Rethinking health care: Preventive health and social needs

Dr. Tracey Conti joins us to discuss the complexity of the U.S. health care system and the importance of social support and preventive care. She explores the connections between providers, insurance, and community support, and how integrated systems like UPMC can make a big difference.

Related to the Episode: 

• Black Equity Coalition
• Season 1: Social Determinants of Health

Episode Transcript:

Dr. Ellen Beckjord: Stronger communities begin with good health—for everyone. You’re listening to the “Good Health, Better World” podcast, presented by UPMC Health Plan.  

From the physical environments that include the food we eat, the air we breathe, and the infrastructure that surrounds us, to social environments that influence the way we interact and behave, to physiological environments that manage the functions of our brains and bodies—when it comes to our health, the systems around us are, in many ways, constructed against us. 

This season, we’re exploring ways to achieve good health in today’s complex world—with guests who have expertise in technology, communication, health care, and more. 

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

In this episode, we're joined by Dr. Tracey Conti to talk about the health care system today, and how the health care system and health insurance play critical roles in our journey to good health.

Dr. Conti, thank you for being on “Good Health, Better World.”

Dr. Tracey Conti: Ellen, it is a pleasure to be here and thank you for having me.

Dr. Ellen Beckjord: You have been a part of the health care system for a long time, for the entirety of your career. So can you tell us in your own words how the health care system works, and in particular, what you see as some of the strengths of the U.S. health care system and also some of the weaknesses or opportunities that we have?

Dr. Tracey Conti: Yeah. So with the U.S. health care system, I think the first word that comes to mind is complex, and we have this mix of public and private entities that make up our health care system—which really makes it sometimes difficult to navigate, especially from a patient perspective.

When you think about the public aspect of our health care system, our federal government has agencies like the Center for Medicare Services and Medicaid, which is a state-run institution. And so even at a governmental level, it's complex because you have some federal legislation, you have some state legislation.

And then when you think about our insurance agencies and their part of our health care system, that's more of a private model, even though there's some public aspects of Medicare/Medicaid—that adds more complexity.

Then when you move on to our health care facilities, whether that be inpatient or outpatient, our nursing homes, all of those entities can be run either through governmental lenses like our federally qualified health center, our nonprofit like we have here at UPMC, but then there are also private institutions. And so the multiple layers of different agencies and the legislative complexities of all those really do make our health system complex.

So some of the advantages, I think, in the U.S. health care system is when you add that privatized model, you do get a lot of innovation. And the technology that exists in health care really can surpass other countries. Some of the disadvantages, I think, lie in the equity part of it, because not everybody has access to the best health care. That's where you can have disparities in how care is given, how care is delivered. But then who has the best outcomes and who has the worst outcomes? Most of that is driven by the economics of a population.

Dr. Ellen Beckjord: I really like the word “complex.” And as you were describing the complexity, it occurred to me that that complexity creates a challenge because when people acutely need to use health care, it's typically not a good time to try to navigate something with a lot of complexity.

And then on the other hand, if you're trying to be proactive and engage in preventive health care, that takes a lot of intrinsic motivation. And typically, I think people need to be pretty well-resourced just to prioritize their wellness. So it's so easy to de-prioritize that, that something like the complexity of the health care system could pretty easily get someone to decide, maybe it's just not worth it to figure out how to get this mammogram, or get this test done, or schedule this appointment.

Dr. Tracey Conti: Absolutely. Primary care, and I am a primary care physician, is really foundational in providing the preventive health aspect. But when you look at the U.S., the amount of investment in primary care is actually lower than other countries.

And so if we only focus on the innovation in moving medicine forward and don't think about the preventive aspects of how to prevent people from becoming ill in the first place, we're going to see our costs rise. And that is one of the issues with the current U.S. health care system is the cost. I mean, it's about 18 percent of our GDP, which is much higher than most other countries—and it's because we just don't have the access to the preventive treatments or the preventive care that other countries do to prevent illnesses before they start.

And while the vast majority of the U.S. population is insured (90 percent of the population), that 10 percent that is not insured can drive up the cost. But even those that are insured, the out-of-pocket expenses can also be a deterrent to accessing or seeking care.

Dr. Ellen Beckjord: Dr. Conti, until very recently, we were colleagues at UPMC—you were the chair of the Department of Family Medicine at the University of Pittsburgh and UPMC. I, of course, work for UPMC Health Plan. So what are some ways that today the health care system, including health insurance, can function as a safety net of sorts? Particularly at a place like UPMC, which is an integrated delivery and financing system, so we’re a health care delivery system and we have a health insurance arm?

Dr. Tracey Conti: Sure. Most hospitals have funds to care for individuals that don't have insurance, so that the brunt of that cost does not necessarily fall directly on the individual. And I think health systems really try their best to not allow costs to deter somebody from seeking health care. But we still know that that's a barrier, because most patients, unless they access the system, don't even know that those programs exist.

There are, from a medication standpoint—a lot of the hospitals will have funds to try to provide medications for patients, whether they're seeking care in the emergency rooms or they're hospitalized, even at the outpatient level for those who can't afford their medications in partnership with some of the pharmaceutical companies that also have some of those same programs. But again, there is a health literacy component to that, because if you're a patient and you don't know that those programs exist, you have a barrier to even seeking the health care to find out about the program. And so oftentimes care is delayed so much until it's just exorbitant costs in order to provide care, to rectify the time that somebody didn't seek care.

Dr. Ellen Beckjord: Is there an example that you can give of a time when the care that you were delivering was, you know, supported or extended by support from the health insurance company?

Dr. Tracey Conti: Yeah, I think that's one of the benefits of working in an integrated delivery system, because it really, truly is a partnership between the health plan and the health system and providers. I love working with our practice-based care managers because they are a resource that helps patients really navigate the physician office, insurance, the hospital, and they’re a help to the providers as well. And so they sit in the in the middle of that patient-provider health system navigating process so that patients really can have the support they need. And it allows patients to really see us functioning together versus, you know, health system and health insurance separately.

The work with community health workers is also critically important. And so that partnership to have community workers, that can actually be from the neighborhoods that patients are in to help develop the trust between the provider and the patient, the health system and insurance, and really work side by side with our patients to help them navigate the system is critically important, and I think is a benefit of having that integrated delivery system.

There's also Prescription for Wellness that really brings in the coaching aspect of managing chronic diseases—whether that's tobacco use or weight loss, all the things that can help management of a chronic disease. And so having someone available to really be the extension of the health care visit that can work with patients outside of the physician on, well, how much exercise, what is exercise? How does somebody incorporate that into their daily lives? Sometimes just in the office visits that we have as providers, we just don't have the time to do that. And so that partnership with the Health Plan and Prescription for Wellness or care managers or community health workers really does create an atmosphere that allows health to occur, whether you're in the office, in your home, or in the community.

Dr. Ellen Beckjord: In the time that I've known you and I've been fortunate to get to work some with you, you've been such a champion for addressing the social health needs of the populations that you serve.

Can you talk a little bit about how—and if you'd like to talk about it specifically in the context of the work that you did as a physician in McKeesport, Pennsylvania, or more broadly—but what are some ways that the care delivery system can help facilitate connecting people to services that can address social health needs? Is that even a feasible ask of the health care system or health insurance?

Nobody seems to disagree that social health factors account for a lot of the variability that we see in health outcomes, and that if we could address some of these foundational or sort of upstream social health drivers, that we could decrease downstream costs. But it requires investment of all kinds. We step up to make them at UPMC in lots of ways and I'd love to hear your perspective on that. Like, so how are we doing and where are we getting it right, and where might there be [an] opportunity to do better?

Dr. Tracey Conti: Yeah, I think it's all of our responsibility. It is not just a burden on the population itself. It's not just a health care provider burden. It's not just a burden for the health care system, whether you're an integrated delivery system or you're operating as an independent hospital or insurance. It's just, it's everyone. And it has to be all in.

One of the things I'm a big proponent for are health in all policies. And so at each and every level, when we are making policy decisions, are we thinking about the health impacts of that policy on populations? And unless we have that framework really integrated throughout our country, we are going to see where policies can really affect the health care outcomes of our individuals and actually continue to drive costs.

When I look at McKeesport, and as you said, social determinants play such a significant role in the health outcomes of populations. And as a physician, if I'm in a room with a patient, even on a health level, as empowering as I can be to that patient as an advocate, if I don't think about their life outside of that exam room, I really can't make a big impact. There's only about 20 percent of a person's health that is really directly affected by health care. The remaining 80 percent of that person's health is determined by where they work, live, and play. And so we as health care providers have to think about what is that 80 percent and where can we play a role in making sure that that 80 percent allows for health to occur, whether that be through advocating on a political level around making sure that there are no food deserts, to working with our health care colleagues around ensuring that everybody has access to good health care, to even advocating for pharmacies in our community so that there isn't a pharmacy desert and patients, when they need medication, can actually have them. We talk about social determinants of health, but the political determinants of health are just as important. And again, why policies and being an advocate on a legislative level, regardless of if that’s at an individual, departmental, system, or state level, we have to be at the table in order to ensure that the policies that exist for our populations really do promote health.

Dr. Ellen Beckjord: Are there initiatives that you worked on in McKeesport that you'd like to talk about, where you cared for a population of patients that came through the clinics that you worked in, but I think you've also done important work at a broader community level. Is there anything you’d like to share about that?

Dr. Tracey Conti: So that population health strategy, again of thinking about a patient not just in the office, but what is it outside of those four walls? And so working with communities to improve health versus doing things to communities is something that I really push in everything that we try to do. So specifically around diabetes--in the McKeesport area, diabetes is one of the common chronic diseases. And how do we help navigate patients through their journey of that chronic disease? If I just look at it from an office, sure, I can have a patient come in. I can make the diagnosis. I can tell them, these are the medications, these are the diets that you should have.

But if we don't talk to the community to find out, well, what are the barriers to you actually helping yourself care for your diabetes and work through that diagnosis? I wouldn't know that one, there's sometimes difficulty with pharmacies because there have been closures of pharmacies in the McKeesport area. I wouldn’t know that it's difficult to get fresh food because there's only two grocery stores really in the community, and most of those grocery stores, patients that we see can't walk to those grocery stores. And so the supplies are limited. And so most of our patients are getting food services from corner stores or Dollar Generals or Family Dollar stores that really don't have fresh vegetables.

And so listening to community, working with community to find out the barriers so that we can come up with creative solutions in order to have appropriate care is so, so important in the work that we do. But we can't do that if we just stay in our offices and only see patients inside of our offices and never step out of the four walls of that building.

Dr. Ellen Beckjord: Absolutely. Well, that's fantastic. Let me ask one follow-up question. As you're talking, something that I spend a lot of time thinking about is how the folks who typically need the most support from the health care system are often the ones most challenged to receive it, and they have challenges and constraints in their lives that make healthy lifestyles often really difficult or attainable. Just even awareness of what that means, much less the resources and time to invest in healthy lifestyle, or the resources and time needed to have fresh foods or pay for medications or even receive care. And it can feel really overwhelming. But I always want to check myself because I feel like while that may be true, and it certainly, I think, underscores the call that you made for advocacy, I worry that that line of thinking for me can be, you know, unintentionally, but still disempowering. So I imagine that you see folks every day who have figured out, through their own ingenuity and perseverance and strength, how to transcend some of those things and recover health or stay healthy or maintain their health. I’m just wondering what your thoughts are about that.

Dr. Tracey Conti: Absolutely. And some of our most vulnerable and marginalized community are some of the most strong people that I know because it takes strength to overcome some of the adversities that they have faced. I think, and sometimes in when we think of the deficits that a community has, versus, you know, what are the strengths of that community and how do we leverage those strengths versus just focusing on the deficits? And so getting rid of, kind of, the deficit framework that oftentimes we have around communities. I think, again, going to the working with communities because they are able to tell you this is what we can do. These are the things that you've already done. And [here’s] how can you partner with us to leverage those things or to make them better versus just assuming what they can or can't do based on what's currently existing. There is ingenuity and so how do we leverage that for everyone's benefit?

Dr. Ellen Beckjord: Oh, I appreciate that reminder and I like the way you put it. I'm going to definitely keep that in mind. Thank you.

Dr. Tracey Conti: Yeah. You're welcome.

Dr. Ellen Beckjord: Well, the last question I have for you, Dr. Conti, what are some things you'd like our listeners to know about when it comes to navigating our complex health care system as it relates to pursuing whatever level of health and well-being is aligned with their needs, preferences, and values?

Dr. Tracey Conti: Again, because our health system is so complex, having someone to help you navigate, I think, is so important. Whether that just be a friend or a family member that's in the room that can hear things that you may not be able to hear and be able to talk with you.

I think also the relationship that somebody has with their provider is so critical, and that's a trusting relationship. And if you feel that you can't have a trusted relationship with the person that you may have seen or was assigned to you, go and find the health care provider that you can have that trusted relationship with, because that's so critical to ensure that your voice is heard and seen and your concerns can be elevated. You always want to make sure that you're able to trust your provider, to be able to tell them what's going on, and you have that provider that's able to listen to you.

And I think the last thing is advocacy. We should all be advocates for better health and having the education around what is health, what does it mean to be healthy, knowing your family history, being able to advocate for your family to go and seek health care is so critically important.

Dr. Ellen Beckjord: Well, it has just been fantastic to get to have a conversation like this with you and to hear your perspective. And I want to say, of course, thank you for being on the show, but thank you so much for all that you did in your time at UPMC. You were such a driving force for the best of what our system has to offer, and I'm very grateful that I got the chance to work alongside you. So thank you so much.

Dr. Tracey Conti: Well, thank you. And it really is an honor to be able to serve our patients and our community in that way.

Dr. Ellen Beckjord: Thank you, Dr. Conti, for joining us on “Good Health, Better World.”

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 Speakers:

Tracey Conti, MD, MBA

Dr. Conti is passionate about health equity, as it was a driving force for her to pursue a medical career. Her clinical and advocacy interests include health disparities and health care delivery to underserved communities, medical education, and women’s health. She is a champion for patient empowerment through education and the development of strong patient-physician partnerships in order to optimize individual, family, and community health care.

In September 2025 Dr. Conti transitioned to SSM Health in St. Louis, Missouri, where she serves in the role of Vice Dean of Clinical Affairs/Vice President of Academic Practices.

Prior to this role, Dr. Conti served as the UPMC Andrew W. Mathieson Chair of the Department of Family Medicine at the University of Pittsburgh School of Medicine and UPMC. She previously held several roles in the department including Vice Chair for Education and Practice integration, Program Director for the UPMC McKeesport Family Medicine Residency Program and Executive Vice Chair. In addition, she was a member of the Board of Directors for the UPMC Health Plan and was selected to lead the primary care subgroup of the UPMC Board of Directors Health Equity Committee.

Dr. Conti is a graduate of Temple University School of Medicine and completed her Family Medicine residency at the University of Maryland, where she served as chief resident. Dr. Conti is fellowship trained in women’s health and faculty development. Dr. Conti received her MBA from the University of Pittsburgh Katz School of Business.