Ep. 152: Wrapping Kids in a Health Hug

Caring for a child with a chronic condition can feel overwhelming – especially when it involves coordinating specialists, therapies and countless appointments. That’s where Health Hug helps. By combining technology with a personal touch, Health Hug streamlines pediatric care, connects families to resources, and eases burdens for both parents and providers. On this episode, Health Hug’s CEO & Co-founder, Christina Sloan-Vélez, takes us back to the kitchen table where Health Hug was born as a result of personal, professional and world circumstances she was facing.

Guests:
Christina Sloan-Vélez, CEO & Co-Founder, Health Hug
Christina Nadaskay, RN, BSN, Chief Clinical Officer, Health Hug

Host/Producer: Carol Vassar

Views expressed by guests do not necessarily reflect the views of the host or management.

Subscribe, review or let your voice be heard at NemoursWellBeyond.org.

Transcript

Announcer:

Welcome to Well Beyond Medicine, the world's top-ranked children's health podcast produced by Nemours Children's Health. Subscribe on any platform at NemoursWellBeyond.org or find us on YouTube.

Carol Vassar, podcast host/producer:

Each week, we'll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor's office. I'm your host, Carol Vassar, and now that you're here, let's go.

Music:

Let's go, oh, oh, Well Beyond Medicine.

Carol Vassar, podcast host/producer:

If there's one thing I've learned from hosting this podcast, it's that innovation doesn't always come from a lab or a clinic. Sometimes it starts at a kitchen table, born from a parent's lived experience and the drive to make things better for others. That's precisely how Health Hug came to life. Founded by Christina Sloan-Vélez with Christina Nadasky, RN, as Chief Clinical Officer (CCO), Health Hug is a pediatric care coordination service, an ecosystem if you will, that combines technology and personal support to help families manage the complex medical, behavioral, and social needs of children with chronic conditions. Today, I'll talk with the two Christinas, Christina S. and Christina N., about how Health Hug works, why it's so needed, and the difference it's making for parents, pediatricians, and, most importantly, kids. But let's go back to that kitchen table in the home of Christina Sloan-Vélez, where Health Hug was born as a result of the personal, professional, and world circumstances she was facing. Here's Christina Sloan-Vélez.

Christina Sloan-Vélez, Founder/CEO, Health Hug:

I had been working in the care coordination space for almost 10 years, mostly Medicare. And when my son was two years old, he was diagnosed with autism. It was very challenging. It was in the middle of the pandemic, which was already chaotic, and I was a single mom trying to manage my career, the pandemic, a two-year-old who just, I'm just trying to keep him alive, and now I have to manage appointments for PT, OT, speech, play therapy, ABA, seeing neurologists, see a psychiatrist, DBP, more than seven, eight different specialists that I needed to see, and I was very overwhelmed. And having been in the care coordination space for so long, I said, "Why isn't anybody doing this for pediatrics?" It's challenging, especially for working parents. And then my mom, she was my support system, she was there to help me the whole time, but then she was diagnosed with cancer. So that added just an extra layer of stress because I'm doing all the work for my child, and then my mom gets sick.

So I lost my mom two years ago, and as soon as I lost her, I was still very overwhelmed with all the complexity that comes with a child with autism; it never ends. And then he was diagnosed with ADHD, and that's where Health Hug was born. It was just a need for the support and the services, and the wraparound services that we need. And talking to a lot of parents and friends, they're like, "I need help too." The more I met with other individuals that were in the same boat as I was, the more validation I had that this was much needed for pediatrics.

Carol Vassar, podcast host/producer:

Well, I'm very sorry to hear about your mom. It sounds like she died in a similar timeframe to my own mom, so I kind of know what you're going through.

Christina Sloan-Vélez, Founder/CEO, Health Hug:

Thank you.

Carol Vassar, podcast host/producer:

I also have a son, an adult son now, who was diagnosed with autism a little bit later; he was eight or nine when he was finally diagnosed. But it is, managing all of that as a single parent, I can't even imagine. It's got to be overwhelming. How does Health Hug's care coordination model, which you've mentioned and talked a little bit about, ease that burden for parents, for caregivers?

Christina Sloan-Vélez, Founder/CEO, Health Hug:

I think every parent, even if they're not dealing with a child with a chronic condition, gets overwhelmed when they are trying to schedule appointments. Even if it's the well visit, or a dentist appointment, school physicals, they're all very overwhelming and take time. And the whole family feels this, it's not just you as a parent, but sometimes there's other children, or a spouse, or someone else in the household, and they all feel the stress and the feelings that come when parents are overwhelmed. And so what we do with care coordination we provide the services, and we take a lot of this off of their plate. So we have this wraparound service where we help parents with scheduling appointments, managing their referrals, locating services that they may need. We track their medications. We remind them of when screenings are due.

So we talk a lot about how a child needs almost 18 appointments before they turn three, and that's a lot for a parent to remember. So we help them track those milestones to make sure that we're proactive instead of reactive on the care that we're providing. We like to identify, and so we use also remote patient monitoring to identify issues before they happen. So if you have a child with asthma, we use smart devices to be able to detect before that becomes an episode that ends up in the ER or urgent care. So, trying to, again, be proactive about child care to alleviate all that stress and burden that comes to the parents.

Carol Vassar, podcast host/producer:

How does this look to a parent? Do I just go over to my computer or my phone, and I go into the dashboard, and I say, okay, Nate has an appointment tomorrow at 3:00, and he has another appointment on Friday at 8:00 A.M., is that kind of how it works?

Christina Sloan-Vélez, Founder/CEO, Health Hug:

So we combine technology, but we also have the human component to it. So we have a team of care coordinators that work with a family to guide them through the journey. So yes, they have access to see digitally, oh yes, I have an upcoming appointment, and let me make sure, my kid is due for a wellness visit. But there's also a human being that reaches out, whether it's via messaging, or text, or phone, and talks to them. Sometimes, there's barriers, right? If there's an upcoming appointment and you don't have a car, or sometimes you're a single parent working two jobs, and you just don't have the time because those few hours equate to a meal for your family. So we help with arranging transportation and making sure that they get the support they need so that the child gets all the care.

Carol Vassar, podcast host/producer:

So it sounds like you've taken the best of human navigators and put some digital overlay onto that, and off you go. Christina N., this is clearly family-centered patient care; it's a platform with pediatric care. From your view as the chief clinical officer, how does that approach help families feel seen, feel heard, feel supported in terms of both physical and mental health, not just for this particular child but for themselves and the rest of the family?

Christina Nadasky, RN, CCO, Health Hug:

Yeah, so I think our software helps do that, but Christina mentioned a little bit about the human component. And while our software is amazing and the digital aspect is wonderful, knowing that physically they're going to have someone that's going to be reaching out to them no matter what each month, and it's at least once a month, being able to know they have that person that they can also reach out to who is dedicated to their family and who, from an active listening standpoint, they're going to listen to that family's unique needs and circumstances because they're all different. And we can't say that every child with asthma or every family that's dealing with one concern, one condition, is the same. So being able to explain that to someone on the other side and say this is what we're going through, and that person is heard there, and the care manager gives that respect and that empathy to that circumstance.

And then seeing that because of that they're able to have a tailored care plan, or activities, or goals that are inside that care plan is really important for that family because they begin to realize that they do have a voice, that it matters, that they're empowered to walk into a visit with the right information knowing what's happened between the last time that the child was there and now. Sometimes we've heard stories where one caregiver, or spouse, or someone in the home has to take the child to a visit, and they don't really know what's going on. But with our software and our service,s they are able to have that there in front of them. And so being able to know that their voice matters, that they can be an integral part of the care team is really, that support is emotionally strengthening for them.

And so I think when a parent or a caregiver, they have a child with a condition, whether it's chronic or acute, there's so many things that become out of their control, but us being able to put some things in their hands and help them to realize that they do have a positive impact and some control in that situation with their child, I think is really special.

Carol Vassar, podcast host/producer:

Christina N., I want to go back to something that Christina S. mentioned, and that is the fact that you do patient monitoring remotely, you've partnered with other startups like yourself to offer this. How do these innovations from a clinical perspective improve the care experience for families and for the care teams?

Christina Nadasky, RN, CCO, Health Hug:

So, one thing that it really helps with I think from a family standpoint is a peace of mind. So there's a reduction of that stress and that concern on them knowing that we're remotely monitoring their child and that information, they're not the only ones left to monitor and manage that. So they have someone else that's seeing that information that's coming over, that's detecting something potentially early on. And when that does happen, we have alerts and things that we're then reaching out and saying, "Hey, we see this going on. Tell us what's happening." And they're able to talk to us. So I think a quality there from that care experience for the family it provides. And if we can, like Christina mentioned, we can reduce a long wait period in an ER or a hospitalization or something, we know what type of care experience that usually is, unfortunately. And so if we can help avoid that unnecessary trip, then that's a huge, huge win for us.

For the care teams, I think the way it improves their care experience and what they already do is optimizing the care that they're providing, and the quality with that comes with we're providing something that they necessarily don't see or have in that 20 minutes that they're with that patient. So they see the patient, they do the best they can, they send them off. And then in between that time there's insights that we're gaining that we're able to bring back to them through that remote monitoring, and through qualitative things, things that come up in our conversation. So oftentimes, we're the first ones that will hear about something, and we're able to take that information back to the provider. That gets that back to them in a timely manner, and it also helps them be able to tweak that care plan and adjust it as needed based on what we're able to bring back to them. So I think that really helps the care team that we're able to do that and provide some of that holistic insight back to them.

Carol Vassar, podcast host/producer:

Well, it's interesting you raised the long wait times at emergency rooms, and getting diagnoses can take a long time. Another area where that happens is mental health, there's an urgent need for this in pediatrics, Christina N., Does Health Hug integrate behavioral health into the broader care ecosystem that you've created?

Christina Nadasky, RN, CCO, Health Hug:

So we do. And mental health and behavioral health, we all know it's challenging, it's critical right now. The way we do it in our ecosystem is through several ways. So first of all, we know with an adolescent a lot of behavioral health struggles and situations start arising now even earlier than ever before, but in that adolescent period. And so when we are screening and identifying a potential child that is at risk, being able to have those automated triggers, those automated workflows, that care manager who's dedicated to that family, and depending on the condition, if that child is struggling with something from a mental health standpoint or behavioral health, it's a different care manager, it's a different care team. So we try to tailor the care teams specifically to that risk stratification, and what we're seeing, and where they are, and meet them there in terms of a care manager as well.

And so, providing a safe place for that adolescent, that family, shared care plans between their primary care provider and any other specialist is one of the great things about Health Hug, as we bring all that into one place. And so it's not just like an EHR portal where you're looking at the doctors that only belong to that system, but if that child is seeing anyone outside of that, we have a place where we've built them into the care team. And so being able to refer them, provide a warm handoff when we can, which is important if it's something outside of our scope that we can handle, but holding their hand through that. So once we've referred them over and we've handed them off, we follow up. And just because we've given them a connection and a resource doesn't mean they're going to use it, doesn't mean they even know how to get started.

So being able to help them once we've identified that risk early on and helping that adolescent feel connected. I think one of the things that is really important, and I think we kind of overlook it, is that transition from that adolescent period and what they're facing into adulthood. And if they already have a chronic condition or they already have something clinically going on with all of the things that we know that contribute outside of just the medical domain and realm, being able to get them prepared, and equipped, and ready to say, okay, now you're not going to be with this pediatrician any longer. What are you going to do, and where are you going to go, and how can we help you get into the right place? As far as their very first appointment, even from, I'm done with my pediatrician, I've aged out, and I need an adult provider. Having that already lined up and teed up for them so that they can just transition very nicely into an adult system, and how do they self-manage tha,t and how do we empower them to do that?

So I think all of that has to do with the behavioral health and mental health aspect of how we incorporate that in. And I know transparently as we grow, we've not been doing this a super long time and we're new, but we have so many plans, and ideas, and things that will further support following the evidence of how we can get really good education, content, therapies that are potentially even digital with the app that they have in that digital piece to really help them and connect them with what they need. So I'm really excited for the expansion of that and how much more we integrate that into our ecosystem as the years go on.

Carol Vassar, podcast host/producer:

You mentioned education. Are you making available to your clients, your patients' education with regard to either support services or just general information about their specific condition? You're both nodding your head. Who wants to take that one?

Christina Nadasky, RN, CCO, Health Hug:

We are, yes. And so there's so many great national organizations out there, but also locally. A lot of times, so when we go to a provider and a practice, there may be local things in their area. There may not be, obviously, we know that there's access issues. But we have certain credible resources and things nationally that we put in their hands, but also from a local standpoint of trying to connect them. And us being very familiar and aware when we go into contract with a provider, what is in your area? What do you have and what don't you have?

And that helps that care manager really understand that, and then they can point them in the right direction and connect them with something locally, and if not getting them to where they can connect with someone, even if it's over the phone. The education, trying to build that into our system, and then that goes out. Obviously, what an adolescent sees in the phone or on their apps is different and engaging for them versus what a parent wants to see or a younger child. So, looking at your audience and who that digital application is going to speak to is really important and something that we're excited about as well.

Carol Vassar, podcast host/producer:

Christina S., as we talk about resources, as we talk about education in the clinical sense, I want to move over to find out how Health Hug identifies and responds to things that you might find out about the family. Maybe they don't have enough food, maybe they're unhoused, maybe they have transportation issues, which we alluded to earlier. How do you deal with those for the families that you're serving?

Christina Sloan-Vélez, Founder/CEO, Health Hug:

Yeah, so we know that this is a problem, especially within children and pediatrics. So one of the things we do is that as part of the care plan, we screen for those social determinants or social drivers of health, and we look for those factors, whether they're social or environmental factors, that are directly impacting the child and the family. So we have a team that will screen and then step in and support the family. Sometimes, if it's food insecurity, connecting them with the right resources, sometimes it's locating local food pantries or other resources to make sure that they have the food on the table. Transportation, that's another one. So we work with local, like Christina said, during our client implementation, we always work with the providers to identify local resources, they're the ones that know best what's going on in the community. And we also work with community health workers that help with that sort of support.

So, identifying the social needs of that family. Sometimes they need guidance. We know that the majority of the population that we serve are on Medicaid, and sometimes they just need a little bit of guidance and assistance on locating food stamps or even assistance with their utilities. So we have a team that helps with those items as well. And we always follow up with them to make sure that we were successful in it. So we'll work with the family, we'll help them locate the resources, we'll do a follow-up, check in, did you get everything you needed? And sometimes things come up after. So we try and screen a few times a year, but even in the course of a conversation with their care manager, they may say, I just lost my job, or we had additional expenses, or something happens, life happens, things happen.

So we always work, and like Christina said, we always listen to their needs and we try to meet them where they are, and support them, and provide those services for them. If it's a child that needs healthier meals because of their diabetes, or a child with asthma, and there's environmental factors that are driving that, so in some cases, there's a smoker in the house. So, there's a lot of things that we do to improve any of the social or environmental factors that are impacting the whole family and the well-being of that child.

Carol Vassar, podcast host/producer:

Looking back, Christina S. first and then Christina N., what have been the biggest challenges you've faced when you're building this platform, Health Hug?

Christina Sloan-Vélez, Founder/CEO, Health Hug:

Christina and I met doing this kind of work over 10 years ago; that's how the friendship started, but it was mostly with the adult and Medicare population. I think one of the challenges has been helping pediatricians understand that the services are also available for this population. So, a lot of education and awareness that we've had to do. There's a misconception that it's only for adults or seniors because that's how the services were first presented by CMS, but there's a lot of evidence that shows that care coordination of remote patient monitoring can significantly improve outcomes. So we're on a mission to educate and build that awareness.

Carol Vassar, podcast host/producer:

Christina N., any issues, barriers that had to be overcome to get you to this point?

Christina Nadasky, RN, CCO, Health Hug:

I think I would echo what Christina just said. I think the other thing that we're in right now and facing as well is we're not alone in this, I know many, many people are in this world where we have one foot in fee for service and one foot in value-based care, and we very much want to be about outcomes over time and trying to drive something that is a value-based care model in a fee for service world, it's a struggle but everyone, it's the same struggle. So we're not alone in that. And just trying to bring that awareness, bring that education, and over time, I think we'll get there as a healthcare system. Like she said, adults they're much farther along than they are in the pediatric population, unfortunately. But I think it's coming. And so I think that that's something that we all face, that are in this type of industry or any type of pediatric care, when that day comes for value-based care, we'll be ready.

Carol Vassar, podcast host/producer:

Hopefully soon.

Christina Nadasky, RN, CCO, Health Hug:

I hope so.

Carol Vassar, podcast host/producer:

I want you both to look back for a moment again, any patient stories, any clinical outcomes that stand out to you that indicate, yeah, we're on the right track? Christina N., I'm going to start with you.

Christina Nadasky, RN, CCO, Health Hug:

Yes. So we get validation and have gotten it from the beginning. At first, when we sat down and talked about this, it was like, okay, we knew intuitively, we felt it was the right thing, we knew we needed it based on our experience in the past years and what we've seen as parents. But then when we started talking to pediatricians and clinicians, and we started hearing, Christina mentioned, other parents coming forward. And she may bring this up, but the social media of people seeing what we're doing and saying, I need this. I need this right now. How do I get it? Where do I get it? And so that's been a really continually driving force to keep us going. That days can get hard, and we can feel like, are we going to make a difference? And then we have those stories come along, and we have a provider that, adoption's not the problem, as soon as the awareness is there and they realize what we're doing and they realize what they have, they want it. And so that's been a wonderful thing and something that just keeps us going. And it's exciting every day when we hear that.

Carol Vassar, podcast host/producer:

They see the value in that. Christina S., anything to add?

Christina Sloan-Vélez, Founder/CEO, Health Hug:

Yeah, just like Christina said, we've gotten a lot of validation from both parents and pediatricians. Just a few days ago, we were talking to a pediatrician, and she just... her eyes lit up when she said, "This is exactly what I need. Because for me in particular, it's so important to get that in between that I often miss because I see my patients every three months, every six months, and I don't know a lot. Sometimes I don't even know that they've been into the hospital until I talk to them." So this helps her fill that gap.

And even from parents, I post a lot on social media about my own personal experiences with my son and how challenging it is day to day. And I had parents reach out to me, "I really need help." Or I see parents, a few weeks ago, a mom posted on Facebook that she was really struggling, that she was feeling overwhelmed. She had two kids with chronic conditions, single mom trying to manage career, life, all the responsibilities. And she said, "I'm drowning. Is there anything that's out there to help me?" And I just immediately reached out to her and I said, "How can we help you? Tell me? Tell me. We're here." And she's actually become someone that we work with to get feedback because she's living through a lot of these challenges, just like many parents are nowadays. So every single day we talk to people that really want and need the services.

Carol Vassar, podcast host/producer:

How are the services paid for? Is this covered under Medicaid?

Christina Sloan-Vélez, Founder/CEO, Health Hug:

So most Medicaid plans cover it because Medicaid. It's state-specific. Some states have not adopted all of the services; they may cover some. But for the most part, it is covered by Medicaid.

Carol Vassar, podcast host/producer:

And private insurance?

Christina Sloan-Vélez, Founder/CEO, Health Hug:

Yes.

Carol Vassar, podcast host/producer:

Excellent. Let's see where this is going. Where is HealthHug headed in the next five years? What's your vision for the impact moving forward, Christina N.?

Christina Nadasky, RN, CCO, Health Hug:

So I think I mentioned a little bit about the value-based care, but having a model that fits in with that approach and seeing those outcomes, expanding upon it. So just diving deeper and I would say more integrated, multidisciplinary, really that entire virtual kind of care piece that will improve access and that will come alongside the providers to expand what they're already doing, to optimize what they're doing. We have a vision and a dream of a HealthHug foundation, and I won't spill all the wonderful things that we're thinking about and coming up with, but just being able to do outreach, and work in areas that are underserved, and bring just care and a support into those neighborhoods, into those areas where we can do more, just right there on the sidewalk, in the homes is really a dream of ours.

Carol Vassar, podcast host/producer:

Christina S., I'm going to ask you the same question, but one first, how's your son doing?

Christina Sloan-Vélez, Founder/CEO, HealthHug:

He's doing great, he is doing great.

Carol Vassar, podcast host/producer:

Excellent. So, how do you see the future going? What's your hope in shaping the future through HealthHug?

Christina Sloan-Vélez, Founder/CEO, HealthHug:

We've done this for 10 years. Like I said, we started with the Medicare population, so we've learned what works and what fails in this space. So we want to set an example of what that true whole family, and we talk about whole person, but in pediatrics we can't do that, a child is not a silo it's the whole family. So we really want to set that example of what true integrated care is, and what that model should look like, and to expand our services. We started in the country we call home, but we're currently doing a pilot in Mexico right now. So being able to expand outside of the US because chronic conditions are not defined by the demographics, it's something that's impacting every child around the world.

Carol Vassar, podcast host/producer:

Christina Sloan-Vélez is the founder and CEO of HealthHug. We also heard from Christina Nadasky, RN, Health Hug's, Chief Clinical Officer.

Music:

Well Beyond Medicine.

Carol Vassar, podcast host/producer:

Thanks so much to Christina and Christina for joining us today, and thanks to you for listening. Have you subscribed to the Nemours Well Beyond Medicine Podcast yet? Don't worry, we've got you covered. Just go to NemoursWellBeyond.org where you can also catch up on recent episodes you may have missed, and drop us a voicemail with an idea for a future episode. Speaking of subscribing, be sure to subscribe to our monthly newsletter while you're there, that's NemoursWellBeyond.org. You can also find the podcast and subscribe to it on your favorite podcast app and on the Nemours YouTube channel.

Our production team for this episode includes Cheryl Munn, Susan Masucci, Lauren Teta, and Alex Wall. Video production by Britt Moore and Sebastian Riella. Audio production by yours truly. Join us next time as we look at the emerging use of AI for both clinical research and pharmaceutical development. I'm Carol Vassar, until then remember, we can change children's health for good. Well Beyond Medicine.

Music:

Let's go, oh, oh, Well Beyond Medicine.