CapYear Cast - Andrea Lowe, MBA, MHA, PA-C

Andrea Lowe, MBA, MHA, PA-C, joins the CapYear Cast today to discuss the social determinants of health, namely health equality and equity. Andrea talks about the factors that enable health from the ground up and why simple waiting room questions can change the narrative. Andrea's 20-year experience spans boots-on-the-ground operations to hospital leadership, so she knows firsthand how important holistic thinking and PA/NP dynamics are to the overall patient experience. Definitely worth a listen - great stuff!

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Transcript below:

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John Walkup: Hi, and welcome to the CapYear Cast. Today we're joined by rockstar Andrea Lowe. She is a physician assistant. She has a master’s in health administration. She also has an MBA. Andrea, welcome to the show. Thank you for taking the time to be here. Why don't you tell our audience a little something about yourself?

Andrea Lowe, MBA, MHA, PA-C: Well, first, thank you for having me. I'm excited to be here. As you said, I am a physician assistant (the title has physician associate). I have been practicing for 20 years in emergency medicine. I went into healthcare leadership and administration six years into my career. I've been a director of advanced practice providers, which are basically PAs and NPEs or APRNs, and then, I went in to be a vice president of operations and led hospital operations for six years before going to the American Academy of PAs, which is the PA membership site. So, I've had a lot of experience, and I actually was over medical assistants, scribes, physicians, as well as PAs and NPEs. So I know about the dynamics and how important those healthcare providers are to the whole patient experience.

John: Great. Today we're going to be talking about health equity and equality and some of the things that factor into those and why they are so important.  I'm going to give the floor to you, of course. Let's talk about health equity and equality.

Andrea: I think it's important for all parts of the medical team to understand the importance of health equity and health equality. The first thing I always tell people is that you have to really understand the difference between the two. Health equality is really treating all patients the same. You're promoting fairness, but that really only works if everyone is sort of starting from the same place and needs the same help, which is not always the picture of our healthcare environment. So when we talk about health equity, it's really when all patients and communities have the same opportunity to obtain the highest level of health.

But the thing is, it requires the recognition and foresight from everyone on the healthcare team as well as an intentional allocation of resources to help them reach those outcomes. So it's really giving everyone what they need to be successful. And so recognizing health inequities in that space are really the differences in health that are avoidable when you address health equity.

John: Right. If you're not used to thinking about health in these sorts of terms, what are some of the things you could do to remind yourself of the difference on a daily basis?

Andrea: So you know, especially as PAs and then with what you all are doing at CapYear with medical associates, we're usually the first encounter to the patient in their healthcare and continuum. So understanding things like the social determinants of health is so important. Understanding that barriers to access are very important to recognize. And understanding and treating the patient beyond the healthcare visit. So things as socioeconomic status, access to certain healthcare services, even neighborhood and level stressors, and access to nutritious foods. All of those things contribute to that patient's health and their medical conditions. Sometimes they're even more in the patient's medical conditions. So really understanding what we call social determinants of health in a patient and then understanding to ask the questions: are you eating nutritious foods? Are you able to get nutritious foods? Instead of coming from a place of: “This is what you need to do.” Really asking those questions - are you able to do it? So changing that narrative is so important for everyone on the team.

John: Interesting. I like the idea of changing that narrative and putting yourself on the same playing field, almost as the patient. I'm curious, what are some of the kinds of questions you can ask? Are they really so simple as to say, “How  are you eating every day?”

Andrea: From an emergency room standpoint, there are triage questions that we ask all the time for the patient. And one of them really that's required by most sites is saying: “Are you safe at home?”  So even if you're going to a clinic visit or emergency room visit, especially when you're seeing patients that are constantly coming back for things as not being compliant with medications, going beyond and asking – before saying that the patient is not compliant (which is really an outdated term) – “Well, can you afford your medications?” “Do you have pharmacies around you?” “We notice your cholesterol is up. Do you live someplace where there's a food desert, or you don't have access to nutritious foods?”

It's really just baking in the same triage questions that we would ask when we're doing what we call the history of the present illness when you're coming in. It's really having the best practice and making those questions part of the healthcare plan because you're not going to see the most beneficial health outcomes unless you're addressing those issues.

John: Right. So let me ask. Sometimes, the patient, they're sitting in the waiting room. The physician is not in, maybe the PA's not in, it's just a medical assistant that's sitting there. Is that a special time that the medical assistant can really make productive? I don't want to say small talk because this is anything but small talk, but it's patient-facing time that contains valuable information. How can you use that time to advocate for these patients?

Andrea: That's a really great question. And I'll tell you, just in my practice, MAs have brought stuff to my attention in the emergency room or even in a clinic situation, and you're kind of going, going, going, and sometimes even you as a provider are like, oh, wait a minute, I didn't ask that. Or, I forgot to ask that. So again, it could be as simple as if the MA is doing the intake or taking the vitals and they see that the patient’s BP is a little elevated: are you taking your meds? Do you have them? And if it's no, instead of saying, okay, the patient is not taking meds and walking out the room, do that step: why?

Sometimes it could be because “I truly can't afford them. You know, I've lost my job.” There are so many other factors that can lead to that. So asking those questions is important. And another thing, too is that one of the things that I always used to have my team do is really be aware of the resources around us.

So wherever I'm practicing, anybody from really the front desk person to the MA to the provider to the discharging physician, whatever it is in that continuum, understands the resources. Understanding PR prescription help. Understanding places where you can go, like food pantries, to get nutritional food. Those simple things – just even having the list of resources you're contributing and even advocating for the patient in that sense.

John: Interesting. I imagine that most practices or locations would most likely have a list of resources. But is there a set list of resources or a location where you can find these resources, either online or are there, are there offices in which you can go and understand what the local resources might be for patients who might need that help?

Andrea: So especially one of the things that many people are speaking of and are aware of that's come out of this pandemic is understanding that there's so many health inequities. And so I think one of the things that we're seeing is the elevation of really resources that have kind of always been there. But places like CMS, the CDC, the National Minority Health Institute, there's so many, there's so much information out there. I know the CMS has it based on location and maps on their website and it's. Of, of resources that you can get.

And then really partnering at the community level, that's really important as well. So, you know, working for an organization that's saying, okay, here are all of the community health clinics, here's what the churches are doing. Really getting boots on the ground. And understanding what that environmental scan is for the resources that you have is really not that hard. The hard part is actually having them. But understanding where the resources are from a national to a local level is really important.

John: I'm going to try and put this in a little capsule here because I think this is really important stuff. It sounds to me that if you are an MA and you're sitting alone with a patient, perhaps they're waiting for the provider to come in, you have this window of opportunity. I'm wondering first, is their guard down a little bit when they're sitting there with someone who's not wearing the full white coat and has the authority to write prescriptions? Is it more of a one-on-one moment?

Andrea: Yeah, I think it definitely is. Especially because some patients could have what they call ‘white coat syndrome.’ When you're like, oh my gosh, I'm on guard, I have to make sure to say this, this, and that. Many times I've had patients tell things to either the MA or the front desk person, down to not feeling safe at home. Things that they may not feel as comfortable telling me yet. So I really think that there's an opportunity for there to be a candid conversation.

To go back a little bit of my history, I actually was a front desk person in a medical clinic. And that's what I worked at before I went to PA school. And there were many opportunities where the patient came in and said: “I'm so late, I'm so sorry. I've just been laid off.” Or “I couldn't come in, I had to take three buses to get here. I know I'm 15 minutes late. Do you think I could still be seen?”

That is an opportunity to say: Okay, is there anything else that you haven't been able to do because of that? You know: “Is your health insurance still intact so you'll be able to afford your prescriptions?” Because here's the thing: that's many times what, as a provider, we're not going to ask because we're just there to treat the patient. We don't really care if they have healthcare insurance or not.

But the issue is: you have to change that narrative. We treat people the same, so that's where it comes to that equality, but the equity is if I give you a prescription that's $250 out of pocket, and now you don't have health insurance… well, now I'm not addressing the equity part.

So that's where there’s that opportunity for that MA to make that connection and sort of remind. And then, as I said, as providers we're trying to do our best. Healthcare is super busy, more than it's ever been before, so having that best practice where the MA is part of that healthcare plan and is looking for things like that, and even writing a little note, or even coming in the room and saying, “Hey, the next patient that's in the waiting room, just want to let you know they shared this. This is going on with them.” So when you are discharging them, keep in mind that you may have to tweak something or make a call for verification to cover certain things. That is so helpful.

John: Right. It's amazing to me because it's establishing this lower-level relationship. There's the high level, which is like, “Hey, what is wrong with you today, and how can we treat what's going on with you?” But then there's that level of you as a person and getting to know it. And I'm wondering, from your point of view, how does that drive improvements in healthcare?

Andrea: Yeah. So it's not even so much like a high and a low level. It's really treating the patient holistically. As I was saying, treating them beyond. But that is a significant part of healthcare because if you are not addressing the health inequities, you're really kind of shifting what the health outcomes are going to be. Because sometimes the social determinants of health can play a huge role in patient health outcomes, even more than medical conditions themselves.

So it's really doing a disservice to the patient, but also a disservice to the provider, because I can't tell you how many times in the emergency room this person has come back and their sugar is still high. Well, can they afford the insulin? Can they take the insulin? Do they have a place to store the insulin? There are so many other things that go into that instead of a patient not just wanting to take their medications.

And so if you address that before, you can avoid what we call in the emergency room some of the bounce backs. But even in clinics, when you're doing all this healthcare planning, and you want to bring the patient's cholesterol down and blood pressure down. But if you're not addressing their food intake, what's causing their blood pressure to be high, work stretchers, socioeconomic status, then you're just kind of going in a hamster wheel. You're not doing anything. So you really have to approach it with a holistic approach.

John: Right. I like the idea of approaching it holistically. It's not a new concept, but it's one that I think needs new thinking. Because I think the revolution, I suppose it’s not even a revolution, but the idea of healthcare as being holistic is fantastic and I think it's long overdue.

Andrea Lowe, thank you very much. We appreciate all of your insights. We appreciate you stopping by, and we will certainly have you on again to continue this talk. Thank you very much.

Andrea: Thank you so much for having me.