← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Harminder (Mindy) Grewal, MD, MBBS, DGO, DiplABOIM, FAAFP, Chair of the Department of Family Medicine at the Wright State University Boonshoft School of Medicine and Whole Health Clinical Lead at the Dayton VA Medical Center
00:21:35
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- [00:01]
A
This is Laura Dardo with the Beckers Healthcare podcast. I'm thrilled today to be joined by Dr. Harminder Grewal, who is the Chair of the Department of Family Medicine at Wright State University Boonshoff School of Medicine, a physician at Premier Health, and the whole health clinical lead at Dayton VA Medical Center. Dr. Greywell, it's a pleasure to have you on the podcast today.
- [00:21]
B
Thank you so much. Good morning and thank you for this opportunity to share my journey in medicine.
- [00:27]
A
Absolutely, absolutely. Well, let's get right into it. Could you tell us a little bit more about yourself and your background? What's really brought you into the role you have today and what inspires you to keep delivering great care?
- [00:38]
B
Absolutely, absolutely. Yeah. So I currently serve as academic Chair for the Department of Family Medicine at Wright State University Moonsha School of Medicine. And my clinical practice, as you mentioned, is at Premier Health with Premier Physician Network. And I'm also the whole health clinical Lead at Dayton VA Medical Center. I am a servant leader and I do wish to bring positive change in the communities that I serve. Regarding my background, it's somewhat unusual and unique. I was born in India and my journey in healthcare spans between three countries in three different continents to this point in my career, India, United Kingdom and US. And my training spans three specialties. I started with obgyn, then I did pediatric medicine, pediatric surgery and then family medicine was my final resting place. So I worked also in three different types of healthcare systems. As you know, aware, systems in India, UK and US are very different. So this international experience has informed my current thoughts and belief system. I'm a systems thinker. As a child I was fascinated by the logic and beauty of mathematics and physics and nearly actually decided to train in physics or specialize in physics. But somehow, as universe would have it, it wanted me to go in medicine. I wanted to find the same foundational truths in medicine. So that has been difficult to find. It's not just advancement in pure sciences that's going to change health care for all of us, but the collective will, the people that need this health care. So there's also another layer of extreme complexity of the health care systems which operationalize the delivery of care. So all that is going to affect how medicine advances, but I'm still hoping to be able to found those foundational truths. Finally, I completed my medical degree at University of Delhi, obkind training as well. And then I was in UK where I did, you know, OB gyn, pediatric medicine, Pediatric surgery, moved to US for family reasons, pursued a residency in family medicine and Completed my residency at the Ohio State University in Columbus, Ohio. So after completing the residency I was in different roles, both academic non academic. I was in Upstate New York, Portland, Oregon and now I'm in Ohio. I've had exposure to practicing medicine in various private and public healthcare settings and I would just talk about some transformational things that happened during this practice. My practice as a Women's Health Medical Director at Syracuse VA Medical center was transformational as I learned not only to treat my female veteran patients as patients, but also to advocate for the best health care for them. I realized the limitations of what I had to offer with my traditional medical training and I pursued to increase my toolbox by initially getting board certified in Integrative medicine, started applying for some grant funding to support development of high value health care system for our patients and that started my journey towards the whole health systems of care. We were successful in getting grant funding from VA Central Office for Syracuse to become a design site for Whole Health and some of our wins were development of a strong foundation of a Whole Health pathway with recruitment and training of Whole Health coaches, Whole Health Partners, in addition to development of Whole Health wellness options and clinical care for our patients. There were some amazing people who joined me in this journey and they were my team. I will always cherish them. At around the same time I was also recruited to be Vice Chair of Medical Student Education at SUNY Upstate Medical University Department of Family Medicine. Did the foundational work which was needed to develop a new residency program in Family medicine and we were successful. It started in 2019, it's been very successful since then. Then we were also interested to develop a rural residency. So we were successful in getting a HRSA grant for development of a Rural Track program, you know, for a rural residency program at Auburn Community Hospital, which our first metric learning class was in 2022. So during my work as a PI of this grant, I also ended up kind of doing a deeper dive in the state of rural health, rural interprofessional faculty development and also to look at how to provide equitable care to our rural communities. Subsequently had some extra training in leadership. I was nominated by Sony Upstate for Executive Leadership in Health Care at Drexel and completed my fellowship in 2023. I've had some wonderful mentors in my journey at SUNY as well who helped me grow and become a useful member of the community. So my next big transition in life. I was recruited to be Chair of Family Medicine at Wright State University b som in February 2023 and have been very Fortunate to have had some very gifted and accomplished faculty members and mentors as well. And since the beginning of my tenure as chair here, we have seen significant growth and development of our rural residency at Greenville, Ohio Addiction BEST and Fellowship. Our Department of Family Medicine has supported global health education for our medical students. And now we are developing lifestyle medicine education for our medical students. And so this comes, this is in my wheelhouse. And so we also have a brand new street medicine program that we care a lot about. So that in a nutshell summarizes where I am.
- [05:44]
A
Well, that's amazing to hear and what a unique career journey you've had. But that passion for medicine and helping people in really making sense of the complexities in health care shines through. And so that's amazing to hear all the things you've been able to accomplished so far and then what you're working on today. And speaking of that, what are some of the opportunities and headwinds that you have your eye on right now?
- [06:04]
B
Yeah, so there's been a lot of change here. So since I joined. Yeah. So the most exciting change has been that Premier Health and Wright State University closely aligned their operations under a new long term affiliation agreement in April of 2024 which enhances Dayton region's access to state of art medical care. So this new agreement highlights the institution's shared commitment to excellence in education, workforce and economic development, research, clinical program development and community. The partnership is obviously transformational and it prioritizes producing more clinicians, nurses, other healthcare providers that would support our community, spurring new research opportunities, providing patients better access to vital medical care like closer to home so they don't have to drive away to other places to get their care. And also formally establishes a primary academic affiliation between Wright State and Premier Health, including all Wright State colleges and academic programs and all of Premier's sites of care. So this provides us new opportunities for federal funding to support clinical activities, teaching, research. And this will also position Premier Health and Wright State to develop a comprehensive collaborative approach to meet the needs of the community for the future. For the Department of Family Medicine, it will support our missions of education, clinical care and research by supporting innovation community engagement on a much larger scale. We'll also be able to have increased access to interdisciplinary interprofessional collaboration. BSOM already has strong track record in primary care medical student education and this agreement will likely give access to more educators for the medical students at Premier and greater access to quality and high value care for our community. We are also very excited about introduction of AI so It's the introduction of Ambient AI Dax Copilot at Premier Health. It's starting this month and it's going to allow us to focus more on what we do best, that is take care of patients, not having to spend twice as much time on documentation. So it will help with physician wellness. The next one I would like to specifically mention is Premier's partnership with Agilon. So this is a healthcare tech company which helps to improve health outcomes for seniors with resources like new technology and care navigators. So Premier Health is a nonprofit healthcare System. It has five hospitals, more than 100 locations across seven counties. AgileOn Healthcare offers resources to physician partners to practice value based care through its total care model. So this is a more holistic approach to Medicare Advantage patients. So it gives them a high value enhanced total system. And so it kind of provides technology people capital process access to a peer network of more than 2,700 primary care physicians. So one of the benefits of partnership is additional care managers to help our patients navigate the health system between appointments. Agile Loan tech platform connects multiple payers, patients and physicians into single platform to create a single experience for patients and physicians. And physicians also experience data integration and clinical programs through agilence platform. And patients also spend more time in wellness visits and less time in the hospital. So I'm very excited about it as it's very closely aligned with my concept of whole health and whole person care. So I'm very excited to participate in this other one is our development of Street Medicine program that we were very fortunate to get grant funding for and I will talk a little bit more about that later, but it's in collaboration with the Premier Health and it is to meet the underserved members of a community where they are and to get them established in regular health care. Regarding Education of America students, we are excited about a new elective which we started offering to our students in Food is Medicine and we are planning for another elective next year which is going to be Exercises Medicine. So that's our beginnings of our foundational work in lifestyle medicine here. I'm also looking very closely at Rural Health Transformation Program funding and it'll be interesting to see if Ohio gets funded and then what innovative solutions are going to be coming our way to help with the problem of healthcare access and capacity in rural America. Now headwinds. Headwinds are same as everyone in healthcare and education. It's a very complex healthcare landscape and same actions do not always translate to same results in different situations in different locations. So we have to always plan for that, AI in healthcare is another wild card. I'm very optimistic, but unethical use of AI can be disastrous. So I participate in Dayton V's Vision 10 AI Committee to Support the Ethical Use of AI in Healthcare and it's very interesting to see all the different projects that are coming our way. Rural health landscape is obviously a bit unpredictable at this time, despite our best efforts. And then I'm really looking forward to see what happens next.
- [10:56]
A
Absolutely. It's just so many factors, as you said, coming together to really create a bunch of opportunities, but also some challenges and especially thinking about the tech, technology and AI and really where that can converge into a space where you can get to more of that predictive holistic care and value based care too. Now, when you think about value, especially how are you looking at growth in the future, adding value to the organizations that you're working with? What does that really look like for you and how are you thinking about that at a strategic level?
- [11:25]
B
Absolutely. So the big goal of Wright State University BESOM Department of Family Medicine is to align with the current healthcare environment, mission, value and vision of our organizations and also still stay true to our own mission and values. So we have our own vision which is preparing tomorrow's family physicians to enhance the health and well being of the communities they serve by defining and providing state of art health care. Our mission is to lead the way in educating the next generation of physicians by modeling the patient centered principles of family medicine, serving our community's health needs and contributing to the scholarly advancement of medicine. So we have to support rural medicine and support rural residency. We have to learn how to leverage technology and AI to support rural health. So we'll continue to strive for that and I am working with Premier Health and I actively participating in that. We have to continue to do community outreach which we do both from BUNCHA School of Medicine as well as from Premier side and the VA side. We support Street Medicine Program and Addiction Medicine Program for Health Equity to support the community. These are new programs for us and we are very excited to support their growth. We also have an MD in three program for Family Medicine in which our medical students can graduate in three years if they decide to go in family medicine or pediatrics and then go into a residency in Family medicine. And this is one of the initiatives at Bonsha School of Medicine to support primary care. We also support our family medicine interest groups and students so that we can continue to have a robust pipeline of our primary care providers that stay in the area and that serve our communities with My specific background in integrative medicine, Whole health developed the UME and GME in education about lifestyle medicine, especially nutrition and exercise and fine arts and how to build health and not just treat disease and how to engage with leadership to support ambient AI, agilent partnership implementation in primary care. How to help with recruitment of strong primary care workforce which not only provides excellent care but it's curious and loves to teach. How to support our faculty, how to do robust research and how to engage in clinical trials, how to use lean principles to optimize current processes, build capacity, higher value care then innovation and sharing of knowledge. We have to disseminate knowledge as well and publish and also develop innovative processes in clinical care. Engage in philanthropic activities which support the mission of my department. I think the most important one is that we have to create a replicable patient centered high value whole person care model in outpatient setting which is powered by digital tools, agentic and ambient AI as well as high touch and humanistic and community based tools such as health coaching, health partners, primary care, mental health integration, nutrition, lifestyle medicine, group visits which are financially sustainable. So develop whole health and lifestyle medicine all the way from in vitro trials in the lab to clinical care in the community with a lofty goal to create a mini blue zone and engage local communities and organizations. And I think I worked very hard to gather some of the tools to help with this goal and I'm just hoping that I could be the spark.
- [14:42]
A
I love that there's so much you said there that really truly was inspiring to think about how healthcare is changing the possibilities and you know, just having someone like yourself being that spark, being that person who can think it and dream it and then actually implementing go start doing it is amazing and incredible to see, you know, how you've been able to manage all these factors coming together to really truly support the communities that you're serving. I know resources are tight, we've kind of touched on it briefly here in our conversation now. But so many hospitals and systems and organizations are looking at tight margins now and the potential for even more tighter financial situations in the future. So when you think about all of these things, what is one risk or investment that is still worth making in the next year or so, even as resources are tight.
- [15:29]
B
Absolutely. So right now I think it is going to be the street medicine program for us. You know, we just launched it, you know, in January of 25 and the lead institution is Wright State University, Bunch of School of Medicine. Our key partners are Premier Health, Dayton Dream Center. You know, we have full funding from the federal government for this we also have a two year one Ohio Recovery Foundation Award for nearly $300,000. We have a new Hersha Street Medicine Training grant which is a five year federal award supporting expanded training, capacity building, long term program sustainability. This is going to be it's a mobile community based clinical initiative and it is designed to bring low barrier primary care, behavioral health support and substance use services directly to the individuals that are experiencing homelessness or housing instability in the Dayton. So this program integrates our community service with robust federally supported clinical training. Through the HRSA award, we'll be providing primary preventive care delivered at mobile clinic sites, behavioral health services including counseling support, substance use screening, you know, brief intervention, referral to treatment care, navigation, you know, case management and sort of low barrier engagement for patients without transportation or insurance. Right. Same time we'll also be educating, you know, our residents. So there's going to be structured training for about 50 right. State students across medical school behavioral science disciplines to enable them to have deeper competency, you know, in this work. So the training elements are going to be street medicine foundations, which is low barrier care, trauma informed practice, harm reduction, then clinical skills in the field, patient assessment, how you wound care, chronic disease management, substance use disorder curriculum, social determinants of health education, interprofessional collaboration with behavioral health community workers, documentation, continuity of care in mobile settings, reflective practice and team debriefing and then HRSA different enhancements like faculty development, evaluation, infrastructure, sustainability planning. So community impact. So this program will increase access to care for individuals often who are disconnected from the healthcare system and experiencing homelessness, substance use disorder and behavioral health challenges, hopefully to reduce ED reliance and improve linkage to ongoing care. So strategically it strengthens right to university's mission and community engagement and primary care education and also expands our workforce training and underserved population medicine with these HRSA supported competencies.
- [18:00]
A
Got it. Wow, that's amazing to hear. Certainly such a needed service for the community and especially thinking about how you can bring care to people and make sure that you're hitting all the boxes, bringing those community workers and everybody on board so that you can have such a functional and beneficial program. I think looking ahead with our last couple of minutes here, where do you see some of the best opportunities for that continued growth in the future? How are you looking even further ahead to really build the blocks of foundation for the programs that are so important to you in those next few years?
- [18:35]
B
Absolutely. Chronic disease management and population health. Absolutely. With rising rates of diabetes, heart disease, ckd, multimodal morbidity. Primary care is the center of management. Future is in value based care pivoting towards providing best, fastest, most primary care in the most cost effective manner by leveraging technology such as telehealth, remote patient monitoring, agentic AI that supports triage documentation in addition to revenue cycle management generative AI which empowers patient providers at the same time. And then again, as we see.
- [19:13]
A
AI.
- [19:13]
B
And healthcare explosion and digital health growth is going to redefine interest and value based care for all populations. So the future is where the patient is not, not just caring for the sick, where the providers are. Right. So virtual chronic care clinics, building hybrid outpatient models inside healthcare systems are gonna be needed care of the elderly. We're gonna need that as more of our patients are getting older. So all these senior care primary care models are very useful. Obesity medicine, lifestyle medicine, rural underserved primary care models and then preventable lifestyle medicine. So high patient demand, low supply because of demand reimbursement mismatch at this time which may get corrected with new payment models such as direct to people to purchase their own healthcare and decide where they want to put the money. Right. So they can put it in health savings accounts and use it the way they want to use it. So whole person care model for all with a clear definition of what it means and then a clear implementation plan with AI support. I think it'll be an honorable goal for any company that can develop it and scale it up. Yeah, so medicine still hasn't found its beautiful simple basic equations, but we can strive for whole person care that can be scaled up, up and we have to strive for health while taking care of the sick. And we have to strive for happiness and good health for everyone while taking care of those who are less fortunate. And we have to support patients and provide autonomy and goal sharing and you know, opportunities for growth are going to need policy support and advocacy for the same. And it takes a village, you know, to do this. And I mean that's, that's all I would like to say.
- [20:43]
A
Fantastic. Well, you know, this is amazing and this vision of healthcare that you have is truly incredible. Dr. Grewal, thank you so much for joining us on the podcast. This has been a really fun conversation for me. I've learned a lot and I'm inspired by your passion. I look forward to connecting with you and continuing this conversation in the future.
- [21:00]
B
Thank you so much, thank you so much for this opportunity. And I would like to also thank, you know, all of my colleagues, my faculty, you know, who do this work and who make the. Make this happen, you know? Thank you.