Healthy Days at Home: Dr. Monique Reese on Transforming Home and Community Care

Nick Stupakis: Good morning. Welcome to Healthy Days at Home. I'm Nick Stupakis. I serve as vice president at Helion. And this is Dr. Monique Reese, our SVP of Home and Community Care. Monique, have you ever done a podcast before?

Dr. Monique Reese: I have done a few podcasts. I’m so excited, Nick, to have a good conversation with you today and talk about healthy days at home and the transformation we're leading for Highmark Health.

Nick Stupakis: So, tell me a little bit about, you know, obviously care is shifting into the home. That's been a strategy for enterprise since you got here. Tell me a little bit more about the direction that we're going as an enterprise.

Dr. Monique Reese: You know, it's really pretty exciting. I'd say over the last probably 10-15 years, you know, the industry from a home health standpoint and a home-based care standpoint has really been transformed and kind of preparing for where I think we are today. And so, coming into Highmark Health, I was really excited to be able to work with payer provider kind of combination and look at, you know, how benefits are designed, how reimbursements are designed, and then line that up with the actual care delivery.

So, I feel like from a Highmark health standpoint, we're really well positioned with our Living Health strategy. And care in the home is a very central piece of that strategy and it's extremely important in regards to creating a remarkable experience for our patients and our members. And so, I feel like we're really well positioned for the work that we're doing across Highmark Health and the work that we're doing within Helion.

Nick Stupakis: So Dr. Farah brought you in. It's your first day. It was our first meeting together. I came into the room with you. I laid out what we were doing. Here’s Helion, tell me what you were thinking.

Dr. Monique Reese: I was actually super excited because it was the work that Helion was doing was really on the front end of innovation. And to me that's a very exciting place to be. And knowing that you can create and change and drive, that transformation in the home setting was super exciting for me. So I was really excited that first day coming in and really just getting to meet all the different leaders.

But you know, learning what Helion is doing and the work that Helion had been doing for at least the prior five years was really exciting to me because I could see the potential of where we were and really what we could do with that very strong foundation and how that could actually transform care in the home and then really support providers, you know, in our different markets and in driving that transformation.

Nick Stupakis: I remember that meeting so well because I just remember sitting in that room with you and being like laying things out and just saying like, these are all the pieces that you had. And like, my immediate reaction was you were just going to have more questions and you had more questions, but you were like, “Oh, you did this because of this and because of this and because of this, and you're setting the foundation for all these other things.” And I remember being like, she gets it.

Tell me a little bit about your background. I know that you have an extensive background in health care and the work that you've done in the home and community care setting.

Dr. Monique Reese: Yeah, you know, I've always joked that I was kind of a late bloomer, so I actually went to college when I was 28. I actually had worked in government business at that time, and I was kind of going through, you know, some of that life journey in regards to what do I want to do. And I really felt a draw and a purpose around caring for other people.

And so I ended up going into nursing and I remember thinking, I want to be a nurse practitioner. And this literally happened. I Googled like, What jobs are of the future?

Nick Stupakis: And that's what came up.

Dr. Monique Reese: And nurse practitioner actually came up and it said, hey, listen, you know, this is something that in 20 years it's going to be a viable, you know, position. It's something, you know, that will be highly needed. And, you know, so I went on this journey and I went on a ten year journey and got my nurse practitioner, got a doctorate in nursing practice, family practice, and then I'm subspecialties and palliative care and hospice.

And I would say I started at the frontline. I actually worked as an aide, I worked as an LPN, I worked as an RN, I worked as a nurse practitioner and so really got a really good feel. I feel like from a health care standpoint, whether you were in the clinic or the hospital or the home setting of what that felt like for the clinician or the clinical team, but also what that looked like for a patient or a member.

And that gave me, I think, a little bit different insight and a lot of passion around, you know, people want to be in their home setting, they want to be healthy at home, they want to age at home. And that's whether it's a five-year-old or a 105 year old. And so, I really started to move after the first ten years of my career.

I started to move into the home setting and started to really work around what are the type of things that we need to do to enable health and healing in the home? And so kind of brought me to where I am today and the opportunity to work with Helion and drive some of that transformation. So very purpose driven and connected to, you know, how I want to make a difference in the world.

Nick Stupakis: I'm curious, you know, because you talked about like your upbringing in the health care space. Is there a story, something that you can think of that maybe a smaller piece, but leads to a bigger issue that whenever you were giving direct care that you think back on, like this was a moment that I saw something that drove me to think, hey, I can make a bigger change in health care.

Dr. Monique Reese: You know, actually, I was a I was a weekend package registered nurse on med surgical, orthopedics. And at the time I was also finishing my residency as a nurse practitioner. So I was working the weekend package, caring for patients, making sure I was bringing a paycheck home, had benefits type thing. And during the week I was in my residency.

So I was working in clinics and I started to see individuals that I cared for in the hospital, like coming out and they were coming through to do their follow up appointments. And it was one of the first times that I got to see that what we talk about when an individual leaves the hospital and goes home and then what actually really happens isn't necessarily the same thing.

And it was probably it was very early in my career, but it was kind of, for me, a light bulb around all of the all of the barriers and issues and the individuals and or their families run into when they're trying to get settled back into their home environment after they've had an illness or are not being well.

And so for me, very early in my career that I was, I started to connect the dots that and I think some of that was just being new when you're new and in a position or a career of everything's perfect. And I was just one of the first times I think I started to say, oh my, we have problems.

We have a lot we have a lot of opportunities that we could really transform and make a difference for these individuals and their families.

Nick Stupakis: I was in a nursing home for like six months, like learning to be a nursing home administrator had similar experiences, right, where it just started to click and I was like, Why do we do that? Like, why do managed care? You know, why do we do that from a managed care perspective around these patients? And then I started like putting the dots together and thinking to myself, you know, if if I'm just in a nursing home, I can impact 120 people because all of our nursing homes were 120 beds, and then as a regional 1000, and then I started thinking about Highmark and I was like, Wow, if I was at Highmark, I could impact millions of people because there's so many different opportunities and post-acute care, you know, there's so many parts of that journey that are either broken. I mean, fragmented care with the caregivers. There's just so much opportunity to continue driving care. I'm curious, as you think about our care in the home strategy, how it ties into our broader living health strategy.

How do you make those connection points?

Dr. Monique Reese: You know, I, I think it's directly related to our overall Living Health strategy, and it's a very core piece. So when we think about creating a remarkable experience and we back into what are the type of things that we need to make sure that we accomplish in order to do that, from a consumerism standpoint, it's directly related to individuals being in their communities, individuals being in their home environment, whatever that environment is.

And anything we can do around designing and implementing different capabilities that actually support that, I think support Living Health. And when we think about our care at home strategy and we think about the different capabilities that we're developing out, whether that's, you know, buy, build, partner capabilities, those are going to feed into being able to deliver on our promise of creating a remarkable experience, which is, you know, directly related to Living Health.

So, I feel like the work we're doing around care at home and the capabilities that we're developing out, you know, are directly related and honestly, a core piece of delivering that, you know, experience that we're really looking at.

Nick Stupakis: I know you and I talk a lot about virtual care and how it's an enabler. Yeah. Tell me a little bit about your thoughts on, you know, obviously as an enterprise, we're transforming the way that we look at virtual. How does that tie into your strategy and how does that you know, as you think through the work that we're doing at the Allegheny Health Network, at Highmark, with Helion on how does that virtual strategy tie in?

Dr. Monique Reese: You know, I think there's a couple, you know, different ways that I'll speak to around the digital or virtual transformation that's happening in health care. And I would say obviously within Highmark Health and, you know, there's two pieces once around creating access and creating access for individuals in real time no matter where they are. And so I think when I'm looking around, whether it's a digital app or whether it's an actual virtual visit that's going to create access for individuals in the comfort of their home.

And so creating access is extremely important and it becomes even more important as we go through the next 20 years, because, number one, we know that we're not going to be able to hire our way out of the volume of individuals that are going to continue to need care so we don't have enough educators to train, you know, teams.

We don't have enough individuals going into that profession. So this is going to create access and this is a way for us to scale. The second piece, I think around digital or virtual strategies, that is really going to help us in regards to care at home strategy and our Living Health strategy is around workforce. So it helps us scale the workforce.

So it instead of, for example, a nurse practitioner driving to the home to make a home visit, we can have the ability to have a virtual visit and have the technology aligned with that virtual visit to listen to heart, lung sounds, for example, and do a complete assessment. And that really helps us give the ability to scale a workforce and care for more individuals.

And so I think creating access and scaling workforce are very core pieces of our virtual and digital strategy, and they're very important for us to be able to care for the populations and the individuals out in the community.

Nick Stupakis: You know, we've talked about this before. I think one of the challenges that we have from a staffing perspective and post-acute care, right, is that we bring in vendors, we bring in other companies, and then the nurses and the nurse practitioners go from delivering bedside care, you know, and that's why we build our episodic program that we built because we want to give and empower skilled nursing facilities, home care agencies, to not think about, you know, how long someone staying in a skilled nursing facility or how many days that they're going out to visit them.

You know, we want them to take better care of the patient virtually with the staff that they have. And so it really ties into our overall Living Health strategy as well as sustainability of our provider network. So I love the way that you think about that.

Dr. Monique Reese: Well, and, you know, it also creates that opportunity in regards to when’s the right time, who's the right person. Yeah, in leverage that interprofessional team to the full scope and top of their license, which is very important in regards to access and scalability also. So that the episodic payment model creates that space for providers to make those decisions based on individual's needs and preferences.

Nick Stupakis: Yeah, so we’re going to play a little game. I'm going to give you a word and then you have to tell me how it associates. All right. The first word is Iowa basketball.

Dr. Monique Reese: Well, wow.

Nick Stupakis: You’re supposed to say Jersey for you. Nick. You're supposed to say…

Dr. Monique Reese: Nick’s trying to get a Caden Clark Jersey. I may have a few connections. So Nick as you know, I'm from Iowa. It's very close to my heart. My family's, a lot of my family is in Iowa. And I worked years in Iowa and I graduated from the University of Iowa. So and then I may happen to have a couple kids, you know, that are employed by the university, in athletics.

Nick Stupakis: So I'm assuming that that's coming my way pretty soon.

Dr. Monique Reese: I don't know. I don't know. We'll see. We'll have to work on it. But, you know, I think when I think of Iowa, it really connects me to why I do what I do. And I think of home, I think of purpose. I think of it's kind of where I started my career, and it's why I'm where I'm at now. And so and it's why I do what I do so very close to my heart. And I do think of the University of Iowa quite often.

Nick Stupakis: What's next for us? Whenever you think about all of the work that's happened and where we're building capabilities, where we're driving care into the home, how Helion is involved in effect, of that change. You know, what's on your next three years? What's on in the back of your mind that these are the things that we need to do as an enterprise to be successful going forward.

Dr. Monique Reese: So, you know, we're in year three of our five-year strategy. So depending on the capabilities we're scaling. So we're at full scale in some capabilities and then in others we're really testing and learning. And so, I think as we think over the next 3 to 5 years, we'll obviously go through some strategy refreshes. We will continue to scale and commercialize the capabilities that, you know, we've proven out, and I think really learn what's working and what's not.

So there's going to be things we stop doing and then things that we really power through and start to look at. Okay, we need to also commercialize these and create an opportunity for other individuals, you know, to have access to that capability. So I continue to see growth in the space from a care at home standpoint, and I really start to learn what's working, what's not working, and be able to start to move a little bit quicker. And again, growth. I think if I thought of one word growth.

Nick Stupakis: Yeah, it's really interesting that you say that, because I think that's one of the things that I've learned from you specifically is, you know, we've done a lot having that ability to say these are changes that we need to make. We're going to make those changes. But sometimes it just doesn't work. And having the ability to say, we're going to fail, we're going to fail fast, we're going to try a bunch of different things.

We're going to go out and build capabilities. There going to be some that work that some that don't. That's the way health care is, right? So, like, you can't always think that everything you're going to do is working. But I think that that growth and that opportunity, you know, you've done a tremendous job there so well.

Dr. Monique Reese: And I think the adaptability and versatility is extremely important. So we want to test, learn, see what works quickly and then be able to move on. So the adaptability of organizations, individuals and versatility become extremely important in the work that we're doing. Yeah.

Nick Stupakis: Well, I appreciate everything that you've done for the enterprise and coming here today. I know that you said you watched some podcasts before you came. I did not. I wish I would have probably would have helped me but appreciate you joining us today. And I can't wait for our next chat.

Dr. Monique Reese: Absolutely. Thanks, Nick.