Advancing Health Podcast

00:00:00:03 - 00:00:13:18
Tom Haederle
Welcome to Advancing Health. Trauma is not a word we hope to associate with childbirth, but it is a reality for many new moms. And it's time we pay attention to it.

00:00:13:20 - 00:00:39:14
Julia Resnick
Welcome to today's episode of Advancing Health. I'm your host, Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. Childbirth is usually a joyful occasion, but for some women, it's the beginning of something much more complicated. Even when parents bring home a healthy baby, the birth experience can be traumatic. And when that trauma goes unrecognized or untreated, it can have lasting impacts on both physical and mental health.

00:00:39:17 - 00:01:01:06
Julia Resnick
Today, I'm talking with the directors of Oregon Health and Sciences University's Perinatal Trauma clinic. Doctors Katie Au and Katherine Jorda will explore how trauma shows up during pregnancy, birth and postpartum, and what it takes to build a model of care that better supports healing and recovery. So let's jump right in. Dr. Au, Dr. Jorda, I'm so happy to be here with both of you today.

00:01:01:08 - 00:01:05:15
Julia Resnick
To start, can you help us better understand what perinatal trauma is?

00:01:05:18 - 00:01:27:15
Katie Au, M.D.
Yeah, I'm happy to start. Thank you so much for having us. It's really a pleasure to be here today. So perinatal trauma can really encompass someone that's had a traumatic birth experience. Which about 1 in 3 parents, are considering their birth experience to be traumatic. So that's a lot of pregnant people and new parents.

00:01:27:18 - 00:01:40:10
Katie Au, M.D.
And about 10% of birthing patients go on to develop the perinatal PTSD, which is like a little bit more of a persisting condition, that can affect folks postpartum and sometimes years after the event.

00:01:40:13 - 00:01:48:00
Julia Resnick
That is a huge proportion of people who give birth. And yet, as a society, I feel like we barely talk about this.

00:01:48:02 - 00:02:13:15
Katie Au, M.D.
Yeah, I would definitely say that that's true. And if we think about, you know, pregnancy and birth, it is one of the most monumental milestones in someone's life. Everyone remembers the moment that they became a parent or met their new baby. And the majority of pregnant patients are people that are young and that are healthy and have never needed to be in a hospital or have an IV, or maybe have never had a surgery before.

00:02:13:17 - 00:02:36:03
Katie Au, M.D.
And many of those things can happen in the childbirth process. And so, a lot of those things can be unexpected. Most people, when they become pregnant, don't anticipate having a complication or something that is difficult or challenging in their birth. And so it's hard to prepare for those things. And for many folks, it's the very first time that they have interacted in the medical system in this way.

00:02:36:03 - 00:02:51:27
Katie Au, M.D.
And it can be extremely challenging. And, when you experience those things at the very same time as becoming a parent for the first time, it can feel really isolating and, you know, be an extreme challenge, in the journey of becoming a new parent.

00:02:51:29 - 00:02:54:27
Julia Resnick
Absolutely. Dr. Jorda, anything you want to add there?

00:02:54:29 - 00:03:17:05
Katherine Jorda, M.D.
I do think some of the societal norms around pregnancy and birth are very rosy, and I do think it makes it hard when a patient finds that their experience is not rosy. They're like, what just happened? Has this ever happened to anybody else? This was not my expectation. And it can come out of left field for a lot of patients.

00:03:17:12 - 00:03:38:23
Julia Resnick
Yeah, I think a lot of people are not prepared that pregnancy and giving birth is really a major medical event. And so when something does go wrong, they feel like it's abnormal when actually it's more the norm. So when we talk about perinatal trauma, it can really look different from person to person. So what are some of the ways that it shows up both during pregnancy and during postpartum?

00:03:38:25 - 00:03:59:12
Katherine Jorda, M.D.
Yeah, I think for a lot of patients, it can come up in a lot of different ways. I think patients who have had a traumatic birth sometimes don't even want to get pregnant at all. They don't necessarily want to come back to the hospital or the clinic where they had a traumatic birth, so they might be lost to follow up.

00:03:59:17 - 00:04:10:22
Katherine Jorda, M.D.
And if they do decide to get pregnant, they might be very hesitant to interact with medical system again after a prior negative experience.

00:04:10:24 - 00:04:13:29
Julia Resnick
Dr. Au, anything you want to add there?

00:04:14:02 - 00:04:36:17
Katie Au, M.D.
I would say that, you know, having a perinatal mood issue can be really common. But that can also be common with a birth that goes really well without complications. So for some patients, we see postpartum blues or anxiety or postpartum depression. With perinatal PTSD, we often see patients that have symptoms that last longer than a month postpartum.

00:04:36:17 - 00:05:01:26
Katie Au, M.D.
The perinatal PTSD symptoms, often show up as reliving a traumatic event or having some more intrusive thoughts, or maybe nightmares. Many folks have trouble with sleep and might have avoidant behavior. And sometimes we see folks that really have trouble bonding with their infant and their child, and those can persist throughout the that first year, that first postpartum year of life.

00:05:01:28 - 00:05:17:27
Katie Au, M.D.
But often many years afterwards. And it's not infrequent that Dr. Jorda I see patients who maybe have changed plans for their families or have decided to delay childbearing, or maybe just have their one child because they're still affected by their symptoms many years out.

00:05:18:00 - 00:05:28:25
Julia Resnick
So I know that your perinatal trauma clinic is one of only a few of its kind in our country. Can you walk us through how the clinic works? What it's like for patients who come to you for care?

00:05:28:27 - 00:05:56:00
Katherine Jorda, M.D.
Sure. Kind of started a few years ago. Both Doctor Au and I worked at the Portland Veterans Administration's hospital. And so unfortunately, a lot of veterans have experienced military sexual trauma. And we had to learn about trauma informed care, which is a framework of taking care of patients, recognizing that prior traumatic experiences might be impacting their current physical and mental health.

00:05:56:05 - 00:06:28:03
Katherine Jorda, M.D.
But we received a lot of on the job training and experience there, and it wasn't really a part of our formal medical student or OBGYN resident curriculum. And we took care of a lot of patients and realized, gosh, there is a role for trauma informed care, too, in obstetrics. Let's set that up. We submitted a grant to start our clinic, and we made the case that patients who've had a traumatic birth need more of a multidisciplinary approach.

00:06:28:06 - 00:06:59:19
Katherine Jorda, M.D.
We are lucky at our institution that we have a robust reproductive psychiatry department, and so patients who've had a traumatic birth would go see our psychiatry colleagues, and then they would see us in obstetrics for either pregnancy care or postpartum. But we found that they were having to tell their story multiple times to different providers. And sometimes patients would ask me about mental health issues that I could try to field, but didn't have as much experience as my psychiatry colleagues.

00:06:59:21 - 00:07:43:06
Katherine Jorda, M.D.
And the same for my psychiatry colleagues. They'd get questions about their birth, and they were like, I just don't feel equipped to answer that. And gosh, could we get all the same players in the room so that the patient could share their story just one time and have both kind of aspects weighed in. And so we started a multidisciplinary clinic where we see patients who have had a history of a traumatic birth or delivery planning and we see them in our clinic, both general OBGYN, myself or Dr. Au, and one of our reproductive psychiatrists or psychologists all together in the same room to do a longer more comprehensive visit.

00:07:43:13 - 00:07:58:28
Katherine Jorda, M.D.
So typically, these visits are twice as long as our routine prenatal care, because we found that we needed the time to delve into both an obstetric history and psychiatric history and develop a plan for the future pregnancy.

00:07:59:01 - 00:08:02:10
Julia Resnick
That's wonderful. Dr. Au, anything else?

00:08:02:12 - 00:08:44:06
Katie Au, M.D.
Yeah, I would just say that, you know, we find that medical care is so siloed and it's like that in so many different specialties or aspects of care. And that's the same for reproductive health and mental health care. And, you know, Dr. Jorda and I would frequently see patients postpartum who really wanted to talk about how it felt to have postpartum hemorrhage or to have an unplanned C-section, and were really good at talking about why someone had extra bleeding or what exactly was happening in the room during their C-section, but not as well equipped to handle the mental health aspects and help folks process that.

00:08:44:08 - 00:09:06:17
Katie Au, M.D.
Same for a reproductive psychiatrist. They're so wonderful at, you know, accessing those mental health resources and tools and making sure that patients are safe and have a plan for follow up. But they didn't really understand why someone had a hemorrhage or why someone had an unexpected C-section and had a hard time answering questions that the patient would naturally have about, you know, will this happen to me again?

00:09:06:19 - 00:09:31:27
Katie Au, M.D.
What would it look like if I got pregnant again? And we just found it to be so incredibly valuable to all be in a room together where we could go through someone's birth experience if or when they feel ready and answer all their questions about what happened during their labor or their birth, or why certain things happen the way that they did, and real time be able to support them best in a mental health capacity.

00:09:32:00 - 00:10:07:18
Katie Au, M.D.
So it just felt really nice to be able to bring those services to patients at the same time. And as Dr. Jorda mentioned, you know, not having people have to relive their trauma multiple times and tell their story to numerous people, was extremely valuable. And I think that's been one of the strengths of our program is that we've identified a safe space so that patients know that they can have someone who's both knowledgeable about the obstetric details, and then also someone who is attentive to the mental health aspect of care, because really, birth trauma is all encompassing like that.

00:10:07:18 - 00:10:11:11
Katie Au, M.D.
And we needed a space to be able to address all of those things at the same time.

00:10:11:13 - 00:10:25:24
Julia Resnick
Absolutely. And I can imagine that there is a like, you need to rebuild trust with patients so that they're trusting the medical system again. What does it take to create that trust and sense of safety, so that you're not just retraumatizing someone with their next birth?

00:10:25:26 - 00:10:50:05
Katie Au, M.D.
I think it all stems with having an open mind and not being defensive about the care that someone has had, or the outcome that someone has had. You know, I can't tell you how many times Dr. Jorda and I will see a patient and they feel really guilty saying that they had trauma related to their birth, or that they were disappointed in their experience because maybe their baby was perfectly fine and very healthy, and they were perfectly fine too.

00:10:50:05 - 00:11:08:09
Katie Au, M.D.
But that doesn't change the fact that the C-section was really hard or really traumatic. And someone feels guilty for sharing those thoughts, or feeling like it was a traumatic experience when, you know, family members will say, but you're healthy and your baby is healthy and your baby's fine, and you guys are both alive, so it's okay.

00:11:08:16 - 00:11:29:10
Katie Au, M.D.
It just brushes off those complex feelings that people have, because you can be really happy about an outcome, and you can really love your family and really love your baby. And you could at the same time be very traumatized by the experience. And both of those things can be true. And I think it just starts with acknowledging that and letting patients know that those things can both be true.

00:11:29:10 - 00:11:34:20
Katie Au, M.D.
And you recognize that you understand that, and you're here to help them.

00:11:34:23 - 00:11:51:27
Julia Resnick
Really normalizing their experience. Hopefully that helps with some of that guilt. So I'd love to talk a little bit about the impact that you've seen. Either through data you're collecting or patient stories. It really illustrates the difference about what this type of care can make for patients.

00:11:51:27 - 00:12:18:20
Katherine Jorda, M.D.
I can think of one patient who is a nurse by training and had a traumatic birth and delivery. We were seeing her for postpartum care and kind of processing all of that, and she had so much guilt about it. She's like, I'm part of the medical field, and I thought that knowing how the medical field works, I should be able to advocate for myself.

00:12:18:20 - 00:12:38:03
Katherine Jorda, M.D.
And I'm a nurse. I advocate for patients all the time. But when you're a patient and you're laboring and you're trying to push out a baby, I mean, those are a lot of identities colliding, and it can be really hard to advocate for yourself, even if you know what the medical system is like and you are a patient.

00:12:38:11 - 00:12:42:00
Katherine Jorda, M.D.
And our patient population often doesn't necessarily interact with

00:12:42:07 - 00:13:13:05
Katherine Jorda, M.D.
the medical system unless they're giving birth. And so I think it can be a really unfamiliar position for patients that can be very, very challenging to navigate. There's also that element of during my pregnancy I had control, I could exercise, I could, you know, optimize my health in preparation for this pregnancy and birth. But now I'm trusting these individuals in this hospital that I may or may not know the delivery team, to help me get through this.

00:13:13:05 - 00:13:40:03
Katherine Jorda, M.D.
And so when things start to go sideways or, gosh, this C-section for this reason wasn't part of the plan or expectation, it can be very difficult for patients. And so as we talked about this person's experience, we tried to normalize and share that. Yeah, maybe you are a nurse, but you're not a nurse and you're a patient at that time, right?

00:13:40:03 - 00:14:03:26
Katherine Jorda, M.D.
Like you can't have such high expectations for yourself and, try to kind of lift that guilt and kind of put it in a perspective. And so we were able to talk and plan for the next pregnancy. And when patients see us, they can continue seeing us for routine prenatal care. Or it can be a one time consultation to develop a trauma informed care plan.

00:14:03:28 - 00:14:25:05
Katherine Jorda, M.D.
So this patient continued on with us and we were able to be there for this patient's delivery and see them postpartum. And it was just really nice for her to have that shorthand of, hey, I've shared my experience with this team. They know what were the activating factors, they know what was hard for me as a nurse.

00:14:25:10 - 00:14:34:10
Katherine Jorda, M.D.
And here's what we did as a team, and here's a plan, and here's how we can kind of mitigate some of those things that had come up in her prior delivery.

00:14:34:13 - 00:14:53:02
Julia Resnick
That is a really powerful example of you know, what happens when you can integrate behavioral health and physical health. It's better for everyone. So not all hospitals are so fortunate to have a perinatal trauma clinic like yours. So for those who don't, what are some practical ways that providers can recognize and respond to trauma?

00:14:53:04 - 00:15:18:20
Katie Au, M.D.
You know, I think it really goes back to naming it, calling it out, recognizing it and asking about it. So, I mean, if, you know, 1 in 3 birthing patients is experiencing some amount of trauma or dissatisfaction with their birth, that's many of the patients that we're seeing. So we need to ask about it. We need to, you know, it's pretty routine to do, you know, anxiety, depression, mood screening and postpartum visits.

00:15:18:20 - 00:15:41:10
Katie Au, M.D.
But I wouldn't say that it's routine for everyone to be asking how a patient's birth experience was like, how satisfied were you with your care? Are you having trouble sleeping? Does it make it difficult to think about a next pregnancy? But I, I think we should be asking those questions and making sure that patients questions are answered about their birth experience as well.

00:15:41:12 - 00:16:04:12
Katie Au, M.D.
I can't tell you how many times we've seen a patient who you know is scared to get pregnant again. But if someone had just explained what it was that happened to them last time, and that that's not likely to recur again, or you know, even just understanding what it was that they went through their mind is sort of blown in a way that they're like, wow, I had no idea that that was, you know, something that likely wouldn't happen to me again.

00:16:04:12 - 00:16:30:28
Katie Au, M.D.
And I think about pregnancy in the future in a completely different way. So I think talking about it, you know, recognizing it, I mean, it's something that's just so common and yet there are so few people addressing it. It's a disservice to birthing families. And we really need to be addressing these things. And from a systemic perspective, thinking about how do we prevent birth trauma and how do we treat it in a respectful and compassionate way?

00:16:31:00 - 00:16:55:07
Julia Resnick
And I am sure if there are any new parents who are listening to this who have had a traumatic birth experience, they will feel less alone. And hopefully providers will hear this and realize that there are some straightforward things they can do to help their patients feel safer to create better birth experiences for everyone. So Dr. Au, Dr. Jorda, thank you both so much for the work that you do for your patients, for sharing your expertise with us.

00:16:55:09 - 00:16:59:03
Julia Resnick
This has been a really great conversation and I just appreciate both of you.

00:16:59:05 - 00:17:00:11
Katie Au, M.D.
Thank you so much.

00:17:00:13 - 00:17:01:23
Katherine Jorda, M.D.
Thank you.

00:17:01:25 - 00:17:10:06
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:01 - 00:00:19:12
Tom Haederle
Welcome to Advancing Health. Indiana faces a shortage of approximately 4,300 nurses. Today, we hear how a remarkable example of public and private sector generosity has combined to train and retain the nurses Hoosiers rely on.

00:00:19:15 - 00:00:44:09
Tom Haederle
Hello, friends. I'm Tom Haederle, senior communication specialist with the American Hospital Association. And I'm very pleased today to welcome two guests who will tell us how Indiana has jumpstarted its effort to train new nurses and close the gap between demand and supply in the state. Denzil Ross is president of Indiana University Health, South Region, and Erik Coyne is chancellor of Ivy Tech Community College. That is in Bloomington.

00:00:44:12 - 00:00:47:10
Tom Haederle
Gentlemen, thank you both for joining me on advancing health today.

00:00:47:12 - 00:00:48:14
Denzil Ross
Great to be here.

00:00:48:17 - 00:00:49:16
Erik Coyne, JD
Thanks, Tom.

00:00:49:18 - 00:01:04:28
Tom Haederle
Well, let's jump in. Eric, maybe we could start with you. Ivy Tech Community College's Bloomington campus has been a significant pipeline for the nursing workforce in southern Indiana for some time, and now you've got some resources to become an even bigger one. So in a nutshell, what's changed?

00:01:05:01 - 00:01:33:22
Erik Coyne, JD
Well, the collaboration with IU Health is a huge part. They've provided grant money in the past and continue to support us. We've been able to expand and move our nursing facilities. We've renovated and just really built up. We've doubled our bed spaces for training. We've added more simulation labs. So we've really created the, you know, the educational capacity.

00:01:33:25 - 00:01:54:08
Erik Coyne, JD
And then we work really closely with IU Health on the clinical opportunities. Where do those lie? Where are those? And we found, frankly, that we've really maximized our opportunity throughout the course of the day where we're trying some other things. We're still trying to find, you know, that kind of goal, but we're always going the last mile to find those extra clinical opportunities.

00:01:54:08 - 00:02:17:20
Erik Coyne, JD
But really the opportunity was and continues to be in the evening and on weekends. And so really excited. Last year we launched a pilot program for 20 transitioning nurses. So LPNs or military medics or paramedics to transition into the RN program. So it's a one year program and we moved it to the evening, because frankly, there was no education happening at that time.

00:02:17:25 - 00:02:35:00
Erik Coyne, JD
So we had capacity in the evening. So, we're really excited about that program. The first cohort will be wrapping up this summer and we'll obviously be taking all the data from that and seeing how it did and seeing where we can grow. And as a result of that, we've actually found that we can grow our LPN day program.

00:02:35:06 - 00:02:50:11
Erik Coyne, JD
It's interesting how the things kind of, you know, one thing leads to another and we're really excited with the collaboration we've had with IU health and the opportunities that it's presented. Be remiss if I didn't say that we've had some generous donors who really supported us along the way.

00:02:50:13 - 00:03:06:17
Tom Haederle
Yeah. I'd like to follow up on that a little bit, especially from IU Health's point of view. From where you stand, Denzil, what's driving some of the philanthropy and the support here? Have you been hearing from residents in the area that there just weren't enough nurses and it was getting to be a problem and something had to be done?

00:03:06:17 - 00:03:09:00
Tom Haederle
Or really, what was the impetus behind this?

00:03:09:02 - 00:03:40:27
Denzil Ross
Yeah. You know, that this topic of the nursing shortage has been a national topic for quite some time and, we hear very presently so in Indiana. And specifically in the South region. And through this transformational gift from the Fergusons, who are longtime Bloomington residents, they were motivated through the idea that through their investments, coupled with IU Health's support, Indiana can train more nurses by building on the strong foundation that's already in place.

00:03:40:27 - 00:04:07:15
Denzil Ross
We have, a number of hospitals across the state, and we all struggle like our competitors and other health care systems with how do we find nurses? With that continuing to be a challenge with the support of, these gifts coming in, we are now able to say, let's do something about it. Let's own the problem and let's start to build and improve

00:04:07:17 - 00:04:45:10
Denzil Ross
our pipeline. I think the inception of this investment and other investments with Ivy Tech - the Fergusons, their connection has been through their friendship with another philanthropist, Lee J. Marchant, whose transformational gift to Ivy Tech, Bloomington, established the Lee J. Marchant School of Nursing. And that included early support for the nursing program. Now, with this donation, this gift, we're able as Eric mentioned, to take that, expand it even further and really focus on building our own pipeline over the course of the next coming years.

00:04:45:12 - 00:05:06:22
Tom Haederle
If I understand it right, a big part of the focus of the whole thing is to keep it local, in a sense. You want to train people who are Hoosiers, ideally, and who want to stay in this state and live their lives there and plant their roots there. So really, maybe both of you could address how is that working out and why is it important to sort of keep everything, you know, keep it in the backyard to the extent that you can.

00:05:06:25 - 00:05:30:16
Erik Coyne, JD
You know, we're a community college and we support our community, and we see that 85 plus percent of our students across the board tend to stay in our region. And so as we think about the nursing shortage in particular, and I know this was top of mind for the Fergusons as they were thinking about this gift, how do we incentivize, how do we keep those students in our region?

00:05:30:18 - 00:05:50:22
Erik Coyne, JD
What can we do to, you know, provide support for them? And this gift obviously is really going to transform how we're able to do that and how we're able to support them. It's a two part gift. One part is on the operational side, it'll help offset salaries and equipment. And another side of that is scholarships.

00:05:50:22 - 00:06:08:09
Erik Coyne, JD
And so it's going to really help grow some of the support we can give our students in the region. And I think, you know, they can stay here and work here. Obviously there's a connection. My mom was a long time nurse in Bloomington. I was born here. My dad was on the Monroe County hospital board for a long time.

00:06:08:09 - 00:06:29:05
Erik Coyne, JD
So it's a real personal thing for me. But it's really cool when you walk in and you're being treated by someone you know. It is just such a difference when you walk in and it's someone you know, you knew their parents or even their grandparents. How cool is that? That's the community we want to inspire here. I mean, I still hear from people who tell me about my mom treated them and that is pretty cool.

00:06:29:05 - 00:06:41:14
Erik Coyne, JD
And so if we can continue that for generations and make that sustainable and and financially feasible, not just for them, but also for, you know, our local medical suppliers and hospitals and that's terrific.

00:06:41:16 - 00:07:04:09
Denzil Ross
And I think that's the beauty of who we are. And, at IU Health in Indiana and particularly in the South region, we have a number of critical access hospitals that help and support those rural areas. And then within our Bloomington facility, I think that's what really gives the impact to who we are and how we serve our community.

00:07:04:12 - 00:07:27:25
Denzil Ross
A lot of what Eric mentioned is what we pride ourselves on. It's really and truly the community serving the community. So it's not uncommon, like Eric mentioned, that you go into one of our hospitals and you see a friendly face, whether that be the provider, the nurse, APP, the team member greeting you at the door. Those are your neighbors.

00:07:27:25 - 00:07:48:01
Denzil Ross
Those are the people that your kids play soccer with. Those are the people that you spend time, you walk into a restaurant and you see them. And so, I think that's the beauty of this, is that from our perspective, we get to grow that pipeline. But as a health care provider, we're not just talking about filling the gap.

00:07:48:01 - 00:08:16:19
Denzil Ross
We're also talking about retention. And we know if we have staff, particularly here in this scenario, nurses who train here, who are from here, there's a better chance that they stay here in the long run. And that just gives us stability or recruitment. It gives us stability in our outcomes because now we could build and grow programs.

00:08:16:19 - 00:08:44:24
Denzil Ross
The nursing staff knows the physicians' staff and all the other providers, and it just builds a great outcome, quality outcome for who we are and how we serve the community. One of the things we are also really excited about, we are very conscious of the fact that as a new nurse coming out of your educational program, it could be somewhat scary going into the field to care for patients.

00:08:45:01 - 00:09:29:17
Denzil Ross
And for that reason, we have a really strong and robust first year nursing residency program that is really focused on how do we help and support that first time nurse transition from the educational space to how they become a caregiver. And so we're really proud of that. Really excited about having more and more nurses go through that. And we have seen that be a really vital piece of our ability to retain nurses and get them to the level of care that they want to be, whether it's inpatient med surge, they want to be critical care, ICU, emergency medicine or outside of our surgical and procedural spaces.

00:09:29:17 - 00:09:31:05
Denzil Ross
So we're really proud of that.

00:09:31:07 - 00:09:58:13
Tom Haederle
That is absolutely one of the most impressive things, I think, about what you're doing. I wanted to follow up a little bit on something you mentioned earlier, which is just the advantage of, with this money, this grant money, and being able to expand your capabilities for training and how that plays out on the weekend and evening classes. Opening this, you know, nurse training offered to people that maybe want to do it, but just, you know, had full time jobs or for whatever reason, couldn't take advantage of that.

00:09:58:13 - 00:10:01:15
Tom Haederle
So how is that working out? I'd like both your thoughts on that.

00:10:01:15 - 00:10:32:05
Erik Coyne, JD
Our evening cohort that we have right now, we're seeing most of them are full time employees, many of them at IU health. And they have families. And so getting back to school was just a challenge. And having an evening option really just opens it up. I know one of my early degrees after college, I had to do a nights and weekends kind of thing, and it's a challenge to work all day and then race over to class and study all evening.

00:10:32:07 - 00:10:47:20
Erik Coyne, JD
And your weekends get sucked up with more classes and studying. So what I like about it is it's a one year transition program. So it's, it's, you know, can you do it for a year? Give us a year, right? And they can talk to their families and they can plan for it and they can set it up.

00:10:47:20 - 00:11:06:14
Erik Coyne, JD
So I think it's been really transformational for those folks in that current cohort. And one day down the road, we do look to expand it. We're going to take the data from this first year and see how the second year goes. And at some point about halfway through the second year cohort, we'll really be able to make a determination if we're able to grow.

00:11:06:17 - 00:11:27:21
Erik Coyne, JD
As you can imagine, whenever you start something new, it's always a little bit of a challenge. The no knowns and the unknown unknowns, but, working through that. But for the students in the class, I think it's really been just an opportunity that they otherwise wouldn't have. We actually have folks who have been driving in from outside our region because it's an opportunity here that they didn't get elsewhere.

00:11:27:23 - 00:12:07:11
Denzil Ross
Yeah. I think when you really think about it, you know, everything is changing around us and the way people work is also changing around us. The way people learn and go back to school is also changing. And, kudos to Eric and his team for really seeing that change. And, attacking this head on with this new program that we can offer members in the community the opportunity to go to school and work, take care of themselves, take care of their family in a way with a schedule that works for what's ideal for them and their family.

00:12:07:14 - 00:12:32:22
Denzil Ross
I think it gives the opportunity for us to improve or broaden that number of people who now have the opportunity to go back and learn because they're working during the day. Right? They're taking care of themselves, their families. And now this opportunity, this option just opens the door to a whole new set, hopefully interested parties.

00:12:32:22 - 00:12:44:18
Denzil Ross
So we're really excited about the benefit that we'll see, both for Ivy Tech, the hospital at the end of their program. And really what the impact could mean to the community.

00:12:44:21 - 00:13:02:11
Tom Haederle
I came across an article recently, just a few days ago that put me in mind of, of our conversation right now. And I just wanted to bring it up and get your thoughts on this, because I thought it was really interesting. It was in the Wall Street Journal. It was an article ran on April 1st, and the title was "Nursing is the Surefire New Path to American Prosperity."

00:13:02:11 - 00:13:23:25
Tom Haederle
That was the name of the article. I just wonder if that's something that in your experience, have you seen that? Do you think that idea that health care or nursing specifically is now a path to a better life is really starting to take, take hold and, you know, become more widely believed among young people and, and if so, what implications does that have for training programs like yours?

00:13:23:28 - 00:13:54:03
Denzil Ross
Hospitals are very intricate. And there are many aspects of when we think about health care or health and wellness that the nursing occupation plays a very big part. Many times we just think about within the four walls of the hospital, right. Emergency department, inpatient setting, operating rooms. But there are so many opportunities that there are paths within that nursing field.

00:13:54:06 - 00:14:25:05
Denzil Ross
And the more and more that we can educate people about what can be, you know, and give a different perspective sometimes to what a nurse could be and what they do. The path to then to that next step, third or fourth step out from just becoming a registered nurse. There's opportunities there as well. We have fully embraced nurse practitioners in our model of how we care as physician extenders.

00:14:25:07 - 00:14:49:27
Denzil Ross
And they all were exposed to different specialties, different area areas of care as nurses and said, hey, I want to go the next step. And after becoming and RN, there are so many paths to how you continue to grow, opportunities to expand. And of course, we see salaries that come to match that as well.

00:14:50:00 - 00:15:04:10
Denzil Ross
So I definitely think that it's a great starting ground that opens a wide array of opportunity within the health care field, not just the hospital, but with the health care field as a whole.

00:15:04:13 - 00:15:30:09
Erik Coyne, JD
Yeah, we're seeing that play out on the training side. Our nursing program and a few of our other health care programs are competitive programs. At a community college, vast majority of your programs are open access, open enrollment. But our health care programs are highly competitive. The salaries, the outcomes, the career opportunities. One thing I love is the chief nurse at IU Health Wilmington is an Ivy tech grad.

00:15:30:09 - 00:15:48:00
Erik Coyne, JD
Then she went on further and, and now is the chief nurse over at the hospital. I mean, it's fantastic. And we see it with, you know, respiratory therapy. We see it with radiation therapy, all of our other health care programs that we have. We're starting to really see growth and interest.

00:15:48:00 - 00:16:05:22
Erik Coyne, JD
And the retention is there, too. Students in those programs tend to stay in those programs. You know, they worked hard to get into them. And so they're going to stay and they're going to get through. They're not easy. They're tough programs. And we hold our students to a high standard, but they need it. And, it's great. For many

00:16:05:22 - 00:16:34:24
Erik Coyne, JD
it's a, you know, first generation student. This is going to be transformational for their family. This is like generational change that's occurring here. And so that that is really huge and really impactful. We're really excited, especially with our various cohorts we have going on. Every term, we have a cohort starting. So applications are always flowing. Feel free to visit us at Ivy tech.edu/nursing and you'll learn all about how to apply and what you need to do to get started.

00:16:34:27 - 00:16:53:05
Tom Haederle
It's so exciting what you're doing, and I can't congratulate you enough for not only making the difference in the lives of patients by providing trained caregivers that they need, but as you just mentioned, maybe, you know, opening up new paths and, you know, leading people to a better life and doing something, giving them an expanded opportunity to do something they love to do.

00:16:53:05 - 00:17:11:21
Tom Haederle
So I'd like to thank you both for being on Advancing Health today and sharing your thoughts about the value of philanthropy and the value of expanded training and flexibility and how nurses are trained. But most of all, really what you're doing on behalf of the people of southern Indiana, your patients, that's just so, so remarkable and so impressive.

00:17:11:23 - 00:17:14:06
Tom Haederle
So thank you so much again. Really appreciate it.

00:17:14:09 - 00:17:25:00
Denzil Ross
Thanks, Tom. Thanks for having us. And really looking forward to working with Ivy Tech here to make this come to fruition. This has been a long time coming, our relationship that, we're glad that we're here.

00:17:25:03 - 00:17:36:12
Erik Coyne, JD
Yeah. Thank you, Tom. And I'd like to real quick, thanks to IU Health, thanks to the Ferguson family, Connie and Steve, for making this a reality and really moving the needle for our students in the region. So thank you.

00:17:36:15 - 00:17:44:25
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:00 - 00:00:13:22
Tom Haederle
Welcome to Advancing Health. Helping a child grow into a strong and healthy adult isn't always easy. Today, we hear from a large urban care provider that's taken on the challenge.

00:00:13:24 - 00:00:39:28
Tom Haederle
Hello friends! I'm Tom Haederle, senior communication specialist with the American Hospital Association. If you've ever come across this quote: "individually, we are one drop. Together, we are an ocean," then you'll understand what drives the Ann and Robert H. Lurie Children's Hospital of Chicago to forge some of the most amazing examples of strong community collaboration found anywhere. The breadth of Lurie Children's Hospital's work in supporting kids is just incredible.

00:00:40:06 - 00:00:55:24
Tom Haederle
Much of it falls under the umbrella of the hospital's Patrick M. Magoon Institute for Healthy Communities. So it's an honor today to welcome Mary Kate Daley, senior vice president and chief of community health for the McGoon Institute, to our podcast today. Mary Kate, thanks so much for coming on Advancing Health.

00:00:55:26 - 00:00:57:05
Mary Kate Daly
Thanks for having me, Tom.

00:00:57:08 - 00:01:19:24
Tom Haederle
Let me do a little scene setting here for our listeners. Working with community partners, the Magoon Institute supports dozens of initiatives that help kids - across nutrition, behavioral health, car seat safety, and many other things. So I'm just naming a few. So I guess Mary Kate, let's sort of start with...how would you, what ties all this together, the menu of things that that the MaGoon Institute supports?

00:01:19:24 - 00:01:26:08
Tom Haederle
And how would you describe the hospital's philosophy when it comes to working with outside partners to improve the lives of kids?

00:01:26:11 - 00:01:50:29
Mary Kate Daly
Well, Lurie Children's has been engaged in community health programs for many, many years. Like most hospitals our mission is to improve the health of people and in our case, specifically of children. And more and more, we are learning that health is more than health care. So we have to do the absolute best job we can when these young people show up at our doors and need care.

00:01:51:01 - 00:02:12:18
Mary Kate Daly
However, it's just as important to be working with community partners around for us, the city of Chicago, to be improving health of young people in their own communities where they live, where they go to school, where they play. So I think philosophically, that's a key part of who we are and what we value. It's a key part of our mission.

00:02:12:19 - 00:02:21:02
Mary Kate Daly
Our mission pillars include clinical care, research, education and advocacy. And community health is a key part of advocacy.

00:02:21:04 - 00:02:35:18
Tom Haederle
I don't think anybody would argue with the notion that there are many kinds of challenges facing kids today, especially in underserved communities. So how do you prioritize the needs and decide which ones should receive your attention and help with resources?

00:02:35:21 - 00:03:03:15
Mary Kate Daly
I think the framework that has really helped us a lot, and probably some of my other colleagues around the country working at hospitals would agree is the community health needs assessment. So when the Affordable Care Act passed 15 years ago, one of the requirements it included is for hospitals to conduct community health needs assessments every three years and then to use those assessments to develop corresponding implementation strategies.

00:03:03:18 - 00:03:33:00
Mary Kate Daly
So we have come to embrace this requirement. We actually love it. For us, this is a great opportunity to really take a step back and dig into tons of data, community health data, patient data and really listen, conducting surveys and listening sessions and focus groups and really trying to understand what are the most significant health challenges for young people in the city of Chicago, particularly those living in our disinvested communities?

00:03:33:02 - 00:03:55:11
Mary Kate Daly
So once we have that assessment and all that data, then we gather our internal clinical experts, our public health experts, as well as external partners, and we ask some key questions. You have to put these questions through sort of a filter like so we say 'okay, where when we look at all these needs. Where does Lurie Children's have unique expertise

00:03:55:14 - 00:04:17:15
Mary Kate Daly
to address these issues'? Who are the community partners and organizations that are already on the ground doing this great work? And what would be the best way for us to partner with them, learn from them, and then see if together we can impact some of these challenges. How can we develop or advance these programs and policies to make progress on these issues?

00:04:17:17 - 00:04:47:10
Mary Kate Daly
And a key thing is to recognize that a lot of these issues are very complex. They are entrenched. They're rooted in generations. But we have to think about how can we come together to try to address them. And then another key thing, we are an academic medical center and we need to make sure that there is solid evaluation for all of these kinds of programs, so that we're making the impact that we want to be making, and that the community expects of us.

00:04:47:12 - 00:05:11:24
Mary Kate Daly
So this is a process that happens every three years. That's kind of our step back big picture look. And then between those cycles, that's when we're constantly kind of shifting and making small tweaks here and there to different programs in order to respond to what we're seeing in evaluations and new challenges that come along. So that framework has been very helpful to us because it is a very challenging question.

00:05:11:26 - 00:05:13:13
Mary Kate Daly
There's a lot of needs.

00:05:13:15 - 00:05:29:06
Tom Haederle
And when you reach out, having identified a need to reach out to a potential partner, what, just the reception at the other end generally like, yes, we'd love to work with you guys. It's great to collaborate with a hospital. Or are there ever any, you know, turf or jurisdiction sorts of sensitivities around these things?

00:05:29:08 - 00:05:50:20
Mary Kate Daly
I think all of those things can happen sometimes. As soon as we call or someone introduces us to a new partner, they're instantly eager. And I think in those cases, I think a lot of it is when people involved in that organization have had positive clinical experiences at our hospital, and so they've come to trust us in a different way.

00:05:50:22 - 00:06:16:27
Mary Kate Daly
And then the idea of maybe working together in this new way, they may be more open to that. At the same time, there are certainly organizations that have not had positive experiences in these partnership kinds of opportunities. And so, understandably, they're a little bit more hesitant. And I think what we've found works best in that situation is to just start small and start slow.

00:06:16:29 - 00:06:39:05
Mary Kate Daly
And we understand that we need to kind of carefully do this. So let's start with just like a little small thing that we're going to do. And then let's over time build up that trust. And I think when that happens too, there's new opportunities that emerge that we might have not even realized we could have worked together on when we were first introduced to this partner.

00:06:39:08 - 00:06:55:29
Mary Kate Daly
The key thing there is we have certain expertise and they have certain expertise, and the magic's going to happen when we come together in a real and genuine way. But, you know, respecting the strengths that we both bring to a partnership is essential.

00:06:56:02 - 00:07:12:02
Tom Haederle
Great point. And actually to to pull the on that thread a little bit. What are some examples of the magic that has happened? Know when you think about, you know, great examples of partnerships that have made a difference and really measurably helped the lives of kids in Chicago? What are some examples that come to mind?

00:07:12:04 - 00:07:32:08
Mary Kate Daly
So the first one I want to share is a program called the Juvenile Justice Collaborative. This is a great example because I think it shows how a hospital can take a skill that we already have, and you can apply it to community health needs. It also shows the importance of community partnerships and like true partnership in the development and maintenance of these programs.

00:07:32:09 - 00:08:01:06
Mary Kate Daly
So the Juvenile Justice Collaborative, this is a program that provides care coordination and social support to youth involved in our justice system. So in Chicago, in Cook County, our courts and states' attorneys, they can refer young people to this program as an alternative to detention. So this was something where we took what we know about clinical care coordination, and then tried to apply it to a new population of young people.

00:08:01:14 - 00:08:30:09
Mary Kate Daly
After these young people get referred, they work. Then we do a very significant intake process to really understand what the challenges this young person is facing. And then we refer them to the appropriate service providers in our network. And then these providers, they provide the service directly to the young people, but they're also helping to shape the program as it evolves, as we see new challenges, as we may need new partners.

00:08:30:11 - 00:08:55:12
Mary Kate Daly
And then we also have an external evaluation of this program. And we recently, shared the results of an external evaluation that showed that this kind of approach really does help not only lower recidivism, which is an important goal, but it also improves the health and well-being of the young people themselves. So that's kind of a good example of how we take something we know as a hospital and apply it elsewhere.

00:08:55:17 - 00:09:15:14
Mary Kate Daly
Another totally different example. This one is a big project. It's been years in the making. But it's really on the cusp of becoming a reality and we're so excited about it. And this is called the Austin Hope center. So this one goes back, kind of building on what we were talking about before, about how do you start a relationship with a new partner.

00:09:15:14 - 00:09:40:29
Mary Kate Daly
So this one, during the pandemic, we met leaders at a church in one of our disinvested communities, its called Lively Stone Church in Missionary Baptist Church in Austin. And the pastor there and the staff, they were struggling with the mental health needs of young people. And so we kind of started with them working on some smaller projects where we could work together, get to know each other, build some trust.

00:09:41:02 - 00:10:06:01
Mary Kate Daly
Years later, where we are today is that we're actually getting ready to open up a new building with them in a few months. So they had formed a community development corporation. So they are going to be owning the building. Lurie Children's is a tenant. That's very important because we want the economic development in our disinvested communities to be owned from people within that community.

00:10:06:03 - 00:10:27:14
Mary Kate Daly
So we are the tenant. However, we're a very active tenant and, we've really been working alongside them from the very beginning to create this space. So in this new building, we will provide some outpatient clinical care and behavioral health services. And then this is going to be the hub for all of our community health work on the west side of Chicago.

00:10:27:17 - 00:10:49:17
Mary Kate Daly
So we'll have a community conference room, a teen lounge. We'll have an early childhood room. And our goal here is for everyone in the building to work together, our clinicians, our community health experts, the other tenants in the building. The goal here is that this building helps to address the health of young people in this community in a more holistic way.

00:10:49:19 - 00:11:06:11
Mary Kate Daly
So this is an example, and it's an extreme example, because I know not every partnership leads to a building, but, to kind of how we can start small to address a significant need that a partner is having and how that can kind of grow over time. And evolve into something really exciting.

00:11:06:13 - 00:11:21:25
Tom Haederle
Mary Kate, those are a couple of wonderful examples of collaborations that work. What qualities make for an outstanding collaboration partner as you consider partnering with, you know, with a private entity to to do something to help kids, what are you looking for in who you choose to collaborate with?

00:11:21:27 - 00:11:47:04
Mary Kate Daly
Well, we've talked a bit about the importance of trust. That's first and foremost, and that ability to be able to build that, whether that's right away or over time, that's critical. Another important quality we found is organizations who are innovative. So Chicago, as with others, we're blessed with many strong community organizations who are always looking at new ways to solve old problems.

00:11:47:06 - 00:12:07:17
Mary Kate Daly
And so that's really key for us when we have a partner that's excited about thinking differently and open to new thoughts and ways of doing things. And then the third thing, really, I think for me is we found with partners, they do have to understand our limitations. Because as hospitals we can be a little bit more conservative.

00:12:07:17 - 00:12:28:17
Mary Kate Daly
We can be a little bit slower. I think a lot of our community partners are so nimble and so flexible, and we found that it's best when we can find partners who understand we're going to do our best to meet them there. But sometimes our processes take a little bit longer and that can mean contracts or evaluations or things like that.

00:12:28:19 - 00:12:34:17
Mary Kate Daly
I think important to find those partners who are open to that and flexible, and understanding of that.

00:12:34:19 - 00:12:49:03
Tom Haederle
Thank you. That's a great answer. And I think those are also some important takeaways for your peers out in the field who may look at Lurie and think, oh boy, we'd like to do something like they're doing, but what do we need to know in advance? And you've really touched on some important things to keep in mind. Any final thoughts?

00:12:49:03 - 00:12:51:20
Tom Haederle
Anything we haven't talked about that you'd like to mention?

00:12:51:22 - 00:13:14:15
Mary Kate Daly
I think one other key element, really, just as you're thinking about what you know, what peers can learn. I think when it comes to these community health programs, the leadership support is critical. We're fortunate to have this in spades at Lurie Children's. Our previous CEO, for whom the McGoon Institute is named, actually, he was always supportive of this work.

00:13:14:15 - 00:13:36:09
Mary Kate Daly
And then our current CEO and the senior team, they've really embraced advocacy and community health as a key part of our mission and strategy. Our CEO speaks better than I do about the importance of going upstream and addressing health challenges in young people before they become adults. And, he and our other leaders ensure that this work remains priority.

00:13:36:11 - 00:13:47:21
Mary Kate Daly
Engaging our board, philanthropic partners and all the members of our team that are out there doing this work every day. So I think to keep it sustainable, that's a really key element.

00:13:47:23 - 00:14:08:06
Tom Haederle
Well, you speak pretty well yourself about the mission and really, really present it in a wonderful light. So, Mary Kate, thank you so much for your time today and appearing on, Advancing Health and more for your phenomenal work in changing so many lives for the better among the the young kids in Chicago. So, good luck and congratulations on all the great work you're doing.

00:14:08:09 - 00:14:11:13
Mary Kate Daly
Thank you very much. Thanks for everything you're doing.

00:14:11:15 - 00:14:19:26
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:01 - 00:00:16:09
Tom Haederle
Welcome to Advancing Health. For many hospitals, philanthropic dollars are not just nice to have, they're a must have. Today we hear how this reality is supporting youth mental health and behavioral health efforts in central Iowa.

00:00:16:12 - 00:00:43:01
Rebecca Chickey
Hi everyone. I'm Rebecca Chickey, and I'm the vice president of behavioral health and trustee services at the American Hospital Association. And today, we are going to learn about a $1 million gift to advance mental health care in central Iowa that Eyerly Ball provided to UnityPoint health. Joining us today to share the impact of this gift, both now and into the future, is David Stark.

00:00:43:02 - 00:00:51:26
Rebecca Chickey
He is the chief of government affairs and a philanthropy officer for UnityPoint Health. David, thank you for joining us today.

00:00:51:28 - 00:00:53:02
David Stark
Good to be with you.

00:00:53:04 - 00:01:06:09
Rebecca Chickey
Let's get started. If you can first provide the listeners with a bit of a history behind Eyerly Ball. What has their role been in terms of shaping mental health in the Central Iowa communities?

00:01:06:11 - 00:01:31:15
David Stark
We are so blessed to have a history steeped in tradition. Over 55 years ago, two women, Jeannette Eyerly and Elizabeth Ball, saw a need for community health services here in the Des Moines area. And they started what was the county mental health center, now known as Eyerly Ball, a one stop shop that would take care of all the holistic needs, behavioral health wise for patients and families.

00:01:31:17 - 00:01:35:14
David Stark
And we're proud to carry on that tradition today some 55 years later.

00:01:35:16 - 00:01:45:11
Rebecca Chickey
So tell me a little bit about that. Why and how did UnityPoint Health get involved with this? Was there common mission vision? Tell the listeners a bit about that.

00:01:45:13 - 00:02:13:26
David Stark
There was tremendous alignment and synergy with our mission and vision eight years ago. Eyerly Ball became a wholly owned portion of UnityPoint Health Des Moines. Our mission of improving the health of the communities that we serve is not just about physical health. It is also about emotional, social and psychological health. Eyerly Ball's role of taking care of the entire patient fit seamlessly with what we did, and we've had tremendous synergies the past eight years.

00:02:13:28 - 00:02:40:26
Rebecca Chickey
That's wonderful. Particularly as I just saw a report this morning that the demand for mental health services continues to climb across all parts of the country and all ages. So the fact that you're able to step up and address and meet those community needs is phenomenal. But you couldn't have done it without that commitment of those two women, and their dedication years ago, but also without funding.

00:02:41:03 - 00:03:02:02
Rebecca Chickey
We all know that behavioral health services have been underfunded historically. And so I want to get your perspective on this phenomenal philanthropic gift, $1 million. Can you tell us a little bit of how that came about? And then shortly afterwards, we'll learn about how you are using those funds to improve access to care.

00:03:02:04 - 00:03:27:21
David Stark
It was quite remarkable. It is our largest and first endowed gift to Eyerly Ball in the 55 years. So this is a new thing for us which is wonderful. And really what sparked it was an investment in a new facility and an overall campaign we started of One Place for Care. That was a five year process in the making to get a new campus for Eyerly Ball and all of the services with it.

00:03:27:24 - 00:03:52:06
David Stark
Realizing that we had an approach to fund that from a building and infrastructure standpoint. But what inspired this donor was what we needed to do from a service standpoint and really to make sure that we were there, are there for the community each and every day. And so this endowment was sparked by that investment that was also philanthropically supported, and it really was a flywheel.

00:03:52:06 - 00:03:58:18
David Stark
That gift generated an additional gift. And those conversations really made a palpable difference.

00:03:58:20 - 00:04:25:17
Rebecca Chickey
Given your title, can you speak a little bit to the broader value of hospitals and health systems really embracing the path of including philanthropy as a focus area, as a way to help margins because no margin, no mission. So, speak a little bit about that because I've seen hospitals and health systems getting more and more involved in this area, and embracing it.

00:04:25:19 - 00:04:48:27
David Stark
We've made a concerted effort, starting with our board of directors, to talk about philanthropy, not as a nice to have, but as a must have. And we frame it this way. There are three sources of dollars for a not for profit community health center or a hospital. One is patient revenue, clearly. Two, we can go out and issue debt and bring in debt to raise money for capital projects.

00:04:48:28 - 00:05:13:25
David Stark
The third leg of that stool is philanthropy, and we need to use that and talk about that. And identify each and every day and each and every year. And it's become part of our lexicon here at UnityPoint Health of why that's so critically important, to fund those things that are not funded by Medicare or Medicaid or commercial insurance, that are critically important to providing community services right here in their local area.

00:05:13:27 - 00:05:37:02
Rebecca Chickey
The reason I wanted you to go a little deeper on that is for decades, I think, children's hospitals in particular, but it has been more the exception than the rule to see a philanthropic gift go to mental health services. So congratulations for having the broader reach. Also, particularly congratulations for having it dedicated to mental health services.

00:05:37:05 - 00:06:01:00
Rebecca Chickey
And with that, I'd love to turn to the impact of this. You mentioned One Place for Care and how that was the foundation for this. What are you doing with this endowment as it relates to expanding access to services? And I'm particularly interested if you can share how this is impacting access for children and adolescents. As we all know,

00:06:01:02 - 00:06:23:06
Rebecca Chickey
if you are going to have signs of psychiatric or substance use disorders, 50% of those symptoms show by the time you're 14 years old and by the time you're 24, 75% will show symptoms. And so early intervention and prevention is critical. So wondering how you're serving the youth through this endowment.

00:06:23:09 - 00:06:54:05
David Stark
Absolutely. We're so proud of the fact that at Eyerly Ball, we treat the entire continuum from childhood to adulthood and geriatric. And so it is truly caring for anybody that comes through our doors. I'd say the chief improvement we made in this, in this One Place for Care campaign, was to create a no wrong door policy. You can enter the system whether you're an adolescent, a teen, a child, and there's no just one spot.

00:06:54:05 - 00:07:16:10
David Stark
You have to come through an access center. You have to come through urgent care or whatnot. Any door we will get you connected with those services. So we put all the services under one roof. We used to be in three different locations, and so that makes it simple to say I'm going there. We added an urgent care center for behavioral health services, particularly for teens, to be able to come in and see that not in the emergency department.

00:07:16:13 - 00:07:41:19
David Stark
And then we've added things like a pharmacy and medication therapy management that we didn't have before that specifically help families deal with their mental health disorders and meet them where they are. Substance use is another component of the nine services we offer at Eyerly Ball and a tremendous amount of that are early detection for substance use, drinking and drug use with our teens and adolescents.

00:07:41:19 - 00:07:50:29
David Stark
So we're very proud of that fact that we've been able to expand this, that treats patients from over 22 different counties around our surrounding area.

00:07:51:01 - 00:08:12:29
Rebecca Chickey
That's phenomenal. I want to dig a little deeper. You said no one door, no wrong door. Which is particularly important. Does that mean that you coordinate through One Place for Care with your pediatricians that serve? How does that work? Is integrated care where they're looking at both their physical and their emotional health?

00:08:13:01 - 00:08:32:03
David Stark
That's correct. One of the best things that we have done is we have all of our service providers on the same electronic health record. So when you're seeing a pediatrician in an office that's, say, ten miles away from Eyerly Ball and you need that service, the Eyerly Ball provider can see that record and the pediatrician can see that record.

00:08:32:03 - 00:08:58:15
David Stark
So there's not this where did the record go? The patient forgot to bring it. I wasn't sure what happened there. All of that's been coordinated in a much bigger way. The second thing is that we have embedded social workers and mental health counselors in our primary care offices. So we try and do that easy handoff that so often when somebody is in for their wellness visit or in for another PE, they express some issues regarding mental health.

00:08:58:18 - 00:09:15:14
David Stark
Let's make it easy. And reduce the stigma to be able to have that soft handoff and meet with somebody right away to see what can we do to get you into the right level of care. Those are two examples. We put our money where our mouth is when we talk about integration and integrated care. That's what it means to us.

00:09:15:14 - 00:09:18:24
David Stark
And that no wrong door that you can get that access there.

00:09:18:27 - 00:09:41:09
Rebecca Chickey
I would assume as well, that you can report the same that I've heard from others. It also by embedding them in their pediatricians office in the primary care offices, that helps the mental well-being of the clinicians as well, because they may not have the background or the training in, as much in psychiatric and substance use disorders.

00:09:41:13 - 00:09:50:00
Rebecca Chickey
But right there, they have a resource that can help that patient in real time and do a warm handoff. Are you hearing that?

00:09:50:02 - 00:10:07:07
David Stark
I hear it almost every single day. And the ability to hand that patient off to an expert there, that doesn't fit within a 15 minute appointment, but they need a little more time, and they feel better about themselves. We're providing that care for the whole patient, and it really affects their overall health and well-being.

00:10:07:09 - 00:10:12:01
Rebecca Chickey
What question have I not asked you, David, that you're proud of in this work?

00:10:12:03 - 00:10:42:06
David Stark
The question that I think would be helpful for the listeners is what role did governance play in this effort? And I would say two really important things. One is we are blessed to have a board that supports our investment in mental health. That's critically important. And two: that understanding of the importance of philanthropy in pulling off our mission, 100% of the board members of Eyerly Ball gave to this campaign.

00:10:42:09 - 00:11:06:18
David Stark
So we had support from the very top, and that really sent a message to our community that this was important. Not only do I volunteer my time to serve in the governance role, I am providing my well earned and hard earned money to this service. I believe that much in it. So I think that's a critically important role in this is engaging your governance in terms of improving access to mental health.

00:11:06:20 - 00:11:32:26
Rebecca Chickey
Thank you for mentioning that. Last year, actually, we did four podcasts directed towards trustees about the value of philanthropy. They're in the community. They are, as you said, giving up their time already, but then giving up their hard earned dollars. It's leading by example and it allows others to see the value of what their contribution could mean.

00:11:32:29 - 00:11:42:05
Rebecca Chickey
What call to action would you share with the listeners, how to inspire them to have something like this in their own community?

00:11:42:08 - 00:12:05:03
David Stark
I would start with this. The call to action is to ask questions, not to necessarily have the right answer. What I mean by that is engaging community members in what they're passionate about. And the anonymous $1 million donor was a great example of that. And the 55 other individuals that supported the campaign. We started with questions. And where is your passion?

00:12:05:03 - 00:12:25:13
David Stark
Where is your purpose? That is something any of us can do. Board members can do, leaders can do. And it's amazing what you will hear and how that aligns with where you're trying to go from a missional standpoint. So engage your community with asking those kinds of questions. Number two is be willing to put your own dollars into the pot.

00:12:25:15 - 00:12:46:23
David Stark
So one of the biggest pieces of this project, this 15,000 square foot building. We made a commitment organizationally that we would invest our money into it as well. We're not just asking for 100%. So it's a shared responsibility. And really that public-private partnership is critically important. And the call to action is there's no right time to start.

00:12:46:28 - 00:12:55:05
David Stark
Today is just fine. Start today. Don't worry about that you haven't done it in a year or two years. Start today and there's no wrong time to start.

00:12:55:07 - 00:13:20:02
Rebecca Chickey
David thank you. Thank you for sharing your time, your expertise, clearly your passion for all that you do. Thank you for sharing the journey and giving some insights into the impact that two individuals 55 years ago can have because, that's where their passion was. And look at where it's led to today. Thank you so much.

00:13:20:04 - 00:13:22:04
David Stark
My pleasure.

00:13:22:06 - 00:13:30:18
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:01 - 00:00:13:18
Tom Haederle
Welcome to Advancing Health. 7 in 10 U.S. adults say they receive medical bills they can't afford. In today's podcast, meet two experts who say the system just can't go on like this.

00:00:13:21 - 00:00:36:12
Molly Smith
Hello everyone! My name is Molly Smith. I am the group vice president for public policy here at the American Hospital Association, and I am really pleased to have with me two leaders from Undue Medical Debt, Allison Sesso and Eva Stahl, who are here to talk to us today a little bit about how Undue Medical Debt works, particularly how they work with hospitals.

00:00:36:14 - 00:00:56:28
Molly Smith
And just, you know, their ideas about what we can do around the challenges associated with medical debt, both prevention and solutions, once it occurs. So really excited to have them here with me today. So at this point, I would love to just actually turn it over to you both, Allison and Eva. And please just kind of start by introducing yourselves.

00:00:57:00 - 00:01:26:15
Allison Sesso
Great. So glad to be here. My name again is Allison Sesso. And I serve proudly as the CEO and president of Undue Medical Debt. And we really have one mission. We're a nonprofit that relieves medical debt, and our mission is to end medical debt. And we do that both by working directly with hospitals. We've been able to work with over 70 unique systems, representing about 300 plus hospitals across the country buying medical debt.

00:01:26:17 - 00:01:58:12
Allison Sesso
This is the bad debt portfolios that sit on their books that we understand a lot of hospitals have written off and think that they're not creating any harm for patients. But what we've learned is that by getting rid of that debt, we are actually relieving a burden from people. Not only does it live in their like mental health space in their heads, but it actually is, something financially that is hurting them as well because they're always thinking about what they can be doing, how else they could be kept figuring out how to pay that bill, and it creates a sense of overwhelm for them.

00:01:58:12 - 00:02:21:10
Allison Sesso
So our mission really is to get rid of those debts for our patients. We've gotten rid of $27 billion of medical debt for over 15 million patients at this point. And that work just keeps growing. We work like a for profit debt buyer, except that when we get our hands on those debts, we relieve them. We never ever collect a single penny from a patient.

00:02:21:10 - 00:02:41:08
Allison Sesso
We would never do that. We focus on people that are 400% of poverty below, or if a debt or 5% or more of their income. And the reason why I brought Eva here today is because we understand that fundamentally, what we're doing is not solving the problem of medical debt in its creation in the first place. And that is something we really like to do.

00:02:41:09 - 00:02:54:03
Molly Smith
We like to think about how we can be bolder and bigger in terms of making sure that our work absolutely is obsolete one day by solving this problem more fundamentally. And so I'll let Eva introduce herself.

00:02:54:05 - 00:03:16:21
Eva Stahl
Sure. And I actually was brought on to Undue Medical Debt about three years ago. And I think it is it was really anchored in Allison's background in social services, but really a longer term vision for not just being a Band-Aid for people in the moment, but really thinking about how we could influence policy upstream and mitigate the harms of medical debt.

00:03:16:24 - 00:03:53:14
Eva Stahl
So with that, we really focus on listening to our patients. So we hear from patients. So Allison mentioned that we've abolished debt for over 15 million individuals and we hear from them. So we actually have an anthropologist that works for us and helps to listen to their stories and record them and find themes. So those are messages that we can take back both to our hospital partners, but also to policymakers that are interested in learning about that experience and really the most harmful parts of medical debt, which include mental health harm and stress, but also delaying and deferring and forgoing care.

00:03:53:16 - 00:04:03:16
Eva Stahl
And being constantly worried about their financial well-being. So, and that's largely due to, you know, very high out-of-pocket costs and coverage that is not really serving as coverage for them.

00:04:03:23 - 00:04:14:05
Molly Smith
So maybe we could start at the beginning, if you will, which is, maybe helping us understand a little bit about the situation that many Americans are facing with medical debt.

00:04:14:07 - 00:04:27:14
Molly Smith
You just mentioned some pretty, kind of eye popping numbers that you've helped 15 million people relieve $27 billion worth of debt. But what does medical debt look like in the U.S. right now?

00:04:27:17 - 00:04:37:20
Allison Sesso
Yeah. So it is a substantial problem. I think it's something like 1 in 4 Americans have medical debt of some form, how it shows up for them, you know, is it on a credit card?

00:04:37:20 - 00:05:03:21
Allison Sesso
Is it money borrowed from a friend or family? Is it sitting with the hospitals, etc., being written off? It's all bundled together and there unfortunately aren't really great numbers as to specifics. But KFF has put some numbers out that it's at least $220 billion problem. We obviously know that we're going in the wrong direction on this issue as well, because coverage really is the best solution to protecting people from medical debt.

00:05:03:21 - 00:05:23:24
Allison Sesso
And we have made some policy decisions in Washington, to your point, that have really undermined, I think, the coverage situation for way too many people and we've seen, you know, that those numbers just starting to unravel right now. So really, I think the problem is it's large to begin with, and it's only about to get worse.

00:05:23:27 - 00:05:49:06
Allison Sesso
And it's a very, very common American problem, which is why I think that there's so much conversation around this affordability question. And I think the problem for a lot of the people that we help and we hear this from constituents all the time, is they want to pay their bills. But the gap between what they're expected to pay and what they actually have in resources is just way too wide and wider.

00:05:49:12 - 00:06:16:00
Allison Sesso
So while coverage is the best answer, good coverage that actually doesn't rely on them to pay out-of-pocket costs that they no way they can afford, is really an important, I think, element of this. And what we're seeing is a really big and surging under-insurance problem. And now I think increasingly we're going to see, more people with no insurance at all as well, because premiums are just way too high and out of reach for people.

00:06:16:02 - 00:06:39:13
Molly Smith
So this issue of coverage being the fundamental kind of, base protection against medical debt. And yet, you know, we're at a point in time where, you know, around 90% or so of Americans have health care coverage. So I'm wondering if you could just be a little more specific about where it is that we're really falling short in terms of that coverage?

00:06:39:13 - 00:06:48:03
Molly Smith
So, you know, the 10% who are uninsured, but then you just used this term, underinsured, and maybe you could just provide a little bit more color about what that looks like.

00:06:48:05 - 00:07:04:06
Eva Stahl
When we talk about under insurance, that's pretty much saying that somebody has insurance, but it's not really protecting them, right? So it feels useless, right. But really, I think from a granular perspective, it means that people are spending more than 10% of their income on health care expenses.

00:07:04:06 - 00:07:30:15
Eva Stahl
Right? So that tends to be the more formal definition. But increasingly, when people walk through the door of a hospital or emergency room, rather, and they have a $5,000 deductible, but their earnings in no way allow them to pay or meet that deductible, right? They're under-insured because their insurance is actually not serving them or protecting them. And so increasingly, as we see increased rates and take up around high deductible health plans, right,

00:07:30:15 - 00:07:58:12
Eva Stahl
and a move certainly in the proposed rule that came out this spring to increase access to catastrophic coverage with very high out-of-pocket costs, it means that people at low incomes, low and middle incomes that don't have that kind of cash on hand will be able to use their health insurance without accruing medical debt. So we think that that is just a move in the wrong direction, because hospitals then end up having to absorb those losses.

00:07:58:15 - 00:08:12:05
Molly Smith
You know, and I think that even some of the latest data from the federal government regarding enrollment in the marketplace plans for 2026 shows double digit increase in people who are enrolled in bronze plans, which

00:08:12:08 - 00:08:32:07
Molly Smith
in theory, are supposed to protect from catastrophic costs. But I think what we're hearing is that even those, you know, really high deductibles, coinsurance, you know, that comes along with some of those plans people just simply can't afford. So let's play this out. So an individual in your scenario comes to the hospital. They let's say they have one of these high deductible health plans.

00:08:32:07 - 00:08:57:06
Molly Smith
They're facing a $5,000 kind of, out of pocket, contribution towards their care. They can't they can't pay that bill. You know, kind of goes through the process. And now it's kind of qualifies as medical debt. You mentioned that you work with hospitals to help alleviate some of this medical debt where you can. Can you tell me a little bit more about what that process looks like to work with a hospital on this?

00:08:57:08 - 00:09:15:29
Allison Sesso
It's relatively similar to working with with an outsource collections entity, if you will, right. Usually it's after that you've done that already. So there's been attempts to collect, a recognition that there's not going to be an ability to collect, because again, the difference between what the person actually owes and what they have is pretty vast.

00:09:16:01 - 00:09:33:04
Allison Sesso
These are not people have been put on payment plans, but people who are really just not able to pay and aren't, aren't paying anything towards the bill. So that goes into the bad debt file that's been written off by the hospital, written down to zero. We go ahead and we take a look back. We go back seven years.

00:09:33:07 - 00:09:55:10
Allison Sesso
And we do an analysis sort of like presumptive eligibility, like this very similar approach. We identify based on income everyone that is 400% of poverty or below. It is by far the vast majority of the people in the file. If someone said is particularly large and it's 5% or more of their income and they're above that threshold, we will also flag them.

00:09:55:13 - 00:10:14:23
Allison Sesso
We will price the debt. The debt is priced similar to the market. So because these people are unable to pay, you know, in the for-profit debt buying market, the chances of you collecting is very low. So the pricing is very low. Working with us is not going to be a windfall for hospitals. They do get some revenue and that's great.

00:10:14:25 - 00:10:40:11
Allison Sesso
But it's pennies on the dollar. So we do pay pennies on the dollar for these debts. The younger the debt, the more we'll pay. But you know, in general, $1 of, of a donation to us, is $100 on average of medical debt. And, and this is my favorite, most important part is we notify all those patients that the debts have been relieved, and that they then feel confident and comfortable going back to the doctor to getting that, that care that they need.

00:10:40:11 - 00:10:58:19
Allison Sesso
Because we do know that that really is a big barrier to care, which really undermines sort of the purpose of the health care system and the hospitals in the first place. And I think that that's one of the main benefits that hospitals see in working with us is the fact that this removes that barrier to care that they want to see removed.

00:10:58:24 - 00:11:06:21
Molly Smith
There's so many things there that I want to circle back to. But before we go there, you talked about every dollar that you spend. Whose dollars are these?

00:11:06:24 - 00:11:30:15
Allison Sesso
Yeah. So it's a great combination. We have so many donors. There's churches that love working with us that we can focus the debt relief to their communities. It's one of the things that our, proprietary debt engine, as we call it, does, is it actually puts every dollar to a specific patient where they are so that we can restrict their donation, if you will, to the patients living in a specific community, etc..

00:11:30:18 - 00:11:51:20
Allison Sesso
We do get increasingly governments. It's probably to nobody's surprised that governments are increasingly knocking on our door and asking us to work with us. We have about almost 30 government contracts we've completed to date, or in the midst of. And Eva, maybe this is a great time to bring you in to talk a little bit about, these conversations that you are having with policymakers.

00:11:51:22 - 00:11:59:26
Molly Smith
What are some of the things that you are seeing, whether it's state or federal officials thinking about in terms of trying to mitigate medical debt?

00:11:59:29 - 00:12:10:00
Eva Stahl
Sure. So I would say that we really see it as a window of opportunity to talk more broadly around some of the more challenging issues that these patients just along their medical debt journey.

00:12:10:02 - 00:12:48:21
Eva Stahl
And most notably, I would say that you've seen a lot of activity in states, particularly over the last 2 to 3 years. So these are things like, suing people or applying leans or wage garnishment. And that often it comes to top of mind for legislatures. And there is a lot of bipartisan agreement, in that area of extraordinary collection actions, there are other, efforts to, put up guardrails around financial assistance policies, whether that's, applying some thresholds around who should get financial assistance, when they should get financial assistance and when they should be screened for financial assistance or move to debt collection.

00:12:48:24 - 00:13:15:01
Eva Stahl
And then I think we've seen not as much work in the area of health insurance coverage, which we'd like to see more. Unfortunately, a lot of steps are being taken to erode coverage, which will lead to more medical debt. So that of course is frustrating. And then I think, you know, you can't not talk about what is the, you know, most common talking point right now, which is around price transparency, which we're seeing a lot of efforts pop up in various states out of people.

00:13:15:01 - 00:13:26:24
Allison Sesso
I think, you know, states feeling like they want to take action on the cost of health care. And seeing that as a silver bullet, which we don't believe that it is, but it certainly is where there's some interest in movement.

00:13:26:27 - 00:13:37:16
Molly Smith
Yeah. And I think, you know, this point of financial assistance, clearly that is such an important function and benefit that hospitals when they can provide it to their patients, do.

00:13:37:16 - 00:14:02:15
Molly Smith
But I think that the one of the points that you're sort of alluding to is that it can't be the solution to medical debt, not least of which because there just simply isn't enough financial assistance in the country that could be made available to close some of these coverage gaps. You know, Eva, I don't know if you want to talk at all about some of the things you guys have thought about in terms of ways that we could improve coverage to try to prevent this upstream.

00:14:02:17 - 00:14:21:15
Eva Stahl
I mean, I would just say and reiterate, Molly, what you just said, which is financial assistance is not health coverage. And so we need to stop treating it like that because it's an important backstop. I think that, you know, momentum toward something that would really help people on the ground that are experiencing medical debt is to have access to affordable, comprehensive health coverage.

00:14:21:18 - 00:14:45:04
Eva Stahl
So I think for us that we're open to whatever structure that might look like. But where the people that we represent and what's important to us is that any approach or policy or cost containment activity or whatever the spectrum of portfolio of options is that it actually is having a meaningful impact on people's out-of-pocket costs without sacrificing access.

00:14:45:07 - 00:15:06:23
Molly Smith
Yeah. So complicated is definitely, unfortunately, a word that we can use to describe many aspects of the health care system. I do want to ask you really quickly a little bit about presumptive eligibility for financial assistance, because I think that is something that you've done a lot of thinking about. So, could you tell me a little bit about your work around presumptive eligibility and what you think hospital should be thinking about in that space?

00:15:06:26 - 00:15:44:12
Eva Stahl
Presumptive eligibility for financial assistance, not to be confused with presumptive eligibility for Medicaid, is really just screening people much earlier in the medical billing workflow. So closer toward the point of service, rather than sifting through people that might be moving toward debt collection. So by screening people early, then you have the opportunity to, estimate their income or use other sources to identify their income and then decide if they are eligible for your financial assistance program and swiftly move them into financial assistance, reducing administrative burden for yourself downstream.

00:15:44:14 - 00:16:17:04
Eva Stahl
Right. And also offering a contactless and paperless option for patients. So we also know from the deep work we've done around financial assistance, that many people never even fill out the financial assistance application. They feel overwhelmed by it, or they're under duress because they're in the middle of a health episode. So this tool really being introduced early on in the workflow, allows for patients to swiftly move into those categories and before the first bill is dropped. And then they can be notified that they have access to free care or discounted care.

00:16:17:06 - 00:16:18:26
Molly Smith
Regarding presumptive eligibility,

00:16:18:26 - 00:16:39:23
Molly Smith
also, I think for our hospital listeners out there who might be interested in exploring these programs, I do want to note that both the AHA and I'm aware Undue Medical have resources available, including things like case studies where you could learn more about what it takes to implement a presumptive eligibility program. Eva, Allison, thank you so much for your time today.

00:16:39:26 - 00:16:54:19
Molly Smith
I really appreciate all of the information you just provided. That really important, really important work, just been very eye opening. Also, to really get to work with your team and learn from you and these various discussions about what the solutions are here. So thank you.

00:16:54:21 - 00:17:03:02
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.