Navigating change as we age: Implications for population health

Season 4 of “Good Health, Better World” will focus on a topic that’s important to all of us: healthy aging. Hear from UPMC Health Plan CEO Diane Holder in the first episode of the season to understand aging from a population health perspective, and how we can all navigate change as we age.

Episode transcript

Ellen

Stronger communities begin with good health—for everyone.

You’re listening to the “Good Health, Better World” podcast from UPMC Health Plan. This season, we’re exploring the joys, challenges, and opportunities associated with healthy aging. We’ll talk about what it means to age well; how to care for body, mind, and spirit as we get older; and the tools and programs available to ensure a good life, throughout life.

I’m your host, Dr. Ellen Beckjord. Let’s get started.

In this episode, I'm very excited to welcome Diane Holder, the current president and CEO of UPMC Health Plan and president of the UPMC Insurance Services Division. Diane will talk with us about navigating change as we age through the lens of population health and as a key leader in the health care industry. Diane, thank you so much for joining us on “Good Health, Better World.”

 

Diane

Well, thank you, Ellen. I'm very pleased to be here with you today.

 

Ellen

Change is a part of life. Aging is a part of life. It's a privilege for most of us, and we encounter lots of different experiences through different stages of life. And I'd love to hear your general perspective on why it's important to talk about aging, particularly in the context of population health.

 

Diane

Well, I think it's critically important to talk about aging, because it is a large and growing segment of our population that, we know over the decades we've seen people living longer. We've seen the percentage of the population grow. The ability for people to live longer and healthier lives is possible, but sometimes they need some help and information and support to do that.

So I think if we just start with some numbers, because sometimes it just helps if people kind of know, what are we talking about? How many people are we talking about? So if you look at people who've reached the age of 65, starting in 2011, about 10,000 people from the baby boomer generation turn 65 every single day.

So it's quite remarkable when you look at, this is a projection that we will have 74 million people over the age of 65 by 2030, which is just actually right around the corner. First time I read that statistic, it didn't seem so close because it wasn't. But it's right around the corner, and we know that it's important that when we look at our own health plan and the people we serve, we look in our region and we know that Pennsylvania is home to 3.4 million older adults, which is the fifth highest total in the nation.

So when we look at our communities locally here, and I think I would say this is true in most communities, there's a big percentage of the population that is aging and most of them are trying to age in place. Most people want to stay in their homes or in their communities, and they need help and support to do that.

When we think about what does it take to be healthy and stay healthy, I think part of why we need to talk about aging is that there are ways to stay healthy and be healthy, but sometimes you better start talking about it a long time before you're hitting those whatever we're calling the golden years these days so that you can begin to build your resiliency, that you can begin to age with the kind of positive opportunities that are out there.

 

Ellen

You've been such a champion for health equity, and it strikes me that this is a place where we want to make sure everyone has the opportunity to age as well. So in general, how can we support people as they age? How have you thought about leading the efforts that you're a part of as being ones that are providing instrumental support to people as they age from a population health perspective?

 

Diane

When we look around—and I think it's true in all stages of life, right?—I mean, the aging population is not the place we specifically and only talk about equity.

We have to recognize that many of the things that surround people in their lives, are very different. We're born with different, you know, genetic codes. We're all born with certain susceptibilities, risk factors genetically, biologically.

But we are also surrounded by our families, our friends, our communities, our work. We're surrounded by so many variables throughout the course of our life. And so when we talk about equity, we're saying, well, do you as a person have an ability to access, for example, healthy food? Do you have access to a safe place to live? Do you have access to enough money to actually have a reasonableness in terms of your quality of life?

Do you have the capacity, the capabilities, the skills, the support to create interpersonal relationships that often can make a huge difference? And so when I look at equity, it's really across the lifespan. And I say, OK, what are those things we can build as we're aging and growing to increase the odds that we can be our best selves when we're 65 or 95?

 

Ellen

Diane, you supported the idea of us devoting a whole season of “Good Health, Better World” to women's health, a critically important topic. Could you share some thoughts about aging in the context of women's health, in particular?

 

Diane

You know, so women's health has been a really important topic and focus for us here at the Health Plan. I have been, from my early days, a champion for trying to figure out what it is, in our culture, in our environment, that can be useful and helpful for women.

We know that most of the clinical trials that were done historically did not include many women. We also know that women aren't just slightly smaller men. We know that there's a biology that's different, a psychology that's different often, a cultural context that's different. And I think when we're talking about health, which incorporates all of those things, we have to think about health from the perspective of gender, in the same way that we think about health through the lens of race, or we think of health through the lens of age. Gender is very important.

 

And so for me, when I look at what we need to think about for women, we need to understand, how are they assessed differently? How do their symptoms present differently? We also know that their social circumstances are different. Women are often caregivers. I think 25 percent of women over the age of 40 are in a caregiver role. Not sure I like the word caregiver particularly. I sort of am more a fan of, you're a partner in care. But that aside, we do know that there are definitely burdens attached to not only worrying about your own health, but those of your children, those of your aging parents, those of your spouse.

We know that women seem to have more of the social responsibility for health and their families. We know they are often called the CEO of the household for, you know, performing things related to making sure that schools are running well for their children and health care is being attained for their children, etc. And so what we need to do, I think, to help women is help give them good information. Good information is very useful. I think it's very hard sometimes for people to know what's real and not real, especially sometimes online. It's a little indiscriminatory, what you can find.

Women don't have a lot of time. Nobody seems to have a lot of time. But I would argue that women don't have a lot of time. And so how do you make it easier for them? How do you make it more accessible? How do we use online services that can be helpful for them? How do we provide people with the context around which they are trying to secure a certain kind of outcome? How do we facilitate that?

So I would argue as women age and they live longer than men, they are more likely as they age to be left alone vis-a-vis a spouse, which they may never have experienced in the course of their adult life until they are much older. They often don't have as much resource. They're financially less well-off than their male counterparts, as a group. They often have been caregivers, but also then when it's time that they need extra support, there may or not be somebody there to help them.

And so as an organization, as a health plan, one of the things that we've tried very hard to do is reach out in the community, be available in our Neighborhood Center, for example, that we set up in East Liberty, or in our programs where we partner with churches or synagogues to really say, are there exercise classes we can bring? Is there food and nutrition information we can provide? How do we let you know where some of the social support in your community is, and how can we help you get that? Because we know, and I say this whenever I have the chance, your health status is not just related to the medicines you take or the doctors you see—your health status is related to all of the other things that surround you and how you have access to use them.

 

Ellen

I also think that women are so good at creating community and sharing within community. And so the things that UPMC Health Plan has done to create opportunities for women to come together in community across all sorts of contexts, but including to support healthy aging, has just been really important and helps to realize the potential, I think, that so many women have to be resilient and to support one another.

 

Diane

Absolutely. And I think if you look at the literature on aging and you ask people at really at the end of the life, what is it that when you look back on things that actually mattered? What you see matters, whether you're employed or you're not employed, as an older adult, it matters what your social connectivity is. Loneliness is deadly. Helping people be connected, stay connected—and I think that's why you, when you reference a sense of community building, it's very, very important to help people not find themselves isolated. And I think that, I think you're right. I think women do have the good fortune that in many ways they have built some of those skills and expectations over the course of their life and allows them to perhaps use those to great benefit as they age.

 

Ellen

I know personally, as I age, my perspective on aging changes pretty significantly. I think that's probably not unusual. And having spent more than 25 years now in health care, thinking about the population and thinking about what aging look looks like has changed for me too.

And so, I would love to hear any personal reflections you care to share, either from your personal vantage point or your professional vantage point, about how to navigate change as we age?

 

Diane

Well, I know it's a bit of an old adage to say age is a state of mind. But I do think there's a little bit of truth in that. I do think you have to work at keeping your perspective broad. I think that it helps a lot if you are able to connect with people across the generations, no matter how old you are.

Because I think you learn things every single day that benefit and help you as you try to grapple with, well, what is this whole tech world that we're seeing here? And how is it that people believe what they believe? Or why do the kids think X, Y, or Z?

And to me, the most interesting thing in life has always been the ability to expand and figure out the next horizon, whether it's sort of about what plants should you put in your backyard, because that could look really cool—and there's this whole way of thinking about it, maybe that this space didn't look like before, but it would be fun if it did—to things like, how do you think about the, you know, political social environment and how do we understand what we're living with?

And so I think that unfortunately there is a bit of, you know, biology over time becomes harder. There are lots of things about aging that are hard. How in the process of that do you keep a perspective, a positive attitude, a physical resiliency to the extent you can, a social competence. How do all these things come together?

And I think that it is important to be intentional and mindful about it. And I think that when people are willing to be intentional and mindful about it, they have to encounter thoughts and ideas that are unpleasant, thoughts and ideas that are hard, and situations that are difficult. And, I think that's just predictable.

And so as you're kind of navigating the road, you know you're going to hit some bumps and you might hit a whole pasture. So you’ve got to figure out how do you deal with that. And I do think a lot of it has to do with seeking input, asking other people, not assuming that because you did it this way yesterday, that's the best way to do it. And so I do think to the extent one can, staying open to input and expansiveness is useful.

Aging is an incredibly important time in life. And like every other important time in life, it's important to make the most of it.

 

Ellen

I love that. Thank you, Diane, for sharing your perspectives on aging. We really appreciate your taking the time.

 

Diane

My pleasure. Thank you.

 

 Ellen

We hope you enjoyed this episode of “Good Health, Better World.” Be sure to tune in next time and visit upmchealthplan.com/goodhealth for resources and show notes.

 

This podcast is for informational and educational purposes. It is not medical care or advice. Individuals in need of medical care should consult their care provider. Views and opinions expressed by the host and guests are solely their own and do not necessarily reflect those of UPMC Health Plan and its employees.

Guest speaker:

 

Diane Holder

Executive Vice President, UPMC

President, UPMC Insurance Services Division

President and Chief Executive Officer, UPMC Health Plan

UPMC is one of the nation’s leading integrated delivery systems and through its health plans and affiliates provides health care coverage and benefits management for more than 4 million men, women, and children in Pennsylvania. The UPMC Insurance Services Division includes UPMC Health Plan, UPMC for You, UPMC for Life, UPMC for Kids, Askesis Development Group, Community Care Behavioral Health, and UPMC Workpartners. These health benefits companies manage benefits for commercial, Medicaid, Medicare, behavioral health, EAP, health promotion, and workers’ compensation programs and other population health programs and services.

Ms. Holder has held a number of leadership positions in health care, including CEO of Western Psychiatric Institute and Clinic of UPMC and founding CEO of Community Care Behavioral Health. She is also a faculty member at the University of Pittsburgh in the Department of Psychiatry and the Graduate School of Public Health. She received her undergraduate degree from the University of Michigan and her master’s degree from Columbia University.