June is Pride Month, and at In Full Health, we’re continuing to recognize companies that are promoting more inclusive health care in the LGBTQ+ community.

Plume provides high-quality gender-affirming care by meeting patients where they are and working to break down barriers that keep gender-diverse individuals from living their fullest lives.

In Part 2 of this two-part interview (you can check out Part 1 here) — which is a part of our ongoing LGBTQ+ series — Jerrica Kirkley, MD, (she/her/hers), Co-Founder and Chief Medical Officer of Plume discusses the role of community in care, how technology has supported their mission, and how Plume is paving the way for other trans-inclusive health care initiatives.

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Read Part 1 of our conversation with Dr. Jessica Kirkley.

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In Full Health (IFH): What is the role of community in Plume?

Dr. Jerrica Kirkley: Just being in a care ecosystem that acknowledges who you are, treats you with respect, and shares that lived experience — that’s when you start to move the marker on mental health outcomes and health outcomes as a whole.

Now, if you add in something like a peer support group, we’ve seen that seems to be additive. Everybody sees community in different ways, but we do know the trans community at large is one of the most online networked communities that there is because of the discrimination that’s existed and the inability to navigate physical spaces safely. So, it has been really important for folks to have that place of connection.

The groups are peer-led and patient-driven as much as possible to meet the needs of whatever is coming up for the participants. At the same time, we try to provide guidance and an agenda for the groups to navigate and talk through things that might be unique to the trans experience.

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That might be the first time that you’ve ever been in a room — whether virtual or physical — with another person while expressing as your authentic self.

Dr. Jerrica Kirkley, MD
Co-Founder and Chief Medical Officer, Plume

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There are multiple affinity group options. For example, we have groups largely organized by testosterone and estrogen-based therapy. Beyond that, we have a group for BIPOC individuals, we have a group for non-binary individuals. We are always looking to see where those affinities come up and what feels right to patients. As we grow the program and have more participants, we’ll be able to fill different groups out.

IFH: Plume is run by a trans-led care team. How does this promote inclusive care and help the trans community feel comfortable with the care they receive?

Dr. Jerrica Kirkley: I think it helps build trust, and create comfort. I think this is something that is a truism for all humans, right? If we can walk into a place and see other people who sound like us, look like us, and share some element of lived experience — by nature, we will feel more comfortable.

Now, the difference here — and for many marginalized communities — is we don’t often have that opportunity in health care. What’s really neat is when you take somebody who has not had that opportunity and then provide that experience. That’s where you can build so much trust, empathy, and comfort.

If you have trust, if you have comfort, that allows a patient to open up and talk about the things that are going on. You have better information coming in, and you are better able to provide treatment and appropriate guidance.

IFH: How has technology been an asset to Plume? And what future opportunities do you envision to leverage technology in gender-affirming care?

Dr. Jerrica Kirkley: There are significant barriers when it comes to accessing care for the trans community. If you live in a place where you don’t have a provider, you’re going to drive or fly a bunch of miles, or you’re not going to go. From a pure access standpoint, we knew that was critical.

As I mentioned, the trans community is a very online networked community and is seeking information about health care. It’s a community that as a whole is primed for the adoption of digital health.

Some people have cautioned against practicing medicine in a virtual environment — concerned that it’s not going to be safe, or people aren’t going to like it.

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While some might prefer in-person care, we know that, because of institutional discrimination and barriers, that is not actually the case for many trans people. We often dread having to walk out our door and go to a clinic, whereas for somebody else, that might just be commonplace and seem very easy to do.

Dr. Jerrica Kirkley, MD
Co-Founder and Chief Medical Officer, Plume

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Reports have shown that trans people have been twice as likely to utilize telehealth over the past year compared to the cisgender community.

There are so many opportunities to leverage technology. Conducting a video visit is the very base form, but even that can dramatically change somebody’s care experience and provide safety, convenience, and information in a way that they’ve never been able to access in a physical setting.

There are exciting technologies in development that will allow us to capture and utilize data to inform the care experience — including AI, automated algorithms, or wearable devices and collection kits that can be used in the home. I think people will start to see that care delivered by telehealth is not just a convenient alternative, but can actually improve health outcomes, patient and care team experience, and reduce cost.

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IFH: How have you ensured that Plume is a solution that is equitable to all members of the trans community?

Dr. Jerrica Kirkley: It starts by listening to our members. We have members that come from all different backgrounds, identities, and intersectionalities.

We do that in a number of ways including through one-on-one interactions and asking for feedback. We also do surveys periodically directed to our patients and the trans community broadly.

A lot of folks in our company do identify as trans or gender diverse, and also embody many other identities and backgrounds. No singular person can be a representative of all people that come from any particular background, so that is why we try to have as broad of representation as possible, but always take it back to our patients and the community.

It comes from team composition, listening to our members, and listening to our broader community. In addition to building a care experience that meets the needs of our community, we are exploring different ways to reduce the out-of-pocket cost to our patients.

IFH: How do you hope Plume is paving the way for other trans-inclusive health care initiatives?

Dr. Jerrica Kirkley: We see ourselves as one ingredient in the mission to transform health care for trans people. When it comes to building a system of care, there is a lot of learning to be done. We provide education around clinical and cultural competency in-house to our clinicians and employees who are often working with other organizations and community groups in health care.

We have also had quite a few organizations engage with us to learn more about gender-affirming care. I have provided trainings for other health care organizations and academic institutions, including pharmacy schools, medical schools, medical residencies, and medical conferences.

We spend a lot of our time and resources designing a virtual care system that is not only easy, efficient, and affirming, but is delightful to use for both the patients and the care team. We hope these learnings and principles can be adopted in other health care settings.

Caring for such a large group of patients puts us in a position to collect meaningful data and help inform the standards of care. We also work to advocate for health policy changes which support health care access for trans individuals.

IFH: How can the In Full Health Learning & Action community help you strengthen and scale your solution and its impact on the health of the communities you serve?

Dr. Jerrica Kirkley: At a high level, just helping others understand the importance of gender-affirming care — how life-saving and truly medically necessary this is for trans folks.

Gender-affirming care can be broad — it can be gender-affirming hormone therapy, it can be gender-affirming surgery, but also just basic primary care, preventative health, and other specialty services, but ultimately, delivering care with clinical and cultural competence that extends across all those lines and takes into account the lived experience of trans people.

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We know that so many of the obstacles we face are because of a lack of awareness, knowledge, and outright discrimination and stigma. The more that health care providers understand that this is something that can be threaded through everything we do — not isolated to a corner of the health care world — that’s when we really start to change people’s lives.

Dr. Jerrica Kirkley, MD
Co-Founder and Chief Medical Officer, Plume

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There are other ways, including working to block policy and legislation efforts which attempt to impede somebody’s ability to be their authentic self and limit things like health care access and school and athletic participation.

We can push health professional schools to have standardized education when it comes to gender-affirming care. That is something where an organization like the AMA can have a lot of leverage — in medical schools. If we want to create a health care workforce that is providing culturally and clinically competent care to trans folks, and other communities, that’s where it all starts.

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