The Get Healthy Tampa Bay Podcast

E133: Dr. Emma Westermann on Cracks in the System, PANDAS, and the Shift to Direct Care

• Kerry Reller

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Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, returning guest Dr. Emma Westermann shares how her training in health policy at Harvard revealed the deeper flaws in the American healthcare system—and how that inspired her shift to direct care.

Dr. Westermann opens up about the deprofessionalization of medicine, the hidden costs of insurance, and how the system fails complex patients. She also shares her personal journey navigating her son’s PANDAS diagnosis and how that led her to create a new coaching model for families dealing with neuroimmune conditions and medical trauma.

This episode offers a powerful, behind-the-scenes look at what’s really driving medical burnout—and what might restore connection, purpose, and better care.

00:28 – Meet Dr. Emma Westermann and her journey through health policy training at Harvard
02:17 – What is health policy and how it influences patient care in America
04:00 – Who really profits in healthcare? A breakdown of where the money goes
06:07 – The deprofessionalization of medicine and why physicians are burning out
08:30 – How the insurance industry drives cost and confusion for both doctors and patients
10:23 – What “cost-effectiveness” models taught Dr. Westermann about valuing human life
15:41 – Why direct care can restore purpose and better care for complex patients
17:02 – Understanding PANDAS and navigating it as a physician-mom
19:50 – Launching a coaching business to support families dealing with chronic illness and trauma
24:56 – Coaching across state lines and helping families in care deserts
25:16 – Can direct care be the future of American healthcare?
26:41 – A hopeful vision for fixing what’s broken

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Kerry:

Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have a returning guest, Dr. Emma Westerman. Welcome back.

Emma:

Thank you so much, Kerry.

Kerry:

Yes, it's awesome having you on again. Just to remind everybody, why don't you tell us briefly a little bit about who you are and what you do, and obviously that's gonna be a focus on what we're talking about today. So just like a short thing is fine.

Emma:

I should address you as Dr. Reller. Sorry. Okay, so I was hoping that we could talk about my path from doing a health policy training program at Harvard and how that informed kind of how I perceive the healthcare system and eventually led me to doing direct care and now I'm opening a coaching business.

Kerry:

Yeah, you're wearing many hats and doing amazing things, so I can't wait to hear about basically your past and whereas this is going to for your future too. So like you just said, you said you did is it a Harvard Health policy degree? Is that correct?

Emma:

Yes. So after my third year of medical school, I went up to Boston and studied health policy and I was kind of surprised at how. You know, being a doctor in training, the atmosphere was not very pro physician. I got that sense pretty early on. The leader of the training program was on the board of one of the biggest insurance companies in the country. So I'm kind of taking notes as I'm going along and trying to understand different forces that are at play shaping American health policy, taking all these courses.

Kerry:

So what does that mean? What is health policy? Just for people who maybe don't pay attention to any of that stuff.

Emma:

there's many different sectors of health policy. So when you, when you join the program, you have to choose a track within it. And that's a whole nother story. But health policy in general is how do legislators come to decide on the laws and regulations that are going to shape, you know, healthcare in this country And that occurs at the local level, the state level, the federal level. It's very complex beast, as you know.

Kerry:

Yeah.

Emma:

I originally went to be in the ethics track because I was interested in. Just, you know, the ethics of healthcare and a variety of reasons. That track, track kind of fell apart in my first year or two there in one of the, the leaders became a dean and so forth. So,

Kerry:

Hmm.

Emma:

and meanwhile I was taking courses in statistics and really enjoying them. So I ended up switching to a different track that was more mathy and learning a lot of, you know, statistics and modeling. And I did take some ethics courses as well and philosophy courses, which were the most part of the program, but focused on the statistics part.

Kerry:

So with health policy, like where does that, I guess, where did that lead you? When you're saying you were, I cut you off, but I wanted to explain what health policy is. So you said the person in charge was who again?

Emma:

So I don't know that I wanna call them out by name.

Kerry:

No, no, I don't want, I don't want a name. I meant what is their type of profession? Is it a pharmaceutical company or is it, you know, like what kind of, how does that mean for private equity?

Emma:

the, the program was led by a Harvard professor who also happens to be on the board of one of the big insurance companies.

Kerry:

Got it. Insurance company. Mm-hmm.

Emma:

so that was, that was a really interesting part of the training was finding out that, physicians at the time, and this was goodness, like 15 years ago or more now, but I don't think it would've changed very much. But physicians and all of the, the money that patients pay to physicians to do what we do, that makes up only about 8% of the healthcare expenditure pie. We get blamed a lot for being, you know, greedy and why does it cost so much and why is my doctor charging me$4,000 and so forth. But we actually don't. Or we're actually not the problem. And then the next sector that often gets a lot of blame from the public is big pharma. It's a lot of hatred towards them. And I get it. I mean, there are problems, but we did a whole analysis of, you know, how much does it cost to do the research that Big Pharma does to be able to offer these very innovative therapies that often are available first in the US and nowhere else in the world how much does it cost them and how much does it cost to make those therapies available in different parts of the world, like Europe and even less developed nations that can't afford the price tag that we pay. And Americans are actually offsetting those cases. For example, they can't charge as much in Europe for many of the medications that we develop here. So they have to charge more here because our health policy is different from that in Europe. Anyhow, not to go into too many nitty gritty details. The bottom line is that yes, there are issues with big pharma, but they are again, not the major problem in terms of healthcare expenditure. The major problem is insurance companies. And their overhead and the many, many layers of bureaucracy inherent in those mega businesses, that's where most of the money is getting spent and often wasted.

Kerry:

Yeah, I mean, I definitely agree. I think that you mentioned like depro, professional deprofessionalization of medicine. Right? How would you like talk about that and describe that from your experience at Harvard?

Emma:

So we were talking about that earlier. So when I was in college, I took, history of Medicine class, and we read The Professionalization of American Medicine or something like that. It's a really thick book, A wonderful book by Paul Starr, I believe. And it talks about how physicians went from just being arbors almost on the, the fringe of society to being highly respected, very well paid in this country. and now I think we're witnessing the deprofessionalization of medicine. So where the public no longer really respects us, there's not a clear difference in most of the public's eye between physicians and ARNPs and chiropractors and all different kinds of providers. Naturopaths, you know, they're, they're all called doctor. And the years and years and years that, that we put into our training. Public really doesn't understand how that's different from some of these other providers. Not to, you know, say that some of them aren't excellent, some of them are. And I've had patients that have benefited from seeing some of those types of providers. But, you know, respect for physicians has really eroded and we see that and feel that every day in, you know, patients who are angry at us for the cost of their care. Patients who are angry at wait times, not being able to get in to see us, and angry that we can only spend 10 minutes with people. Mm-hmm. The thing that's driving all of that, again, is the insurance industry, which forces us to see more and more patients every day because the reimbursements every year are going down. And often controls what we can do. I mean, even as a direct care physician, which we'll talk about what that is later, you know, I don't take insurance for my consult fee, but I bill IVIG and medications through insurance, so I have to fight with insurance companies, and that takes a ridiculous amount of time that patients don't see.

Kerry:

Mm-hmm. Some of the you mentioned like 8.8% goes to physicians. What is all the rest of it?

Emma:

So I don't remember the percentages. But there, there is a decent chunk, like I would estimate say 20, 25% goes to the pharmaceutical industry, perhaps.

Kerry:

Mm-hmm.

Emma:

But the, the biggest chunk goes to the insurance industry and the administrative costs and overhead.

Kerry:

yeah, I mean, we've seen a lot of crazy stuff with insurances this year, including, you know, the you know, cyber attacks on United Healthcare. The other unfortunate incident with UnitedHealthcare leader and you know, it's scary and I think, you know, a lot of patients sometimes do feel that burden of, you know, they're not really being treated well even though they have this insurance that things are denied, their medications are changed, they can't get this service, the procedures and the surgeries that they need to have done. And I think some, you know, it's kind of being. I guess shed light upon these things, right? Even in the public eye. But I don't really know where we're gonna go to fix it, that's for sure. So a lot of doctors like yourself are, you know, exiting from the insurance based world and creating these direct care models, whether specialty or primary. And I don't know if that's. The hundred percent way that we're gonna be going in the future. But I think that, you know, the things that you're pointing out and the things that you learned, you know, in like you learn, like it sounds like the statistical financial side of it, which is very interesting. That's something I don't know that much about, but I mean, clearly I feel it, right? So I think it's just, it's good to be enlightening patients of what, what's going on there. And I think it's important. Is, is there anything else that your experience at Harvard, like shed light on or made you realize, where you're gonna end up, I guess, next in your career?

Emma:

I mean so many things, but perhaps the most applicable to this conversation is in those computer models that I used to build. We called them at the time cost-effectiveness models. So we would be looking at, you know, is this therapy better than that therapy? Not just in efficacy, but you know, putting it into a giant model of the, the disease state and saying, you know, over the whole course of the patient's life is this therapy going to be cost effective compared to another? And to do that, you have to literally value life. You have to assign a value to a year of life. So that would be put into the models, a quality adjusted life year, which at the time was valued at a hundred thousand dollars and per year of life. Right.

Kerry:

Okay.

Emma:

And that just really never sat well with me. And I understand the, the necessity and the value and trying to make decision making more objective and that. You know, somebody has to make these, these tough calls as to what we're going to pay for as a society.

Kerry:

Yeah.

Emma:

But that wasn't how I wanted to be myself as the, the arbiter of that kind of decision making. So I've over time moved into direct care where I can have a more personal relationship with my patients and it's more like a concierge type relationship where I can really invest in them as a person. And I deal primarily with complex disorders that have kind of fallen through the cracks of healthcare system because nobody under this current incentive system has time to deal with the really complex disorders. And, you know, I try to make it affordable. I am having to reevaluate my pricing structure.'cause I am providing more concierge than direct care. Due to the complexity of these patients. But yeah, a lot of patients just can't get care anywhere. They've been to 14 different doctors and nobody can find the answer. Nobody will even get'em the time of day.

Kerry:

Mm-hmm. Mm-hmm.

Emma:

So I end up seeing them.

Kerry:

Yeah, going back to what you mentioned about like who's making the call of costs and things like that. I think a pretty good example right now would be with those, with the you know, anti-obesity medications because someone is determining whether. You know, what is the cost of this person being on this medication long term? And is this preventing them from having to take all the other medications or all the other chronic diseases that they were having? So somebody is having to do that cost analysis, and I guess recently the current administration has decided that, you know, it's not favorable, so they are not covering them. But I don't know, that's still, you know. To, but I thought it was interesting kind of applicable to what the whole like reference to the policy of what's going on with that. And it's also important with the whole, how you said, we pay more for the medicines here than they do in the other countries because I think these medicines are still popular right now, that people are paying attention to these. Things and they're realizing, yeah, they're way cheaper in Canada, they're way cheaper in Europe. You know, why are they exposed so expensive here and what, what's the situation? And we're trying to get the cost down for that too. But you know, as the, as the most people know, like Medicare and the marketplace things are not covering these medicines. I mean, that's just one example of many. Right? And, same thing. I feel the same way when putting people on you know, the, the chronic asthma medicines that might cost longer, but keep the patients outta the hospital, maybe, you know, less steroid use, which could creates other long-term effects and things like that. So those are all the risk benefits that have to be weighed when they're deciding either what costs something, who's gonna cover something. there's a lot that goes into it for sure. A way to step outside of these things, maybe not as much with medication, but within, with the you know, taking the time and the expertise that's needed to care for these types of patients. You're also, you know, saying that they need more comprehensive care too. I mean, you're speaking of different types of patients, but I think that it could be very similar too. So you have now, I guess created this model of being able to spend time with the patients without the insurance, you know, burden. I, I guess. Right. And it's, it is important you know, to be

Emma:

And. You do a lot of obesity medicine, correct?

Kerry:

Yeah. Yeah.

Emma:

Yeah. And so I, I don't do that, but I have, I have heard about that problem where the, the GLP ones, it's not just that they're, they're not covering them, right. It's, is it also that they're trying to shut down compounding pharmacies so that you can't order smaller volumes of

Kerry:

well that's a little bit, that's going into a whole nother situation of like patents on the medications, and that would be more on the pharmaceutical side, but I'm just referring to coverage for the medicines, for the brand name drugs. Yeah, I, if we go into that, we'll never end up talking abou t anything that you're doing, so let's not go conversation, but how would you say that direct care kind of restores that connection and purpose and patient-centered care that you, you know, wish to provide to your patients?

Emma:

One thing is the amount of time that I can spend with patients. So my initial consults tend to be two hours and follow ups are one hour. So we can cover a lot of ground, not just let's review your labs and I'll do a quick exam and goodbye, but. You know, what else is going on in your life? And I see a lot of neuro immune conditions like pans and pandas, and those come along with, you know, mental health issues and family strife and sometimes educational difficulties for the child. And child may also be constipated or having urinary accidents just because of this complex disease. So I wanna be able to go into all of those things. And address them myself or get them to a specialist that deals with that specifically. And that takes time. So I feel like I'm able to provide better care

Kerry:

Yeah,

Emma:

that time.

Kerry:

Yeah. And you mentioned, you know, the current system isn't able to do that. They kind of leave families on their own and they gotta just figure it out. But you also mentioned, I think we talked more about PANDAS in the last episode, so you could give us a one liner what it is so they can remember, but otherwise they can listen to that other episode. But briefly, what is that?'cause I think you wanted to tell us, you know, kind of about how you navigated as on the patient side with that condition.

Emma:

Yeah, so PANDAS is pediatric autoimmune neuropsychiatric Syndrome associated with streptococcal infection. And Pans is very similar. It just encompasses, you know, similar symptoms but attributable to other infections besides stress. So I see patients that have unusual, you know, behavioral issues, neuropsych symptoms, often with rapid onset following an illness, and we evaluate to see if it's pans or pandas. Sometimes it's not, sometimes it's something else. And you know, a metabolic disorder or other types of complex disorders, which I can also address. And I also look for underlying immune deficiency. So, yes, and my, I came to this specific disorder because my younger child had pandas. I didn't realize it at the time but he did develop pandas when he was about six and now he's 11 and doing great.

Kerry:

Yeah, that's I mean, it's difficult to go through anything when your child is sick. Right. But how, what did you find out during that journey, right, of getting him help of like, what happened with the traditional medical establishment for you there?

Emma:

So I was really lucky because I'm a physician, so I come to it with that background with more background than most parents have. And I don't back down. So I kept pushing and kept pushing and kept reading and learning to where I could finally assemble a team around him

Kerry:

Mm-hmm.

Emma:

support him and get him healed. But it was very frustrating and it was very lonely at times because everyone was telling me, you know, no. It's not what this is, or the school system was saying, no, he's fine, he's fine. And I could tell that there something had changed, his handwriting had gone downhill. He was doing what I now know are very typical you know, changes in handwriting. They're associated with pandas and needed a specific type of occupational therapy, which I was able to get for him. But it was an uphill battle even for me. And so now that I have fought to get my own child, those resources, I feel like I can offer that to other families to get them to the best occupational therapist, the best feeding therapist to deal with, you know, ARFID, which is an eating disorder that often comes with pandas and so forth. it was definitely a lonely battle at times.

Kerry:

Yeah, it's very challenging. So I think, you know, having gone through that like you have now spurred, or developed a whole nother I guess business model to help patients and families with things like this? Correct. Tell, tell me about that.

Emma:

Yeah. So I I'm finding that there are cracks in the system for dealing with the mental health care problems that come along with pans, pandas, and other complex disorders. A lot of the patients have PTSD associated with medical system because they've been told that they're crazy. They've been poked and prodded, they haven't found answers and they're exhausted. So i'm not a mental healthcare provider, but through our family's journey I was exposed to many different types of mental healthcare that's available, and I've been networking with a lot of mental healthcare providers locally to kind of see who specializes in, in each different area. For example, psychodynamic therapy is talk therapy basically. And then there's cognitive behavioral therapy, dialectical behavior therapy internal family cystic, which is often called parts work, where you're, you're going back into your past and identifying a, a part that was traumatized or neglected or what have you that you, you're still carrying some sort of wound or trauma associated with that part, and you go back in a sort of meditative way and give that part what it needed essentially. Sometimes people call it re-parenting that part. So I can't lead that therapy, but I can direct patients to folks on that therapy and podcasts and therapists who specialize in that. If I can identify that, I think that's what they would benefit from. I read probably a hundred books on mental health and neuro immune conditions and improving communication. And all the, you know, side effects of having pandas when my son was sick. And through doing that, I can kind of guide patients on the right path. So I'm starting a coaching business to fill those gaps. And I have patients that are struggling with addiction. And can't get in to see a mental healthcare peer provider or can't afford one. And I can offer, you know, very short segments of coaching that can hopefully get them on the right path until they can get in to sees someone.

Kerry:

Mm-hmm.

Emma:

And again, not providing mental health care, but just life coaching. It to get them through that transition period.

Kerry:

Yeah, that's ama amazing service. Is there any like advice that you would give to families trying to navigate this chronic illness or mental health, like struggles other than what you're saying right now? I mean.

Emma:

So, oh my goodness. I have a reading list that I give to patients. I have a podcast list. I have- I think if we were, certainly, once I'm in a one-on-one situation with a specific person I would be able to give targeted advice. You know, I benefited from having not only a therapist but a life coach through the most difficult period of my child's illness, and it was incredibly expensive. It was upwards of$700 for four 30 minute sessions in a month. It was worth it at the time, and I'm not gonna be charging anywhere near those kinds of prices as I'm starting out. But the, the gap in mental health care is so wide that I think we need a lot of people like me to step in and, and help patients get on the right path.

Kerry:

Mm-hmm. Well, that's a, a perfect lead into what I was gonna say is, you know, one thing we can do is encourage you. Know patients and clients to seek those types of providers like yourself that can focus on that comprehensive care and connection. Right. Yeah. And I don't wanna oh,

Emma:

I have patients like just today I had two patients call from out of state. That they think their child has pandas. And I can't treat patients out of state'cause I don't have a multi-state license yet. But I could provide coaching to say, okay, here's what I would ask your local physicians to think about. Here's what I would consider ordering. Or maybe you might even be a candidate for a genetic testing and ask them what they think. And here's what I do with my patients. You know, one was from, you know, a very rural area. You had no access to anyone like me, or even just an immunologist. So I'd like to be able to provide that service. And, and they're, they're welcome to fly down and, and see me as a patient if they decide they wanna do that. But if that's not feasible at this time, maybe through a coaching capacity, I can at least provide some suggestions. I'm still working out the, the legal aspects of that. But that would be be my hope that I can provide that service

Kerry:

And help them, you know, navigate the system obviously,'cause you've had all that expertise of learning about the broken system with cracks. But let's end on a hopeful note. So you hope you're gonna be able to private this coaching services, which is great. What about with our American healthcare system? Can we say anything that's going positive or in a positive direction?

Emma:

I am really hopeful. I, I really am. I'm always an optimist. Hopeful that direct care will break the system. Honestly, I, I mean, our family pays$25,000 a year for health insurance for a family of four, and that's just in premiums.

Kerry:

Mm-hmm.

Emma:

you have the max out of pocket costs, which are what, 8,000, 10,000? I can't remember. And the deductibles and the copays. And a lot of patients are finding that even with great insurance, they can't see the doctor that they wanna see'cause either they're not in network or that doctor doesn't even take insurance'cause they've given up on the system. So I think the value of this expensive insurance that we all carry is coming into question and a lot of patients are experiencing that. So I think the more

Kerry:

honestly, they should question their healthcare plans and really understand it too, because I think that's what some of the disconnect is between their provider and themselves, is that they don't understand their insurance and what they signed up for and what it covers and doesn't cover and all of that. And then, you know, the, the translation between, you know, a provider like me and them is just never. I guess I don't know a good thing when they don't quite understand what a copay is, what deductible is, why we have to collect that. Like the fact that if I don't, I'm never gonna keep my doors open. Right. Yeah. So,

Emma:

Exactly. And they see the bill and they say, well, Dr. Rower billed me$500. What have you, but you didn't. Right? We have to charge. And I'm, I'm exaggerating you wouldn't charge that much, but doctors and facilities have to charge much more than what they're actually going to get paid because if we charged what we think we're worth, we would get paid, you know, a third of that. Right? So, so you have to charge an exorbitant amount knowing that you'll only get back a small fraction from the insurance company. Patients don't understand that.

Kerry:

Well, hopefully, like you said, the, the system will get broken yet fixed. Right. And I think we can hope that everything is gonna move toward a positive, I guess, outlook. But it, it is a, a different time where we have to just figure everything out. And I don't know what the best answer is, and I'm not one to debate anything, but I, you know, also try to seek a positive outlook and, you know, I do take insurance and it's hard. Yeah, that's all I wanna say about that. I feel like sometimes it's charity work to take the insurance, but,

Emma:

Yeah.

Kerry:

yeah,

Emma:

Yeah. Just last week

Kerry:

thing and I think it's important for patients to understand that too. But yeah. So if patients do wanna work with you, where can they find you?

Emma:

So I have a website www.healthspanimmunology.com. They can call 8 1 3 8 6 9 7 1 1 1. Or they can email health span immunology@gmail.com

Kerry:

Nice.

Emma:

set a meet and greet. I think my next openings are in September at this point.

Kerry:

Oh, that's a good thing. They're busy.

Emma:

Yeah.

Kerry:

Good. All right. Well, thank you so much for joining me again on the podcast. You're always welcome and I hope that patients get a more understanding of where I think our medical system is moving and maybe why from this discussion today. And I think it's a very important discussion, though, kind of a difficult one. So thank you for having that with me. Yeah. All right. Tune in next week everybody. Thank you so much.

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