Advancing Health Podcast

00:00:01:05 - 00:00:23:06
Tom Haederle
Welcome to Advancing Health. At a time when reliance on lifesaving drugs plays a more important role than ever in patient care, nearly one third of America's pharmacies have closed since 2010. In today's podcast, we learn about one forward thinking health system is doing about it.

00:00:23:08 - 00:00:43:29
Chris DeRienzo, M.D.
Hi everyone, this is Dr. Chris DeRienzo. I am the chief physician executive for the American Hospital Association. Welcome to this episode of our Advancing Health podcast. You know, we haven't had a chance on this podcast to talk about the crucial role that pharmacies play in caring for people, for patients all across the country. But today is the day.

00:00:44:02 - 00:01:03:13
Chris DeRienzo, M.D.
I am very excited to welcome John Pastor. He is not only the president of Fairview Pharmacy Services, he is also a pharmacist himself. And I'm excited to welcome John to the podcast, because we have a lot of learning to do around pharmacies and the challenges that folks are facing with access in the country. So, John, welcome to the podcast.

00:01:03:16 - 00:01:05:16
John Pastor
Great. Thanks so much for having me.

00:01:05:19 - 00:01:18:01
Chris DeRienzo, M.D.
And Fairview actually is a health system who just won one of the AHA's most prestigious awards, the 2025 Foster McGaw Award. And John, thank you for joining us and congratulations.

00:01:18:03 - 00:01:31:17
John Pastor
Thanks so much. I can speak on behalf of Fairview Pharmacy Services and Fairview Health Services, and just say how proud we are to be the 2025 recipient of this award and what it means for us in serving our communities.

00:01:31:19 - 00:01:43:27
Chris DeRienzo, M.D.
You know, John, I wonder maybe we can start our conversation with just giving listeners a sense of the role that pharmacies play in the access continuum to care, and perhaps even locally, to you all up in Minnesota.

00:01:43:29 - 00:02:06:25
John Pastor
In some instances, the pharmacy is the first point of health care access for many people. It's the point of health care that they access most frequently, oftentimes more than they're seeing their primary or specialty care physicians, and certainly more than they're seeking hospital care in most cases. The concern is, is that we've seen pharmacies all across the country close at an alarming rate.

00:02:06:27 - 00:02:14:18
John Pastor
And so access is a challenge for many, even in some large urban and metropolitan areas, not just in our rural communities.

00:02:14:20 - 00:02:36:21
Chris DeRienzo, M.D.
You know, you're exactly right. There are some numbers around that that between 2010 and 2021, nearly 30% of pharmacies around the country closed. And I spend a lot of my time on the road. And sometimes, you know, if you're visiting a small town in rural America, there might only be one pharmacy. And so if that closes, we're talking about not just access to care, but access to medications.

00:02:36:24 - 00:02:56:21
John Pastor
Yeah. That's correct. And I think in the state of Minnesota, we've seen that number be even higher for independent pharmacies, a little bit lower perhaps for our chain pharmacy partners. But that number is just alarming. And there's certain parts of the state where people may have to drive, you know, 40 or 50 or 60 miles to get to a pharmacy

00:02:56:21 - 00:02:58:04
John Pastor
in some cases.

00:02:58:06 - 00:03:12:19
Chris DeRienzo, M.D.
That's a multi-hour round trip just to get the prescription for your heart medicine or your neurologic medicine. And we know that with America's aging population, the number of Americans who are on one or more drugs only continues to go up.

00:03:12:21 - 00:03:34:11
John Pastor
Drug therapy continues to grow every year as more and more new, you know, medications are identified and approved by the FDA for use to treat conditions that in some cases couldn't be treated before. So drug therapy continues to increase, is sort of a mainstay of treating many, both acute as well as chronic diseases.

00:03:34:14 - 00:03:54:26
Chris DeRienzo, M.D.
You know, I'm a neonatologist and you couldn't be more right. There are things that we can treat today that the ten, 20, 30 years ago were not problems that we could help patients solve. But in order for the medication to work, first you've got to be able to take it. And again, this is a not only a national challenge, but one it sounds like that has been particularly acute

00:03:54:27 - 00:03:57:08
Chris DeRienzo, M.D.
where were you all are located up in Minnesota.

00:03:57:10 - 00:03:58:15
John Pastor
Yeah, that's correct.

00:03:58:17 - 00:04:09:08
Chris DeRienzo, M.D.
Well, tell us a little bit about the challenge that that specifically your health system faced. And, you know, where did you turn to try to begin solving that challenge for the communities that you serve?

00:04:09:10 - 00:04:41:24
John Pastor
Well, we started with, you know, pharmacy services in our system back as early as 1990, when we had our first retail pharmacy in Edina, Minnesota, and we were providing retail pharmacy services and home infusion services out of that pharmacy. But over the last 35 years, the business has grown and clearly has transformed quite some time ago from being, you know, a prescription dispensing business or a medication dispensing business to a provision of care and focused on outcomes business.

00:04:41:26 - 00:05:10:16
John Pastor
So not only has our volume grown over 35 years, but the scope of our work has grown exponentially in how we contribute to the care and the outcomes of patients. Frankly, we had to build a new, central services facility for our corporate pharmacy location, which houses many of our essential pharmacy functions, including our specialty and mail services pharmacy, our home infusion pharmacy, our compounding pharmacy, and our wholesale pharmacy.

00:05:10:18 - 00:05:17:05
John Pastor
Because that growth was occurring at such an alarming rate, we simply didn't have the space to continue to expand.

00:05:17:07 - 00:05:33:13
Chris DeRienzo, M.D.
That is a wide range of services that you're describing. You know, when I think of a pharmacy, it's I get a prescription from my doctor, I go to the pharmacy, it comes in a little orange, you know, pill bottle. And then and I bring it home. But you're describing what what sounds like a much broader range of services that your patients are needing.

00:05:33:13 - 00:05:36:15
Chris DeRienzo, M.D.
And it sounds like struggling to find access to elsewhere.

00:05:36:18 - 00:05:47:12
John Pastor
Correct. And what I didn't even include in those numbers is we have 26 retail pharmacies in our community, and we also provide the pharmacy services across our 11 hospital locations.

00:05:47:14 - 00:06:05:11
Chris DeRienzo, M.D.
Wow. So let me rewind for a second. You operate 26 retail pharmacies totally separate from the hospitals, and then you have the internal pharmacy as well that not only, I imagine provides the medications that hospitalized patients need, but then offer some connectivity to when they get discharged.

00:06:05:13 - 00:06:17:02
John Pastor
Correct. Correct. To the point of clarification, some of those retail pharmacies are actually located in our hospitals and serve as a discharge pharmacy, as well as a community pharmacy for people that live in the area.

00:06:17:04 - 00:06:26:17
Chris DeRienzo, M.D.
Fascinating. I haven't heard of this model being, you know, deployed at this level of scale too much around the country. What prompted you all to go down this road and how's it going?

00:06:26:19 - 00:06:49:08
John Pastor
Say it first, it's going very well. As I mentioned, we continue to grow from both a volume and a scope year over year. And that's in part just due to organic growth internally within our health system. But also as we talked about earlier, just the pressures in the community with access to pharmacy services from some of our, you know, other pharmacy partners out there.

00:06:49:10 - 00:07:00:11
John Pastor
But the growth has continued year over year, and we've had to continue to evolve and change our footprint and expand our footprint in many cases in order to meet the needs of our patients.

00:07:00:13 - 00:07:14:22
Chris DeRienzo, M.D.
And so when you're planning for those needs, because these kinds of physical plants, for lack of a better word for them, they don't just magically pop up overnight. You know, it takes a lot of planning and effort and logistics to make them happen.

00:07:14:24 - 00:07:40:17
John Pastor
The previous location that we were in from a central services facility we had been in since 2001, and I think we actually started with about 15,000ft². And by the time we started our move this fall to a new location, we were using at that original location about 105-110,000ft². So that's over the period of about 23 or so years.

00:07:40:19 - 00:07:59:20
John Pastor
The location we moved into, we built within tension based on our current and anticipated future needs. There's a 150,000 square foot facility, and we're using a little over 90% of it right now, with the rest of it being intentionally shelled out for strategic growth in the future.

00:07:59:22 - 00:08:06:15
Chris DeRienzo, M.D.
Goodness, you're already at 90% capacity within this brand new space that you've built.

00:08:06:18 - 00:08:20:17
John Pastor
And it's built again with intention. So it's built for efficiency and designed to make it convenient and accessible for patients that come here. But as well, our staff, who, you know, do a lot of work inside the four walls.

00:08:20:20 - 00:08:42:17
Chris DeRienzo, M.D.
We were talking about this a little bit earlier, that it's an interesting space for a health system to be in. When you're talking about, you know, sort of the core of hospital and even ambulatory services. Operating pharmacies at this scale, and the production needed to go into that is fairly unique. But you all obviously have a firm belief in why this is a space you need to be in.

00:08:42:19 - 00:09:14:12
John Pastor
We've learned over the years that it's important for us to provide all the pharmacy care for our patients. Keeping our health system patients within Fairview is very important from an outcome standpoint, a patient satisfaction standpoint, and frankly, it makes it easier for our providers to do their work, too. Our physicians and our advanced practice providers being able to, you know, have access to the records that our pharmacies keep, as well as us be able to see the records that they have in the electronic medical record.

00:09:14:14 - 00:09:33:13
Chris DeRienzo, M.D.
Well, I certainly worry that that I have had, you know, as a neonatologist, if you're discharging a baby home and they need to be on, you know, multiple medications, which frequently they're not on for the rest of their life. But if they're not taking it in those immediate months after discharge, it can be pretty challenging. But, getting access to the you know, was the prescription filled?

00:09:33:13 - 00:09:48:23
Chris DeRienzo, M.D.
Was it then dispensed? Are they taking it? Are they refilling it? That that can frequently be challenging to secure. You want to avoid that patient not being able to access this one medication that without it ultimately leads to them needing to be hospitalized again, right?

00:09:48:26 - 00:10:09:03
John Pastor
Yeah. And a great example I could give you is a physician discharging a patient from one of our hospitals can send a referral to our home infusion team. Maybe that individual needs antibiotics. Maybe they need I.V. or parenteral nutrition for some period of time. And they have access to all of the records that the pharmacy has in terms of progress

00:10:09:03 - 00:10:25:27
John Pastor
notes - notes that the nurse who goes into the home and completes the infusion would put into the record. And so that type of I'll call it seamless care for the patient, but as well as our providers too, being able to have that level of seamless sort of transition is important.

00:10:26:00 - 00:10:39:03
Chris DeRienzo, M.D.
Well, obviously y'all have done an enormous amount of work to build this program and to serve the community the way you are. Looking through the windshield, where do you see your efforts continuing to go over the next several years?

00:10:39:06 - 00:11:02:26
John Pastor
I think our primary focus over the next several years is to continue to build in processes that we can automate. And by that, I mean we've already done a really good job, I think, automating our dispensing process at our new facility. We have some state of the art equipment. More importantly, we have a lot of, I'll say, kind of behind the scenes functions that need help with even further automation.

00:11:02:26 - 00:11:22:20
John Pastor
So our, you know, our business office, our revenue cycle team that manage that. Folks that do prior authorizations with our payers and insurance companies, many of those things we need to continue to further automate to make it more efficient so we can handle the growth and the volume that we expect to continue to get.

00:11:22:23 - 00:11:43:06
Chris DeRienzo, M.D.
Yeah, I mean, it sounds like a demand that isn't going down anytime soon. And recognizing that a lot of our listeners are folks who are operators in hospitals today. What one piece of advice would you give to them when they're looking at the needs of their community? They're saying, man, what the folks at Fairview are doing to close this pharmacy gap makes a lot of sense to us.

00:11:43:11 - 00:11:51:17
Chris DeRienzo, M.D.
But I want to learn more. What would be your first point of reference for folks to learn more about how they might could bring a similar service to their community?

00:11:51:19 - 00:12:20:21
John Pastor
Yeah, that's a great question. I think first and foremost, you know, making sure you're meeting the needs internally for your internal patients, right?
Make sure you're able to capture and provide all the pharmacy services that your internal health system or hospital patients need. But then, doing a community assessment. What's the unmet need in your community? Where are those pharmacy deserts as they describe where people just don't have access to a community pharmacy?

00:12:20:23 - 00:12:49:01
John Pastor
And I'll add one other layer to that is where people don't have access to a specialty pharmacy or home infusion or infusion services. Those gaps exist, too. And frankly, we fill a lot of specialty medications for patients outside of our health system. From the specialty pharmacy standpoint, it's nearly half of our prescription volume comes from external to our own health system, much of it locally, but actually across all 50 states in the US.

00:12:49:04 - 00:12:50:06
Chris DeRienzo, M.D.
All 50 states.

00:12:50:13 - 00:12:52:00
John Pastor
All 50 states, yup.

00:12:52:03 - 00:13:10:27
Chris DeRienzo, M.D.
You heard it here first, folks. Up in Minnesota, they are serving the folks in Alaska and Hawaii. That is fascinating. Well, John, this has been a real privilege again, thank you for helping me and our listeners learn more about the role that access to pharmacy and pharmacy services plays in the community. Congratulations on everything that y'all are doing.

00:13:11:01 - 00:13:14:08
Chris DeRienzo, M.D.
We can't wait to stay tuned and hear how it keeps going.

00:13:14:11 - 00:13:17:24
John Pastor
Well, thanks so much for having me on. It's been great talking with you today.

00:13:17:27 - 00:13:19:07
Chris DeRienzo, M.D.
Thanks so much.

00:13:19:09 - 00:13:27:21
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:27 - 00:00:28:03
Tom Haederle
Welcome to Advancing Health. Being a doctor, both at the bedside and around the boardroom table often means channeling two different skill sets. And as we hear in this podcast, the successful physician leader must learn how to bridge the gaps in knowledge, exposure and experience needed to cross the bridge from clinical practice to leadership and master the art of social capital along the way.

00:00:28:06 - 00:00:55:14
Chris DeRienzo, M.D.
Hi everyone! Welcome to this episode of our podcast. I'm Dr. Chris DeRienzo and it is my true honor to welcome a long time mentor and friend to the podcast, Dr. Tom Lee. Dr. Lee is not only the chief medical officer of Press Ganey, he's the editor in chief of NEJM Catalyst. He's a practicing primary care doc. Got to know him many years ago through connections in the Asheville area.

00:00:55:16 - 00:01:05:24
Chris DeRienzo, M.D.
Tom is here to talk to us today about the intersection of social capital, and the AHA's physician leadership framework, which was just published. Tom, thank you so much again for joining us.

00:01:05:27 - 00:01:10:14
Thomas Lee, M.D.
I'm delighted to be here, Chris. And every time I talk with you, I learn stuff, too.

00:01:10:16 - 00:01:39:12
Chris DeRienzo, M.D.
Likewise, sir. As we get started, it would be good to note for listeners that the paper that I'm referencing, AHA's physician leadership framework - it was published in NEJM Catalyst earlier this year. We have links available to it and so you can read it at will, but at its core has been a challenge that we've wrestled with for some time. Which is there's a gap between, what we know it takes to be an excellent clinician, an outstanding bedside physician,

00:01:39:14 - 00:01:51:12
Chris DeRienzo, M.D.
and what it takes to become an outstanding physician leader. And Tom, that's a gap that you've explored for decades, not only in your research, but also as the editor in chief of NEJM Catalyst.

00:01:51:15 - 00:02:13:13
Thomas Lee, M.D.
Yeah. And these questions are interesting. I mean, they're core to our jobs. We have to actually deal with the situations were working hard is not enough, where it's not clear exactly what we should do. How do you figure out what we should do and how do we do it? That is the nature of the jobs of being a physician leader today.

00:02:13:15 - 00:02:36:21
Chris DeRienzo, M.D.
Working harder is something we've relied on for a long time in health care, and we've thought that we need a hero. And there are absolutely heroes in health care. But your construct of social capital is one that I think we should explore for listeners of the podcast, because the way it intersects with the bridges that we built in that framework, I think are not only interesting but important.

00:02:36:28 - 00:02:45:11
Chris DeRienzo, M.D.
And so perhaps you can just take a moment for listeners who aren't yet familiar with social capital to give them a sense of what it means and how do we develop it?

00:02:45:13 - 00:03:08:12
Thomas Lee, M.D.
Well, the concepts aren't really new or foreign, and they're going to feel very comfortable to everyone listening to this podcast. The different is framing it in a way where we approach it in a tough minded, businesslike way. You know, capital is anything that helps you improve. It helps you be better than your competitors, help you be better than yourself next year.

00:03:08:14 - 00:03:36:00
Thomas Lee, M.D.
Financial capital are the financial resources that enable you to do things you couldn't otherwise do. Human capital or the people with the expertise around you that help you do things you couldn't otherwise do. But social capital is how those people work with each other and with their infrastructure that enables you to do things you couldn't otherwise do. Social capital is based upon currencies like trust and respect and teamwork.

00:03:36:08 - 00:04:00:13
Thomas Lee, M.D.
These are things we're all for, but building them as opposed to just being grateful when we have them, that's what I'm suggesting we ought to all be doing. Getting tough minded like the CFO is about financial capital and building teamwork and trust in high reliability. I think we can do that work, and I don't think it will be annoying.

00:04:00:13 - 00:04:02:15
Thomas Lee, M.D.
I think it'll make our lives better.

00:04:02:17 - 00:04:28:20
Chris DeRienzo, M.D.
Not only make our lives better, but, but lead to better outcomes. In order to get there, though, that requires some intentionality. Relying on working harder is in some ways a simple answer, but reconfiguring a system to enable teamwork, to enable high reliability, I love the way that you frame that. It's like a book that I read recently by the person who founded Panera that that there are things that emerge from the system.

00:04:28:21 - 00:04:43:28
Chris DeRienzo, M.D.
Profits emerge from a high functioning system that is differentiated against other folks operating in that market. You describe teamwork and high reliability as secondary effects of high functioning social capital. Am I getting that right?

00:04:44:01 - 00:05:10:08
Thomas Lee, M.D.
Very much so. But to really have a great team...many of us have been on great teams and we know it took work to get there. It takes sacrifice, sacrifice of some of your autonomy to get there. It means having norms, behavioral norms and enforcement mechanisms for the norms so that if someone isn't being a good team member, they hear about it.

00:05:10:15 - 00:05:35:20
Thomas Lee, M.D.
We don't just say anything. I mean, just very recently, one of my colleagues was saying in the emergency department, you can see everything. You can see who's behaving like a jerk. And he said, do we say anything? And he said, hardly ever. But if you're being tough minded about social capital, you give your colleagues feedback. I know that's uncomfortable.

00:05:35:22 - 00:05:51:22
Thomas Lee, M.D.
But getting into that kind of culture where people give each other feedback on what will make us all better collectively for our patients and for the way we feel coming to work. That is what we're talking about here.

00:05:51:25 - 00:06:18:21
Chris DeRienzo, M.D.
And it's foundationally a different way of thinking than sometimes we would historically apply to physician training. I like to describe for folks that in the medical education world, we are taught to sit on top of a pyramid, and there's a whole lot of weight that sits on our shoulders. The order carries our signature. Our professional license is on the line for the decisions that we make, the patients and their families outcomes

00:06:18:24 - 00:06:50:01
Chris DeRienzo, M.D.
we are personally responsible for. And when that's the world that you've lived in for decades, and you envisioned the pyramid this way, it's pretty hard to invert it. Many folks do. But, it strikes me that leading teams in health care and the getting to the right side of the framework that that we described in our paper is fully grounded in that construct of social capital. That we have to realize that we may be an expert in the things in which we are expert, but that doesn't make us an expert in everything.

00:06:50:03 - 00:07:13:00
Thomas Lee, M.D.
Well, you know, instead of picturing pyramids, but I encourage our audience to think about is think about social network diagrams, you know, web of nodes. Some people right in the middle of things, connected to everyone. Some people just on the edges, you know maybe loosely connected, if at all. And the truth of the matter is, we're all in social networks.

00:07:13:03 - 00:07:43:27
Thomas Lee, M.D.
And social capital means making those social networks more effective, making them stronger, making the connections real among everyone and making them compelling. And then spreading the right norms and values across those connections so that the team can be more effective. And so the teams can interact so that the organization can be more effective. It is real work, but it's cool work, actually.

00:07:43:29 - 00:08:06:16
Chris DeRienzo, M.D.
It can be fun. And, you know, it strikes me that for a long time physician leaders have somewhat informally relied on that social capital to accrete some of the knowledge that it takes to move from outstanding practicing physician to outstanding physician leader. I'll give you one example. I don't have an MBA or an MHA. I learned about EBIDTA from my CFO.

00:08:06:18 - 00:08:28:16
Chris DeRienzo, M.D.
EBIDTA, which for those who don't yet know, is, a commonly used finance abbreviation for earnings before interest, depreciation, taxes and amortization. And when I was in my first C-suite level role as a physician leader, that CFO sat down with me every month and walked their income statement and our balance sheet. So I not only accreted knowledge

00:08:28:16 - 00:08:52:07
Chris DeRienzo, M.D.
and in the framework we describe sort of three gaps. There's a knowledge gap, but then there's an exposure gap. We have to get exposed to how that applies in a hospital and health system. And then ultimately, in order to be able to own that skillset, we need some experience in being accountable for it. And for me, my CFO was a node in that network who was willing to sit down and share with me enough -

00:08:52:13 - 00:09:02:04
Chris DeRienzo, M.D.
I'm never going to refinance bonds - but I know enough now to be a competent operator. And you're exactly right. That is a outcome of social capital.

00:09:02:06 - 00:09:41:29
Chris DeRienzo, M.D.
And I think that the framework that you recently wrote about, breaking down the types of work it takes is a great framework. And, I admire your clear thinking. And it's so much more sophisticated than the advice I was thinking about, which is telling the audience, go watch the TV show The Pit and, the HBO show about the emergency department and watch how over the course of season one, the 15 episodes, the relationships, they get stronger and stronger among the people down in the emergency department together where people are ready to do whatever it takes.

00:09:42:06 - 00:10:11:19
Thomas Lee, M.D.
They're not thinking about their job description. They're doing whatever it takes. They're actually building social capital, including the part where they're sitting on a park bench sharing beer from a cooler in the next to the last episode of the season. So even though they make a big joke about Press Ganey in the first ten minutes and despite that start, it's a fantastic show that captures something what leaders in who are physicians can do and should do.

00:10:11:21 - 00:10:32:12
Chris DeRienzo, M.D.
And that's the kind of experience that I think we are accustomed to clinically having. Some folks have shared, you know, it gets lonely because you're used to - when you're a neonatologist like me, a primary care doc like you, an ER doc, a trauma doc, you know, you get this team camaraderie that builds when you go through those kinds of really hard things together.

00:10:32:16 - 00:10:55:01
Chris DeRienzo, M.D.
It's a different kind of a team when you're sitting around the health system CEO's table, because frequently you're the last doctor left at the party, unless the CEO also happens to be a doctor. And it takes a different degree of intentionality to find ways to connect and as you pointed out, crucially, to build some informal opportunities to relate to each other as people.

00:10:55:04 - 00:11:29:17
Thomas Lee, M.D.
Well, you know, actually, I've an article that'll be coming out soon with Dr. Ale Quiroga, a physician who's the CEO at Children's Mercy Hospital in Kansas City. And what we write about is how the way clinicians think it may be very appropriate for the kind of management challenges that we face in health care today. Because clinicians like us, you know, we're used to complex situations where the right thing to do may not be clear, but we try things and we get some data and we modify things.

00:11:29:24 - 00:11:58:15
Thomas Lee, M.D.
And, you know, we iterate. We're constantly gathering information. Now, that kind of approach to complex patients, for example, that may be more the right thing for complex problems like overcrowded hospitals, overcrowded emergency departments flow through a system more so than complicated management strategy. You know, complicated tasks. There's many people must do many things, but it's pretty clear everyone's got a job,

00:11:58:15 - 00:12:17:10
Thomas Lee, M.D.
do your job. You need those kind, that kind of approach. But it only takes you so far with the kind of complex challenges we have today. So I do think that thinking like a clinician, Ale and I have an article coming out very soon making the case: yeah, we need to do that more in our management life too.

00:12:17:12 - 00:12:43:01
Chris DeRienzo, M.D.
I look forward to reading that. And if anything, Tom, looking back over the papers you've written, many have a degree of foresight that one historically might one only apply to Nostradamus. And I'd like to close on one of those quotes. And this was from ten years ago. You wrote in New England Journal of Medicine that we believe "social capital is likely to be even more important than financial capital in the era ahead.

00:12:43:04 - 00:13:01:15
Chris DeRienzo, M.D.
After all, one can go to the bank to borrow money, but there is nowhere to go to borrow trust, teamwork, reliability, and the desire to innovate and improve." You said that ten years ago. It feels just as relevant today, but I wanted to give you just a chance to share with listeners a closing thought.

00:13:01:17 - 00:13:31:08
Thomas Lee, M.D.
Thanks. Chris and I do still feel that way, and even more so. Because I'm not naive about money, but I know the limits of what money can do. You can get money from the outside, but you can't get teamwork and trust and high reliability and safety. You know, you've got to build that from the inside. And our organizations are not going to differentiate themselves from other organizations on the basis of who can borrow the most money.

00:13:31:14 - 00:14:05:10
Thomas Lee, M.D.
They're not going to differentiate themselves on the basis of who has the best AI. You know, you've got to be competitive and all these things. But where will differentiate ourselves is how we work together. That will enable us to hold on to great employees, and that will enable us to hold on to our patients as well. So I really think that focusing on social capital, how we work together, that is every bit as strategic and really more so than financial capital issues alone.

00:14:05:12 - 00:14:21:19
Chris DeRienzo, M.D.
You know, health care is and will always be a uniquely human experience. And in the words of Tom Lee, you can buy things, but you can't buy trust. You've got to build it. Thank you so much for spending time with us on the podcast, Tom. It is it is really one of the honors of my career.

00:14:21:21 - 00:14:30:02
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:00 - 00:00:28:18
Tom Haederle
Welcome to Advancing Health. Western Wisconsin Health recently put a lot of care, planning and resources into expanding its maternal care services for the rural population it serves. Was it successful? Well, the hospital CEO jokes that she took on a little bit of market research herself by having her own child at the hospital and checking out the experience from a patient's point of view.

00:00:28:20 - 00:00:54:01
Julia Resnick
Hi, I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. I'm so excited to be here today with Eilidh Pederson CEO of Western Wisconsin Health. Today we're going to discuss rural maternal health. As many rural hospitals are shutting their labor and delivery services, some are doubling down. Eilidh’s hospital is one of the ones that's expanding their maternity care for their community and for their patients.

00:00:54:03 - 00:01:06:15
Julia Resnick
And Eilidh has a special connection to share. So let's get right into it. Eilidh thank you so much for joining me for this conversation. To kick things off, can you tell me more about your hospital and the community that you serve?

00:01:06:17 - 00:01:35:06
Eilidh Pederson
Yes. Thank you, Julia, for having me. Thank you to the AHA. My name is Eilidh Pederson. I'm the CEO with Western Wisconsin Health, and we are Critical Access Hospital in Baldwin, Wisconsin. We serve a rural community and we serve as a safety net hospital to both our community and to our region. We employ about 500 people and offer a full breadth of service, focusing on a holistic approach to health care and meeting patients where they are.

00:01:35:08 - 00:01:39:15
Julia Resnick
Fantastic. And tell me more about your family and raising your family in Baldwin.

00:01:39:18 - 00:02:11:19
Eilidh Pederson
So now I have four kids. Very excited to share my pregnancy journey with you with my most recent baby. She was the latest addition to four kids. Two boys, two girls. And I absolutely love raising a family in Baldwin. I think there's nothing better than raising your children in a rural community. Having an opportunity to really get to deeply know people, both people with whom you're raising children at the same time, but also meeting and getting to know people who use and benefit from your hospital services.

00:02:11:21 - 00:02:37:27
Eilidh Pederson
I personally love that opportunity to meet patients in the grocery store, at the local football game, or my family at our hockey games, or big hockey players. And so that opportunity to get to know people outside of just when they're sick and when they're in the hospital, when they're feeling their best out in the community, I think is the absolute best thing about serving as a leader in a rural hospital and living in a rural community.

00:02:38:00 - 00:02:43:29
Julia Resnick
That's so special that you get to see your patients when they're healthy and out of the hospital and back to their day to day lives.

00:02:44:02 - 00:03:07:22
Eilidh Pederson
Yes, yes. I think it also is really what contributes to the quality of medicine and rural communities. There's nowhere to hide if something doesn't go well, if there is displeasure about a service, you're going to hear about it again at the grocery store, at the football game, at church, at the hockey game. And that high level of accountability translates into quality outcomes.

00:03:07:22 - 00:03:13:06
Eilidh Pederson
So it makes a difference to, to live and work in the same community.

00:03:13:08 - 00:03:20:20
Julia Resnick
Absolutely. So tell me about what maternity care is like in your community, all the way from prenatal care through postpartum care.

00:03:20:22 - 00:03:50:12
Eilidh Pederson
So all things encompassing, maternal and child health are really a staple in our hospital. We've made a conscious decision that these are foundational programs to us. So we offer prenatal care, through midwives, certified nurse midwives, obstetricians and family medicine physicians with obstetrical care as part of their training and their service. So the prenatal journey starts there. Patients have an option to see any of those providers.

00:03:50:12 - 00:04:12:28
Eilidh Pederson
It's their choice. Part of our very focused approach to medicine here. Patients are in control. They lead their own show. We're here to support and care for them. So the prenatal care journey starts there, and we see patients through anti-partum visits, and we see for them through their ultrasounds. All of their lab work is done within our hospital.

00:04:13:00 - 00:04:36:10
Eilidh Pederson
And then there's the birth experience that happens in our labor and delivery unit. We are now a seven bed obstetrical care unit where we deliver patients, either vaginally or through C-section. And then once those patients are born, we're there to be serve as their medical home. So on the pediatric side, we have two pediatricians. One specializes in developmental pediatrics.

00:04:36:10 - 00:05:00:23
Eilidh Pederson
So for our patients who have developmental needs, we have onsite pediatric care for patients in need of those services. We have a pediatric nurse practitioner. And then we have family medicine providers who also meet the needs of our pediatric patients. And we really want to be that wraparound service for a patient's life span. So through the birth through childhood and all the way throughout all stages of life, we want to be here for our patients.

00:05:00:28 - 00:05:11:18
Julia Resnick
And it's one thing to talk about pregnancy care in the abstract. It's another when you are the hospital CEO who's getting your pregnancy care at your own hospital. So can you talk about that experience?

00:05:11:21 - 00:05:35:27
Eilidh Pederson
It is just an absolute joy to have my own child at this hospital. One of the things that we do here for all patients is we sign kind of a quasi birth certificate. It's not an official birth certificate, but it's a welcome to the world. We put the baby's footprint on it. It's one of my favorite parts of the job is I get to personally sign all of those welcome to the world, through our hospital.

00:05:35:28 - 00:05:58:01
Eilidh Pederson
And so it was really special and fun too. I had my own baby, and I got my own certificate that I signed welcoming my baby into the world. Being able to experience prenatal care here, I went the midwifery route and had an absolute wonderful experience through prenatal care, sharing and the joys of practice with that personalized approach of a nurse midwife.

00:05:58:04 - 00:06:22:09
Eilidh Pederson
Then, through the labor experience to a nurse midwife by my side, we expanded our hospital a year and a half ago, and to be able to be in a room that we worked hard to bring on site for patients in need. Was great to see every aspect of that design come to life as a patient, to see firsthand why we built it that way.

00:06:22:12 - 00:06:38:11
Eilidh Pederson
All of the funds that we raised to bring that to life. Again, just to experience that firsthand was great. And nothing beats the joy of welcoming a child into the world. And to get to do it in my hospital is beyond words, how special that was.

00:06:38:13 - 00:06:42:26
Julia Resnick
Being a patient in your hospital, how did it make you think about care differently?

00:06:42:28 - 00:07:14:10
Eilidh Pederson
You know you have more vision as an administrator on what you think that care journey should look like. Of course you do that in partnership with physicians, providers, nurses, all of the, caretakers who are closest to the work. And that vision you hope you plan, you prepare that that aligns with reality. And so I joke that this was one way to do market research to determine, okay, did all of that planning go according to plan and a real life experience?

00:07:14:10 - 00:07:33:16
Eilidh Pederson
And I will say, for the most part, it did. It went exactly as we planned and prepared that it should, with few exceptions, and I'm happy to share those exceptions. But it was great to see that vision that we had, that plan of care come to life and to experience that as a patient. I'm thinking, you know, okay, this is what should happen next.

00:07:33:17 - 00:07:41:25
Eilidh Pederson
This is what we plan for. This is what it should look like. And really in every aspect, it it basically did, which was wonderful to experience firsthand as a patient.

00:07:41:28 - 00:07:47:13
Julia Resnick
Yeah. What were those exceptions and how are you thinking about changing things based on those?

00:07:47:15 - 00:08:05:22
Eilidh Pederson
You know, you can't predict some of these things, but I was glad to see how it played out. So this was a unique birth experience and that there was a storm coming when I went into labor. And, my midwife who is as great of a midwife as she is, storm tracker said, “okay, Allie, I need you to be prepared.

00:08:05:24 - 00:08:21:27
Eilidh Pederson
There's a storm coming. I think it's going to hit about 10 p.m..”And that's right around the time when your baby is going to be born. And I said, Sarah, how do you know this? I know you're a great midwife, but how do you also track storms? And she said, “in my spare time, I track the weather and I know there's a storm coming.

00:08:21:27 - 00:08:41:23
Eilidh Pederson
And so we need to prepare you.” Sure enough, I was ready to push at 10 p.m., right? At that time, all of the power went out in the hospital. We had a huge storm. Indeed. Power went out. We were on backup generator power. And so it was this dual thought, I need to have this baby right now.

00:08:41:23 - 00:09:03:00
Eilidh Pederson
And I'm also very curious to see how our emergency preparedness planning is going to work in this moment. Minutes before the power went out, the team moved everything to the red outlets, which are the outlets that make sure that when generator power comes on, all of the monitors and equipment still works the way that it should. They did this quietly, discreetly.

00:09:03:00 - 00:09:32:17
Eilidh Pederson
I, of course, knew what they were doing. My husband had no idea, which is what you want. It happened seamlessly. It was clear that our emergency preparedness planning went the way that it should. Everything functioned. Indeed, when the power went out a few minutes later and was able to safely and healthily deliver my baby girl in the midst of a storm with no power, only operating on generator power, the team knew the emergency preparedness policies training was effective.

00:09:32:20 - 00:10:03:21
Eilidh Pederson
The power was out until the next morning at 7 a.m., so we had a full evening of without, regular power. The hospital was still able to deliver many babies that night. The other unique thing about the experience that I thought about differently as a patient is when our OB rooms are full, which they often are because of the need in the community, we have to move patients to either a triage room or, to, a postpartum care room.

00:10:03:23 - 00:10:30:20
Eilidh Pederson
And we do this routinely. And as we plan for this, you know, I thought, okay, well, this won't be a big deal to families. They'll understand. We've got a patient coming in who needs a labor and delivery room. But as I experience that as a patient, I saw firsthand the challenges of moving everything. You know, the new baby, the partner, all of the mountains of things you have, and doing that at 3 a.m., was not an ideal time.

00:10:30:22 - 00:10:41:00
Eilidh Pederson
And so I saw firsthand that we can probably do that in a better way. So the market research continued with how do we interact with our patients better when those needs arise?

00:10:41:03 - 00:10:57:03
Julia Resnick
That is such a helpful learning that I think you can only realize by being in it. So I want to talk about rural maternal health generally. So many rural hospitals are being forced to close their labor and delivery services. While you all seem to be expanding, how do you do that?

00:10:57:05 - 00:11:27:07
Eilidh Pederson
We've made an investment and a commitment to sustaining rural obstetrical care. Despite all odds. We've really taken it as our personal mission that when others close, we have to be there for those communities in need. How do we do that? Number one, quality of care. That's the foundational aspect of this training, making sure that we know our patients needs because of that relationship, to be there to deliver the best care possible.

00:11:27:10 - 00:11:55:03
Eilidh Pederson
We have a 4% C-section rate. So clearly that foundational level of quality care rings true. Number two is workforce making sure that we have a diverse, sustainable workforce to meet the varied needs of our patients. And that's why we employ certified nurse midwives, obstetricians, family medicine physicians with OB, so we can have a variety and enough caregivers to meet the needs of our patients.

00:11:55:06 - 00:12:19:02
Eilidh Pederson
And then number three is advocacy work that needs to continue so that our government partners, our community partners, know the challenges that we endure and know how they best can support rural hospitals to stay open. And our minds, those are the keys to success. And that's our daily mantra. And how do we do this? How do we keep our doors open and do it well?

00:12:19:05 - 00:12:28:07
Julia Resnick
And as labor and delivery departments around you are closing their services, how are you adapting to meet not just the needs of patients in Baldwin, but in the communities that are around you?

00:12:28:09 - 00:12:48:24
Eilidh Pederson
The thoughts that we have as we work to adapt to the changing landscape and the ever growing needs, goes back to what I shared earlier. Number one workforce. We need more caregivers and providers to do this work. And the number two is increasing our space. Just a year and a half ago, we doubled the size of our labor and delivery unit.

00:12:48:24 - 00:13:10:06
Eilidh Pederson
And we're already pushing up against those limits. I personally had to move as a patient because we had more patients coming in to deliver. We need more space. And that's why as part of our five year strategic plan in this hospital, we intend to add yet again, more space, more clinical space to meet the needs of our growing region.

00:13:10:08 - 00:13:29:01
Eilidh Pederson
I think we do this and can do this well because we're local, we're independent, we're very accountable to our community. And it highlights why it's so important for rural, independent hospitals to stay open, because they keep these things at the heart of their work, keeping labor and delivery open.

00:13:29:03 - 00:13:54:25
Julia Resnick
Absolutely. And it's just such a powerful story for how you can have rural medicine really serving the needs of the community and providing high quality care that even the CEO or be willing to have her baby at. And listeners, I've met that baby and she is adorable. So congratulations on your new little one. Thank you so much for the work that you do every day for your community, and I just really appreciate you sharing your story with our listeners.

00:13:54:27 - 00:13:57:12
Eilidh Pederson
My pleasure. Thank you for having me.

00:13:57:15 - 00:14:05:26
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:01 - 00:00:27:01
Tom Haederle
Welcome to Advancing Health. Behavioral health resources are in especially short supply in many rural areas of the country. Sutter Health in Northern California is committed to dramatically expanding access to behavioral health services for rural residents. And as we hear in this discussion, it's game plan goes beyond just constructing new facilities.

00:00:27:03 - 00:00:54:14
Rebecca Chickey
I'm Rebecca Chickey, the senior director of behavioral health at the American Hospital Association. And it is my honor, truly, today to have two speakers for this podcast. Dan Peterson, who is the CEO of Behavioral Health Services, as well as the CEO for Sutter Center for Psychiatry at Sutter Health; and his colleague, Dr. Matthew White, who is the chair of the behavioral health service line at Sutter Health.

00:00:54:17 - 00:01:26:11
Rebecca Chickey
Welcome to both of you, and thank you for being willing to share your time and expertise on how Sutter is expanding access to behavioral health in rural communities. Before I launch my first question to you, though, I just want to set the stage for the listeners who may not know the severity of accessing services in rural communities. 65% of rural counties do not have a psychiatrist, and 70% of rural counties have no child and adolescent psychiatrist.

00:01:26:13 - 00:01:50:29
Rebecca Chickey
And for nearly two decades now, suicide rates have been consistently higher in rural America compared to urban America. So just to level set, how important it is that Sutter is doing this work. As we start, could you give the listeners a sense of what is Sutter Health, you know, what's its clinical footprint? And, Dan, I'll pitch it to you.

00:01:50:29 - 00:01:53:26
Rebecca Chickey
And, then Dr. White, please weigh in.

00:01:53:29 - 00:02:21:14
Dan Peterson
Yeah. So Sutter Health is a large, integrated health care system. We're really geographically focused in Northern California, but we cover the breadth of services across our footprint in Northern California. We have 23 hospitals. We have 57,000 employees, 6,000 physicians, clinicians, and our medical groups, almost 6,000. And so we're really quite a large health system, but we are also quite geographically diverse, right?

00:02:21:15 - 00:02:41:00
Dan Peterson
We have hospitals and clinics everywhere from downtown San Francisco, right in the middle of the city, all the way up to Crescent City, a small town up on the Oregon border, eight hours north. We have a number of rural hospitals, critical access hospitals and rural health clinics that we're very proud to support.

00:02:41:03 - 00:02:48:02
Rebecca Chickey
And for the listeners who may not be health care experts, per se, can you describe a little bit of your critical access hospital?

00:02:48:09 - 00:03:16:19
Dan Peterson
Yeah. Thank you. A critical access hospital is just a designation for a hospital that is essentially a sole provider in a community. You have to meet certain geographic distance requirements from other hospitals. And really, by definition be in a rural area. I was actually the CEO at Sutter Lakeside Hospital in rural Lake County several years ago, about 8 or 9 years ago, serving in a community living in a town of Lake Park, with just a couple thousand people there.

00:03:16:25 - 00:03:45:24
Dan Peterson
And it's really meaningful care provided in those communities, because you really are the provider that those residents have to depend on. Many of them simply cannot travel. Either can't afford to travel, don't have the means to travel or logistically because of the needs of their care, cannot travel long distances in order to reach another provider. So the communities really depend on these providers in the rural communities to do - not just to be there - but to do a great job for them.

00:03:45:27 - 00:04:03:00
Rebecca Chickey
Well, and I can tell there's a piece of your heart that is clearly committed to rural communities. Sutter has recently made investments to expand behavioral health services in two rural areas in California. Can you tell me about that? Let the listeners know what you're doing and why?

00:04:03:02 - 00:04:27:08
Dan Peterson
Yeah, I'll start with some of our capital investments and then maybe Matt can talk about some of the programs. We have recently announced we're building more infrastructure in these rural communities. That's an important piece of what we have to do. So, we are going to be building some additional office buildings, about 18,000ft² of additional office buildings for primary care and urgent care up in Crescent City on the Oregon border.

00:04:27:10 - 00:04:57:24
Dan Peterson
We're also really excited to announce something called an empath unit, which is a crisis care unit, for individuals in a behavioral health crisis immediately adjacent to our emergency department there in Crescent City. It'll be a 3,000 square foot facility really designated for behavioral health crises. We're also building an additional medical office building on Lake County at our lakeside hospital, another 7,000ft² or so, about a $5.5 million investment in that community.

00:04:57:27 - 00:05:19:03
Dan Peterson
And this coming summer, we'll be opening another rural health clinic in Los Banos actually, just outside of Modesto. We have a rural hospital there, and we're excited to open a new rural health clinic there, which does tie into our behavioral health strategy as well as we're really looking programmatically to embed these services in our primary care offerings at all these communities.

00:05:19:03 - 00:05:26:03
Dan Peterson
And Matt, as a psychiatrist, can probably talk a little bit better about that. The strategy behind that and why that really works well.

00:05:26:05 - 00:05:27:26
Rebecca Chickey
Dr. White, you're up.

00:05:27:28 - 00:05:51:12
Matthew White, M.D.
First to expand, on the Empath unit a little bit and then talk about some other ways in which Sutter is supporting behavioral health in these rural communities. As Dan articulated, Crescent City is up in the far, far north coast of California, and it's really pretty much an island in a very rural community. So if you're in a behavioral crisis, you end up in our emergency room there more often than not.

00:05:51:14 - 00:06:15:10
Matthew White, M.D.
So Sutter recently got some state funds to build a specialized kind of crisis care unit, a crisis stabilization unit. But an empath unit is really a particular type of crisis stabilization unit. It's designed differently in a more therapeutic way. It doesn't have the bright lights of an emergency room. It tends to have chairs rather than gurneys. It's really just a much more soothing environment.

00:06:15:10 - 00:06:31:26
Matthew White, M.D.
And it's shown to have significant reduction in hospitalization rates and reduced length of stay. So we're really fortunate to be able to leverage a state grant opportunity to kind of provide a place for folks in crisis in that area can go to get more therapeutic relief than the current state.

00:06:31:28 - 00:06:52:15
Rebecca Chickey
So it sounds much more patient centered for someone who is in a psychiatric crisis compared to an emergency department, which, as you articulated, can be loud, with lots of lights and lots of activity. You really are being able to deliver patient centered care in a different way. Is there an average length of stay? What is the time period?

00:06:52:15 - 00:07:16:25
Matthew White, M.D.
Usually it's significantly less than 23 hours, so that the average length of stay in an emergency room in these rural communities can be literally days sometimes, because if you need to be in a hospital, there's very few resources around. So people can spend several days sometimes waiting to get a hospital bed and then travel six hours to the nearest hospital. Because empath units are more therapeutic

00:07:16:25 - 00:07:26:15
Matthew White, M.D.
actually, if folks don't end up getting hospitalized quite as frequently and didn't get the care they need right then and there, instead of going a long, long distance after a long stay.

00:07:26:17 - 00:07:36:21
Rebecca Chickey
If that's not patient centered care, I don't know what it is. I know that Sutter has been the driving force behind some of these initiatives, but have you had engagement or worked with community partners?

00:07:36:24 - 00:08:00:03
Matthew White, M.D.
Yeah, the empath unit is a perfect example. It actually started a number of years ago where our community benefits liaison had been working with local behavioral health and local tribal entities, because it's been a long identified problem. And they actually got some early seed grant funding a number of years ago to sort of plan for something like this empath unit.

00:08:00:06 - 00:08:25:03
Matthew White, M.D.
So when this larger grant opportunity came along last year, which was prioritizing projects that were kind of, quote, "shovel ready, ready to go because of the existing kind of groundwork that Sutter had done, working already with the local communities and hoping and planning for one of these empath units. It was a project and a grant application that really rose right to the top and got funded because again, some of that community work that had already been happening.

00:08:25:06 - 00:08:28:21
Rebecca Chickey
Dan, anything you'd like to add about the community partnerships?

00:08:28:24 - 00:08:54:28
Dan Peterson
One of the things that I have loved about working in rural communities is you have an opportunity to truly rally everyone in the community around something, right? Because there just aren't that many people to rally. And so it is logistically possible to bring together all the stakeholders, you know, to bring together multiple interested parties, multiple interested organizations, and get them all physically at the same table and co-develop some of these ideas.

00:08:55:05 - 00:09:16:00
Dan Peterson
It's an ideal scenario in many ways. I think sometimes we think of the rural communities as having challenges and difficulties because that's true. But on the other hand, there are some of these advantages where you truly can bring the whole community together and come up with a dream and a vision as a community in a way that is far more difficult in a metropolitan area.

00:09:16:02 - 00:09:43:10
Rebecca Chickey
I so concur. I grew up in rural Alabama, in a community of about 30 homes, so everyone knew everybody. The local police officer, you know, of the tiny little town seven miles away, used to come on my mother's grass. I mean, her primary care physician was right down the street. And so the support system and the ability to identify needs and then come together and collaborate to meet those needs, it's truly unique in rural communities.

00:09:43:13 - 00:09:50:24
Rebecca Chickey
Beyond the empath unit, can you share how center is working to expand access to care in rural areas in California?

00:09:50:27 - 00:10:11:17
Matthew White, M.D.
There's a couple ways, actually a number of ways. As Dan mentioned earlier, finding a psychiatrist or even a therapist is so challenging in this environment. So one of the initiatives Sutter has been leveraging virtual opportunities and tele-psychiatry, and one such way is through embedding primary care into pay for help using a nationally recognized model called collaborative care.

00:10:11:20 - 00:10:37:13
Matthew White, M.D.
And so we've been able to stand up collaborative care using a virtual provider. So this is where a primary care physician can get support and access to a therapist for the patient and psychiatric support for help medication management through Content Health, our virtual partner. Additionally, in Los Banos, which Dan mentioned earlier, Sutter has recently hired some nurse practitioners to serve patients in their rural health clinic.

00:10:37:15 - 00:11:05:19
Dan Peterson
One of the reasons that this model is so successful - at Sutter Health we've embraced this collaborative care model - is because it really allows our clinicians to work at the top of their license, and it allows us to maximize our clinician workforce, right? There are only so many psychiatrists out there, and there are only so many psychiatric nurse practitioners and advanced practice clinicians, it's like clinical workforce especially in rural areas is difficult to come by.

00:11:05:21 - 00:11:34:15
Dan Peterson
Recruitment is difficult. There are many rural communities that you just can't find a dedicated psychiatrist to come move to that rural community, but by embracing other care models that sort of allow these clinicians to come in and consult on the care of the patient and allow the primary care doctor to continue to be the prescribing clinician but with the support of a psychiatrist, those models really lend themselves towards virtual support, which is very helpful in the rural communities.

00:11:34:17 - 00:12:06:22
Dan Peterson
And second of all, it helps you sort of maximize the impact of the workforce that you do have available. And so then, you know, we look at places like Los Banos where we haven't been able to bring in a psychiatrist for that model, but we have had success in recruiting a psychiatric nurse practitioner or some of the other areas where we're able to find some therapists and they just need some support, or we have a strong core of primary care doctors, but they just need some support from a psychiatrist. Embracing different types of models like that really just helps logistically embrace the challenge of recruitment in those areas.

00:12:06:25 - 00:12:32:15
Rebecca Chickey
So it sounds like from this approach, you are meeting the patients where they are, you're better supporting the staff, the clinicians that you do recruit practicing at the top of their license. I've seen some studies in integration that show that integrated care or collaborative care not only improves patient satisfaction, but workforce satisfaction. It can reduce stigma, which can be great in rural communities.

00:12:32:17 - 00:12:56:26
Rebecca Chickey
It has just an abundance of positive outcomes. So thank you for taking it there. Dan, Matthew, thank you so much for being here with us today. And for sharing your experiences and your innovative ideas on how you're improving access to behavioral health services in rural communities. And before I go, I'd like to remind everyone that November 20th is National Rural Health Day.

00:12:56:29 - 00:13:06:01
Rebecca Chickey
Be sure to check out the links in the show notes below for a wide variety of resources that'll allow you to participate in this important awareness day.

00:13:06:03 - 00:13:14:09
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.