population.

Health plans need to gain visibility into all the costs and codes associated with diabetes care and common comorbidities, and that includes important changes like prioritizing integration of Social Determinants of Health (SDOH) data into predictive algorithms that serve the best interests of all patients.

Reframing the partnership between health plan and member 

Working directly with community representatives can also help health plans understand the touch points that matter most to the people they serve. For example, faith-based groups can be ideal partners for making a big impact on education and building connections, since they are strong fellowship hubs that can host diabetes screenings, hold nutrition classes, or simply partner with health plans to reinforce the importance of making positive lifestyle choices.

Organizations like the Partners in Health and Wholeness (PHW), a multi-faith program developed by the North Carolina Council of Churches, is one such group that fosters healthy communities through events, financial support, and peer-to-peer education that reaches beyond the traditional clinical sphere of influence.

Communities as a point of connection and education

Using human-centered strategies for member-focused interactions can help to build and maintain trust, turning plans into more proactive allies that can effectively anticipate and respond to member needs. 

For operational leaders, this includes creating workflows that attract and retain top member-facing talent and developing performance metrics that prioritize member satisfaction, relationship building, and problem solving.

This shift in perspective can empower staff to provide culturally aware, socioeconomically sensitive support and collaborate more closely with clinical care providers, social workers, digital health platforms, and community-based resources to ensure comprehensive care for higher-needs members.  

Health plans that invest in creating pathways to connect with historically unseen populations before they become extremely ill will be crucial for containing spending, fostering better outcomes, and breaking the cycle of health disparities in underserved communities. 

Health plans would be well-served to reassess how they are supporting some of their most at-risk populations, especially those living with complex diabetes. Doing so will not only improve health outcomes, but it will also put a significant dent in total costs of care for minority patients who are hit hardest by chronic diseases like diabetes

About Jon Bloom, MD, Chief Executive Officer, Podimetrics

Dr. Jon Bloom is a board-certified physician and entrepreneur with over 20 years of experience in technology development, patient monitoring, biomedical research, and health care delivery. He co-founded Podimetrics in 2011 while a student at the MIT Sloan School of Management, and he’s served as CEO ever since. Dr. Bloom was first inspired to create a solution to help prevent diabetic amputations while practicing anesthesia. He frequently treated patients who required foot amputations, and saw the pressing need for a less drastic way to prevent diabetic foot complications. He previously served as a Clinical Assistant Professor and staff anesthesiologist at the University of Pittsburgh Medical Center and as the Director of Global Medical Affairs for Covidien’s Respiratory  and Monitoring Solutions division. Dr. Bloom has co-authored more than 20 peer-reviewed publications with a primary focus on health care economics and perioperative complications. He holds an MD from the University of Pittsburgh School of Medicine and completed  his residency at Massachusetts General Hospital.

About Sukanya Lahiri Soderland, Chief Strategy Officer at Blue Cross Blue Shield of Massachusetts  (Board of Directors, Podimetrics)

Sukanya is an impact-focused senior executive with deep knowledge of the healthcare ecosystem and expertise in innovation and digital transformation. She has spent over 20 years serving as an executive and trusted advisor to the boards and C-suites of companies across the healthcare continuum. Sukanya possesses deep insights into product design, partnership development, omni-channel consumer experience and the use of AI and advanced analytics to support business decision-making and operational redesign. She has used her unique combination of skills and experience to drive profitable growth, at scale, and improve health care affordability.

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What You Should Know:

– Anthem Blue Cross and Blue Shield in Virginia and Aledade, the nation’s largest network of independent primary care, today announced an expansion of their collaboration to provide more Virginians with access to high-quality primary care.

– The expanded strategic partnership will impact more than 80 practices, 15 health centers, and 25 rural health clinics across Virginia and covers Medicare Advantage, commercially insured, or Medicaid members.

– Aledade is particularly focused on bringing the benefits of value-based care to underserved communities and those receiving care through community health centers (CHCs). The company currently serves as a partner to 15 of Virginia’s 26 CHCs and supports the care of more than 90% of Anthem’s CHC members in Virginia.

Improved Outcomes for Diabetes and Breast Cancer Screening

Anthem and Aledade’s collaboration has already demonstrated positive results. In 2022, primary care practices and CHCs working with the two organizations improved their rates of hemoglobin A1c testing by 10% for patients with diabetes, reaching 9 out of every 10 eligible patients. They also achieved high levels of kidney health evaluation for patients with diabetes. Additionally, practices working with Anthem and Aledade ensured that 3 out of every 4 patients eligible for breast cancer screening received a mammogram.

Shared Savings and Reinvestment in Care Delivery

Shared savings generated through value-based care provide valuable revenue that can be reinvested in care delivery. In Virginia, this high-quality care led to substantial savings among Anthem’s commercially-insured patients, bringing more than $2M in shared savings payments back into community primary care.

“Putting our members and consumers at the center of what we do is our priority through partnerships with innovative companies like Aledade,” said Mark Schneider, Regional Vice President Medicare Market Performance. “Together, we can address the health of people and our healthcare system in the right way, improving health outcomes and lowering costs.”

Understanding the multifaceted dimensions of patient wellness goes beyond the medical symptoms presented in a clinical setting. In order to maximize positive patient outcomes, healthcare providers must examine and monitor the social factors and life circumstances, or the Social Determinants of Health (SDOH), that significantly influence population health. These determinants – encompassing aspects of life such as access to care and technology, food or housing insecurity, core demographics and more – play a pivotal role in shaping the health trajectories of individuals and communities alike. 

Monitoring social determinants of health can have a profound impact on healthcare outcomes, but there are challenges faced by healthcare providers in leveraging this data. Understanding SDOH creates promising pathways toward a more informed, equitable, and effective healthcare ecosystem.

The Importance of Monitoring SDOH Data

Enhanced awareness of a patient’s background and social environment has the potential to elevate patient engagement and experience, significantly improve patient care and lead to more positive outcomes. A recent survey shed light on an encouraging trend – as many as 80% of American hospitals are now collecting data on SDOH. This growing recognition of SDOH’s importance reflects a positive shift towards a more holistic approach to healthcare. However, the survey also unearthed a concerning disparity: only 53% of these hospitals are collecting the data regularly.

This gap underscores a compelling opportunity for healthcare providers to further harness the potential of SDOH data for improving patient care. The structured collection and analysis of SDOH data is needed to achieve a more informed approach to healthcare and to unlock the transformative potential of SDOH insight through powerful use cases including:

• Enhancing Patient Engagement and Experience: Gaining a holistic understanding of a patient’s social circumstances by collecting, monitoring, and analyzing SDOH data fosters a more empathetic and personalized approach to patient experience. It enables providers to engage with patients in a meaningful way, aligning care plans with the individual’s unique life circumstances. Furthermore, when patients perceive that their healthcare providers understand and respect their social circumstances, trust may be strengthened. This trust is foundational for effective communication and adherence to care plans, thereby enhancing the overall patient experience.
  
• Improving Patient Care and Outcomes: Awareness of SDOH can inform the development of tailored care that considers not just the medical, but also the social and lifestyle needs of patients. This nuanced approach facilitates personalized care, better adherence to care plans and improved health outcomes. Additionally, a robust understanding of SDOH helps healthcare providers become better positioned to educate patients about the impact social factors can have on their health and empower them to take proactive steps toward improved health outcomes. Beyond individual care, awareness of SDOH supports broader community health initiatives. It provides a lens through which healthcare providers can identify and address systemic issues affecting community health, thereby contributing to the overall well-being of the populations they serve.
  
• Program and Solution Innovation: SDOH data can be instrumental in informing health policy and program development, ensuring that policies, programs and solutions are designed to address the most pressing social factors impacting health. The integration of innovative technological solutions such as machine learning, predictive analytics and people-based data can further augment the analysis and utilization of SDOH data, driving more informed decision-making, better patient care and the creation of the next innovative solution.

The rich insight that SDOH data provides is indispensable in bridging the healthcare gap between providers and the communities they serve. As healthcare evolves towards a more patient-centric model, the importance of nurturing a deep awareness of the SDOH among healthcare providers cannot be overstated. This awareness is not merely a conduit for enhanced patient engagement and improved care but a basis for advancing health equity in a progressively interconnected world.

Challenges in SDOH Data Utilization

The road to regular SDOH data collection is fraught with challenges as limited resources pose a significant barrier, especially for smaller or underfunded healthcare facilities. The requisite technology, personnel training and the process alterations necessary for regular data collection and analysis demand a level of investment that may be prohibitive for some. 

Furthermore, the rising tide of patient mistrust adds a layer of complexity to this endeavor. Patients may be wary of sharing personal information pertaining to their living conditions, financial status or other social factors unless there is a clear understanding of how this data will be used to enhance their care. The “creepy factor” often associated with extensive personal data collection further exacerbates this mistrust, potentially hindering the efforts towards regular SDOH data collection.

However, there are a few ways healthcare providers and their partners can overcome the challenges that come with consistently monitoring social determinants of health:

• Collaboration and Partnership: Forming partnerships with tech firms, data companies, community organizations and other healthcare providers can pool resources and expertise to overcome resource limitations. Joint initiatives such as partnering with an SDOH data provider or the development of shared platforms for SDOH data collection and analysis can reduce the individual resource burden on healthcare providers.
• Standardized Frameworks: The lack of a standardized approach to collecting, analyzing and utilizing SDOH data is a significant hurdle. Without a coherent framework, the efforts of healthcare providers may remain siloed, thereby diminishing the potential impact of the collected data on patient care and outcomes. Developing standardized frameworks for SDOH data collection, analysis and utilization can drive consistency, collective utility, and quality in SDOH data practices.
• Training and Capacity Building: Investing in training healthcare personnel on the importance of SDOH, ethical data practices and effective data utilization techniques can significantly enhance the effectiveness of SDOH data utilization efforts. Harnessing the power of technology to automate data collection, analysis and integration can significantly mitigate the resource constraints faced by healthcare providers.

Taking Action

The healthcare landscape is in a state of constant evolution, with the potential to profoundly impact lives on both an individual and community level. Central to this evolution is the recognition, integration and continuous use of Social Determinants of Health (SDOH) data in the delivery of healthcare.

As healthcare providers and stakeholders continue to delve deeper into the realm of SDOH, the ripple effects are bound to extend beyond the confines of healthcare facilities into shaping policies, engaging communities and improving individual health outcomes. The potential to enhance patient care, improve community health outcomes and cultivate a more equitable healthcare landscape is within reach, hinging on our collective resolve to embrace and effectively utilize SDOH data.

And now is the time to act.

• For Healthcare Providers: Embrace continuous learning, foster inclusivity and engage in collaborative initiatives to share insights on SDOH data utilization.
• For Policymakers: Champion supportive policies and encourage dialogue with healthcare stakeholders to understand the practical implications of SDOH data.
• For Technology and Data Firms: Innovate ethically and advocate for seamless data integration in healthcare.
• For the Community: Stay informed, engage with local healthcare providers and support advocacy efforts towards health equity.

Monitoring and leveraging Social Determinants of Health (SDOH) data is pivotal in the pursuit of a more holistic, patient-centered approach to healthcare, which is essential for improving individual and community health outcomes. By understanding and addressing the social and environmental factors that significantly impact health, healthcare providers can tailor patient care and experiences, optimize resources and contribute towards a more equitable and inclusive healthcare system.

About Christine Lee
Christine Lee is Head of Health Partnerships for predictive data innovator, AnalyticsIQ. Christine has over a decade of experience in the data and analytics space and has worked with industry leaders across verticals like healthcare, pharma, non-profits, and more.

What You Should Know:

• NextGen Healthcare, Inc. a leading provider of innovative, cloud-based healthcare technology solutions, today announced that its clients participating in the Medicare Shared Savings Program (MSSP) leveraged NextGen® Population Health to achieve a cumulative $82 million in total Medicare savings last year.
• The MSSP incentivizes hospitals, associations of physicians, and other healthcare facilities to form accountable care organizations (ACOs) that optimize resources to save costs and better serve Medicare beneficiaries in their communities.

NextGen’s Impact: Transformative Results in MSSP ACOs Across the Nation

In 2022, nine NextGen Healthcare clients across the nation took part in MSSP ACOs, marking the most recent year for available data. Through the implementation of NextGen Population Health, these entities seamlessly incorporated actionable patient insights into electronic health record (EHR) workflows, ultimately enhancing engagement and elevating the quality of care provided to attributed beneficiaries. With an improved capacity to pinpoint and address gaps in care, the MSSP ACOs demonstrated noteworthy advancements in quality performance. The collective outcomes for the 129,000 Medicare beneficiaries served included:

– Total Medicare savings amounting to $82 million

– Shared savings reaching $42 million

– An average shared savings of $27.85 per member per month

– An impressive average quality score of 83.9%

Hutchinson Clinic, a NextGen client catering to South Central Kansas and representing a network comprising over 100 physicians and 600 employees, actively participated in an MSSP ACO during the same period, achieving savings for their Medicare beneficiaries.

“As the healthcare landscape increasingly shifts towards value-based care, NextGen Healthcare is helping ACOs leverage data and actionable insights at the point of care to reach evolving standards of clinical and financial excellence,” said Srinivas (Sri) Velamoor, chief growth & strategy officer for NextGen Healthcare. “We are proud to support our clients’ commitment to providing high-quality and cost-effective care for Medicare patients and manage their transition to risk-based arrangements.” 

What You Should Know:

– Cone Health, a non-profit healthcare network in North Carolina, and Helix, a population genomics company, have partnered to launch a five-year research study that will enroll and track 100,000 healthy people.

– The study will use Helix’s population genomics platform to provide medical insights for Cone Health patients and help identify people at risk for certain diseases and conditions.

Study Enrollment & Benefits

Enrollment in the program is optional and at no cost. Participants will be screened for genetic predisposition for certain diseases and conditions, such as breast and ovarian cancer, colorectal cancer, and high cholesterol.

Key benefits of the program include:

– Better, more effective care: The study is expected to result in better, more effective care for people who develop health conditions.

– Potentially delay, reduce or even prevent illness: Participants will receive information that they and their providers can use to potentially delay, reduce or even prevent illness.

– Uncover what risks might be occurring at disproportionate levels within communities: The program will help Cone Health uncover what risks might be occurring at disproportionate levels within communities.

– Better understand the health of the overall population: The program will help Cone Health better understand the health of the overall population.

– Build wellness programs for the broader community: The program will help Cone Health build wellness programs for the broader community.

Sequence Once, Query Often

Helix’s unique Sequence Once, Query Often™ model will allow individual patients to have future genetic tests run without the need for an additional sample. This will give them, and their providers, access to ongoing genomic insights about their health throughout their lifetime.

What You Should Know:

– CareAbout, a healthcare management services company, has selected Innovaccer’s data platform and analytics solutions to help its providers achieve their clinical and financial goals.

– The partnership between CareAbout and Innovaccer will help CareAbout’s providers achieve their clinical and financial goals in a value-based care environment.

– Innovaccer’s platform will provide CareAbout’s providers with actionable insights into quality, performance, and cost metrics, as well as support for risk stratification and predictive analysis. Additionally, CareAbout will use Innovaccer’s Population Health Management solution suite to unify patient data and drive whole-person, equitable, patient-centered care.

Value-Based Care for Expanding Provider Network

Key benefits of the partnership include:

– Unified patient records: Innovaccer’s platform will integrate disparate HIT data sources to create a unified patient record, making it easier for providers to access and analyze patient information.

– Rapid deployment: Innovaccer’s platform can be deployed quickly, allowing CareAbout to support its providers and their 150,000-plus covered lives.

– Scalability: Innovaccer’s platform can scale on-demand, allowing CareAbout to support up to 200,000 additional lives as planned.

– Actionable insights: Innovaccer’s analytics solutions will provide CareAbout’s providers with actionable insights into quality, performance, and cost metrics.

– Risk stratification: Innovaccer’s platform will support risk stratification and predictive analysis, helping CareAbout to identify and prioritize patients who are at risk of poor outcomes.

– Whole-person care: Innovaccer’s Population Health Management solution suite will help CareAbout to deliver whole-person, equitable, patient-centered care.

– Improved care coordination: Innovaccer’s analytics will help CareAbout’s care coordination team track care protocols’ performance, assessments, and improve productivity.

– Intelligent point-of-care insights: Innovaccer’s physician engagement solution will provide providers with intelligent point-of-care insights to help them address quality and coding gaps.

– Population health analytics: Innovaccer’s population health analytics solution will help CareAbout to better stratify the population and prioritize care operations to improve patients’ lives.

What You Should Know:

• Cognoa, a leading child development and behavioral health company, today published a new report, The State of Pediatric Autism Diagnosis in the U.S.: Gridlocks, Inequities and Missed Opportunities Persist, that underscores the longstanding waitlist crisis for children and their families seeking a diagnosis of developmental delays and autism evaluation. The report assesses results from 111 specialty centers across the U.S.
• On average, children and their families are forced to wait three years from the time of first concern of developmental delay to an autism assessment. Delays in diagnosis mean that children are missing the opportunity for early intervention during the critical early neurodevelopmental period when interventions have the greatest life changing impact.

A study by Scott Badesch, former President of the Autism Society of America, and sponsored by Cognoa, highlights significant concerns within the healthcare community. The main issues identified are excessively long waitlists to see specialists, the absence of a standard of care, and reimbursement barriers that disproportionately affect disadvantaged families.

Key findings from the study reveal:

1. Long Wait Times for Evaluation:

   – Approximately two-thirds of specialty care centers have wait times of over 4 months from the initial request for an autism evaluation to the diagnostic evaluation.

   – Out of these, 21% have waitlists of over a year or have stopped accepting new referrals due to high demand.

2. Reimbursement Barriers and Healthcare Inequality:

   – 44% of surveyed centers do not accept Medicaid, disproportionately affecting underserved communities.

   – Only 65% of practices accept commercial insurance, making it difficult for those unable to pay upfront costs to access care.

   – Lengthy assessment processes, heavy documentation burdens, staffing shortages, and inadequate reimbursement processes are significant barriers to timely evaluation.

3. Lack of a Standard of Care:

   – The study reveals a lack of consistency in the assessment tools used for autism diagnosis, with over 30 different tools in use.

   – Variability exists from state to state and healthcare payer to payer in the requirements for recognizing an autism diagnosis for reimbursement.

   – The majority of centers report that autism evaluations take over 3 hours, with 25% taking over 8 hours, even though research suggests that such lengthy assessments are not necessary for most children.

“Equipped with a diagnostic made for their setting, primary care clinicians and pediatricians can accurately and rapidly evaluate, diagnose, and manage most children with developmental delays and autism – all from within the medical home” said Dr. Sharief Taraman, CEO of Cognoa. “Yet, in most cases, the forces that be make the ‘autism specialist’ the only option for a diagnosis. This is an imbalance that healthcare leaders and policymakers must take seriously when directing future resources and developing initiatives to standardize, equitize, and streamline evaluation processes for families, irrespective of insurance type. We are failing our children as a nation. It is vital that we expand and empower the pool of providers who can evaluate and diagnose children, and we need to start in primary care.”