In this episode of Clinician Real Talk, we sit down with Lea Witt, a family nurse practitioner passionate about caring for patients with substance use disorders and obesity. Leah shares her journey from postpartum nursing to leading addiction-focused care, and how value-based care empowers clinicians to meet patients where they are. Through real stories and practical insights, Leah reveals what it takes to build trust, intervene early, and transform lives.
Episode Notes
Title: Meeting Patients Where They Are: Addiction, Obesity & Value-Based Care
Guest: Lea Witt, DNP, FNP
Duration: ~24 minutes
Theme: Empowering clinicians to address addiction and obesity through education, trust, and value-based care.
Episode Overview:
Lea discusses her personal and professional journey, the importance of clinician education, and how Optum’s model supports proactive care. She shares powerful patient stories that illustrate the ripple effect of early intervention and preventative care.
Key Topics & Timestamps
Episode Highlights
Resources & Links
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Welcome to Clinician Real Talk, where we have honest conversations about what it really means to practice medicine in a value based world. Today I'm joined by Leah Witte, a family nurse practitioner whose passion is caring for patients with substance use disorders, people who are often overlooked, misunderstood and underserved. Lee is here to talk about what it really takes to meet patients, where they are, and how value based care makes that possible.
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Mia, welcome. Yeah, so good to have you here. Tell us a little bit about your background, like where you started and how you ended up working with Optum.
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Sure. So, graduated as a nurse and worked in a local hospital in Ohio. And I did mother infant. So postpartum was kind of my my niche.
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And. Yeah, I'd.
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And, decided that I loved being a nurse, but I wanted to have even more impact for patients. And, also be kind of one of those clinical decision makers to really help patient outcomes.
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So I went back to school, got my family nurse practitioner degree, and worked, in urgent care for a few years. And the office that I practice now is actually the office I was a patient with. And my family doctor called me and said, hey, you know, I'm getting ready to retire. I would love for you to come and join Optum, come join our practice and kind of help in that transition and help care for these patients.
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So it was a really neat experience to come on board. And you know, work in a place that took such great care of me and to kind of continue, developing those relationships with the coworkers I have, but then also caring for some of those patients as my family care provider transitioned out.
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Yeah. That's excellent. So what drew you to. So you said you started with postpartum, and then you moved on, to urgent care for a little bit. What got you started in this work? What drew you to caring for patients with addiction and substance use disorders and obesity?
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hospital. And then obviously an urgent care, right. Seeing so much of patients that have substance use disorders, obesity and all of those, you know, related complications, all of us have friends, family that we know that have been touched by addiction. We've all probably been touched by that in one way or another. And that is the case for me as well.
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I have addiction history in my family and have, you know, seen first hand those effects of what untreated addiction. And some of those things can happen not just for an individual, but for their community and where they live. And so that, really recognizing that those patients were neglected because providers, they didn't know what to do or didn't feel as comfortable, really kind of gave me a passion for that.
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And then I graduated with my doctorate of nursing practice degree last fall in
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Congratulations
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you. And my whole doctoral project was actually about specifically alcohol use disorder. And the under recognition of this in primary care. And how can we empower clinicians to feel more comfortable to bring up that discussion with their patient, to provide some of those resources and help patients
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Yeah. What solutions were you? Were you thinking of when, like you, I'm sure you saw the problem areas. It's like. Here's the gap. Like, what solutions were you thinking of working on and are still probably working on to that. You saw.
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Yeah. So one of the biggest things that I found in doing some research for that project was one of the biggest impacts is a provider's comfort level.
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right.
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providers feel educated and, understand what resources are out there, what things they can do to help their patients, they're going to be more likely to bring up topics to help patients with those specific conditions.
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Can you, share any stories about the impacts of that, like working with this population and their potential for recovery? Knowing what you know now.
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One of the patients that I have taken care of for quite a while, you know, came to me as a new patient with a, I'll say, laundry list of medications
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Okay. That
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I felt were, maybe a little bit too much. And there was a big hesitation on the patient from this perspective of I need these. I, I don't think I can not have these meds.
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I don't think I can, you know, not take these controlled substances, these types
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And.
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exploring and talking with her about that. You know, what has happened now we've gone from using a medication to treat an issue to now you're taking a medication to not feel
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Right in that, is
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a warning sign that something has transitioned here and is not really a proper use anymore.
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And it was a really amazing story. You know, I will be honest that initially that conversation put her off a little bit. She
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imagine so. Yeah.
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But, you know, she really did take that to heart. And it was a great experience to be able to see her back, you know, three months later. And she had worked with me and was had weaned off all these medications and was feeling better than she had really in, decades and realized, like, wow, I really wasn't using these appropriately.
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And I didn't even recognize that in myself.
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And, also hearing from her husband, who is also my patient of just the impact that that has even had on their relationship
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Yeah. So.
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decreasing some of that tension and, and all of those things. And, both of them were just so very thankful that I was willing to have that difficult conversation and go ahead and maybe approach something that would be a little bit uncomfortable.
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And it was a great impact for not just her, but also for her family.
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Yeah. It's going deeper into that a little bit. Do you see that across the board where, relationships can shift? Once somebody starts having these kinds of conversations and working with their provider in that way.
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absolutely. And, the conversation shift doesn't just impact the patient's relationship with their family, but even with the provider. And, that is something that, you know, in order to start some of these conversations really is about developing trust and rapport with your patient that, I always try to make sure it's not me coming from a attacking, antagonistic type of approach, but that I'm saying, hey, I care about you as an individual and I care about your health, and I'm concerned about what I'm seeing and I want to help you.
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So, speaking of that support, how, would you say that value based care gives you the time and space to build that trust? And and, the build the trust that patients need.
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Yeah. So value based care is really important in this work, especially in our older adult population. You know, when we think about addiction, you know, a lot of people think about young adults, teens.
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But there is a whole subset of older adults that struggle with this problem, too. And oftentimes without those visits, like our wellness visit or some of those longer visits to really get into some of those social determinants
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And yeah, things.
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you don't take the time to properly screen and have the time to really discuss those concerns with your patient.
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And and.
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so having a, set up or just an understanding of really being able to dive into someone's health, their concerns, their health outcomes is really foundational. And being able to kind of pick up and recognize some of these things that could be a little more subtle.
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Yeah. Speaking of picking up on things that could be subtle. Addiction. It often goes undiagnosed for years. Right? So what are the signs? That's the get missed by providers. And how do you catch them, you know, in the system that you've developed? Yeah.
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Yeah. So lots of different signs that can be out there. And I think it is also a very individual person, a person and sometimes across age demographics. So for, you know, younger adults or teenagers, school performance issues. Right. Mental health issues with draw, increased depression in absenteeism, whether that's job performance, school related, those types of things.
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In older adults it could show up as confusion
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falls, frequent er visits
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Right
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over medication or medication misuse. And in our older adult population, from a economic standpoint, you know, that is something that we can see a lot of of patients that could potentially be either, abusing medications on their own or potentially selling medications to get extra
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Sure. Yeah. We know
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older adults have a lot of pain. They have trouble sleeping. Right? Those are a big reasons that people start some of these substances that could have an addictive potential.
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Yeah.
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so
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recognizing individual nuances in that patient population, and then also just making sure to really evaluate why do I have my patient on these meds. Am I consistently evaluating if this is still the right choice for them?
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Are they asking for a higher dose? Are they calling in or running out early? Are these medications being lost? Are they, you know, calling in saying my meds were stolen? Right. Some of those things are can all be red flags
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Yeah.
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maybe we need to explore this a little more.
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So will you share? I know you shared a story of one patient that you encountered, where you share another story, of, a patient where the catching that, those things that are normally not caught and, and how finally naming the addiction finally change things for the patient.
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One patient in particular was on kind of multiple medications, which we know can increase the risk of adverse effects and bad outcomes, and really took about a year
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Okay.
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slowly weaning these down, having those frequent visits and touchpoints, you know, saw that patient every single month. But, you know, still making sure to say if there's a concern that you have, if, you know, yes, we're going to see each other in a month, but I'm here, I'm available at any time.
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And, maintaining that patient access and to just say, you know, you're not out here doing this by yourself like I'm here. If you're concerned, please call me. And what's really amazing and empowering is that, you know, most of the time, and this is the case with this specific patient,
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Yeah.
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were able to not just decrease the dose, which was what I first suggested, but really went off of these meds entirely.
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And in the end they felt better.
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Yeah.
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You know, we did substitute and use and safer alternative options for them for their chronic issues that they were being prescribed for, but found that with newer, better options that were less risky, the patient actually ended up feeling better. And instead of just being concerned that I'm going to feel worse,
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Right.
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they actually improved.
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Definitely. So how does options model support you in identifying and addressing those issues early?
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Yeah. So lots of great resources that we have at Optum. One of the things that is, newer in the past couple of years that I have been a part of is a what we call the APC fellowship program. And so we actually have a dedicated weekly teaching session just specifically around addiction.
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And how do we recognize that? How do we screen for that? Very supportive, from Optum and taking the time to do some of this education and
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Yeah.
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you know, to be able to attend those CMAs and to do some of those resources to feel better prepared as a clinician, to talk with patients and then just being able to have that value based care mindset of being able to take those longer patient appointments if I need to, and not having to just turn patients over quickly through the door every time.
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But to be able to take that time for a dedicated visit, to make sure that every patient and their family is really understanding and on board with what we're concerned about and what we're trying to do to
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Yeah. And also, like you just mentioned, like making sure you get that person in if they call, if they need to be seen. That's amazing. So you mentioned preventative care, when we were talking a little bit earlier on. So let's let's talk a little bit more about that. How do you use preventative care to shift the trajectory for patients at risk of, of addiction or of obesity?
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care screening is vastly important. I make sure that all of my patients have a type of wellness visit where we can just specifically talk about what screenings do you need, what screenings are coming up to allow patients to kind of research and consider those options, and then also really explaining the why, right. Why do I want you to have a colon cancer screening?
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Why do I want you to have, lipids screening? You know, why does that matter? And so really taking that dedicated time to review all of those evidence based preventative guidelines, because even catching one patient, even making a difference in one person's health trajectory has dramatic impact. And that ripple effect, not just for that patient, but then for the community, as you know, their family, all of those things, it makes such a big difference.
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So preventative care is a huge component of my practice. And oftentimes is that visit where I'll ask them about their alcohol use, I'll ask them about their drug use. So that can doing a preventative visit is a really great time to do some of those screenings for addiction, and to kind of broach that subject when patients are open to talking about things that, you know, they don't really have their own checklist of what they want to talk about, they're coming in to just kind of hear, what things are you recommending for me?
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And so that can be a great time to bring up some of those things and, and really look at them more closely.
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Yeah. Have you encountered any moments? And can you share any stories about where that early intervention really made a difference, either with substance use or with somebody at risk of obesity?
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Had a really great conversation with, a patient where, you know, they had come in for their wellness visit and talking just about some various concerns that they had around, you know, fatigue, joint pain, just very like nonspecific things and pulled in, you know, into that discussion about their BMI and about their weights. Yes. Patients can potentially be metabolically healthy
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even if
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they're obese, but that it still has an effect on their mobility and on their long term outcomes.
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Had a patient that was, 28 years old and, very, very morbidly obese and had a very, you know, honest, transparent discussion with her about her asthma and high cholesterol and diabetes and said, you know, from a statistical standpoint, in the next 30 years, we are going to be in a very difficult place if we cannot improve your health.
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Really had a discussion with her around because of her BMI at the time around looking into bariatric surgery, and that for her was very, frightening, right? I mean, as someone a young adult, you know, that's a major surgery. And she was very unsure about what she wanted to do. And I said, you know, go to the information session, like, just listen, see what it's about.
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And, I'm happy to say that I saw her last month as she had the surgery. She's lost 140 pounds. Her BMI is normal.
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Speaker 2
Yeah.
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Speaker 1
Weight lifting three times a week.
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Speaker 2
Amazing.
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Speaker 1
Four days a week.
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you know, and I mean, she when she came in the class and she's like, this has changed my life.
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Speaker 2
Yeah.
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I feel so much better than I ever have.
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She's come off of 80% of her medications and, you know, the impact on her life for the rest of that. But then also on her kids with having with making those better healthy choices with food and all of those things. It was especially with being the, you know, woman and the the primary caregiver in her family. Right. This has also changed the trajectory on her children, too, and on some of their lifestyle patterns and behaviors.
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Yeah. And then being able to see that example. Yes. Yeah. I imagine that was extremely gratifying.
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oh, it is it is it makes it makes it totally worth it.
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I love hearing the the better outcomes, obviously. And how would you say that, value based care, allowed the model allows you to be more, proactive instead of reactive. We can get to those better outcomes.
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So because I think we have lots of resources out there to help patients
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Speaker 2
Yeah.
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you know, taking those time and making sure that we, dedicate time to those preventative screenings is number one, right? Because that's where we're going to be able to identify and see, you know, here are some early warning signs. And so that's the benefit of value based care is understanding and knowing what great network of resources we have, where I don't have to feel like I'm the only person
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Yeah. In this
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patient,
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Yeah.
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have a whole, you know, it's a spoken we'll model right where we have multiple different people and their expertise and and their lines
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of work that can come alongside and impact this patient. And the more touchpoints that we have in the more different ways that we look to address an issue, the better that outcome will be.
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I imagine there's a lot that you have to deal with emotionally. So, what kind of support have you found at Optum? That really helps you keep showing up for your patients.
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Clinician well-being is so vitally important because if we are not taking care of ourselves, we can't show up and be the best provider for our patients. And so, having some of those extra resources that are out there, you know, some of the clinician well-being visits and summits and opportunities
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that are out there, you know, the Optum Provider Development Institute has a lot of things on clinician burnout.
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I also think it's important to stay connected to other providers and to be able to network with each other.
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What does that look like?
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Yeah. So that's been really great for, me personally. And then just being a part of Optum nationally. So like the Optum partnership forum where you know, we can network with providers across the country, even doing things at a more regional level, connecting with other providers, even from different offices or different states, to really be able to share best practice, to feel, supported, to realize that, you know, you're not the only person potentially dealing with this issue or, getting, you know, innovative ideas of, you know, have you tried
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this or have you thought of this? You know, this has really helped me in the past. Building that community for yourself
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as Sean.
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Yeah,
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is so important, too, because the work can get heavy and it often does. And, it's more manageable when we can share the load and when we can realize, like, this isn't just a me problem or a my patient or my office problem, but this is part of health care and other people are experiencing this too.
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And here are the things that they've done.
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So you talked a little bit about the partnership. How do you. Are there other ways that you experience, you know, meaningful belonging?
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So that has been really part of my leadership journey here at Optum. So about four years ago, I was approached by
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My leadership to say, you know, we would like for you to.
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as kind of this lead nurse practitioner in, in our local area to really come alongside and encourage and support the local nurse practitioners, physician assistants, and just, you know, be that resource and be that voice for them.
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I just actually this week was made aware of a situation with a specific nurse practitioner and had on, just a couple days ago. Right. A two hour phone call with her of, you know, what are some of the concerns that you're having, what has been, you know, what are some of the barriers, the issues that are preventing you from, you know, feeling like you get things done, getting those charts done?
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Seeing the patients you need to see, you know, feeling like your workloads manageable. And so then being able to use some of the resources we have nationally and some of the networking that I've gained with that to help this one individual provider, and then that ripple effect is so huge, right? When we create a environment where every person, whether they're a clinician or even non clinicians, feel like they have a opportunity to speak and have their voice heard, it doesn't just improve, business metrics or, you know, provider satisfaction or, you know, decrease burnout, but
00;21;05;29 - 00;21;20;05
See? Right. Yeah. So, what would you say to a clinician who wants to do this? Work with patients who might be struggling with, patients who might be struggling with addictions or obesity? But they don't feel like they're equipped or supported.
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Yeah.
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Yeah. How does how does Optum help set the stage for success?
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my recommendation would be like you know take those classes learn more. There's great addiction societies out there and obesity societies where you can, you know, do the CMA. You know, that's the beautiful thing about, Optum is that we are allowed time and opportunities
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to take
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that education and to, you know, continue to grow and develop as a clinician.
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And once once that education is there, then you really can, I guess and say, have your eyes opened to really see the need in your own community and be able to impact where you work and where you live.
00;21;58;01 - 00;22;04;05
Leah, tell me why you think Optum is uniquely positioned to transform health care.
00;22;04;05 - 00;22;40;03
Sure. So the great part about Optum is that we are not operating in just a silo. It's not just one region, one state, one type of health system that Optum is really reaching our patients at all different levels of their health journey, whether that is from a hospitalist, from a primary care office, from a wellness center, we are able to impact patients at all different levels of that health care journey and across the region,
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like crossroads.
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Right. Yeah.
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And, that is so beneficial because I believe that it really helps to see what is happening with patients in the United States. This isn't just a state issue or a specific local issue, but really able to say what's happening in our health care nationally. And what are some of the overarching themes and concerns that we're seeing, and what are the meaningful areas that we need to change to improve health, not just in one specific place,
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But
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everywhere?
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Yeah. And why do you think more clinicians and medical groups should consider joining Optum?
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Yeah. So as a nurse practitioner that is a part of Optum. And I have many friends. You know, locally, that work for different organizations or health care systems. And in my discussions with them they are frequently
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Shocked and surprised by the amount of resources, opportunities and even just knowledge base. Yeah. Because,
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we have access to as Optum clinicians.
00;23;50;05 - 00;24;09;21
Leah, thank you so much. This has been an amazing conversation. I feel like I could sit and listen to you talk for hours. Thank you for your honesty, your heart, and your commitment to the work. Wonderful. If you are a clinician who knows you need to transition to value based care, now is the time to assess how ready you are to make the shift.
00;24;09;23 - 00;24;27;01
We've created a quiz for you to take to do just that. Click on the link in the show notes to take your quiz today. For clinicians listening, if you're looking for a model that gives you the time, tools, and support to care for the whole person, especially those who need it most. This is what it can look like.
00;24;27;04 - 00;24;37;26
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