A Lifeline for Rural Communities: Sutter Health’s Bold Behavioral Health Access Expansion

00:00:01:01 - 00:00:27:01
Tom Haederle
Welcome to Advancing Health. Behavioral health resources are in especially short supply in many rural areas of the country. Sutter Health in Northern California is committed to dramatically expanding access to behavioral health services for rural residents. And as we hear in this discussion, it's game plan goes beyond just constructing new facilities.

00:00:27:03 - 00:00:54:14
Rebecca Chickey
I'm Rebecca Chickey, the senior director of behavioral health at the American Hospital Association. And it is my honor, truly, today to have two speakers for this podcast. Dan Peterson, who is the CEO of Behavioral Health Services, as well as the CEO for Sutter Center for Psychiatry at Sutter Health; and his colleague, Dr. Matthew White, who is the chair of the behavioral health service line at Sutter Health.

00:00:54:17 - 00:01:26:11
Rebecca Chickey
Welcome to both of you, and thank you for being willing to share your time and expertise on how Sutter is expanding access to behavioral health in rural communities. Before I launch my first question to you, though, I just want to set the stage for the listeners who may not know the severity of accessing services in rural communities. 65% of rural counties do not have a psychiatrist, and 70% of rural counties have no child and adolescent psychiatrist.

00:01:26:13 - 00:01:50:29
Rebecca Chickey
And for nearly two decades now, suicide rates have been consistently higher in rural America compared to urban America. So just to level set, how important it is that Sutter is doing this work. As we start, could you give the listeners a sense of what is Sutter Health, you know, what's its clinical footprint? And, Dan, I'll pitch it to you.

00:01:50:29 - 00:01:53:26
Rebecca Chickey
And, then Dr. White, please weigh in.

00:01:53:29 - 00:02:21:14
Dan Peterson
Yeah. So Sutter Health is a large, integrated health care system. We're really geographically focused in Northern California, but we cover the breadth of services across our footprint in Northern California. We have 23 hospitals. We have 57,000 employees, 6,000 physicians, clinicians, and our medical groups, almost 6,000. And so we're really quite a large health system, but we are also quite geographically diverse, right?

00:02:21:15 - 00:02:41:00
Dan Peterson
We have hospitals and clinics everywhere from downtown San Francisco, right in the middle of the city, all the way up to Crescent City, a small town up on the Oregon border, eight hours north. We have a number of rural hospitals, critical access hospitals and rural health clinics that we're very proud to support.

00:02:41:03 - 00:02:48:02
Rebecca Chickey
And for the listeners who may not be health care experts, per se, can you describe a little bit of your critical access hospital?

00:02:48:09 - 00:03:16:19
Dan Peterson
Yeah. Thank you. A critical access hospital is just a designation for a hospital that is essentially a sole provider in a community. You have to meet certain geographic distance requirements from other hospitals. And really, by definition be in a rural area. I was actually the CEO at Sutter Lakeside Hospital in rural Lake County several years ago, about 8 or 9 years ago, serving in a community living in a town of Lake Park, with just a couple thousand people there.

00:03:16:25 - 00:03:45:24
Dan Peterson
And it's really meaningful care provided in those communities, because you really are the provider that those residents have to depend on. Many of them simply cannot travel. Either can't afford to travel, don't have the means to travel or logistically because of the needs of their care, cannot travel long distances in order to reach another provider. So the communities really depend on these providers in the rural communities to do - not just to be there - but to do a great job for them.

00:03:45:27 - 00:04:03:00
Rebecca Chickey
Well, and I can tell there's a piece of your heart that is clearly committed to rural communities. Sutter has recently made investments to expand behavioral health services in two rural areas in California. Can you tell me about that? Let the listeners know what you're doing and why?

00:04:03:02 - 00:04:27:08
Dan Peterson
Yeah, I'll start with some of our capital investments and then maybe Matt can talk about some of the programs. We have recently announced we're building more infrastructure in these rural communities. That's an important piece of what we have to do. So, we are going to be building some additional office buildings, about 18,000ft² of additional office buildings for primary care and urgent care up in Crescent City on the Oregon border.

00:04:27:10 - 00:04:57:24
Dan Peterson
We're also really excited to announce something called an empath unit, which is a crisis care unit, for individuals in a behavioral health crisis immediately adjacent to our emergency department there in Crescent City. It'll be a 3,000 square foot facility really designated for behavioral health crises. We're also building an additional medical office building on Lake County at our lakeside hospital, another 7,000ft² or so, about a $5.5 million investment in that community.

00:04:57:27 - 00:05:19:03
Dan Peterson
And this coming summer, we'll be opening another rural health clinic in Los Banos actually, just outside of Modesto. We have a rural hospital there, and we're excited to open a new rural health clinic there, which does tie into our behavioral health strategy as well as we're really looking programmatically to embed these services in our primary care offerings at all these communities.

00:05:19:03 - 00:05:26:03
Dan Peterson
And Matt, as a psychiatrist, can probably talk a little bit better about that. The strategy behind that and why that really works well.

00:05:26:05 - 00:05:27:26
Rebecca Chickey
Dr. White, you're up.

00:05:27:28 - 00:05:51:12
Matthew White, M.D.
First to expand, on the Empath unit a little bit and then talk about some other ways in which Sutter is supporting behavioral health in these rural communities. As Dan articulated, Crescent City is up in the far, far north coast of California, and it's really pretty much an island in a very rural community. So if you're in a behavioral crisis, you end up in our emergency room there more often than not.

00:05:51:14 - 00:06:15:10
Matthew White, M.D.
So Sutter recently got some state funds to build a specialized kind of crisis care unit, a crisis stabilization unit. But an empath unit is really a particular type of crisis stabilization unit. It's designed differently in a more therapeutic way. It doesn't have the bright lights of an emergency room. It tends to have chairs rather than gurneys. It's really just a much more soothing environment.

00:06:15:10 - 00:06:31:26
Matthew White, M.D.
And it's shown to have significant reduction in hospitalization rates and reduced length of stay. So we're really fortunate to be able to leverage a state grant opportunity to kind of provide a place for folks in crisis in that area can go to get more therapeutic relief than the current state.

00:06:31:28 - 00:06:52:15
Rebecca Chickey
So it sounds much more patient centered for someone who is in a psychiatric crisis compared to an emergency department, which, as you articulated, can be loud, with lots of lights and lots of activity. You really are being able to deliver patient centered care in a different way. Is there an average length of stay? What is the time period?

00:06:52:15 - 00:07:16:25
Matthew White, M.D.
Usually it's significantly less than 23 hours, so that the average length of stay in an emergency room in these rural communities can be literally days sometimes, because if you need to be in a hospital, there's very few resources around. So people can spend several days sometimes waiting to get a hospital bed and then travel six hours to the nearest hospital. Because empath units are more therapeutic

00:07:16:25 - 00:07:26:15
Matthew White, M.D.
actually, if folks don't end up getting hospitalized quite as frequently and didn't get the care they need right then and there, instead of going a long, long distance after a long stay.

00:07:26:17 - 00:07:36:21
Rebecca Chickey
If that's not patient centered care, I don't know what it is. I know that Sutter has been the driving force behind some of these initiatives, but have you had engagement or worked with community partners?

00:07:36:24 - 00:08:00:03
Matthew White, M.D.
Yeah, the empath unit is a perfect example. It actually started a number of years ago where our community benefits liaison had been working with local behavioral health and local tribal entities, because it's been a long identified problem. And they actually got some early seed grant funding a number of years ago to sort of plan for something like this empath unit.

00:08:00:06 - 00:08:25:03
Matthew White, M.D.
So when this larger grant opportunity came along last year, which was prioritizing projects that were kind of, quote, "shovel ready, ready to go because of the existing kind of groundwork that Sutter had done, working already with the local communities and hoping and planning for one of these empath units. It was a project and a grant application that really rose right to the top and got funded because again, some of that community work that had already been happening.

00:08:25:06 - 00:08:28:21
Rebecca Chickey
Dan, anything you'd like to add about the community partnerships?

00:08:28:24 - 00:08:54:28
Dan Peterson
One of the things that I have loved about working in rural communities is you have an opportunity to truly rally everyone in the community around something, right? Because there just aren't that many people to rally. And so it is logistically possible to bring together all the stakeholders, you know, to bring together multiple interested parties, multiple interested organizations, and get them all physically at the same table and co-develop some of these ideas.

00:08:55:05 - 00:09:16:00
Dan Peterson
It's an ideal scenario in many ways. I think sometimes we think of the rural communities as having challenges and difficulties because that's true. But on the other hand, there are some of these advantages where you truly can bring the whole community together and come up with a dream and a vision as a community in a way that is far more difficult in a metropolitan area.

00:09:16:02 - 00:09:43:10
Rebecca Chickey
I so concur. I grew up in rural Alabama, in a community of about 30 homes, so everyone knew everybody. The local police officer, you know, of the tiny little town seven miles away, used to come on my mother's grass. I mean, her primary care physician was right down the street. And so the support system and the ability to identify needs and then come together and collaborate to meet those needs, it's truly unique in rural communities.

00:09:43:13 - 00:09:50:24
Rebecca Chickey
Beyond the empath unit, can you share how center is working to expand access to care in rural areas in California?

00:09:50:27 - 00:10:11:17
Matthew White, M.D.
There's a couple ways, actually a number of ways. As Dan mentioned earlier, finding a psychiatrist or even a therapist is so challenging in this environment. So one of the initiatives Sutter has been leveraging virtual opportunities and tele-psychiatry, and one such way is through embedding primary care into pay for help using a nationally recognized model called collaborative care.

00:10:11:20 - 00:10:37:13
Matthew White, M.D.
And so we've been able to stand up collaborative care using a virtual provider. So this is where a primary care physician can get support and access to a therapist for the patient and psychiatric support for help medication management through Content Health, our virtual partner. Additionally, in Los Banos, which Dan mentioned earlier, Sutter has recently hired some nurse practitioners to serve patients in their rural health clinic.

00:10:37:15 - 00:11:05:19
Dan Peterson
One of the reasons that this model is so successful - at Sutter Health we've embraced this collaborative care model - is because it really allows our clinicians to work at the top of their license, and it allows us to maximize our clinician workforce, right? There are only so many psychiatrists out there, and there are only so many psychiatric nurse practitioners and advanced practice clinicians, it's like clinical workforce especially in rural areas is difficult to come by.

00:11:05:21 - 00:11:34:15
Dan Peterson
Recruitment is difficult. There are many rural communities that you just can't find a dedicated psychiatrist to come move to that rural community, but by embracing other care models that sort of allow these clinicians to come in and consult on the care of the patient and allow the primary care doctor to continue to be the prescribing clinician but with the support of a psychiatrist, those models really lend themselves towards virtual support, which is very helpful in the rural communities.

00:11:34:17 - 00:12:06:22
Dan Peterson
And second of all, it helps you sort of maximize the impact of the workforce that you do have available. And so then, you know, we look at places like Los Banos where we haven't been able to bring in a psychiatrist for that model, but we have had success in recruiting a psychiatric nurse practitioner or some of the other areas where we're able to find some therapists and they just need some support, or we have a strong core of primary care doctors, but they just need some support from a psychiatrist. Embracing different types of models like that really just helps logistically embrace the challenge of recruitment in those areas.

00:12:06:25 - 00:12:32:15
Rebecca Chickey
So it sounds like from this approach, you are meeting the patients where they are, you're better supporting the staff, the clinicians that you do recruit practicing at the top of their license. I've seen some studies in integration that show that integrated care or collaborative care not only improves patient satisfaction, but workforce satisfaction. It can reduce stigma, which can be great in rural communities.

00:12:32:17 - 00:12:56:26
Rebecca Chickey
It has just an abundance of positive outcomes. So thank you for taking it there. Dan, Matthew, thank you so much for being here with us today. And for sharing your experiences and your innovative ideas on how you're improving access to behavioral health services in rural communities. And before I go, I'd like to remind everyone that November 20th is National Rural Health Day.

00:12:56:29 - 00:13:06:01
Rebecca Chickey
Be sure to check out the links in the show notes below for a wide variety of resources that'll allow you to participate in this important awareness day.

00:13:06:03 - 00:13:14:09
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.