Dr Ellen Stang of ProgenyHealth: In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System

An Interview With Luke Kervin

Mental health and physical health services are equally important and contribute to overall health and well-being. It is important to screen all caregivers for their mental well-being and moms in particular, for post-partum depression. Should there be any concerns identified, this will allow for timely interventions and support. Ensuring the mental and physical health of all moms and caregivers will allow them to be fully present and able to care for their children and families.

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.

As a part of this series, I had the pleasure to interview Ellen Stang, MD.

Dr. Stang is a board-certified pediatrician, a member of the American Academy of Pediatrics, and a recognized leader in improving care management and health outcomes for premature and medically complex newborns. She founded ProgenyHealth in 2003 with the goal of improving outcomes for premature and medically complex infants, enhancing patient and provider experience, and reducing overall costs of care. Taking an entrepreneurial approach in an industry that is historically innovation averse, she built the business literally from the ground up — starting alone in her basement and now employing over 230 people.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?

When I look back, it began with some experiences I had in elementary school and junior high school. That’s when I really fell in love with science and realized that I had an aptitude and interest in science. I especially loved biology and learning more about living organisms. I was very competitive from a young age and was always trying to push myself to be the best and to develop my God-given talents. In eighth grade, we had a school science fair with our entire school district, and I remember being very excited about it.

I competed against juniors and seniors in high school and ended up becoming the junior grand champion. When that happened, I remember feeling that I may have just found something that could work very well for me in the future. That is really what started my interest in science and eventually a career in medicine.

I also had a few friends whose fathers were physicians, and I was able to see how science could actually help people. Around age 14, I began thinking that I also wanted to learn about the practice of medicine — I even had an opportunity to volunteer in a hospital — and thought it would be really cool if a woman could be one of these doctors I always saw. My mother was always fully supportive of my goals and would always tell me that I could be anything that I wanted to be.

Fast forward, I went to medical school and pursued a career in pediatrics as I always had a natural affinity and love for children. After my residency, I was in private practice for about ten years when a good friend reached out to me about a potential opportunity in managed care. In this role, I could support a more children and families at a population level through policy and benefit administration. After much thought, I decided to interview for the position and was offered the job. This is when I began to learn more about the business side of medicine, and I loved the positive impact I was able to have on a larger population.

Can you share the most interesting story that happened to you since you began your career?

I would say that when I was very happily involved in my private pediatric practice, I wasn’t considering a different career path. I loved what I was doing and was surrounded by many supportive colleagues. And then, I was suddenly presented with an opportunity that really changed the trajectory of my career.

Along with the interesting stories I’ve collected there are some very important core learnings that have played a consistent role in my career. One of these is that if there is something that you want, you need to want it more than anything. There are always multiple paths that we can choose in our life, and a career in medicine is not an easy journey. When I think about going to medical school and the challenges that it presented, I remember my mother saying, ‘if it was easy, everyone would have an MD after their name’ and she was right. I chose a path that was challenging and tested me. I have so many stories of perseverance, sacrifice and hard work paying off for me and my team. Those are the stories I love to share.

Can you share a story about the funniest mistakes you made when you were first starting? Can you tell us what lesson you learned from that?

When I first started ProgenyHealth, we were very small. I had two employees and everyone else were outside consultants. We were in this very small office, and I remember working closely with a software developer. At the time, I needed software that was very niche-oriented for NICUs, and I remember sitting down with our developer and putting together a PowerPoint slide that had four things on it. I asked him ‘Can you build this?’ and he put together a proposal for me.

Once we developed the Baby Trax®platform, I remember thinking ‘Okay, we are done. We are good’. The funny mistake is that I didn’t realize at the time that our proprietary software would need to be modified and revised based on changing business needs as we grew. What started out as a simple PowerPoint slide is now probably hundreds of thousands, if not millions, of lines of code that are continually updated by a full team of software developers and a chief technology officer, all of whom work full-time within our company. They continually help us to remain innovative and cutting edge with our technology and work tirelessly to support the important work of our health services teams.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

I am actually quite a collector of quotes. I love reading inspiring words from wise people, and I think one of my favorites is from Louis Pasteur. He said, ‘chance favors the prepared mind.’ I very much live this quote. As a CEO, you need to be prepared. When I was in my teenage years, I remember preparing for my career. At age 14, I read a book about how to get into medical school. I always like to prepare for what is ahead of me as much as possible. I do think that when you are prepared, you get your desired message across and engender confidence in your position and viewpoints. Chance favors the prepared mind … That is such a profound statement that is very meaningful to me.

Are you working on any exciting new projects now? How do you think that will help people?

I am really excited about our movement into maternity care management, which is a new program we are rolling out this Fall. This is an expansion into a line of business that is going to further our mission of improving the health outcomes of infants and their mothers. Our belief is we want to get ahead of a medical complication event, whether it is for mom or baby, to improve the health outcomes for both. Engaging with a mom during her pregnancy, we can work to course correct issues that otherwise would lead to an adverse maternal outcome or a premature birth and subsequent NICU admission. Early pregnancy support and interventions are going to produce better outcomes. We will be closely monitoring a mother’s pregnancy to make sure she’s healthy and does well throughout the entire episode. This new focus for ProgenyHealth is about furthering our mission and creating effective end-to-end solutions, that broaden our reach to impact the full continuum of women’s health.

A significant advantage we have over other competitive businesses is that we have almost 19 years of insights and experience working and learning in the healthcare space that we are applying to our maternity program. We are applying our learnings to maternity care, which will allow us to go above and beyond existing maternity management programs. and be a stronger more impactful program right out of the gates.

How would you define an “excellent healthcare provider”?

To be in healthcare today, especially with the ongoing pandemic, you are truly dedicated to your patients. I remain so impressed with the incredible doctors, nurses and clinical staff who have not stepped away from their post and have continued to work hard to save lives throughout this pandemic. I just hope that as a society we continue to move forward to protect our healthcare workers and get immunized now that vaccines are available, as they are truly putting their lives on the line for all of us.

Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?

Even before the COVID-19 pandemic, I think the U.S. healthcare system has struggled mightily with providing our citizens equal opportunities to receive health insurance coverage. Inadequate health insurance coverage is one of the largest barriers to health care access, and the unequal distribution of coverage contributes to disparities in health outcomes. Out-of-pocket medical care costs may often cause individuals to delay or forgo needed care (such as preventative doctor visits, dental care, and medications) and increasing medical debt is becoming all too common among both insured and uninsured individuals.

Vulnerable populations are particularly at risk for insufficient health insurance coverage.

Lack of health insurance coverage negatively affects health, and uninsured adults are less likely to receive preventive services for chronic conditions such as diabetes, cancer, and cardiovascular disease. Similarly, children without health insurance coverage are less likely to receive appropriate treatment for conditions like asthma or critical preventive services such as dental care, immunizations, and well-child visits that track developmental milestones.

Since COVID-19, health disparities and health inequities have been highlighted even further. I think to correct these issues, there needs to be top to bottom industry support for eliminating health inequities and addressing Social Determinants of Health head on. The healthcare industry needs to continually become more of a partner in the overall health and wellness of our communities. Addressing and solving for social determinants of health is important for improving health and reducing longstanding disparities in health and health care. For us to truly achieve good health and achieve health equity, it will require incorporating broader approaches that address social, economic, and environmental factors.

Of course, the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives.

Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.

The doctors, nurses and all healthcare providers who showed up every day to help those in need during this pandemic are truly heroes. Clearly this time of crisis revealed the selflessness, dedication and expertise of our frontline healthcare workers, the incredibly talented researchers and scientists who worked tirelessly to expedite the development of effective vaccines, and more rapid adoption of telemedicine, to maintain access between providers and patients while keeping everyone as safe as possible.

We also saw healthcare organizations responding to social determinant of health issues that worsened during COVID. For example, many of the families with NICU infants who we serve found themselves facing greater food insecurity, housing, and childcare challenges. Our case management team — including NICU nurses, social workers, and lactation consultants — stepped up quickly to support families to help to solve for these issues real-time. Because we work in communities across the country, our extensive database and local experience were critical in getting more immediate assistance to the families who needed it most.

Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

First, as I have mentioned previously, I believe that our healthcare system needs to address the increasing issue of health equity and work toward the elimination of health disparities that are linked with social, economic, and environmental disadvantages. Health disparities adversely affect populations that have systematically experienced greater obstacles to health based on their race or ethnicity, religion, socioeconomic status, gender, age, mental health, disability status, sexual orientation, geographic location, or other characteristics historically linked to discrimination or exclusion. Research over the last 20 years has helped demonstrate the significant harm that structural racism has inflicted on our mothers and their newborns.

Second, I believe that all health benefits need to have a greater focus on eliminating barriers to adequate maternity and pre-natal care. We know that health plans, medical providers, businesses and government leaders want to make a difference and have the very real ability to impact significant change in our country. In my home state of Pennsylvania, for example, in 2018 the Pennsylvania Maternal Mortality Review found that nearly half of women that experienced a pregnancy-associated death between 2013–2018 did not receive adequate prenatal care. Barriers to prenatal care access run the gamut, from financial difficulties, insufficient insurance coverage, lack of nearby facilities, lack of transportation options, rigid work schedules during office hours, childcare obligations, substance abuse, and more. Statistics such as these are unacceptable.

Third, I believe that their needs to be an increased focus on post-partum health coverage. Postpartum care is woefully inadequate in the U.S. — often consisting of a single health care appointment between two and six weeks after delivery. Modern medicine is organized around standardized care and clinical guidelines, yet postpartum Medicaid coverage is not only insufficient, it varies from state to state. For example, only 61% of Medicaid mothers schedule a postpartum visit — a figure that can range as high as 72% in Rhode Island but only 23% in Oklahoma.

The American College of Obstetricians and Gynecologists has recommended providing standard care for a “fourth trimester” to manage chronic conditions, offer breastfeeding support, screen for mental health disorders, and support contraception planning. Maternal mortality and postpartum depression are two critical areas that a Fourth Trimester could address. The American Rescue Plan Act is now giving states a new option to extend Medicaid postpartum coverage to 12 months following birth. This is a great start and is available to states for the next five years.

Fourth, there needs to be a continued focus on value-based care over volume. Care that drives better health outcomes at a lower cost. This will involve a village of support with companies like ProgenyHealth, who can provide support services 24/7 after the mom leaves the hospital or her doctor’s office to ensure there are no gaps in care and any issues that might arise between office visits are addressed in a timely fashion. Telehealth and virtual care models do work and can ensure care is received when it is needed and at a time that is convenient for families. As more innovative approaches to care delivery become more mainstream, health issues can be identified sooner and treated as necessary to ensure more optimal health outcomes.

Finally, mental health and physical health services are equally important and contribute to overall health and well-being. It is important to screen all caregivers for their mental well-being and moms in particular, for post-partum depression. Should there be any concerns identified, this will allow for timely interventions and support. Ensuring the mental and physical health of all moms and caregivers will allow them to be fully present and able to care for their children and families.

Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?

Since my days as a practicing physician, there have been many changes in the way that medicine is practiced. While these changes have brought about tremendous technological advances, our industry still needs to have qualified physicians delivering care. The Association of American Medical Colleges projects that by 2033, we will face a primary care physician shortage of between 21,400 and 55,200. Those figures are even more pronounced among specialty physicians where we could reach shortages of up to 86,700. We will have fewer young people available for medical careers as the population over 65 surges. Conversely, there will be very low growth among those under 18, which will likely suppress demand for pediatric specialties — an area of personal interest to me as a pediatrician whose team works closely with neonatologists.

We need to think more broadly about how we address this issue:

• For starters, we’ll need to get more young people in a medical career pathway, particularly from diverse and less represented communities.
• We’re already seeing the growing role of Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs), and I think that trend will continue out of sheer necessity.
• We saw how COVID made an already demanding career more challenging. If our medical schools, health systems, research and other physician employers want to attract future practitioners, we’ll need to think about work/life options, mental health needs and more mentor/mentee relationships. These issues are vitally important to today’s younger physicians.

How do you think we can address the issue of physician diversity?

I believe that increasing physician diversity will greatly benefit the entire health industry. While I am no longer personally working in a direct clinical setting, I know this remains a very important issue. It’s an important question, because of persistent health inequities, particularly in Black, Asian Pacific, Native American and Latinx communities. Studies show that patients want to be treated by physicians who understand their background and culture. We need to grow a more diverse physician population to help reduce those inequities and engage patients who often lack trust in our healthcare system. The AMA has made grassroots “pipeline” programs a priority in recent years, and it will take a concerted effort by all healthcare stakeholders to help make a career in medicine more accessible.

How do you think we can address the issue of physician burnout?

Although it has been many years since I have been in private practice, I am able to offer thoughts that are based on current observations and discussions with my physician colleagues. We need to recognize that physicians are not superhuman. They experience the demands, disappointments and worries in their work and personal lives that affect all of us. COVID-19 exacerbated these challenges and led to some physicians leaving frontline roles and many experiencing mental health issues.

I think we need to implement several steps to address this issue including:

• Emphasizing self-care at the earliest stages of a medical career. Carving out even an hour a day for exercise or some other personal activity is key to battling burnout.
• Adding a “float pool” to cover for life events, allowing physicians some control over their schedule, decreasing patient panel sizes, adjusting staff ratios, and lengthening visits, can all reduce stress levels.
• Including provider well-being and satisfaction in quality metrics to keep this issue front and center

While this isn’t a complete list, these represent solid first steps.

What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

As I mentioned earlier, I believe that all stakeholders in our communities have an important role to play in driving change, especially relating to health equity. With the majority of healthcare needs being met locally, in neighborhoods with those that patients most trust, I believe that ultimately change needs to begin at this level.

Health plans, medical providers, businesses and government leaders all want to make a difference that has the very real ability to impact significant change in our country. Corporations can begin by talking to their employees about the maternity benefits that are available to them and consider revising benefit packages to better meet the needs of all generations. Our government leaders can continue to lend their support to legislation that seeks to improve access to care and increased health equity for all. And most importantly, I feel, is that individuals and businesses in our communities can continue to be supportive, toward new moms, parents and families, and the challenges that they face in today’s world. The old saying of “it takes a village to raise a child” remains true to this day. Together, we will continue to drive change and make progress in improving the health of babies and their caregivers.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

I’ve always been an outspoken advocate for women and infant’s health and health equity since I started my career. Mothers carry 100% of our future, and so ensuring all moms get what they need for a healthy pregnancy and life is foundational to the future success of our country and its citizens. This focus is the right thing to do; it will improve health outcomes, lower the overall cost of care, and deliver on the American dream of a better society.

How can our readers further follow your work online?

I recommend people visit our website, particularly our blog (https://blog.progenyhealth.com/)

and follow us on LinkedIn (https://www.linkedin.com/company/progenyhealth-inc-)

where we often share important updates, resources, and our insights on the world of maternal and fetal health.

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.