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Becker’s Healthcare Podcast
Advancing Rural Health Access and Innovation with Brendan Harris & Patti Jackson-Gehris
00:23:52
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- [00:00]
A
Hello, everyone. This is Jacob Emerson with the Becker's Payer Issues podcast. Thrilled today to be joined by two senior leaders from upmc. Brendan, Patti, thank you both very much for taking the time to be with me on the podcast today. Before we dive into everything we want to talk with you about and some really impactful initiatives going on at upmc, can you both first tell our audience a little bit more about yourselves, your background in healthcare and what your roles entail at UPMC today? Patti, I'll come to you first.
- [00:31]
B
Yes, thank you. I'm very happy to be joining with you today. My name is Patti Jackson. I'm the market president for what I refer to as UPMC and North Central pa. I'm coming to you today from Williamsport, Pennsylvania in Lycoming county, and I oversee four hospitals in a very rural part of Pennsylvania. So my career started a very long time ago in my twenties in the Philadelphia market, and I worked primarily as a consultant in the healthcare industry and moved to a for profit health system and then joined 11 years ago, UPMC here in Williamsport, Pennsylvania. The thing that I love most about my job is waking up every day in these communities and figuring out how we meet the needs of every single member and how we continue to do things differently and better to ensure access to great healthcare. So I, I work with a great team and a lot of people really dedicated and passionate about what they do here.
- [01:29]
A
Thank you, Patty. How about you? Brendan?
- [01:31]
C
Hello. It's great to be back on the podcast. And I'm Brendan Harris. So I'm responsible for all of our state programs that work on Medicaid. And I'm glad to be part of this conversation because I'm originally from a small rural community here in southwestern Pennsylvania. And I've seen firsthand in my life, you know, growing up in that small community, but also in my time in government, really working through a lot of the challenges that our communities face in making sure that they're able to maintain access to health care and a lot of these essential services.
- [02:07]
A
Wonderful. Well, thank you both very much for taking the time out of busy schedules to chat with us about some really important issues going on across the country. So I know you both are very familiar about the crisis that rural communities across the country are facing. And certainly in Pennsylvan, Pennsylvania, with growing challenges to accessing high quality health care and that pressure, it's hitting hardest in places you mentioned, Patti, places like Lycoming, Potter Counties in Pennsylvania. So can you detail for us, Patti, a little bit about how UPMC is approaching rural health right now. New strategies, new initiatives to really boost high quality care access.
- [02:52]
B
Absolutely. So the, the area, even though I'm here in Williamsport, I have three critical access hospitals that I oversee in our region. One is in Lycoming county, one is in Tioga county, and one is in Potter, which you mentioned. And I use a little fun fact about Potter county when I talk about it. You know, a lot of urban markets have 1700-2500 people per square mile. In Potter county there's 15 people per square mile. So beautiful, beautiful land. But, but it is a low population. So you know, for me it is always rooted in the needs of the community first. And so we do a health needs assessment every three years and that's really where we get a pulse on where are the gaps in care, where are people struggling most. And, and it's always things like diabetes, heart disease, you know, growing, you know, disease states. But also it's food insecurity, it's transportation issues. Those are some of the fundament with access to care. So we start there and the challenges facing us now is really looking at how we reinvent and do things differently. We're focusing on right care, right place. We can't be redundant. We can't have everything everywhere. But we can make sure there's access points for care and that we can get people to the next level of care if they need it. And really focusing on people getting further upstream, prevention, education, how do we keep people healthier to avoid some of those disease states that we address on a regular basis? I always say to people, you know, the last place we want to see you is in the emergency department. Right. We want to keep you in your primary care office, keep you well outside of the walls of the hospital. We'll have the services for you if you need it, but we need to figure out how to address it further upstream. So it's a lot of things that challenges that are facing health care and it's going to take partnerships across all areas for us to figure out what we're going to look like three, five, ten years from now.
- [04:52]
A
And Brendan, bring the policy standpoint in here from the strategy that Patti just laid out for us for UPMC and where federal, state, rural health transformation goals are heading have been laid out over the last year or so.
- [05:08]
C
Well, I mean, I think Patti hit the nail on the head really with talking about those other things that have an impact on someone's health and well being. And, and really I think at the heart of it is meeting People where they are and finding those different avenues to provide care in that sense. And you know, because really from a policy standpoint, rural access is at a critical inflection point. I mean, I think we're seeing growing care deserts at the same time that we're seeing that the traditional models are not necessarily working. And it's not just about financial pressure on hospitals in rural areas, which is obviously a big piece of things. It's about really trying to look at the overall healthcare system and how you can access those different gaps or assess those different gaps and really look at how you can get care to people either through technology and telehealth or meeting people where they are. Because really the care shouldn't be in the emergency room. And that's what's happened in a lot of areas. And you know, really we're seeing some really truly key policy opportunities as we look forward here by the federal and state government with the Rural Health Transformation Plan and program that was part of the big HR1 legislation that passed last year. And a lot of that is really aligned around redesigning and not just short term relief, because really at the end of the day short term relief is not going to do that. And this is really where UPMC has a unique position in this really at the end of the day, because you know, we're really hitting all the different parts of the full continuum with the health plan, obviously where I work, but also working in conjunction with our hospital partners, our physicians, our behavioral health network and our home and community based providers to really invest in the workforce, the bringing technology enabled care to the table and doing this as a regional collaborative, collaborative approach. Because at the end of the day we're all in this together and it's not just an us versus them scenario. And I think that's really where we look at some of these broader policy opportunities and that strategy is becoming more and more clear. We can't just preserve what's here today. We have to look at how we redesign how care is delivered in these communities. And I think that's really where this program gives us some unique opportunities. Because you know, the funding is focused on building infrastructure and then bringing insurers and some of us to the table to really help with that sustainability. Because that's really at the end of the day you can put a pilot together, you can try something new, experiment, but if you can't sustain it, it's not going to solve the long term problems. And I think that's really where you need that broad collaborative approach together from both the payers, the providers, the community based organizations, the local elected officials to really come to the table to really understand what's happening there and really look at how we create sustainable programs, alternative payment models, and having benefit design that really encompasses how you can meet people where they are and really continue to serve in these rural communities. And you know, while with the program there's only five years of funding, I think the way that we can approach it collectively, and this is how we've done it at upmc, is having all sides at the table so that we can work together to really sustain this and make sure that we're able to really reinvigorate rural healthcare and continue to provide that access.
- [08:49]
A
Absolutely, and you touched on this, Brendan, but part of this $50 billion federal initiative is grants for workforce development in rural areas. So can you talk to the audience a little bit about why workforce development is a central piece of solving rural healthcare access?
- [09:09]
C
I think at the end of the day, you can't really provide care unless there's people. This is the people business. And in places where you have care deserts, you have a lot of services that are disappearing. And we need to make sure that the workforce is really there and that we can have infrastructure in place, technology and, and all those different things and big buildings and everything. But if you don't have the people, you're not going to be able to make it work. And that's really at the heart of it. And you know, we see opportunities and we look at this in obviously that's a big challenge that we've got across the board, but also with substance abuse, behavioral health, all these things, even in urban areas. So we need to really kind of collectively come together to look at that. And it's a safety issue at the end of the day for a lot of this. And if you don't have the infrastructure in place and the workforce that's able to provide that care, it really limits what you can or cannot do with providing that care.
- [10:09]
A
And Brendan, I know that UPMC has been investing in surgical OB fellowships for family medicine physicians, rural OB GYN fellowships. Actually, Patty, I know Brendan touched on this earlier in terms of the care deserts that are emerging in parts of the country. So from the clinical standpoint, if we're talking about maternity care deserts specifically, they're becoming more common across your region as well in the markets you serve. So what does that mean for pregnant women in an emergency right now? What are you seeing at the hospitals that you oversee?
- [10:46]
B
Right. So over the last year we have been working to transforming to a new model of care for labor and delivery and for women's services across Potter and Tioga counties. You know, Brendan talked about the financial pressures, and they're real. I have never seen in my 40 plus years in health care this level of financial pressure. But that is not the only thing. The workforce is definitely one of the factors that's really causing us to rethink some of our care delivery and how we do it. For instance, in Potter county, we had a labor and delivery unit that we regionalized with UPMC Wellsboro, which had a labor and delivery unit about 45 minutes away because we had been recruiting for an ob GYN doctor for over two years with zero recruits. And so we really had to critically look at that. With declining population, declining volumes, we had to reinvent care. So it's easy to just say we're going to stop doing something. It's hard to say how can we meet the needs of the community, but in a different way. And so that's what we've been doing in this space in my market. And so we're really doubled down on prenatal care, on getting people to those appointments and having a care team that they can see in their community close to home for all of their prenatal care. But when it's time for delivery, making sure they have a planned delivery and that they have the same care team they're seeing in the office when they come to the hospital for delivery. And looking at that full continuum of care and access in all areas is what's really important. And these are hard decisions, but we're seeing it work and we're seeing women really step up. And what we've been able to do in that market is we've been able to stabilize the workforce. We've been able to recruit to this model in Wellsboro. We've been able to hire our first family medicine obstetrics doctor that we've not had before into this model under the leadership of our OBGYN lead doctor that there. So it is about doing it differently. And that's the hard part for communities to understand is we've always had this, but with what's facing us moving forward, how do we reinvent and how do we deliver care in a different and hopefully better way? I think the work that we're doing around prenatal care and doing more and opening up more access there is helping the community and is improving outcomes.
- [13:04]
A
And Patti, sticking on this topic, but expanding a little bit beyond maternal and prenatal care. Can you talk A little bit about UPMC's work and some of the outcomes you're seeing around areas like dementia diagnosis, behavioral health, access in the markets you serve as well.
- [13:19]
B
Sure. So, you know, so much of the work we do is outside the walls of our facility. So the more we are out there, so we have a mobile health unit that we deployed in Tioga county and Potter county, and they're doing things to get out to the people. Brendan said it exactly right. You got to go to where people are, and they're bringing out providers, they're bringing out our, you know, community health workers, and we're educating people and we're getting to them. You know, about early diagnosis with dementia. We know if that we can educate them on what to look for, get them to that primary care doctor quicker. We're going to see better outcomes with them. Same things around prenatal care. I'll share an interesting story. Something that is a simple innovation is food insecurity is rampant throughout all of the communities that I serve. And food is health, right? Food is medical. You need to have good nutrition and access to food to be healthy. And so we partnered with the local food banks and we do two different programs. We use our mobile health unit to go out, and while we're doing that education, we distribute food boxes and we distribute food to those communities, and it's wildly successful. In addition, we have an emergency food box program in all of our hospitals. So if you come to any of our hospitals or physician practices and we ask the question, you know, do you have access to food? Do you have something to eat when you go home? If the answer is no, they leave our facility with a box and we enroll them with the local food bank to make sure they continue that access to food. And that is one of the ways we improve outcomes. Because, you know, if I talk to. I had an interesting conversation with one of my dietitians not too long ago, and they see people coming in here in cardiac arrest and diabetic, you know, shock and things like that. And they said, you know, when they sit down and meet with these patients, they believe that that could have been avoided. But it was the food insecurity that triggered, you know, that. That increase in that disease state that got them into the emergency department. So. So that's a way that we're improving outcomes, is getting out and about to the community, meeting them where they are, providing them with information, and then help connect them to the care that they need.
- [15:31]
A
Well, Brendan, let me come back to you and talk a little bit about Other things that the Rural Health Transformation Program will be funding or providing grants to around technology development and adoption in rural areas. I know telehealth, econsults, remote monitoring or are a big piece of UPMC's rural work and strategy. So can you talk to us a little bit about how those technologies are helping bridge some of the geographic gaps without displacing the local care teams that you're trying to build up right now?
- [16:04]
C
Well, and I think that's at the end of the day, it's not about replacing the local care teams, it's about supplementing it. Ultimately, it's an access multiplier, but it's not a replacement for that local care. You still need that local, local care and that local presence. But one of the great things about telehealth and econsults remote monitoring is another one. It's extending the reach of our providers into places they otherwise would not be able to go and that would otherwise be in isolation. And we've actually brought a lot of telehealth into some of our rural hospitals here in Western Pennsylvania with one of our facilities in the Northwest where you've got a local care team there. But they're able to then access a lot of incredible infrastructure and specialists to really stabilize patients in the population. And the goal isn't to centralize that care, it's to support the local teams with that specialty expertise and real time backup so that patients can stay in their communities whenever possible. And we see this happening also with behavioral health. Telepsych and consults that are happening have extended the reach of behavioral health providers into a lot of these communities. But you also need to make sure that the local care teams are supported and having initiatives that really provide consult services, but also give them additional support and expertise to be able to provide that care and get the patients and the population stabilized locally. So I think that's really a lot of where our first focus has been through the years is how can we develop that, that infrastructure to really connect into some of those specialists and really be that extension. Because to a lot of Patty's points, you know, trying to bring that workforce into some of these rural communities gets very difficult. But if you can extend it from an area where they are, it opens up a world of possibilities as you can bring that infrastructure locally and really meet people in those rural communities.
- [17:59]
A
Absolutely. And Patty, talking about this from the perspective of how this impacts older adults, what would you add there in terms of what Brendan just laid out and how you're now able to better or will be able to better reach seniors who of course face travel challenges across long distances trying to reach your brick and mortar facilities. What does that all mean for them?
- [18:21]
B
Yeah, so it's interesting. Pre 2020We've said people aren't going to do it, they're not going to adopt telemedicine, they're not going to do videos visits with their doctors. And then you know, a global pandemic happened and it catapulted forward people's adoption of this kind of technology. And the older adults were probably the most resistant. But I, you know, fast forward to where we are today. They love it. They love the ability to get that access and to be able to do the video visit and you know, we do some training and some education with them, but they love that access. You know, this ties directly into the work we're doing with our or emergency medicine professionals in the field are EMS workers. They can go into a home of an older adult who maybe can't leave their home easily and they can do a video visit back to their primary care doctor or their specialist and can be the intermediary to make sure that they're getting the care they need and help get them checked out. So it's really helpful. And it's not just the, the visit, the primary care doctor visit or the specialty doctor visit. There's education that can be done. We can do med checks, we can do diabetic education, we can do falls and risk management, you know, via video visit in talking to people and talk them through what they need to look for. And the other great thing about it is it's easy for families to participate. So sometimes, you know, maybe that caregiver isn't in the same location as their, their mother or grandparent is. And when you do the video visit, they can participate, participate in their care. So it's really opened up a new world of possibilities and adoption is going very well.
- [19:53]
A
That's amazing to hear and it's so great to hear that you've also been seeing older adults really pick up the use of this technology. Patty, Brendan, before we go, you know, we've touched on a lot of different things today. I know we could have a much longer conversation about this program and the trickle down effects for your patients. But if we're looking, as you mentioned, it's a five year program. So if we're looking at that timeline five years out from now, how does UPMC measure success here and what should some of your rural patients be expecting on the ground over this Timeline, I
- [20:27]
C
mean, I think over the next five years. And you're absolutely right, we could be going on and on for quite some time about this. But. But really, I mean, I think when you look at the opportunity before us and a lot of what Patty has put into place and what we've done across UPMC is success is going to be measured in practical terms. I think that's really where a lot of this comes in. It's more local access points, maybe not through the traditional means, but through telehealth and some of the other things that we talked about here. It's a stronger rural workforce. We know individuals who come and work in those rural communities oftentimes want to stay there. And when you invest in them and invest in that, it can go long way, you know, trying to look at fewer avoidable emergencies. I think to Patty's earlier point, it's meeting people where they are and going to them so that care is not just defaulting to the emergency department and having some of those mobile opportunities. And, you know, really looking at how you can bring some of that care to them. And really for the residents, it's. The hope is that there's going to be less fragmentation with this. Again, a lot of this is really looking at the overall continuum and all of us coming together to really solve the core issues, which means hopefully less long drives and having that care accessible and local. And it's not how many programs we launch, it's how many are still working and growing at the end of that point. Because again, back to the funding that's coming through this. It's some startup capital, but we need to be able to sustain this by models that actually make sense and really provide the true supports that our communities need and deserve.
- [22:07]
A
And Patti, your final thoughts for us and how this all shakes out over the next five years?
- [22:12]
B
Yeah, I mean, I feel a tremendous need to really advocate and share, just like I'm doing here today, you know, what the needs are in these rural communities. And, you know, we need to maintain the funding that we currently get. But the real Health Transformation funds is exactly what Brendan said. It allows us to really find another avenue to reinvent the care models. You know, if there's one thing I can tell you for sure, the future of healthcare and hospitals is going to look very different. And for us to make sure that difference includes great access, great care and a thriving health care network, it's going to be be these new models of care. So some of the work that these funds will enable us to do with workforce development with education and prevention and wellness with getting access through non conventional methods like different telemedicine centers, video visits. And a big piece of what we're looking for in our rural communities is really bolstering that EMS profession, because when you talk about hospital at home and taking care of where the people are, they're going to be critical to that. And so these funds are going to allow us to sort of forward in a quicker way some of those initiatives around our ems, you know, that serves these very critical rural regions.
- [23:28]
A
Wonderful. Well, Brendan, Patty, thank you both very much for being with us today and for sharing about the latest strategies going on under your leadership to provide this high quality care in rural areas. We really, really appreciate it.
- [23:41]
B
Thank you.
- [23:42]
C
Thank you.
- [23:43]
A
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