← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Expanding Rural Access and Strengthening Community Health with Kelly Macken Marble
00:18:16
Loading summary
Transcript19 lines
- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.
- [00:32]
B
This is Laura Dardo with the Becker's Healthcare Podcast. I'm thrilled today to be joined by Kelly Mackin Marble, Chief Executive Officer at Osceola Medical Center. Kelly, it's a pleasure to have you on the podcast today.
- [00:42]
C
Well, thanks so much for having me.
- [00:44]
B
Absolutely. Now, I'm excited for our conversation because I know there's so much happening in the healthcare space and particularly looking at how hospitals and systems are staying transformative and really meeting some of the big demands and needs in healthcare today. But before we dive into that discussion, can you tell us a little bit more about yourself as well as Osceola Medical Center?
- [01:05]
C
Absolutely. So again, Kelly McEn Marvel CEO here at Osceola Medical Center. I've been in healthcare leadership now for close to 35 years, so a very long time. Started out in nursing and in Michigan and have sort of made my way along and most of my career spent in the twin cities, Minneapolis, St. Paul area as well. And I've been in my current role for about three years and really enjoying it. It's been for me a nice opportunity to come back to my roots in population health, which is an area that I have a lot of passion around. So excited to be here. Osceola Medical center is a critical access hospital and also a rural health clinic. And we are located in Northwest Wisconsin. We're literally just a bridge away from Minnesota. So we sit right on the Wisconsin Minnesot border, and we are less than an hour away from the Twin Cities. So we're really in a nice place geographically that while we're a critical access hospital, that our patients have access to tertiary care centers pretty close to us as well.
- [02:18]
B
That's great to hear and definitely, you know, so appreciate that perspective because I know a lot of our listeners are covering similar communities and areas within their own regions. So this will be a great conversation. Now, could you tell us a little bit more about the last year or so? What was an initiative that you led? What did you do, and what were the results?
- [02:38]
C
So we have some big expansion work happening in the organization. We're in the middle right now of adding about 20,000 square feet onto the facility. This is all about improving access to care. I would say some of the most important work for the community and really a big part of our mission is was focused on our community health needs work and increasing and expanding our work in the mental health and substance use treatment areas. We added new members to the team, really worked on growing that part of our service. We are now treating patients that need help with substance use withdrawal in the hospital. Currently there are not a lot of resources for that type of service in our region, so this is really important. One thing that we saw in our data and our county data is that substance use in addition to mental health really sort of hit the highest need for people in our communities. So that was our focus and significant work on expanding those services. And it's been exciting to watch and to see the increases in the number of patients that we're caring for. We have all kinds of outcome measures. It's going to take a while to see that obviously our goal is to reduce the number of people in our region that need that type of support. That's there's a long play I think in that work. But right now we're just really focused on sort of meeting those immediate needs for patients and then making sure they get handed off to appropriate treatment options. This year we will add to that an outpatient treatment program as well. We do have some outpatient services today, but a more intensive outpatient treatment so that were fully able to manage supporting patients who need substance use help once they've gone through withdrawal and are out of the hospital. So that's been exciting work for us and I think really meaningful again in rural health, very population health focused. That is an opportunity that is part of our mission is to improve the health and well being of the communities we serve. And this ties that work ties directly to do that part of our mission.
- [05:01]
B
Got it. That makes a lot of sense. And you know, it is really cool to hear being able to grow that type of service line and have those services available for the community because it's so, so much needed. And you know, when you look at bringing in more of that substance withdrawal abuse and you know, really services for the community, what does it take to build that type of program? How do you go about doing that within your organization and making sure you have the right resources allocated to it so that you can build something that is efficient and effective for treatment?
- [05:34]
C
That's a great question. We are incredibly fortunate. We have a Chief Medical Officer Dr. David Friends, who is board certified in addiction medicine. So that very helpful. And he's worked for a long time in the region in caring for patients who have substance use needs. So very helpful. And he sort of led to charge and bringing in skilled and qualified team members that can help us create the service and now expand the service. So for us, I think foundationally having experts in the field of mental health and substance use is critically important. And he continues to help us sort of lead the charge with that.
- [06:14]
B
I love it. That's so helpful to have a leader that takes the lead there and can really push those things forward. Now, looking ahead, what are some of the big priorities and headwinds that you're focused on for 2026?
- [06:27]
C
Yeah, and as I mentioned, you know, we are in the middle of this expansion and our expansion is really focused around again tying back to our mission, improving health and wellbeing. We had an access problem and part of our access problem was not only clinicians but having the physical footprint to care for more patients. So the growth that we're experiencing and the construction and expansion we're going through is a part of that. And so that is we've got a construction project right now adding 35 exam rooms, specialty space, new rehab space, a new rehab pool that will all open by the end of this year. In addition to that, we're opening a second clinic in Minnesota that we consider part of our service area. It was a underserved area, had a deficit of clinicians to support them. So that new clinic will also open later this year. So we're excited about that. That's a big focus for us. But I would say the other work is really just making sure we're staying focused on some of the other big headwinds that are facing. I think everyone in healthcare and impacts critical access rural health in a different way. So we've all been paying close attention to what's happening with Medicaid. We're still waiting to hear and understand more about how that's going to impact us here in Wisconsin. And, and also there are potential changes to how rural health clinic reimbursement works in our state. So paying very close attention to that. For those listening that have rural health clinics understand that that's a big part of your margin in a critical access rural health environment. So any significant changes to how we're paid and reimbursed for that care is going to be difficult and then always on the list is 340 B funding and that is a hot topic across the country and for pharmaceuticals. And so if that program were to go away or change significantly, it would have a pretty significant impact on our bottom line at a time. Again, all health care margins are very thin in rural health and critical access. You know, our margins are also thin and you know, we're not attached to a large system. So we're independent and trying to work through that and would have to manage that on our own. So those are some of the big headwinds I would say that we're just paying very close attention to. There's still a lot that's unknown, but you know that that will be part of the work we're focused on this year and I assume into 2027.
- [09:11]
B
That makes a lot of sense. And you know, I appreciate everything you mentioned there. Whether it's looking at expanding access to care, bringing in clinicians into underserved areas and trying to figure out how you're going to have the financials work and make that work. I think, especially on the 340B funding side, what is top of mind for you when you think about that potential challenge and changes coming down the pipe? How do you prepare for some of the unknowns with 340B and while still, you know, taking care of the day to day to make sure things are functioning the way you need them to in the current atmosphere?
- [09:48]
C
It's a really difficult balance, is what I would say. You know, at a time where we are experiencing growth, which is exciting, we also have to really balance potential reimbursement changes. And so for us, I think that is being really smart about what we add and when we add it, making sure that we are just very fiscally responsible, bringing services to the community that the community really needs, but also being really careful that we don't overextend ourselves. So that if we do experience a reduction in reimbursement or we end up paying more for the procurement of medications, with the 340B potential changes that, you know, we've got the financial bandwidth to manage that. So I think right now it is just this balancing act and we're just watching that. But I think we just have to be really smart about where we invest and making sure again that we're financially in a position that we could weather any reduction in reimbursement. So it's tricky.
- [10:55]
B
Absolutely. I think there's so many that are walking that line or doing that balancing act. And so to understand how you're thinking about it and what it means for you is really helpful. What do you think the hardest Thing you'll have to do in the coming
- [11:08]
C
year will be, yeah, I think that financial viability work is going to be incredibly hard and critical just for survival. It also makes me think about, you know, the other thing happening not just in Wisconsin, but across the country is small critical access, hospitals ceasing to deliver babies. And so this balancing act is also in part to make sure that we can keep doing that for women in our area if we were to stop delivering babies. You know, they're driving close to an hour away to find OB care, so it's a big deal. So that, that to me, just maintaining financial viability is going to be critically important. I would say the other, and I don't know that I would describe it as hardest, but I think incredibly important work for us is increasing our focus on team member and caregiver well being. You know, we went all went through Covid and watched clinicians and caregivers and staff really burn out. I think there's a whole lot of things that contribute to that, including some of the administrative burdens that our teams carry that we as an organization need to put more focus on. So we've got a couple initiatives. One around moral injury, which really starts to address what are the things that are happening sort of day to day responsibilities that our staff and physicians and clinicians overall are having to take on that are just administrative burden and not really focused on caring for the patient necessarily. And how can we eliminate those, break down those barriers so they can focus on the most important work of patient care. So moral injury is a focus for us. And then we're participating in a Wisconsin initiative around caring for caregivers. And that really looks at all kinds of things. One, reducing the stigma seeking mental health or substance use for clinicians. And you know, some don't do that because they're afraid of what could happen, you know, loss of licensure, those kinds of things. So it's a exciting project. There's a couple phases to it. It sort of starts out with this reducing stigma for licensing and credentialing. And then the next two parts really focus on creating an infrastructure to support team member well being caregiver well being. And then just making sure that we hardwire that into our organization operational improvements that reduce that administrative burden that I mentioned. So as I think about all things that are on our plate, we need to take care of our teams first and foremost so they can take care of patients. And so that will be challenging and rewarding and exciting all at the same time.
- [14:03]
B
Absolutely. I think you know, there's so much opportunity and possibility when you look at ways to continue to boost your workforce and staff and especially for clinicians, you know, coming into the work every day that they're doing with patients. So I really, you know, think that is so, so important. And as you mentioned too, you know, looking at the work that you've been doing around the financial viability and keeping services in particular, that ob care locally in the community makes a big difference for women and their families. And so I know a lot going on there, but I think I wanted to wrap up before we finish our conversation here looking at some of those growth opportunities you mentioned as well. Could you talk just a little bit deeper? Deeper on those best opportunities that you're seeing and how you're, you know, planning for those and really what you're excited about for the future?
- [14:58]
C
Yeah, we are excited and like I said, we are going through a growth phase and that isn't happening everywhere. So we feel really grateful for that and we see it as an opportunity to care for more people in our service area. And our service area is actually growing, which is also exciting. So we've been really focused on making sure that we have enough in the way of primary care clinicians to meet the needs of the community. So we've been recruiting like crazy. We've added 10 clinicians in the last year and a half or so, which is really great. In addition to that, looking at demand forecasting data to tell us what other types of specialty care would be helpful to have here to keep as much care close to home for people. So, you know, some of the subspecialty areas in primary care, like pediatrics, we added additional ob GYN care here and then also looking at specialty care. So some of the hot areas for us that we're continuing to recruit, recruit for, we'll be adding additional dermatology, which is not always easy to find. Would love to have some specialties like rheumatology and gastroenterology here. These are very hard to recruit specialties, but those are. That's the type of growth that we have potential for here as we look at, you know, what additional specialties that is needed in our community based on kind of what we see, what we're sending out and then also what we see in demand forecasting data that our patients are looking for. So, yeah, it's an exciting time. Again, we're experiencing growth in services like primary care and specialty care. I would say the other focus from a growth perspective would be looking at some of the subspecialty type of care that we could bring to the organization that would help our doctors and EPCs take care of patients locally. So partnerships is important to us. So we have a partnership with Children's Hospital in Minneapolis, and we have a tele NICU service that we just added. We're in the process of adding a telestroke program as well. And all of that just expands the types of care that we can provide locally, helps us provide more emergent care for babies and for those that may be experiencing strokes and symptoms. So in addition to sort of our core primary care services, specialty care services, we're looking at what other partnerships can we add to help us grow and care for more patients close to home? And then, of course, you know, sending patients to a tertiary care center when needed.
- [17:43]
B
Absolutely. That is so helpful to understand and really cool that you are in a position to be in this growth phase, to add services, to look out into the community and see what they need. And then being able to bring that through partnerships in other resources that you're bringing in is so amazing. Kelly, thank you so much for joining us on the podcast today. This has been such a fun conversation, and I look forward to connecting with you again soon, as well as seeing you in April at our annual meeting. I know you'll be speaking on a panel, and so it'll be a lot of fun to catch up there.
- [18:12]
C
Yeah. Thank you so much, Laura.