"I've always said a touchpoint is better than no touch point. And so while I'm extremely grateful that through these Medicaid plans we have an access point to still be able to connect with those patients, I feel like there's still a lot of work to be done, traditionally. And you know, to be able to help with accountability and success and outcomes." - Dr. Andie Lee Gonzalez, Phd, MPH, RDN, LD, FAND
Dr. Andie Lee Gonzalez is from South Texas and started as a registered dietician nutritionist with HEB Nutrition Services. She now serves as a sales representative for HEB. Within this role, she helps maintain relationships with physicians, employers, and serves as a spokesperson for nutrition education, and health and wellness. As a delegate, she’s a part of the public policy task force within the Texas Academy of Nutrition and Dietetics.
Dr. Gonzalez’s goal is to promote, encourage and empower healthy habits with her friends, family and community.
Shireen: Dr. Andie Lee Gonzalez is a native to South Texas. In her current career she is with HEB Nutrition Services, where she started as a registered dietician, and now serves as a sales representative. Within this role, she helps maintain relationships with physicians employers, and serves as a spokesperson for nutrition education, and health and wellness. As a delegate, she’s a part of the public policy task force within the Texas Academy of Nutrition and Dietetics. Welcome, Dr. Gonzalez.
Dr. Gonzalez: Thank you for having me. I’m humbled by this opportunity. And I feel really inspired by our chat today.
Absolutely. Thank you so much for coming on. I just want to start out with by asking you, what really, what really made you curious and what got you in this space of public policy? What was it that led you to that?
Dr. Gonzalez: Thank you, I became interested in public policy when I recognized the limitations of the Registered Dietitian on reimbursement, access to nutrition care for patients, and the limited visibility into patient care plan, and also our healthcare system. With this interest, I also saw an opportunity to continue to be part of the movement for change. So I became really involved with the Academy of Nutrition and Dietetics, the Texas Academy of Nutrition and Dietetics, and the Latinos and Hispanics and Dietetics and nutrition. This has allowed me to do the work to build awareness, be able to speak up, push boundaries, and be intentional to change policies that impact nutrition for the greater good of the patients that we get to serve every day.
Shireen: And so when we’re talking about public policy, how does it really impact the cost of healthcare for individuals?
Dr. Gonzalez: Yes, so public policy impacts the cost of health care for individuals because it helps support decisions on bills, legislation that support reimbursement for services and access points for health for patients seeking nutrition care. For example, through COVID, the 100% reimbursement for nutrition allowed patients to seek preventative nutrition health, and also to prevent or manage chronic health conditions, which can help reduce the costs that we spend on healthcare today.
Shireen: And what specific policies influence what exactly is covered by insurance?
A great example in this is the expansion of tetanus medicine during COVID. This wasn’t possible if it wasn’t for the push on our legislation in the need for Medicare and other large carriers to ensure that this was a covered benefit through this pandemic. This allowed for patients to access nutrition care, more than ever, as what we saw the Academy of Nutrition and dietetic members across the nation took action and wrote to their legislators to see this urgency and need. Currently, I do also want to add that with the Academy of Nutrition and Dietetics, there is an action alert through our advocacy page where it asks RD’s, such as myself, and across the nation to take action and reach out to their representatives, because there is a bipartisan treat to be able to reduce obesity Act, which is hr 1577 s 596. And has been introduced that would allow RDS writer registered dieticians to continue to provide intensive behavioral therapy for obesity with Medicare Part B. Again, this is just another example in how we can really be able to step up and have a voice in some of these legislation.
Shireen: You know, Dr. Gonzalez, when you, when you mentioned that, to me becomes, you know, when you look at nutrition therapy, the answer so obvious, right, that nutrition therapy helps people. We should definitely put money and we should make it reimbursable and we should make it reimbursable, be it virtual or be it in person, it should be at the same level. And so the answer seems more obvious. So why is it that we’re still fighting against that? Why is it that we’re still pushing for these policies to come in place where it would almost seem obvious that it is something that would get covered by insurance?
Dr. Gonzalez: I agree with you. I think that there’s still a lot of work when it comes to just building that awareness. And I’ve always been strongly feel that it starts with our profession as registered dieticians to continue to have a seat at the table, continue to voice that need that awareness and how nutrition can really play a part in preventative and and also managing chronic health conditions for reducing healthcare costs, but then also the bigger picture of quality of life when we think about the communities that we live in. And I think that there’s just a lot of urgency. And I think that the first step is just really having dieticians step into this role when it comes to public policy and advocacy.
Shireen: What is, what is really being covered by Medical nutrition therapy today and how can individuals utilize their insurance to acquire nutrition assistance?
Dr. Gonzalez: Yes, so diagnosis such as diabetes is often covered benefit by medical nutrition therapy. And individuals traditionally can utilize their insurance like Medicare via referral by their provider to be able to utilize this service. But I also want to add that carrier by carrier, it just depends as far as those benefits. So again, when we think about advocacy, another way that we could really step into this space is having employees speak up on how important it is to also have these benefits as part of their, their benefits plan.
Shireen: And so when you’re talking about it, it… It varies from one insurance company to another. Can you talk about some of that variance? What kind of variants have you seen?
Dr. Gonzalez: Yes, so oftentimes, if there’s, you know, different carriers, large carriers, usually preventative plans, like PPO plans will often be covered at 100%. But then gets a little tricky, right, because employer by employer, whether they’re self funded or not self funded, they have the opportunity to participate in programs such as, you know, offering nutrition care for their employees. And so that’s why I say, you know, when it comes to just really building awareness, it’s important that not only employers, right, see that relevance, but then also the employees to really be able to speak on that, that need, right, the relevance of having these type of programs in their care plan.
Shireen: And then when we’re talking about coverage, what kind of variants have you seen in terms of nutrition therapy, that allowable amounts, either in terms of dollars or even hours, for the year that you see, again, variants from one carrier to another?
Dr. Gonzalez: Yeah, so traditionally, we know that Medicaid plans, specifically for adults only allows for three visits a year. Again, for us, I’ve always said I’m very passionate about this again, and it’s more of a personal view. But I’ve always said a touchpoint is better than no touch point. And so while you know, I’m extremely grateful that through these Medicaid plans, that we have an access point to still be able to connect with those patients, I feel like there’s still a lot of work to be done, traditionally. And you know, to be able to help with accountability and success and outcomes. I’ve always said that we need to be visiting with that patient, at least every 30 to 45 days. Some of some of my peers, and my colleagues might challenge me on that, and they might want to sooner, but I always say that if we are trying to just create a more holistic approach. That would be my recommendation or suggestion to some of these carriers is like how do we continue to create these additional touch points to help with accountability and be able to measure success, you know, with these programs, you know, when you’re talking about having touch points every 30 to 45 days, that’s so interesting, because going from the three touch points to three hours, if you will, for the year, which by the way, three touch points for the year, just to contextualize that we eat over 1000 meals. So if we look at three meals per day, we’re eating and making decisions on foods for over 1000 meals for a year.
Shireen: Right. And we’re only limited to three hours with a registered dietician to help us understand how to eat over 1000 meals. It blows my mind that that happens today.
Dr. Gonzalez: I hear you.
Shireen: And so to that end, when we’re talking about increasing the frequency, whatever that frequency may be, how do you… is there, is there research? Are there studies out there that you can point us to that, that point to the impact of having more touch points beyond the, the three sort of allocated touch points for the year? Is there research to prove the efficacy of increased touchpoints with a registered dietician?
Dr. Gonzalez: There is. I know the Academy of Nutrition and Dietetics through their evidence library. They have a few different resources and references that we can share. But there has been research to support that, you know, behavioral therapy that includes Medical nutrition therapy is successful when meeting with the dietitian, as far as the timeframe. I think that that’s still an opportunity or a limitation that we haven’t really fully explored. But what we do know is that when that patient has that support, right, whether the dietician that interdisciplinary care team, they are going to be more successful. I don’t have the numbers specifically but I could definitely share that after, after our chat today. But we know that, that there is impact and there is outcomes that have been proven to be successful.
Shireen: You know, when we’re looking at illnesses and just chronic diseases at large, you got cardiovascular disease and stroke and then you have diabetes, type two diabetes in particular, which is 90% of the diabetes out there, and how rooted these illnesses are within. I mean, there are other risk factors as well, but how rooted they are within nutrition and what we’re eating and being able to exercise and our physical activity. But the nutrition component to me is, is, again, not to put it all on nutrition, but nutrition has a huge role to play in that. And to have, you know, what I almost think of registered dieticians to have this, someone who’s an on your side, just working with you, rather than this entire healthcare sick care system, as I like to call it was working against you and just maintaining, you know, your, your sort of illness, where I would This is my personal view, of course, but when I see a registered dietitian shining, is really enabling someone to be able to take control and really empowering them in their care to understand how their decision making how they can make better decisions for themselves. If that’s what is taking how they can change habits. I think there’s so much that can be done there that is still unexplored, right from a, from a standard of care standpoint. And so it was my mind that we’re sort of against this uphill battle in trying to get more coverage, better, better benefits for, for people with insurance, which is where now I want to shift to people who are uninsured. So for individuals who are uninsured, are they able to acquire nutrition assistance under current public policies?
Dr. Gonzalez: No, they’re not. I mean, oftentimes, these on it historically, right, these uninsured individuals, acquire nutrition assistance through nonprofits, I do want to highlight, you know, programs such as it’s time to Texas, there’s community clinics that oftentimes are regionally can offer these additional support systems for these patients. And I also want to highlight that even some health care outpatient programs, so I know, regionally here in South Texas, there’s a couple of different health care entities, right hospital systems that do provide some outpatient programs. And historically, you know, it’s limited, but there is at least some resources available. But as I shared earlier, right, really the role of the Registered Dietician like how do we continue to, to create this interdisciplinary care team approach where, you know, they’re allowed to provide, you know, that support for these patients that are really struggling around nutrition and food, and being that wellness partner, I really love that you said, I think that you’re my new best friend, but when you said that, you know, dieticians, goals to really motivate and empower, I’ve always said that we’re like inspirational health leaders, we’re really helping patients just really take control of their health, and not only their health, but also their family’s health. We know in Texas that one in three Texans will become diabetic, you know, the research shows that, and I always see that there’s some areas that have a greater risk, right, I live in South Texas in the border region, the Rio Grande Valley. And that, you know, ratio is even higher. Now, they usually say that one in two people will become diabetic, right? And so that’s really alarming. For me. That actually is what drives me every day. And I know that I’m part of a team that feels just as committed as far as that social responsibility.
Shireen: Are there any resources or action items that you recommend to help expand public policy in the realm of health care costs, and really point us to where we can go to find those. Those who are more equally passionate as us out there who are listening to this can also take action?
Dr. Gonzalez: Yes, there are a few action items that I recommend to join this movement for change, to be able to expand public policy in the realm of healthcare costs, and medical nutrition therapy. The first step as I shared with you sharing, I encourage more registered dietitians to keep showing up and holding a seat at the table where public policy issues and decisions are being made. We need to continue to advocate for better insurance reimbursement, increase that access to health care through our local and state legislators to ensure that we continue to build and be able to support nutrition and health and preventative health. One way that they can do this is through our Academy of Nutrition and Dietetics website: eat right pro.com. They have a portal for advocacy, where they can receive these action alerts to write to their legislators, it’s a few clicks. And then I also want to add that we also need to develop strong partnerships through other health allies. We cannot do this alone. As you mentioned earlier, there’s these additional layers when it comes to having, you know, that voice that sit at the table. Really, building a coalition with other health care providers is key and I think that is another solution that could help us get closer To our goals, collaboratively with other medical providers, payers, healthcare systems, we really need to come together to advocate for the profession of the dietitian, but also the impact that we can have in that space of healthcare.
Shireen: Just a quick note on that, I think you mentioned dot comm is eatrightpro.org want to make sure, folks are headed to that. And so just just to your response to what you just said, so, you know, building a coalition coalition with other healthcare providers, how can patients really start this movement? So a lot of our listeners, are those who either have a chronic illness have a caregiver with a chronic illness? How can they take action today?
Dr. Gonzalez: I think the first step is when, when, you know, just depending on the insurance that they have, I that would be the first step calling your insurance and really sharing that need, that… that importance of meeting with the dietician, because I guarantee you that they’re just as committed, sometimes you just don’t know how to get that program started. And so I think that it really does have to come from those members, right of those carriers, you know, whether it’s Medicaid, Medicare, some of these large carriers like Blue Cross Blue Shield, United, Molina, you know, at NIH, you name it. Oftentimes, hearing that response from their members, is just as powerful. And so I would say that if they were interested in having this as an access point, the more people that request this as part of their benefits, the more awareness that those carriers will have. And then, you know, it’s twofold. Right? I, you know, as I mentioned earlier, I think that as dietitians, we also have that responsibility of continuing to voice the need, the importance, so that these members, these community members, right, these patients could really utilize these, these type of programs.
Shireen: And you’re absolutely right. I think being a with Yumlish and the work that we do, we’re a provider ourselves, we have very little say, y’all who are listening out there, if you’re a patient, you have so much more power, because you’re paying that copay, you’re you know, you’re sort of staying with that insurance company. So they’re, they’re really listening to you over providers, even even an HEB you’re, you’re louder than an HEB.
Dr. Gonzalez: Yes.
Shireen: Right. Because there’s so much power in being a member with an insurance company, and helping them understand the importance of nutrition education, in your health. So, so yes, it’s really request everyone out there who’s listening, who is a patient, pick up the phone, flip your insurance card to the back, call that, the dreaded 800 number.
Dr. Gonzalez: You’d be surprised, you’d be surprised. The movement that we’ve had, because of those conversations, right? in conversations with medical providers, and just, you know, highlighting to them, like how important that is their key stakeholder in these decisions as well. And so the more people that we can have, you know, advocating for, for the role of the dietician, the further we’ll move as far as introducing these type of programs for all carriers.
Shireen: And then the earlier you mentioned, Dr. Gonzalez said, there’s, there’s ways that we can contact our local representatives. Can you speak to that a little bit?
Dr. Gonzalez: Yes. So I think that that’s important as well, right. So I always say that it’s important to start at the bottom right, getting connected with your local, local and state government representatives. For example, I know for national Nutrition Month, I personally with our local chapter of dieticians, here, we reached out to a number of our cities, just showing them how important it was to have the role of the dietician in all spaces, right, not only the outpatient programming, not only like the dietitian at egb, but also like in your community settings, right nonprofits, clinical setting, food service, right school nutrition programs. And honestly, I felt like it started to open up people’s eyes. And do those, even those contacts that day, to start reaching out to their representatives, like how can we continue to create programs for nutrition? How can we allocate additional resources, right funding to be able to have these programs in place through our, you know, employees, or even through our community? So it’s twofold. But then even just, you know, learning who your state representative is, you’d be surprised for the number of people that don’t know that and I am just as guilty before I started, you know, this did advocacy work, right. I didn’t realize how important it was. And there are people too, they want to know what they’re the needs of their constituents, right. And it’s really surprising to me how little our communities Connect with them, right? Aside from like, during voting and election time, but I think that it’s our opportunity to also get to know who they are, and really have those deep meaningful conversations around. Okay? How can you ensure that my families continue to stay, you know, healthy and safe, right? Because we know that, you know, we think about nutrition and health, now more than ever, right? Because you even think about some of the experiences that we’ve had based through COVID. Nutrition plays a huge piece in that too. research continues to show that the number one most chronic health condition associated was obesity. Right. And so you know, that’s alarming as well. Another Another thing to consider another, another touch point to really emphasize how nutrition and food can really have an impact on health.
Shireen: Well, with that, thank you so much, Dr. Gonzalez for being on the episode today. How can our listeners connect with you and learn more about your work after this episode?
Dr. Gonzalez: Yeah, so they can visit with me via LinkedIn. I am on Facebook as well. You can find me at Dr. Andie Lee Gonzalez, and I’m an easy search. There’s not many Andie’s.
Shireen: Love that. And what we’ll do is we’ll link your LinkedIn to the show notes in this episode. And so with that, thank you very much again for joining us.
Dr. Gonzalez: Thank you.
Shireen: And to our listeners out there. Thank you so much for joining us, head over to our social media. Let us know what you think about nutrition therapy and expanding access and also expanding the coverage of benefits associated with nutrition therapy on our social media channels. Thank you so much for joining us and we’ll see you at the next one.
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