Dr. Jerrica Kirkley, Co-Founder, Plume
Health care is rooted in 400 years of oppression. Can technology transform the system? Dr. Jerrica Kirkley, family physician and co-founder of Plume, shares an optimistic realism approach that shifts from the one-size-fits-all healthcare model to envision care that is identity-centered and addresses the needs of the trans community and other marginalized groups.
Jerrica is a queer trans woman, doctor, and startup founder based in Denver, Colorado. With her co-founder Dr. Matthew Wetschler, she started Plume, an app-based gender-affirming care service for trans folks, to increase access to gender-affirming medical care across the country. She hopes to use her platform to not only provide much-needed medical services but to transform the way the world thinks about healthcare and gender.
Show Notes
Dr. Jerrica Kirkley shares her journey into the healthcare system as a family physician. [02:52]
An optimistic realism approach that envisions transformation in six key areas in health care. [06:23]
The healthcare system follows a one-size-fits-all model that’s rooted in 400 years of oppression. [08:02]
How can technology along with a community and identity-centered approach create breakthroughs in the system? [15:12]
What are the positives and potential negatives of technology in healthcare? [20:45]
How will we pay for health care in 2049? [22:28]
What role will artificial intelligence play in 30 years? [26:25]
Hospitals will change as health care focuses more on prevention. [30:06]
Achieving the vision of person-centered care would lead to healthier, happier people with a better quality of life. [32:16]
Transcript
Jason Helgerson: I’m Jason Helgerson. And you're listening to Health 2049.
Dr. Jerrica Kirkley: Realistically, we have a healthcare system that is quite literally rooted in 400 years of oppression, built from the beginning and largely, that oppression focuses on lines of race, gender and sexuality among many others. But that's kind of what's brought us to where we are today. So we've built a health care system that does, like a pretty good job of taking care of a fairly monolithic community. And for a long time, we've just been trying to fit everybody else into that one-size-fits-all model. And so I think, as a patient walking into that, if you don't fit that nice, neat box that the healthcare system was designed from the beginning to really address, then you start to hit a lot of friction points.
Jason Helgerson: [01:56] This week's guest is making waves in the world of transgender health. Not only is she a doctor, but she is also a startup founder at Plume, an application-based healthcare services company focused on meeting the needs of transgender individuals. Through Plume, our guest aims to increase access to gender affirming medical care across the country, if not the world, she imagines a future where transgender individuals no longer face any stigma or inadequate access to affordable care.
Given her work to date as well as her own personal journey, I can't wait to hear what she envisions for health and health care in the year 2049. I'm Jason Helgerson, and you're listening to Health, and it's my pleasure to welcome Dr. Jerrica Kirkley to our program. Jerrica, welcome.
Dr. Jerrica Kirkley: [02:44] Thanks, Jason. Yeah. Really happy to be here. And thanks for having me on.
Jason Helgerson: [02:47] So, Jerrica, tell us a little bit more about your interesting background.
Dr. Jerrica Kirkley: [02:52] Yeah. So I'm a family physician by training, I guess, professionally. And I think back to just when I first started thinking about getting into health care and going to medical school, for me, it really looked like finding a career path that allowed me to engage with, I think a lot of different communities and especially to be able to engage with communities who were particularly underserved and just didn't have the resources that a lot of other communities had. So I saw healthcare as a vehicle to do that.
And that was really my draw of getting involved in healthcare at all. Recognizing there's obviously many ways to do that type of work and family medicine just kind of matched a lot of that. It was a community of health care providers who were oftentimes rooted in social justice oriented causes within medicine and the community and society at large for a long time, really dating back to the civil rights movement. And so that was the specialty I picked to be able to have a lot of skills to address sort of a wide breadth of needs when it comes to different communities.
And that was kind of my professional pathway. But yeah, I also have my own experiences with healthcare. And as a trans person myself have felt that pretty intimately in different ways. And after finishing training and then getting into practice, I wound up in a community health center setting. It was sort of where I always wanted to be getting back to the community, providing primary care. And then I just noticed a lot of barriers coming up, really for everybody. But that were particularly emphasized and significant for trans folks.
That sort of led to the founding of Plume, but that's, I guess, sort of a broad overview of who I am and where I come from. But beyond being a medical practitioner, I really love educating folks. And I've done a lot of teaching on gender affirming care and other things within medicine for a long time. I'm a parent, mother and just enjoy, I think, all things outdoors in nature and being physically active.
Jason Helgerson: [05:06] Great. Well, Jerrica, one of the things that I found very compelling about your company when I first got to know was that you would provide potential investors with a vision for the company in the future that took us through 2030, I think was the year, which I think is a longer horizon than many in the healthcare world are taking. But obviously the purpose of this show is to think even further into the future. And so I'd like you to sort of describe for us what you think healthcare looks like in the year 2049, roughly 30 years in the future.
Dr. Jerrica Kirkley: [05:39] Yeah. Easy question. I know I thought long and hard about this, and I think my approach to answering this question is something along the lines of optimistic realism, which I guess is where I live most of the time because I was thinking, okay, well, that you could take a very utopian, just like everything that seems would be needed or wanted. And for me, that's a little hard to do. I think just living in the world that we're in. So I was like all right. Well, how do I see things moving and sort of mixed with how I'd want to see them move and be in 28 years.
That was the high level approach. What I do see is really healthcare moving along six key buckets or lines. And to me, that looks like culture really being a big one. And I can break down how I see each of these moving. But then I think there's policy, there's education, there's technology and then payment and care models, and a lot of these go hand in hand, and there's a lot of overlap. But that's sort of what I've seen historically and sort of the things that I see changing as we go.
Jason Helgerson: [06:52] So why don't we start breaking those down because I think one of the things we always like to get our guests to describe is thinking about the system, but also from the perspective of the patient to help our audience really kind of get their heads around the future. And I like your realistic optimism. We believe here on this show, we say we don't want Pollyannas, but we also don't want pessimists. We want this to be about what the future could and should look like. So I think your perspective is exactly correct. So give us a little bit more flavor for that future state.
Dr. Jerrica Kirkley: [07:30] For sure, I always like to start with the culture piece, because I really see that being the focal point where all of these other things come into play and the driver of all those things, whether it's policy, education, technology, payment reform or just how we facilitate care, I think it all is driven from how we approach it culturally. And I'll explain what that means and getting to the patient perspective in this.
Realistically, we have a healthcare system that is quite literally rooted in 400 years of oppression. I mean, built from the beginning and largely that oppression focuses on lines of race, gender and sexuality among many others. But that's kind of what's brought us to where we are today. So we've built a healthcare system that does a pretty good job of taking care of a fairly monolithic community. And for a long time we've just been trying to fit everybody else into that one-size-fits-all model. And so I think as a patient walking into that, if you don't sort of fit that nice, neat box that the healthcare system was designed from the beginning to really address, then you start to hit a lot of friction points.
An example of what the work we do at Plume as a patient, we have a healthcare system that is based around insurance and largely fee-for-service billing with health insurance companies. But if I, as a trans person, try to get healthcare, there's a good chance that it'd be hard to find a health insurance company that one even covers the services that I need. But then I have to find a clinic that can deliver those services, whether the health insurance covers the cost or not. It just keeps going from there.
So for maybe certain individuals, it can be easy just to plug in. You get your health insurance, you go to your local clinic and you get what you need. But it's not the same for everybody. So that's kind of the framing that I'm getting at and where that takes us is instead of this legacy system of really disease-based care, where it's just like we're teaching our medical trainees and then we're doing this in practice to treat hypertension and treat diabetes, treat HIV, whatever it might be. I think we have to take a step back from that. And again, free focus on that patient. And what I mean by that is the identity of that patient, the community of that patient.
And these are not necessarily new themes. We have community health centers that came out of the 1960s because black Americans just literally did not have a place to get health care, because a lot of the clinics were white only. And that's why these health systems and clinics were formed. We've done this on some levels, and we have LGBTQ-oriented community health centers and along other lines of identity. But we've yet to see it, I think really applied to a large scale, and yet to see the paradigm truly shift.
So that's why I think that's such a cornerstone is because we have to get to that point where through everything that we do in medicine is really be focused on where that individual is coming from and acknowledging that, hey, we might need to do things a little bit differently depending on who that individual is and where they're coming from. I always like to throw out some examples, because this is already happening and love to highlight folks who are doing that. We're definitely the big thesis here at Plume, where we're focusing specifically on the trans community and reshaping how we deliver healthcare, how we think about healthcare in our minds more adequately and appropriately address the needs of the trans community that has oftentimes fallen through the cracks and just the general legacy system.
But there are startup companies like City Block who are really creatively looking at leveraging value-based contracts in a virtual and in-person environment to focus on urban communities that are primarily black and brown. And FOLX is another company doing broader LGBTQ plus virtual care, Violet and T Buddy, focusing on the mental health needs of trans and queer folks, both trans and queer founded. Euphoria looking at helping navigate just the process of being trans in the world through all the institutions we face and then couple other neat ones.
Perspective and Hurdle are in particular looking at the mental health needs and focusing on the black community and connecting directly to providers with that identity residence in mind. The list goes on. There's emerging marketplaces that are doing this as well. So it's definitely starting. And I think we'll see that momentum continuing and again, because where all this goes is we want better health care outcomes. We talk about that all the time from a policy standpoint and from a public health standpoint. But yet we keep seeing the same numbers.
Why do we see black Americans are the most disproportionately affected by hypertension, that trans folks have the least access to and culturally and we'll say clinically-informed provider and list goes on. So I think until we really start to change that, those outcomes will probably not change. But when we do what we're doing is promoting comfort, we're promoting safety and really buy into the care process. And then I think that's when we really start to see health get better, health improve.
The last two pieces. I wanted to mention are policy and education, because those will also have to change to really achieve a lot of these things. And so the only thing I'll say about those is I think educational systems for healthcare providers will start and they are starting, but really, in 30 years is a good question, where will they be? I think the majority will have a lot of these sort of culturally informed elements of care baked into curricula. But the healthcare education system is perhaps even slower moving than the healthcare system at large. So we'll see where that is.
But from a policy standpoint, what I foresee are these universal licensing. Because I think where we go from taking the great work that folks are doing in community health centers and really acknowledge identity-based care, how do you get that to everybody? And so I think we need to see the regulatory side catch up and have universal medical licenses for various health practitioners, universal DEAs, the list goes on, more universal standards of care and not having each medical board kind of dictate these nuances and requirements that become an impairment, actually practicing across state lines. So those things I do see happening as well.
Jason Helgerson: [13:57] Yeah, I mean, I so agree with you in the sense that we use the words patient-centered or person-centered healthcare all the time, the words are like ubiquitous. But yet the system couldn't be farther from the truth. I often also say that so much of healthcare, not just the United States, but in other countries as well, we took the Ford assembly line approach and basically implemented it in healthcare and turned patients into just cogs in the machine. And I couldn't agree with you more that the cogs that this system was designed around white individuals with means.
And everyone else expected to sort of fit in to that same assembly line. And I guess in a sense is that what do you see, in order to get to that more person-centered that system with a culture that really begins to see patients holistically and designing care around those needs, as opposed to expecting people to sort of conform to the system. What do you think is the sort of biggest impediments to us getting to that desirable future state?
Dr. Jerrica Kirkley: [15:12] Great question. And I think really it feeds along the lines of the sort of policy, technology and care model change which I'll get into. But before I dive into all those, there's this other sort of cultural piece. And it's just like that how do we feel being in healthcare? And I think if we had to pick one word, unfortunately, if you ask a lot of people and certainly if you ask me, it's frustration, right? I mean, if you're a medical provider and you think about walking into your clinic to see 40 patients and just knowing that, how can you provide the highest quality care with five minute visits and 40 people?
And then as a patient like, oh, gosh, just shuttering at the fact of having to go to a clinic knowing the potential fallout that can occur there or more so afterwards and lack of transparency, you're going to get stuck with a big bill. It's a lot of frustration and fear, honestly, that's super important, because that is sort of some of the defining cultural elements of healthcare right now.
How do we get the 180? How do we get to where healthcare does actually feel welcoming and not frustrating and at the very least, if not exuberant, but like, oh, this is like an okay place to be. And I know what's going on. And I know what's coming. And there's not a bunch of surprises. And I think to do that, of course, part of that is the cultural shift we were talking about before, but changing the system. And because if you have a system that's built again in fee-for-service and health insurance carries a lot of unknowns and unpredictability, and then you have technology which is built to support those insurance companies that sort of leads providers kind of clicking buttons that feel completely meaningless, because they're purely built to move codes back and forth from a medical provider to an insurance company.
Then it really detaches the provider from the patient. The patient feels sort of left out of contact with their provider, even though they're sitting right in front of them. But it really doesn't feel like there's a relationship there. A lot of this is just re-establishing the patient and medical provider relationship that, in my mind, has been stripped away over the last 40 plus years because of these system elements which have been driving the system.
And so if we start to get into that a bit, let's talk about the technology. Again, we've had these electronic medical records which are really serving a singular purpose, but then started to be advertised as, oh, this is actually, better for care and it makes it more efficient, and we have data. But then we find out that, oh no, it actually slows down care. You have dissatisfied, burnt out medical providers, frustrated patients, and a whole bunch of data that we can't do anything with. And so what I do see is starting to happen now, and I think we'll be in a really good place in 30 years, especially with as quick as this is evolving, is moving away from this classic electronic medical record or EMR to what I would call healthcare delivery platforms, holistic healthcare delivery platforms that can facilitate care seamlessly, whether in-person or virtually via tele-health.
And when we talk about data again, we're capturing gobs and gobs of data, but we just can't use it that well in these systems. And so I think we really need to redefine how we are talking about data, structuring it and collecting it, so that we can actually go back in and look at these population-based trends to inform the clinical care that's happening in the moment and at that clinical site. But also then, of course, to be able to link to data that's being collected elsewhere and really have some just absolutely robust insights into the care of individuals.
And then if you couple that with an approach that is community and identity-centered, then really having breakthroughs. So I think that's where technology can really be leveraged in a way that just hasn't been for a long time and not for lack of having the capacity to do it. But just again, sort of system forces which are pushing it in a particular direction.
Jason Helgerson: [19:45] So you mentioned already, and I love the description that you just provided in terms of this platform and individuals being able to have their holistic needs met. And these platforms able to tailor the health solutions truly around, it really sounds to me much more like a patient or person-centered approach than what we have today. But the role of technology and all of this, obviously, in the show, we have guests who are very optimistic about the role technology plays, but there's also potentially a darker side of how technology and data can and will be used in the future within healthcare.
What do you see as both the positives as well as potentially negatives of this robust data that you envision these platforms having access to? Are there things that government or others or institutions in society need to do to make sure that we get to them more optimistic, as opposed to the darker version of how that data is used?
Dr. Jerrica Kirkley: [20:45] Yeah. Excellent question. With power comes responsibility. And it is exciting to think about, again, just like, sort of the insights that we can glean from that and really start to radically transform care. But there is that other side. And I think if you start to have these sort of big consolidated buckets of data, of course, you think about data security and does that, then open up these opportunities for hacking into that data. And, of course, all kinds of things can come from that, especially if the data is centered on communities which are traditionally marginalized and oppressed.
And that is a super important concern. And a lot of that comes down to data security, and there will have to be a balance. That's something that we've struggled with in the healthcare community for a while now. And we do have electronic medical records that in many ways can communicate with each other to some degree. But even just having visibility to that information as a provider to help with the care of somebody has been really hard because of regulatory forces that are concerned about various things when it comes to privacy and information sharing.
So I think it's going to have to come to a middle ground of some sort. And what that actually looks like is hard to say. But absolutely. I think it's something that we always have to keep in mind in a company like Plume that we're thinking about all the time.
Jason Helgerson: [22:22] So in the future, how do you think we're going to pay for healthcare in the year 2049?
Dr. Jerrica Kirkley: [22:28] Yeah. Well, this is like a question that I can come up with an answer ten different days, and there'll probably be ten different answers. And I don't know if I trust any of them. So where are we now? We have this largely fee-for-service based system that's linked to health insurance, quote, unquote companies that pay for a lot of the healthcare. But what we've seen more recently is that actually they're shifting that burden onto the patient more and more. And also the medical providers providing the care where they're refusing to reimburse many services. If they do, there's high deductibles, there's high copays, there's coinsurance list goes on.
And so it's actually not really doing a whole lot of what it set out to do. And I think that is going to go away. That will not exist in 28 years. I really hope so. At least the fee-for-service aspect of insurance. Now, where that goes is a really interesting question. I see going a couple of ways.
I do see a lot of energy being generated around this direct care model, which classically we call direct primary care, the more traditional brick and mortar world. But now that's sort of evolving into this direct to consumer health, which are the virtual health care companies like us and many others I mentioned who are coming up, and there's a lot of them. I was talking about a lot of the identity-focused ones, but, I mean, there's something for almost everything now that you can go into a website and see a clinician and get a prescription as needed. Obviously, the population is really coming on to that. I think it's for all the reasons that we discussed.
It's like, okay, well, why do I need to drive across town to go to a clinic that's where I don't feel very comfortable anyway. And I'm going to get a bill and I don't know what it is when I can just come to a provider, have full transparency, know what the cost is, know exactly what I'm getting and talk to somebody who has deep experience in that. And so I do potentially foresee a system that is perhaps largely built in cash pay, kind of direct cash pay.
Will insurance go away completely? Probably not, but moving more towards a true health insurance in the sense that it's covering catastrophic events. But otherwise you are actually paying reasonable cost for the healthcare that you're receiving. There's definitely a lot of energy in these value-based contracts as well. And I think that's interesting. And so maybe it's sort of a hybrid world where we have completely moved away from fee-for-service. But perhaps there are these kind of value-based contracts set up where we're not having to think about codes and billing by procedure or medication. But the health insurance is kind of charging health providers to take care of a population and do it well and get compensated for doing that. And so I do think that could have a role. But that's where I see that moving.
Jason Helgerson: [25:45] Great. Well, on technology, a topic that's come up over multiple episodes of this program has been the role of artificial intelligence, machine learning in direct healthcare delivery by the time we get to 2049. What role do you see those technologies playing? Do you see them replacing the human position in some tangible ways? Do you see people seeking or wanting those kinds of technologies to support them? Or do you continue to see the human healthcare provider as still the preeminent clinician in the health care system?
Dr. Jerrica Kirkley: [26:25] Yeah. I get this question a lot. And no, I don't think it's going to replace, for sure like any one profession or role when it comes to healthcare providers. I do see it as a really important supplement. I mean, people have been asking that about things like IBM Watson for the last seven years or more and it's obviously not replaced anybody yet. Now a lot of that is just an adoption thing and a comfort thing with that kind of technology. But I do think it can be really helpful.
There's so much of what we do that is very algorithmic. And also I think you couple that with there is just so much happening. And in the sense of research studies coming out in publications and sifting through information and that in and of itself, Ironically, is also delayed. I mean, to get to that point, you're talking about months to years before something kind of becomes a, quote, unquote guideline or standard of practice. I think what will enable us to do is to really accelerate that process where we're not always on our heels and years behind where we can again modify our practice in more real time and having that ability to sift through massive amounts of data that presumably these systems will be collecting in 30 years.
I see it as a supplement to both in real time care, also getting insights into population health dynamics, and then how that changes practice. And so some of the things that we do might be replaced by, you could say AI or whatever that technology might be. But I think there always will need to be a clinician leader to that, if you will, somebody who is and this gets another culture piece. It's never going to be one singular person. I think that's also an unfortunate paradigm that we're in now, where it's like we kind of have this expectation that you can walk into a primary care facility and we're going to do everything for everybody.
I think primary care is amazing. I'm a primary care practitioner myself. It will always have a place and never go away. But we really do need to rethink how we're I think approaching that because it's just not a reasonable expectation for one provider to be responsible for all these different things. We're going to have to lean on other whether it's providers, groups, technology, etc. and care teams. You're going to see more expansive care teams. And I think that's one of the neat things doing a healthcare technology startup is like we live and die by teams.
We have product teams, we have our community outreach teams. We have our obviously clinical teams, our operations teams. And I think traditionally a lot of health centers and hospitals and clinics aren't necessarily thinking that way. So it really provides us a nuanced approach to just problem-solving and approaching patient issues. And so all I have to say, I think it's a supplement. We'll see more coordination and true team-based approaches, which again, another buzzword, patient-centered team-based care. Yeah. I've been in the PCMH world for many, many years, but I think that will actually help promote sort of those ideals that we've been talking about for a long time.
Jason Helgerson: [29:51] So I have to ask, given your background, both of what you've been saying today, as well as your background as a primary care provider, what role do you see the hospital playing? What is the hospital look like in the year 2049?
Dr. Jerrica Kirkley: [30:06] Yeah, that's a great question. I think it will always be that kind of tertiary care place where people are going when the care just exceeds the capacity of the primary care clinic and for more emergency situations. But I have to believe that as these systems change, like we're talking about that, we actually really will see more through preventative care and better managed conditions. And really the hospital now it's serving the role of catching the folks who just have these conditions that are spiraling out of control and have bloated emergency rooms and ICUs and, of course, overlay pandemics on top of that, and it really gets out of control.
So I think we'll see less of that, hopefully where it really kind of starts to hone in on the folks that need the care the most, but sort of weeding out the people that we can prevent these things in the first place. But I think technology will play a big role, too, similar how it can do in an outpatient setting in terms of just being able to manage the data that's coming. In hospital settings it's just tons of data points and metrics all the time in real time. And I think it could be a struggle to sort of put our heads around it, so certainly can help shape that.
And then the coordination piece, this is a huge thing that is a massive problem. It's like when people leave the hospital, what happens and where does that information go? And how is it getting transmitted to the people that need it? And that is a big reason there are a lot of teams who focus to do this work specifically, but like preventing readmissions.
Why do people end up back in the hospital? So I think that's where these healthcare delivery platforms come into place and the communication between them to really have seamless communication and visibility into what's going on. So I think that can be a big change for sure.
Jason Helgerson: [32:16] All right. So our final question that we always ask is to ask you to take a step back and envision we're in the year 2049 and your vision for the future. And these platforms that provide truly person-centered care are, in fact, now not only in existence, but they are the standard of care. And if we achieve that, how will that actually make the world a better place?
Dr. Jerrica Kirkley: [32:40] Where does this take us? And how does this truly make the world a better place? I guess put as simply as possible, it's just happier and healthier people. We have built a system that's inadequately addressed needs, it infuses a lot of frustration itself and the end result is not great outcomes and unhealthy people.
For me, the flip is you're going to have people that are healthier. If you're healthier, your quality of life goes up, you're happier. And if we're really digging into some of these kind of social injustices which are built into the system that can have, I think, very broad reaching effects culturally beyond what we're doing in healthcare. And I think can really start to create a more cooperative and an understanding world.
Jason Helgerson: [33:30] Well, I couldn't agree with you more. And that was Jerrica Kirkley's vision for health and healthcare in the year 2049. As always, thank you for listening to Health 2049. If you enjoyed what you just heard, please subscribe to us and share this podcast with a friend. Thank you and see you next time.
