Advancing Health Podcast

00:00:00:10 - 00:00:31:16
Tom Haederle
Challenges and opportunities. Hospitals and health systems face plenty of both as 2024 winds down and we head into a new year. Workforce issues. Supporting our care teams. Financial sustainability. New technology. These are but a few of the realities confronting health care providers and leaders in the near future and beyond.

00:00:31:18 - 00:01:02:01
Tom Haederle
Welcome to Advancing Health, a podcast of the American Hospital Association. I'm Tom Haederle with AHA communications. Every January 1st, the baton is officially handed off. The chair of the Board of Trustees of the American Hospital Association rotates as the one-year term concludes for the outgoing chair and begins for their successor. In today's podcast, the incoming and outgoing chairs of AHA, both highly respected leaders of major health systems, share their insights, hopes and plans for the health care field

00:01:02:06 - 00:01:04:10
Tom Haederle
on the cusp of a new year.

00:01:04:13 - 00:01:39:04
Joanne Conroy, M.D.
Thank you, everyone for joining me today for this Leadership Dialogue. I'm Joanne Conroy, president and CEO of Dartmouth Health and board chair of the American Hospital Association. And this will not only be our last Leadership Dialogue session of the year, but it will also be my last as chair of the AHA Board of Trustees. I've enjoyed bringing you these interviews throughout the year and updates from health care leaders across the nation who are happy to share their experiences and advice on the issues that we all face.

00:01:39:07 - 00:02:16:28
Joanne Conroy, M.D.
As I get ready to pass the torch, I'm pleased today to introduce to you Tina Freese Decker, president and CEO of Corewell Health and AHA’s incoming board chair. Corewell Health is an integrated, not for profit health system headquartered in Grand Rapids, but serving the entire state of Michigan. The system includes 21 hospital facilities with over 5,000 licensed beds, 300 ambulatory and outpatient locations, 65,000 team members, and includes over 12,000 physicians and close to 16,000 nurses.

00:02:17:01 - 00:02:40:15
Joanne Conroy, M.D.
And as a health plan, they cover over 1.3 million members. Tina is a transformative leader known for working boldly to reimagine how we deliver care. Plus she is passionate and driven when it comes to taking on health care's biggest challenges. She is also deeply committed to making sure that access to health care is simple, affordable, equitable and exceptional.

00:02:40:17 - 00:03:10:21
Joanne Conroy, M.D.
Tina spent much of her career at Spectrum Health, serving in a variety of roles including president of the System Hospital Group, chief strategy officer and chief operating officer, before being named president and CEO of Spectrum Health in 2018. Later in 2022, she was a key architect in the integration of Beaumont Health and Spectrum Health, which are now unified as Corewell Health, and she continues to drive significant transformational change as president and CEO.

00:03:10:24 - 00:03:41:12
Joanne Conroy, M.D.
While this is my last time hosting one of these discussions as chair of AHA, Tina will be picking them up as she steps into the role of board chair beginning January. And we could not be in better hands. Let's get to some of our questions. So often when we approach the holidays, we're thinking about the New Year, and it's helpful to reflect back on the past year, maybe identifying some of our biggest challenges, maybe considering what we could have done differently.

00:03:41:14 - 00:03:48:11
Joanne Conroy, M.D.
What do you think have been the biggest challenges that you've faced in Corewell in 2024?

00:03:48:13 - 00:04:13:00
Tina Freese Decker
Well, it's been a tough year. You know, as you said in the introduction, we have both a health plan and a robust health care delivery system. And the health plan, just like many other health plans in the country, has had significant utilization that has impacted everyone. And we are kind of in a down cycle. And the down cycle is not just in Medicare utilization or Medicaid utilization, but it's just been across the board.

00:04:13:03 - 00:04:42:09
Tina Freese Decker
And so we've had to navigate that. On the flip side from a health care delivery perspective, and we have amazing hospitals and outpatient clinics in Grand Rapids and West Michigan and southwest Michigan, and also in Detroit and southeast Michigan. They've seen increased utilization as well and that's taxed our team members. So when I think about what's been going on in 2024, it's how do we continue to take care of our team, how do we help them do what they do every single day of the year?

00:04:42:11 - 00:04:59:27
Tina Freese Decker
And to always be there to care for our community and to put their best foot forward. They've been through so much. And as I was rounding last week, you know, I'm starting to hear: we're coming out of this. We're coming out of the pandemic. So they have this new outlook, but we need to make sure that we're still there for our team.

00:05:00:00 - 00:05:21:19
Tina Freese Decker
I've seen some incredible things happening. For example, one of our security officers at one of our regional hospitals, a rural hospital, saw a patient that was leaving, didn't have anything, and was able to grab a blanket from his own car and give it to him because he knew he needed to have something to wrap up in. And I met a little kid that we care for at our children's hospital.

00:05:21:21 - 00:05:44:19
Tina Freese Decker
And, you know, he had, two prosthetic legs. He calls them his robot legs. And he is just so excited to be an astronaut and a truck driver. And his mom was beaming because of the amazing care that was provided to him and the new outlook on life that he has. So all of that really comes together, and it's about the people that provide that care.

00:05:44:21 - 00:06:07:00
Tina Freese Decker
So that's where I think it's just essential that we continue to be focused and invested on our team, that we invest in the systems and the technology and the platform so that our team can do what they do best and that we're focused on doing what matters most. Because ultimately, we're here to serve our neighbors and everyone in our community and they're counting on us to do that.

00:06:07:03 - 00:06:38:24
Joanne Conroy, M.D.
At Dartmouth Health, we have many of the same challenges. People are just feeling like they're coming out of the pandemic, but they are a little bit stressed in terms of the adequacy of the workforce to care for patients. I think when I look at Dartmouth Health, we have a aging population. We're one of the three oldest states in the country and our close colleagues, Vermont and Maine, are the ones that are usually one and two and three with us.

00:06:38:26 - 00:07:01:09
Joanne Conroy, M.D.
And how do you deliver care in a different way that's probably a little bit more people intensive in their homes? I think that's the challenge that's going to face all of us. We have great hopes for the use of technology that may replace vacancies, but remains to be seen how effective that's actually going to be in the clinical setting.

00:07:01:16 - 00:07:26:04
Joanne Conroy, M.D.
We are using the ambient listening technologies, which I'm sure you are at Corewell as well, to actually make the providers lives a little bit easier in the office. However, we're talking about starting to use them in the nursing units, because I think we underestimate the amount of paperwork our nurses do in caring for patients every day

00:07:26:04 - 00:07:37:11
Joanne Conroy, M.D.
and how could we use this technology to actually give them more time at the bedside, which is really, I think, where they get their energy from and where they find the greatest satisfaction.

00:07:37:14 - 00:07:59:15
Tina Freese Decker
Yeah, I love that we're helping people get back to why they went into the profession. Instead of doing clicks and typing and recording the data, which is all critically important to have so we can provide the patient care. It is about being able to be with people and help them navigate whatever they're going through so that they can get to be a healthier state.

00:07:59:18 - 00:08:10:18
Tina Freese Decker
And sometimes it's for the patients, sometimes it's for the family member. But just having the ability to get back to that and it helps the person that we're caring for, it also helps us because that's why we're in health care.

00:08:10:20 - 00:08:28:28
Joanne Conroy, M.D.
So when you look broadly at health care across the country, and we've had the opportunity at the board level to kind of listen to many of our colleagues and listen to the things that they struggled with and the things they've been successful in. What do you think we've really done well in health care over the last year?

00:08:29:01 - 00:08:59:03
Tina Freese Decker
I think there's things that we've done well, especially with figuring out how to support our team members. You know, I'm really proud of the workforce task force that was put together and the amazing ideas, I mean, the compendium of ideas that was put together for the workforce was really helpful. And we need to make sure we're continuing to do that, continuing to advocate for our team members, for their safety, for addressing fulfillment and wellness and the issues of burnout, just like we were talking about with ambient listening.

00:08:59:03 - 00:09:19:11
Tina Freese Decker
And how do we get the resources and the technology and systems in place - so again people can focus on what they enjoy and what matters most is the people who we're caring for. I think there are a number of challenges, though, and we've been tackling those throughout the year. I believe the AHA has been doing a good job with that.

00:09:19:14 - 00:09:39:06
Tina Freese Decker
We also know that there's challenges coming forward, like the cost of health care, and we're going to continue to have to have that conversation about how do we address that. We've put together as the AHA workforce on the payment methodologies that should be out there, and also on principles of health reform. And what do we need to be thinking about?

00:09:39:09 - 00:09:53:17
Tina Freese Decker
I think that's extremely helpful to launch many, many initiatives from so that we can continue to put the right things forward that don't just fit for the next year or the following year, but for the next decade and the decade after that.

00:09:53:20 - 00:10:19:29
Joanne Conroy, M.D.
You know, I agree that people have looked at our field and said, you can't really disrupt yourself. You have to be disrupted from outside. And yet we see so many people that said, well, we can fix health care. Getting into the health care space and saying, wow, this is way more complicated and this is way more difficult to make a profit in this industry than we thought.

00:10:20:04 - 00:10:46:00
Joanne Conroy, M.D.
And now they're exiting the field. I think, though, what we've learned from all that is when we're understanding how the disruptors work and understanding what they're teaching us, we are starting to disrupt ourselves internally. We are focusing on getting people out of the hospital. Remember 20 years ago, people used to say you were successful if all your beds were filled.

00:10:46:03 - 00:11:11:19
Joanne Conroy, M.D.
And yet now we say we are successful when we're getting people home faster. And we're actually keeping people out of the hospital rather than encouraging them to come to the hospital. Many of us are developing different ways of delivering care and pushing a lot of our stuff to the ambulatory setting. Now if you think about it, years ago, people were admitted to the hospital for 3 to 5 days for joint replacement.

00:11:11:19 - 00:11:33:05
Joanne Conroy, M.D.
And now the expectation is that with all of our rehab and our supportive physical therapy and home care, they don't stay a night in the hospital. And when you look back, you say, wow, that is actually a huge shift. So we are disrupting ourselves. Your work on the pathways, which is, you know, how do we deliver care differently?

00:11:33:08 - 00:11:41:07
Joanne Conroy, M.D.
I think was really important for the AHA to think about disruption in a controlled, effective, sustainable way.

00:11:41:10 - 00:12:01:16
Tina Freese Decker
And I think you're right. We are disrupting ourselves well. Is it at the pace that we need to? Probably not. But we're also trying to take care of a population that needs us. And it's an evolution. And so I think the challenge will be figuring out what the pace is and how fast can we go or how slow can we go and what do we need to do?

00:12:01:18 - 00:12:13:13
Joanne Conroy, M.D.
Now you're looking forward to your year in 2025 as AHA chair. What's top of mind for you? You know, what are the priority areas that you want to focus on over the next year?

00:12:13:15 - 00:12:35:14
Tina Freese Decker
Well, Joanne, as you and I have been working together over the past year or several years, I think as we've talked to many others in the country, but also outside of the country about health care, we have some similarities. We're all seeing that we have an aging population. And so the demand for services is increasing. And, I believe health care needs will become more complex.

00:12:35:16 - 00:12:57:26
Tina Freese Decker
And, and then add on to some of the pharmaceutical breakthroughs that are coming forward, which are truly amazing. But we have to figure out how we're going to pay for those because it does put a financial strain on health care. The workforce availability will continue to shrink. You can aging population. People will be retiring from working in health care, and new generations come in and have different expectations of what the work is and how we navigate that.

00:12:57:26 - 00:13:18:06
Tina Freese Decker
So we'll have to do that. And then the third is funding. We all see that to care for an aging population, a more complex, chronic disease population - as much as we would like for them not to be in the hospital and to be as healthy as possible, we are still dealing with an unhealthy population and people that unfortunately have some illnesses.

00:13:18:09 - 00:13:40:27
Tina Freese Decker
And so we need to figure out how do we fund this in the most appropriate way. And people across the country are tired of health care costs going up, and they want to see greater value for what they're getting. And I think that ties into trust. Through the pandemic, we had a lot of trust. I think that trust in general, in institutions, has decreased.

00:13:40:29 - 00:14:01:20
Tina Freese Decker
And so we need to focus on building back that trust. And part of that is having honest conversations about the value that people provide and what we need to do as partners in the communities, as partners with people on their health. So those are a couple of things that are top of mind for me. We're going to focus on those, but also we're going to navigate a new administration.

00:14:01:23 - 00:14:21:19
Tina Freese Decker
And there's knowns and there's unknowns as we go into that. The AHA is very strong. They know how to work with various administrations and I feel that we'll be able to work together as we figure this out and advocate for the best interests of the field and the best interests of the neighbors and the people that we serve every single day.

00:14:21:21 - 00:14:46:22
Joanne Conroy, M.D.
I totally agree. And I would say that, you know, if we just stay focused on the patient and delivering really high quality care that people can afford, we'll make all the right decisions. It's shifting it - our focus - maybe from the business operations to the impact that we have on our communities. And that's something we have to talk about every day, and it's something we have to deliver on every single day

00:14:46:28 - 00:15:11:19
Joanne Conroy, M.D.
as sometimes the largest employers in our state and often the largest employers in our region. And, it's a responsibility as well as an honor to actually be able to participate in that way. I've got a lightning round of questions for you. Just so people actually really get to know you a little bit better.

00:15:11:21 - 00:15:17:19
Joanne Conroy, M.D.
So as a kid, you thought you'd grow up to be what?

00:15:17:21 - 00:15:18:21
Tina Freese Decker
An architect.

00:15:18:24 - 00:15:20:23
Joanne Conroy, M.D.
Oh, wow. That's interesting.

00:15:20:25 - 00:15:25:10
Tina Freese Decker
And I did go into industrial engineering. But, yeah, I always loved to design things.

00:15:25:17 - 00:15:31:16
Joanne Conroy, M.D.
Oh, wow. So are you very involved in your facility projects at Corewell?

00:15:31:18 - 00:15:49:01
Tina Freese Decker
You know, I'm not anymore. You know as CEO, you got to stop doing certain things. But, you know, it's just always interesting to see how things come together. Some of my passion is how do you, make things easier, simpler, for both, you know, the patients and also the people providing care?

00:15:49:04 - 00:16:19:25
Joanne Conroy, M.D.
You know, that's interesting. When I was an undergraduate, I was thinking about doing a major in religion, music and architecture. Because when you think about it, it creates the environment that we live in. The physical environment, the artistic environment and the spiritual environment are actually very connected. And I think we shouldn't underestimate the message that our facilities actually send patients when they walk through the door.

00:16:19:27 - 00:16:26:08
Joanne Conroy, M.D.
So second question, your favorite subject in school was?

00:16:26:11 - 00:16:30:29
Tina Freese Decker
I would say the math or chemistry. I love both of those.

00:16:31:01 - 00:16:41:24
Joanne Conroy, M.D.
Something we have in common. I was a chemistry major and a math minor, so no wonder we get along so well. What's the worst job you ever had?

00:16:41:26 - 00:17:00:09
Tina Freese Decker
Well, you know, it wasn't the worst job. And I learned a lot on it, but my first job was at Pizza Hut, and I was a cook. And, let's just say there's certain things I will never eat on pizza again, but, you know, you learn a lot by working in the back of a restaurant.

00:17:00:17 - 00:17:09:20
Tina Freese Decker
And how do you navigate the different team environment there? And then getting things done and, in a productive way.

00:17:09:22 - 00:17:22:24
Joanne Conroy, M.D.
You know what? Health care is a hospitality industry. If anybody has any questions about that, all you have to do is actually work in a hospital. How do you like to start your days?

00:17:22:26 - 00:17:40:21
Tina Freese Decker
I usually like to start my days exercising because I know at the end of the day, it's not going to happen. So I want to make sure I get that done, because that's important to me to do. And then, I'm more of a morning person to get things going. And I like some of that quiet time at the beginning of the morning just to think.

00:17:40:24 - 00:17:45:10
Joanne Conroy, M.D.
Yeah, I do Wordle. Now, how do you end your day?

00:17:45:11 - 00:17:51:15
Tina Freese Decker
I do Wordle at the end of the day. But don't tell me the answer!

00:17:51:17 - 00:17:53:19
Joanne Conroy, M.D.
How do you spend your free time?

00:17:53:21 - 00:18:11:29
Tina Freese Decker
I love just to be with my family. I have two kids and a loving husband and a dog. And so it's with them. Or traveling, exploring, new places to learn about.  Reading - I read a lot. And I love to play sports with my family and other games.

00:18:12:01 - 00:18:27:24
Joanne Conroy, M.D.
You are a voracious reader. You put us all to shame with the number of books you read and how quickly you read them. I'm impressed every time I travel with you. So one word to describe how you're feeling about stepping into the chair role at the AHA.

00:18:27:27 - 00:18:49:28
Tina Freese Decker
Oh, I only got one word. I'll go for optimistic. I think that I'm very proud of the AHA and I believe in the AHA and what the team can do. And I think there's a lot of things that can come to my mind, but I believe we have to be focused on how do we partner and move forward.

00:18:49:28 - 00:18:51:22
Tina Freese Decker
And so I'm going with optimistic.

00:18:51:25 - 00:18:54:16
Joanne Conroy, M.D.
So any closing comments, Tina?

00:18:54:18 - 00:19:12:18
Tina Freese Decker
First I just want to say, Joanne, you've done a fantastic job. Thank you so much for all that you've done this year, and you've been a great partner and mentor so that I can take the advice and, apply that as well as some things that I'll bring to the table and help the AHA move forward.

00:19:12:20 - 00:19:42:28
Tina Freese Decker
It's been wonderful to get to know you and to watch you lead. And I'm just really looking forward to working with all of our members, on behalf of our members, to help the AHA move us forward. The AHA really believes in our membership and what we do every single day to take care of our patients and our neighbors and our communities, and we'll make sure that that is the focus as we go forward in this challenging environment, but that we believe in partnership and we believe that we can achieve the objectives that we set forward.

00:19:43:06 - 00:19:45:09
Tina Freese Decker
And I look forward to working with everyone.

00:19:45:11 - 00:20:14:26
Joanne Conroy, M.D.
Well, Tina, thank you again for joining me today and for sharing your insights. Your perspective is both helpful and inspiring, and the AHA board is very fortunate to have you as their leader in 2025. I want to thank you one last time, for everybody has joined me over the last year. As I said when we first began last January, there's great value in listening and learning from one another and I know those valuable lessons will continue next year

00:20:14:26 - 00:20:32:23
Joanne Conroy, M.D.
As Tina takes the reins hosting these peer-to-peer discussions as AHA board chair. Best wishes to all of you for a happy holiday season and a healthy and peaceful 2025. Thank you.

00:20:32:25 - 00:20:41:06
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 - 00:00:30:16
Tom Haederle
When you are the health care destination for five rural counties in northeast Texas, your operational strategies have a lot of impact on patient lives. For Titus Regional Medical Center, 174-bed independent hospital, the driving operational strategy, or principle, is an unshakable commitment to health equity in all its forms.

00:00:30:18 - 00:01:08:27
Tom Haederle
Welcome to Advancing Health, the podcast of the American Hospital Association. I'm Tom Haederle with AHA  Communications. Health equity is a journey. Each hospital or health system pursues this goal in its own way, according to the needs of the communities it serves. In today's podcast, a sort of audio case study hosted by Jackie Hunter, vice president of health equity strategies with the AHA’s Institute for Diversity and Health Equity, we learn how the Institute's Health Equity Roadmap, currently used by 720 hospitals nationwide, has helped Titus Regional design a system of individualized care that relies on data to deliver impressive results.

00:01:09:00 - 00:01:10:13
Tom Haederle
Here's Jackie.

00:01:10:15 - 00:01:25:18
Jackie Hunter
So I would like to welcome today Terry Scoggin, the chief executive officer of Titus Regional Medical Center, a joint commission accredited 174-bed independent rural hospital system serving the northeast Texas area. Welcome, Terry.

00:01:25:20 - 00:01:32:26
Terry Scoggin
Thank you so much for having me. So glad to be a part of this program and talking about rural health care and health equity in rural communities as well.

00:01:33:01 - 00:01:38:17
Jackie Hunter
So let's get started. How does health equity fit into your organization's strategic priorities?

00:01:38:20 - 00:01:58:21
Terry Scoggin
It's the foundation of what we do. On a daily basis, health equity impacts everything there is about health care. In a rural community, especially in northeast Texas, we're 60 miles from the Arkansas border, the Oklahoma border and the Louisiana border on I-30. We're 45 to 50 miles from a health system equivalent in every direction. So our county is 32,000 people.

00:01:58:22 - 00:02:27:14
Terry Scoggin
We're surrounded by four counties that don't have a hospital. So we have about 82,000 people. We are the independent health system for those five counties. And in northeast Texas, health equity is one of the driving factors in health. So when you see all the analysis and you talk to people, 80% of a person's health is determined by those health equity factors, whether it be in Texas, the non-medical drivers of health, or across the rest of the nation when they call it social determinants of health.

00:02:27:17 - 00:02:53:28
Terry Scoggin
Those are the driving factors in health. So health equity is so much deeper than just diversity, equity, inclusion. But it really gets into what are the individualized needs of that patient and how do you affect it. So from our strategy perspective that's how we build our strategy. Trying to understand the needs of our community, of our physicians, of our team members, and all of those things for the individualized care of each one of them.

00:02:54:04 - 00:03:10:16
Jackie Hunter
So it sounds like you are doing some great work in that space. And, you know, thanks for sharing that information with us. So I know you're very familiar with our Health Equity Roadmap. What has been your experience with the Roadmap thus far? And in particular, how does it align with your current organization’s strategic plan that you mentioned?

00:03:10:22 - 00:03:33:09
Terry Scoggin
So from a Roadmap perspective, we've had the opportunity the last few years to go through the process, have our data submitted, then review our results. We've been lucky enough to participate with the American Hospital Association and the different regional parts of AHA to really analyze health equity and listen to podcasts and websites and all those different resources that AHA makes available. Podcasts like this one.

00:03:33:09 - 00:04:05:21
Terry Scoggin
And we learned so much about health equity, but we've used that Roadmap to kind of really do the drivers of health. And I encourage anybody who's going to look at that Roadmap, those drivers are the ones that I've really found valuable to us. So when you look at the levers and the summary of levers of transformation that the Roadmap has, I think you're going to find some great foundations for strategies, for milestones, for action items that you, as a health entity, can take into, that are going to have a dramatic impact on your daily work.

00:04:05:23 - 00:04:29:12
Jackie Hunter
That's great. And I'll chat a little bit about, you know, our Health Equity Roadmap. In March 2022, the AHA launched the Health Equity Roadmap. And it's a national initiative to help drive the improvement in health care outcomes, health equity, diversity and inclusion. Right now, we have about 720 member hospitals that have completed the health equity transformation assessment. Oftentimes we reference as the HETA.

00:04:29:14 - 00:04:56:08
Jackie Hunter
This electronic tool serves not only as diagnostic, but also to assess the current state, of health equity as a baseline for continuous improvement, helping organizations like yourself become more equitable and inclusive. The journey towards health equity doesn't end with assessment, as you already referenced. After completing the HETA, members receive a comprehensive profile and links to assess the transformation action planners, which sometimes we call TAPs.

00:04:56:11 - 00:05:20:27
Jackie Hunter
Additionally, all members participating in the Health Equity Roadmap are invited to join the journey, a virtual community designed to support ongoing efforts in health equity transformation. So we really appreciate your involvement within the HETA, as well as being a champion for this work. How did you leverage the data collected through the HETA, and corresponding results to inform your actions?

00:05:21:00 - 00:05:39:09
Terry Scoggin
As far as using the data, it was amazing just to see how the data was put together in the HETA analysis. It's not what I was expecting. We talk about expectations and we talk about the data. I was expecting it to be something about more like a community health needs assessment. And I want to talk to our peers and other people who are taking this assessment.

00:05:39:11 - 00:06:01:27
Terry Scoggin
It's not what it is. It's not a CHNA. This is a way of really breaking down how are you looking at diversity, equity, inclusion across your health system, across your community, and really looking into deep into your foundation? I was very surprised by the data and how it was put in a way that we could use it, whether it be policies, whether it be committee structures.

00:06:02:00 - 00:06:19:06
Terry Scoggin
And then, especially in our strategic, you asked earlier about that strategic priorities. It's critical when we look at the mission and the vision of our community, vital independent rural health system, that we understand the health equity impact on each one of those milestones that we put in place.

00:06:19:14 - 00:06:37:09
Jackie Hunter
That's great. And I know, you know, earlier during my introduction, I talked about you all being a joint accredited, you know, with The Joint Commission. I'd like to chat a little bit about that. So what impact do you hope this will have on your accreditation and compliance with The Joint Commission, as well as the Center for Medicare and Medicaid Services?

00:06:37:12 - 00:07:00:12
Terry Scoggin
We were accredited or surveyed in 2023 now by The Joint Commission. And during the end of Covid, we went through this process and went through the playbook and did our first really analysis from a health equity standpoint, and we realized how many gaps we had. And I’m truly appreciative of AHA. And I've shared that with many of my colleagues of the AHA, how it prepped us for what we didn't know.

00:07:00:14 - 00:07:22:18
Terry Scoggin
We were looking at health equity so wrong. Health equity is not just race or it's just not diversity and inclusion. Health equity is so much more. And going through this Roadmap and going through this assessment, we are able to look at so many different areas of it, and what it really made us focus on is data. And there's a lot of things

00:07:22:18 - 00:07:40:06
Terry Scoggin
in there you start asking yourself, let's get into the data. I had the opportunity with the AHA to go through a cohort a couple of years ago as well, and we were able to access some tools, and we use one of those tools that really gets into the socioeconomic and really the health equity matrix and indexes for your community. And that's, we started pulling data.

00:07:40:06 - 00:08:04:26
Terry Scoggin
I'm a CPA by background, I love numbers. I'm probably not the guy you want to invite to dinner and have to the cocktail party. But I love data. And when we really what was encouraged through this analysis is we started pulling data and it wasn't just pulling ethnicity and race and stuff. We were looking at all the different segments in our community, insured and uninsured, race, ethnicity, religion, uninsured.

00:08:04:28 - 00:08:31:18
Terry Scoggin
We're working. We don't have insurance, but we have commercial insurance, Medicare, Medicaid, all those different aspects that you break down when you start looking at it. We're 47% Hispanic in our county, 43% white, 9% African American. Really breaking in what does it look like in the census areas of our county? The life expectancy in the north part of our city was almost 12 years higher than the south part of our community.

00:08:31:21 - 00:08:48:29
Terry Scoggin
That is right next to one of our manufacturing plants. Those are the types of things when you start looking at health equity and you really break down the segments in your community, there's so many segments. And one of the levers that it talks about in here, and I think I hear all the time from AHA, is talking about individualized care.

00:08:49:01 - 00:09:16:24
Terry Scoggin
If you are not treating each patient from an individualized needs point of view, you're missing it. You're not providing the care that they need. It's not just we treat everybody this way. That's wrong. The health equity lens that we're trying to put on it really focused on in this assessment, is really trying to say, what are the individual needs of that segment and more importantly, what's the individualized needs of that patient and their family and how can we meet it?

00:09:16:24 - 00:09:34:03
Terry Scoggin
So from a Joint Commission standpoint, when they came last January, they said, okay, what are you doing with health equity? And I said, okay, here we go. How much time do you have? Here's all these slides that we worked on. We've broken down this our social vulnerability index. This is our uninsured rates. This is how it is for our prenatal group.

00:09:34:03 - 00:09:53:15
Terry Scoggin
Here's what is for geriatric population. We were able to show all the segments of our population that they looked at. And then they looked at my board members and said, okay, what do y'all know about this stuff? And we, part of our board package every month, I have a section of the board meeting that's focused on health equity, something educational, or some facts about health equity.

00:09:53:18 - 00:10:16:00
Terry Scoggin
It may be something we got from AHA. It might be some data we want to look at. That's the difference. And so when my board members started saying the same thing that I was saying, and then they looked in our board reports, they were like, okay, we get it now. I will tell you this, I was impressed by Joint Commission, and I would encourage my peers and colleagues across the health care industry to be prepared.

00:10:16:00 - 00:10:33:00
Terry Scoggin
I think Joint Commission has it right. If we're going to make a difference in the lives of people across the United States, we have to focus on health equity. And I think the things that a Joint Commission are asking and the data they're asking for, and they're wanting to see it in your board reports, they’re wanting to see it in your strategic initiatives

00:10:33:00 - 00:10:40:06
Terry Scoggin
as you talked about earlier, I think they've got it right, and I'm excited for what CMS is doing and what Joint Commission's doing related to health equity.

00:10:40:12 - 00:10:47:03
Jackie Hunter
What are some early lessons on how the Health Equity Roadmap has influenced and transformed the culture within your organization?

00:10:47:05 - 00:11:05:13
Terry Scoggin
From a culture standpoint, I think the Health Equity Roadmap has allowed us to see the data, to see the information. Once you see this, you can't unsee it. And that's a difference that I've had over the last four or five years. And I appreciate AHA for the opportunity they've given me to participate in these things and try and ,once you see it, you can't unsee it.

00:11:05:17 - 00:11:25:03
Terry Scoggin
Once you see the inequities in health care or the inequities caused by our own actions and our own policies, you don't unsee it. And when you look at this data in a rural community, it's different because that's not a number. That's not a percentage. I know who that person is. I know who that segment is. I know where they go to church.

00:11:25:06 - 00:11:47:06
Terry Scoggin
I know where they live. I understand that they don't have the exercise things in that part of the community. So the difference is really from our standpoint where it's influenced in our organization is we've seen the data and once you've seen it, you cannot unsee it. And I think we're challenging ourselves, whatever it is, if it's a committee, if it's a group task force, who's on it?

00:11:47:08 - 00:12:05:29
Terry Scoggin
Do we have enough men and women? Do we have enough of the age groups? Do we have enough of the different race and ethnicity? Have we considered our gay-lesbian community? Have we considered our uninsured community? All the different things. I think that's one of the things I've loved about this is it's opened our eyes and we're asking questions and we're having conversations.

00:12:06:01 - 00:12:29:08
Terry Scoggin
Rural is one of the inequities in health care, and being in rural is a health inequity. And I think those are the things we've got to talk about. Whether it's at the Texas Hospital Association or the American Hospital Association, you know, we asked ourselves, do we have the right mix on this committee? I think the AHA does a great job of trying to balance all the different measures of health equity, and they put a committee or a group together.

00:12:29:08 - 00:12:46:08
Terry Scoggin
And it's exciting to listen to some of these, you know, some of the ambassadors of health equity, when we come to some of these meetings. I think we have to continue to do it, whether it be our small organizations, our regional, our state. We have to focus to ensure that we're not creating an environment that is detrimental to health equity.

00:12:46:10 - 00:12:52:13
Jackie Hunter
That's great. No. Wow. That was powerful. And you know, with that, how do you expect this cultural shift to be sustainable?

00:12:52:15 - 00:13:08:02
Terry Scoggin
That's the hard part. How do you keep it sustainable? That's where it's going to be very difficult. But you know, where I think it is, and this is the discussions we've had in Texas over the last few months with the Texas Organization of Rural & Community Hospitals, TORCH, and also the Texas Hospital Association. This is where we need to talk to our legislatures.

00:13:08:09 - 00:13:28:25
Terry Scoggin
This is where we need to talk when we're lobbying for additional funds. You know, we struggle from a health care perspective, especially with the payers. The payers, for the most part, are for-profit companies, and they have lobby groups that are talking about all the bad things that are going on in health care. We've got to turn it on its side and say, okay, what are you doing about the uninsured population?

00:13:28:25 - 00:13:44:18
Terry Scoggin
What are you doing about this segment? How are you addressing health equity? These are the things when you talk to your legislatures, when you talk to the people in the Senate and the Congress and the state legislatures, that's the stuff that's going to make a difference. And I think there's funds out there. We just need to put money in the right place.

00:13:44:21 - 00:14:08:13
Terry Scoggin
And I think if we start focusing more dollars on initiatives related to health equity, we will be able to mitigate a lot of unnecessary health spend. And I know that's not a popular statement, but I believe it. The money's there. It's just going to wrong places. So using these health equity data that you talked about, I think we can use those numbers and statistics to really once you see it, you're not going to unsee this.

00:14:08:15 - 00:14:32:04
Jackie Hunter
You know Terry, this was great. It was great chatting with you. You know, definitely have me fired up and really appreciate the hard work. And thanks for continuing to be a champion for us in this work. And, you know, thank you for sharing your insights and experiences with us today. And hopefully this will also help our rural counterparts, navigate through the HETA, and just want to again, thank you so much for your time and continue to do the great work in your rural setting.

00:14:32:06 - 00:14:33:08
Jackie Hunter
Thank you Terry.

00:14:33:10 - 00:14:35:03
Terry Scoggin
Thank you.

00:14:35:05 - 00:14:43:16
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.

00:00:00:07 - 00:00:23:11
Tom Haederle
The overall aging of America affects health care as much as any other field. For example, more than 60% of our currently practicing psychiatrists - who provide a significant portion of behavioral health services to patients - are over age 55 and are likely to retire within the next decade. So, how to recruit, train, and retain enough people to meet the future demand for behavioral health services in our nation?

00:00:23:13 - 00:00:35:09
Tom Haederle
Integration may hold the key.

00:00:35:12 - 00:01:02:16
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In this podcast, hosted by Rebecca Chickey, senior director of behavioral health services with AHA, we hear how the dismantling of the traditional silos between behavioral health and primary care practice benefit patient and provider alike. Her guest is Dylan Panuska, a clinical psychologist and manager of behavioral health integration with Endeavor Health in Illinois.

00:01:02:19 - 00:01:13:09
Tom Haederle
Dr. Panuska shares real world examples of how integration can increase workforce productivity, satisfaction, and retention for both primary care and behavioral health clinicians.

00:01:13:12 - 00:01:40:21
Rebecca Chickey
Dylan, thank you for being here today with us. To set the tone, can you please share just the workforce shortage realities in the behavioral health workforce? Maybe provide a couple of examples of what's going on in your own organizations. Challenges around recruitment, retention, worker satisfaction. Just give a sense to the audience of the realities that are going on in the field right now.

00:01:40:24 - 00:02:13:05
Dylan Panuska, PsyD
So health care is stressful, right? And takes a special set of characteristics in a person to be drawn to that field. And the workforce shortage is also really coming about from just  - particularly in behavioral health - a huge increase in demand for behavioral health services, where, I mean, really, there's just simply not enough behavioral health professionals across the spectrum to meet the demand, particularly staying within traditional models of care.

00:02:13:07 - 00:02:47:03
Dylan Panuska, PsyD
I came across one thing in my research for the podcast: that in 2021, the American Association of Medical Colleges reported specifically for within Illinois that we had the capacity to meet just 24% of the mental health need in the state with its current workforce. That is staggering. Really alarming. Within Leonard Oaks and Endeavor Health, there's not necessarily something that as far as the workforce shortage goes, that makes us unique and not feeling that.

00:02:47:05 - 00:03:07:01
Dylan Panuska, PsyD
And I think as an industry, it's really about looking at what are some different solutions and innovations that we can implement to better meet the demand for services, while also keeping retention and increasing recruitment of qualified practitioners.

00:03:07:04 - 00:03:30:08
Rebecca Chickey
And I think that's what we're here today to discuss. That is one of those solutions, not the sole solution by any means, but one of the solutions is the value of integrating physical and behavioral health care, and how that can help with workforce satisfaction, recruitment and retention. And I'll add another really just soul-settling statistic to the one that you shared.

00:03:30:08 - 00:04:01:15
Rebecca Chickey
And that is over 60% of our current psychiatrists, and admittedly, behavioral health work is done by a broad team of individuals in the field, whether it's psychologist, social workers, counselors, marriage and family therapists. So we're not just speaking about psychiatrists, but just in that one specialty area, 60% are age 55 or older. And while not everyone wants to retire at 65, a lot do.

00:04:01:17 - 00:04:23:20
Rebecca Chickey
So just looking out over the next decade, there could be a significant drop off in the current workforce. I know you've had some experience at Linden Oaks, which is now part of Endeavor Health, integrating physical and behavioral health. Can you share how you've seen it help improve worker satisfaction and retention of those workers?

00:04:23:22 - 00:04:55:15
Dylan Panuska, PsyD
So I had the distinct privilege and opportunity to grow our behavioral integration program over the last ten years with Linden Oaks and Endeavor Health. I was fortunate enough to be that original pilot person for it. So one of the areas that behavioral integration really helps with retention and recruitment is through each role, being able to practice within their scope and better supporting other disciplines.

00:04:55:17 - 00:05:34:23
Dylan Panuska, PsyD
I describe it this way often where, really the magic of behavioral health integration is the patient is able to receive both their behavioral health care and their primary care within the same setting. And when you have satisfied patients, you also have more engaged physicians, therapists, psychiatrists across the board. One of the other big areas that BHI, or behavioral health integration really helps with is it enhances the patient care team and system of care where you can work smarter, not harder.

00:05:34:25 - 00:06:00:21
Rebecca Chickey
So let me dig into that last point just a little bit. Working smarter, not harder. That seems to me that's a way to increase productivity. Not only can the behavioral health team be able to practice their full scope of practice to their full license, but they can be able to better support their other clinicians and health care workers that are working with the patient.

00:06:00:23 - 00:06:09:14
Rebecca Chickey
Is that what really helps productivity? Is it also maybe that satisfaction drives productivity? What's your opinion?

00:06:09:17 - 00:06:54:07
Dylan Panuska, PsyD
Another really important part of it is a lot of patients present in primary care with some component of either psychosocial stressor or behavioral health condition present. By having both of those disciplines in one place, it really keeps a busy clinic working efficiently while also providing high quality patient care. I have two examples just from the past month where patients present in primary care with some sort of behavioral health crisis or they're identified as having some degree of suicidal ideation.

00:06:54:09 - 00:07:21:17
Dylan Panuska, PsyD
And when you have behavioral health right on site to be able to come in for a warm handoff, help with the assessment and evaluation recommendation for next steps, that one helps reduce sort of emotional load or burden on the primary care physician and primary care team, helps make sure the patient is navigated to the most appropriate and safest level of care.

00:07:21:19 - 00:07:41:21
Dylan Panuska, PsyD
And you have the behavioral health expert right on site to help direct those pieces. It's a really fun role reversal, I guess is how I'll describe it, where that behavioral health professional is really helping navigate and guide that patient experience and safety of care.

00:07:41:23 - 00:08:13:09
Rebecca Chickey
So I don't want to put words in your mouth. Keep me honest here, Dylan. Please. But I think it's an interconnectedness that integration provides between meeting the patient's needs...having the clinicians whether they're the primary care clinician or the behavioral health clinician, be able to work together to meet those needs and not have that frustration of the physical health need isn't being met, or the mental health need or substance use disorder need for treatment isn't being met.

00:08:13:16 - 00:08:26:09
Rebecca Chickey
That it's that interconnectedness and the ability to treat the whole person that's a key factor in driving improve satisfaction and productivity because you feel better about the job you're doing.

00:08:26:12 - 00:08:56:18
Dylan Panuska, PsyD
Absolutely. And when we're able to have that like multi-disciplinary approach and easy access of communicating, you know, for primary care, that's what behavioral health and with behavioral health have, you know, of course, having greater access to the primary care physician in the primary care team, coordination ends up being just so much easier where historically health care has functioned in big silos.

00:08:56:21 - 00:09:40:16
Dylan Panuska, PsyD
And so it's been hard to, you know, for primary care to know what behavioral health doing and vice versa. And from a predictive standpoint, it can help reduce like duplicative work. And then also it's making sure that the correct role or person is helping a patient navigate one of their needs. So as a psychologist, I'm going to be much more tapped into not only the resources that are available to a patient from a behavioral health standpoint within our own behavioral health Linden Oaks and Denver Health System, but also what other resources and opportunities are available to the patient within the community and how to help get them connected.

00:09:40:18 - 00:10:17:15
Dylan Panuska, PsyD
The other thing that, I'll say a lot about behavioral health integration, particularly in busy primary care practice, is we give the gift of time. When there's a behavioral health component that can, you know, really take a lot more time to fully and adequately address. And primary care physicians and mid-level NP, PAs' schedules are overloaded. Back to that idea of, you know, workforce and not having enough primary care physicians either. When you have psychology or social work professional counselors on site, that warm handoff takes place.

00:10:17:18 - 00:11:06:09
Dylan Panuska, PsyD
So we sort of step in, and help navigate and manage behavioral health needs. And the primary care physician is able to move on and stay within the bounds of their schedule, also leading to happy physicians. So EPIC, our most common EMR, but they have a term they call "pajama time." So, it's time spent from health care providers outside of office hours in EPIC documenting, responding to in-baskets, things along those lines. When behavioral health is onsite and integrated it can help reduce that amount of pajama time or time spent outside of the office, not just from a pure time in-basket or documenting standpoint, but we all get into

00:11:06:09 - 00:11:31:09
Dylan Panuska, PsyD
this field because we're compassionate and trying to help people. And so the mental load of wanting to navigate somebody and not knowing how to do that weighs on people. And so now they have, immediate access to the team members that can really help offload or unload that burden that they've really historically have carried.

00:11:31:11 - 00:11:54:09
Rebecca Chickey
That's great. I think one of the things I would say is that the magic of integration. I'm loving this work, Dylan. I'm going to use it over and over. The magic of integration is to allow time for all of the individuals involved in the treatment of a patient to decompress. They may still have pajama time but it's not going to be spent on the EMR, so that's a good thing.

00:11:54:11 - 00:12:13:16
Rebecca Chickey
So just got a call from a primary care physician who's leading a small but mighty multi-specialty in primary care. I mean, so family medicine, internal medicine, etc. They're considering embracing integrated care to convince them to do so.

00:12:13:18 - 00:12:47:16
Dylan Panuska, PsyD
In my experience in growing behavioral health integration at Endeavor Health and Linden Oaks, where I've been mostly successful is in starting with the why we should integrate. And when you're able to start with why and have you know, solid, positive, patient stories to help support that, that's really where it starts to sell itself. At the beginning of it when we were looking for a pilot, it's like primary care is designed for, well, primary care.

00:12:47:19 - 00:13:17:24
Dylan Panuska, PsyD
What if we bring on these patients with behavioral health conditions to the practice and back to the why. It was, well, they're already there adding behavioral integration. The why to it is really to help better treat and improve the lives of patients through whole person care. And then one of the other things I'll say is behavioral health integration is hard.

00:13:17:26 - 00:13:58:01
Dylan Panuska, PsyD
But that's okay because hard things are hard. Or the other way I usually describe it is primary care was not designed with behavioral health in mind. So it requires somebody and a team of people to be very persistent and clearly communicating and engaging all of the stakeholders along the way. And one of the things that can be challenging in behavioral integration is really everybody has to be engaged and shift their idea of how both primary care and behavioral health meet the patient's needs, including the patient.

00:13:58:04 - 00:14:20:14
Dylan Panuska, PsyD
It is not a traditional model of behavioral health, and it is so much more than just a brief solution focused individual therapy. And what's really amazing is when you bring these two pieces together, it really ends up being more than the sum of its parts.

00:14:20:16 - 00:14:48:19
Rebecca Chickey
Integration is more than the sum of its parts. Integration improves outcomes. It's a magic that can give the gift of time. The gift of time goes to all of those involved in the treatment program, but to the patient as well, because when they're able to have more time to live a healthier, productive life, that is, as my father used to say, without your health, you have nothing. Having better health,

00:14:48:25 - 00:15:01:20
Rebecca Chickey
it's priceless. We can't put a price tag on that. So, Dylan, thank you so much for sharing your expertise and time with us here today. We're very grateful to you and to your team and, keep up the great work.

00:15:01:23 - 00:15:09:00
Dylan Panuska, PsyD
My pleasure. Thank you for having me and can't imagine practicing psychology any other way.

00:15:09:02 - 00:15:17:12
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.