Advancing Health Podcast

00:00:00:27 - 00:00:28:25
Tom Haederle
Welcome to Advancing Health. Changes and challenges. That pretty well sums up the state of American health care in the last quarter of 2025. In this month's Leadership Dialog podcast hosted by Tina Freese Decker, president and CEO of Corewell Health and the 2025 Board Chair of the American Hospital Association, we get a briefing from Stacey Hughes, AHA’s executive vice president of government relations and public policy, on the outlook for ending the government shutdown that began October 1st...

00:00:28:27 - 00:00:40:19
Tom Haederle
insights on what's expected on the legislative front for the remainder of the year...and an update on a host of issues important to the field.

00:00:40:22 - 00:00:59:26
Tina Freese Decker
Thank you, everyone for joining us today. I'm Tina Freese Decker, president and CEO of Corewell Health and the board chair for the American Hospital Association. I did my first leadership dialogue with Stacey Hughes, and there have been so many new changes and challenges, opportunities, developments since January that I felt that it was the right time to bring Stacey back for an update.

00:00:59:29 - 00:01:21:17
Tina Freese Decker
I can't wait to hear your insights, Stacey, on all that is playing out in Washington, D.C. and how the American Hospital Association is continuing to advance this work on behalf of our field. So, you and I have had lots of conversations over the past year. I am so grateful for your expertise. And just understanding what it feels like, what it's about, and what we should be doing as we go forward.

00:01:21:19 - 00:01:35:22
Tina Freese Decker
So let's start with what is top of mind for many of us, the current federal government shutdown. Can you give us a sense of how this government shutdown is the same or different from previous times? What do you think's going to happen?

00:01:35:24 - 00:01:55:22
Stacey Hughes
I'm so grateful that you invited me, and it's so fun to talk to you always and appreciate your leadership through all these different this this year for sure and heading into Q4, which is nice, but still a lot of challenges. So yeah, to your point, the shutdown, what is different? One, it's a full shutdown. The last shutdown in 2018 and 19, Tina, was a partial. And HHS was funded.

00:01:55:23 - 00:02:19:23
Stacey Hughes
Department of Defense was funded. This is a 100% shutdown of full government. And so that's really different.  I think second, one of the reasons a government shutdown, which I know we'll talk more about, is the concern Democrats have and want to use this opportunity to have leverage to get Republicans to support extending the EPTCs. I say that's a second difference in that this is going to play out in real time.

00:02:19:24 - 00:02:39:18
Stacey Hughes
You know, as we're speaking now and 21 days from now during this shutdown, or maybe it reopens, people are going to get their notices about their premium subsidies and those that have gone away during this time. So you've got sort of this dramatic dynamic that Democrats are kind of banking on so that people, everyday Americans, understand what a shutdown is.

00:02:39:18 - 00:02:57:13
Stacey Hughes
So for those two reasons it's very different. I will say in a lot of people ask me, how will it end? And, really nobody knows. I'll just add a few more facts about kind of this particular shutdown. You know, in terms of where we are, they've got about five payroll periods that are going to be coming up that are important.

00:02:57:13 - 00:03:20:17
Stacey Hughes
One I think it's been highly reported, which is the active military paycheck stops on October 15th. The second full government federal government employee paychecks stops between the 20th and 31st. Senate employees stop the 20th. You know, go down the line.  October 31st, the House employees stop receiving their paycheck. So that's kind of a an important mash up right there in terms of will that be impactful?

00:03:20:24 - 00:03:40:25
Stacey Hughes
They are moving money around to try to protect the WIC program. That funding is also expired. So there could be some action forcing events. I will say the president is going to be in Israel this weekend, rightly so, for an important ceasefire. And that's going to really occupy the news cycle till Tuesday. So I think we get back here Tuesday and we're kind of still stymied, Tina.

00:03:40:28 - 00:03:53:13
Stacey Hughes
So I don't know how this ends, but both sides feel like they're doing well. And I think frankly starting Tuesday it's a test of political stamina. You know, which party can withstand the things we just talked about.

00:03:53:15 - 00:03:56:24
Tina Freese Decker
Right. And it's challenging because all of those impact people.

00:03:56:26 - 00:03:57:09
Stacey Hughes
That's right.

00:03:57:16 - 00:04:01:25
Tina Freese Decker
The people, the federal workers. So on. And so what's a way to get unstuck from that?

00:04:02:01 - 00:04:27:08
Stacey Hughes
For sure. And I think for us, you know, because it is the Department of HHS, we also have some things that are affecting rural patients, in particular the telehealth pieces. As you know, that program expired September 30th when the CR was unsuccessful. And so did hospital at home. And, you know, that does affect real lives. According to CMS, there are about 1200 patients that were in the system during that month, between about 419 hospitals.

00:04:27:08 - 00:04:39:26
Stacey Hughes
And those patients, almost all had to be moved under the fact that the program was no longer authorized. So we feel it a little bit more than we normally would acutely. And with some of these programs not on the mandatory side, but it is real life implications.

00:04:39:28 - 00:04:56:11
Tina Freese Decker
True. So you mentioned this before. One of the sticking points is the enhanced premium tax credits, which, you know, expire at the end of the year. Why is extending those tax credits so important for hospitals and our members people? And what do you think is going to happen with those?

00:04:56:13 - 00:05:23:01
Stacey Hughes
Yeah. Boy, that's there's a great question. A couple things. Certainly we just came off the OBBA debate, right? And that already includes scoring estimates that up to 10 million people will be displaced from coverage over the next ten years. If you were to lose the enhanced subsidies which were part of President Biden's Inflation Reduction Act, as well as his American Rescue Plan, if those were to expire, you would see at least another 5 million individuals that would go from insured to uninsured status.

00:05:23:03 - 00:05:46:03
Stacey Hughes
But in addition, you know, under the four years of these enhanced subsidies, about 10 million people have come on the rolls and it's a substantial part of their ability to afford their care. 19 or 20 million people will see some reduction in their actual subsidy to pay for their premiums. And even if you get some of it, some people say a $12 differential to be the choice of staying covered or not covered.

00:05:46:06 - 00:06:06:19
Stacey Hughes
So that's number one was to create more people who are uninsured that would come through our doors. But importantly, also in terms of our own fiscal health, you know, we would estimate that's about a $28 billion loss of our ability to continue to provide services over the next ten years. So it's very real to hospitals in terms of what it would mean to our overall day-to-day ability to serve patients.

00:06:06:21 - 00:06:31:29
Tina Freese Decker
Right. And it is impacting in communities where we have payers offering the products and some not offering the products. So it's a very dynamic time happening on the ground. But then also what will happen in D.C. So thanks for that update. There are some more things from a comprehensive health care package that come together, such as structural changes to how pharmacy benefit managers operate or changes to Medicare Advantage.

00:06:32:02 - 00:06:36:24
Tina Freese Decker
What do you think is going to be put together in that sort of comprehensive package?

00:06:36:27 - 00:06:56:13
Stacey Hughes
Let's talk about the health part first. I guess I'll say that's where the PBM reform really does lie, and there's probably a combination of MA with regulatory and Hill. But right now is so acrimonious, Tina, I think while there was a lot of bipartisan support for both of those, I think that until they resolve this issue, it is going to be very difficult to restart those bipartisan conversations.

00:06:56:13 - 00:07:19:13
Stacey Hughes
And frankly, the longer this goes on, I think the more it will, you know, spoil the waters for those kind of conversations. In terms of, you know, is there an opportunity in December, you know, we would hope so. As you know, there was some significant proposals, ones that you mentioned, that were left on the cutting room floor last December when we had the health care, you know, end of year package and some other priorities on community health centers in May, as you mentioned.

00:07:19:13 - 00:07:43:15
Stacey Hughes
And so I think there's an opportunity, but it may actually bleed into next year. It's going to be solely dependent on the appropriations process. And once we open the government back up and there's a bipartisan solution for that, the question is how long, right? Is it a bipartisan solution just till next March? And normally our priorities and those types of priorities tend to travel just the length of the amount of time of the continuing resolution.

00:07:43:15 - 00:07:58:07
Stacey Hughes
So I'm not so sure when we'll be at that point of having more permanent PBM reform or MA reform. But the good news is I think the commitment to those are high. So we'll see if they revisit it. But I think they'll pick up where they left off once we can get the appropriations settled.

00:07:58:09 - 00:08:17:15
Tina Freese Decker
Okay. So you talked a little bit about December. I know the American Hospital Association has a full end of the year list of priority items. What are some of those other key issues that your team is tracking? And, you know, immigration, H-1B visa exemptions, maybe some of those. What are you thinking about that that we should be mindful of?

00:08:17:22 - 00:08:41:12
Stacey Hughes
There's no shortage of issues and it's real diverse. You know, I'll start with immigration. You know, I think everyone saw tension around the president's proclamation a couple weeks ago around adding a $100,000 fee going forward, the companies who are sponsoring H-1B visa applicants. And so on that one, we're looking and working very hard with the administration to try to seek exemption for health care workers. And that would be every clinical aspect, right?

00:08:41:12 - 00:09:02:26
Stacey Hughes
It would be lab technicians, physicians, nurses. You know, we are probably only 4.2% or 5% of the total of H-1B visas. So we're hopeful with the demonstrated workforce shortages that exist that we can have a good chance of leaning on the administration to be thoughtful about the exemption process for health care workers, that's number one. Tariffs,

00:09:02:26 - 00:09:29:05
Stacey Hughes
I think you mentioned to me that continues to be an area of concern. You know, we've engaged very significantly with some of the other stakeholders, obviously  AbbeMed and some of the other organizations. But for us, you know, a significant part of our PPE, which the president has now threatened a tariff on. Medical devices, which he's just renewed, a threat that an investigation about foreign and national security around tariffs, all of those really impact our domestic supply chain, our ability to access products.

00:09:29:05 - 00:09:48:07
Stacey Hughes
So those two are, you know, I wouldn't say left field, but they continue to occupy a lot of our bandwidth in trying to get some remedies for those two issues. Not to mention we're in that statutory rulemaking season. You know, we're in the part of this of the rule-making process. Our comments have been submitted but the government shut down. But the statutory rules still need to be addressed and worked on.

00:09:48:07 - 00:10:06:27
Stacey Hughes
This is when we spend our time with all the agency leaders, both political and career, and make our case coming off of our submitted comments and the field's comments. So a lot of challenges there, including some proposals on price transparency, obviously 340B, 340B obviously separate from the rule. There's the rebate model.

00:10:06:27 - 00:10:13:05
Stacey Hughes
So a lot is going to occupy our time and trying to influence these next 2 or 3 months for the year , Tina.

00:10:13:07 - 00:10:36:06
Tina Freese Decker
So, Stacy, my final question for you is, you know, you've been in this field for a long time. You know the players, you know the process. What advice can you give to our members as we're hearing about it, navigating through it, trying to be active with our government relations teams and legislative leaders and administrative leaders. What advice can you give to us that we should be doing?

00:10:36:09 - 00:10:53:02
Stacey Hughes
I just think it's engage. Engage, engage, engage. And I think that, you know, while it's a new, you know, group of single party leaders that are in town, I think everyone appreciates being able to hear our story and telling it well and telling it well with data, with real life consequences. And so I think just don't take your foot off the pedal on that.

00:10:53:02 - 00:11:09:12
Stacey Hughes
You know, the whole field really rose up in a way to tell Congress and the executive branch about the impact of the Medicaid cuts that were being considered. And I think we've got to continue to do that as we try to mitigate some of these issues and also make sure we're telling our story where we're innovating. Where we're creating efficiencies.

00:11:09:15 - 00:11:19:11
Stacey Hughes
What we're doing that is helpful in chronic disease. You know, we have a positive story to tell as well. And I think you'll find some, some people are really interested in what we can be doing to help improve health care.

00:11:19:14 - 00:11:38:26
Tina Freese Decker
I think that's a great reminder, Stacy. Of all the positive stories that we have, I was just rounding in one of our hospitals and I'm so impressed by what is happening. There's so many things that are happening to improve patient care that many people, including our legislative leaders, need to understand and recognize and know that they impact that our ability to provide that.

00:11:38:29 - 00:11:51:16
Tina Freese Decker
So thank you so much, Stacy, for your time today, for all of the work you and your team do on behalf of our field. And thank you so much for finding the time to listen to us. We'll be back next month for another Leadership Dialog conversation.

00:11:51:18 - 00:11:53:18
Stacey Hughes
Thank you Tina, appreciate your time.

00:11:53:21 - 00:12:02:03
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.

00:00:01:02 - 00:00:23:18
Tom Haederle
Welcome to Advancing Health. The impact of philanthropy can be a difference maker for a hospital or health system's mission of great patient care. In this episode of a four part podcast series, two experts from a leading health system share how philanthropy empowers clinical excellence and improves patient outcomes.

00:00:23:21 - 00:00:50:19
Sue Ellen Wagner
Hi everyone. Welcome to Advancing Health. I'm Sue Ellen Wagner, vice president of trustee engagement and strategy with the American Hospital Association. I'm happy to be joined by the leadership of Inova Health today. I'm happy to introduce Toni Ardabell, chief of clinical enterprise operations at Inova Health System and Sage Bolte, chief philanthropy officer and president of the Inova Health Foundation.

00:00:50:21 - 00:01:14:14
Sue Ellen Wagner
My first question: philanthropy can have a huge impact in helping a hospital or a health system achieve its mission and caring for our patients of our community while also supporting our operations. Can you talk about the role that philanthropy is playing right now on health care, and can you also talk about some of that broad, high level role that philanthropy is playing in Inova?

00:01:14:16 - 00:01:16:17
Sue Ellen Wagner
Toni, let's start with you.

00:01:16:19 - 00:01:52:01
Toni Ardabell
Philanthropy is extremely important to health care, and what it helps us do is provide services that we could not provide otherwise. And at Inova in particular, it works with our mission and it works with our priorities. We have three year priorities and annual priorities, and Sage makes sure that the fundraising is actually meeting those priorities. It helps us develop our service lines and our service lines, our specialty, for instance, neurosciences, pediatrics.

00:01:52:04 - 00:02:07:13
Toni Ardabell
And it really helps program development in those service lines so that we can offer extremely high acuity care and care that the community just wouldn't have without the help of philanthropy.

00:02:07:15 - 00:02:10:05
Sue Ellen Wagner
Thanks, Toni. Sage?

00:02:10:07 - 00:02:37:26
Sage Bolte, Ph.D.
Yeah. I think, you know, philanthropy across the nation right now is critical. We know that we are facing headwinds that some of us have really never faced before, and the opportunity for philanthropy to come forward - our community to come forward and support their local health system or hospital is critical. Right now, philanthropy is going to help keep the lights on for some health systems.

00:02:37:28 - 00:03:03:28
Sage Bolte, Ph.D.
Philanthropy in many systems are going to help extend care to areas where care might be minimized currently. The other aspect that philanthropy helps, at least at Inova, it really helps accelerate the things that we want to do but may not be able to do today, tomorrow, or five years from now, but with the support of philanthropy, allows us to accelerate on the work that we're committed to doing.

00:03:04:00 - 00:03:24:19
Sage Bolte, Ph.D.
The other aspect I think of philanthropy, at least at Inova, is, as Tony alluded, philanthropy follows strategy. And that's really critical because we don't want philanthropy starting and stopping. We don't want it to start something that then can't be sustained. We really want the investment of our community to be a legacy of the investment of the community.

00:03:24:19 - 00:03:42:28
Sage Bolte, Ph.D.
And that's really where I think currently and in the past and the future, philanthropy has such an opportunity to make an impact on the health of our communities and really connect people's hearts to the health and health outcomes of our community.

00:03:43:00 - 00:04:03:10
Sue Ellen Wagner
Thank you both. I think it's really important that connection to community because that really connects to the mission. Next question, I'm sure you've heard a lot about this before. Why is cancer and heart getting all of the support and the dollars? How do you begin to approach answering that question when folks ask you that from the community?

00:04:03:12 - 00:04:40:06
Toni Ardabell
They're getting all of the dollars because many people use those services. Many families have people who've had heart issues or who've had cancer, and so people's hearts are already tied to those two service lines. The other thing about those service lines is they are sort of image makers for health care systems. People think if you can do heart transplants or you can do the most sophisticated oncology like Car-T, then everything you do must be really good

00:04:40:06 - 00:05:07:01
Toni Ardabell
and you have a very high level of care in your organization. I also think a certain type of physician is attracted to those two specialties, and they are not shy about going out and working for philanthropic dollars. They will work with the foundation, they will show up at events. They will go to national meetings. And so they're very involved in that fundraising as well.

00:05:07:01 - 00:05:33:12
Toni Ardabell
It helps support their research. It helps support, special programs like We Have a Wonderful Life with cancer program that was started by philanthropy and continues to get supported by not 100%, but does get supported by it every year. And so they actually are two service lines that understand the importance of philanthropy to what they're able to do for their patients.

00:05:33:15 - 00:05:39:00
Sue Ellen Wagner
Yeah, I think the physician point is a really critical one that most of us probably don't think of.

00:05:39:01 - 00:06:06:23
Sage Bolte, Ph.D.
We have to remember that more than 85% of philanthropic support comes from grateful patients. And that is an important statistic, because when you think about the gratitude of patients and where the highest volume of patients live, it often is in those two areas in cancer and in heart. And beyond that, the relationships that they establish - because these are not short term

00:06:06:26 - 00:06:40:23
Sage Bolte, Ph.D.
you know, two visit relationships - these are relationships that they build over months, over years, sometimes over decades. And so the gratitude that these patients feel and their families feel for the care in which they receive, it shows up in the way that they provide philanthropic dollars. And to Tony's point, because many of these physicians, nurses, APPs, social workers like myself, I'm an oncology social worker, went into the field with the intention of those longer term relationships.

00:06:40:28 - 00:07:00:18
Sage Bolte, Ph.D.
I think they understand that, and they are capable and more willing to connect when they hear, "Thank you so much. Thank you for saving my mom's life. What can I do for you?" They're not shy to say, would you be willing to talk to one of my colleagues on the foundation team, right? Would you tell your story?

00:07:00:23 - 00:07:29:23
Sage Bolte, Ph.D.
Would you be willing to support the research that saved your mom's life, right? Those kinds of conversations they don't shy away from. The other piece of that, though, that I think it took me a while to understand, is when cancer is supported, at least at Inova, when cancer is supported, our musculoskeletal team is supported because what happens when a philanthropic dollar comes is it does offset the operational investment.

00:07:29:23 - 00:08:00:23
Sage Bolte, Ph.D.
So it frees up additional operational investments to be able to support something that might not have had philanthropic support or might not have had the operational dollars. And that's something that Tony and myself and the rest of cabinet are really working on creating that culture and that mindset of: we all win when a philanthropic gift comes in. We all win when a philanthropic gift comes in to any service line because it does support something that otherwise would have either had operational dollar support or wouldn't have happened.

00:08:00:23 - 00:08:04:25
Sage Bolte, Ph.D.
And would have waited for, you know, months to years. So we all win.

00:08:04:27 - 00:08:30:23
Sue Ellen Wagner
Yeah, very important points. Thanks so much. And that leads to my next question. You know, when people think of philanthropy and donations, they tend to focus on those large donors from the community. But there's really, you know, so much more than that. Can you both talk a little bit about the successes that you've had when creating philanthropic initiatives, and then the balanced donor audience?

00:08:30:26 - 00:08:41:10
Sue Ellen Wagner
We talked a little bit about that. You both did with the physicians, and then, you know, the community members who have that heart and cancer connection. But can you elaborate a little bit more on that?

00:08:41:12 - 00:09:14:28
Sage Bolte, Ph.D.
You know, again, I think what's really important in order to be successful in fundraising for a health system is that you have clear focus on your mission and you have clear alignment with the strategic priorities of the organization. That is critical. And when you do that, and when everyone in leadership is able to articulate what your mission is, what your strategic priorities are, and where the philanthropic alignment is with those strategic priorities, you're able to tell a really powerful story to the community.

00:09:15:00 - 00:09:41:24
Sage Bolte, Ph.D.
And that story in many what we call segments in philanthropy is critical. So, yes, a lot of health care right now is winning with the larger donors who are coming and giving substantial what we would call transformational gifts, right? Multimillion dollar gifts. And those are truly transformational and life giving to an organization. And there's only so many of those.

00:09:41:24 - 00:10:07:10
Sage Bolte, Ph.D.
So to be successful in philanthropy, you really have to look at a wider scope of donor opportunities. So those we call those mid-level giving donors, those annual donors, the people that are willing to give you $100 a month or $100 a year, those opportunities to keep them connected, that $100 is so valuable to them, and they're giving it to you.

00:10:07:13 - 00:10:14:25
Sage Bolte, Ph.D.
And our opportunity as an organization is to ensure that they feel that $100 matters.

00:10:14:28 - 00:10:46:02
Toni Ardabell
So what I would say from an operations perspective, I've learned over the years how important it is to take every gift seriously. I would also say we need to role model giving to our own organizations. If we believe in the work we're doing as executives, then we need to step up and donate ourselves. I also know, I tell Sage this, I have the experience of one family

00:10:46:05 - 00:11:08:13
Toni Ardabell
when I was in charge of women's and children's services, sent me a check out of the clear blue sky because their baby was in the NICU, had never really been involved with Inova. It was maybe a $10,000 check and I called them to thank them and asked if they would like to be recognized in some way. They're like, no, no, we don't want to get involved,

00:11:08:13 - 00:11:34:18
Toni Ardabell
we just want to give you money. And every year that increased. For the 6 or 7 years I was in that job, the check kept getting more every year. And I've learned it's important to let people give to where their hearts are. And if you've been a patient of ours, maybe it was the NICU, or maybe it was the pediatric floor or maybe it was the cardiac ICU.

00:11:34:21 - 00:11:54:21
Toni Ardabell
Whatever you give is meaningful. And folks need to know that their giving makes a difference. And when you believe that and your heart's in it already, then you're willing to give the larger and larger gifts that you can afford to give and know that it's appreciated.

00:11:54:23 - 00:12:21:26
Sue Ellen Wagner
Thank you both. A lot of really great important points. I really like the fact that no matter of the dollar amount of the gifts that you need to make everyone feel important, that they're contributing to their local hospital. So I think that's a really important takeaway. And that leads to my last question. Do you both want to share any final thoughts with our members on the philanthropy strategy that they should be looking at today?

00:12:21:28 - 00:12:55:03
Toni Ardabell
Hire a Sage Bolte! No, actually your leader is very important. It helps if you're a clinical leader in health care for fundraising because Sage understands the organization and what we do here in a way that a non-clinical leader may not understand. There are good non-clinical leaders in philanthropy but I think it is even better for the team to have a clinical leader there.

00:12:55:06 - 00:13:04:19
Toni Ardabell
And there needs to be total integration between philanthropy, strategy and operations. I think that's the secret.

00:13:04:22 - 00:13:44:13
Sage Bolte, Ph.D.
Where health systems have an opportunity is just to reinforce what Tony said. Your chief philanthropy officer should be at the table with the executives, issued a report to the CEO. And I'm fairly biased on that because I've seen the success that can be had when your CEO is highly integrated into the philanthropic strategy and opportunities. When you see your CEO giving others gifts, creating a culture of philanthropy, not just externally, where people around the health system have the opportunity to give, but those inside the health system, those who are caring for patients. When they give

00:13:44:17 - 00:14:17:15
Sage Bolte, Ph.D.
they also are, more connected to how the gifts have impact. They're more connected to the work of philanthropy, and they're more willing to tell their own story of gratitude, of where they've had impact. So giving, as Tony said, at the highest level, down to our frontline staff. And again, that could be $5 a year. But knowing that they're giving to the organization,  that culture of philanthropy, of both giving but also connecting people to the opportunity to give is really, really important.

00:14:17:18 - 00:14:35:26
Sue Ellen Wagner
Toni and Sage, thank you so much for joining me on this podcast today to discuss the impacts that philanthropy has had on your community and your employees. We really can't wait to hear what's next for Inova and appreciate all that you're doing for your community.

00:14:35:29 - 00:14:44:11
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.

00:00:01:02 - 00:00:29:13
Tom Haederle
Welcome to Advancing Health. October is Breast Cancer Awareness month. Each year more than 300,000 women in the U.S. are diagnosed with breast cancer. And like most cancers, the earlier it's detected, the better the prognosis. In today's podcast, we learn how one hospital has increased the reach of its mammogram screenings by sending a state of the art mobile unit out to communities - making care accessible where people are.

00:00:29:15 - 00:00:45:03
Julia Resnick
Hi, I'm Julia Resnick, senior director of health outcomes and transformation here at the American Hospital Association. I'm really happy to be here today with Dr. Lindsey Fauveau, the medical director of breast surgical oncology at Women's Hospital in Baton Rouge. Lindsey, thank you so much for joining me.

00:00:45:06 - 00:00:46:24
Lindsey Fauveau, M.D.
Thank you for having me.

00:00:46:26 - 00:01:10:04
Julia Resnick
You know, the timing for this really couldn't be better because to all our listeners, I just turned 40. And two days after turning 40, I got a nice message for my health system saying it's time for a mammogram. So what a great opportunity to talk about mammograms and how the important they are for women. Can you start by telling us a little bit about Women's Hospital in the community you serve, and really what the breast cancer landscape looks like in your region?

00:01:10:06 - 00:01:44:25
Lindsey Fauveau, M.D.
Absolutely. Women's Hospital is a woman dedicated, very woman centric hospital located in Baton Rouge. We serve not only the greater Baton Rouge community, but, pretty much statewide. I love as a breast surgeon, we have a really focused, breast centric workplace here. We have dedicated surgeons, as well as medical oncologists and radiation oncologists, who lead to a very wide breadth and depth of expertise when it comes to taking care of not only breast cancer. But because this is a women's hospital

00:01:44:25 - 00:02:13:04
Lindsey Fauveau, M.D.
we also are dedicated to gynecologic cancer and obviously having babies. So premium obstetric care and the thing that I really like to put in the forefront is that our radiologists, our mammography, is the most important to this hospital. They are really skilled. They are supreme with regards to what there is offered in Louisiana. So they're very talented and they catch a lot of things that otherwise wouldn't be noticed

00:02:13:04 - 00:02:14:24
Lindsey Fauveau, M.D.
if you were somewhere else in the state.

00:02:14:26 - 00:02:27:07
Julia Resnick
Amazing. Your community is really lucky to have you. And I know that you're based in a pretty urban area, but serve rural communities. So are you seeing differences in breast cancer rates and treatment between urban and rural communities?

00:02:27:09 - 00:02:55:06
Lindsey Fauveau, M.D.
There is really a great depth of data, not only with regards to the cancer community in Louisiana, but as you well know, there's a lot of barriers to care for access if you are not close to of a comprehensive center like Women's Hospital. So unfortunately, what that does is it leads to an increased incidence of cancers in rural areas as compared to urban areas like Baton Rouge or New Orleans or Lafayette or Shreveport.

00:02:55:06 - 00:03:07:18
Lindsey Fauveau, M.D.
But ultimately, what we're trying to do here at Women's Hospital is to increase access, increase our availability to outlying communities to decrease barriers to care and to lead to better outcomes throughout the state of Louisiana.

00:03:07:21 - 00:03:15:21
Julia Resnick
Wonderful. So I think that transitions us nicely to talking about your mobile mammography program. So can you tell me about the coach and how it came about?

00:03:15:23 - 00:03:43:21
Lindsey Fauveau, M.D.
So the mobile mammography coach started in 1995, actually, really in its inception started out pretty basic. It was ultimately a van that traveled to outlying areas in Louisiana. And back then we did in the 90s, mammography was on, actual like paper. And so it's this big kind of black chart that had your image of your breast on it.

00:03:43:24 - 00:04:12:02
Lindsey Fauveau, M.D.
And they took it in two views. So it was very simplistic. It could be transported, but as we have progressed into digital, that required a transition. So they upgraded to digital mammography in 2005. And so our first coach was born in its inception there, which then led to it opening its arms to see more people, have more availability for the radiologists to read digitally, remotely.

00:04:12:04 - 00:04:39:23
Lindsey Fauveau, M.D.
And so as the technology has increased to our current state, we do 3D mammography on our brand new coach. We're able to give communities who otherwise would have prior availability of updated technology, access to something that's right here in Baton Rouge. And so it's really changed the game and giving the greater community of Louisiana as much of what we have, as if you walked in the door of women's campus.

00:04:39:26 - 00:04:57:16
Julia Resnick
Yeah. And that access piece is just so key because, you know, if your mammogram is not convenient, it will be hard to get people to want to do this. So can you walk me through how the program extends care? Like where do you typically meet patients, and how do your community partners support that?

00:04:57:18 - 00:05:28:10
Lindsey Fauveau, M.D.
So the way that the mammography coach works is that they have dedicated schedules. So if, a particular community or a company or whatever it may be wants to offer this service to their patrons or their church family or, you know, whatever it may be, they reach out to Women's Hospital, they have a dedicated trip. So that helps that community then advertise because you would think that that if you build it, they will come is a pretty transparent thing.

00:05:28:10 - 00:05:46:21
Lindsey Fauveau, M.D.
But no, the world we live in today, if you build it, they might come. So you have to tell them. So we want it to be scheduled so that we have as much people that take advantage as possible. And so there are 15 minute appointments where you are scheduled and it goes through your insurance if you have insurance. There's outreach programs

00:05:46:21 - 00:06:09:06
Lindsey Fauveau, M.D.
if you don't have insurance. But the mammography techs are on the unit. So you are having the same techs that are in the hospital do your mammogram on a scheduled time so you can go at a very predictable time and live your life. And that mammography image digitally goes to our radiologists here at Women's Hospital. And they get real time feedback on if they need additional images.

00:06:09:06 - 00:06:28:15
Lindsey Fauveau, M.D.
And so it's really nice to upgrade the system, have a brand new coach and provide that kind of experience, remotely, which is when you think about it, where we came from, where you're driving around in a van with paper mammography charts that have to then be put up on walls with like, backlighting for them to look at.

00:06:28:15 - 00:06:32:00
Lindsey Fauveau, M.D.
It's just amazing to think where we've come from, where we've started.

00:06:32:03 - 00:06:50:26
Julia Resnick
Yeah, that's a huge upgrade. And getting state of the art medical equipment anywhere and everywhere, is incredible. I wonder how you all manage, like the stigma or reluctance around mammography, because some people are just...there are remaining concerns about if they should do this and why.

00:06:50:29 - 00:07:10:20
Lindsey Fauveau, M.D.
I think that that is something that's very important to touch. In addition to the obvious barriers to care being the fact that you have to either if you're not near a coach, you have to physically go to a hospital, which to some people is not ideal. They also are more acutely aware in the current climate of what am I doing to my body?

00:07:10:20 - 00:07:35:08
Lindsey Fauveau, M.D.
What am I putting in my body? What is this going to do in the long run? And I think that's very important. But I think that there's a lot of disinformation and misinformation on the internet that can lead you to not doing something that actually the benefit outweighs the risk. So with a singular mammogram, that equates to three months worth of your exposure to background energy of the Earth.

00:07:35:11 - 00:07:57:06
Lindsey Fauveau, M.D.
So things like uranium, things that are in the dirt that we are physically standing on. If you are standing on this earth for three months, you've got your milligram. So it's really like a drop in the bucket when you think about it. And then the benefits that you would gain or that it can change your life, it can cause you to have an early detected breast cancer that's going to have a better prognosis, may even get you out of some treatments like chemotherapy.

00:07:57:06 - 00:08:01:23
Lindsey Fauveau, M.D.
And so the benefits tremendously outweigh the risk of having a mammogram.

00:08:01:25 - 00:08:10:13
Julia Resnick
And I'm sure that as you've been doing this work, you have a lot of stories that kind of illustrate the impact of the mobile coach. Are there any of those you'd be willing to share?

00:08:10:15 - 00:08:33:25
Lindsey Fauveau, M.D.
I am a very big proponent of knowing your medical history, knowing not only yours, but your family history. I consider this a miracle, but it's not as, granular as, like, you went from a very poor prognosis to like, surviving. But in my own experience with this particular patient, I do consider it one of the miracles that I've witnessed.

00:08:33:25 - 00:08:55:14
Lindsey Fauveau, M.D.
So within the realm of breast surgical oncology, we not only take care of cancer patients, but we take care of those that are high risk of breast cancer. And so knowing your mammogram density is part of that risk factor. And so sometimes your ObGyn or your mammogram can prompt you to knowing that your high risk of breast cancer.

00:08:55:14 - 00:09:15:14
Lindsey Fauveau, M.D.
And if that's the case and you're lucky enough to go to a high risk clinic, then you'll be met with a surgeon who's going to do a risk assessment and then potentially genetic testing. So the patient that I have in mind was identified through her mammogram as being high risk. She came to see me. She had a stark family history.

00:09:15:17 - 00:09:38:15
Lindsey Fauveau, M.D.
She was recommended for genetic testing. She ended up having a mutation that was going to really tremendously increase her risk of having breast cancer. And so she elected to do risk reducing surgery with her particular mutation. And I don't like surprises personally as a surgeon. So I want to have breast imaging prior to going to the operating room.

00:09:38:17 - 00:09:57:23
Lindsey Fauveau, M.D.
And so we set her up with some imaging approximately a week before her planned surgery. And lo and behold, it diagnosed her with early stage breast cancer. So she went into that same surgery, which is supposed to be risk reducing and then became curative. And so it really shows like the full depth and breadth of everything that we do.

00:09:57:23 - 00:10:19:05
Lindsey Fauveau, M.D.
So this isn't just a cancer service. We do preventative, we do treatment. We see everything from benign all the way up to the most aggressive cancer that there is. And all of it truly matters because it's so circular. Right? So my patient who has cancer has family members who are high risk. And so we have to take the whole patient into consideration.

00:10:19:07 - 00:10:43:08
Lindsey Fauveau, M.D.
And I love that patient story, particularly because it highlights the importance of not just having the program, getting the diagnosis. It shows that like what we do in continuity can change the outcome. And she is just - she's thriving. It did not cause any anxiety because everything was already set up. I mean, it was kind of pretty remarkable about how that worked out.

00:10:43:10 - 00:10:58:24
Julia Resnick
That so beautifully illustrates the power of prevention and why it's just important to know before things go downhill. So as you've been doing this for a few years and are like looking ahead, what lessons have you learned, that you think other hospitals could apply?

00:10:58:26 - 00:11:18:25
Lindsey Fauveau, M.D.
I think that you have to have awareness and outreach that's ongoing. You know, again, the idea that if you build it, they will come just doesn't quite work. You really need to consistently engage with your community and make sure that the education that they need to have people show up for themselves medically is there.

00:11:18:25 - 00:11:21:05
Julia Resnick
Fantastic. And what's next for you in all of this work?

00:11:21:08 - 00:11:48:13
Lindsey Fauveau, M.D.
I ultimately get the pleasure to oversee a lot of this as the medical director. So I head the accreditations for Women's Hospital. The acronym is NABCC, but it's national associations of breast cancer centers as well as we are CoC, which is Committee on Cancer certified. And so there's lots of national checkpoints that Women's Hospital exceeds and really excels at.

00:11:48:13 - 00:12:12:02
Lindsey Fauveau, M.D.
And so I dive deep into that because I feel like not only Louisiana, but the Baton Rouge community deserves the best. I think that was the idea in forming Women's Hospital, born and bred in its inception with the ObGyns, who thought my deliveries, my OB patients deserve the best and I think that we carry that mentality through to cancer.

00:12:12:02 - 00:12:41:17
Lindsey Fauveau, M.D.
And so I am very happy that we have a brand new mammography unit. I think we're going to be able to reach a lot of people in the state of Louisiana. Gearing up for October, my hopes are that our good work that we've done here will be expanded throughout the state. But as well as taking care of our house, you know, I really want to make sure that the Baton Rouge community continues to have good access and quality driven care.

00:12:41:17 - 00:12:54:12
Lindsey Fauveau, M.D.
And so we've got a great team of marketing as well as business development. And I love that Women's Hospital really only focuses on women because it allows us the power to do that.

00:12:54:14 - 00:13:06:14
Julia Resnick
Fantastic. Well, thank you so much for all the work that you do to serve your patients and to serve all the women in Baton Rouge and Louisiana. Really fantastic work. And just thank you for joining us today and for everything you do.

00:13:06:17 - 00:13:08:24
Lindsey Fauveau, M.D.
It was good to see you. Thank you for having me.

00:13:09:01 - 00:13:10:21
Julia Resnick
Likewise.

00:13:10:24 - 00:13:19:06
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;01;02 - 00;00;28;12
Tom Haederle
Welcome to Advancing Health. An effective cyber attack against a large hospital, especially a ransomware attack, often has a cascading effect on nearby hospitals as well, who may depend on the operational readiness of their bigger brethren. Experts call it a regional blast radius, and in this podcast, we learn how the Texas Hospital Association has stepped up with its members to meet that challenge.

00;00;28;15 - 00;01;01;01
John Riggi
Hello, everyone. Welcome to Advancing Health. This is John Riggi, your National Advisor for Cybersecurity and Risk at the American Hospital Association. I am so pleased and privileged to be here with my good friend and colleague, Fernando Martinez. Fernando is the Texas Hospital Association's chief digital officer. Fernando is also a former hospital CIO and chief information security officer. He's a certified IT security professional and a professional educator who's worked with some of the largest health care systems in the country.

00;01;01;04 - 00;01;19;17
John Riggi
Fernando has been with the Texas Hospital Association for over 11 years, and he's been an adjunct professor at Florida International University College of Business for over 15 years. Fernando, as I mentioned, so great to have you here, be on this podcast with me and talk about a great partnership.

00;01;19;20 - 00;01;21;00
Fernando Martinez, Ph.D.
Thank you John. My pleasure.

00;01;21;03 - 00;02;03;16
John Riggi
We've worked so closely with the Texas Hospital Association over the years with doing workshops, regional tabletop exercises and other educational events. And as we often discuss and as you've heard me say many, many times, cyber risk is an enterprise risk issue. But first and foremost, it is a risk to patient care and patient safety. We emphasize that hospitals should prepare for clinical continuity to mitigate the impact of a cyber outage, but also to understand what the regional impact would be to care delivery and the disruption to care delivery if a particular hospital is struck with a ransomware attack.

00;02;03;19 - 00;02;23;21
John Riggi
So our joint events focused on regional cyber incident response scenarios, just as we would all prepare for a regional physical disaster. From your perspective, how does this partnership enhance hospital resilience and patient safety across Texas?

00;02;23;24 - 00;02;55;20
Fernando Martinez, Ph.D.
Well, I have to tell you, I recall the first time that I heard you use the phrase "regional blast radius" I think this is the way you refer to it. And I thought to myself, well, you know, much of what we're doing to help our member hospitals prepare is really focused on individual hospital performance and intra-hospital performance, but really not something looking at the true operational impact to hospitals that would result as a result of a cyber incident.

00;02;55;22 - 00;03;24;12
Fernando Martinez, Ph.D.
And it's such an appropriate way to look at it, even more importantly than an individual hospital being prepared for incident response. It's really important to consider the impact that a hospital would have to endure, should they be the ones that are impacted or should any of the adjacent or in the same catchment area of patient care hospitals be affected the same way.

00;03;24;12 - 00;03;48;08
Fernando Martinez, Ph.D.
So they could be the source of the disruption and they could be the downstream recipients of the disruption. So the whole approach is quite brilliant, and I'm glad that we've been able to take that model to our hospitals in Texas. This is especially true because Texas has a lot of areas that are generally referred to as white space.

00;03;48;10 - 00;03;57;27
Fernando Martinez, Ph.D.
You'll have one level two or level one trauma hospital and ten, 12, or 15 smaller hospitals dependent on it.

00;03;58;00 - 00;04;30;03
John Riggi
Appreciate that, Fernando. And yes, unfortunately we have learned from the hundreds, hundreds of cyber attacks, but particularly the ransomware attacks, which caused victim organizations to disconnect from the internet and shut down their networks, ultimately resulting in, yes, as you indicated this is what we call ransomware blast radius. Victim is hit, but then there are cascading shockwaves throughout the entire region as patients and ambulances are diverted to surrounding hospitals.

00;04;30;06 - 00;05;00;02
John Riggi
And again, some of these surrounding hospitals, as you said, depend on the availability of the technology, whether it's the electronic medical record or linear accelerators that deliver radiation oncology of that victim organization. And with your help, we came to understand that, you know, we don't really need to develop a whole new series and set of rules and structure to develop cyber incident response plans on a regional basis.

00;05;00;02 - 00;05;25;19
John Riggi
They already exist to a certain extent. And, Fernando, your example of that white space. Unfortunately, we've had a couple of major ransomware attacks against level one trauma centers in Texas within in the past year. And I recall speaking to the CEOs and saying they were very concerned, saying, John, the next nearest level one trauma center is 400 miles from here.

00;05;25;21 - 00;05;46;29
John Riggi
So really placing not only just the patients, but entire communities at risk, really becoming a state issue as well. In Texas, again, very forward leaning on a lot of cyber issues and best practices. I understand Texas has established a cyber command. What does that entail and how does it support hospitals?

00;05;47;01 - 00;06;25;20
Fernando Martinez, Ph.D.
The Cyber Command was established in Texas, very forward looking position that the state of Texas government took, which is to build a consolidated  - at a state level - a consolidated threat intelligence, cyber readiness incident response organization that would support all of the government activities of the State of Texas. Texas has always had a cyber response organization but it's been part of the larger Texas Department of Information Resources organization.

00;06;25;22 - 00;06;59;05
Fernando Martinez, Ph.D.
What this piece of legislation, which was signed into law by the governor in June of this year as a result of the legislative session - House Bill 150...What they did is they appropriated, and this is all public domain information, they appropriated $135 million and took the cyber resources that are spread across several organizations, including Texas DIR, consolidated them into one cyber command for the state of Texas.

00;06;59;05 - 00;07;35;04
Fernando Martinez, Ph.D.
And so the idea here is to provide a baseline for cyber preparedness, for cyber threat analysis and threat intelligence and incident response. And then in doing so establish policy standards. That body is actually empowered with rulemaking. The chief is appointed by the governor. So it's a very forward thinking governance architecture and structure around cyber. Although it's initially the scope of command is limited to state government.

00;07;35;06 - 00;08;10;00
Fernando Martinez, Ph.D.
It does incorporate services that can be used in public sector education, higher ed in particular, but also public sector education and other public sector organizations like municipalities, city governments, down to and extending to critical infrastructure vertical departments that might be water power, a number of other sectors. So very forward leaning, forward thinking steps being taken to approach this at a state level.

00;08;10;02 - 00;08;36;25
John Riggi
Really a model for all states. And again, Texas being leader in this area. So Texas and through the Texas Hospital Association is leading in other ways, and with our work at the American Hospital Association we have joined forces with you to develop these regional tabletop exercises. Fernando, from your perspective, could you tell us what these regional tabletop exercises look like?

00;08;36;27 - 00;09;04;24
Fernando Martinez, Ph.D.
Sure. So the idea that you take a regional hospital, a level two, level one, trauma hospital that has a community relationship with ten, 12 or 15 smaller critical access or rural hospitals. We converge them. We bring them together into a day long activity, where is the primary dependency being the level two or the level one trauma center

00;09;04;26 - 00;09;41;07
Fernando Martinez, Ph.D.
suffers an incident, a cyber incident of some sort that interrupts the service that these downstream hospitals need that are required for life safety care to patients in their communities. And these are primarily non-IT executives that are brought together, operational clinical operations, hospital operations, emergency preparedness. By bringing those individuals from all the different hospitals together, they have an opportunity to flesh out the circumstances that they might have to confront.

00;09;41;09 - 00;10;07;27
Fernando Martinez, Ph.D.
You mentioned earlier, the fact that if a level two or a level one trauma center goes down, now you're talking about potentially transporting patients instead of transporting them 45 minutes, 30 minutes or an hour away. Now you've he's looking at 2 or 3 hours, which in the cases that that would have catastrophic consequences in terms of patient outcomes and clinical care and clinical safety.

00;10;08;00 - 00;10;32;11
Fernando Martinez, Ph.D.
They have been very effective in bringing those individuals together to talk about how it is that they would work together. What are the alternatives? How would they address incident response? How would they leverage each other's resources? As simple as how would they communicate with each other? That's proven to be very effective. The exercise we did last year was remarkable

00;10;32;13 - 00;11;04;09
Fernando Martinez, Ph.D.
inasmuch as there actually was two days before the exercise, there actually was a level one trauma center hospital upstream that went down and affected the actual host hospital that was in fact upstream from the small hospital. So we know that the threat is real. And we know that this is a very effective way to bring many hospital executives together to consider obstacles that they would not necessarily contend with during their traditional

00;11;04;15 - 00;11;09;19
Fernando Martinez, Ph.D.
standalone emergency preparedness exercise. Brilliant approach on the part of AHA.

00;11;09;21 - 00;11;32;14
John Riggi
Thank you for that, Fernando, truly a great partnership with THA. And you know, when we did that exercise, many thought that the exercise and the news of the ransomware attack upstream was all somehow connected. Very unfortunate coincidence that it happened at that time. But talk about a sense of realism to really conduct an exercise during the heat of battle

00;11;32;14 - 00;11;49;03
John Riggi
in a sense. What do you think, Fernando? Again, having been there now for several of these exercises, helping me moderate these, what do you think some of the key lessons learned are from these exercise? And how do you think these exercise build trust and coordination across the attendees?

00;11;49;05 - 00;12;17;22
Fernando Martinez, Ph.D.
Well, first of all, communication was the key takeaway. A lot of the hospital executives, from a risk averse point of view, a lot of the hospital executives look at cyber incidents as something that they don't want to communicate to anyone else for a variety of reasons, many of them prompted by being legally discreet and not disclosing information that might jeopardize the organization.

00;12;17;24 - 00;12;56;09
Fernando Martinez, Ph.D.
Unfortunately, when you look at emergency preparedness, other types of emergency response circumstances, whether it's mass casualty or acts of nature, the communication protocols were all there so that organizations can notify each other. But where cyber incidents are concerned, something as simple as just communicating indicators of compromise, right? Techniques and tactics. Those are bits of information that would help downstream organizations potentially identify if there was a threat that was being directed at them, so that they would avoid the same set of circumstances.

00;12;56;12 - 00;13;30;08
Fernando Martinez, Ph.D.
And that's not there. So one of the big takeaways was hospitals need to develop these communication pathways that will allow them to share a small amount of information, just sufficient information without disclosing more detail than they need, disclosing the fact that there is an incident underway, that there are some of the indicators of compromise are XYZ, so that the adjacent hospitals have the opportunity to prepare to look for and potentially avoid being victims.

00;13;30;10 - 00;13;42;26
Fernando Martinez, Ph.D.
I can assure you that the bad guys are sharing information the moment that they exploit one organization, then they know regionally that they can go to other organizations with similar success.

00;13;42;29 - 00;14;18;09
John Riggi
Communication, within the organization with their peer organizations in region, with the federal government, with the state. Really crucial during these exercise, although there is this tension between trying to preserve confidentiality, risk of civil liability and potential regulatory liability, all these factors tend to shape an organization's outlook. But with education they understand they can mitigate all those risks and develop these trusted relationships which will not expose them to legal and regulatory risk,

00;14;18;09 - 00;14;45;07
John Riggi
again, if they have these preexisting relationships in agreements in place. Fernando, I view the work being done at the Texas Hospital Association quite frankly as a model for other states. And I just want to let you know I value your partnership and your capabilities and all that you do, not only for all the hospitals in the state of Texas, how you've been contributing on the national level as well, helping me, helping AHA to do our job for national benefit.

00;14;45;10 - 00;15;03;28
John Riggi
So thank you again, Fernando, your partnership, your friendship and all that you do. And thanks to all our listeners for all that you do every day to defend networks, care for patients and serve your communities. This has been John Riggi, your National Advisor for Cybersecurity and Risk.

00;15;04;00 - 00;15;12;11
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:28 - 00:00:34:10
Tom Haederle
Welcome to Advancing Health. Artificial intelligence and advances in digital technology give care providers more and better tools for patient care than ever before. In this month's Leadership Dialogue podcast hosted by Tina Freese Decker, president and CEO of Corewell Health and the 2025 Board Chair of the American Hospital Association, we hear from one expert on harvesting the potential of so many new technologies to deliver better, safer and more accessible care for patients and communities.

00:00:34:13 - 00:00:53:19
Tina Freese Decker
Hello everyone. Thank you so much for joining us today. I'm Tina Freese Decker, president CEO for Corewell Health. And I'm also the board chair for the American Hospital Association. We know that there are many pressures and challenges facing our hospitals and our health systems, but there's also never been a better time to truly transform how we care for people.

00:00:53:21 - 00:01:15:03
Tina Freese Decker
I believe that AI and other technology innovations play an important role in this transformation, which is why I'm so excited to explore this topic today. With so many tools and technologies out there, it can be difficult to really focus on what delivers that value to the patients, to our communities. That's why I'm so pleased to be joined by Dr. Jackie

00:01:15:03 - 00:01:36:20
Tina Freese Decker
Gerhart, chief medical officer of Epic, to ensure that we talk about these opportunities for health care. In addition to her role at Epic, Jackie is also a practicing family medicine clinician, so she can give her firsthand perspective on how she sees technological advances improving care for her patients. So, Jackie, thank you so much for joining us today.

00:01:36:20 - 00:01:55:09
Tina Freese Decker
We are so appreciative of all you do for Epic, but then also what you do to serve people in your community. And it's been a pleasure knowing you throughout the years in various areas, but it's wonderful to be able to talk to you today. When you think about the possibilities ahead for us, especially as it relates to technology and all these things that you can learn from,

00:01:55:12 - 00:01:58:09
Tina Freese Decker
what area do you think we have the greatest potential?

00:01:58:12 - 00:02:27:15
Jackie Gerhart, M.D.
Potential as a an interesting term, because I think it's kind of two different things. There's the part of it that is the option for transformation. And then there's the part, as you mentioned earlier, that's really practical and being able to be applied now. So I do think that AI, the use of agents, the use of bringing that technology into medicine, both the care of medicine and the transformation of new medicine is going to be a game changer, just like the internet was transformational.

00:02:27:15 - 00:02:45:13
Jackie Gerhart, M.D.
I think this age of AI and AI agents is also transformational. I think in terms of practical, one of the things we struggle with in health care is being able to evaluate different tools, understand are they going to be useful for our populations, or are they going to be tuned for our specific populations we're caring for? What do we already have?

00:02:45:16 - 00:03:04:27
Jackie Gerhart, M.D.
What do we still need to purchase? So I think there's so many pieces out there right now, especially within the AI sphere, to help us answer patient messages as clinicians to help patients be better informed about their care, to be able to use their patient portal - Epic's is called my chart - to try to better inform them of what's coming up next.

00:03:04:27 - 00:03:18:29
Jackie Gerhart, M.D.
So I think, well, the transformation part is absolutely AI and AI agents and that future.  I think just digital health in general, we can't forget that that's something that's already bringing us together with things like telemedicine and care from your phone.

00:03:19:01 - 00:03:43:04
Tina Freese Decker
I think that's absolutely correct. That is the digital piece to this, how we design it. And we can't design it based on the paper model into a digital model. It's truly transforming. I also think the key element is we need to be clear about the problem we're trying to solve. There's so many shiny objects that are out there that can distract us, and we must be laser focused on that solution that we're trying to solve.

00:03:43:06 - 00:04:02:19
Tina Freese Decker
Otherwise we can get very distracted. So when you think about that, you know, we have to evaluate all of these new technologies, this transformation, It's important to evaluate the cost and the benefits of those new innovations. What are some of the criteria that you believe hospitals health systems should keep in mind when we look at those opportunities?

00:04:02:25 - 00:04:07:06
Tina Freese Decker
And do you see major barriers when we adopt the new technologies?

00:04:07:08 - 00:04:24:23
Jackie Gerhart, M.D.
Yeah. Great question. You hit the nail on the head. It's absolutely everyone is inundated with new shiny technologies. And I think the very first question, as you put it is what is our problem that we're trying to solve? And then I think the second is do we already have technology that could actually be solving this better than we're using it?

00:04:24:23 - 00:04:43:12
Jackie Gerhart, M.D.
Is there something in workflow that we're not optimizing? Is there is it a people or human factors issue and not even a technology issue? So first, evaluating what the problem is and then seeing where within the workflow, literally studying how is it that this could either be more efficient or more effective. And then I would say, just like I was talking about before, there's digital health,

00:04:43:12 - 00:05:00:28
Jackie Gerhart, M.D.
there's AI. Evaluate if there's already a digital health solution that may be lower cost than the cost and compute of an AI solution. And see also if you already have it. One of the things we noticed with hospitals is that they have technology that they've already purchased, and they may just not be optimizing it or have even turned it on.

00:05:01:02 - 00:05:20:14
Jackie Gerhart, M.D.
One of the hardest things we do at Epic is we create software and we created a, you know, a very fast clip trying to keep everyone up to date with the best and greatest. But if they don't turn it on, or if they don't fully optimize it or help train their users, then it really isn't allowing for that technology to get to the point where it's actually being optimized.

00:05:20:16 - 00:05:55:18
Jackie Gerhart, M.D.
So after all of those questions, then when you get to the AI question and in terms of what's cost effective and what's not, oftentimes we see people do one of two things. They'll either kind of do a pilot and then learn if it's the right technology and then try to expand from there. But we've actually found that sometimes some of the greatest technology solutions are caught in this "death by pilot" cycle, where in reality, if you're able to if you've seen another organization already do it and you're able to apply those results to your organization, you may not need to do a full randomized controlled trial or a full study of it.

00:05:55:18 - 00:06:15:12
Jackie Gerhart, M.D.
Just make sure that it really fits in with your clinicians, your workflow, and your patient population. Be sure to test it locally and understand that it's going to actually be effective. And then and then go for it and be a little bit bold about this, because this is a technology that's actually really changing and advancing care. And we have the opportunity to have that now.

00:06:15:15 - 00:06:42:08
Tina Freese Decker
So as a physician, I'm curious to know what you've, seen over, you know, your eight years, really practicing in that area and maybe even before in your, in your education training and what you're excited about coming forward to make it easier. And then any advice you have for us as we implement these things and ensure, you know, the whole goal is to make it easier for our physicians and clinicians to provide the care and easier for patients to receive the care.

00:06:42:10 - 00:06:44:19
Tina Freese Decker
What advice do you have for how we would implement it?

00:06:44:21 - 00:07:17:02
Jackie Gerhart, M.D.
Yeah. Great question. So I practiced for about eight years and then started at Epic. And I've been at Epic for about eight years. I remember this - man, probably in maybe 2015 or so, I had a patient who I was doing a physical exam on, on the exam table in my practice. And I was examining her thyroid and I found a small lump on one side. And I wanted to finish her exam, but I also wanted to order a ultrasound and think about if I need a needle biopsy and also see if she had a prior TSH and all of these different things that were both passive and active.

00:07:17:02 - 00:07:42:21
Jackie Gerhart, M.D.
And I felt myself hamstrung to this one point in the exam room thinking, okay, do I turn to the computer? Wouldn't it be great if something could kind of bring this all together, a technology, perhaps. And she and I were going back and forth and saying, you know, wouldn't it be nice if I could just say, in this case, I was using Epic, so hey Epic, order a TSH and follow up in two weeks, and if the TSH is elevated, let's go ahead and do for an ultrasound.

00:07:42:27 - 00:08:03:06
Jackie Gerhart, M.D.
And then, by the way, you know, record this into my notes and also give me some decision support as to, you know, what is going to be covered by her insurance, etc.. And, she was a little bit of a tech nerd so we geeked out about it for a while, and it really got me thinking, as one of the reasons for me wanting to get into tech is that yes,

00:08:03:06 - 00:08:30:00
Jackie Gerhart, M.D.
I love patient care, and I can have such a good impact on the people in front of me. But if there's a way to truly transform medicine, to try to make it both easier on clinicians and also more practical for just getting access to care and being able to democratize care, then that's really the secret sauce. We just had our users group meeting, UGM, a few weeks ago, and I was so thrilled because it was kind of this, way that we embodied everything I was hoping for all those years ago.

00:08:30:04 - 00:08:46:27
Jackie Gerhart, M.D.
We showed how a patient with their, My Chart can go in and actually speak and ask questions to be able to create a patient agenda. So instead of a patient coming in to me and me saying, hey, what brings you in or what else? And then having my hand on the door and leaving and being like, oh, there's one more thing.

00:08:47:03 - 00:09:25:18
Jackie Gerhart, M.D.
I can actually pace the visit by having the patient tell me specifically what it is that they want to accomplish. And then on the clinician side, we have art, which is the AI for clinicians, and that then in real time can go through the patient agenda and choose each topic. So say the first is hypertension. It can bring up to me a summary of all of the hypertension information that's in the chart, as well as blood pressure cuff information that they may have from home, and even help me with decision support, using real world evidence, and actually looking at that person themselves, how old they are, what they've tried before and

00:09:25:18 - 00:09:32:05
Jackie Gerhart, M.D.
help me decide what might be the best course of action for this person with all of the tools that I have in my tool belt.

00:09:32:07 - 00:09:50:06
Tina Freese Decker
Do you see patients readily engaging in this? And do you see the potential for the use of technology and the things that allow us to do, like sharing the agenda, changing patient behavior to more healthier behaviors?

00:09:50:09 - 00:10:16:02
Jackie Gerhart, M.D.
Yes. So I think I discussed some stuff in the exam room. And I think that's really important for change in behavior and treatment. But really again, it's those in between spaces that actually have the biggest opportunity for changing behavior I think. And so I've loved how some of the technology we're using again, going back to just digital health, I was speaking about how wearables can help affect people's behavior.

00:10:16:05 - 00:10:40:06
Jackie Gerhart, M.D.
And what's interesting is we have, a website called Epic research.org where we study different questions of Cosmos, which is a real world evidence, platform. And one of the questions that I had asked was: in patients that are wearing a prescribed continuous glucose monitor, in those patients, pre-diabetic, just wearing it to try to improve their health - in those patients,

00:10:40:06 - 00:10:57:28
Jackie Gerhart, M.D.
Does their A-1C change? And it turns out over all of those patients, it didn't have a statistically significant change. That was actually surprising to me because I thought behavior would change enough. But then as I went back, I thought, you know what? I'm asking the wrong question. It's not whether the A1C, which is a measure for diabetes, is really the question.

00:10:57:28 - 00:11:27:10
Jackie Gerhart, M.D.
It's while the rest of their lifestyle, what's their BMI? Are they getting heart disease? How is their hypertension? All of the other things that we need to look at to determine if something is actually changing behavior? Because the behavioral change actually might be the thing that we should be measuring. And it brings me to this thought of - traditionally in medicine we've thought of things like labs or treatments or medications, and it's very, very much been sort of like a medication focused career.

00:11:27:15 - 00:11:46:13
Jackie Gerhart, M.D.
And I really think we have the opportunity now to further expand that into person-focused career and really have it be you tell me what it is that you're coming in for. Maybe it's you just want to make it down the aisle, and so I need to help you with your knee pain. Maybe it's not that I need to, you know, fix what is on my agenda, but it's actually what's on your agenda.

00:11:46:15 - 00:11:54:07
Tina Freese Decker
That's fantastic. That's really good. So I'm going to close today with just asking you about what you're most excited about when it comes to innovation and transformation.

00:11:54:13 - 00:11:58:10
Jackie Gerhart, M.D.
I'll go second, why don't you tell me what you think you're most excited about? Oh, I love it.

00:11:58:10 - 00:12:22:17
Tina Freese Decker
Oh, I love it, how you turning it over to me! I'm really excited about the potential that we can create. Yeah. I think that there's so much opportunity for harnessing some of the new technologies and artificial intelligence, but really seeing the impact to patients. Yeah, I was just in talking to some of our teams the other day and hearing about the amazing progress we've had.

00:12:22:24 - 00:12:51:29
Tina Freese Decker
When you talk about surgery, when you when you talk about the research elements and we're just at the cusp. I mean, you feel like you've made so much progress, but there's so much more that we can do. And that's what gets me excited. And really the impact is back to patient care. I was just rounding and met one of our patients, and he had an essential tremor. And he couldn't sign his name for 30 years.

00:12:52:01 - 00:13:22:06
Tina Freese Decker
And so he did a focused ultrasound procedure where we, you know, have you have a laser focus as part of the brain heated up to 58°C, which is like 130 plus degrees Fahrenheit. And after the procedure, he could draw a straight line, he could sign his name. And he sent us a handwritten note, a two page handwritten note that he wasn't able to do before, detailing his gratitude and how he can now hold a cup of coffee and drink from it.

00:13:22:10 - 00:13:32:22
Tina Freese Decker
So that is the incredible piece that I see. You know why I'm in health care and what I'm so excited about, to see the progress that we can make and the impact we can have on people.

00:13:32:25 - 00:13:58:18
Jackie Gerhart, M.D.
I love that story. That's beautiful. I completely agree. It centers around the patient. In addition to specific patient care, I'm thinking also about sort of the broad population health and what can this do to advance medicine. And I think as clinicians, we tend to think about the information that we put into a record or the information we gather, and we see that as part of the health care visit.

00:13:58:18 - 00:14:25:25
Jackie Gerhart, M.D.
But then it's kind of put into the background. And I really think that data isn't the exhaust of health care, but instead it needs to be the fuel for personalized medicine. And as we start to learn from these journeys, and AI can learn from these journeys more quickly than humans can, we actually can figure out how to personalize medicine, advance new cures, figure out how to research things more quickly, and hopefully get that out to people.

00:14:25:27 - 00:14:41:05
Jackie Gerhart, M.D.
One of the things people have is, they're curious. They want to know what's going on and how that can be fixed or helped. And I think as that curiosity grows, we have more and more tools to help inform and democratize data for patients and also inform personalized care.

00:14:41:07 - 00:14:51:11
Tina Freese Decker
Our health is an every day, every minute sort of thing. It's really important that we connect all of that data, and we give people the tools that they need so that they can reach their health outcomes and their goals.

00:14:51:11 - 00:14:52:18
Jackie Gerhart, M.D.
That they want to achieve.

00:14:52:20 - 00:15:05:23
Tina Freese Decker
Jackie, thank you so much for your time today, for sharing your insights and expertise, for caring for our communities and for being so active and a supporter with Epic and partnering with the American Hospital Association.

00:15:05:25 - 00:15:08:11
Jackie Gerhart, M.D.
Yes. Thank you. It's been a joy. I thank you so much.

00:15:08:13 - 00:15:17:02
Tina Freese Decker
And thank you to all of our viewers for finding the time to tune in. We will be back next month for another Leadership Dialog conversation. Have a wonderful day.

00:15:17:04 - 00:15:25:15
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.