Advancing Health Podcast

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St. Louis Children’s Hospital is helping new moms, families and communities thrive through its Raising St. Louis program. In this "Caring for Our Kids" episode, Traci Carter, program manager of Raising St. Louis, and Nicole Kozma, director of school and community outreach programs at St. Louis Children’s Hospital and BJC Community Health Improvement, discuss the scope of the Raising St. Louis program — from home visitation teams and early childhood development, to engagement with fathers and plans to expand support with doulas.


 

View Transcript
 

00:00:00:18 - 00:00:23:24
Tom Haederle
Welcome to Advancing Health. Coming up in today's episode, a conversation about how Saint Louis Children's Hospital is supporting new moms so their babies can thrive. It comes down to basics, including systems that surround and support young families. And we'll learn more about a specific program called Raising Saint Louis, which offers multidisciplinary home visitation teams that provide comprehensive care and support.

00:00:23:27 - 00:00:30:08
Tom Haederle
Our host is Julia Resnick, Director of Strategic Initiatives with AHA.

00:00:30:10 - 00:00:40:06
Julia Resnick
Traci and Nicole, thank you so much for being here today. To kick things off, I'd like to learn a little bit more about each of you. So can you introduce yourself to our listeners? Traci, we'll start with you.

00:00:40:08 - 00:01:13:02
Traci Carter
Traci Carter, manager of Raising Saint Louis. Honestly, what kind of drove my work in this space is I've worked in social services for a while. I started off at the Urban League and realized that a lot of the work was always in disparities. And it wasn't really until I went back to school, in 2018 for my MHA, that I actually did my dissertation on infant and maternal child health. Finding and understanding, like the root cause of things.

00:01:13:02 - 00:01:35:28
Traci Carter
And when it came to maternal child health, had been working in that space for a while, just dealing with health disparities. But now it's just like the work that we're doing now is so impactful. And I was really drawn to this position a few years ago when I applied. And, yeah. And it really has impacted so much of what I do because I realized that mothers are suffering every day.

00:01:35:29 - 00:01:41:08
Traci Carter
And it's really about how do we help them? How do we help them in this work?

00:01:41:10 - 00:01:46:06
Julia Resnick
That's wonderful. And we will certainly dig more into that in a few minutes. But, Nicole, I'll turn it over to you.

00:01:46:08 - 00:02:11:15
Nicole Kozma
Sure. So Nicole Kozma, the director of school and community outreach programs for Saint Louis Children's Hospital and BJC Community Health Improvement. I have been working in the field of public health for 25 years. And what I love so much about public health, it's very broad so you can work in so many different health topics and different populations, which I really enjoy.

00:02:11:17 - 00:02:34:13
Nicole Kozma
And I've worked at Saint Louis Children's Hospital for the last 14 years. What I've enjoyed with that is just the variety of programing as well. Working with children and families in our community. And so it's exciting to be able to help people do preventative health education, preventative services, try to keep people healthy so they don't have to come to the hospital and see us.

00:02:34:15 - 00:02:42:26
Julia Resnick
So new moms certainly face a number of challenges. How is Saint Louis Children's helping support new moms so that their babies can thrive?

00:02:42:28 - 00:03:11:26
Traci Carter
Honestly, Julia, we look at that from a host of different areas, right? Starting first and foremost with, like, the Maslow's Law of, hierarchy of need, right? Which is really looking from, you're not worried about certain things if, if you can't even meet those basic needs. So we kind of really start at the basic needs, with realizing that people need resources, they need a system, a village.

00:03:11:27 - 00:03:41:13
Traci Carter
Most families, that's what they're in need of. The mom or the dad, whoever, is just in need of just trying to get those basic quality of life necessities fulfilled. So when we come in our program, we come in to kind of help facilitate with that. From our community health workers, social work - I know we'll go into a little bit more of this - but we really try to provide more like a village around our families to kind of help uplift them along their way on their journey.  

00:03:41:15 - 00:03:44:18
Traci Carter
So just providing a slew of resources to them.

00:03:44:21 - 00:03:53:00
Julia Resnick
So that all takes us to your program, Raising Saint Louis. Can you tell us about the program and how infant mortality became a priority for Saint Louis Children's?

00:03:53:03 - 00:04:22:29
Nicole Kozma
I think there are three main points when you're looking at research that really help share the reason why, as a pediatric hospital, we would want to have a program like Raising Saint Louis for our community. One development: research shows that children who are in early intervention programs and they provide those services, they have significant improvements in their physical, cognitive, communication and social development.

00:04:23:02 - 00:04:50:03
Nicole Kozma
Second, early intervention can reduce the need for special education and related services after children enter school, which leads to a huge cost savings for our school districts, which is gigantic. And then there have been long term studies done to show that children who participate in early intervention programs are more likely to graduate from high school, hold jobs, and live independently.

00:04:50:05 - 00:05:14:28
Nicole Kozma
And these programs have been associated with lower rates of grade repetition, special education, and justice system involvement later in life. So I think because of all the strong research in early intervention programs and home visiting, that is what led the Saint Louis Children's Hospital to say, yes, this is a program we want to provide to our community.

00:05:15:00 - 00:05:31:04
Julia Resnick
Absolutely. And that early start prevention at the beginning of a child's life is just so huge for supporting their outcomes throughout their life. Traci, I know that raising Saint Louis is really your baby so can you talk me through what happens when a new mom joins the program?

00:05:31:06 - 00:05:51:29
Traci Carter
Yes, absolutely. So one of the great things about Raising Saint Louis is that anybody can refer you to the program. The only criteria that we really have is that we work with 22 zip codes. And they are typically some 22 of the most high need zip codes. But we work with those zip codes. And again, like I said, we take referrals from anywhere.

00:05:51:29 - 00:06:17:13
Traci Carter
But our team is basically once you come in and you are brought in, you are asked whether or not you would like a community health worker. Would you like a community health educator, also known as parents as teachers, and if you'd like, a social worker? And of course, we also offer nurses. We work with a partner, Nurses for Newborn to also help facilitate with that.

00:06:17:15 - 00:07:00:18
Traci Carter
Once you're in, you decide which service line because we again we work with the multidisciplinary staff. And so once you kind of pinpoint where you want to come in, you then are greeted by some of our wonderful coworkers who are there to help facilitate. So you're brought in if you want to work with the community health worker. That community health worker is working with that family, from the very jump to kind of top down and break down those social economic barriers that, you know, most of our families see, and really helping them have a hand in walking through that process of whatever that is, whether it be housing, transportation, food insecurity, they're

00:07:00:18 - 00:07:22:03
Traci Carter
there to help you. Our parent educators, also community health educators, they are working more so with the physical and developmental milestones, with the baby and the parents, making sure that mom and dad are doing their job, they're not noticing anything. And if they are, we're there to kind of talk you through that and let you know and to kind of figure that out for you.

00:07:22:06 - 00:07:34:11
Julia Resnick
I love that you've built in a community building aspect to the program that's really special. So at what point can new moms join the program? Is it once they've had the baby when they're pregnant? What's the timeline like?

00:07:34:14 - 00:07:54:03
Traci Carter
Yes. So the timeline is we work with prenatal and postnatal. So we work with mothers who are prenatal from zero all the way up until 4 to 5 years of age before they hit kindergarten. They graduated from the program. So any time in between that, that 0 to 4 years of age, we are there for the parents if they need us.

00:07:54:06 - 00:08:01:08
Julia Resnick
So let's talk about access for the other parent, dads. How are you supporting new dads as they embark on fatherhood?

00:08:01:10 - 00:08:23:27
Nicole Kozma
That's a great question, Julia. You know, back in 2017, we held two different focus groups with our families, and we were fortunate enough to have men that came to the focus groups. And what we heard was this was a program for moms and babies. And we were like, oh, no. Nope. That wasn't what our intention was. We want dads to know about their involvement.

00:08:23:27 - 00:08:33:13
Nicole Kozma
We want them to feel included and welcomed when the home visitor comes, and also to be able comfortable to ask questions about their child's development and growth. And so

00:08:33:13 - 00:08:34:00
Traci Carter
we

00:08:34:00 - 00:09:03:04
Nicole Kozma
recognized we needed to put dedicated services toward father engagement. So through the years we've done different things. One of them is the evidence based curriculum called 24/7 dads. It has 12 lessons. We've been fortunate through the years to have male team members who have gone and gotten certified in this curriculum, and who are able to participate and lead sessions of this curriculum with different fathers and males who are part of our program.

00:09:03:07 - 00:09:16:23
Nicole Kozma
And we've also done different things with barbershop tours and locker room chats. And Traci can probably share more about some of the fun events that we do to try to engage our males and our fathers.

00:09:16:25 - 00:09:43:20
Traci Carter
Yeah, we've hosted a several series of different events throughout. Speaking of like the barbershop tours where we kind of go out and talk about, you know, the misconceptions of why few black men are really involved or taking better care of themselves from high blood pressure to prostate cancer. You know, we're trying to normalize it and let them know that it's okay to talk about these things or have a community that enables you to.

00:09:43:26 - 00:10:09:09
Traci Carter
We've also done things and work with the Justice Center here in Saint Louis, where we've spoken to some of the men who are actually incarcerated on how they could steal, even though  - I think that's the biggest takeaway - even though our families, they may not look like the traditional model, there is this thing where we want you to know that despite it all, there is a way to still be active and present in your children's lives.

00:10:09:09 - 00:10:36:14
Traci Carter
And so we really, we kind of bond around that in letting them know that it's okay, you know, it's okay if you and mom aren't together. But here is how you manage that here is how you work through those, those tough areas. And so I think we do a really good job with our team, especially our males CHWs that we have that really, you know, kind of meet those fathers where they are and kind of bring them along and tell them, you know, it's okay, we can get through this.

00:10:36:14 - 00:10:37:15
Traci Carter
And this is how.

00:10:37:17 - 00:10:57:07
Julia Resnick
That's so great, because, you know, no two families look alike and everyone is just trying to forge their own path. So in community health, I know we're always trying to make the case for why these investments are so important and impactful for the communities that we serve. So can you share how you're measuring the impact of Raising Saint Louis and any metrics that you have that that show that?

00:10:57:09 - 00:11:22:25
Traci Carter
So we have an evaluation team who really helps us kind of keep all of our metrics and things together. But what we found is that Raising Saint Louis clients have a 0.4% infant mortality rate, compared to 1.3% mortality rate for ST. Louis city. To put that in perspective, out of 744 babies that we've had come through our program, we have only lost three.

00:11:22:27 - 00:11:29:03
Traci Carter
You know, that's the thing that's showing that what we're doing is making an impact, and we love what we do.

00:11:29:05 - 00:11:31:16
Julia Resnick
Nicole, is there anything else you want to add?

00:11:31:18 - 00:11:54:16
Nicole Kozma
It's hard when you're a health promotion program and...we're not like a research program. We're not doing research on our clients and participants. So sometimes it's hard when we get asked these questions about infant mortality rates and things like that. And because, you know, we can take the small percentage of families we've been with through the years, but then we have to compare that to like a larger population.

00:11:54:16 - 00:12:18:20
Nicole Kozma
So it's not always like apples to apples comparison. So I think sometimes like if you're coming with a research focus, people could have a little bit of a different thought about those. But if you come from a health promotion health evaluation program focus, you know, we are still collecting that data. We're still looking at birth weights, we're looking at gestational age when they're born.

00:12:18:20 - 00:12:51:14
Nicole Kozma
We're talking with our mothers about birth spacing in different things that we know are important in the medical world, right? But along that way, we're really emphasizing child development and child learning and family goals and making sure like Traci mentioned earlier, that families feeling like they have a support system around them. And if there is something that pops up, they're going to have someone who's in their corner who's going to help them.

00:12:51:17 - 00:13:15:15
Nicole Kozma
We have amazing examples of our team members who have gone to doctors visits with our families, because a child might have a diagnosis, and it's overwhelming to the parent. And our community health educator creates a medical binder and says, hey, we're going to keep everything inside this binder so that at the next visit, these are the forms they're always asking us for.

00:13:15:15 - 00:13:39:14
Nicole Kozma
We're going to have a section in here for questions, answers so that we can keep everything together. We've had team members have gone to court for our families, who have been there to support them during those times. We've had families - you know, they just show up. So if they're if they're confused about, oh, you know, my child seems to be a delayed in speech

00:13:39:17 - 00:13:52:29
Nicole Kozma
okay, I can help you get connected with your school district and early education services and help you understand what an IEP is and how do we want to use these services that are available to us.

00:13:53:02 - 00:14:02:04
Julia Resnick
This is such impactful and powerful work. And I'm really curious as you're looking towards the future of Raising Saint Louis, what's next? What's on the horizon for you?

00:14:02:06 - 00:14:48:12
Traci Carter
Oh, Julia. So, we definitely want to keep expanding for sure. Definitely, because the need is great. So we already have our team together now, but we are currently in the process of exploring adding doulas as a source to combat infant/maternal health. And so one of the reasons are the causes behind that is that we know that doulas, they contribute to reducing infant and maternal health risk. Through continuous support, education and, of course, and advocacy and helping to facilitate better communication between the parents, the mom and the clinical staff. Those decision making aspects of what health care looks like.

00:14:48:12 - 00:15:09:23
Traci Carter
And so with doulas, we can help during the pregnancy. It helps during the childbirth and of course, postpartum. But by promoting more personalized and compassionate care, doulas help us ensure the safer and more positive outcomes for mothers and their babies. And so that's all the more reason why we're really looking to adding doulas to Raising Saint Louis.

00:15:09:23 - 00:15:12:21
Traci Carter
So that's my vision for it, for sure.

00:15:12:24 - 00:15:23:23
Julia Resnick
Nicole, Traci, thank you so much for sharing your time and your expertise with us. We look forward to seeing how you continue to grow Raising Saint Louis and grow those kids.

00:15:23:25 - 00:15:32:06
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.

Key findings from a report titled "The Case for Change" have identified four drivers of some of the most pressing challenges facing health care in New York state. In this conversation, Bea Grause, R.N., J.D., president of the Healthcare Association of New York State, discusses the tough findings and partnerships needed to solve these problems, insights into the correlation between health care and legislative advocacy, and how the report’s learnings are translatable to states around the country.



View Transcript
 

00:00:01:07 - 00:00:21:05
Tom Haederle
Welcome to Advancing Health. Coming up in today's episode, a conversation with Bea Grause, president of the Health Care Association of New York State, about the drivers that have health care in the Empire State perched on the edge of - quote - an existential cliff. We'll talk about what can be done and what the rest of the country can learn from how New York is handling its health care challenges.

00:00:21:08 - 00:00:29:27
Tom Haederle
Your host today is yours truly. I'm Tom Haederle, senior communication specialist with the AHA.

00:00:30:00 - 00:00:45:26
Tom Haederle
Bea, thank you so much for joining me this morning. Really appreciate your time. And, appreciate your effort in helping our listeners get into what Billy Joel might call a New York State of Mind about what health care challenges and the most effective ways to address them. So welcome. And thank you for being here.

00:00:45:29 - 00:00:46:27
Bea Grause, R.N., J.D.
Thank you, Tom.

00:00:47:00 - 00:01:05:26
Tom Haederle
You really are so well qualified to assess the challenges of today's health care from so many angles. And I'd like to just briefly share with our Advancing Health friends a little bit about your background so they know you know where you're coming from. You began your career as a nurse, an RN. You have done time on Capitol Hill as a legislative aide.

00:01:05:29 - 00:01:26:11
Tom Haederle
I know you're a veteran of senior positions with two other state health associations, Vermont and Massachusetts. You're a former member of AHA's board of trustees - thank you for your service. You also found time along the way to earn a law degree. So you've been a very accomplished person. And now, of course, you're president of one of the largest and most influential health care associations in the country.

00:01:26:13 - 00:01:44:01
Tom Haederle
And really, the purpose of our discussion today is, to discuss the concern that you and many other people have about what you see happening in New York State that's led to the production of "The Case for Change," this this new report that's kind of - frankly, a punch in the gut when it comes to - in terms of shaking things up and speaking

00:01:44:02 - 00:01:55:09
Tom Haederle
very candidly about some of the problems that the state is facing, what needs to be done. So let's start there. What is happening in New York state that prompted the release of The Case for Change?

00:01:55:12 - 00:02:23:02
Bea Grause, R.N., J.D.
Sure. I think what is happening, really was the post-pandemic reality. We realized that state and federal lawmakers wanted to move on from the pandemic. And our members - and this was true for members, for hospitals and health systems across the country - they hadn't moved on. They were not able to move on from the pandemic. The workforce shortage that was beginning to emerge, exacerbated during the pandemic.

00:02:23:03 - 00:02:55:10
Bea Grause, R.N., J.D.
It's now a chronic national workforce shortage. As a nurse, I recognized that demographically, New York had an aging population, which, again, I know is happening in many other states, not all, but many other states across the country. And we wanted to understand that environment better, what was actually happening at the core? Because at the core of health care, I understood, is you have patients and you have people taking care of patients.

00:02:55:13 - 00:03:33:00
Bea Grause, R.N., J.D.
And we knew that we were facing a crisis in both the demographics and who was able to take care of the increasing and changing demand that we saw happening and our members saw happening every day. That's why we did the report, was really to better understand that environment. And it has really helped us in creating a narrative that cuts through all the clutter and gets to a common set of facts where, rather than talking about, you know, this is, you know, a sophisticated podcast.

00:03:33:00 - 00:04:08:13
Bea Grause, R.N., J.D.
So rather than continuing to talk about all the symptoms of what's wrong with our system: 343B crisis, site neutral, all of the many, many, many issues that are very confusing to lawmakers, very confusing to us. You know, we're the experts in that space. And to patients and to consumers and to businesses completely impenetrable. We began this report with looking at demographic data on patients who were currently using hospitals and post-acute care

00:04:08:15 - 00:04:38:13
Bea Grause, R.N., J.D.
now and ten years out into the future. That was our starting place and then obviously looked at workforce data as well. And that really helped us to create the narrative that patient demand was increasing and changing. We didn't have the right number or the right type of health care worker to meet that demand. We had consistent and long standing disparities in care, urban rural poverty, haves and have nots, both on the provider space as well as the patient space.

00:04:38:15 - 00:05:13:27
Bea Grause, R.N., J.D.
And all of that was leading to unaffordability at every level. At the government level, at the business level and the consumer level. And without resolution in those four areas, that is the tipping point or the existential cliff that will cause our system to fail. Everything else is a symptom. We're trying to make it more understandable as well as more compelling, not just to all of us who understand all the nouns and verbs in health care, but to lawmakers and consumers and others.

00:05:14:00 - 00:05:35:14
Tom Haederle
Of the four drivers that you just outlined: health care demand is growing. Health disparities persist. Affordability, and lack of enough workers to provide the care that really is ever-growing. Of those four, is there one that is - they're all important - but is there one that's primary concern, that really needs the most urgent attention?

00:05:35:16 - 00:06:16:12
Bea Grause, R.N., J.D.
I'm going to stick with demand. Because as a clinician, to me, demand drives everything. And you'll see in that report, as I often say, there's not a HANYS ten point plan on how to fix our health care system. It's not designed for that. It is designed to, again, put out a common set of facts to bring people together, particularly, you know, for here in New York, lawmakers and others, other stakeholders to talk about what are some of the strategic things that we need to begin to work on in order to solve some of these much more difficult problems that are not being talked about or not being understood and then therefore not being resolved.

00:06:16:15 - 00:06:54:10
Bea Grause, R.N., J.D.
So to me, the most important one is demand. And I'll just use New York for a second. In five years we are going to have 700,000 new, net new, senior citizens in New York State. And you know, I think, as you well know, the per capita spending for senior citizens increases as people age. And so when you think about our blue H, and the brand of that blue H, I always think about that from a patient perspective as the only open door.

00:06:54:12 - 00:07:21:18
Bea Grause, R.N., J.D.
So if you have other open doors to get health care in a community, you will use them. But if there are none, you will go into that blue H. And if you have a medical need at any point you will go through that hospital door and then your care journey will begin from there. So that demand and you can you see it in the headlines with crowded emergency rooms, overload, nursing home closures, back up in the emergency room, the inability to get an appointment.

00:07:21:19 - 00:07:47:06
Bea Grause, R.N., J.D.
You're starting to see the overload in health care systems happening today. It is largely being driven by elderly patients coming in, not being able to get upstairs to get to a bed because there are no health care workers there, or there are 80 or 90 patients who would be better served in a nursing home and cannot be discharged because there's no nursing home bed.

00:07:47:09 - 00:08:12:06
Tom Haederle
And what is the role of community collaboration and partnership in addressing that particular problem? And frankly, all four drivers. I know one of the key takeaways of the report is that it's a joint effort that involves many different partners. And if you could talk a little bit about finding the right organizations to work with and who needs to lead that discussion, and what comes out of having these collaborative partnerships underway?

00:08:12:09 - 00:08:51:18
Bea Grause, R.N., J.D.
There are no right or wrong organizations that we're looking at. We're talking to other provider groups, businesses, unions. Using The Case for Change report to try to get a common understanding on the core facts and the core reasons for why our health care system is beginning to fail. And that collaboration is essential when you think about politics, state politics in this case, because you need to have, at least in New York, it is much better to get initiatives over the legislative finish line if you have a coalition, formal or informal.

00:08:51:24 - 00:09:02:01
Bea Grause, R.N., J.D.
But if you have broad based support, in other words, for an initiative for that year is a priority to try to get enacted.

00:09:02:03 - 00:09:07:25
Tom Haederle
Is there consensus around what we need to do in New York right now, or you feel or do you feel like you're getting there?

00:09:07:27 - 00:09:34:24
Bea Grause, R.N., J.D.
I feel like we're getting there. I have two examples. One is in the workforce space and the other is in the governor's budget, which our budget cycle has just begun. And we've been talking all year with Governor Hochul on using the case for change. And talking about the challenges that the state of New York faces with an aging population and a workforce shortage, primarily.

00:09:34:24 - 00:09:58:09
Bea Grause, R.N., J.D.
And, as you may know, I mean, the state of New York is already beginning to try to address disparities in care with the recent 1115 waiver. But certainly affordability is a huge problem for the state of New York. And helping them to understand that demand is going to increase for the next 25 years. The aging population will increase.

00:09:58:12 - 00:10:46:28
Bea Grause, R.N., J.D.
And it's not a question of if patients are going to need care, it's when and how much and where are they going to get that care. And if there's a mismatch between the capacity or the workforce gap gets worse, the cost to the state gets higher. And those kind of related messages, case for change related messages, were all part of our narrative with the governor all during last year. And in her budget and her state of the state, she did take a more strategic view, adopting many of those concepts in her budget and in her message to fund hospitals and nursing homes, but also for other across the continuum, continue to invest in workforce,

00:10:47:01 - 00:11:12:25
Bea Grause, R.N., J.D.
but also invest in capital so that more sites of care can be provided upstream or, you know, pre-hospital, so that patients are actually getting care outside of the hospital where they need to get care, and decreasing that expensive demand on hospital and post-acute services. So we were very pleased to see more strategic framing with the governor. So that's example number one.

00:11:12:25 - 00:11:48:06
Bea Grause, R.N., J.D.
Example number two is in workforce. As an advocacy organization where we are particularly and more externally or visibly focused on reaching out to other stakeholders to work on a whole host of workforce initiatives that are designed to recruit new workers, retain workers, eliminate the bottleneck in terms of not enough, faculty for, as one example, helping various health professions expand, work up to their full license.

00:11:48:09 - 00:12:01:29
Bea Grause, R.N., J.D.
And all of that is designed to close that gap in health care workers, particularly in the post-acute space, which hopefully will improve capacity. But it will help to bend that expense growth curve.

00:12:02:02 - 00:12:21:12
Tom Haederle
As we wrap up, we're almost at the end of our time, let me ask this. The concepts that are presented in The Case for Change, how translatable are they, would you say, to other systems because the four drivers that you've mentioned facing New York's system really can be found to a greater or lesser degree in every health system in the country.

00:12:21:12 - 00:13:11:18
Bea Grause, R.N., J.D.
100% translatable. I mean, just imagine, Tom, if there were a case for change narratives, rather than having lawmakers and others confused around 50 different issues where you have different groups, one side opposes, the other supports, lawmakers cannot break through that noise. And I've talked to many lawmakers who find health care impossibly confusing. So I think having this common set of facts that are based in what we all care about, that we have access to care that someone's going to be there to take care of us, that we're helping communities and individuals who don't have access to care, and that we're trying to make health care more affordable over time.

00:13:11:21 - 00:13:38:23
Bea Grause, R.N., J.D.
That is a narrative that I think we can all relate to. And I think when people understand and look at the details in the report and again, anybody who wants to take that report and make it, you know, it's open source, take it and build on that narrative. But if we were all and when I say we, but if providers across the continuum, providers in other states or associations in other states were using that, I call it a patient forward-narrative,

00:13:38:23 - 00:14:15:20
Bea Grause, R.N., J.D.
and framing it that way, lawmakers would then begin to think that way. Because if they if that's all they're hearing and they're hearing that consistent message: We're concerned about access. We're concerned about ED overloading. We're concerned about a workforce shortage. We want to make sure, we think it makes good economic sense to provide health care to underserved communities. If they're hearing those messages consistently and have written documents and written reports and other information to help them to understand that, and it will start to make sense to them.

00:14:15:22 - 00:14:34:20
Tom Haederle
That is a great summation. Thank you so much. You have been listening to us discuss a new report called The Case for Change. This has, come from the Health Care Association of New York State. Thanks again, Bea. Really appreciate your time. And good luck with making progress on the changes facing New York State right now.

00:14:34:23 - 00:14:39:04
Bea Grause, R.N., J.D.
Thank you, Tom, so much. This has been such a great conversation.

00:14:39:07 - 00:14:47:13
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.

Children with serious medical conditions can also face complex psychosocial challenges and barriers, including food and transportation insecurity and housing instability. In this new “Caring for Our Kids” episode, David Wagner, Ph.D., pediatric psychologist at OHSU, discusses the Novel Interventions in Children's Healthcare (NICH) program, and how this innovative approach is transforming care for vulnerable children.



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00:00:00:18 - 00:00:27:25
Tom Haederle
Welcome to Advancing Health. Coming up in today's episode, a conversation with a pediatric psychologist about the psychosocial challenges for kids with complex medical needs. The challenges can be many: Missed school, food insecurity, transportation issues and others. Our host is Julia Resnick, director of Strategic Initiatives with H.R.

00:00:27:27 - 00:00:33:12
Tom Haederle
Julia, over to you.

00:00:33:14 - 00:00:42:12
Julie Resnick
So I'd love to start with learning a little bit more about you and the work that you do. Can you introduce yourself to our listeners and tell us just a little bit about your professional background and interests?

00:00:42:14 - 00:01:07:02
David Wagner, Ph.D.
Sure, yeah. Again, my name is David Wagner. I'm a pediatric psychologist and a clinician scientist. Very passionate about and interested in ways to identify youth at risk of health and life inequities, as well as evaluating programs and developing programs that can address those inequities. Work at OHSU and in Dawn Becker Children's Hospital. We are the top ranked children's hospital in Oregon.

00:01:07:02 - 00:01:28:07
David Wagner, Ph.D.
We serve a population of roughly 50% youth on Medicaid. We don't just serve the state of Oregon, but also southern Washington, northern California and Idaho. I particularly work in the Department of Pediatrics. With the Novel Interventions and Children's Health Care Program, where we work with young people who have a combination of medical complexity and high social risk.

00:01:28:09 - 00:01:34:18
Julie Resnick
So talk about that a little bit more. What are some of the psychosocial challenges for kids with complex medical needs?

00:01:34:20 - 00:02:08:22
David Wagner, Ph.D.
It's a great question. I mean, just in general, we know that kids with complex medical needs already have to engage in really complicated disease management. Miss school for attending medical appointments. They and their caregivers spend a lot of their day engaged in care. Outside of everything else, that's tricky about being a young person. In addition, we actually have a subset of young people who have complex medical conditions who also experience high levels of food insecurity, houselessness, exposure to domestic violence, transportation challenges that make it nearly impossible to engage in recommended care.

00:02:08:24 - 00:02:26:28
Julie Resnick
Yeah. So if it wasn't hard enough to be a kid with a complex medical issue, to have all those other issues surrounding your family and your community, it's just got to be really challenging for those kids. And I think that all leads us to the work that you do with NICH. So can you tell us about the program and what its origins were?

00:02:27:00 - 00:02:51:07
David Wagner, Ph.D.
Yeah, another great question. So this is a little over ten years ago, I had yet to come to OHSU. Dr. Michael Harris, he's our pediatric psychologist who leads our inpatient consult service. And so when young people are admitted to the hospital for reasons that the medical team believes is avoidable, they call in our inpatient console team to try to help understand what are some of the challenges experienced outside the hospital, and how can we help improve the child's health.

00:02:51:09 - 00:03:10:22
David Wagner, Ph.D.
Even with all of his advanced training and experience, he identified that there was a group of youth where there were no medical interventions or mental health or behavioral health interventions that were going to effectively change the factors that were driving the health problems that they are experiencing. The health problems they're experiencing were happening outside the hospital, in the communities, in the neighborhoods. In general,

00:03:10:22 - 00:03:37:09
David Wagner, Ph.D.
these youth experienced just a lot of social challenges, as did their families who were doing the best they could. And so I think any innovation comes from that combination of passion, frustration and curiosity. How can we do this better? And so Dr. Harris, Kim Spiro, they co-developed this program NICH, where we deliver services to the community in the homes of the youth who are experiencing medical conditions and social risk, to address the inequities they're experiencing.

00:03:37:11 - 00:04:09:17
David Wagner, Ph.D.
Often it's how do we find stable housing? How do we find secure food that you can reliably depend on? How do we help you gain access to transportation? We go with young people to their schools. We go to them to the mall. We meet their friends, we meet their extended family, and we work closely with the medical providers here at OHSU and other medical centers, just to better understand the challenges that families are facing and collaborate to help ensure that we're all on the same page and can help support them in managing their medical condition at home.

00:04:09:19 - 00:04:24:15
Julie Resnick
Yeah. I often like to say that people are only patients for this short, finite period of their life and the rest of who they are is everything outside of the hospital. So can you talk a bit about what kind of support and services kids and their families receive when they're part of the program?

00:04:24:18 - 00:04:43:09
David Wagner, Ph.D.
Yeah, it's a combination of services. We really like to tailor our services to family needs. The providers who go out into the home, they are not mental health providers. They are not medical providers. We call them interventionists. And what they do is they first assess the needs the families have and then they tailor their services depending on what families tell them.

00:04:43:10 - 00:05:11:09
David Wagner, Ph.D.
So for some families, it's really intensive case management. How do we figure out how we can get you access to the resource, to resources to address basic needs so that we have more time and energy to manage the medical condition? For others, it's making sure that all of the different providers involved in their child's life are providing consistent recommendations across providers and also making sure that the family and providers are interacting in ways that the family is able to and interested in accessing care and following through with recommendations.

00:05:11:12 - 00:05:28:26
David Wagner, Ph.D.
And a lot of what we also just do is reinforcing all of the efforts that they're already doing to try to manage their medical condition and then working with them in the other environments that they live to ensure that the insulin gets in the body, that they're able to follow the recommended dietary plan and engage in other parts of the medical care that are recommended.

00:05:28:28 - 00:05:39:12
Julie Resnick
Let's talk a little bit about the care team. I know that your team has child psychologists and interventionists, but who else is part of the care team? And how do you all work together when caring for patients?

00:05:39:15 - 00:06:00:14
David Wagner, Ph.D.
We work really closely with our specialty and primary care providers, especially here at OHSU. They are super invested in these families and so they're often providing us with guidance and education on what that medical regimen would look like at home, so that when we're out in the home, we can support the family in their, their efforts to engage. Our team, our interventionists come from all walks of life.

00:06:00:17 - 00:06:19:10
David Wagner, Ph.D.
We've recruited folks from Starbucks. We've recruited people who are working for other community agencies interested in populations that are less represented, making sure they get equitable care. The common theme is that the folks who work on our team are all heavily invested and passionate about this population. And we like to refer to them as social chameleons:

00:06:19:10 - 00:06:36:25
David Wagner, Ph.D.
they're able to walk into a physician's office and briefly and quickly summarize patient care in a way that they're taken seriously, but then walk into a family's home who's living in poverty and take their time and slow down and connect and better understand the family's lived experience. So, there's really a diverse range of individuals who work with our team.

00:06:36:27 - 00:06:51:07
Julie Resnick
I love that idea of a social chameleon and just needing people who can be adaptable in different situations. So I want to pull on that thread about schools. You mentioned that these are one of the organizations that you partner with a lot. What does that partnership look like?

00:06:51:09 - 00:07:08:04
David Wagner, Ph.D.
Yeah. You know, the schools we've worked with have been heavily invested in the youth health. We actually work a lot with school nurses, so a lot of our young people have to go to the nurse to get their medication or to take their insulin. And so a lot of what we're doing is working with those in the schools who are directly interacting with the youth.

00:07:08:06 - 00:07:21:22
David Wagner, Ph.D.
A lot of our kids have been missing school, too, or having difficulties attending school because of their medical condition. So we work with school staff to help get them caught up, to make sure that the accommodations that they need are in place. And just in general to support their education.

00:07:21:25 - 00:07:32:20
Julie Resnick
So by now, I think our listeners are probably wondering, how do I do something like this in my organization? So my question for you is, how do you get this off the ground? What do they need to do to get started?

00:07:32:22 - 00:07:51:24
David Wagner, Ph.D.
It's a complicated process. You know, what we've learned is that in the beginning, often having philanthropists seems to sometimes be the best way. Having somebody in your community who says, I really care about this population, whether it's because they just are very invested in health equity, or maybe they have a close family member they themselves who have a chronic condition.

00:07:51:24 - 00:08:05:27
David Wagner, Ph.D.
And they imagine to themselves, wow, what would that be like if I had this or my child have this, and we didn't have secure housing and we didn't know where our next meal would come from, or we were trying to adapt to a new culture. Part of it is engaging those who really care about this population.

00:08:06:00 - 00:08:25:26
David Wagner, Ph.D.
Another part of it is working within an institution that truly cares about health equity and is willing to, essentially put their money where their mouth is. So we don't make money for OHSU. They see the benefit to their patient population. They see the benefit to their medical providers who can sleep well at night. And they generally just see the benefits of their institution as a whole.

00:08:25:28 - 00:08:45:06
David Wagner, Ph.D.
Once we start building a team and launching, what we tend to find is over time, that we are able to get revenue from other sources as well. A lot of local Medicaid entities are interested in kids staying out of the hospital. And so they become invested in that and they'll contribute funding. And we also have larger research foundations that also contribute.

00:08:45:08 - 00:08:54:14
David Wagner, Ph.D.
Leona M. and Harry B. Helmsley Charitable Trust has been one of our biggest supporters. And they've actually helped us spread not only here in Oregon but to the Bay Area in California.

00:08:54:17 - 00:08:59:15
Julie Resnick
Let's talk more about impact. How do you know that you're making a difference for the kids you're serving?

00:08:59:18 - 00:09:16:25
David Wagner, Ph.D.
Yeah. No, it's another really good question. You know, when we got into this, this work, a lot of it was really focused on like, number one is how do we help these kids and families get the outcomes that they want? And so first, understanding from them what's most important and how to get their needs met and address any life inequities they're experiencing.

00:09:16:27 - 00:09:46:02
David Wagner, Ph.D.
We've increasingly focused to collect data that  is most important to the stakeholders who then fund programs like this. So we're very focused on the quintuple aim. We measure lab values and other physical findings to understand the patient's experience, improved health. We look at the kids experience fewer emergency department visits and admissions for avoidable reasons. We talk to our medical providers and give them surveys to assess provider burnout and improve quality of life they experience when they're not up late at night thinking about kids that they're worried about.

00:09:46:05 - 00:10:08:02
David Wagner, Ph.D.
We also look at attendance. We found that youth in the program are much more likely to attend outpatient visits, and they're much less likely to no show, which is really good for them, but also good for the medical community. We also find that when one of the one of our studies looked at youth of color and essentially found that the youth of color referred to our program had roughly half the access to care of non-Hispanic white youth.

00:10:08:07 - 00:10:29:22
David Wagner, Ph.D.
And then we looked at two years following program involvement. We saw that that disparity in access had completely disappeared. And so for sites who are invested in health equity, we have we have outcomes that demonstrate that the NICH bridges that gap. We also do focus to some degree on medical costs. And we find that there are substantial reductions in medical costs that benefit primarily insurers, but also, institutions.

00:10:29:22 - 00:10:34:07
David Wagner, Ph.D.
So we look at a wide range of outcomes to meet that quintuple aim.

00:10:34:10 - 00:10:45:19
Julie Resnick
I love that focus on designing care around the specific needs of kids and their families. So I'd love to hear more about those kids and families that you're serving. Do you have any stories that could bring this to life?

00:10:45:21 - 00:11:08:18
David Wagner, Ph.D.
There are more stories than I have time to share. A couple of young people come to mind. Often insurance providers will pay for this intervention after a youth has been hospitalized numerous times and has experienced multiple complications that are really costly. We will sometimes argue that, wouldn't it be great if we actually started investing in these children before they have these costly complications?

00:11:08:18 - 00:11:30:01
David Wagner, Ph.D.
And so this is actually one example where an insurer did pay for the program prior to any costly complications. We had a four year old girl who was newly diagnosed with Type One diabetes, who was living with her father, who was experiencing houselessness and who was also in recovery. All of the places that they could stay had people who were using there, which made it difficult for father to stay sober.

00:11:30:05 - 00:11:49:15
David Wagner, Ph.D.
And at the same time we couldn't find any shelters that would take in single dads with children. Our interventionists worked closely with dad to get him into needed mental health and recovery services. He was able to find a place that would take them in where nobody was using, and ultimately was able to sort of assess where is social support in this community

00:11:49:15 - 00:12:06:00
David Wagner, Ph.D.
and ultimately, when we found that there wasn't social support in the nearby community - but we were able to contact and reach an extended family - we were able to work with the insurance company to help the family access that support and secure housing. And that's one example. You know, there's another example that comes to mind of a kid who was experiencing lots of frequent infections.

00:12:06:00 - 00:12:29:09
David Wagner, Ph.D.
The two year old girl who was having multiple line infections. And when the interventionist went out to the home, she noticed that the living conditions were such that you would expect a lot of infections. The family was doing the best they can. Multi-generational family, and numerous family members had the skills to essentially, like, replace the carpeting and the flooring and whatnot, but they didn't have the resources to have the materials to do so.

00:12:29:09 - 00:12:47:03
David Wagner, Ph.D.
And so she actually worked with the local hardware store who donated supplies after hearing about the family situation, got those to the family. The family replaced the flooring and was able to replace other parts of the house to improve the living conditions. And next thing you know, this this young child was no longer experiencing these dangerous complications.

00:12:47:05 - 00:13:10:05
Julie Resnick
Those are both such powerful stories and I think really go to show how important it is that people have a stable place to sleep at night, that they have access to food. Because if you're worrying about all those basic needs, how can you be worrying or taking care of your own health or your kid's health? I really appreciate how your work ties all those medical and social needs together to really give kids the best care possible.

00:13:10:07 - 00:13:23:23
Julie Resnick
Dr. Wagner, thank you so much for sharing your time and your expertise with us. I just really appreciate the work that you do and your commitment to kids in your community, and trying to give them the best shot at a healthy life, now and in the future.

00:13:23:25 - 00:13:26:12
David Wagner, Ph.D.
Thank you, Julie, and thank you for your time and excellent questions.

00:13:26:14 - 00:13:28:26
Julie Resnick
Thank you so much.

00:13:28:28 - 00:13:37:10
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.

2025 will bring new and familiar challenges for the health care industry, and the American Hospital Association is ready to support hospitals and health systems across the nation. In the first Leadership Dialogue of 2025, Tina Freese Decker, president and CEO of Corewell Health and 2025 AHA board chair, talks with two policy experts at the AHA — Stacey Hughes, executive vice president of government relations and public policy, and Ashley Thompson, senior vice president of public policy analysis and development — about the current political climate, the potential impacts to health care policies, and how the AHA is primed to continue its mission to advance health in America.



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00:00:00:20 - 00:00:29:13
Tom Haederle
Welcome to Advancing Health - and to the first Leadership Dialogue of the year - hosted by the American Hospital Association's 2025 Board Chair, Tina Freese Decker, president and CEO of Corewell Health. Today, two senior AHA leaders join Tina to discuss key issues in health care and how the AHA is working on many fronts to support hospitals and health systems so they can provide the best care to patients and communities.

00:00:29:15 - 00:00:56:10
Tina Freese Decker
Hello and thank you everyone for joining us today. In 2025, the American Hospital Association is all in in tackling the challenges that are facing health care today. I am looking forward to using this Leadership Dialogue series to highlight the incredible ways the American Hospital Association and our member hospitals and health systems are making health better. My name is Tina Freese Decker, and I'm the president and CEO of Corewell Health

00:00:56:12 - 00:01:23:05
Tina Freese Decker
and the 2025 American Hospital Association board chair. As we kick off this new year, I want to start by introducing you to a few amazing leaders within the American Hospital Association who will help us navigate the year ahead. The American Hospital Association is here to help remove those barriers so as hospitals and health systems, we can provide the very best care to our patients and communities.

00:01:23:07 - 00:01:45:04
Tina Freese Decker
So today, while we don't have all the time to meet the full AHA team, I'm so excited to introduce you to Stacy Hughes and Ashley Thompson, two fantastic individuals who lead the AHA's government relations and public policy work. One of the things that gives me the most confidence in our approach is when I listen and I talk with them.

00:01:45:07 - 00:02:02:23
Tina Freese Decker
So I thought it would be really beneficial for all of you, our members, to hear from them. So let's begin. So Stacy and Ashley, welcome. So glad to see you today. Let's start with some introductions and share what you do with the American Hospital Association. Stacy?

00:02:02:25 - 00:02:21:05
Stacey Hughes
Sure. Thank you for this opportunity. We're so excited about your year ahead and working with you. And we're really appreciative of having a chance to showcase a little bit about what our team is up to. But I'm Stacy Hughes. I'm executive vice president in the D.C. office and oversee regulatory policy, federal relations PAC, and some of our communication efforts.

00:02:21:08 - 00:02:25:06
Stacey Hughes
Have a great team here. And we're going to talk more about that. But that's my role here, Tina.

00:02:25:14 - 00:02:26:28
Tina Freese Decker
Thank you. Ashley?

00:02:27:00 - 00:02:50:00
Ashley Thompson
Thank you, Tina, so much for giving us this opportunity and for your leadership on the board in the past and especially this year as chair. I'm Ashley Thompson. I'm the senior vice president of policy here at AHA. I lead a team of about 24 very amazing, talented individuals. The work that we do is really on behalf of hospitals and the patients they serve.

00:02:50:03 - 00:03:10:11
Tina Freese Decker
As we think about the work ahead of us this year, I also want to learn more about what you and your teams are doing. So the American Hospital Association is a bipartisan organization, and we work with all lawmakers to advance the issues that mean the most to us as hospitals and health systems. So, Stacy, tell us about the team that you lead.

00:03:10:14 - 00:03:17:10
Tina Freese Decker
The depth of expertise and their balance and how your team is preparing for this new administration in Congress.

00:03:17:12 - 00:03:36:03
Stacey Hughes
Sure. And I couldn't be more proud to be honest with you. And I have to say, you know, I give Rick and others a such a shout out for the legacy, you know, Ashley says she's here 23 years, I'm starting year five. Boy, both what I inherited as a team that were here day one, and then how we've grown as people have, you know, rolled off or changed jobs.

00:03:36:05 - 00:04:01:12
Stacey Hughes
It is solid. We've got, you know, lobbyists that have all worked largely on Capitol Hill or they were deeply, deeply immersed in the issues that are critical to hospitals. I'll ask you to talk about the policy team that we work on together. We've got such currency politically with the lobbyists that are on the team. Our colleagues and my colleagues, Lisa Kidder, she's been here 20 years. Amy Kuhlman, there's no one better than Amy in terms of leading our lobbyist team.

00:04:01:12 - 00:04:24:17
Stacey Hughes
So both their experience actually on the Hill, writing bills, knowing all the member offices. You know, we cover every single office here, you know, House and Senate. That's a lot to say Grace over. In terms of preparing, obviously this is a unified town now, it's a Republican town. We had a bit of a sweep. So we're busy getting ready to look at how we frame our issues with a very specific audience.

00:04:24:19 - 00:04:44:10
Stacey Hughes
But in addition, Tina, as you know, this is a pretty sweeping election in terms of retirements. There are 14 new Senate freshmen between Republicans and Democrats. There are about 55 new freshmen House members. So a big part of what we're doing is educating them early and often. Lisa and Amy and others are putting together a 101 of hospital issues.

00:04:44:16 - 00:05:00:09
Stacey Hughes
They understand our field immediately and early, and be a resource for them. So everyone is readying for what is going to be. And then we'll talk more about what the year ahead, what the expectations are. But it's a lot. And we are excited that the team is ready, but they have great skills.

00:05:00:09 - 00:05:04:20
Stacey Hughes
And, couldn't be more proud to be collaborating with them and leading them.

00:05:04:23 - 00:05:14:25
Tina Freese Decker
And as you do that education, are our lawmakers interested in health care? Are they appreciative of the education, the orientation and the one on one that we provide? And when we show up.

00:05:14:28 - 00:05:31:24
Stacey Hughes
They are and, you know, we're in the process of so getting out some of our very specific every congressional districts or what that hospital footprint looks like, you know, who's in your backyard, how many jobs are you providing that community? What is your role in the economic engine of that community? What are you doing in terms of serving that population?

00:05:31:24 - 00:05:48:28
Stacey Hughes
And they are interested. I think that, you know, as you know, there are a lot of threats around the financing of hospital, particularly the burden on the federal government and debt. And so being able to bring it to life to them, what we're really doing with limited resources and our contribution to communities,

00:05:48:28 - 00:06:03:25
Stacey Hughes
they do appreciate it. And particularly the role we play in terms of our jobs and their district. But it takes time. You know, you really have to tell the story, go to make sure you invest in that time. You always want to know your members before you need them. And I think that's important.

00:06:03:27 - 00:06:16:00
Tina Freese Decker
Ashley, I'd like to ask you the same question. So share a quick overview with us of some of the issue areas of policy expertise that you have amongst your team members, and what's the one thing your team is gearing up for this year that you can share with us?

00:06:16:02 - 00:06:42:09
Ashley Thompson
Well, like Stacey, I am so proud of the policy team. Many of the individuals, I think there are 24 of them, have been here for a very long time. They are true issue area experts. They are smart, they are talented, they are motivated. And I will say that they really want to improve health and health care in America and get hospitals, the resources that they need to really care for their patients.

00:06:42:11 - 00:07:09:03
Ashley Thompson
We are kind of divided into four areas. So we have Medicare payment, coverage, quality and patient safety, and data and research are kind of the big buckets. But underneath them we tackle probably any issue that hospitals deal with. We have experts on AI, we have experts on prior authorization. We have experts on quality. So it's really a diverse group.

00:07:09:06 - 00:07:27:09
Ashley Thompson
I would say that it's really hard to pick the one issue that they're going to be dealing with this year. I think that there's probably four that are most important. And Stacey and I have been working on this together with others across the association. I think one of them is to protect Medicaid and its enrollees.

00:07:27:09 - 00:07:49:16
Ashley Thompson
I think the second one is to ensure what we call the marketplace premium tax credits continue after the end of this year. About 10 million people have gotten coverage due to those tax credits, and we don't want them to lose coverage. The third area is to make sure that hospitals are not subjected to site neutral payments.

00:07:49:18 - 00:08:09:12
Ashley Thompson
And then I'd say the fourth area is probably protecting 340B, which is the drug pricing program. So those are definitely on our radar. But it goes beyond that. There are so many issues, I think our advocacy agenda came out this week. I haven't counted there's probably 75 plus issues that we are actively working.

00:08:09:14 - 00:08:34:21
Tina Freese Decker
And we're so appreciative of kind of highlighting the main areas that we need to focus on, but then understanding that as hospitals and health systems, we're not all alike and there are different issues that come up that we need to navigate as we move forward. Again, what I am so proud of is your team, both of your teams, really have the expertise and the experience to help tackle this and guide us as members as we move forward.

00:08:34:23 - 00:08:56:08
Tina Freese Decker
You know, there's also a much broader team at American Hospital Association that's supporting the work of our field  - from legal to communications to the quality of patient safety, field engagement. There's so many people that are ready to assist our members. So let's talk a bit about how our members and our leaders and our hospitals and our health systems might work with the American Hospital Association on those issues.

00:08:56:11 - 00:09:13:02
Tina Freese Decker
So, Stacy, can you tell us how your team engages with the members? And this time not the members of the Capitol Hill, but it's like hospitals and health systems. How can our hospital and health system leaders get more involved in advocacy efforts, and why is that important?

00:09:13:05 - 00:09:31:26
Stacey Hughes
Sure. Well, first and foremost, you know, our teams are constantly working with our members. I know Ashley would say the same, whether it's policy or federal relations. And that's just in the everyday, just grind of learning how to address issues and learn from them in terms of what we actually advocate for, that's an ongoing thing. But to your point, there are a lot of different ways that we work with members.

00:09:31:26 - 00:09:51:09
Stacey Hughes
One is through our government relations officer network. Certainly we work through our allieds, all the 50 state hospital executives, and is a huge partner for us in terms of our advocacy. But in terms of your of a hospital health system, main thing you can do is get to know your delegation. You know, I know you guys do this both obviously with your state, representatives and your state elected officials.

00:09:51:09 - 00:10:07:20
Stacey Hughes
But on the federal side, really getting to know them and telling that story often. And also, don't be afraid to go to them and let them know when you have a problem. You really want to get them invested in your success. And it doesn't take much. And I think we all, going through Covid, we saw how much everyone does stand up.

00:10:07:20 - 00:10:25:00
Stacey Hughes
They recognize the importance of making sure we have a sustainable, functioning hospital network and health systems. And so being sure to take that leap, give your member a call, get to know the staff and being willing to advocate. I mean, I will say, you know, we put out these advocacy alerts and, we try to be judicious.

00:10:25:00 - 00:10:45:00
Stacey Hughes
We don't want to say "hair on fire" every day, but we do have a lot of challenges coming, Tina, as you know, in terms of all the pressures to address some of the deficit issues, mandatory programs like Medicare, Medicaid are the top drivers of the deficit and spending. So we have a lot coming up. But we really say when we do give a call to action, we really need it.

00:10:45:00 - 00:11:00:21
Stacey Hughes
And in particular, if you know you have a member of Congress or senator that is uniquely positioned on committees of jurisdiction as well as leadership, you want to make sure there no daylight between what you're doing, what your needs are, and what they understand in terms of their education.

00:11:00:24 - 00:11:11:25
Tina Freese Decker
Great advice. Thank you so much, Ashley. Similarly, are there examples of member engagement that you can speak to that have been particularly successful or impactful in influencing policy development?

00:11:11:28 - 00:11:38:24
Ashley Thompson
Yeah, I actually think that one of the reasons why AHA is so successful is because of our policy development process. I think it's very unique. Through our committees and our regional policy board meetings, we touch probably 550 CEOs or C-suite leaders three times a year. And we bring to them, you know, our committees, our grouped by kind of type of hospital, whether you're rural or post-acute or whether you're behavioral health.

00:11:38:26 - 00:12:02:26
Ashley Thompson
And then our regions are just what it says. We divide up by region and they weigh in on policy development. So they weigh in on what should we do about physician payment, what should we do about health care affordability? What should we do about the increase in medical debt? What should we do about X, Y, and Z? And it's a really a thoughtful, like iterative process.

00:12:02:29 - 00:12:39:24
Ashley Thompson
We also have strategic leadership groups. We also have task forces that we staff on certain issues, whether it's principles or whether it's health care, the future. You know, what should we do about workforce issues? So we really rely on everyone to weigh in. And of course, our board of trustees. So we rely very heavily on our board. And thank you again for your chairmanship of it to help direct the association, to direct our policy positions, to direct what recommendations we come up with, and often to direct our strategy of how to achieve what we want in terms of outcomes.

00:12:39:24 - 00:12:59:11
Ashley Thompson
And so I do think that AHA, and particularly probably the policy team given the work that we do, has a lot of connections and we really rely on that and we want to hear from our members and we want them to be active and engaged, because the more they communicate with us, the better we can represent them on Capitol Hill or with the administration.

00:12:59:13 - 00:13:28:16
Tina Freese Decker
I completely agree, and one of the most impactful, stories that I have is when I took one of our lawmakers through our mental health area and just highlighted what we are doing well, but what we need their support in. And then you could see that happen with bills came up and things needed to be impacted. And so I'm sure that there are stories like that in every part of our organizations and our membership about how that personal touch is so incredibly important as we drive forward.

00:13:28:16 - 00:13:37:27
Tina Freese Decker
All right. Are there any last comments, or thoughts on the year ahead that would be most helpful for you and your teams that you want to share with us?

00:13:38:00 - 00:14:02:21
Ashley Thompson
I think it's going to be a very challenging year. I know that the AHA is going to be really working hard on behalf of our members, and I think that the team at is very motivated to do so. Very similar to employees in hospitals, or the staff in the hospitals. I think that we tend to rise when there's a crisis and we rise to that occasion.

00:14:02:21 - 00:14:24:08
Ashley Thompson
And whether it's Covid or whether it was going to be repeal and replace of the ACA a few years ago, several years ago, or whether it's the Change Health care cyber event, I really think that AHA is here to serve its members, to get them through those hard times and to put them on a trajectory in the future.

00:14:24:08 - 00:14:35:13
Ashley Thompson
And I want our members to know that this the staff team at AHA is really committed to doing so, to really making sure that you have the resources that you need in order to care for your patients.

00:14:35:15 - 00:14:44:00
Stacey Hughes
Yeah, so well said. I would just add, you know, we think about the year, reflecting back between Change Healthcare, OneBlood supply in Florida and Baxter.

00:14:44:03 - 00:15:04:12
Stacey Hughes
And that was just weeks ago, if you really think about it in terms of the need for the association with your leadership and others, Tina, to really jump in and problem solve quickly and mitigate those types of issues. But I'll just say going into the year, I think I've kind of beaten that drum a little bit. But you know, we are, as Ashley said, we are working so far, the policy team and others to bring forth data.

00:15:04:18 - 00:15:22:11
Stacey Hughes
One of the ways that we win these battles is being able to tell a story with very specific data. We've got some pretty difficult issues, one of which is extending the ACA subsidies, I think Ashley mentioned. Knowing what that looks like to your hospital. How does it affect your bottom line? How does it affect patients? How does it affect the insurance coverage?

00:15:22:11 - 00:15:45:18
Stacey Hughes
I think that's true for Medicaid. So when we put all this stuff together, really would encourage everyone or field to take that information and help tell the story and amplify as much as we can. We'll do all the work for you in terms of making sure that we get you guys what you need to be able to understand the implications of some of these policies, but really just, welcome everyone's ability to engage with their members of Congress.

00:15:45:18 - 00:15:49:10
Stacey Hughes
So, that's my final note, I would say, Tina, in terms of the year ahead.

00:15:49:13 - 00:16:12:15
Tina Freese Decker
That's perfect. So thank you so much for your time today. And I really enjoy working with you and working with your teams. As you both said: the AHA teams are all in, we're ready to go. We're excited, we're passionate. This is you know what gets us up in the morning moving forward. And we need that partnership with our member hospitals and health systems to make sure we have the data and the stories and the connection there.

00:16:12:18 - 00:16:33:05
Tina Freese Decker
So it really takes this whole ecosystem to come together to make an impact and to make an impact for policies, the regulations that are coming forth, most importantly, so we can do an even better job taking care of our communities and improving health. And so we're so grateful for all the work that you and your teams are doing at the American Hospital Association.

00:16:33:08 - 00:16:50:11
Tina Freese Decker
I know that it's going to be a tough year but with the focus and the energy, I think we can accomplish a lot of things. So thank you so much. To all of our members listening in, thank you so much for joining us today. And we'll be back next month for another Leadership Dialogue conversation.

00:16:50:13 - 00:16:58:24
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.

Opioid use has been on the rise in post-pandemic America, and its effects on communities have been devastating. Decreasing opioid use is a major priority for health systems across the nation. In this conversation, Vinnidhy Dave, D.O., hospice specialist and director of palliative medicine at Englewood Health Physician Network, and Lauren Savage, director of population health at Englewood Hospital, discuss what Englewood Health is doing to prevent opioid use in its communities, and how an opioid risk tool provides guidance and protocols to protect higher-risk patients.


View Transcript
 

00:00:00:01 - 00:00:20:00
Tom Haederle
Welcome to Advancing Health. Coming up in today's episode, a conversation with Englewood Health about the rise in the use of opioids since the pandemic. We'll talk about what providers can do to decrease their use and what Englewood Health is doing right now by way of prevention. Your host is Rebecca Chickey, senior director of behavioral health services with the AHA.

00:00:20:03 - 00:00:30:27
Tom Haederle
She's speaking with Lauren Savage, director of Population Health, Englewood Hospital, and Dr. Vinnidhy Dave, director of palliative medicine, Englewood Health Physician Network.

00:00:30:29 - 00:00:57:04
Rebecca Chickey
Dr. Dave and Lauren, thank you so much for being here with us today to talk about this incredible topic. The opioid crisis during Covid did nothing but escalate, unfortunately. And the more creative the suppliers of opiates and synthetics become, I think the more challenging your job, our role in helping individuals with opioid use disorder, the more challenging it becomes.

00:00:57:04 - 00:01:24:27
Rebecca Chickey
So I'm delighted to, first of all let the audience know Englewood was a Foster McGaw Prize finalist. They were acknowledged and presented with this award at AHA's Leadership Summit in 2024. The prize was for a much broader perspective. They have really done a lot of work around all of behavioral health and improving access. But today we want to focus in on opioid stewardship.

00:01:25:04 - 00:01:48:05
Rebecca Chickey
And I'm going to break this down in a number of ways. My first question to you is that I'd like you to provide some statistics. What are the driving factors that really allowed you to say this is a problem? This is a challenge, and we have to focus on it. So can you start there? Everyone knows what's going on in their community, but they don't know what's going on in yours.

00:01:48:08 - 00:02:06:16
Lauren Savage
Yeah. I mean, I can start and Dr. Dave, feel free to add to the conversation. I think you said it best, Rebecca. This is a problem in everyone's community, and nobody is surprised by the concerns that we're seeing. We do use our community health needs assessment to better understand our community and their needs.

00:02:06:18 - 00:02:34:16
Lauren Savage
In the 2016 and 2019 Community Health Needs Assessment, the need for behavioral health increased tremendously. And at that point, we knew we needed to do more. We also were seeing it in within our own patient population, within our community. And there was also a very generous family that donated to the hospital. And so in 2018, we were also able to open the Gregory P. Shattuck Behavioral Care Center.

00:02:34:18 - 00:03:12:07
Lauren Savage
And this center is dedicated to behavioral health and to substance use. The Shattuck family lost a family member to substance use. And they were clear that part of this center should be focused on our treating our patients and our community on substance use, as well. And it was through the Shattuck Center that we were also able to form an opioid stewardship committee, so that we were really able to get a group of dedicated providers, mostly disciplinary team at our hospital, to come together to talk about the epidemic, to learn, you know, what's happening in our community amongst our patients, and to begin to address it.

00:03:12:09 - 00:03:32:08
Vinnidhy Dave, D.O.
I would say from the physician side of things, you know, my background is internal medicine. And then I trained in palliative care. For years we always, you know, thought about surgeons as the ones that were giving opioids first to patients. But there's been data over the last few years showing that hospitalists and internist were actually the ones that were exposing patients to opioids

00:03:32:08 - 00:03:54:12
Vinnidhy Dave, D.O.
first from the hospital side. So, I think that's where my interest came in, was really how do we work on decreasing the use of opioids in the hospital? How do we decrease the amount of patients we're sending home with opioids? After I read this article in the New England Journal medicine, where it was showing that internists were probably the ones that were exposing patients to opioids first, before surgeons and surgeons have done better job with the last few years.

00:03:54:15 - 00:04:13:12
Rebecca Chickey
So a couple of things. One, I heard in terms of key success factors, Lauren, that you said is when you identified the need, you had the data, you replicated it, you shared it, you then found a generous philanthropist to be able to provide you with the funding and the backing that you needed, but then you also created a committee.

00:04:13:13 - 00:04:36:09
Rebecca Chickey
So this was not being done in isolation. And that really leads me to my next question. One key part if I understand your program correctly, one key component is around prevention. And it is in terms of what are some alternatives to opiates as well as what are best practices around prescribing privileges?

00:04:36:11 - 00:04:58:15
Vinnidhy Dave, D.O.
This is where my kind of work has been with the team and the task force, is really creating what a lot of hospitals are now calling out alternatives to opioids, in the emergency room when we started it and then we started in on the floors in the hospital as well to provide it to our internists hospital as surgeons for normal pain, things that we commonly see.

00:04:58:15 - 00:05:19:17
Vinnidhy Dave, D.O.
So in the emergency room we've created a protocol for back pain, kidney stone pain, headaches, intractable abdominal pain that's not surgical. And there's an order set in our Epic system where we put in non opioids that can be given for those types of pains. So you would just type in alto and in that let's say back pain comes up.

00:05:19:17 - 00:05:45:17
Vinnidhy Dave, D.O.
And then under back pain there's options of steroids, muscle relaxants, anti-inflammatories, reminding providers that have been trained for years just to go to opioids automatically when someone's in severe pain that these are all the other options we have. And sometimes, you know, as physicians, sometimes when you're in the E.R. you're seeing 40 patients it's hard to remember. But now when you type in pain and your alto pops up and now you see back pain, you can check off these things.

00:05:45:19 - 00:06:23:20
Vinnidhy Dave, D.O.
It makes it easier for the providers. And then, of course, we've done a lot of education with the providers. We've done education with the doctors on the floors in the E.R. Most recently now we're working on pain protocol or pain order set, where basically what a lot of hospitals have done for insulin, where there's long acting insulin, short acting insulin, how to check sugars more frequently so that you run into less problems with hypo and hypoglycemia is now we have a whole pain order set that is smart and it uses like if someone has kidney function issues, a liver function issues, certain medications will automatically not pop up so that patients won't accidentally get

00:06:23:20 - 00:06:41:26
Vinnidhy Dave, D.O.
like an ibuprofen if they have kidney issues. This will be the only way to order opioids. They can't just give someone oxycodone. They want to give them oxycodone, they have to go to the order set and the order that has your non-opioids there, your opioids there. So you're always actively thinking about other options to give than just automatically going to opioids.

00:06:41:29 - 00:06:50:00
Rebecca Chickey
Absolutely. Thank you for that. I may come back to you here with a question, but I want to give Lauren the opportunity to jump in a little bit as well.

00:06:50:03 - 00:07:10:28
Lauren Savage
I think we always say this in our department, but we will never have enough providers to provide the treatment needed for the need of our community. So we really have focused a lot on prevention. So a lot of what Dr. Dave is saying in terms of limiting opioid initiations and leveraging our electronic medical record to provide better care.

00:07:11:01 - 00:07:34:24
Lauren Savage
He's gone out and done lots of trainings. We've done some targeted trainings to certain providers who need that further education, but we've also done training for our patients when they are prescribed opioids. So, any time a patient is prescribed opioids at discharge that are provided, automatically provided educational materials to better understand what they're being prescribed and how to not, you know, misuse that prescription.

00:07:34:26 - 00:08:00:07
Rebecca Chickey
I should share with you. We worked with the CDC, AHA worked with the CDC probably about five years ago now, but I think it is still very on point and helpful. We have a two-pager that we can provide to families and patients. So not just the patients, but letting the family know what are some of the signs and symptoms if they start to see you know, perhaps abuse of the opioids if they do go home with them.

00:08:00:09 - 00:08:22:18
Rebecca Chickey
So my next question is, I think you've also developed a screening tool for OUD, probably, much broader, but for all substance use disorders, particularly given the statistics that you just said, Dr. Dave, regarding, you know, what happens upon admission and discharge. So can you tell me a little bit about the screening tool and how you baked it into your EHR?

00:08:22:21 - 00:08:50:12
Vinnidhy Dave, D.O.
So we've implemented the opioid risk tool, which is probably the most studied one out of what we have right now. And it's implemented into our EHR, where anybody can put the phrase in: dot.org.key or dot.risk. And it pops up and it's also part of our preoperative screening as well. So in the preoperative area, if someone is tagged to be high risk, then they're referred to a pain management provider so that we can follow them

00:08:50:12 - 00:09:08:09
Vinnidhy Dave, D.O.
postoperatively if there's any concerns. We've done education with the residents and the hospitals about using this tool. So if they do start someone on opioids in the hospital, they're able to understand what risk factors the patients have. And then we've shared this with our outpatient providers as well, because we have hundreds of primary care doctors that are part of our network.

00:09:08:09 - 00:09:13:07
Vinnidhy Dave, D.O.
So they can use that as well when they're prescribing opiates to their patients.

00:09:13:09 - 00:09:15:29
Rebecca Chickey
Lauren, what would you like to add?

00:09:16:01 - 00:09:36:03
Lauren Savage
Yeah. So in addition to the opioid risk tool, we've also implemented a screening tool in our emergency room. So I'm going to go back to my point of prevention. And if we can screening individuals and earlier determine whether or not they have a substance use concern, we can provide them the correct resources and connect them to the appropriate level of care.

00:09:36:06 - 00:09:59:14
Lauren Savage
So all individuals who come to our emergency room, I believe it's 18 and up. We are screening for all substances, opioids included. And any patient who screens positive will receive counseling by one of our emergency room doctors, by our social workers. And if needed, a social worker will make a referral for that patient for additional services.

00:09:59:16 - 00:10:22:07
Rebecca Chickey
I have to admit, one of my biases is that that's the wave of the future, to screen for psychiatric and substance use disorders for every admission, it's somewhere between 1 in 4 or 1 in 5 admissions to the hospital has  - and is probably much higher than that in the emergency room - has a comorbid psychiatric or substance use disorder.

00:10:22:15 - 00:10:44:05
Rebecca Chickey
That is not, as you said, they're presenting diagnosis or the presenting reason for their admission, but it's there nonetheless. And we should always take the opportunity to identify and treat, if needed. And also, you know, that happens sometimes to improve outcomes and shorten length of stay. And anyway, I could speak on that for hours. I won't here.

00:10:44:12 - 00:10:51:17
Lauren Savage
You are correct though. It's about 20% of the individuals we are screening have a positive screen for substance use.

00:10:51:19 - 00:11:14:05
Rebecca Chickey
As we begin to bring this to a close, let me ask you this key important fact. What's the impact then, for all this work, for creating the center, for implementing the screening programs, for doing the training, for changing the culture, quite honestly? For using technology to help in decision-making process. What's the impact you've seen?

00:11:14:07 - 00:11:39:23
Lauren Savage
One impact I can share. I think you touched it when you just said changing the culture. Englewood Health has really recognized that 20% of the patients that we've screen in the emergency room are in need of additional counseling and support. So, just two months ago we have now opened an outpatient addiction medicine office so that we are more easily able to treat the patients that we identify within our own system.

00:11:39:26 - 00:12:01:14
Vinnidhy Dave, D.O.
And I can follow what Lauren said. I think, you know, we've seen a huge difference just from the hospital side, from our providers, from our residents when you know, they're ordering, I'm seeing less opioids being ordered if we're ordering opioids. Even the nurses are sometimes questioning it or they'll ask me on the side like, is this appropriate? So there's this huge culture shift that we've seen with education.

00:12:01:16 - 00:12:23:21
Vinnidhy Dave, D.O.
And I think making the providers feel comfortable using other medications and not feeling like they have to go to an opioid first, that it's kind of a domino effect throughout the program. And, you know, we're seeing outpatient providers, inpatient providers really trying to make sure that they're only using the opioid when they feel it's really appropriate. And it's not the first thing that they're going to do in terms of treatment.

00:12:23:23 - 00:12:55:18
Rebecca Chickey
That's phenomenal. What would you say are two key success factors that allowed you to do this? Was it a champion like Dr. Dave stepping up and saying, we've got to do this, and I'm here to be a team player to make it happen. Obviously, I think earlier you mentioned, a wonderful philanthropist that allowed you to have the funds to do that. But what are a couple of key success factors that the listeners would need to know about to implement something similar in their own organization?

00:12:55:21 - 00:13:17:15
Lauren Savage
I think for our stewardship, it really was a collaboration of different disciplines coming together and recognizing the role that each of us plays in this process. Because it was all of us working together that we were able to implement all of these workflow changes and utilizing our electronic medical record and the education of our providers and the education of our community.

00:13:17:18 - 00:13:21:07
Lauren Savage
It required all of us to work together to achieve the goals we set forth.

00:13:21:09 - 00:13:44:05
Vinnidhy Dave, D.O.
I was thinking the same thing that Lauren said. I think it's really getting the providers in different areas to really bring this together and make it move forward quickly, whether it's, you know, someone from IT, whether it's you know, someone from social work, whether it's ER doctor, the chief of anesthesia, you know, chief of medicine, chief of psychiatry, and then, you know, Lauren making sure these meetings happen on top of it.

00:13:44:05 - 00:14:05:16
Vinnidhy Dave, D.O.
and we're making sure we're planning for it beforehand. And then making sure we have a plan for the next one, and really, I think, a point person and then being able to get the right people together to implement it, and then everyone being passionate about it. Everyone on the team was excited about, we want to try to do this, and we want to try to reduce opioids and we want to try to, you know, get better care for our patients.

00:14:05:19 - 00:14:40:09
Rebecca Chickey
Awesome. Well, thank you so very much for your willingness to share your time and your expertise. I'm hoping that this podcast, along with other work that AHA has done and that you have done, will inspire others to go on this journey for this very, very important clinical disease and disorder. And I again say congratulations on being one of AHA's Foster McGaw Prize finalists, and I will point the listeners to AHA's resources on opioids at AHA.org/opioids.

00:14:40:11 - 00:14:48:22
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.

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