Access to Veterinary Care: A National Family Crisis

Hi everyone, This is Krista with Episode #141. On the Wag Out Loud pawdcast. I am so excited to share with you that I'm going to be expanding my Wag Out Loud business, with lots of exciting things to come. I wanted to let you know that as of January 2022, I'm going to go from releasing weekly episodes to releasing bi monthly episodes. Putting the Show on is so important to me. But to do it right, and all on my own, I've decided to bring you the same awesome guests and content, but just with a lesser frequency. That's going to give me more time to work on other fantastic projects and the canine health and wellness space. So stay tuned for some exciting future announcements.

I am begging everybody. Please restrain your pup while traveling in your car. According to the pet advocacy group, Bark Buckle Up, a 60 pound dog in a car traveling just 35 miles an hour can turn into a 2700 pound projectile in an accident. So please play it safe and make sure your dog is secured in a crash tested crate or buckle them up via an appropriate harness either in the backseat or for smaller dogs in an appropriate booster seat. Let's ensure that your dog doesn't become one of these statistics.

Welcome to the Wag Out Loud pawdcast, where we are obsessed with bringing you helpful tips on canine health care, nutrition, and overall wellbeing. If you'd like to support the show, check out the amazing online events, products and resources that I personally recommend on the Wag Out Loud website. I'm your host, Krista and I'm super excited to be bringing you yet another tail wagging episode.

Access to Veterinary Care: A National Family Crisis

Dr. Michael Blackwell had a doctorate of veterinary science as well as a masters in public health. He directs the Program for Pet Health Equity at the University of Tennessee, chairs the Access to Veterinary Care Coalition, and serves as a member of the HSVMA Board of Directors. In the past he has served as dean of the College of Veterinary Medicine at the University of Tennessee, the chief of staff at the Office of the Surgeon General of the U.S., the deputy director of the Center for Veterinary Medicine at the Food and Drug Administration, and the chief veterinary officer of the U.S. Public Health Service and The Humane Society of the United States. During 23 years of active duty, he achieved the rank of Assistant Surgeon General of the U.S Public Health Service Commissioned Corps. He has owned two private practices and has received numerous awards and recognitions.

Hello dog lovers. Today we are going to learn something new as we chat with Dr. Michael Blackwell, about access to veterinary care, a national family crisis. Dr. Blackwell, thank you so much for being here. I've been looking forward to this interview. And everybody's going to be blown away about all that you do. So if you could introduce yourself, and tell us why you have such a heart for providing veterinary care for underserved families.

Well, certainly thank you for the opportunity to join you with on this podcast and share information with your audience. Yes, Dr. Michael Blackwell. I'm the director of the program for pet health equity at the University of Tennessee. And our mission is to improve access to veterinary care for underserved families. It's a huge societal crisis that we have and such important work. We often hear about access to health care with respect to human members of the family, but not as much about the non human members. And so we need to catch up in this work. And I'm just so thrilled to be doing it.

You must have a huge heart and I can't wait for everybody to learn about the program. So why don't we start with statistics. So according to a study from the University of Tennessee's College of Social Work, and the Access to Veterinary Care Coalition, 28% of households reported having barriers to veterinary care in the past two years. So money being the biggest factor and the study also estimated more than 29 million pets live in homes that rely on SNAP benefits, or food stamps. Can I first ask what are SNAP benefits?

Yes, SNAP is an acronym for the Supplemental Nutrition Assistance Program, formerly known as the food stamp program. So many of our families rely on public assistance in the form of food stamps, I do want to hasten to say we are having to overcome a bias about the people who need assistance. The bias is many might think that these are people who are irresponsible if they just worked harder or went out and got a job, they wouldn't be needing help. But the truth of the matter is the largest percentage of these folks do contribute. They do work, but they're paid such low wages that they can't support the family without some assistance. So we use that measure because if you qualified for the Supplemental Nutrition Assistance Program or SNAP, then you probably are not walking into a veterinary clinic paying for veterinary care. And so that was thought to be pretty sound measure or estimate of the size of the problem.

Sure. Well, and you and I both know, in this day and age, so many more dogs are not only getting cancer, but all of the other diseases associated with the lifestyle and toxins in our environment, that I mean, even people with means more and more of us are having to face the fact of an awful diagnosis or a surgery or what have you. And it could be so expensive. And it's expensive to have pet insurance as well. So I can't even imagine having a dog where I would have to make a life or death decision, all based on my financial means.

Yes. You know, in, in that situation, everybody loses. Let's start with the individual who needs medical care. And then let's look 360 degrees around that pet and see the pet’s people. And we see the veterinary care team that wants to help, that lose, and then our communities lose. Because if we're not preventing and controlling zoonotic diseases, those diseases that an animal can pass on to a human, then our communities are at risk as well. It's a very, very difficult and important situation that must be addressed. And we think it can be, but we need to intend to fix that.

You, a few years ago, you did a lot of research in this area. So can you share what your findings are?

Many Need Affordable Veterinary Care

Yes. And let's start with the stats that you just shared. More than one out of four families reported a barrier to veterinary care in the previous two years. That is, as bad as that number is, things have gotten worse since COVID-19. You know, there are still individuals who are unemployed or not fully employed as they were before the pandemic. So the numbers have worsened, the problem has worsened. We wanted to understand those barriers. And as you pointed out, the biggest one is finances. But there are some others. And these pet owners, a very important stat is 88% of the respondents consider their pet a family member. And interestingly, the veterinarians that were surveyed, about the same percentage considered the pets family members. And the veterinarians, with 90% believe that when these pets do not get veterinary care that there are emotional impacts, negative impacts upon the pet’s family. And so we wanted to characterize the problem with an initial study. And of course, our work has continued since then, that Access to Veterinary Care Coalition wanted to understand better what these barriers are. And let me just point this out, you know, in animal welfare work, and in veterinary medicine, we are historically very pet centric or animal centric in our thinking in our activities. But when we talk about barriers to medical care, the pets don't present the barriers. The barriers are human derived human factors. I point that out because both the veterinary medicine industry or profession and animal welfare industry need to broaden our scope so that we understand we've got to like the people well enough to help them because that is the way by which we're going to help the the pets, the individuals we want to reach.

Sure, that makes sense. Well, I know you've talked about the data and what it looks like for bonded families versus the health metrics with non-bonded families. Can you talk a little bit about that?

Yes. And just as a reminder, we coined the term bonded family, or bonded family in order to be more precise about who it is we're talking about. so bonded means, families that have animals. Bond bonded families are the ones where there is truly an emotional bond between the humans and the non human members of that family. In other words, the human animal bond And so we thought that it was important to be clear that these families are very much deserving of support because of those emotional impacts. And so previous studies and our own work that's ongoing shows that humans benefit from these relationships. And the benefits are both psychological and physiological or physical. We know that, for example, people with pets are more physically active, especially with with dogs, because they take them out for a walk, they're more socially engaged, less depression, and anxiety is measured less stress. Our recent work shows that these families, these bonded families, report a higher rate of happiness, if you would, and well being. So in summary, there, there's some work that's been done. And we need to continue to do the work to better understand why we humans are healthier or better off when we're in these relationships. And this then gets back to the fact that helping the animals means understanding what's going on with, in this case, the pet’s' people. These benefits, by the way do translate into economics. So for example, the very people who struggled to pay for needed services don't need to be getting sick. There are people who struggled to access health care for the humans don't need to be getting sick. And if the pets are helping them to stay healthier, man, don't we want to make sure that that they are able to have that relationship. And so we take the position, we don't believe you should be denying a relationship with another. Period. But in this case, denying the relationship with a pet because of finances. In that the end of the day. It's more costly for the family. It is more costly for our nation. When families are unhealthy, human members are unhealthy.

Well, I just want to let everybody know that Dr. Blackwell is behind this whole concept because you have both a Doctorate of Veterinary Science, you are a veterinarian, as well as a Master's in Public Health. So those two married together brings us to this program and this cause. And to your point, the lack of veterinary care impacts not only our pets and ourselves as the pet family, the veterinary care team and the community. So I love how you are trying to address all of these areas. So what we are going to do is take a quick sponsor break and then why don't we dive into this program for Pet Health Equity, and how you foresee making an impact on veterinary care, so we'll be right back.

SPONSOR AD

We are so grateful to the Original Mine Pet Platter for sponsoring this episode. This has to be one of my favorite products ever!  The Mine Pet Platter is designed to benefit the health and well-being of your dog and promotes the ultimate natural feeding experience for both meals and treats.  What is it?  Well, it’s a patented, bone shaped platter designed for your dog’s feeding instincts.  It includes scoops and ridges that naturally slows your dog’s eating routine and makes mealtime fun.  After watching my dog Winston slow down instead of inhale his food from a bowl, we’ve never gone back.  Now he explores, sniffs, paces, walks around the platter and licks it clean!  Its BPA free, made in the USA, dishwasher safe, sustainable, recyclable and has a 100% money back guarantee.  There are too many benefits to fit into this ad, so I encourage you to learn more by going to https://minepetplatter.com/ and learn that how you feed your dog is just as important as what you feed them.  And as a bonus, Wag Out Loud listeners can take advantage of a 10% discount by using the code WOL10 at checkout!

And we are back for this fascinating conversation with Dr. Michael Blackwell about access to veterinary care, a national family crisis. So Dr. Blackwell, we we laid the blueprint of what exists today and the barriers and obstacles that we have for everybody to afford veterinary care for their family. So let's talk about how do you foresee addressing these obstacles?

What is AlignCare?

Well, I appreciate that question. Our work today is to expand a health care system called AlignCare. And those two root words have real meaning. Align means aligning our resources, aligning our activity at the community level in order to ensure better outcomes. In this case, providing veterinary care for underserved families. The care part of course is not only the medical care that these non human family members need, but it's the care that their people need. So AlignCare is built on a One Health principle. One Health means that the new paradigm…that means basically, if you want to improve the health outcomes of humans, you need to factor in animals, you need to factor in the environment in which they live or the ecosystem because all three of these intersect. Likewise, if we want to reach these pets that are not getting medical care, we have to attend to what's going on with their people. And I mentioned a moment ago, the people are the ones presenting the barriers. And we need to understand their ecosystem. And the ecosystem is largely low socio economics, which means more than limited money, sometimes it's housing insecurity or food insecurity, then we understand that we need to take a holistic approach in solving this problem. So AlignCare was built to solve this problem as a organized structured approach intending to address what are the key barriers and changing if you would, through time or transforming that or medicine to be a more effective service delivery industry. Now, what do I mean by that? Human healthcare functions as a system of healthcare, involving not only physicians and nurses, but many Allied professions, and the payment systems and so forth, databases that are compiled, there is a real system that operates. Well, with the non human members of the family, there is no such system, because veterinary medicine is still largely made up of individual sole proprietorships called veterinary practices, and increasingly more corporate entities. But operating in an independent set, not sharing information so that we grow databases, where we're learning more and more and more about the needs of our community. So our work AlignCare is the first systems approach to providing veterinary care, we started with the underserved those who qualify for public assistance, but as you mentioned earlier, the problem extends up into the middle class. So a system ultimately would mean better financing. You know, when your income is below a certain level, you get pretty high interest rates that drive you deeper into the hole, some would say even predatory loans, we need better pet health insurance policies. These reimbursement models, only work for those who already have the money, who can pay for the care and then be reimbursed by the insurance company. We need policies that work for our families that fall below the $50,000 a year household income. And then of course, veterinarians need to become more comfortable with third party payments. So in human health care, third party payment is the way that system functions. Largely, it's the health insurance policy. Well, our industry, veterinary medicine industry is based on just a direct relationship with that client. And there is no third party, except for the few cases where pet health insurance is used. But that’s less than 3% of the annual transactions. So there are a bunch of innate structural problems with why we are not reaching more families and having an organized, structured approach to providing health care is what we believe is needed to get better outcomes.

And how is this AlignCare program actually funded?

Yes. So up to now, we have been funded by animal welfare foundations, in particular Maddie's Fund. The Dave and Cheryl Duffield Foundation and Petsmart Charities. We went to those organizations to provide the initial funding to enable us to research and develop a health care system, in this case called AlignCare. And to test that system, we tested it in nine communities. The testing ended in June of this year. And now we're transitioning to expanding AlignCare into other communities. And in that instance, we're working with communities to identify those funding streams, that will enable that community to support their families. Through Time, more and more funding vehicles will be developed. But at this stage, it requires those who already get it, the animal welfare industry, and increasingly, those involved with human support missions. And so pulling those together with the intent of some of those dollars being intended to keep the family together, because medical care is provided to the non human member. That's what the future will look like. We are operating in a number of communities right now where that new model is underway. It's called the community ownership model. And the councils that we work with the community to set up AlignCare Community Councils, made up of key stakeholders, veterinary service providers, animal welfare organizations, social service agencies, and we intend to have the Department of Public Health involved because, again, disease control is a very important matter for this country to stay healthy. So that's where the work is today, this pivot to expanding now that we've tested the system, and we've come to understand, for example, veterinarians are willing to give a 20% discount. That's a workable discount level, that families, most families can pay a 20% co payment. This is what we learned in the testing of this system. In the instance where they can't, there are organizations within the community that pays, pays 20% on their behalf, and then the fund, the AlignCare. Fund pays that 80% subsidy. That's what we've tested. That's what we have learned a lot about. And that's what we're intending to expand out to a broader number of communities.

Okay. So how do you know which veterinarians want to take part in this program?

Yes, you know, the short answer is a bunch. Now, let me explain what I mean by that. When we did the national study, it was clear from the responses that most veterinarians understand that there's a problem with access to veterinary care. More than three quarters of the veterinarians reported, they agreed that the current business model in veterinary medicine is not reaching a lot of the pets. So the profession is getting it. But here's where it's more painful. Increasingly, every day that veterinarians have been presented with a patient, potential patients needing health care for families in crisis, they're begging and pleading for help. But they don't have the resources. And veterinarians are either turning these folks away, not helping them, or they're euthanizing their loved one. And you know, what? We are not built to make those kinds of decisions on a recurring basis. This may explain in part why the suicide rate among veterinarians is so high, the highest of all medical professions. So there is no we've got a problem. They want to help they want to fix it, but they also know that they can't fix it by themselves. Now, what we have found is our pilot started right as COVID-19 hit. So that was March of last year. We had a number of practices that indicated they wanted to be part of this. But they couldn't take this on at this time, because they were doing the best they could to keep up with the workload. And that's still a national problem. So the takeaway here is veterinarians know we have a problem. Veterinarians want to help. Veterinarians are willing to work within a system, including third party payment system, as long as that system does not overly burden them with paperwork, and other other challenges.

Sure. Okay. So on the part of the pet parent, how would they become involved with this program?

The AlignCare Program

Okay, so the portals of entry, up to now have been either an animal welfare organization or veterinary practice where someone has shown up needing health care. When it is understood that they may qualify for AlignCare, then they're given the information that allows them to go online and fill out an application, which is very brief. If they don't know how to use the internet, or they don't have the computer or smartphone to do it, then the agencies and the community that we work with would assist with that enrollment process, they do have to upload their credentials showing that they receive public assistance. Now, we needed to do the public assistance piece because veterinarians, I just said they want to help. But they also don't want to be taken advantage of and to the extent that they can be assured, that the veterinarians can be assured that the person is getting their sacrifice in this case 20%, or the people who deserve to get that help, then they're willing to help. So the family enrolls, and then, within that community, they are presented or with the computer system, a list of practices in their community that are providers in the AlignCare system, and they are directed to go to those practices. the family needs to make their appointment with that practice. And the practice operates under their normal policies and procedures. It's just that now the family is paying part of the bill. And the AlignCare Fund is paying the balance of that bill, which is a discounted bill. Social workers assist where families may have other challenges. So we we train members in the community, called human support coordinators to also work with families because as I mentioned a moment ago, when when one is living within most low socio economic realities, there's often other needs that are beyond money that may be housing, food, or other needs. And so we literally have a system now where we work with those families to link them with other community resources, so that we are treating the family in a more holistic way. I wish I could give a lot more detail. But you know, given our time, I'm trying to give a broad brush.

Thank you. Okay, so is this similar to you know, I'm in Colorado, so we have the Morris Animal Foundation that helps people with finances for medical bills for their animals. Is this similar? Or is this different?

There are a lot of similarities with when we look at AlignCare, what you see are component parts that you can find, in a number of places in the country. What's different is at the heart of AlignCare is the people centric piece, the social workpiece because remember, the barriers are caused by the humans. But from the veterinary side, we have to address the runaway costs of healthcare. And so the veterinary practices that participate in AlignCare are agreeing to practice what we call incremental veterinary care. It's quality, veterinary care, quality medicine, that is based upon what decisions the doctor would make understanding limited resources. A good example of that would be in ideal world gold standard care, you're doing all the testing using, you can possibly run just to make sure about things although you already have an idea what the patient needs. In other words, the testing is not going to change your opinion about the patient's needs. Under our system, you don't run those tests, you base the treatment upon a good examination, and using your scientific knowledge and judgment to prescribe treatment. In other words, we have to control the overall cost. So whether it's the Morris Animal Foundation or the AVMA Foundation, and you can just line them up. Nobody is trying to control the costs. And nobody's attending to the fact that the humans are the ones presenting the barriers. And this is why we needed the more holistic approach to fixing this problem. Controlling the cost, sharing the cost family, the veterinary practice, the AlignCare fund, which is a community derived fund. These elements were all very important. And every community that runs AlignCare has the same core elements. So in the end, AlignCare operates as a national health care system, not government, but private sector.

Got it. Well, we are running out of time. Dr. Blackwell, I could chat about this forever. It's just a brilliant program that is going to help so many. My one last question is, once you're enrolled in this program, does it cover just the family and all of their animals? You know if it travels with them or is it just per Pet specific?

Great question. So our policy at this stage is that a family can enroll up to four pets. Now, here's the critically important piece, you can only enroll at the time you need sick or injury care. Now, why is that? Because we look at the many programs across the country, especially run by nonprofit organizations, animal welfare organizations. Most of them are providing wellness, and preventive care . spay/neuter programs, vaccination programs, there is no crisis when the family needs that care but don't have the money. They don't have a crisis, even though they need care, the crisis happens when there's illness or injury. And so we decided to fill that gap because most of the shelters do not have the ability to treat sickness or injury. And certainly, if they do, it's on a limited scale. So we wanted to direct those funds at the time of a crisis, you can enroll up to four pets at that time. Once you're enrolled, and you can certainly get wellness and preventive care, you're not kicked out of the program once the treatment is provided. Because we want to follow those families and understand better the benefits to the humans, the health outcomes to the humans, when they have access to health care, in this case for their non human member. So I would just simply say when you think in terms of a complicated national crises, it's complex. It takes a complex solution. And that's what AlignCare presents. And when you dig down, you see little pieces that look like other programs, but nothing out there compares to AlignCare where all of those pieces come together, attending to the humans, non humans, that ecosystem.

It serves so many. And it took a brilliant man like yourself with accolades and the vision to create this, and I can't wait to hear once it actually launches, nationally. You know how this is impacting so many lives. And I want to follow that. So you have to keep us posted. But in the meantime, where can everybody find out more information about you, Pet Health Equity and the AlignCare program?

So our website is the program for pet health equity. So our website is the website address, de pheuk.edu. So that pPHG is program for pet health equity. pphg@utk.edu.

Wonderful. Well, Dr. Blackwell, thank you for all of your work, and vision and strategic mind. I just I love what you're doing. So thank you so much for sharing all of this with us today.

Well, we should thank you because people like you are critically important in helping to educate the public about these issues. And we appreciate the opportunity to share with your audience, the work that we're doing, and we invite them to really take a look at what we're doing and consider trying to bring AlignCare to their community. We'll be happy to chat with them about how to do that.

                Facebook: https://www.facebook.com/aligncarehealth

                LinkedIn: https://www.linkedin.com/company/program-for-pet-health-equity/

Thank you Dr. Blackwell.

Thanks again to the team at The Original Mine Pet Platter for sponsoring this episode.  Check out the ultimate mealware for all dog foods by going to https://minepetplatter.com/and be sure to use the code WOL10 for 10% off!

Thanks for listening. You'll find some helpful links in the show notes and if you enjoy the show, please be sure to follow and listen for free on your favorite podcast app. And please, please share your feedback. Visit WagOutLoud.com for great product recommendations with discounts, amazing online events and fantastic resources. That's also where to visit our Bark About It page where you can suggest topics, guests or products. Be advised that this show offers health and nutritional information and is designed for educational purposes only. You're encouraged to do your own research and should not rely on this information as a substitute for nor does it replace professional medical advice, diagnosis or treatment. If you have any concerns or questions about your dog's health, you should always consult a veterinarian or a nutrition expert. Have a tail wagging day and we'll catch you next time.

Hey Winston was that another tail wagging episode?