- [Narrator] From the Geisinger Commonwealth School of Medicine in Scranton, this is "Keystone Edition Reports", a public affairs program that goes beyond the headlines to address issues in Northeastern and central Pennsylvania.

And now moderator Tracey Matisak.

- Well, hello everyone, and thank you so much for joining us for this special edition of "Keystone Edition Reports".

We're talking today about critical issues in healthcare in Pennsylvania, from the alarming shortage of healthcare professionals to the many ways in which the pandemic has affected maternal and family health outcomes.

These are national problems, but they are especially acute here in Pennsylvania.

In a moment, we'll hear from three people who represent a big part of the solution.

Dr. Julie Byerley is President and Dean of the Geisinger Commonwealth School of Medicine.

Her focus is to maintain the school as an industry leader and model in its community service mission.

Dean Byerley attended Duke University Medical School and was a chief resident in pediatrics at UNC Chapel Hill, where she also earned her Master's in Public Health with a focus on maternal and child health.

Pennsylvania House Speaker Joanna McClinton is the first woman and only the second African-American to hold that post.

A graduate of Villanova University School of Law, she is a former public defender who now represents parts of Philadelphia and Delaware counties in the state legislature.

She serves on many delegations and caucuses, including the Bipartisan Woman's Health Caucus.

And Dr. Maria Montoro Edwards is the president and CEO of Maternal and Family Health Services, a nonprofit organization dedicated to meeting the health and nutrition needs of Northeastern Pennsylvania's women, children, and families with information, education, and quality care.

We have asked Speaker McClinton to kick off our program with a brief update on the status of the state budget and an overview of important policy priorities.

Speaker McClinton?

- Thank you.

Good afternoon.

It's an absolute honor to be in Scranton today.

I must acknowledge my colleagues that are here, my former colleague, Senator Marty Flynn, and from both Lackawanna and Luzerne Counties, we have representatives in the audience.

Eddie Pashinski, we have Bridget Kosierowski, we have Kyle Donahue just showed up.

(laughing) He wasn't on my mental list.

And certainly Kyle Mullens.

Get everybody?

Oh, thank you so much, Jimmy Haddock, let's not forget.

Through the hard work that we've been doing in Harrisburg with the busy few months here, we've been able to get over 150 pieces of legislation out of the House into the Pennsylvania Senate.

Some of those bills include just passing a budget a few weeks ago.

We know that the budget work is not finalized.

However, we are all waiting with bated breath for when the Senate will sign the budget bill and get started on the fiscal codes.

But what we are talking about here today is that we have an obligation to make sure that the state is doing its job and taking care of Pennsylvania's business.

We take it as a high priority.

And I don't need to tell this panel here, but as the first woman to do my job, I take it very seriously that not only the budget process, but the pieces of legislation that we send over to the Senate, that it gets to Governor Shapiro's desk so that it really begins to improve lives.

But we've been doing legislation that will expand access for future leaders, some of which are here today, future doctors, future teachers, future engineers, and future nurses.

We see the shortages.

We've experienced the waits, the holes.

It's not hardly any place you can go anywhere in Pennsylvania where there is not a sign somewhere that says we are hiring.

That being said, we've gotta do everything possible starting with all of our students in public schools to get them prepared for all these great careers and to solve some of the disparities we're gonna talk about today.

- All right, thank you so much, Madam Speaker.

On that note, we also want to hear from our other panelists before we get into our Q and A.

So before we do that, let's go to Dean Byerley.

- Thank you.

And thank you all for being here at the Geisinger Commonwealth School of Medicine in Scranton, part of the Geisinger College of Health Sciences.

You know, many of the things that you just mentioned, Speaker, are things that we are trying to do here at our school.

More than seven years ago, a group, excuse me, more than 15 years ago, in 2007, a group of visionary community leaders saw a pending shortage of physicians for this area, and they addressed the problem.

The Geisinger Commonwealth School of Medicine, originally the Commonwealth Medical College, was founded, has had 11 graduating classes, and has graduated nearly 1000 physicians who will be serving our community and communities like ours.

Now, medical education takes a really long time.

So of our 961 graduates, 550 are still in training.

You know, medical school is four years after a college degree, and then depending on specialty, the physician goes on to train for three, four, sometimes seven, eight more years before they independently practice.

So in fact, almost 2/3 of our graduates are still in training, but they're maturing.

And you'll begin to see shortly the numbers of those physicians serving our community multiplying.

And we're really proud of that.

But there's so much more to do.

We're now beginning to focus our efforts on addressing the nursing shortage as well.

We at Geisinger partner with about 16 nursing programs to provide clinical education sites for other nursing schools.

But also we've brought a nursing school into our College of Health Sciences.

The Geisinger Lewistown College of Nursing has become part of our school, and we're offering an associate's degree there.

So those students and the thousands of others that train in Geisinger facilities, we hope will address the nursing shortage in our community.

And then lastly, I'd like to highlight that we really are doing our best to inspire the young people, the young people in our public schools and private schools, and all the young people we can find into these needed careers.

We have pathway programs as early as middle school with our Reach High program, high school programs funded by the $500,000 PAsmart grant that allows high school students to come into our building and learn first aid, CPR, and so forth.

We're trying to inspire young people into this science and service career.

So we're grateful to get to talk about that today.

- All right, thank you, Dean Byerley.

Dr. Montoro Edwards?

- Well, thank you everyone for coming here today.

It is such a privilege to be here at the Medical College.

And for me, it is a privilege to be president and CEO of Maternal and Family Health Services.

This organization was founded over 50 years ago.

It was founded as a family planning organization through the Title X program, federally funded, and shortly thereafter became one of the piloting WIC providers of Pennsylvania.

So Maternal Family Health Services right now is the largest provider of WIC in the Commonwealth of Pennsylvania.

We serve 17 counties, and about 50,000 people per month receive WIC services through Maternal and Family Health Services.

And this program is really key to the topics we're gonna talk about today with maternal health.

The WIC program is critically important in terms of nutrition education, but also there is a ready population of individuals who are receiving WIC benefits who could be a very fertile pool for the workforce programs that we're talking about for nursing and medical colleges.

And I think that that's going to give us a wonderful opportunity to be able to partner more.

We already do partner with the medical college in terms of our WIC program and students coming to work with families and getting some hands-on experience and direct care experience in the nutrition education program.

Maternal family health services provides WIC in 17 counties.

We provide family planning in 15 counties.

We have the Nurse Family Partnership Program, which is an evidence-based model that pairs a pregnant mom with a personal nurse through the child's second birthday.

And this is a very empowering program that really helps to build strong families.

And we have our maternity program, which is based here in Lackawanna County.

And some of the things we're going to talk about today and demonstrate this model of efficacy we'd like to replicate in other parts of the state.

And we're looking forward to be able to do that with our colleagues at the medical college.

- Thank you so much, Dr. Montoro Edwards.

Thanks to all of you for being with us.

One of the biggest healthcare issues in Pennsylvania is, as we have mentioned, the critical shortage of healthcare workers.

In fact, since 2019, we have lost roughly 1/3 of our nurses, nurse practitioners, and respiratory therapists.

We're also short about 6,000 mental health professionals, which makes us the third worst in the nation in that category.

So in a state with one of the largest populations of older adults, healthcare professionals are in greater need than ever.

And so I wanna begin by talking about the shortage, how we got here, and some ways of addressing it.

And Dean Byerley, I'll begin with you.

What are some of the factors that have led to the shortage we find ourselves in?

I mean, how did we get here?

- Sure, well, multiple factors have influenced this.

One, we have an aging demographic and that influences the healthcare needs in two ways.

All of us are more likely to need healthcare as we grow older.

Of course, we recognize that.

And then the community members who have been working in the healthcare space are aging out of the profession.

So the aging demographics that are present in many rural areas, but especially northeastern Pennsylvania, are compromising the healthcare workforce because of retirement, as would be expected.

And by increasing healthcare needs.

Also, as we all recognize, the pandemic was a very difficult time for those of us working in healthcare.

Unfortunately, shortages were a problem before the pandemic, burnout in the healthcare work setting was a problem before the pandemic, and then the pandemic exacerbated both of those things.

So I recently read that up to 40% of physicians describe themselves as burned out and are considering leaving their profession.

That further exacerbates the concern that we all have about the workforce shortage.

- And there's a whole other area that needs to be addressed, right, is physician burnout.

Dr. Montoro Edwards, your organization deals directly with women and families who are in need of care.

And so I'm wondering if you could talk a little bit about how the shortage of healthcare professionals, and I'm thinking of about nurses in particular, has affected the work that you do.

- So recruiting and retaining nurses is a big challenge.

And for example, in our Hazelton practice, our ability to provide care is directly related to having a nurse practitioner full-time there.

And we've had a hard time recruiting for some of those positions.

And one of the challenges we have is that we are competing with larger organizations, larger institutions who may have sign-on bonuses and things that we're, as a smaller nonprofit, not really able to provide.

Now we are competing much better with our benefits and generous time off, and we like to say work life balance.

So we've had some growing interest that way.

But not being able to fill the nursing positions really hinders what we can do.

And it's not just the nursing positions, it's all frontline positions, medical office assistants, medical assistants, and our nutritionists.

- And Speaker McClinton, you mentioned a moment ago some legislation that would be designed to address some of these shortages that we're seeing.

What are some policy solutions and what can the state do to help address the shortage that we're seeing of doctors, nurses, and other healthcare professionals?

- So one of the things that we did under Governor Wolf's administration was use some of the federal relief dollars from the pandemic to relieve our nurses with student debt.

When you think about some of the reasons why someone does a certain practice and chooses not to opt for a desk executive position, salary is a factor and your debt is a factor.

So we spent a great deal of money sending it to FIA so that those who had loans through FIA would be able to get them forgiven.

Since Governor Shapiro has taken over this year, we were able to champion his legislation to make sure that not only nurses but also police officers and teachers would be eligible for a tax credit every year if they remained in Pennsylvania and in the profession.

So while we sent that bill over to the Senate, we're waiting for them to get it over to the governor's desk.

If it becomes law, every year, a nurse will be able to deduct $2,500 and get a state refund for once, no complaints.

But everybody wants a little money back at tax time.

The other thing we just were able to pass thanks to my colleague, Representative Kosierowski, who's no longer the only health professional in the House.

We now have a nurse practitioner and also an emergency room physician.

We passed the Patient Safety Relief Act.

One of the things that we heard from our constituents as to why they were remaining licensed nurses but leaving the bedside is because of the capacity, the challenge of always being overworked, particularly after and throughout the pandemic.

It was just very tough, it was grueling and very difficult.

I personally do not have any background in the medical field, but this year my mother has struggled with some sickness challenges and has been in either a care facility, a rehab, or a hospital all year long.

And I've built relationships with all of the nurses.

We've become first name basis.

They think I work there, I just don't wear scrubs.

But I'm there that much.

So, you know, I always say, all right, you know, have a good three days.

And they tell me, oh, Joanna, you know I work somewhere else.

I'm gonna now go to this other place and take care of patients when I should have three days off of my feet and give my body an opportunity to recuperate from this grueling care.

So we have a lot to do, and I've seen it firsthand with my mother's challenges this year, to support that profession, to bolster it, and to make it attractive.

- And Dean Byerley, for you a two-part question.

First of all, what are some of the attributes that you're looking for as a medical school administrator in doctors and nurses of the future?

And then maybe you could talk a little bit more about some of those strategies designed to not only recruit prospective professionals, but to retain them here once they're educated.

- Absolutely.

So the world is changing so much.

We all recognize that.

As artificial intelligence and technology helps us to do our jobs, challenges us in doing some of our jobs, we recognize that what we need in the health profession workforce is very different now than it used to be.

It used to be that you wanted a physician with an encyclopedia in his mind, and I say his on purpose.

And that you came to him with a list of complaints.

And it was up to his memorized textbook in the head to determine what was going on and what the right therapeutic pathway for your outcome ought to be.

We don't need that anymore.

All of us have encyclopedias in our pockets.

And the evidence that influences the appropriate therapeutic choice changes very rapidly.

What we need in our healthcare professionals today are individuals who can build trust with patients, who can hear the human priorities that patients and populations bring to their care providers, who can help the patients understand and recognize the health behaviors that will most positively influence their outcomes.

And then of course, they have to know how to use the literature, the evidence in the literature to optimize the prescriptions they write.

But that becomes the easiest part of what we do.

So what we need in our future health professionals are real people who engage with real people.

And that often is built in setting up patterns where the people caring for you are people you recognize from and in your communities.

And that's one of the things that we're trying to do at our medical school.

We're prioritizing admissions from our area, from northeastern and central Pennsylvania.

We want kids growing up here, coming to our medical school to be doctors that serve our communities.

That will help them stay.

While they're here we educate them in what really matters to their success in doctoring.

We deemphasize the memorization and really let them work on things that will help them feel successful in communicating, building relationships and so forth.

The skill sets that they need.

We also like for them to grow roots while they're here.

So we do a lot of community engagement.

We want them to know the people and populations they're serving.

And then most importantly, if we want them to stay, it's like you said, we minimize their debt.

In fact, we try to forgive their debt.

And Geisinger is making a tremendous investment in the future workforce of physicians by the Abigail Geisinger Scholars Program.

Of our 115 students in each medical school class, 45 of them are on full scholarship as long as they promise to work for Geisinger and serve our communities in the needed specialties year for year of the scholarship they get.

It's a big investment upfront, but it will pay off in the workforce down the line.

- So it's really a multi-pronged approach.

It's policy, it's medical schools, it's even primary, primary education, to your point, exposing young children to the medical profession.

And encouraging them in the STEM sciences and all that sort of thing.

We have so much to talk about here, and I wanna shift gears just a little bit so that we can make sure that we cover everything we need to cover.

But another big topic is maternal and family health.

And Dr. Montoro Edwards, I wanna start with you on this, because as you very well know, Pennsylvania has a relatively high rate of maternal mortality compared with other states.

I'm seeing from information that you provided to us, 82 deaths per 100,000 live births.

And for Black women, the rate is much higher generally.

So I start with the general population.

Why are the numbers so high and what are some of the ways that your organization is addressing it?

- Sure.

One of the big drivers is fragmented healthcare and connecting the dots.

One of the other pieces, I sit on the Maternity Mortality Review Committee in Pennsylvania.

And one of the things that I see from reviewing some of those cases is that there are so many deaths of despair.

And that is suicide or substance use, intimate partner violence, postpartum depression.

And so what we are trying to do at our location in Scranton is a maternity medical home model of care.

We had, in our previous location, nurse home visiting, WIC, maternity care, family planning.

What we've done now is add the other services that a pregnant and parenting person would need so that everything's under one roof and transportation is no longer a barrier.

So we've added oral healthcare.

So when you come in for your initial visit, we can do an oral health assessment and link mom with care, and other children.

And so the WIC nutrition program is there, lactation counseling, breastfeeding support, the ultrasounds are there, lab work, you can get that done in one location.

And also fetal monitoring.

We've added a pantry for food, and we also have maternity clothes.

So if mom can get to this one location, and we can help with transportation as well, everything is available there.

And we have patient navigators to help make sure that every client is connected with everything that they could possibly need.

- Speaker McClinton, Governor Shapiro's proposed budget has included money not only to promote maternal health, but to study Black maternal health in particular.

And why it is that Black women are three times more likely or almost three times more likely to die from a pregnancy related cause than white women.

Can you speak to that reality and how the $2.3 million, I believe, that's been allocated in the budget might help address that?

- So when we talk about the maternal mortality crisis, it is absolutely at the emergency level in communities of color, not only African American women, but Latina women are facing this crisis as well.

And what we have found is it's either rooted in lack of sensitivity, cultural sensitivity from the practitioners who are caring for the patients.

And then there are other factors that we just learned about here sitting at this panel today.

But what the money will help do, the $2.3 million that was allocated in the budget, is even adding a new law, Act 5, severe maternal morbidity is a reportable event.

It was not previously something that we tracked, but we now will have data tracked under Act 5 for severe maternal morbidity to make sure that we have the most accurate numbers and the research can be done to prevent this from being something that expands as opposed to that decreases.

- I read something that really shocked me as it relates to Black maternal health.

And it was talking not only about, you know, preexisting conditions and things like that that may be overlooked in the process, but the statistic said something to the effect that, here it is, a Black woman with a college degree is 1.6 times as likely to die as a result of pregnancy or childbirth as a white woman with less than a high school diploma.

So that speaks to something other than medical issues and perhaps, you know, not being taken seriously or maybe biases within the medical profession as it relates to, you know, certain populations.

Which is all part of what I imagine this legislation is designed to help with in terms of studying some of these factors that are getting us to where we are.

- Unfortunately, the numbers have only expanded in recent years.

They have not decreased.

I always use the example of Serena Williams, one of the most famous, wealthiest athletes in our country, really in the world, shared her own story a few years ago when she had her oldest daughter about how she was not being taken seriously when she described the pain she experienced and how difficult things were getting.

But it's not only at labor and delivery, we see it happening in the postpartum world as well.

So the follow up that's needed, the care that's needed, any treatment for depression that might be needed, if there is a disconnection, you fall high at risk even once you give birth and are successfully discharged from the hospital with your children or child.

- And extending Medicaid coverage as well, right?

Because I think it's like 60 days in some places, but states can extend it for that first year, which is critical as well.

Dean Byerley, can you address some of the risks that anyone who is dealing with a pregnancy might face for lack of access?

Because Dr. Montoro Edwards sort of introduced the idea of access and the problems when we don't have access and trying to sort of address that.

But what are some of the risks to someone who is carrying a child when they don't have access to enough medical care during that time?

- Sure.

Well, you talked about the maternal morbidity and mortality being at emergency levels.

You know, as a child is developing, whether that is in utero or after birth, it's a race against the clock and it's not something that can wait.

The initiation of prenatal care has to start at the beginning of the pregnancy or ideally even before that.

And then the pediatric care of children is urgent, because those children are growing and developing and accumulating potentially adverse events that will affect them lifelong unless we treat them preventatively and provide for them the services and care that they need.

So, you know, some of us might occasionally have medical problems that delaying care, delaying an opportunity for an appointment won't worsen.

That's not the case in a pregnancy or a growing child.

- And Dr. Montoro Edwards, I wanna come back to you because you did talk about access.

And I think that's so important, not just for reproductive care but for healthcare across the board in Pennsylvania.

And I wonder if you could speak a little bit to that, to what some of the barriers are to access that you're seeing in the population that you work with, and what are some of the things that keep people from getting what they need?

- Well, access to behavioral healthcare continues to be a challenge.

We have social workers at our location that can, if someone is screened for postpartum depression, we can link them with care.

But there is a shortage of behavioral health providers.

And there's also difficulties with reimbursements for organizations to be able to get paid for the care that they're providing.

And so that unfortunately makes it very difficult to have the adequate staff that we need to provide the care.

So, you know, that supply and demand is at this point not even.

There are significant challenges in terms of transportation, language barriers.

If you're in a rural community, you do not have access to public transportation.

We see that all the time, that someone cannot physically get to the grocery store that they need to get to to get their WIC groceries.

And so these are some of the social and economic determinants of health that we see, housing shortages, food insecurity, that are really affecting folks across the board.

- Yeah, and I think it's really important to have that conversation, because I don't think it's obvious all the time how much your zip code can impact the quality of care that you get.

- That's very true.

- And Dean Byerley, the pandemic certainly laid bare the disparities in healthcare outcomes in a way that I think many of us had not seen before.

Could you talk a little bit about the ways in which Geisinger as part of the sort of larger medical community is working to address some of those disparities?

- Absolutely.

So one of the things that we are trying to do is make sure that our patients get plugged into primary care providers that can provide rapid access to care that's needed.

And one of the strengths of Geisinger is our informatics and electric health record management.

We set up our informatics infrastructure such that we track, for example, how long it takes a patient to be seen when they call for an appointment.

And that's an outcome measure that we work on to ensure that our access is available.

We also track our outcomes based on the predictable demographic factors that go along with the social determinants, like zip code for example.

And we can look, for example, at our cardiovascular risk and the patients that we serve by zip code.

And when we take that, one of the things that's fascinating that we can do is take the zip code data and the genetic data that we have about our patients and look at them together and really focus our efforts in the areas of greatest risk, and reach out to those patients to bring them in for preventive care.

You know, we talk a lot about value-based care, and value-based care influences, when you have quality metrics that you track and cost metrics that of course we all have to tend to, when we have the greatest quality at a reasonable cost, that's the greatest value.

And Geisinger is a value-based care system.

Our educational enterprise is targeted toward value.

We want to ensure that we reach those preventive outcomes as soon as possible using demographic and other data that helps us address the patients in the most dire need.

- Speaker McClinton, as a member of the Women's Healthcare Caucus in Harrisburg, you are certainly well aware of the issues around lack of access.

And I wonder if you could talk about some of the barriers that you've seen, you know, beyond the shortage of professionals, the barriers that you see.

And then what can be done perhaps from a policy perspective to help eliminate some of those barriers for people?

- So what I've noted is I might live, and I do live in an inner city where I have public transportation.

I can, you know, easily even use rideshare to get to an appointment.

But even managing my own health, when they ask me on the phone what's my calendar in September, I'm in a little panic.

Oh yeah, you want a physical?

Sure thing, today's July the 18th, but September 20th, you available?

I'm like immediately stressed out.

I'm hoping I'm available, I'll put on my calendar, don't schedule for two hours, so that I can do it.

But inevitably when something happens and it's September, then that preventative appointment I'm not able to make and now it's November to get that preventative care, to get my blood pressure checked, to be able to make sure everything is okay.

So this isn't something that I've just been informed about from my constituents.

It happens in making my own appointments.

My mammogram is due in October, I've scheduled it, but it may have to be rescheduled, right?

So when you see challenges to access, the barriers that we face, even in a populous area with public transportation, they're very similar to areas like in northeastern Pennsylvania.

When we look at the disparities that we saw during the pandemic about who was able to get tested and where testing wasn't available, who was able to find out if they were positive and who was never able to get that information, once we finally had a vaccine where it was accessible, and with the trust issues and how they were lacking, we see it both in the inner city and we also see it in rural parts of Commonwealth of Pennsylvania.

So we have a lot to do in terms of breaking down the barriers.

And some of the backlog, even with patient care, comes from not having enough providers.

So it's a circular conversation, but we are gonna get to solutions when we get to a point where we have more providers, where we have more practitioners that are able to see patients and we won't have to wait the three months and then wonder if you're going to be available.

A good friend of mine has been doing some studies with health disparities in the African-American community as it relates to lung cancer and how difficult it is for folks who live in my zip code to be able to get the screenings and to keep up with them, and then God forbid they actually have the cancer, keep up with the treatment to be able to prevent from eventually falling dead to it.

So we have a lot of work to do in that area, but it is something that's collaborative.

It's both on the healthcare side and also on the government side, making sure that the insurers have everything they need so that the barriers that currently exist or the yield or stop signs, they don't discourage people from taking care of their health.

Because inevitably that is what happens sometimes.

- And Dr. Montoro Edwards, Speaker McClinton just mentioned trust.

And we saw a lot of that, particularly during the pandemic, where in communities of color oftentimes there was a distrust of medical professionals.

And there are historic reasons for that.

But I wonder if you could talk about how in the work that you are doing, and I'm sure that you see a wide array of clients who use your services, what needs to be done to build trust?

Particularly in communities of color, so that they will be more inclined when the barriers are removed to seek the care that they need.

- We need more providers who reflect the communities that we serve.

I think that's the bottom line.

We need more providers that are bilingual.

We do have translation services, but it would be helpful if we had more clients, more staff that were reflective of the cultural differences among our clients.

- We also were talking about insurance.

It was mentioned briefly.

I think Speaker McClinton mentioned that.

And Dean Byerley, that can be another difficult area when it comes to seeking care, just simply being able to get insurance.

If it is not provided through an employer, if you're not employed, if you're in a position of having to buy your own health insurance, it's another barrier.

And what are some ways that Geisinger is talking about, thinking about how to address the problem of insurance or the lack thereof for so many people in our area?

- Right.

Well, Geisinger's proud of course to be a Medicaid provider and also to provide insurance directly in the Geisinger Health Plan for many of the patients that we serve in the Geisinger footprint in northeastern and central Pennsylvania.

I believe that ensuring that our patients can get public or private insurance is key to access.

And then I would like to also reinforce the points that have been made about a health profession workforce that is trustworthy, that looks like the patients who are being served, and that shares community with the patients that are being served.

Both of those things are key to access to the care that we know our patients need.

- And Dr. Montoro Edwards, one of the services that you offer is WIC, as you mentioned early on.

It's the supplemental nutrition program for women, infants and children.

It is a critical service, and yet participation in Pennsylvania, from what I have read, has dropped dramatically in recent years by something like 25%.

Why is that?

And what is being done to encourage greater participation?

- So I can say thankfully our WIC participation is up 10% since January.

The economy is certainly driving that.

But Pennsylvania unfortunately is one of about nine states that makes it a little bit more difficult to access your WIC benefits than other states.

In Pennsylvania, even during the pandemic, mom had to come physically in every quarter to have her WIC card loaded.

That means putting the kids on the bus and getting them to a location.

And in other states that's electronic loading, just like your SNAP card.

And so we have some work to do in Pennsylvania.

We lost participants in WIC during the pandemic.

And so we're building some of that back.

But there's still much to do.

We just launched a mobile WIC unit that we're going to be able to take on the road to head starts and such to be able to help us to alleviate what's going on in the rural communities with lack of transportation.

But I think it's very important that we accelerate the timeframe in Pennsylvania to make those benefits easily accessible.

- It seems that it always comes back to removing the barriers, one way or the other.

Dean Byerley, every three years, as you know, Geisinger conducts a community health needs assessment of the areas that it serves.

And the most recent survey identified behavioral health as one of the key concerns for northeast Pennsylvania.

In fact, on Mind Over Matter, we talked about it as well.

And this is at a time when, as I mentioned earlier, Pennsylvania is the third worst in the nation when it comes to our shortage of mental health professionals.

So I'd love for you to talk a little bit about some ways that we can address that need, whether it's making it easier to become a practitioner or perhaps expanding access in some other ways.

But what are some ways that we can work in that space?

- Right.

And an additional factor that influences the demand for mental health services is the good thing that the stigma around mental health concerns is being decreased.

That's a great thing.

We all are beginning to acknowledge that mental health illness affects our families, affects us individually, affects our friends and our workplaces and our community.

We acknowledge that and we recognize that we need help with our mental health.

That's great.

But when all of us are seeking mental health care, it makes the shortage of mental health providers even more dramatic.

So we're doing all we can to educate psychiatrists in the Geisinger system at our medical school.

We've graduated 57, 57 of our 961 graduates are training or serving as psychiatrists.

But psychiatrists are not enough.

We definitely need some of the non-physician mental health providers that mean so much to us.

The therapists, counselors, the licensed clinical social workers and so forth.

And we need to provide clear and supported training pathways into those health professions.

That's really, really important.

But I believe that we will never, in my lifetime, have enough mental health professionals for each of us to get one-on-one care like we all might like.

And therefore we have to put resilience into our communities and make sure that we as laypeople help each other with our mental health.

That we recognize concerns in our friends and family and selves early.

And that we build our communities to encourage mental health and wellbeing and build resilience in those communities.

It's something that we all have to work on together in addition to addressing the specific healthcare delivery related concerns that you've already highlighted.

- I think that's really critical, that idea of resilience and that idea of everyone sort of taking responsibility, right?

Being their brother's keeper it sounds like.

And sort of keeping an eye on each other.

And I wonder if, you know, here at Geisinger, just in conversations you have had with others in the profession, if there has been any conversation about ways to do that.

Whether it's starting with, you know, kids in elementary school and building resilience there, or you know, in community organizations and what some ways might be that we can kind of help ourselves in that respect?

- Yes, well I have to check myself 'cause I can get on a big soapbox about this.

But I think that we all need to encourage our own and our community's health behaviors.

First, nutrition, we need to eat well and ensure that healthy foods are provided for all of us.

And that matters.

Fitness, exercise and sleep are the two key components to fitness.

And we need to build our communities to encourage walking.

We need to build our facilities to encourage daily exercise.

We all need fresh air, time in the wilderness, which we have so much beautiful wilderness here in northeastern Pennsylvania.

That's a wonderful thing.

We need to spend time there.

We need fellowship, we need friendship and peer groups that are supportive.

We need to treat each other kindly, as simple as that is.

- There's an idea.

- And then we do need access to mental health care when we need it.

And that I call, you know, friendship with our ourself and soul.

And so I like to think my own health behaviors in those five F's of food, fitness, fellowship, fresh air, and friendship with yourself and soul.

- I love that.

- I'm sorry for the soapbox.

- No, I think we could take a lot from that honestly.

And I think if that was something that everyone took seriously and embraced, that that would go a long way to improving our collective mental and probably physical health as well.

Speaker McClinton, what about from a policy perspective when we're thinking about mental health and the great need?

And you have no doubt seen it, particularly during and in the early aftermath of the pandemic, so much anxiety, so much depression, particularly among our young people.

Can you speak from a policy perspective about what needs to be done to, you know, help all of us get where we need to be and to restore our mental health?

- So once again, as it's state related, we've been trying to make incentives for there to be more skilled professionals going into these lanes, the counselors, the therapists, and the psychiatrists.

One of the things we were able to achieve in the budget last year was use $100 of federal funds from the COVID Relief Act.

Thanks President Biden, I hear he's from here.

(all laughing) We were able to allocate that for mental health.

That money still has not gone out.

But in this year's budget that's pending, we added $50 million to also go into that.

And what we hope to be able to achieve with that is to make sure that the two million Pennsylvanians who live in areas where they cannot access a therapist, a psychiatrist, that they'll be able to perhaps use it by telemedicine and that we'll also be able to bolster the practitioners that we have around and available.

In addition to that, we recognize that amongst youth, the stigma that was once, even in the generation that I am as an older millennial, it's starting to be something that's no longer in existence.

People are talking about how they feel, checking in on themselves.

But we recognize whether you're an actual parent or a caregiver, that we have to monitor social media.

Every study shows that social media usage and suicide amongst teenagers are very connected.

Sometimes they're just doing something they saw on the internet and end up hurting themselves.

So it's serious.

It's not something that we can ever minimize or dilute.

And I know Governor Shapiro has also been championing having more counselors in school buildings, with their hope being that they can alleviate some of these challenges.

Unfortunately in my district, a gentleman had a mental breakdown, so we suspect, right before the 4th of July and went on a massacre spree.

Three weeks prior to that in Juniata County, another gentleman did that with state police troopers, one sadly succumbing to his injuries, five people killed in southwest Philadelphia.

These incidents are happening all over the nation.

But we have to also tighten laws.

If the Senate had already passed our Extreme Risk Protection Act, perhaps both of those incidents could have been avoided.

Because what we've heard, at least in my community, is that the people who lived with this gentleman were aware that there were some challenges happening and that that person had guns in the home.

Not only the assault weapon that was used, but other firearms.

So we have to talk about what does it mean to be able to get arms away from people who are in danger of hurting themselves or someone else?

How are we able to peacefully be able to disarm people?

Sometimes folks don't turn people in because they're afraid of ramifications.

I mean, they're real community level conversations that we have to have so that these sad incidents do not continue to overwhelm us.

- And Dr. Montoro Edwards, you mentioned the term deaths of despair early on.

And I'm curious, in the work that you do with your organization, to what extent do you deal with mental health issues?

I mean, obviously like postpartum depression comes to mind as one of them, but tell us a little bit about how that's addressed within your organization.

- Sure.

We work towards family integrity across all of our programs.

And for example, the Nurse Family Partnership program is a home visiting program.

And that pairs a pregnant mom with a nurse, this personal nurse who will stay with her until the child's second birthday.

The nurse makes home visits and works with the family, the extended family, to help see what the dynamic is and how they can help them with housing stability, with potential career goals, to strengthen that family unit.

And I think opportunities like that are tremendously important.

We also have telehealth options.

And so I think that's been one of the good things that's come out of the pandemic is that we're able to offer behavioral health or reproductive health, some other services via telehealth.

Our WIC program, we can do our WIC nutrition counseling via telehealth.

And I think those have been very important to helping to strengthen that family model.

- Dean Byerley, circling back to the shortage that has sort of weaved its way through our conversation, do you have a sense of what the pipeline looks like at this point for the healthcare professions?

And kind of, you know, who's coming down the pike and how are things looking at this point?

- We're fortunate as communities that health careers remain popular among young people.

We have more medical school applicants than we can place, more qualified medical school applicants than we can place at our school or any other medical school in the country.

So if we could open more slots, we could certainly fill them with well qualified individuals.

That's also true in nursing.

And that's a wonderful thing.

What we need to do is bolster our teaching and learning opportunities for those students so that we can add to the capacity that we currently have.

I think enticing those students into the health professions is really important.

And also, if I were a young person looking toward a 40, 50 year career, I think humans caring for humans is an important place to focus our efforts, especially as we envision what technology might do to some of the other disciplines that they might be choosing from.

So I would encourage all young people to explore direct science and service in care of other humans.

- Dr. Montoro Edwards, wanna come back to you.

Actually, let me go to to Speaker McClinton before I get to that.

But I guess my question for you would be also about, you know, how we can not only encourage young people, but also about the call that has come to the governor's office to set up sort of a healthcare worker's council with a chief talent officer.

There is an organization that has made a call for that.

And kind of a council that would be specifically dedicated to addressing healthcare shortages.

And they've been talking about that for some time.

Do you have any sense of kind of what the status of that is in Harrisburg, or what kind of conversations have been taking place around that?

- So I can definitely talk about the conversations.

The conversations are about seeing where the needs are, where are they most predominant.

And once we see where the needs are, how do we make sure that we're recruiting directly to the talent pool?

I was personally, and I'll take a moment of personal privilege, blown away by the Pathways Program here at Geisinger on my tour earlier today.

It's just incredible to stand with medical students in their second year, along with high school students simultaneously who already have their minds made up that they want to be a part of humans caring for humans.

That's it, right?

(laughing) It's exciting and we need more of that in other parts of the state.

We need to make sure that young people are able to not think that the dream of becoming a doctor is only a dream, but it's something that can become their reality through the exposure, through being in a medical school at 15, 16 years old and apparently all the way to middle school.

It will help us fill these gaps.

We have to be targeted, though, and I'm appreciative to the administration for having these conversations and getting everything hopefully settled out this year.

- So in our last few minutes, since we are honored to have the Speaker of the House with us, I want to ask both of our other panelists to take advantage of the moment and maybe dream a little bit.

What would your wishlist be okay for Harrisburg, or the things that you would want Speaker McClinton and the legislature to be aware of as it relates to some of the healthcare needs in our state?

So Dr. Montoro Edwards, I'll start with you, and then Dean Byerley.

- Davina Coleman, a lactation therapist based in Philadelphia, asks the question, everyone wants to hold the baby, who will hold the mother?

And I think that's what we need to think about as we move forward.

We need to provide the services so that we can hold the mother.

We been able to do that at our Circle of Care Maternal Medical Home with the support of foundations and federal appropriation.

But moving forward, we're going to need to have the reimbursements from medical assistance, the managed care organizations that will be able to support this.

So we need to look at those reimbursements for the Healthy Beginnings Plus Model for postpartum depression, so that we can really provide that wraparound care, that circle of care to hold the mother.

- Dean Byerley?

- Well, I love that, hold the mother.

And I'd like to take a piece of that and talk about hold the future of the health professional as well.

I think, you know, there are a lot of challenges in working in the healthcare space that we've talked about.

The pandemic only worsened those.

I think for our young people that want to go into the health professions, we need to approach them as if we recognize that this is service.

And we should enable their pathway through pathway programs that allow exposure.

Some of the pathway program investment is paying off, as you say, but there's room for so much more.

There's so many more middle schools and high schools that we could all touch.

And then nursing debt in particular, which you've already emphasized, but we certainly would love for anyone to become a nurse with zero debt as long as they serve in a needed area.

And then similarly, the doctors.

Now the doctors will currently pay off their debt, I understand that.

But we can incentivize them into areas of more needed service with debt forgiveness as well.

And then the last thing that I would say is we need to create the healthcare environment to be one that is welcoming and encouraging, where people want to stay for that 40 or 50 year career.

It's become so pressured by so many external factors that it's a difficult workspace right now.

And there are lots of ways to lighten the load in that workspace that each of us individually can participate in, but also policy has tremendous influence over.

- Speaker McClinton, final thoughts?

- I've got a lot of work to do.

(all laughing) I'm glad there are five state representatives here and the Senator whose district we sit in.

We have collective homework, and I appreciate the opportunity not only to join and talk about what's going on in Harrisburg, but acknowledge the fact that we still have a lot more work ahead in order to make sure that our constituents will be well taken care of, not just today, but most importantly tomorrow.

- Dr. Montoro Edwards, if there were a key message that you would want to leave with those who are listening in on our conversation, what would it be?

- If you don't have insurance, if you may be undocumented, reach out anyway.

We have programs that can assist.

- Dean Byerley?

- If you're a young person or a person looking for a second career, a different career, a shift, come talk with us.

We'd love to inspire you into the health professions.

- Well, thank you all so much.

We are just about out of time, but that is going to do it for this special edition of "Keystone Edition Reports".

Speaker Joanna McClinton, of course, Dean Julie Byerley, and Dr. Maria Montoro Edwards.

We want to thank all of you for being a part of this conversation.

Special thanks of course to Geisinger, Maternal and Family Health Services, and the law firm of Myers, Brier, and Kelly for hosting this special event.

For WVIA, I'm Tracey Matisak.

Thanks for watching.

(audience applauding) (cheerful music)