Kathleen Wessel (Host): Hospitals and health systems are increasingly recognizing the impact of drivers of health, such as housing instability, food insecurity, and transportation barriers on patient outcomes and readmissions. The challenge is how to address these non-medical needs in a way that aligns with organizational priorities without overloading already burdened care teams.

 Welcome to AHA Associates Bringing Value, a podcast from the American Hospital Association. In this series of podcasts, we speak with AHA Associate Program business partners, check in on their efforts and learn how they support AHA Hospital and Health System members. I'm Kathleen Wessel, Vice President of Business Management and Operations at the AHA.

And today, I'm joined by Katie Keating, Vice President of Solutions Engineering at Unite Us. Together, we'll explore how healthcare organizations are re-imagining interoperability to extend care beyond the clinical settings and into the community. Whether your organization is addressing health drivers or looking to scale your impact, this conversation offers practical strategies to improve health outcomes across your patient population. Katie, I am so glad to have you on the podcast today. Thanks for joining me.

Katie Keating: Kathleen, thanks so much for having me. I'm really excited to get into it with you about what's of interest to your members.

Host: I do like to set the stage. And before we really dive into the meat of the discussion, love to learn more about you, your background, your professional journey, and what brought you to Unite Us.

Katie Keating: I like to say it was a dream journey that got me here, but I started off my career in Eligibility Entitlement Programs in government, so helping people apply for Medicaid and SNAP and TANF benefits. And I joined IBM through an acquisition. And there, I found I often got to be the special guest star talking to healthcare providers and payers about the importance of SDOH and the work they were doing.

I started tracking Unite Us doing that work, where this whole concept of a community information exchange kept coming up and how you could really reach into the community to provide support for programs, especially government programs that are collaboratives. If you think about mental health intervention programs and the community, if you think about substance use-related courts and recidivism, they are really this, coming together of healthcare and social care and community in a way that really drives great outcomes for folks. And so, I started tracking the work Unite Us was doing. And I said, that sounds like something I really want to be a part of.

And so, I applied and I sort of landed my dream role of getting to create this team of folks who are out in the industry, talking to our customers and talking to community organizations about the work they're doing and how technology can really enable their goals

Host: I can't thank you enough, both for your career journey and just sticking with these types of programs. I think where organizations can focus at this level, they really see great improvements across care. So, thank you very much. So, the field is always looking for innovative ways to improve patient outcomes. Why is interoperability so important when it comes to addressing patient's non-medical needs?

Katie Keating: This is such a great question. And I think what I have learned over and over again is we have to make it easy. We have to make it easy for clinicians. As you said at the beginning, folks are overworked, they're overtaxed, they are being asked to do too much. People are burnt out, left, right, and center.

And so, how can we make it so that folks can have the best data in front of them for informed decision-making to really drive to those outcomes for a patient. And so, when I think about how to make it easy, you really have to make it part of somebody's workflow. You have to make it just the next click, or you have to put the data right in front of them to ask the right question or ask the right followup question, and that can really change the conversation for folks.

One of the things we talk about a lot is that if you're in a care management scenario and you're working on a nutrition plan with someone and you tell them to go to the food bank, that's one thing. But being able to see if they actually went, the next time you talk to them, you don't have to start from scratch again and say, "Hey, did you go check that out?" Instead, you can ask them questions about were they able to access food that supports their nutrition plan. You might learn that they got a referral to a diaper bank for their infant as well. And it really allows you to change that conversation of not starting from square one over and over again, but taking that next step.

And, you know, I think this applies everywhere across the healthcare system when you think about discharge planning, sort of the moment you enter a hospital for an incident, you might have a case manager coming to ask you questions about like, "Do you have stairs at home? Do I have to get a physical therapist?" But it can also be like, "How are you going to get home from the hospital? Do you have a transportation need?" I had a personal incident where I ended up in the hospital and when I first got there, they're like, "Well, you're a single person who came in alone and we have all these things we have to plan for." And by the end of my hospital state, my parents were there. I had friends who would come in. And my whole plan of care had changed drastically from what we were planning for from what I looked like when I entered to when I left.

And so, I think the more we can give care teams access to that data that informs the picture holistically of who a person is, it can work into their workflows. It can address barriers earlier, and it can make sure that we are really focused on the patient and the way we talk about wanting to be.

Host: Yeah, absolutely. So, what types of integrations do you see hospitals using today to address drivers of health, and where do you see this work going in the future?

Katie Keating: I think hospital systems have really been on a bit of a journey that's kind of exciting to see. When interoperability rules first came out, it was really about providing sort of one-time access to information or building in a SMART on FHIR application to talk between tools. And right now, there's this really big uptake around screening initiatives. Medicare's requiring it, Medicaid's requiring it. Sometimes there are programs in the hospital where we want to ask particular questions. I love now when I get asked by my provider am I safe at home, I think that's a great question to be asking people.

And so, from a Unite Us perspective, we took the approach of how to address the so-what of asking a patient to be vulnerable. We talk a lot about trauma-informed and person-centered care. But if you ask someone a number of screening questions and then you're just like, "Have a good day," why did I open up and tell you those things? Why did I put my trust in you to share that with you?

And so, what we did was we built the ability to take in a screening from that EHR where it's happening and automate back the sharing of resources that can help with those identified needs. So from a clinician standpoint, we've saved them a lot of time. They don't feel like they have to be social care experts. They don't have to do more steps in their workflow, but they have something they can get to the patient when they walk out the door, or they can put it in their patient portal and say, "When you get home, take a look at it. See if you want to avail yourself of any of those resources." But it means that we've asked a patient to be vulnerable and now we're able to support them, and it doesn't all have to be on the clinician. This is a great place where we can use technology to help with that.

Then, I think from a hospital standpoint, when I think about what are the benefits of interoperability and integration, is really being able to do new and interesting things with data, right? So, if we think about those screening initiatives, what is the next step where I can get a patient connected to a paid-for community service?

So if they have a transportation barrier, instead of just saying like, "I can arrange you a ride. But you have to figure that out yourself," is there a program that can support that ride being paid for? Or when I think about interesting work being done between payer and provider collaboratives about closing care gaps, both of those teams need see that information. You only know of care gaps being closed by a provider, if you can send that data back to the payer to see it. If we're going to look at total cost of care initiatives, or how total cost of care initiatives can be affected by social interventions or community interventions, you have to give everyone that ecosystem access to that data to see how outcomes are happening and improving.

And then, finally, I think being able to surface key data points into those workflows to make it easy for clinicians. If you think about population health work, traditionally, you know, you have data scientists and analysts looking at data and creating cohorts and then like hoping something happens with them. But if you can take some of that information about why someone belongs in a program or what is something you connect them to and put it into the workflow, all of a sudden that's not just like a spreadsheet somewhere that someone's looking at as a cohort of folks, but it's making it actionable at the point of care.

Host: Well, yeah, and just from a clinical standpoint, from a clinician standpoint, just being able to see progress in some of your patients. I mean, that has got to be incredibly gratifying. You mentioned, like you see the information, but giving them the tools to say, "Okay, and here's how you fix that," or "Here's how you address that," or "Here's some resources for you." You're not going to get a brick wall there. You actually have actionable next steps. So, that's great. So when it comes to integration and interoperability, how can health systems plan for both immediate impact and long-term scalability?

Katie Keating: I feel like this is a place where I have nothing new to say, but I think best practices are worth reiterating. I always talk to my team about starting from a strong business use case. A clinician is never going to say to you, "I want interoperability." What they're going to talk to you about is a pain point that they have. It's a problem that needs solving. Are they having to redocument the same thing over and over again? Are they trying to make a decision and they don't have access to a piece of data that would really help them? And then, we should tie that also to understanding what is success. So, what are the KPIs? What is the ROI? What is the data you want to look at to show that interoperability? Has it helped achieve that use case?

I think we also need to create champions and quick wins. I know there's sayings about how like gossip travels quickly, but so does good news. So as soon as you have folks who are finding success or you're easing their workload, they tell a friend and they tell a friend, and you can very quickly gain adoption through that.

And I think it's important to also have a strategic roadmap for where you want to go and also have checkpoints to review and iterate upon that. So like any process we do, or anytime we do a strategic planning, it's great to take stock of, "Are there new policy initiatives I have to consider? Is my hospital system asking me to send everyone to a particular program in the next six months? Do we have a new wellness initiative? What are the things that we need to incorporate into our planning to see like, "Are we still on the right path or should we take a moment to pause, reflect, and maybe change the way we're going?" Because interoperability is going to keep changing every time someone talks about AI and big data, right? There's this whole world of new possibility coming. So, we always have to sort of reflect on the success we have, but also see like, are we still headed in the right direction? Or based on any of these factors, should we pivot and update our roadmap based on that?

Host: You've shared impactful real world experiences with us. So, what should healthcare leaders consider when evaluating whether an integration strategy is built to scale over time? What questions should they be asking potential technology partners?

Katie Keating: This is a hard one because I think some of these decisions are also inherently very personal from a company perspective. But I think, again, there's some things you can look to as guideposts for best practices, which is asking folks what are the industry standards that your integration approach aligns with? So, are you looking at the Gravity Project and the definition of how to code social determinants of health as a way to exchange data? Are you going to use the same dictionary everyone else is using? Or do you want to look at technology standards? Do you want to look at REST APIs and FHIR APIs as a way to exchange data? Like, who else is using the technology around you that you want to connect to? And then, really understand how it works with other systems. What does it mean really from that workflow perspective and that use case perspective? What are the possibilities of how we can exchange data? Is it you're going to be able to send things just one way, or you're going to be able to exchange one field and nothing else?

Like, does that interoperability support the use case you're moving towards? And again, continue to evaluate that as well because, even the Gravity Project, which we participate in and we are big fans of, when we went to implement a program in New York this year, it was not well-defined enough for everyone to use the same standards. So, some work still needed to be done to make sure that all of the data that was expected to be exchanged around the state had a clear definition and there was no room for interpretation so that we could guarantee that the data meant the same across the whole state. So, things will continue to evolve, and I think it's important just to continue to evaluate what industry best practices are to make sure that your technology is keeping up with them.

Host: Could you give us maybe a 30-second or a thumbnail on the Gravity Project?

Katie Keating: So, the Gravity Project is an initiative really focused around how to codify social determinants of health information and social care information in a way that it can be exchanged between systems of care. So, it really started as this healthcare initiative based around HL7, and how within EHRs and from an interoperability landscape there, you could exchange data, but is really now expanding out to payers and to community-based organizations and organizations like Unite Us that are doing that coordination of care across care environments so that everyone is speaking the same language. Everyone understands what the data means. And if you're doing a screening in one system, everyone knows in another system that that data's the same.

Host: Critical work. Thank you. Now, we're almost to the end. So as we wrap up, can you share with members what excites you the most about the future of this work?

Katie Keating: I feel like we're on the precipice of realizing all of the things that we talk about around whole person care and evaluating like how to get to good outcomes. I feel like it's really taken a moment for everyone to be bought in on that. So, a clinician might've realized that originally, but now payers are bought into the idea of government has bought into the idea. Community-based care has always been like, "We've been here, we've been waiting for you to catch up." But the ability to really look at all of that information at the same time and to securely share that information between these systems of care. We're making that data available and actionable to be able to use in a workflow at the point of care, but also to be able to measure how are we getting to good outcomes.

So, it's often not just any one program, it is not that you went and got WIC, it is not that you got good maternal, prenatal care. It is not just that you can access the diaper bank. It is the combination of all those things together that are leading to success and interoperability and data are really leading the way, and being able to measure that and evaluate what it takes to really get to good health outcomes.

Host: Oh, that's wonderful. Katie, I want to thank you so much for joining me on the podcast today and sharing your takeaways with AHA members. It's been a pleasure. For listeners, if you would like to learn more about Unite Us and the AHA Associate Program, please visit us at sponsor.aha.org. This has been an AHA Associates Bringing Value Podcast, brought to you by the American Hospital Association. Thanks for listening.