Advancing Health Podcast

00:00:00:22 - 00:00:19:08
Tom Haederle
Welcome to Advancing Health. For patients dealing with opioid or stimulant use disorders, a lot depends on how smoothly they can transition through the health care system to access the care they need. Today, we hear from two experts on effective ways to improve their navigation.

00:00:19:10 - 00:00:55:18
Jordan Steiger
Hi everyone, and welcome to AHA's Advancing Health podcast. My name is Jordan Steiger, and I'm the director of Behavioral Health and Violence Prevention at the AHA. Really happy to be joined today by Dr. Ben Springgate and Dr. Seth Viens, who are both here from joining us from New Orleans. And they are going to tell us a little bit more about the work that they're doing at their organization around improving care transitions for patients with opioid use disorder and stimulant use disorder, and how their work just kind of touches all patients that are experiencing substance use disorders and helping them just get where they need to go and get the care that they need.

00:00:55:19 - 00:00:59:07
Jordan Steiger
So Dr. Vignes and Dr. Springgate, thank you for being here today.

00:00:59:09 - 00:01:03:09
Seth Vignes, M.D.
Thanks, Jordan. We're really excited to be here. Thank you Jordan. Excited to join us.

00:01:03:12 - 00:01:12:04
Jordan Steiger
Before we jump in, I would love the audience to get to know you a little bit. So, Doctor Viens, could you just introduce yourself and let us know who you are and what you do?

00:01:12:07 - 00:01:26:14
Seth Vignes, M.D.
Yeah. Thanks, Jordan. My name is Seth Vignes. I'm an assistant professor of internal medicine. I primarily work as a hospitalist in New Orleans at a few different hospitals, but I'm also an addiction medicine researcher on the Louisiana Department of Health public grant.

00:01:26:14 - 00:01:28:28
Jordan Steiger
And, Ben, what about you?

00:01:29:01 - 00:01:43:10
Benjamin Springgate, M.D.
I'm an internal medicine and addiction medicine doctor-professor here at LSU School of Medicine and active in clinical care, principally for patients with opioid use disorder and other addictive disorders, but also research and education.

00:01:43:15 - 00:02:04:21
Jordan Steiger
I just want to make sure everybody in our audience is aware of some of the work that we've been doing together on our Bridge to Care collaborative. So this is a CDC funded project that we have been working on for the past few years, and the CDC really asked us to find ways to improve linkage and retention for patients with opioid use disorder and stimulant use disorder.

00:02:04:21 - 00:02:33:12
Jordan Steiger
So one of the ways we've been doing that is through the use of our Bridge to Care guide, which lays out lots of different options for organizations to kind of consider and think about how they can adapt those things into their own practices. Focusing on the inpatient setting, primary care setting, the role of pharmacy, and really thinking about what some of those leadership roles are, how we can improve education and communication around care transitions, and how we ultimately can improve access to care.

00:02:33:14 - 00:02:48:12
Jordan Steiger
Before we kind of jump into that, I would love to hear just based on some of the things that are we really are focusing on in this collaborative together, where are some of the biggest breakdowns in care transitions that you see with your patients? Ben, let's start with you.

00:02:48:14 - 00:03:13:03
Benjamin Springgate, M.D.
Thanks so much, Jordan. It's a great question. One of the things that we, you know, see is that breakdowns occur across the continuum of care. So breakdowns occur when patients enter the emergency department once they're admitted to the hospital, when they're discharged, and when they're navigating follow up after a hospital admission. So in the emergency department, for example, opioid use disorder and stimulant use disorder are under-recognized.

00:03:13:04 - 00:03:39:06
Benjamin Springgate, M.D.
They're frequently under-treated, and this can result in delayed care in patients boarding in the emergency department, in patients leaving prior to engaging in treatment, or completing treatment. On the inpatient side, following an admission, many patients across the country are not met with the kind of empathy and patient centered care we'd like to see for patients with substance use disorders. Many are not receiving evidence based care.

00:03:39:08 - 00:04:17:08
Benjamin Springgate, M.D.
Most don't receive standard of care life saving medication for opioid use disorder, for example, medications like buprenorphine or methadone, which can prevent withdrawal and increase retention and care, as well as decrease the likelihood of death. And most don't receive expert inpatient support from addiction consult services or addiction board certified specialists. And with each missed opportunity, that means that the patients who we are trying to care for have a greater likelihood of worse outcomes, a greater likelihood of relapse to substance use, and a greater likelihood of disease progression, including risk of death.

00:04:17:09 - 00:04:46:21
Benjamin Springgate, M.D.
We know that many hospitals across the country don't carry buprenorphine on formulary, even though it's standard of care, even though the World Health Organization has designated it as an essential medication. And we know that even more hospitals don't carry methadone or create barriers to initiation of use of methadone for opioid use disorder. And methadone, as well as buprenorphine, are the two medications demonstrated to save lives in the treatment and care for patients with opioid use disorder.

00:04:46:26 - 00:05:31:09
Benjamin Springgate, M.D.
Following up further on those transitions of care opportunities, many people who come through our care settings, in our hospital and in other hospitals may not have a telephone. They may not have transportation. They may really struggle with costs of care. And those things make a difference when we're trying to anticipate facilitating follow up. So although the likelihood of a really bad outcome, such as death for someone who's had an opioid overdose is about the same as for someone who's had a heart attack, the likelihood that someone gets standard of care and receives evidence based care across each of these care settings on the continuum and during the care transitions is much, much lower for someone

00:05:31:09 - 00:05:51:12
Benjamin Springgate, M.D.
with opioid use disorder or stimulant use disorder compared to a heart attack. If you've had a heart attack and you look at the quality metrics that all our hospitals across the country care about, the likelihood of getting standard of care exceeds 95%, and the likelihood of getting standard of care for opioid use disorder or stimulant use disorder is abysmally low by comparison.

00:05:51:13 - 00:06:11:25
Jordan Steiger
Wow, I did not know that. I think that's a really great way to frame this conversation, and I'm hearing some of the threads through everything you said. It sounds like there's a lot of stigma that exists out there in the world. And then just like we were talking about with access, you know, some of those social aspects of care that are really affecting your patients in the way that they're able to transition.

00:06:11:27 - 00:06:13:22
Jordan Steiger
Doctor Viens, what do you think?

00:06:13:25 - 00:06:41:03
Seth Vignes, M.D.
You know, one of the biggest challenges we see in our region is that our addiction care is very siloed. It's highly siloed. Inpatient teams, outpatient providers, community care workers. They're often operating as a separate systems rather than a coordinated continuum. In that environment, I really find that a lot of times, the responsibility for connecting the dots between them falls on the patient at a really, you know, a time when they should be spending their energy and focus on recovery.

00:06:41:06 - 00:07:06:25
Seth Vignes, M.D.
From a hospitalist perspective, it's really evident in a subset of patients that are having injection related infections, things like endocarditis, skin and soft tissue infections. Back to (?) Those cases, they have introduced additional transition points where they're going to skilled nursing facilities or LTACS before eventually reentering the outpatient system. And so each of those transition points is another potential point of failure.

00:07:07:01 - 00:07:39:07
Seth Vignes, M.D.
So building a cohesive like really long term care plan that spans inpatient, post-acute to outpatient to medication access while also addressing housing and transportation and phones, it's really time consuming and incredibly complex, and each of those aspects are in a different silo with a different EMR, different providers, different knowledge bases and capacities. And so without coordination across it, even our best inpatient interventions can fail to reach sustainable engagement.

00:07:39:08 - 00:07:45:25
Seth Vignes, M.D.
And so that's when we see those heightened readmission rates and long lengths of stay and preventable overdoses.

00:07:45:27 - 00:08:05:14
Jordan Steiger
I'm really glad you brought up some of the physical aspects of substance use. I feel like that's not something that's always a part of the conversation when people aren't in this world and kind of experiencing it every day. And I know that there can be some additional challenges sometimes, you know, with getting patients to LTACs, getting people to skilled nursing facilities because of their substance use.

00:08:05:14 - 00:08:29:01
Jordan Steiger
So I think that's a really important thing to bring up. And also, for listeners, a really good thing to think about - how can they improve those partnerships and maybe provide some of that education and reduce some of the stigma. So thank you. I know one of the ways that you all have really done some great work is by creating an integrated clinic that treats physical health and substance use at the same time.

00:08:29:03 - 00:08:34:05
Jordan Steiger
Tell us a little bit more about that, because I think we could all really learn from that model.

00:08:34:07 - 00:09:20:03
Benjamin Springgate, M.D.
Yeah. The LSU Integrated Health Clinic draws on the medical evidence showing that patients who received integrated care of their substance use disorders, their physical health, their behavioral health are more likely to achieve improved outcomes, more likely to stay engaged in care, more likely to receive evidence based care. And that really is our goal. So this enables a patient who perhaps has chronic medical conditions like diabetes or hypertension, as well as mental health conditions like depression and post-traumatic stress disorder, as well as conditions associated with drug use like chronic hepatitis C to receive care all in one place, even as they're getting care for their substance use disorder. And providing that combined care with addiction specialty

00:09:20:04 - 00:09:43:22
Benjamin Springgate, M.D.
care, primary care, medical services, psychiatric or mental health services in an accessible, non stigmatizing, supportive clinical environment really makes all the difference in terms of facilitating the likelihood of people staying in care, facilitating the likelihood that they're going to get the types of evidence based care that we know actually work and that reduce the likelihood of relapse and overdose risk.

00:09:43:22 - 00:10:06:03
Benjamin Springgate, M.D.
And so this type of a model has been advanced by national organizations across the country, and really represents a sharp contrast to a lot of settings across the country where, as Seth was describing earlier, there are such silos. And patients with addictive disorders really perceive a lot of a lot of barriers and potentially a lot of bias.

00:10:06:10 - 00:10:29:02
Seth Vignes, M.D.
The hospitalists love the integrated health clinic. You know, when my patients nearing discharge, I can call Dr. Springgate. I can call his clinic staff scheduler and have an appointment in hand for my patient. I can tell them who they're going to see and what date and time. And that also allows me to leverage the in hospital case managers and social workers, if things arise, that are going to be a barrier for my patient transportation,

00:10:29:02 - 00:10:50:16
Seth Vignes, M.D.
for one. It also is nice because it's proximity right next to us. And so I can I can tell my patient where it is. So it just lowers those barriers for access. And I think the other thing that's really important is that the staff at Integrated Health Clinic really recognize that this is a time sensitive appointment, and they can really coordinate with you to get it urgently and get your patient and when they need to.

00:10:50:19 - 00:11:06:27
Jordan Steiger
That makes so much sense. And I mean, I'm hearing from both of you just, you know, addressing all of those barriers that we're talking about at the beginning, you know, getting that appointment in hand before the patient actually leaves the hospital, helping them to address all of their needs at one time with one appointment as much as possible.

00:11:06:27 - 00:11:14:04
Jordan Steiger
I think this is amazing. And I'll ask the question I'm sure a lot of people are thinking is, how do you pay for this? How do you make this happen?

00:11:14:07 - 00:11:39:01
Benjamin Springgate, M.D.
We were fortunate to advocate 8 or 9 years ago to our hospital leadership that we really wanted to try to expand access to services for patients with substance use disorder in our primary care center in a non stigmatizing environment. Leadership at that time bought in and we're thankful for that. And I think that they realize there are a number of beneficial outcomes for the system, for the hospital

00:11:39:02 - 00:12:07:07
Benjamin Springgate, M.D.
beyond just for the patient you know. So yes we all want to help the patient. But if we can reduce the likelihood that the patient is going to come back into the emergency department and, you know, be a border in the emergency department and see that bottleneck to other emergency care. If we can reduce the likelihood of a readmission, which many of our hospital leaders are concerned about, if we can reduce the likelihood of a prolonged length of stay because we have an adequate opportunity for follow up.

00:12:07:08 - 00:12:19:27
Benjamin Springgate, M.D.
These are things which really speak to hospital administrators across the country. And fortunately, we were able to see some residents from our leadership as they made this decision to allow us to open up this clinic.

00:12:20:00 - 00:12:39:14
Jordan Steiger
I think that is a great example of bringing in that that leadership component, really getting that buy-in and then just going from there, you know, and building on the success and the outcomes that you're showing through the work that you're doing. I want to change topic a little bit here. So a lot of the work that we are doing together is really focused on opioid use disorder.

00:12:39:16 - 00:12:53:12
Jordan Steiger
But the other component of this work is around stimulant use disorder. So could you tell us just a little bit, maybe some of your experience with treating patients with stimulant use disorder - how that could be a little different than the approaches you would use with opioids.

00:12:53:14 - 00:13:17:21
Benjamin Springgate, M.D.
It's a great question, and it is important to recognize that frequently we do see patients with stimulant use disorder. Frequently these people who are using stimulants are also using other drugs concurrently. The toolkit for clinical treatment of stimulant use disorder isn't quite as robust as the toolkit for treating opioid use disorder. The medications that are available are used off label in many environments, including our own.

00:13:17:22 - 00:13:42:25
Benjamin Springgate, M.D.
The standard of care contingency management isn't covered by many insurances or most insurances, so this makes a big difference. What we try to do is engage those patients who are using stimulants in a way that we can help them with all of their substance use problems, and perhaps if we're supporting them in the care with evidence based medication and treatment for their opioid use disorder, that increases the likelihood that they're not going to go back to stimulant use.

00:13:42:25 - 00:14:03:02
Benjamin Springgate, M.D.
If we can concurrently offer them mental health services for something else that they're concerned about, their anxiety, their depression, their PTSD, perhaps that increases the likelihood that they're not going to go back to use of stimulants. And engaging them where they are, helping them to identify their priorities for treatment and their goals can facilitate the likelihood that they'll remain in care

00:14:03:03 - 00:14:07:04
Benjamin Springgate, M.D.
following a care transition from the inpatient to the outpatient settings.

00:14:07:06 - 00:14:11:19
Jordan Steiger
Makes a lot of sense. Dr. Viens, what about your perspective from the hospitalist side?

00:14:11:21 - 00:14:31:09
Seth Vignes, M.D.
You know, what we're seeing is that we need to recognize that it's a growing problem. And it's especially in our location we're seeing a rise. And so a lot of our education right now is just on recognition because like Dr. Springgate mentioned, our toolkit for treatment is limited. And so recognizing counseling, referring to care for more expertise is really important.

00:14:31:09 - 00:14:37:27
Seth Vignes, M.D.
But I think the first step that we're kind of currently undergoing is just recognition and education to our providers.

00:14:38:03 - 00:14:56:00
Jordan Steiger
Really, really important component of all of this. So as we wrap up, Dr. Viens, I'd like to start with you. What is one thing that you think a hospital leader or maybe a health system leader listening to this podcast really needs to know about care transitions, and if they could kind of walk away with one thing from this, what would it be?

00:14:56:02 - 00:15:20:28
Seth Vignes, M.D.
Yeah, it's a great question. I think for me, one of the highest impact practical interventions you can think about for a health system is investing in peer navigators, I would say is something I think is really important. These are trained professionals. They oftentimes have lived experience. They understand kind of both the clinical system and how to navigate it in the local community resources in a way that most providers can't.

00:15:21:01 - 00:15:39:19
Seth Vignes, M.D.
And as we talked about before, you know, our systems struggle at the transition point. So even when we initiate medications for opioid use disorder and we stabilize that patient on the inpatient side to follow through can fall apart without dedicated support. And so peer navigators kind of help bridge that gap, and they serve as a trusted guide.

00:15:39:20 - 00:16:03:02
Seth Vignes, M.D.
They support follow up. They troubleshoot the barriers like transportation. And they just maintain engagement at a really vulnerable point. There's a growing body of evidence that peer support improves linkage across a lot of different settings. That's post hospitalization, post carceral. And so as we think about like scaling the model, I think we should be amplifying the message that these services should be sustainably funded.

00:16:03:02 - 00:16:20:09
Seth Vignes, M.D.
So expanding reimbursement particularly through CMS would be really important. And so if I had to recommend one intervention, I would say you should pair your addiction kind of infrastructure with well integrated peer navigation support and then advocate for policy change to make it sustainable.

00:16:20:12 - 00:16:28:18
Jordan Steiger
That is a great point. We are big fans of peer support over here, and I'm so glad you brought that into the conversation. Dr. Springgate, what about you?

00:16:28:20 - 00:17:15:14
Benjamin Springgate, M.D.
Great point, Seth. I think that in addition, you know, I know that many of our hospital leaders are concerned about things like overcrowded emergency departments. They're concerned about things like preventable readmissions and reducing preventable readmissions. They're concerned about things like ensuring follow up care. And the scientific evidence, you know, that's come out in the last several years shows that patients who are engaged in care in inpatient settings inside the hospital by addiction medicine specialists like an addiction consult service, are 700% more likely to receive life saving standard of care medications like buprenorphine, likewise 7 to 8 times more likely to follow up and remain in care after discharge.

00:17:15:14 - 00:18:08:02
Benjamin Springgate, M.D.
So that's a tremendous benefit that can be associated with having an inpatient addiction consult service that can result in reduced crowding from substance use and overdose patients in the emergency department. That can result in reduced readmissions from substance use, comorbidities, and overdose, and that can facilitate that sustained engagement and care. So whether a patient is coming in with endocarditis or other sequelae of substance use, then follow the evidence. The medical evidence, the health services evidence shows that meeting your inpatient addiction specialist face to face, giving them the opportunity to engage in that discussion with the patient and giving them the opportunity to receive recommendation of evidence based care and facilitate timely follow up in

00:18:08:02 - 00:18:25:17
Benjamin Springgate, M.D.
a way that helps the patient overcome some of their challenges, is really what's going to result in improvements in length of stay, decrease readmissions, decrease boarding in the emergency department, things that we should all care about, even as it's also dramatically improving the likelihood of good clinical outcomes.

00:18:25:24 - 00:18:44:13
Jordan Steiger
I don't think there's a better way to wrap up this episode than what you just said. I think that pulls it all together perfectly. So thank you both so much for being here and sharing just a little bit of your knowledge. I feel like we could talk about this all day, but just thank you for your support of the work that AHA is doing and your participation.

00:18:44:13 - 00:18:48:14
Jordan Steiger
And we couldn't do any of this work without you in the way that you serve your patients.

00:18:48:16 - 00:18:52:08
Benjamin Springgate, M.D.
We're grateful to you and to the AHA and everyone involved in this. Thank you so much.

00:18:52:14 - 00:18:54:00
Seth Vignes, M.D.
Thanks, Jordan.

00:18:54:02 - 00:19:02:25
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.

00:00:00:01 - 00:00:19:06
Tom Haederle
Welcome to Advancing Health. Patients grappling with substance use disorders can get temporary care within a hospital setting. But where is the continued support after discharge? In this podcast, we learn about one answer to that question. It's called the Bridge to Care Collaborative.

00:00:19:08 - 00:00:49:20
Jordan Steiger
My name is Jordan Steiger, and I am the director of Behavioral Health and Violence Prevention at the American Hospital Association. I'm joined today by Dr. Heidi Bray, who is a nurse practitioner and hospitalist at Providence Saint Peter Hospital in Olympia, Washington. Heidi serves her patients in her community through working at a community-based peer led low barrier suboxone program, where she provides outpatient MOUD care or medication for opioid use disorder and works with the team to refine clinical pathways.

00:00:49:22 - 00:01:14:07
Jordan Steiger
I'm really excited for this conversation today because I got to meet Heidi through the work that we are doing through a CDC funded project here at the AHA through our Health Research and Educational Trust called the Bridge to Care Collaborative. And what we are trying to do in this collaborative is improve the pathways, improve linkage to care, and improve retention and care for patients with opioid use disorder and stimulant use disorder specifically.

00:01:14:07 - 00:01:23:26
Jordan Steiger
But we do know that all of the work we're doing can really help patients across the care continuum that have substance use disorders. So Heidi, thank you so much for joining us today.

00:01:24:00 - 00:01:25:08
Heidi Bray, DNP
Of course, my pleasure.

00:01:25:08 - 00:01:35:10
Jordan Steiger
Before we get into the details of the work we've been doing together, I would love if you could just tell us a little bit more about the community you serve at your hospital and just kind of where you're from.

00:01:35:16 - 00:02:18:25
Heidi Bray, DNP
Sure. So I am a Olympia, Washington native, and I have the privilege of serving and caring for patients in the community where I grew up. Providence Saint Peter Hospital is part of a larger system, Providence Health Care, which extends over five states in the western United States. We are a faith based Catholic hospital system that has a rich heritage and culture based in our in a deep history, based in our community of over 150 years of caring, really for the most vulnerable patients in in our communities. And serve a five county area,

00:02:18:25 - 00:02:33:08
Heidi Bray, DNP
so we have a large geographic catchment, which is part of our challenge as we seek to adapt to a changing healthcare system and changing realities in both our suburban and rural communities.

00:02:33:10 - 00:02:54:22
Jordan Steiger
Absolutely. And that's a great overview to get us started. And you know, one reason I'm so excited to have you here today is because you have that hospital perspective, but you also have community perspective. You serve a largely rural population across a very large geographic area, even though you're located in more of a suburban, larger city setting. Is that right?

00:02:54:25 - 00:03:26:07
Heidi Bray, DNP
Correct. We're set - our setting is then sort of a mid-size city, but we draw from the surrounding counties accepting in-transfer patients from smaller rural hospitals and facilities that either don't have capacity or ability to handle certain patient demographics. Complex patients requiring infectious disease consultation or logic consultations, oftentimes surgical consultations, cardiac consultation, that kind of thing come to us.

00:03:26:07 - 00:04:00:06
Heidi Bray, DNP
And oftentimes those patients have layers of substance use disorder as well. So these are patients that may be out in rural counties where there is one small 20 bed hospital and a dwindling number of outpatient resources. Certainly very limited resources for substance use disorder care, who come to our hospital with a multitude of needs. And so we try to manage those as optimally as we can in the acute care setting and then figure out pertaining to our work with the AHA

00:04:00:08 - 00:04:20:14
Heidi Bray, DNP
how do we link those community, those patients back to their community, to their home, to their families, and still keep the ongoing, important aspects of their care intact so that they can live well? And that's a particular challenge with substance use disorder.

00:04:20:19 - 00:04:40:07
Jordan Steiger
Thinking about some of maybe those specific challenges, you know, you mentioned comorbidities that might bring people into the hospital, and then they also have a substance use disorder. And let's say the patient gets the treatment they need. They're ready to go back to their families and their communities. What are the challenges that they face as they're making those transitions?

00:04:40:09 - 00:05:10:13
Heidi Bray, DNP
So let's say we have a patient who maybe came to us in-transfer from a small outlying rural critical access hospital, where they were admitted and it was there was a high level of concern for a infection, for a complex infection, maybe in a joint or a heart valve. And they are transferred to our facility where they undergo whatever surgical consultation is needed, whatever infectious disease consultation is needed.

00:05:10:13 - 00:05:38:21
Heidi Bray, DNP
But we know that this patient was placed at risk for this infection because of their substance use disorder. They may be with us for a number of days, even weeks, while we sort through the acute critical problem. And optimally we transition them to MAT for their opioid use disorder. And now we're preparing to discharge them back to a community that doesn't have anyone who prescribes Suboxone or methadone.

00:05:38:21 - 00:06:17:26
Heidi Bray, DNP
And what does that look like for this person? So figuring out issues of, say, transportation into a larger center of care where they can come, you know, monthly for their medication management, sometimes that's interwoven with telemedicine opportunities that are many of our community partners also offer. We are blessed to have rich tribal resources in our northwest communities, where the tribes are really doing great work around growing access to care, both primary care and substance use disorder care, and oftentimes have transportation support available to their patients as well.

00:06:17:26 - 00:06:54:06
Heidi Bray, DNP
And many times they very generously serve patients who are not affiliated with the tribe. So we're able to connect people to their services, which is wonderful. But all of this takes a lot of care coordination, a lot of connection, a lot of knowledge around what resources exist so we can support patients. I think what's really tragic to me, and really continues to be tragic to me, is that, quite honestly, it's easier to purchase drugs in many of these outlying communities than it is to get access to good health care that serves people with substance use disorder.

00:06:54:06 - 00:07:19:25
Heidi Bray, DNP
And until we address that underlying problem in our communities, this will be an ongoing challenge for these patients. Because quite honestly, it's easier to find some fentanyl, purchase fentanyl, than it is to in many cases than it is to stay engaged with a provider who can continue to help manage your chronic disease of substance use disorder with MAT.

00:07:19:26 - 00:07:24:08
Heidi Bray, DNP
So we need to shift that narrative in order to really succeed.

00:07:24:13 - 00:07:38:28
Jordan Steiger
I know one thing I've come to know about you and your professional life is that you're really passionate about access to these medications that help with treatment, and you've been doing a lot of work through this collaborative to educate your fellow providers about how they can prescribe.

00:07:39:01 - 00:08:07:02
Heidi Bray, DNP
Sure. Well, the AHA collaborative project has been really a gift. What the opportunity has given me is sort of is some time and some connection with other providers and communities and systems across the country through the AHA collaborative who are struggling with the same issue. The issues have a different flavor in different communities, but they really, at their core are the same.

00:08:07:02 - 00:08:33:04
Heidi Bray, DNP
And so I practice as a nurse practitioner. Certainly I have one foot in the nursing tradition and one foot in the medical world. I practice as a medical provider in my facility, but I am very connected to our nursing staff and very interested in figuring out how we collaboratively across nursing and medicine, serve these patients. Because these patients require that. They need it,

00:08:33:04 - 00:09:11:01
Heidi Bray, DNP
they need us all to bring our best game forward. So I have approached this problem to date a couple of ways within the AHA collaborative work. First is that we decided to focus at the bedside, which is we have a number of passionate clinicians, providers, prescribers in our facility who are open to and engaged with this patient population and work diligently to transition patients to MAT while they're in the hospital. We have bedside nurses who have relative inexperience with these medications.

00:09:11:01 - 00:09:51:10
Heidi Bray, DNP
And so what I have found is that I can work together with a patient to develop an induction plan that's fairly complex. Sometimes getting patients off of the medications we've been managing pain with in the hospital and transitioning them successfully to, for instance, sublingual Suboxone is a fairly complicated several day process. I can put all those orders into our EMR and then find that the bedside nurse is really perplexed by this medication, perplexed by this process, perplexed by cross tapers and taper plans, and coming off of when do I give the opioid?

00:09:51:10 - 00:10:19:00
Heidi Bray, DNP
When do I give this the Suboxone? And even more importantly, how do I educate a patient who's never taken a sublingual medication? I'm handing them this strip. What do I do? After innumerable opportunities to do one on one coaching with bedside nurses, I realized we need to just do a house wide education. Identified a RN in our facility who is working on her master's in nursing and education, and she was seeking a clinical project and education project.

00:10:19:00 - 00:10:44:08
Heidi Bray, DNP
And so we've partnered together to develop some teaching tip sheet for our bedside nurses that we are rolling out with a presentation to our nurse educators across the facility, and it will be reaching every nurse at the bedside with just some specific clinical information and how to administer sublingual Suboxone as a place to start, as buprenorphine, as a place to start.

00:10:44:08 - 00:11:14:15
Heidi Bray, DNP
And I'm hoping what this will do, because in my experience, this is what happens, is you put out some clinical pearls, some tidbits, and it really starts a larger conversation about, wow, we have a tool that we can use. And so how does this tool start a conversation not only with nursing but with patients starts that dialog around teaching and coaching, gives nursing bedside nurses the confidence to have that conversation.

00:11:14:15 - 00:11:37:04
Heidi Bray, DNP
And then also, I hope, will help our biggest cohort of providers in the hospital, the bedside nurse, as they see this strategy work with their patients. I'm hoping they will also push hospitalists and family medicine providers who may be a little reluctant, or maybe hadn't thought to address this issue with the patient.

00:11:37:04 - 00:11:59:12
Jordan Steiger
I love that you're bringing in learners. I love that you're creating advocates across your organization through, you know, nursing, you know, staff at the bedside seeing that this works and seeing that it helps patients. I think these are all amazing examples. And I think, you know, creating the learning materials that you mentioned is a great example for others on listening to this podcast.

00:11:59:12 - 00:12:28:08
Heidi Bray, DNP
And it's fun to work with learners in this space because when in this case, even better, because it's a learner who I also work alongside in the care of patients. And she and I had actually cared for a patient with opioid use disorder. She is an orthopedic nurse on her floor. And so I think that piqued her interest when she saw the shift in the therapeutic relationship with this patient.

00:12:28:08 - 00:12:58:03
Heidi Bray, DNP
When we were able to step away from the angst around, when is my next oxycodone dose, to oh, I've actually feeling pretty good on this, on this buprenorphine and wow, all of a sudden it extracts the angst and the time clock watching and the sort of edginess of that relationship that can develop between the bedside nurse and the patient, who has legitimate pain and substance use disorder.

00:12:58:03 - 00:13:30:24
Heidi Bray, DNP
And if you remove that, that discomfort, that conflict around the PRN opioid dose and replace it successfully with scheduled MAT, you open up space for the real therapeutic work that nurses want to do. They want to talk to their patient about how to adapt to the injury that they had, or the surgery they just had. Those are the things that everybody thought they were getting into bedside acute care nursing to do.

00:13:30:25 - 00:13:54:19
Heidi Bray, DNP
It really lights fires when they see the restorative nature of creating space for those conversations with their patients, and just an honest conversation about substance use disorder. I mean, this is a cohort of patients that they come to us, not trusting us. And yet when you build a little bit of trust and open the door, they'll teach you all kinds of things.

00:13:54:21 - 00:13:56:18
Heidi Bray, DNP
You learn about your community. And, you

00:13:56:18 - 00:13:57:19
Heidi Bray
know, we live

00:13:58:03 - 00:13:58:28
Heidi Bray
and work

00:13:59:00 - 00:14:29:09
Heidi Bray, DNP
in this community. And we have found a way to put our blinders on as we, you know, drive through town to the suffering that happens in our sidewalks and our forests where many are living. I think to come to understand that and open the door to understanding it with the patients we care for at the hospital, is really enriching and important for both sides of that relationship.

00:14:29:09 - 00:14:44:13
Heidi Bray, DNP
We need to understand their life better and they need to understand that we are kind and that we have something to offer to improve their wellness as a stepping stone to potentially improving their overall circumstances.

00:14:44:20 - 00:15:01:09
Jordan Steiger
As you were talking, even before you said it, the first word that was coming to my mind is trust. And trust is going to help those patients know that we have their best interest in mind, and we're going to send them to the next level of care and keep them going on a path that's good, that is going to help them get to their goals.

00:15:01:15 - 00:15:11:27
Jordan Steiger
I think that is a great place to end this conversation. And I just want to say thank you so much for being here and really bringing this topic to life for our listeners in a different way.

00:15:12:00 - 00:15:21:07
Heidi Bray, DNP
Of course. Jordan, my pleasure. It is, um, this is the most gratifying patient population to take care of, I think.

00:15:21:09 - 00:15:30:02
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.

00:00:00:03 - 00:00:18:25
Tom Haederle
Welcome to Advancing Health. Programs to transform and improve health outcomes can work well as standalones. But as we hear in this podcast, they make an even bigger difference by connecting clinical care with community based strategies to create a coordinated ecosystem.

00:00:18:27 - 00:00:58:13
Julia Resnick
In health care, there is no shortage of innovative programs, but scaling them into a coordinated, system wide approach is a different challenge entirely. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association, and this is the Advancing Health podcast. Today, I'm talking with Ryane Jackson, vice president, Community Health Network for Memorial Hermann Health System in Houston, about what it takes to move from strong individual programs to a truly coordinated, systemwide approach, one that centers community and the strategy, integrates social drivers of health and brings patients and partners into the work as co-designers. We'll explore how they're structuring teams and partnerships, measuring progress, and rethinking what care can look

00:00:58:13 - 00:01:04:03
Julia Resnick
like when it's built with and for the communities they serve. Ryane, thanks so much for being here with me today.

00:01:04:08 - 00:01:05:22
Ryane Jackson
Great. Happy to be here.

00:01:05:28 - 00:01:20:09
Julia Resnick
So I know that Memorial Hermann places a lot of emphasis on being community owned, including the community in every step of the strategy. Why is that so essential to your systems approach, and how does it really influence the way you think about care and delivery and community engagement?

00:01:20:12 - 00:01:50:09
Ryane Jackson
Yeah, that's a great question. And so just a little bit of background, I've been with Memorial Hermann now for soon to be two years. And you know what I think is really unique about being in this healthcare system is that we do tout ourselves as community owned. And I think that is critical, I'd say, to our approach. Community owned means that we're not just providing programming or programs or working to address their needs from the seat we sit in from a healthcare perspective.

00:01:50:10 - 00:02:17:08
Ryane Jackson
But we're letting the voice of our community, the voice of our experts in the community, actually guide and shape our strategy so that whatever it is that we are providing to them, whether it's financial investments, whether it's very strategic programing designed to address, you know, healthcare access disparities or economic disparities, we know that it is being built from the community's voice.

00:02:17:12 - 00:02:20:13
Ryane Jackson
And hopefully I answered your question. I know there was a second piece to that.

00:02:20:14 - 00:02:31:27
Julia Resnick
You did. And I want to get into that, like how you get community voice in that sense of ownership, like what are the mechanisms for engaging communities and hearing those voices and then translating them into programing?

00:02:32:02 - 00:02:54:25
Ryane Jackson
Awesome. So this won't be a surprise. You probably would get this answer from a lot of other healthcare systems in our country, but we do start from the place of our community health needs assessment. So we do conduct our assessment once every three years, and then we do annual refreshment of that assessment just to make sure that, you know, we're staying on top of the shifting landscape of our environment, especially in today's times.

00:02:54:25 - 00:03:19:08
Ryane Jackson
So the community health needs assessment for those who may not be familiar, but I imagine if they're listening to this podcast, they're very familiar just by default. But the community health needs assessment, really in order to produce one that is worth its weight in anything, you have to talk to the community. And so we really lean into the community survey aspect of the development of that CHNA.

00:03:19:10 - 00:03:55:24
Ryane Jackson
We distribute the survey electronically, but we also provide it in person. We've been able to really leverage our thoughtful community partnerships with local nonprofit organizations, and they've allowed us to physically come in with our community health workers, with some of our own employees who may be nurses or sitting in other roles across the system. We're asking people things not only how old are you and what zip code do you live in, but we're wanting to understand your household income, you know, have you, you know, in the last few months not been able to afford your food?

00:03:55:24 - 00:04:20:18
Ryane Jackson
What are you worried about? We're asking about mental health. We've even have asked about have you given birth recently and were there complications? So I say all that to say, the survey is very detailed and really gives us a strong picture. Then from the community voice perspective, when I talked about that, in addition to the survey, we bring in those public health and leaders of these organizations to weigh in as well.

00:04:20:18 - 00:04:51:19
Ryane Jackson
They are what we consider from a healthcare system perspective, frontline. Healthcare is the front line, right? They think of us for the front line. But these nonprofit organizations who are working directly with our community, especially those who are most vulnerable, they are the front line. So listening to the experts leading those organizations also complements that individualized, authentic voice for getting through the survey and help shape, you know, where we're going to go for the next three years and beyond.

00:04:51:21 - 00:05:10:14
Julia Resnick
That's great. And so I imagine as you're coming up with your priorities from your CHNA, a lot of those health needs are parallel to the health needs that are seen in the clinical side. So how do you think about connecting clinical strategies around those with community strategies to really maximize the impact that your work can have?

00:05:10:21 - 00:05:30:02
Ryane Jackson
Great question. So going back to the voice of the community, and then I'll show you how it links back to our clinical approach to the work. You know, in that community survey, in those interviews, you know we're learning also, you know, what are some of the healthcare conditions that you have been diagnosed with that you are dealing with currently?

00:05:30:02 - 00:05:52:00
Ryane Jackson
And then we match that up with secondary data that helps us determine. It looks like a lot of our community are dealing with obesity, which is a major, major issue in the country, but definitely here in Houston as well. We're one of the cities that definitely is not known for walkability compared to some of the other cities, I mean, you cannot get anywhere, barely anywhere without a car.

00:05:52:01 - 00:06:17:25
Ryane Jackson
So if you're dealing with obesity and we're also learning that people are dealing with diabetes and heart conditions. We then crosswalk that to see, well, how is that translating in our hospital walls? Some people don't like when we talk about this, especially in the space of community health and community benefit, where we often like to lean into, we want to help the most vulnerable, which we do, but there is a clinical and a operations aspect to it.

00:06:17:25 - 00:06:41:25
Ryane Jackson
So we crosswalk what the community has said from a healthcare perspective: we're diabetic, obesity, mental health issues, and we try to see are we seeing the same type of conditions in our hospital walls, starting with our E.R.? Because I think most people can agree, one of the most utilized aspects of a healthcare system is their emergency department or their emergency room.

00:06:41:25 - 00:07:03:27
Ryane Jackson
We look to see, are we seeing a lot of people coming in for these similar or related conditions? How does that translate to our readmission rates? Are they coming in for things that we think are preventable or could be managed, you know, outside of the E.R. setting, or are they coming in for very serious things that, you know, by nature of the condition, there's not very much you can do about it.

00:07:03:28 - 00:07:29:14
Ryane Jackson
Like, you know, I think about, like, cancer, you know, and a few other things. When we're able to validate or if we're able to validate that, what we're seeing in our hospital data also corresponds with what the community is saying they're dealing with, and then all the surrounding, what we call non-medical factors. When you match it up with all the non-medical drivers, you know, it helps us tell the full story and helps us determine where we actually want to focus our resources.

00:07:29:14 - 00:07:37:07
Ryane Jackson
And those resources come in a variety of ways: financial resources, programmatic resources, among other things.

00:07:37:07 - 00:07:39:25
Julia Resnick
So what are those priorities that you're focusing on?

00:07:39:25 - 00:08:09:14
Ryane Jackson
So from us being able to crosswalk, you know, what we're seeing within our hospital walls and specifically looking at our ER data, our readmissions, and coupling it with our findings from our community health needs assessment, the voice of the community - we actually have determined that we have the greatest opportunity to improve outcomes related to five key disease states. Hypertension, obesity, diabetes, cardiovascular disease, and then maternal and infant health related conditions.

00:08:09:19 - 00:08:30:25
Julia Resnick
So you have these priorities. They impact your community health programing. How do you connect them with the clinical programing? Because like you could be doing the best work in the world in diabetes in the community, but if they're not getting clinical care, they'll deteriorate and vice versa. They could be getting great diabetes care, but if they don't have access to healthy food, there's nowhere to walk, like they don't have the environment to make them healthy.

00:08:30:25 - 00:08:37:08
Julia Resnick
It's only half of the puzzle. How do you really like connect those two sides together? Because I think a lot of health systems struggle with that.

00:08:37:09 - 00:08:40:01
Ryane Jackson
That's a great question. So, you know, it's always a work in progress.

00:08:40:01 - 00:08:41:04
Ryane Jackson
But I think that we're

00:08:41:04 - 00:08:42:06
Ryane Jackson
doing and we're making

00:08:42:06 - 00:08:44:03
Ryane Jackson
some really good strides, I'd say, in

00:08:44:03 - 00:08:44:23
Ryane Jackson
creating what

00:08:44:23 - 00:09:10:26
Ryane Jackson
I like to call this ecosystem of care. So Memorial Hermann, I'd say we're somewhat unique in our approach to trying to do exactly that. How do you address and prevent some of the chronic conditions that we're seeing in our community, while also addressing some of those non-medical drivers that may have actually led to those conditions coming about? And so I'd say our approach is 2 to 3 layers of it.

00:09:10:27 - 00:09:53:28
Ryane Jackson
One, we really lean into screening for non-medical drivers of health. We have more than 40 to almost 50 community health workers across the community health division, who are strategically placed throughout our traditional community benefit programing. But more recently, we have created a community health worker hub, which acts essentially as a form of air traffic control, but also a safety net to ensure that every single patient who walks through our hospital doors is screened for at least one non-medical driver of health. Something, or I'd say, a misconception for some people when it comes to non-medical drivers or social drivers

00:09:53:28 - 00:10:17:10
Ryane Jackson
for everybody else, they associate them more with the underserved, the uninsured. But all of us, regardless of your race, your gender, your sexual orientation, we all have them. It's just a matter of how are they showing up in our lives. So we have a community health worker hub that we started just at the end of last year, at the end of 2025, and they served two purposes.

00:10:17:10 - 00:10:40:26
Ryane Jackson
One, as I said, every patient who enters our hospital, we want to make sure is screened for at least one non-medical driver. If they are discharged from our hospital before our community health workers can get to them to do that screening - because they're the ones who do it. In the E.R. setting and inpatient - that patient receives a follow up call from our community health workers that are positioned in this hub.

00:10:40:26 - 00:11:03:18
Ryane Jackson
That one, hope your stay was good, which I know is weird for hospital, but also we're doing it so we can capture those non-medical drivers. Specifically, we lean into asking questions about food, housing, utility assistance, transportation, and then after those four, it just really depends on the direction the conversation goes. So that won't be new for anybody in the space.

00:11:03:18 - 00:11:29:09
Ryane Jackson
So we capture the non-medical drivers on that side. And then of course we're doing it directly when in front of the patient. So first, once we understand what is negatively impacting our patients from that regard, we then are able to make the appropriate referrals. Sometimes those referrals go out to external nonprofit organizations who are best equipped to address things like food insecurity or housing based on where the patient lives.

00:11:29:09 - 00:11:49:01
Ryane Jackson
But where I think Memorial Hermann gets unique is we have a lot of our own in-house programing that we're able to refer these patients to. You will probably hear often with different health care systems they're screening and then they're referring them out to nonprofits. And we want to reduce readmissions. So you got to get them out your hospital and get them locked in somewhere else.

00:11:49:04 - 00:12:27:15
Ryane Jackson
That is not our approach. We genuinely, authentically are trying to help get them established in the best place possible. So we will refer them out to other organizations who have the ability to serve them in their community. But what I like about our system is that we have charity clinics that we operate. So sometimes those referrals, especially if it's an uninsured or Medicaid patient, that referral will go right there to our neighborhood health centers, which are charitable clinics that cater to that population, where we can provide not only primary care but have started to expand to provide more specialty care.

00:12:27:22 - 00:12:52:19
Ryane Jackson
Very recently, we just hired our very first endocrinologist, speaking about diabetes, who's dedicated to our neighborhood health centers. And so that is our approach to making sure that we can truly provide that diabetic care in-house for these patients, and then layering on the non-medical driver piece that we also have already come to understand that they are food insecure.

00:12:52:22 - 00:13:16:02
Ryane Jackson
We also operate in-house food pantries. We have what we call community resource centers. Their whole focus is addressing those non-medical drivers that we uncover in our populations. They can do anything from helping people sign up for SNAP, which our CHWs will sit there with them in person or telephonically and help them fill out that application and get it submitted

00:13:16:02 - 00:13:41:04
Ryane Jackson
because it can be a complicated process. Language barriers can sometimes be an issue, so our CHWs come into play there. All the things. We help them sign up for Medicaid if we determine that they're eligible for Medicaid, and they just haven't taken the steps to sign up or didn't know they were eligible. Utility assistance. But then also within our community resource centers, in addition to those eligibility applications, we have food pantries.

00:13:41:04 - 00:14:07:24
Ryane Jackson
So when our patients are screened as food insecure and need emergency food, we have the ability to right there in our pantry address that need. If they're housing unstable, we have the ability to get them do a warm connection to the organizations in our community who can help address those things. Beyond the community resource centers which are our main mecca, you know, of addressing non-medical drivers in our CHW hub

00:14:07:24 - 00:14:21:28
Ryane Jackson
that's uncovering them. As I said, we've had our neighborhood health centers that creates that clinical care piece. And then I want to take it back to our other priority area I mentioned. So diabetes is one. And then our NHC address hypertension and the others.

00:14:22:01 - 00:14:47:19
Julia Resnick
Yeah you have so much incredible work going on that is so mindful about like making those connections and making care available where people are so they can get the services they need to be healthy. I know this is complex and long term work, and it's not going to solve all of the issues today or tomorrow. But as you're looking towards the future, like where do you see this going and what would Houston look like in five years if this work was having the impact you wanted it to?

00:14:47:21 - 00:15:10:08
Ryane Jackson
It's hard to predict where we're going. I can tell you where I would love for us to be. And it's, you know, from a healthcare system perspective, all these things that I've talked about is truly a ecosystem where somebody comes in our hospital, we understand their non-medical driver needs, and then we're plugging them into their medical home at our neighborhood health center.

00:15:10:08 - 00:15:36:06
Ryane Jackson
And then we learn that they're food insecure. So we get them locked into our food support programing, and then we figure out that they are unemployed. So then we link them into our workforce development efforts, which are also part of our investment. Like somebody who we can fully wrap around with the approach that we're taking from an economic side all the way to the direct care side, and then seeing that patient or person ultimately thrive.

00:15:36:06 - 00:16:09:06
Ryane Jackson
And then hospitals' language, you say then, hey, and they didn't readmit, you know, you always take it back to that. The other part of me, though, where I would like to see things go, at least in this community, and I don't know fully what it's like in other communities, is I would like to see these large employers here in Houston, not just healthcare systems, but energy companies, higher education colleges, universities, oil and gas, which is very big here in Houston, hospitality, all these major employers in Houston, we are a major hub for business.

00:16:09:13 - 00:16:38:22
Ryane Jackson
All of us coming together in recognizing that we all have a piece or a role to play in this. There are people who are utility, you know, or electricity insecure. They can't afford their electric bill and that has health implications. So you have those major utility and energy companies saying, okay, well, we're going to own this piece in collaboration with you so that we're not operating in a silo, but we're linking everything back to what the health care system is doing.

00:16:38:22 - 00:17:05:09
Ryane Jackson
And then the universities are saying, we're going to own this education piece, and we're all working truly as a network. And I know that sounds very idealistic. It can be done. It's a collective social corporate agreement that everybody has to come to, and everyone's going to own a piece of it, rather than what I think we are starting to see, which can work too.

00:17:05:09 - 00:17:24:15
Ryane Jackson
But we're starting to see, you know, different bodies try to take on all aspects. Like everything I described here in healthcare, it is our responsibility because we care about the health, like we are a healthcare system. We need people to be healthy, and if that means we have to help people with transportation, we're going to help on transportation.

00:17:24:15 - 00:17:57:26
Ryane Jackson
If it means we're going to have to invest in affordable housing, we're going to do that. But if you step back, I believe this is our responsibility. But how much more effective could this work be if HUD said we have a agreement with the TMC, Texas Medical Center facilities and so healthcare systems, when you uncover somebody's housing insecure, we have a fast pass process to get that patient or that person, you know what they need.

00:17:57:27 - 00:18:22:00
Ryane Jackson
I'm still working it out in a more succinct way to say it, but I would just say just this corporate convening where we all own our piece while working under the same objective and outcomes reporting to actually transform. We all have enough funding, you know, on some level to do something amazing. So that's my idealism on full display.

00:18:22:03 - 00:18:44:07
Julia Resnick
I think the thread from all of these answers that it's all about the ecosystem. It's not just one program within the world of things that contribute to health. There are healthcare systems, there are social service agencies, there are community based organizations. There are other companies. Everyone has a part to play in creating healthier communities. So we're going to check back with you in five years and see how things are going.

00:18:44:09 - 00:18:46:03
Ryane Jackson
Yeah, ask me in five years.

00:18:46:10 - 00:18:54:19
Julia Resnick
Perfect. Well, thank you so much, Ryane. This has been fantastic and we look forward to hearing how this work continues to evolve and grow to serve the communities in Houston.

00:18:54:24 - 00:19:15:27
Ryane Jackson
Awesome. Thank you so much for having me. I always like talking about all the work we're doing in our healthcare system. My passion, you know, for helping. And I will continue to push my ideal vision of this massive convening where we don't just talk about it because that's very common in our space, but we're actually acting on it.

00:19:15:27 - 00:19:17:26
Julia Resnick
Love it. Thanks so much.

00:19:17:28 - 00:19:20:00
Ryane Jackson
Thank you.

00:19:20:02 - 00:19:28:22
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.

00:00:00:06 - 00:00:21:00
Tom Haederle
Welcome to Advancing Health. A child's ability to thrive starts long before the first day of school. Early literacy and language development have the power to shape their lifelong health and well-being. That's why the experts we hear from today are encouraging pediatricians to make literacy screening part of routine care.

00:00:21:02 - 00:00:49:18
Julia Resnick
Pediatric hospitals are increasingly looking beyond clinical care to support the longterm well-being of children, and literacy is emerging as a critical part of that work. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association, and this is the Advancing Health podcast. Today, I'm talking with Dr. Sara Bode, pediatrician and medical director of School Health, and Carneshia Edwards, lead of the Kindergarten Readiness program, both from Nationwide Children's Hospital in Columbus, Ohio.

00:00:49:25 - 00:01:09:18
Julia Resnick
They're working at the intersection of healthcare and education, helping children and families build the foundation for success through literacy and school readiness programs, that extend beyond the hospital and into the community. So to get started, why is early childhood literacy so important for children's health and long-term outcomes? Sara, we'll start with you.

00:01:09:24 - 00:01:31:15
Sara Bode, M.D.
Well, as pediatricians and working in the healthcare sector, we know that there are so many factors that affect whether kids thrive, grow up and are healthy, and their education is actually one of those most important determinants of if a child is going to thrive long term. And so we really care a lot about getting that start right off the bat.

00:01:31:15 - 00:01:50:15
Sara Bode, M.D.
So we know that if kids start kindergarten with the skills they need ready to learn, they're much more likely to succeed in school. And if they start behind it can be very hard to catch up. So those early years are critical to make sure that they're getting those early literacy skills and that when they start, they're ready to go.

00:01:50:21 - 00:01:56:10
Julia Resnick
Absolutely. And how did that connection lead Nationwide Children's to invest in literacy and kindergarten readiness?

00:01:56:15 - 00:02:18:28
Sara Bode, M.D.
Well, one of the things that we found is that when you are coming to Children's or any pediatric practice, you're getting checkups every couple months when you're first born, and actually you come to the doctor 15 times for checkups before you start kindergarten. So at a healthcare clinic, we have really like frequent repeated, you know, meetings with these families.

00:02:18:28 - 00:02:42:24
Sara Bode, M.D.
It's a trusted environment. And so we really want to make sure that we're addressing these early literacy skills as we have families come back. So it really is such a great place for us to address this, and traditionally, this has not been something that has been really looked at in the primary care clinic. We see if you walk on time, you talk on time, we check your development, but we've never really assessed reading skills.

00:02:42:24 - 00:02:47:28
Sara Bode, M.D.
And so this is a new idea and an addition to kind of help make sure families have what they need.

00:02:48:06 - 00:02:55:00
Julia Resnick
Yeah, this certainly is unique for children's hospitals, which is why we are so excited to talk to you. Carneshia, anything you want to add to that?

00:02:55:04 - 00:03:15:09
Carneshia Edwards
I think Dr. Bode hit it right on the nail. But just to add, like we recognize that healthy children need both medical care and developmental support. Our main goal is to really help families feel supported, empowered, equipped to really help get their child ready for kindergarten.

00:03:15:12 - 00:03:19:21
Julia Resnick
Amazing. And can you walk us through what those programs look like in practice?

00:03:19:27 - 00:03:45:19
Carneshia Edwards
Absolutely. So we go into the primary cares, and we see children preschool-aged between the ages of three and five, and we go in right before the physician goes in at their well-check visit. And so we'll go in and do a literacy screening on the kiddos. The screening looks at early literacy, language, fine motor, school readiness skills.

00:03:45:19 - 00:04:10:14
Carneshia Edwards
And so we use the book, The Reading House book to just really demonstrate for the families what they can do at home as well. And so after that screening is completed, we will connect the families to community resources. We're talking to them about their concerns. Every family receives a kit from us. And so we'll provide little things in the kits just to kind of help.

00:04:10:14 - 00:04:23:28
Carneshia Edwards
We put scissors in there, fine-motor skills that they can work on. Every child receives an individualized literacy plan as well, and so we walk the family through things that they can do to work with the child at home.

00:04:24:01 - 00:04:47:03
Sara Bode, M.D.
I mean this is really, it's a partnership. It's having this addressed in the primary care clinic really helps to show the importance of this, so those three components. It’s coming in doing the screener, and that screener's directly with the child. So it's an aha moment for the parents because our coordinators are specialists in early childhood development, and they're testing the children to see what they know.

00:04:47:03 - 00:05:09:09
Sara Bode, M.D.
And parents have one of two reactions. Either the child starts answering all the questions and the parents sometimes say, “I didn't even know my child knew that. And it's amazing,” or sometimes they're saying to us, “Wow, I didn't understand I was supposed to be teaching my child that. Isn't that something they learn in kindergarten?” And that opens up the conversation for us to say no,

00:05:09:09 - 00:05:30:26
Sara Bode, M.D.
there's a lot of early literacy skills you have prior to kindergarten. And so here's what those are. Once they finish that screening tool, then  just like Carneshia said, parents are their first teachers. So then they're giving them a bunch of materials, ideas, activities, kits, of what they can do at home, and then they're actually coordinating and connecting them to programs too.

00:05:30:27 - 00:05:39:04
Sara Bode, M.D.
So, they work really hard to get them into preschool and other library programs, different resources they need. So it's a really comprehensive program.

00:05:39:06 - 00:05:49:19
Julia Resnick
That's amazing. So when you detect that a kid is like a little far behind on their literacy, like what happens? How do you support them and their families so that they are ready for kindergarten?

00:05:49:21 - 00:06:18:00
Carneshia Edwards
I feel like everyone learns different at different paces, at different rates. And so it's not to really stress the families out about the child necessarily being behind, but more so what we can do to help support them to make sure when they get into kindergarten, they know all the things that they need to know. And so really just providing the materials that they can use to help get them there is huge for us, especially when we have major concerns.

00:06:18:01 - 00:06:40:13
Carneshia Edwards
I feel like we catch a lot of developmental delays when we're in the primary care setting too. And so really getting them connected to the resources is huge. So we make referrals for preschool. Special-needs preschool is a big one too. And just kind of going about those steps of making sure that they get enrolled into special-needs preschool.

00:06:40:16 - 00:06:59:01
Carneshia Edwards
We also refer to SPARK program. That's a huge one for us, because they actually go out to the family's home and work with the child one-on-one in the house, which is very helpful for families. And so I think the resources is really the huge piece of getting families the help and the support that they need.

00:06:59:04 - 00:07:24:24
Sara Bode, M.D.
And part of it is just working with the families to understand that, like, this is fun. Early learning is fun. So they're not sitting down completing hours of workbooks, right? So, you know, for example, we have these like, you know, magnetic letters that can go on the refrigerator. And so what are games they can play with their kid as they start to learn and understand, you know, letters, having that pencil with the grip they can use to start to think about how they doodle and trace things.

00:07:24:24 - 00:07:49:28
Sara Bode, M.D.
So it's really empowering families to understand, here’s some things you can do at home and engage and play with your child. Not only are they learning those skills, but that time in relational attention between the caregiver and the child is so important. Families are busy, competing priorities. You know, we have a lot of electronics available for kids, which are really not the greatest, you know, forum for this age to learn from.

00:07:49:28 - 00:07:59:19
Sara Bode, M.D.
So it's like turning that off, sitting down, playing together. And here's some ideas of how to do that, that’s going to support that home learning environment.

00:07:59:21 - 00:08:20:15
Julia Resnick
Incredible. And just so important for the long-term health and well-being of kids. I'm sure there are barriers that have made this program hard to start or been challenging for the families that you work with. Are there any things that other hospitals should anticipate when they're thinking about integrating childhood literacy programs into their clinics?

00:08:20:21 - 00:08:50:20
Sara Bode, M.D.
A couple things I'll say to start. One is that, you know, clinics and pediatricians have been doing developmental assessments and support for years. So sometimes people will say, well, we kind of already do this, right? We're checking on their development. We're talking to them about this. Why do we have to add an additional component? And one thing I will say is we did a lot of research before we started this, where we actually were assessing our own kids that were coming in and we were checking their developmental screening.

00:08:50:20 - 00:09:08:13
Sara Bode, M.D.
We were seeing all the advice we were giving in clinics, and we were doing great. We were checking their development and they were doing well. And then we said, okay, you're so healthy. We talked to the family, you're doing a great job. And then what happened is we had all of those kids take a kindergarten assessment when they started kindergarten in the state of Ohio.

00:09:08:13 - 00:09:31:07
Sara Bode, M.D.
And what we found is they were a majority of them failing the test. So to me, that was an aha for us that what we're currently doing isn't enough. We're not, we're making sure they're not behind, but we're not seeing if they're thriving. And that's a very big difference to be developmentally on track, but to be thriving, that's different with those early skills.

00:09:31:07 - 00:09:54:14
Sara Bode, M.D.
And so I think one is just an awareness that this is important. The second thing I'll say is that anytime you talk to anyone in the healthcare setting about adding in something, whether that's a screening tool or a new component to the well-check, there's concern because families know this too, right? You go in and you have like eight minutes for your well-check and there's so much going on.

00:09:54:14 - 00:10:25:26
Sara Bode, M.D.
But what we found, and the first thing we tested, was an ability to do this quickly with our coordinators. And so we did a feasibility study to say, can we do this at these checkups in the clinic without slowing things down? And we were able to find that, yes, we can when we're thoughtful about it. And so sharing that advice on how to incorporate it, how to get it done quickly so that it's not disrupting everything else you have to do, and then really the outcomes, it's just so worth the time and the investment for this.

00:10:26:01 - 00:10:57:06
Carneshia Edwards
I would also add partnerships are essential with developing a program within the primary care settings too, like schools, libraries, early childhood programs, community organizations, like really knowing what's in the community that can really help serve the families, and being able to share that with the physicians because everybody's working together to help serve the family. A story pops in my mind as I'm talking about this. Being in the clinic,

00:10:57:07 - 00:11:27:09
Carneshia Edwards
I had, shout out to Dr. Urs, he's a great physician. He's in the clinic, and a lot of times the physicians here, they actually have to really be sensitive to families because families are hearing for the very first time that their child may have a developmental delay, or there are some concerns. And a lot of times you might see families, especially moms, crying and very just devastated about the news.

00:11:27:09 - 00:11:52:18
Carneshia Edwards
And so Dr. Urs, I was in there one time and he was in there and mom's crying. She’s just received bad news. Not necessarily bad news, but just hearing this for the first time that there's developmental concerns. Immediately he got the social worker involved. He got me involved to help with getting the child connected to special-needs preschool.

00:11:52:22 - 00:12:17:03
Carneshia Edwards
And the social worker was also there to just kind of help with housing concerns because mom had like a lot of things on her plate, and he was just so sensitive to her. And just to see that, that does something for me because I think families need that support. And just to have everyone all together in the clinic working to help support that mom, she left, she actually left smiling.

00:12:17:03 - 00:12:32:27
Carneshia Edwards
So I think that's a huge win, and I think physicians just knowing that you're giving this kind of news to families, just being sensitive to that, I think that's helpful being in the primary care setting, doing this kind of work too.

00:12:33:01 - 00:12:35:28
Julia Resnick
Caring for kids just as much as you're caring for their parents.

00:12:36:00 - 00:12:36:28
Carneshia Edwards
Absolutely.

00:12:37:00 - 00:12:46:15
Julia Resnick
And giving the parents the tools to help their kids thrive. So how do you track the impact of these programs and like, what does that look like long term over a child's life?

00:12:46:19 - 00:13:08:20
Sara Bode, M.D.
We are tracking outcomes. When we are connecting these kids to resources and they're seeing the coordinator, we’re taking a look at these kids and their eventual scores when they take that kindergarten entrance assessment, when they start school in the state of Ohio. And so we're really excited as we continue to follow this, because we want to make sure we're moving the needle.

00:13:08:20 - 00:13:36:24
Sara Bode, M.D.
And we got our first set of results back last year. So kids last November took that assessment by their kindergarten teacher. And what we found is if they had gone through our program, where they actually had a 10 to 25% increase in their literacy score for kids, that didn't. And so we're just really excited to continue to pull in those results and track it and really understand how are we doing with moving the needle and getting these kids ready, so.

00:13:36:24 - 00:13:52:19
Julia Resnick
That's incredible. And is there any data? And I know this hasn't been going on for 18 years, so it's hard to tell. But like, how these early childhood literacy interventions impact health as they become adolescents and adults.

00:13:52:21 - 00:14:21:26
Sara Bode, M.D.
There's quite a bit of literature to show a couple of things. One is when you start kindergarten ready to learn, and specifically with literacy skills, you're much more likely to by third grade, be a fluent reader. And what we know for kids, you learn to read initially, but then after third grade you have to read to learn. So at some point, every subject that you're learning, whether that's math or science, you need to be a fluent reader in order to process that information.

00:14:21:26 - 00:14:46:08
Sara Bode, M.D.
And so what we know for kids and even teenagers, if we can get that early literacy going so that then their fluent readers later, they are so much more successful in all of their academic ventures throughout school. And kids that can like complete high school and graduate are actually less likely to have a host of health conditions. It's even associated with, like the rate of heart disease in adults.

00:14:46:09 - 00:15:18:27
Sara Bode, M.D.
So if you are healthy and graduate high school, you're much more likely to meet your potential and be a healthy adult. You have better health behaviors, health literacy, less likely to have any of those chronic diseases we talk about like diabetes or heart disease. So this is very much linked to ultimate adult health outcomes. And so, you know, it's interesting to think about this, but we tell this to parents, if you can sit with your child and do these fun activities now, they might be less likely to have a heart attack in their 50s.

00:15:18:28 - 00:15:21:22
Sara Bode, M.D.
I mean, it is totally linked.

00:15:21:25 - 00:15:26:25
Julia Resnick
Talk about return on investment. Read fun books with your kids. They don't have a heart attack.

00:15:27:01 - 00:15:42:28
Sara Bode, M.D.
Exactly. Keeping kids healthy and really meeting their potential learning. It just has huge ramifications for us. And that's what we're all about in pediatrics, it's all about prevention. And so this is what we want to kind of work on with our families when they're coming into the office.

00:15:43:01 - 00:15:59:01
Julia Resnick
That is the whole point. And Dr. Bode, Carneshia, thank you so much for sharing this and for all the work that you're doing to help parents and kids in your community thrive. It's just really incredible work that you're doing. I'm inspired. I'm sure our listeners will be inspired as well. So thank you both.

00:15:59:06 - 00:16:00:03
Carneshia Edwards
Absolutely.

00:16:00:06 - 00:16:02:04
Sara Bode, M.D.
Thanks for having us.

00:16:02:07 - 00:16:10:28
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;08 - 00;00;20;01
Tom Haederle
Welcome to Advancing Health. It's now been one year since Congress allocated $50 billion aimed at upgrading and expanding access to health care in America's rural communities. So, is the funding making a difference? What can rural residents expect? We explore these questions and more in today's podcast.

00;00;20;04 - 00;00;38;13
Shannon Wu
Hi everyone! My name is Shannon Wu. I am a director of payment policy here at the American Hospital Association. On this episode, we're going to talk about something very near and dear to my heart, the Rural Health Transformation Program Fund. As of this taping in June 2026, we are a little bit more than halfway through the first year,

00;00;38;18 - 00;01;02;25
Shannon Wu
where about $10 billion will be awarded to all 50 states. We thought it'd be a good time to talk about how the program is going, and what policymakers can do to further support rural communities. So with that, I'm really happy to introduce my fellow podcaster, Maya Sandalow from the Bipartisan Policy Center, joining me today to talk about everything Rural Health Transformation Fund related.

00;01;02;26 - 00;01;22;21
Shannon Wu
Maya is an associate director for BPC’s Health Program, where she leads work on health innovation policy. Her portfolio includes digital health, artificial intelligence, rural health, behavioral health, and nutrition. So with that, Maya, would you mind just describing a little bit more about the center and the work that you all do there?

00;01;22;23 - 00;01;44;24
Maya Sandalow
Thanks so much, Shannon. It's great to be with you today, and I'm so glad to be talking about the Rural Health Transformation Program. As you mentioned, I work at the Bipartisan Policy Center, and we're a nonprofit that's been around since the start of the 2000s, founded by former Senate majority leaders. And we work across the full political spectrum on domestic policy issues.

00;01;44;24 - 00;02;08;07
Maya Sandalow
So we aim to bring together diverse perspectives to craft solutions focused on lowering the everyday cost of living for families, expanding opportunities and strengthening the American economy. And we have a pretty robust health program that focuses on a range of topics, including rural health care, which is an area that we focused on for years, because one in five Americans live in rural areas.

00;02;08;07 - 00;02;12;27
Maya Sandalow
And so therefore, it's important to make sure that they can access the care that they need.

00;02;13;00 - 00;02;40;09
Shannon Wu
So we're really happy to have you here. Before I let you describe some of the key initiatives each of the 50 states are undertaking — I know you all have done a lot of work in that in the past couple of months — I'm just going to briefly describe the basic structure of the Fund for our listeners. So the basic structure of the Fund is that all 50 states had to apply for this funding, of which half of that $50 billion will be equally given to every state that applies.

00;02;40;09 - 00;03;02;24
Shannon Wu
And the other half is based on an application process the states went through at the end of last year in 2025. The program will run for five years, and the application process, as I mentioned, began at the end of last year. And the Centers for Medicare and Medicaid Services, which is the agency tasked for administering the fund, announced those awards the end of the year in 2025.

00;03;02;26 - 00;03;23;14
Shannon Wu
The Bipartisan Policy Center and the AHA have put out excellent primers on the notice of funding opportunity, if our listeners want to learn a little bit more about that application process, and you can find both of those primers on our websites. So, that's kind of the basic structure of the Fund. We’re into year one of the program now.

00;03;23;16 - 00;03;46;00
Shannon Wu
So Maya, I know the Center has done a lot of work in analyzing the applications, the key initiatives and projects that states have applied for. Do you want to talk a little bit more about, you know, kind of the broad programs each of the states have applied for, and then one or two key programs that you and the Center is focused on diving into a little bit further.

00;03;46;02 - 00;04;16;19
Maya Sandalow
Yeah, absolutely. And just to pick up on kind of the broad overview of the Fund, I think that it's important to note that CMS has a stated goal for the use of these funds to really transform healthcare delivery, right. So this $50 billion program was included in last year's reconciliation package, largely in response to concerns about federal Medicaid funding cuts in the years ahead and the impact on rural areas.

00;04;16;19 - 00;05;02;12
Maya Sandalow
But the Fund itself isn't necessarily intended or designed to directly replace those funding cuts to providers. Rather, it's focused on broader healthcare transformation. So CMS has a variety of strategic goals, including addressing the root causes of disease, investing in technology innovation, workforce development, value-based care. They really outline several strategic goals. And so what my organization BPC did was we reviewed all 50 state plans, state proposals, that they put together as part of their application process in the fall, to try to pull out some common themes and look at really across these strategic priorities that CMS has outlined.

00;05;02;14 - 00;05;32;15
Maya Sandalow
Where are states really committed to investments? The level of detail varied widely in their state applications. But that said, we were able to discern that every single state plans to invest in technology and workforce in some way. So those are really two of the biggest themes that we picked up on. And we outlined specific categories of how they plan to invest in technology and workforce in several publications.

00;05;32;15 - 00;05;35;16
Maya Sandalow
So I'm happy to walk through the details of those, if helpful.

00;05;35;19 - 00;06;05;16
Shannon Wu
That'd be great. I know on the topic of workforce, especially, for example, you know, the AHA believes that the needs of rural providers and rural communities and rural hospitals are really fundamental, and one key initiative and support that we're really looking for is a workforce development, both in recruitment and retention of current workforce, but also really building that pipeline out to make sure that access to care in rural communities is maintained and even expanded.

00;06;05;16 - 00;06;18;17
Shannon Wu
And so we really strongly believe that the funds should really prioritize these fundamental priorities in rural communities. So I would love to hear from you, the workforce type of initiatives that you are seeing in these state applications.

00;06;18;23 - 00;06;41;09
Maya Sandalow
Yeah, absolutely. Workforce is a central priority of the states, and to your point, it's no surprise, right? Because the rural areas have long suffered from workforce shortages and providers who are fantastic but really stretched thin. So we identified broadly three ways in which states are planning to invest in workforce development and workforce issues. The first is training and bringing along new providers.

00;06;41;09 - 00;07;13;26
Maya Sandalow
So the pipeline piece that you mentioned, and that's from a pretty young age, we see some states investing in healthcare training at the high school level. We see some states investing in medical school. So Delaware, for example, is proposing the state's first ever four-year medical program. Also, investments in new rural residency programs. And then many states focused on how can we retain those new providers through things like housing bonuses and incentive structures?

00;07;13;27 - 00;07;43;21
Maya Sandalow
That whole bucket a lot of that is subject to a five-year service requirement. So every investment that's tied to an individual and leads to a credential or a degree of some type, based on CMS's requirement, those individuals are required to stay in that rural area for a minimum of five years. The second category that we kind of pulled out is upskilling and building the infrastructure needed to sustain the existing workforce, right?

00;07;43;22 - 00;08;14;19
Maya Sandalow
So that's everything from training providers who are stretched thin. They may not have the time or the resources to really ensure that they're kind of practicing at the top of their license. So investing in training for those providers, things like how to use telehealth, or like robotics and surgery, right. So various types of training initiatives. Also, states focused on closing the data gap so that they have the information that they need to know where are their workforce shortages, so that they can kind of allocate resources efficiently.

00;08;14;19 - 00;08;43;12
Maya Sandalow
And then also lots of focus on non-clinician workers right. So community health workers, peer support specialists. These really important workers making sure that they're reimbursed adequately. And I'll just say the third theme that we pulled out relates to policy actions. So through the Rural Health Transformation Program, states received points in the potential for more funding if they commit to certain types of policy actions. Two with a lot of relevance for workforce are interstate licensure.

00;08;43;17 - 00;09;06;00
Maya Sandalow
By default, providers have to be licensed in the state that the patient is, in order to deliver care, but states can join what are called interstate licensure compacts, which makes it easier for providers to practice in other states. And so states are incentivized and some states are committing to joining interstate licensure compacts through the Rural Health Transformation Program.

00;09;06;01 - 00;09;25;15
Maya Sandalow
And then the second policy piece is scope of practice. right? So that relates to what healthcare workers are allowed to do based on their state medical licensing board requirements. So some states are proposing to, for example, expand what pharmacists or nurse practitioners or physician assistants can do with their funds.

00;09;25;15 - 00;09;51;21
Shannon Wu
And I know another piece of some key programs and initiatives that I think all 50 states applied for, as well is related to technology, whether it's AI, whether it's telehealth. I also know that the Center has put out some great primers on the projects and initiatives states have applied for in that regard. Do you want to talk a little bit about what you all are seeing across the states, in some key themes that are coming out from that bucket of funding?

00;09;51;27 - 00;10;26;00
Maya Sandalow
Yeah, technology investment is a really big focus across all 50 states. We identified four broad categories. So the first is states investing in the foundational health IT infrastructure that's needed as kind of a prerequisite for broader transformation. And that's really important, right? So modern healthcare really runs on data, but right now rural facilities might not necessarily have the resources that they need to make sure that the data of a patient is moving with them when they, for example, see a specialist in another town.

00;10;26;00 - 00;10;49;29
Maya Sandalow
And that can lead to duplicative tests and unnecessary care. So states are investing in that foundational infrastructure. Also in that category, cybersecurity readiness. We know that rural healthcare facilities have been subject to cyberattacks in recent years. So states are investing in kind of ensuring that healthcare facilities are prepared for potential cyber. That first bucket is really foundational.

00;10;49;29 - 00;11;11;26
Maya Sandalow
We also see states investing in expanding access to digital health, things like telehealth and remote patient monitoring. Patients in rural areas tend to live pretty far from providers, have to travel really long to get the care that they need. So you can imagine this telehealth and patient monitoring being really valuable for patients, but rural areas tend to have less access.

00;11;11;26 - 00;11;44;07
Maya Sandalow
So states are focused on closing that gap. One story that really illustrates the potential here. I talked to a patient named David last year, and he's in his mid-80s and he lives in rural North Carolina. And he really credits his remote patient monitoring program with keeping him out of the hospital consistently. Like every morning he checks his blood pressure, he uses a weight scale, and his data is automatically sent to a remote healthcare provider who, if there's something out of range, can call him, adjust his medications.

00;11;44;07 - 00;12;12;28
Maya Sandalow
So there's really a lot of potential here for it to help patients health and also save money. The third bucket is artificial intelligence, which everybody is talking about right now. Same story here. Rural areas tend to have less access to AI. You know, AI is long been used in areas like medical imaging. Increasingly it's used a ton in clinical documentation, which can help to reduce burnout and kind of administrative burden on rural areas.

00;12;13;04 - 00;12;39;07
Maya Sandalow
Then the fourth and final category that we pulled out are something called rural technology catalyst funds. And these are created by the Rural Health Transformation Program. States are allowed to invest up to 10% of their money into this. And it's really meant to be a catalyst for innovation. So states partner with external entities. So maybe a startup incubator to vet technology proposals.

00;12;39;07 - 00;12;51;25
Maya Sandalow
And then those external entities can also bring in outside capital, so it's a way to combine public investment with private investment. So that fourth bucket is definitely something to keep an eye out for.

00;12;51;27 - 00;13;16;06
Shannon Wu
That really runs the spectrum of kind of the core infrastructure needs of setting up health IT. You know, for us, we tend to think of kind of the broadband needs of rural communities, right, kind of having that initial infrastructure. But now you also describe the fourth bucket in terms of really innovative care using drones, etc. So this will be a really interesting, I think, bucket of funding to see what states do.

00;13;16;09 - 00;13;56;27
Shannon Wu
Well, I know that, you know, with this funding, as we said before it's a five-year program. The AHA and BPC have suggested to policymakers other initiatives and models of care for rural communities. You know, that this funding could use, but also beyond the scope of this Transformation Fund, right? So for us, for the AHA we publish our Rural Advocacy Agenda every year at the beginning of the year, which our listeners can find on our website. For this year, in addition to understanding and seeing where the progress of this Transformation Fund is going, one of our main focus is also holding commercial insurer actions accountable so that patients have timely access to care.

00;13;56;27 - 00;14;23;22
Shannon Wu
And these actions include prior authorization denials for patient care, delayed payments to providers, among other actions used by commercial insurers. I'm curious, does the BPC have any particular recommendations or policy that you are thinking about now or in the future, that's really aimed at ensuring that access to care in rural communities is maintained or expanded on? We would love to hear kind of what you all are thinking in this space as well.

00;14;23;25 - 00;14;51;20
Maya Sandalow
Yeah, absolutely critically important, and we are focused on a lot of the same areas that AHA is. We're coming out with an issue brief in the next month that will really elevate federal bipartisan policy priorities to bolster rural healthcare. And that will include really re-upping recommendations that have existed for a long time, as well as some new ones, to help to kind of sustain and maximize the investments of the Rural Health Transformation Program.

00;14;51;22 - 00;15;15;07
Maya Sandalow
There's going to be a lot of recommendations in that. I'll highlight two. Both relate to Medicare funding, because Medicare is really a primary payer for many rural hospitals and rural health care facilities. So the first one that I'll talk about is something called Medicare rural hospital designations. Those are extra funds that are given to hospitals with low volume in geographically-isolated areas.

00;15;15;07 - 00;15;40;25
Maya Sandalow
And there's a really strong track record for a lot of these programs and incentive designations. Yet, several of them lack permanent authorization. And so Congress has extended them year after year. And that makes it harder for providers to really have the security to be able to invest in kind of supports for their hospital and know that there's going to be financial stability over time,

00;15;40;25 - 00;16;11;09
Maya Sandalow
so we think that those should be made permanent. And then another thing that we think should be made permanent is access to telehealth and telehealth funding through Medicare, right? Telehealth is a fixture in the U.S. healthcare system at this point, yet Medicare payment for most of telehealth relies on temporary extensions. And we saw the repercussions of that this fall when there was a government shutdown, actually. Authority for Medicare financing for telehealth lapsed,

00;16;11;10 - 00;16;23;08
Maya Sandalow
right? And so this is a big barrier to long-term investment in the telehealth infrastructure is the need for these temporary extensions. So we call for permanency on that as well.

00;16;23;11 - 00;16;47;15
Shannon Wu
We really appreciate those recommendations. We support all that and especially on the Medicare-dependent designations and low volume, I think that's been a long -standing AHA policy as well, making those permanent, because we do hear from our members that having that security in payments, in these really geographically-isolated and Medicare-dependent hospitals, it really makes a big difference.

00;16;47;15 - 00;17;12;14
Shannon Wu
So we appreciate all the work that you all are doing to spearhead all that as well. Maya, we really appreciate you, appreciate your time and coming on to the podcast and of course, efforts from the Center and supporting rural communities. I know you all are hosting a virtual event coming up this month, right on the Transformation Fund? So do you want to give our listeners a little bit of detail on how to sign up for that, and what you guys will be talking about during that virtual event?

00;17;12;19 - 00;17;40;26
Maya Sandalow
Yeah, absolutely. Thank you for highlighting that. So BPC will be hosting a webinar on June 30th. You can go to our Events page at bipartisanpolicy.org to sign up. And we're going to bring in some experts that represent different state perspectives and can kind of speak to implementation, transparency, sustainability, some of the key questions that experts are raising when it comes to the Rural Health Transformation Program.

00;17;40;26 - 00;17;59;23
Maya Sandalow
And then we'll also outline some of the key themes that we've picked up as we reviewed all the state plans and give a preview to some of those federal policy recommendations, that are important for sustaining access to rural healthcare. So definitely tune in. We've got lots of great experts joining that event.

00;17;59;28 - 00;18;24;20
Shannon Wu
That's great. I'll definitely be tuning in. I know we're really looking forward into how that transparency piece is going to play out for the Fund and knowing where the funds are going, how they're being awarded, where they're being used. We really are looking into that as well. So, as the Fund continues into years two through three through four through five, we'd love to have you back on other episode of the podcast.

00;18;24;21 - 00;18;43;06
Shannon Wu
Just discuss how things are going, how progress is doing, what other programs and models of care that you all are suggesting to policymakers at the Bipartisan Policy Center as well. So again, we really appreciate you coming and joining us on this episode of this podcast, and we look forward to having you back. Thanks very much.

00;18;43;08 - 00;18;48;10
Maya Sandalow
Yeah, thank you so much for having me. Look forward to coming back in the years ahead.

00;18;48;13 - 00;18;57;03
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.