Becker’s Healthcare Podcast: Expanding Rural Access and Strengthening Community Health with Kelly Macken Marble

Date: March 2, 2026
Host: Laura Dardo, Becker’s Healthcare
Guest: Kelly Macken Marble, CEO, Osceola Medical Center

Episode Overview

This episode focuses on how Osceola Medical Center, a rural critical access hospital in Northwest Wisconsin, is expanding care, meeting acute population health needs, and navigating the complex challenges of healthcare delivery in rural settings. Kelly Macken Marble, CEO, shares practical insights on facility and clinical program expansion, innovations in substance use and mental health services, and ongoing challenges regarding financial viability, workforce well-being, and future growth strategies.

Key Discussion Points & Insights

1. Background on Osceola Medical Center & Leadership

• Location & Reach:
  • Osceola is a critical access hospital and rural health clinic in Northwest Wisconsin, less than an hour from the Twin Cities. It provides access to both rural care and nearby tertiary centers.
• Kelly’s Career & Passion:
  • Over 35 years in healthcare, including nursing and leadership roles, with a strong focus on population health.
  • “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.” (01:18, Kelly Macken Marble)

2. Recent Initiatives: Expanding Access, Especially in Substance Use & Mental Health

• Facility Expansion:
  • Construction underway to add 20,000 square feet and 35 exam rooms, new specialty, and rehab spaces, including a new pool.
  • Opening of a second clinic in an underserved Minnesota community.
• Program Development:
  • Expanded mental health and substance use treatment, including hospital-based withdrawal management—a rare resource in the region.
  • New hires to build expert capacity in the mental health and substance use team.
  • “We are now treating patients that need help with substance use withdrawal in the hospital...our county data is that substance use in addition to mental health really sort of hit the highest need for people in our communities.” (03:00, Kelly Macken Marble)
  • Plans to introduce intensive outpatient substance use treatment programs in 2026.
• Population Health Focus:
  • “This ties that work directly to our mission to improve the health and well-being of the communities we serve.” (04:57, Kelly Macken Marble)

3. Building & Sustaining New Clinical Programs

• Role of Clinical Leadership:
  • Chief Medical Officer Dr. David Friends, an addiction medicine specialist, was pivotal in developing substance use services.
  • “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.” (05:35, Kelly Macken Marble)

4. Top Priorities & Headwinds for 2026

• Facility & Care Expansion:
  • Adding new clinical and rehab space, expanding clinics into underserved regions.
• Financial Viability Challenges:
  • Ongoing uncertainty around Medicaid and rural health clinic reimbursement changes in Wisconsin.
  • Watching federal programs, especially 340B (critical for pharmaceutical procurement), which, if reduced or ended, could significantly impact margins.
  • “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...is going to be difficult.” (07:27, Kelly Macken Marble)
• Balancing Growth with Financial Responsibility:
  • “It’s a really difficult balance...being really smart about what we add and when we add it, making sure that we are just very fiscally responsible...also being really careful that we don't overextend ourselves.” (09:49, Kelly Macken Marble)

5. Workforce Well-being & Operational Improvements

• Burnout & Moral Injury:
  • Recognizes COVID-19’s impact on clinician and caregiver burnout and increasing administrative burdens.
  • Launching initiatives to reduce “moral injury” by minimizing unnecessary administrative tasks so clinicians can focus on patient care.
  • “We need to take care of our teams first and foremost so they can take care of patients.” (13:39, Kelly Macken Marble)
• Statewide Well-being Programs:
  • Engaged in Wisconsin initiatives to lower stigma and barriers for caregivers seeking help, especially around licensing and credentialing, and to create supportive infrastructure for team member well-being.

6. Protecting OB & Localized Care

• Maintaining Local OB Services:
  • Determined to continue long-standing obstetrics care despite regional, national trends of rural hospitals dropping these services due to financial strain.
  • “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.” (11:22, Kelly Macken Marble)

Notable Quotes & Memorable Moments

• On Immediate & Long-term Impact:
  • “Obviously, our goal is to reduce the number of people in our region that need that type of support. There's a long play in that work. But right now we're just really focused on sort of meeting those immediate needs for patients.” (04:11, Kelly Macken Marble)
• On Balancing Expansion and Risk:
  • “It's tricky...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.” (10:42, Kelly Macken Marble)
• On Workforce Support:
  • “Moral injury is a focus for us...how can we eliminate those [administrative burdens], break down those barriers so they can focus on the most important work of patient care.” (12:20, Kelly Macken Marble)

Key Timestamps for Important Segments

• [01:05] – Kelly’s Background & Osceola Medical Center Overview
• [02:37] – Substance Use & Mental Health Expansion Initiatives
• [05:33] – Building and Sustaining New Clinical Programs
• [06:26] – Major Priorities and Upcoming Challenges (2026)
• [09:48] – Approaches to Financial Uncertainty & 340B Program Risks
• [11:07] – Hardest Tasks Ahead (Financial Viability, OB Service Protection)
• [12:36] – Clinician/Staff Well-being and Workforce Initiatives
• [14:58] – Growth Opportunities: Recruitment, New Services, Partnerships

Growth Strategies & Future Opportunities

• Recruitment & Primary Care Expansion:
  • Added 10 clinicians recently to meet growing population and service needs.
• Specialty & Subspecialty Care:
  • Focus on adding services such as dermatology, rheumatology, gastroenterology to keep care local.
• Telehealth & Partnerships:
  • Recent additions include tele-NICU services (Children’s Hospital in Minneapolis) and a forthcoming telestroke program.
• Community-Driven Approach:
  • Uses demand forecasting and patient data to guide expansion and recruitment.
  • “It’s an exciting time. Again, we’re experiencing growth in services like primary care and specialty care.” (15:58, Kelly Macken Marble)

Conclusion

Osceola Medical Center is proactively addressing rural health access through facility expansion, strengthened resources in substance use and mental health, and workforce well-being initiatives. The organization’s leadership remains steadfast in balancing ambitious growth with financial prudence and is committed to ensuring localized, high-quality care—including critical OB services—despite significant industry headwinds. Their strategies highlight the importance of community-driven care, adaptability, and innovation in today’s rural healthcare landscape.