Advancing Health Podcast

00:00:00:25 - 00:00:20:03
Tom Haederle
Welcome to Advancing Health. Sometimes making a difference in a patient's life starts with noticing a need or asking a question. Today, we explore how Duke Health is tapping into the insights and compassion of frontline staff through its Frontline Liaison Network.

00:00:20:05 - 00:00:41:29
Julia Resnick
Hello, and welcome to Advancing Health. I'm your host, Julia Resnick, senior director of Health Outcomes and Care Transformation here at the American Hospital Association. Today, we'll be talking about how to engage frontline staff and screening patients for social needs. I am so pleased to be joined by Dr. Erica Taylor. She is an orthopedic surgeon and the vice president of Health Equity at Duke Health.

00:00:42:01 - 00:00:44:09
Julia Resnick
Dr. Taylor, welcome to the podcast.

00:00:44:11 - 00:00:56:01
Erica Taylor, M.D.
Thank you for having me. It's really a privilege and an honor to be able to talk about not only the screening and why it matters, but also how we activate teens to be part of our solutions.

00:00:56:06 - 00:01:09:10
Julia Resnick
Absolutely. Just really excited to have you here to have this conversation. So to start, I think it would be really helpful for our listeners to understand what challenges you were seeing at Duke Health that inspired you to develop this frontline liaison network.

00:01:09:12 - 00:01:33:18
Erica Taylor, M.D.
Yes. Thank you for that. I love a good origin story and this one is no exception. One thing I should mention I am also a practicing orthopedic surgeon, so I'm in my 14th year of practice as a hand and wrist orthopedic surgeon, which means I spend quite a bit of time really on what we would term the front line of care.

00:01:33:18 - 00:02:01:09
Erica Taylor, M.D.
The point of care and understanding both as a clinician leader and as someone who's practicing how the decisions we make at the top, if you will, really translate to application for our patients and our teams. And so the challenge that was happening not just at Duke Health, but really beyond, was a lot of change, a lot of rapid growth, a lot of rapid decision making.

00:02:01:11 - 00:02:26:19
Erica Taylor, M.D.
And while there were quite a few voices in many different rooms, a perspective that was consistently missing or should I say an expertise that wasn't always present was that of our clinic staff. And by clinic staff I'm referring to our medical assistants, the team members at the front, our nurses, the team members who are X-ray techs and athletic trainers.

00:02:26:23 - 00:02:57:06
Erica Taylor, M.D.
And I noticed that we had created frameworks for quality, for culture, for patient safety in order to translate decisions to the point of care. But there really wasn't an opportunity to do that when it comes to advancing health. When it came to ensuring all of our communities, all of our patients from all geographies and backgrounds were really experiencing care in the way that would lead to their optimal levels of health.

00:02:57:09 - 00:03:18:11
Erica Taylor, M.D.
And so the interesting part of the origin is that I was in a presentation learning about a liaison program for quality, and I leaned into one of my other colleagues and I said to him, you know, we should really create a version like that for social drivers and then health, etc.. And he leaned back to me and he said, do it.

00:03:18:13 - 00:03:52:13
Erica Taylor, M.D.
And so that's where it was born. And the reason the origin story matters is because as people hopefully try to create similar programs in their own environment, there's not a need to start from scratch. We often are doing things correctly and effectively, but perhaps could apply it more broadly. And so this is an example of where there was a gap and whose expertise we were gleaning from, and then a gap in how we were delivering the solutions to the patients, particularly the patients who needed them the most.

00:03:52:16 - 00:04:06:28
Julia Resnick
I love a good origin story, and that just so perfectly illustrates why this program is so important. I'd love your perspective on what do you what do you think frontline providers see that others don't and that they can use to support patients?

00:04:07:00 - 00:04:40:27
Erica Taylor, M.D.
Yeah. So one of one of my favorite things to do as a leader is really dive deep into clinical operations. There's many reasons for that. I am a stickler on efficiency and utilization. And are we really delivering practical care that can be replicated and sustained longitudinally? And so one of the areas that as clinicians, as leaders that we often don't see is practical implementation. The best of ideas and the best of vision can be articulated,

00:04:40:28 - 00:05:08:19
Erica Taylor, M.D.
we can have campaigns around them, but if they can not actually be supported by the right systems and processes, then the impact is minimal. And so what our frontline staff and again I'm using that term, you know, rather broadly - understand there's some nuances with it. But one thing that they can offer is really honest perspective and experience to tell us what worked, what didn't work and how it could work better.

00:05:08:22 - 00:05:33:09
Erica Taylor, M.D.
And they do it in such a way because not only are they on the front line, but they have a relationship with patients that many people don't have, and they're often the first and the last team members to touch our patients. They're often the first people to hear from our patients. They hear the feedback in the experiential data that doesn't make it into the survey, right?

00:05:33:11 - 00:05:52:23
Erica Taylor, M.D.
Doesn't make it into Press Ganey, and so this is where I really value not only perspectives but I call it expertise. And so what the liaison program does and what was always intended to do was to not just listen, but to follow that with action and improvement.

00:05:52:29 - 00:05:57:29
Julia Resnick
So can you talk a little bit more about how the liaison program works in practice?

00:05:58:01 - 00:06:30:13
Erica Taylor, M.D.
Yeah. So this is this is interesting. And I'm definitely smiling thinking back to when I first proposed the format. And as I said earlier, I wanted to take a little bit of what was working in similar network programs, albeit in different domains. And one of the things that consistently was valuable was allotting a specific amount of time in a consistent way for education around the topic, to the clinic staff team members, to the liaisons.

00:06:30:18 - 00:07:01:25
Erica Taylor, M.D.
And so the way I offered this was that once a month for an hour, I will host a meeting. And because we're very widespread, we're big health system with multiple ambulatory clinics. I will do this virtually. And for the first 20 minutes, I'll teach something around the dynamics and the intricacies of advancing health. But then another 20 minutes will be spent really reviewing what policies, what new changes, what workflow opportunities there are.

00:07:01:28 - 00:07:45:00
Erica Taylor, M.D.
And then the last 20 minutes of the hour, I'll just listen and not listen just to say I listen, but I'll actively listen and we'll have an exchange that is productive and honest and advances us forward. Now, my initial vision when I proposed this was that out of our inventory clinics at the time, there were about 80 or so, and now we definitely have over 100. Maybe ten, maybe 12 clinics would identify a liaison, would sign this commitment form, and I will teach these 10 or 12 people, and we'll go from there. Within two weeks of offering this opportunity, over 8,100% of our clinics had identified a liaison to represent them in this capacity.

00:07:45:03 - 00:08:04:10
Erica Taylor, M.D.
And, you know, as someone who is really, really a fan of entrepreneurship and innovation, there are times where you do have a solution, but you don't realize how important it was. And that was a testament to the need. And so, again, true to my commitment, the way it works is once a month I will teach the liaisons and they'll teach me back.

00:08:04:16 - 00:08:31:09
Erica Taylor, M.D.
But importantly, they receive the content in a way that is digestible and applicable to the rest of their teams. In the next day of their huddles, they'll share it. So a little bit of a teach the teacher or train the trainer, and then we will circle back the following month and address any barriers or opportunities that arose. And we are now in our fourth year of doing this program.

00:08:31:11 - 00:08:35:18
Erica Taylor, M.D.
And I just see the benefits multiply each and every month.

00:08:35:21 - 00:08:54:01
Julia Resnick
I love that, and it's so incredible when you think there might just be a tiny bit of interest but really, people have such a deep and passionate commitment to supporting patients that are really just becomes a groundswell. So congratulations on that. On that topic, are there any stories you can share that really illustrate how this program works?

00:08:54:04 - 00:09:17:00
Erica Taylor, M.D.
Oh my goodness. Yes. Thank you for that. I have so many stories. I'll share one or two. So as I mentioned before, I will, you know, meet with liaisons as a whole. And afterwards, if they have a solution they want to talk about further, we can meet them between. But for the most part, I just see them that one time.

00:09:17:03 - 00:09:40:22
Erica Taylor, M.D.
Well, one day I received an email from one of the liaisons, unsolicited, unprompted. And it is an email that I actually share anytime someone asked me to share a story. And she wrote about a patient who had come to their clinic, who needed help paying their medical bills, and as they dove deeper and asked the patient questions, said, well, you know what?

00:09:40:24 - 00:10:12:23
Erica Taylor, M.D.
I really don't even understand what all my doctors do and who I'm supposed to see. I need help understanding my medications. I need help with transportation. And so in that moment, the liaison and another member of her team who worked at the front desk went through the social drivers of health screening questionnaire with the patient, identified what they needed, put in a referral to our central resources hub, and then also gave them the number for county services for things that fell without the community based resource list.

00:10:12:25 - 00:10:44:25
Erica Taylor, M.D.
And when she composes this email to me, she writes the statement, this is very important. This is the first time that this team member and I had ever been involved in this process, and we became very emotional. Thank you to Duke Health. Thank you to the program. I am proud to work here. And the reason I bring this up as a story, and there's so many variations of this that I could share if we have more time, which we don't, is that this is more than connecting patients to resources.

00:10:44:25 - 00:11:30:29
Erica Taylor, M.D.
This is more than amplifying perspectives. What we are doing is connecting the most valuable resource, our clinic staff members, to the mission. And if you look at where health systems may miss the mark when it comes to retention, when it comes to development is often identified as not connecting their individual team members to their mission. And this is an example of what can happen when you just give someone the tools and the agency to create progress, to create solutions on their own, and they can take it to places that we can't, as leaders oftentimes do.

00:11:31:00 - 00:11:52:04
Erica Taylor, M.D.
And so I share that story. There are numerous others where, unbeknownst to me, supply chain had an opportunity to add something to a formulary and a liaison picked that up. Other things that are so granular, they don't make it to the PowerPoint deck. And so those are the types of stories that, if I ever wondered, are we making a difference?

00:11:52:10 - 00:11:54:09
Erica Taylor, M.D.
I think back to those.

00:11:54:11 - 00:12:18:05
Julia Resnick
I think that was just a really powerful reminder that people are experts in their own spaces and can connect with patients from wherever they sit, that they don't have to be a doctor or a nurse or a clinician. But even those frontline folks can see patients and connect with them and help them. And I think it's just like really connects back to why people work in healthcare, that they can help their patients from wherever they are.

00:12:18:07 - 00:12:47:17
Erica Taylor, M.D.
Absolutely. And, you know, the interesting thing about that particular team member is she was the financial care counselor, which we term FCC. And so before that, she had no background or training in this. And since she wrote that, she's entered into nursing school. And it's again, this is just one example and one factor to her decision to identify her leadership capabilities and take it to a different level.

00:12:47:19 - 00:13:01:06
Julia Resnick
So I'm sure that some of our listeners are now thinking about what it would take to set up a frontline liaison network at their hospitals. So over the course of implementing this, what have you learned and what advice do you have for hospitals who'd like to do something similar?

00:13:01:09 - 00:13:43:15
Erica Taylor, M.D.
Yes. That's a really important question. You know, I, I love hearing great ideas. And sometimes you hear them and you're excited and you're inspired and then you wonder, wait, how is that going to work back in my place and what do I need? And so the first thing that I would suggest to other systems and hospitals and even the ambulatory specialty care world that's considering this would be to take a beat, take a moment and really listen to what your clinic staff members are seeing and what they need to help you do your job.

00:13:43:17 - 00:14:11:23
Erica Taylor, M.D.
It is an interesting concept that we don't talk about enough is that many of our team members, myself included, are here to help the organization, that we have a servant leadership mentality where we want to use our time and talents to help to contribute, and we want that contribution to be valuable. To assume that there's a certain solution that your team members need would be a bit of a misstep

00:14:11:23 - 00:14:44:05
Erica Taylor, M.D.
and so the first thing I would advise is listen to your clinic staff in a productive capacity that allows them to co-create the future with you. When you do that, actively listen and have this bidirectional exchange you might find that the liaison program is exactly what you need to create. And if that is true, then the next step would be ensuring that you have not just the capacity to do it, but also someone who is empowered as a leader to really commit to this.

00:14:44:07 - 00:15:22:15
Erica Taylor, M.D.
Now, what's interesting, because I do get the question, how much time is required for this? How much of a impact would this be to our clinic workflow? The only time commitment for your liaison is one hour per month. It's about repurposing their time for ultimate downstream benefit to the environment and to the patients and communities we serve. So the first thing actively listen. Hear what solutions could be co-created and then ensure you have the capacity coupled with the expertise to deliver on this type of network.

00:15:22:17 - 00:15:37:12
Julia Resnick
Well that's just fantastic. Thank you so much for sharing this work. Thank you for championing it in your hospital and building this incredible network. It's such a powerful tool to support patients in your community, and I just really appreciate you sharing with us.

00:15:37:15 - 00:15:48:00
Erica Taylor, M.D.
Thank you so much. It's been amazing to be able to disseminate this in many different places, and I look forward to seeing what becomes of it.

00:15:48:03 - 00:15:56:18
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 - 00:00:20:28
Tom Haederle
Welcome to Advancing Health. Increasing numbers of adolescents are turning to AI chatbots for mental support, a practice that experts say has the potential for both good and harm. What is AI's connection to suicide prevention, mental health and safety? We'll explore that question in this discussion.

00:00:21:00 - 00:00:42:29
Jordan Steiger
Welcome to Advancing Health. My name is Jordan Steiger, and I'm the director of Behavioral Health and Violence Prevention at the AHA. Really excited today to be joined by Dr. Christine Moutier, who is the chief medical officer at the American Foundation for Suicide Prevention. And we're going to have a great conversation today about youth mental health, suicide prevention and safety.

00:00:43:01 - 00:00:46:00
Jordan Steiger
So, Dr. Moutier, thank you for joining us today.

00:00:46:03 - 00:00:54:10
Christine Moutier, M.D.
Thank you so much for having me on. I'm very thrilled to reach the folks that your podcast reaches. So glad to be here.

00:00:54:13 - 00:01:14:18
Jordan Steiger
Yeah. So, you know, we're here to talk about, you know, something, I'm sure our listeners who care for children and adolescents and also the parents that are listening to this podcast, you know, something that they're probably thinking about all the time, which is the role AI is going to continue to play in their lives as we integrate AI more and more into our daily practices.

00:01:14:18 - 00:01:21:05
Jordan Steiger
And then, you know, like I mentioned before, kind of what are those connections to mental health and suicide prevention and safety?

00:01:21:07 - 00:01:39:19
Christine Moutier, M.D.
We're going to have so much to talk about because there's a lot going on within the clinical setting. But what we at AFSP have been even more focused on is actually out there in the general world of like general chatbot LLM utilization and seeing some of the things that are going on there.

00:01:39:25 - 00:01:57:13
Jordan Steiger
Yeah, I mean, I know that you and your team are doing so much work right now in this space, and I really think it's going to be valuable to our audience today. You know, the people that keep our hospitals and health systems running, both on the administrative side and the clinical side. You know, just really understanding this issue a little bit more.

00:01:57:16 - 00:02:13:06
Jordan Steiger
So could you just tell us what you are seeing out in the field when it comes to children and adolescents turning to AI chatbots for emotional support. And tell us maybe why these tools seem particularly appealing to kids who are experiencing mental health crises.

00:02:13:09 - 00:02:55:22
Christine Moutier, M.D.
Well, I would think of AI and the availability of chat bots and AI kind of services as being so ubiquitous now that we would need to actively create an environment that our children and others are growing up in and living, working, playing, to kind of curb that. And, and so that means that the impact on mental health and suicide as well, which we can look at both of those areas as complex health outcomes with like environmental, social drivers of risk, if you will, and protection in the suicide prevention field.

00:02:55:22 - 00:03:22:18
Christine Moutier, M.D.
We think of these secular forces in the world. And that's where I would put AI, and there's a lot of potential for good and there's potential for harm as well. And I think, you know, with regard to your question about why is this becoming such a thing? When people have mental health experiences and needs going on, it's not framed in their brain in that way.

00:03:22:21 - 00:04:07:13
Christine Moutier, M.D.
They're experiencing what they're experiencing. We are in a society that still has a lot of misunderstanding, obviously, around mental health experiences. And so finding a psychologically safe way to disclose what you're going through is something that we're all doing all the time. And I think particularly for people who are at that developmental stage where they haven't necessarily had practice unconsciously, the narrative and the dialog can go from very mundane, pragmatic, informational tool utilization to much more personal and health and mental health related dialog, even though the user may not be intending it that way.

00:04:07:19 - 00:04:33:09
Christine Moutier, M.D.
And we do have data that shows that people who have less access to health care are turning to chatbots for personal and mental health and social support reasons more than people who do have access. And that's been looked at by, you know, insured versus uninsured, or even when you look at marginalized populations and their issues with lacking access to care.

00:04:33:11 - 00:04:52:25
Jordan Steiger
I appreciate you bringing up that angle of this and that data, because that's something that, at the AHA we're really focused on is thinking about access to care. How do we create more access to care in our communities? And I can totally see what you're saying with this, where if you don't have that access, it's very easy to turn to this tool that's online.

00:04:52:28 - 00:05:13:15
Jordan Steiger
And it's, I think, an interesting point that you bring up that people might not necessarily be turning to an AI chatbot for mental health first. It might be just like a gradual thing. You know, you mentioned that there is kind of a line between this being a potentially very helpful resource and, you know, a tool that could inadvertently increase risk.

00:05:13:17 - 00:05:17:07
Jordan Steiger
So how do we kind of toe that line and what is that line.

00:05:17:10 - 00:05:42:25
Christine Moutier, M.D.
Yeah. Great question. And I'm happy to kind of try to talk about again why it's so important and then get into a little bit of breaking it down. So just kind of with both of your questions in mind and thinking about the fact that ChatGPT does now have, as an example, 1.2 billion weekly users, according to Open AI as of late fall 2026.

00:05:43:01 - 00:06:18:22
Christine Moutier, M.D.
And there's a recent study that looked at college students and found that those with moderate to severe symptoms of anxiety and depression were utilizing AI tools for mental health support at a much higher rate, double the odds of utilizing it in that way compared to the students without those symptoms and experiences. So it does mean that some of the more vulnerable among every population may be leaning on AI tools even more heavily related to mental health needs.

00:06:18:24 - 00:06:50:27
Christine Moutier, M.D.
And the reason that there is concern about that...some are data driven, some are observational, some are anecdotes or cases, you know, more known publicly available cases, media reports, lawsuits, and some are applying what we know about mental health clinically and from the science into this space. So just to say that there's sort of like varying degrees of what I'm going to say here in terms of how we know this.

00:06:50:29 - 00:07:26:06
Christine Moutier, M.D.
So there is the issue that there are some individuals who are prone to heavier utilization, almost in an addictive manner, where synthetic emotional intimacy and dialog that becomes very, very lengthy. That is a known phenomenon. And there are a number of issues with those types of users. And I will say, some of what I'm going to say about the harms are much, much more tilted on that heavy use end, whereas some of the harms can be there for really anyone who is experiencing mental health vulnerabilities even without that heavy utilization.

00:07:26:13 - 00:07:55:11
Christine Moutier, M.D.
So the heavy utilization is obviously going to, in a, you know, time in our lives zero sum game, it is likely going to detract from real human relationships, and especially for a young person or someone experiencing distress, that they may not be turning to a trusted adult or a mental health professional or any health professional, and instead to that AI LLM - that is problematic in, in and of itself.

00:07:55:13 - 00:08:29:12
Christine Moutier, M.D.
And then there are some of the ways that the dialogs are going that I think many of the companies are trying to improve these patterns that we're observing. But some of the patterns are around sycophancy, where the AI will endorse and applaud the person's thinking and ideas so much that for someone with vulnerabilities, it could reinforce cognitive distortions, hopelessness, feelings of intensity, of overwhelm, or even delusions and psychosis.

00:08:29:12 - 00:09:04:28
Christine Moutier, M.D.
Those are all known phenomenon that have happened, at least in case reports. There are also cases of AI LLMs giving suicide instructions or urging the user towards suicidal behavior. And sometimes that's because the individual asks them for those specific lethal methods. Sometimes it's that the user was speaking in metaphorical terms, and the AI may or may not have understood they were talking about taking their life, but instead, you know, coming home.

00:09:04:28 - 00:09:26:19
Christine Moutier, M.D.
Come home to me. Keep this between us. This kind of dialog can be very dangerous for someone who's in that suicidal mindset, where there are already cognitive distortions and that sort of tunnel vision that we know can happen neurophysiologically in the moments preceding a person's attempt or death.

00:09:26:22 - 00:09:49:05
Jordan Steiger
Absolutely. And that vulnerability, I think, is a huge piece of all of this. Thinking about, you know, hospital leaders and what they need to understand about this, and I know, Christine, you're a psychiatrist. You have done plenty of suicide screenings and risk assessments I'm sure, throughout your career. I'm a clinical social worker, same thing. You know, this is things that we're trained to look at and really understand.

00:09:49:06 - 00:10:03:29
Jordan Steiger
But do you think that, you know, in hospital based, you know, suicide screening, risk assessment, things like that - we should be talking to patients and families about AI LLMs and, you know, the safety aspects of all of this.

00:10:04:01 - 00:10:34:04
Christine Moutier, M.D.
I do, I think, especially for pediatricians or any youth serving health professional, that is a reasonable thing to do as a matter of just general history taking in the same way that I had recommended that social media utilization be incorporated into history taking, so that you can understand the patient's full world of experiences, kind of getting inside their internal world.

00:10:34:11 - 00:11:01:03
Christine Moutier, M.D.
I think it's important to educate parents and family members about just becoming more educated about what this means for us. There are chatbots now implanted in infant and toddler toys. And you know, when I first heard about this several months ago, I was kind of like, is this for real? And I had to look at it myself.

00:11:01:03 - 00:11:05:27
Jordan Steiger
And I just read an article about this myself. And I was also shocked. Yes.

00:11:05:29 - 00:11:32:11
Christine Moutier, M.D.
And they can be so sweet and innocent appearing. Right? If you think about what's going on with social and brain development and infants and toddlers and frankly, children all the way through young adulthood, there's a lot going on in development. We're allowing an influence, potentially a pretty heavy influence if the time is heavy, especially. But even if it's not, it's become part of their world.

00:11:32:11 - 00:11:34:23
Christine Moutier, M.D.
So I do have some caution around that.

00:11:34:27 - 00:12:02:23
Jordan Steiger
I mean, absolutely. And I think, you know, you mentioned educating patients and their families. I think really this starts with educating clinicians too. So this is a good first step today. And I know you are all doing a lot of work to do that, but just making sure that clinicians and administrators at hospitals really understand the risk and the need to talk about this without stigma, without judgment, which we know can be a big part of those conversations, unfortunately, sometimes.

00:12:02:25 - 00:12:32:24
Christine Moutier, M.D.
Yeah, it's so true. There's so many facets of mental health that warrant those first steps of clinician education. I mean, I'm thinking of even things like safety issues, like lethal means in the home where if we as clinicians aren't very comfortable with the topic, we have our own barriers then to raising it in a really, you know, the normal way we would in a compassionate, patient centered, clear, direct form of communication.

00:12:32:27 - 00:13:09:15
Christine Moutier, M.D.
I love the way you put it. Like that's the first step is for clinicians to feel a really solid sense of the latest, you know, ways of understanding, especially something that is emerging and rapidly evolving as this AI space is. When I trained now, I am a little bit getting into the older set. But, you know, training several decades ago, none of what we know now in terms of screening, risk assessment, safety planning, lethal means, counseling, most of that did not exist.

00:13:09:16 - 00:13:33:27
Christine Moutier, M.D.
And in fact, we were role modeled if not taught about contracting for safety and things that have been now proven to be ineffective and we don't recommend anymore. So it has actually been if you look at several decade time frame, a lot can change, obviously in every specialty: cancer, heart disease, I mean clearly emerging treatments, new ways of understanding.

00:13:33:27 - 00:13:39:07
Christine Moutier, M.D.
And that same thing is true for suicide screening and care.

00:13:39:10 - 00:13:59:03
Jordan Steiger
As we wrap up. You know, Christine, if you had a crystal ball and you were thinking about what this world of, you know, LLMs and youth, mental health and everything, you know, it's going to look like in the next five years or so, like, what should hospitals be thinking about? And how can they kind of maybe stay ahead a little bit of what you think is coming?

00:13:59:05 - 00:14:38:19
Christine Moutier, M.D.
I would say in the wider world of AI, I dream of a time where the companies would be working alongside with experts, including clinicians, scientists, people with lived experience embedded as part of the design team so that protective factors and experiences could be worked into the design, not just harm reduction. Certainly we need that. We need those safety benchmarks, but also be thinking about enhancing protective factors for mental health and suicide prevention.

00:14:38:22 - 00:15:21:27
Christine Moutier, M.D.
It's becoming an ambient force in our lives. So I do hope for that. And there are some reasons to hope, because there are many of us who are working within and alongside. Within the clinical environment, I think there are some really exciting things happening. I would call it in the machine learning, AI, precision medicine space of suicide research and suicide prevention, where the predictive modeling around the ability in a high risk population of patients to be able to say with the same level of precision that we can for other clinical outcomes outside of even outside of mental health, you know, the area under the curve is like the predictability score.

00:15:21:29 - 00:15:52:23
Christine Moutier, M.D.
And we're reaching now the .8.87 mark for area under the curve with 90 day suicide attempt predictability, again amongst a high risk population. That's very similar to the ability that other fields have to predict, you know, post-op outcomes and things like that based on risk factors and and how things went in the surgery. I think some of those will begin to be rolling out into practice.

00:15:52:23 - 00:16:22:00
Christine Moutier, M.D.
Right now, almost none of that exists. I would point health system leaders to the reach vet model at the VA. They have been using AI systems to be routinely analyzing about 140 factors in the electronic health record for veterans in terms of suicide risk, and when the suicide prevention coordinator or clinician sees the indicator rising, they reach out and call that veteran in.

00:16:22:03 - 00:16:49:07
Christine Moutier, M.D.
And that is a really proactive form of suicide prevention. That kind of modality is mostly being used in research, but again, is rolling out in some larger health systems even beyond the VA. If your health system has made suicide prevention a priority, then these are the ways, I think, to be staying fully on the cutting edge, to be kind of looking for, well, how would that be implemented actually, you know, in my health system.

00:16:49:13 - 00:17:13:16
Jordan Steiger
Yeah, those are some great points. And I think early intervention - any way we can achieve that - I think is going to be a true life saver for patients and family members. And I mean, hearing you today, I think I'm leaving this feeling a lot more hopeful about what the future can hold and how we can really use this to intervene and help kids and families and adolescents and everybody that touches their lives.

00:17:13:18 - 00:17:22:04
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 - 00:00:13:21
Tom Haederle
Welcome to Advancing Health. Today we hear how a regional health system in rural Georgia combined innovative recruiting and clinical training programs to vastly expand the services it offers to area residents.

00:00:13:23 - 00:00:34:18
Elisa Arespacochaga
Hello, I'm Elisa Arespacochaga, AHA's group vice president of Clinical Affairs and Workforce. Delighted to be joined today by Jim Matney, president and CEO of Colquitt Regional Health System in rural Georgia. Today, we're exploring how Colquitt has developed successful training programs for physicians, nurses and others growing their own from the start. So, Jim, thank you so much for joining me.

00:00:34:18 - 00:00:40:00
Elisa Arespacochaga
And to get started, can you tell me just a little bit about how long you've been at Colquitt in your role?

00:00:40:03 - 00:00:57:05
Jim Matney
Well, I'm Jim Matney. I've been the CEO here since 2011, spent my career for the most part in Georgia. But then I've been in other parts of the country, too. Really enjoyed coming down, being here and really looking for the needs of those needs of the people in their region.

00:00:57:12 - 00:01:20:09
Elisa Arespacochaga
That's wonderful. So as a rural provider, you've had a history of providing medical education. You're one of the first in your region to have standalone rural residency programs. What made you decide first to jump in? Putting up a rural residency program is not a quick or easy job, but not only put it in, but then continue to expand those training opportunities.

00:01:20:09 - 00:01:22:12
Elisa Arespacochaga
And how'd you go about it?

00:01:22:15 - 00:01:45:12
Jim Matney
Well, you know, when I first got here, I was going to established care here, and I was the CEO. And, you know, I tried to make a doctor's appointment to get in and see a doctor. I came in August and the first available was January, and I was the CEO. It was like 4 or 5 months older. And I said, there's no way we could take care of people giving them appointments 4 or 5 months out.

00:01:45:17 - 00:02:12:18
Jim Matney
So I realized that probably the number one thing on our needs assessment was workforce. And I went through year after year recruiting docs. So I decided on a strategy of not just with our physicians, but with our nursing, with our ultrasound tax, with everybody of growing our own. And, you know, recruiting people that came from the local high school, recruiting them from the region.

00:02:12:20 - 00:02:27:21
Jim Matney
Even down to where we were successful at recruiting a four year medical school, Philadelphia College of Osteopathic Medicine to come here. And they opened up a medical school that now is graduating 100 doctors a year.

00:02:27:24 - 00:02:37:07
Elisa Arespacochaga
That's amazing that you were able to bring that locally. Obviously, this didn't happen overnight, but what are some of the other programs for physicians that you've put in place?

00:02:37:10 - 00:03:06:13
Jim Matney
Well, we started out first with family medicine, and that was the obvious need because we looked at Georgia; Georgia was the 44th worst state in the nation for the ratio of physicians to the population. So I knew we had to have some primary care doctors. Well, then we started taking care of the primary care needs, and we realized that mental health is a prevalent disease in a lot of folks that's untreated or really had lax access to care.

00:03:06:21 - 00:03:28:00
Jim Matney
So a few years later, we decided to open up the psychiatric training program, psychiatrists. Was real funny when we came up with the idea is, we did not even have psych beds here. We had no psych services, but we decided to open up a psychiatric training program. So many people that used to have to travel for mental health services had to go.

00:03:28:01 - 00:03:49:21
Jim Matney
The local mental health agency had closed down. So people in Cochran County didn't have access to mental health. And then the legislature passed this bill called the 1013 bill, which was to increase access to mental health in rural areas. So we kind of took advantage of that, applied for a grant and was able to start a psychiatric program.

00:03:49:27 - 00:04:18:00
Jim Matney
We'll always do it ourselves. Their problems as we worked with a bigger hospital called Emory Health System to do surgery. That was another area of need. So now we had 12 general surgery residents that rotate through this hospital every year and actually learn how to do community surgery. Lots of times in tertiary care, they do the tertiary surgeries, but they come down here, they learn how to do appendectomy, gallbladders and all that.

00:04:18:06 - 00:04:45:07
Jim Matney
And that's been a wonderful recruiting ground. The other thing is that I kind of listened to the needs of my people. Maternal health. We live in a farming community, and we have a lot of people that weren't getting appropriate maternal health prenatal care. So this year we partnered with WellStar out of Atlanta to open up the OB, what we call a rule track OB program where we will actually start to have OB ready.

00:04:45:10 - 00:05:07:01
Jim Matney
We started just this year getting OB. So we look at the biggest needs of hospital primary care, mental health, maternal health and general surgery and you pretty much covered a lot. And as a result, we went from 36 docs on my staff that would change out, to now we have over 150 docs.

00:05:07:07 - 00:05:27:06
Elisa Arespacochaga
That is amazing. And I love the fact that you are addressing - I mean those are not just the key needs at your hospital. They're the key needs at every hospital, particularly since, you know, if you're about to have a baby, you're about to have a baby to regardless of who's there to deliver it. So having that access in your community is got to be huge.

00:05:27:12 - 00:05:37:04
Elisa Arespacochaga
Let's pivot a little bit to some of the nursing programs you've also put in place, realizing you needed more nurses and you've done some interesting things with high school students.

00:05:37:06 - 00:05:55:10
Jim Matney
Well, you know, if you remember during Covid, big demand for nurses. Couldn't find nurses anywhere. Well, my staff came to me and said, we don't want contract nurses in there. That's people that are coming in and working six weeks and leaving. Because of our culture, our culture is one of caring and they said, you just can't do that, Jim.

00:05:55:10 - 00:06:16:17
Jim Matney
Back when I was in high school years ago, our high school had a LPN program, a cosmetology program, mechanical program, and electrical program. So I met with the superintendent of the school system, and I said, you know, when I was in high school, they had a LPN program. And it was Ben Wiggins at the time.  And Ben said well,

00:06:16:17 - 00:06:41:12
Jim Matney
I bet we could do that. I said, just think about what we're doing for the workforce. We can start an LPN program in the 11th grade, and by the time they graduate, they're going to be licensed practical nurses. Being able to make 50 to 60 to $70,000 right out of high school. So it was just it was an idea that I came up with based upon when I was in high school

00:06:41:12 - 00:06:45:16
Jim Matney
and I had a superintendent that was willing to try with me.

00:06:45:18 - 00:06:55:12
Elisa Arespacochaga
I love that, I love that, and again, bringing people who are local to your community, people who are probably going to stay in your community and provide care to their neighbors and their friends.

00:06:55:19 - 00:07:12:05
Jim Matney
And, you know, we worked with Asco, but we also worked with the technical school, the technical college here had an LPN program. So we had to pull in another partner too. So we worked with Jim Glass, who was the dean of the local technical school. So we kind of pulled them all together. We agreed to fund it.

00:07:12:06 - 00:07:39:16
Jim Matney
We agreed to provide the clinical sites for them. And this year we're going to graduate 20 LPN nurses to it. You know, and nursing shortages across the nation a big issue. But if you look at our website, we have very few nursing openings. We're one of those hospitals that are fully staffed just because we decided rather than waiting around and complaining about not having nurses, we decided to grow our own.

00:07:39:18 - 00:07:47:25
Elisa Arespacochaga
That's definitely a theme with you. I love that. So, any lessons learned from working specifically with high school students?

00:07:47:28 - 00:08:19:07
Jim Matney
Yeah. You know, and I would tell everybody that those old high school nursing programs still are credited. What we found out was the high school did it 40 years ago when I graduated. So you can really get it done. But the lesson I learned was the first year we took everybody that wanted to be in the program. We had success and but we started out with 11 and only graduated three the very first year because they hadn't taken enough of the prerequisite courses they didn't pick enough of the sciences.

00:08:19:12 - 00:08:42:19
Jim Matney
So probably the big lesson we learned was is make it special. Increase the level of entrance or academic performance. Because when these kids do this LPN program, they give up their senior year. While other kids are off on Christmas break, if you're in the LPN program, you're probably working at the hospital here, you know, learning your skill set.

00:08:42:21 - 00:09:07:00
Jim Matney
So we have gotten a lot more selective, but then these kids are graduating with a salary of 50 to $60,000. So that's pretty big. Not everybody has to go to college. The other thing that we learned, which is really key to the whole program, is that we wanted to hire students that wanted to go on and get an RN  degree, because ultimately, we'd to advance their education.

00:09:07:03 - 00:09:26:21
Jim Matney
So part of the prerequisite was, not only do I become the last practical nurse, which knew about 90% of the work, but I also want to continue my education. So what we did was we said, if you'll go into LPN program in your high school, we'll pay for your RN degree, which really it's called a bridge program.

00:09:26:22 - 00:09:31:11
Jim Matney
And then they just have one year out of college. They're making over $100,000.

00:09:31:18 - 00:09:42:24
Elisa Arespacochaga
I love that you're continuing not only to bring in to meet the need you have, but helping to grow local students into careers that they can, you know, practice their entire lives.

00:09:42:29 - 00:09:53:16
Jim Matney
And we meet with their parents, we meet with them, and we came up with a contract that says, hey, if you will do this and you'll do this, we'll pay for everything and we will give you a job.

00:09:53:22 - 00:09:59:28
Elisa Arespacochaga
I love that, and I love involving their parents because at the end of the day, these are still minors when they're starting these programs.

00:10:00:05 - 00:10:16:21
Jim Matney
And the other thing we learned was just kind of funny was our first class to graduate were only 17 years old. And in the state of Georgia, you had to be 18 to get a license to be a nurse. So we had to wait like five months on some of them to turn 18 so they could get the license.

00:10:16:23 - 00:10:21:18
Elisa Arespacochaga
I love it. So what's on the horizon? What roles are next? What are you going to grow next?

00:10:21:24 - 00:10:49:10
Jim Matney
Well, you know, I I've always got tons of ideas. But in health care you get pockets. Like for example, used to be primary care needs. And now we've gotten to where we fulfilled the primary care. We filled a lot of our RN positions. But now you're starting to see, like, ultrasound techs. The program just started about eight months ago with MRI techs that can do X-rays, but they've not been trained on MRI.

00:10:49:16 - 00:11:10:09
Jim Matney
Well, we have a 3T-MRI. So I met with the local technical school and I said here's what they have to do. It's they have to finish this didactics. So we actually graduated our first five MRI techs the other day from Southern Regional Technical College. So my scope as it comes to academics - now I've got other things on the horizon -

00:11:10:11 - 00:11:38:03
Jim Matney
if you look at it on the front side, it's impossible. But if you start to try to figure out how to peel that onion back, you can get it done. And I'm just fortunate that we developed some really good relationships with our rural stakeholders, and they are always willing to say yes. One of the secrets is the fact that on a monthly basis, I meet with the county administrator, I meet with the city manager, I meet with the superintendent of schools.

00:11:38:05 - 00:12:04:23
Jim Matney
And then we sometimes about the dean of technical college. We meet monthly. And this is to me a best practice to just talk about what's going on in our areas and how we can help improve the community. And when you start to develop those relationships, that's when you could start to get things up. You don't want your first conversation with the superintendent schools to be an ask.

00:12:04:29 - 00:12:15:10
Jim Matney
So you're kind of going to start nurturing those relationships with them so that when you do come up with an idea that you're familiar and that they're willing to work with you.

00:12:15:12 - 00:12:30:05
Elisa Arespacochaga
Well, you answered my last question before I even asked it, which is what advice you have for your rural communities who want to build these programs. And I think that's a great point. To leave it on is really you got to look outside your walls and connect with the people who are doing the work.

00:12:30:07 - 00:12:52:24
Jim Matney
I believe in giving back to the community. So to work here, to work at the hospital, you have to put one hour a week in for volunteer work if you're a leader. So and we log it, we put it on a sheet. So we hold people accountable. So every one of my leaders, including all my directors, have to go out to some not for profit or some organization.

00:12:52:27 - 00:13:15:10
Jim Matney
It can be church related because we have to let people do it, but we try to go to the food bank, we try to go to the hero house, all those different ones, and we put volunteers. So they have to do 48 hours a year of volunteer work to be eligible for a raise every year. And that's a lot of times where I'm hearing that we've got food deserts.

00:13:15:10 - 00:13:48:27
Jim Matney
That's where I'm finding out that we've got a student that just needs a wheelchair, that basically can't seem to get funding for it, and of having all those leaders out and they have to come back once a month. We have each of those not for profits come into our leadership meeting and just talk about what's going on with their agency to see if there's people in that room that could get involved. And then all of a sudden people start to love their hospital because all of those organizations represents your community, and they've got somebody from your hospital tied into it.

00:13:48:29 - 00:14:06:05
Elisa Arespacochaga
Oh, I love that. I love that, you know, we do some volunteer hours as part of our work here at AHA and I love that you've brought that forward, that that because you are integral to Colquitt County, your leaders, your organization. And it's not just you as a leader, it's everybody on your leadership team.

00:14:06:10 - 00:14:12:29
Jim Matney
Yeah, you have to do it yourself. And I publish my volunteer hours every year too, so many hours I put in.

00:14:13:04 - 00:14:29:21
Elisa Arespacochaga
That's wonderful. Well, Jim, thank you so much for sharing just a slice of the amazing work you're doing in rural Georgia, and how you're really integrating your hospital into your community and to everything you do, and making sure you have the workforce now and into the future.

00:14:29:23 - 00:14:38:09
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:01 - 00:00:19:12
Tom Haederle
Welcome to Advancing Health. What does it take to make primary care the foundation of a more consumer focused health care system? In this episode, we explore how AdventHealth is transforming primary care by extending care beyond hospital walls.

00:00:19:15 - 00:00:34:22
Julia Resnick
Welcome to Advancing Health. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. I'm here today with Brent Davis. He's the chief executive officer of the primary health division of AdventHealth. We're here to talk about primary care transformation. Welcome to the conversation, Brent.

00:00:34:24 - 00:00:35:24
Brent Davis
It's great to be here.

00:00:35:29 - 00:00:44:24
Julia Resnick
So to set the stage, how do you see the current primary care landscape in the US, and what challenges or trends convinced you that you should be doing it differently?

00:00:44:27 - 00:01:14:00
Brent Davis
Primary care I think over the last several years, if not decades, have been forced to concede their role, their primary relationship with patients. It's come in the form of reimbursement challenges or even declines or cuts. It's come with then new entrants, point solutions and folks that are looking to eat away and say, hey, you know, maybe I can do vaccines, maybe I can do your flu shot, maybe I can be your urgent solution, maybe I can be a virtual model.

00:01:14:00 - 00:01:32:04
Brent Davis
And so gradually that I think the confluence of those two have forced primary care providers to have to step back and other people coming in. And now you have this challenging dynamic where multiple people seem to quarterback and own that continuum and that consumer relationship.

00:01:32:10 - 00:01:40:07
Julia Resnick
And that's so counterintuitive because like, if you want to focus on prevention and keeping people healthy, you really need to expand primary care, not erode it.

00:01:40:09 - 00:02:02:09
Brent Davis
Exactly. Yeah. And that's why AdventHealth is so committed to expanding it. Just a few years ago, AdventHealth formed what we call the Primary Health Division, which is really designed to focus on those businesses that are outside the traditional acute four walls. What does that include? Includes urgent care, primary care, virtual care, home health hospice or so, and clinically integrated networks.

00:02:02:12 - 00:02:16:10
Brent Davis
That dedicated team, that dedicated strategy, dedicated capital has freed us up to think beyond the legacy hospital-centric view and expand some of these modalities for the communities that we are serving.

00:02:16:11 - 00:02:20:07
Julia Resnick
Yeah, and that's more of that, like health care system approach instead of just a hospital approach.

00:02:20:09 - 00:02:20:25
Brent Davis
Exactly.

00:02:20:27 - 00:02:25:03
Julia Resnick
So can you describe that model that you've built and what the strategic thinking was behind it?

00:02:25:04 - 00:02:54:28
Brent Davis
Hospital operators are running complex organizations. They're 24/7. They have thousands of people, often within those within that footprint. They're specialists. And there's a 24/7 emergency room. They have a busy and complex operating room schedule. Full transparency, I was a hospital CFO and grew through those ranks. Division CFO and I had a pretty clear understanding of how that business model worked, what a high performing hospital did and does.

00:02:55:04 - 00:03:25:18
Brent Davis
And I can tell you now, being on this side for the last few years, that I didn't spend any time really thinking about home health or around optimizing primary care, I knew I had to have it. I knew it was important, but it was important because it somehow fed my specialists who then filled up my OR. Or they were somewhere I could maybe decant some segment of my emergency room volume too, if necessary.

00:03:25:20 - 00:03:49:11
Brent Davis
I mean, maybe it was a transition of care clinic or something small, but it wasn't integral to my hospital based strategy. So AdventHealth, looking at this now over 50 hospitals, nine states, you know, what would it mean to operate some of these businesses outside the four walls, like in class competitors? Is there value in doing that? Is there a creative opportunity in those spaces?

00:03:49:11 - 00:04:28:15
Brent Davis
And it turns out there is. Secondarily to that or actually equal to that is AdventHealth really desires to be a preeminent, faith based, consumer focused clinical health care system. And that's only possible if we actually extend the continuum. And so the primary health division is, is really how can we operate those things we have, but also to extend outside the four walls along the full continuum from whether you need us in a virtual setting or a primary care relationship, a longitudinal relationship all the way through home health, transitioning out of your acute care stay and even end a life with our hospice services.

00:04:28:21 - 00:04:41:01
Julia Resnick
I want to tap into your CFO brain about this a little bit, because the financial side of it is a little bit trickier. So how do you make that value case that investing in primary care is the right thing for health care systems to do?

00:04:41:03 - 00:05:07:23
Brent Davis
Sure. We of been on a journey for these last few years to really enhance that value proposition across the board, so it's enhanced for our communities and consumers. It's enhanced for our physicians and APPs, it's enhanced for our team, and it's enhanced for the system. From a purely financial perspective, there are multiple reimbursement models, the largest being fee for service and value.

00:05:07:25 - 00:05:41:05
Brent Davis
The majority of our reimbursement comes through a fee for service model today. And in that work, we found a rich environment of opportunities to really enhance that primary care model. And bottom line up front, we've been able to take the support the subsidy just in in direct terms of a primary care physician and APP in half over the last couple of years, just because of, we've figured out how to engage the right people at the right point and give them systems to make that easy.

00:05:41:05 - 00:05:53:03
Brent Davis
And it's been exciting work. When we've cut that subsidy in half, it means we can afford to be twice the size. And that is a tremendous value equation to all those stakeholders I mentioned.

00:05:53:05 - 00:06:02:03
Julia Resnick
Fantastic. So I know that a key component of this is really consolidating primary care. Can you tell me about what that looks like and how they advance your vision?

00:06:02:07 - 00:06:38:03
Brent Davis
When we started this work, we found that a large number of our physicians and APPs were in small locations. You've probably driven through some of them. Some of the communities in or some of the neighborhoods in your community where you'll see almost it looks like a house and it'll say, well, Dr. so-and-so's office. AdventHealth, we purchased those. This came together over decades and we had a hodgepodge of locations across our communities. As we went through this work of saying, how can we make primary care more effective and more efficient,

00:06:38:04 - 00:07:07:05
Brent Davis
it turns out that scaling support resources, clinic resources, those are scalable, meaning that you need the same level of effort to support a location with one, two and three providers, as you do with seven, ten, 12, and 14. And at the same time, there's tremendous efficiencies to be gained both on an operating model, but also from a consumer standpoint, because then there's going to be someone there.

00:07:07:10 - 00:07:30:16
Brent Davis
If your provider's sick that day, you don't need to reschedule because their care team is there. If the physician or APP goes on vacation, it's okay because they have a large care team ready to really provide a high continuity experience during those just normal ebbs and flows of life and business. And so that's been an unlock for us.

00:07:30:16 - 00:07:46:03
Brent Davis
We've been blessed to be able to capitalize a number of new locations. And getting primary care people together, like any team, it brings energy. It brings focus. It brings really strong results. And so it's been exciting to see that come to life.

00:07:46:07 - 00:07:53:10
Julia Resnick
That's really fantastic. And I'm sure it's not just better for the providers, but better for patients who can have their whole care team in the same location.

00:07:53:11 - 00:08:16:13
Brent Davis
Right. Right! You know, like one thing, for example, I was talking to my grandma. She's 91, and she was talking about her primary care relationship on the West Coast and loves the clinic, great reputation. The community loves her physician and the care team. Love so many things about it. But she said it's really hard to call them.

00:08:16:16 - 00:08:33:27
Brent Davis
That's what she does. She doesn't have a lot of other tools that are disposable, so she calls and she gets routed to a call center. Now she may be calling in error, talking to a bot for all I know, but in her mind, she's calling a large central call center one that doesn't know her physician or her care team or her location.

00:08:33:27 - 00:08:58:11
Brent Davis
And so she'll get routed through that phone tree and that service and ultimately gets what she needs. But by putting this work together, we have now been able to bring phone calls back into each one of our practices. So when you call your practice, you're actually talking to someone at the front desk. It seems it's something we all grew up with, but today that's a rare find.

00:08:58:12 - 00:09:20:07
Brent Davis
And we've found that that really helps accelerate the connection and solutioning. Script refills. It helps reduce some of the inboxing. It helps people get in much faster than they ever were able to before, and were able to do that because we have enough size and scale in each one of our locations to accommodate that staff and that service.

00:09:20:10 - 00:09:23:03
Julia Resnick
And I'm sure it helps people feel better connected to their care team.

00:09:23:07 - 00:09:23:23
Brent Davis
They love it.

00:09:23:24 - 00:09:34:24
Julia Resnick
That's great. So continuing to think about like that patient perspective, what does the model look like and feel like as patients move through it? And how does that differ than how primary care was traditionally practiced?

00:09:34:27 - 00:10:03:11
Brent Davis
AdventHealth as a whole has a strong emphasis on consumerism. We believe that we are here entirely because of and for consumers. So we desire to make it easy to access and simple to use. Ultimately helping our consumers that we serve feel whole. That is our AdventHealth brand promise. In primary care that looks like you call your provider and sure enough, your location answers the phone and is likely able to connect you quickly and easily.

00:10:03:12 - 00:10:28:27
Brent Davis
We introduced a same day promise in 2025 and new patient wait times or current wait times, you know, I'd like to have a primary care provider, but I've never waited a month for my new patient appointment. So I don't have one when I get sick or when I need it. Other people said, hey, I'm finally sick and I'd like to see my doctor, but the first appointment I can get is four days or five days or seven days from now.

00:10:28:29 - 00:10:55:00
Brent Davis
I'll likely go to urgent care, I'll seek out virtual or something else. And so being able to get in access is such a huge part of meeting your consumers needs. That's been a big focus of ours. Once you're there, we've talked about this care team model, and we have different primary care models built for different consumer types. So the type of care that the primary care I wanted or needed in college is different than it is today.

00:10:55:00 - 00:11:21:21
Brent Davis
And that's different than my mom, who just turned 65. And it's different than my grandma, who's 91. And what we found is that people have gravitated towards several of our different primary care models. They've self-selected. And by honing in on what makes that model especially effective, especially efficient, we've been able to connect the right consumer with the right provider type in the right business model.

00:11:21:28 - 00:11:43:03
Brent Davis
That is a then a virtuous cycle. That flywheel starts to turn. So what we found is that by creating access overall, but then creating access to the right care with the right team, that's been really exciting. I'll just continue this because I'm so excited about this point. You know, you're at the dentist when after you're cleaning or even maybe they're still finishing up.

00:11:43:03 - 00:12:01:12
Brent Davis
Someone comes in and says, I'd like to schedule your next appointment. And when was the last time that happened in your doctor's office. It happens in the vet. It happens a number of other places. But for some reason, in primary care, it's been like, you know what, give us a call if you need anything, right? And so we've taken a proactive approach.

00:12:01:12 - 00:12:16:25
Brent Davis
And so when you're still in the room, we'll go ahead and book your next appointment. We'd like to see you again. Maybe it's to review your labs. Maybe it's true of you some of your imaging tests. Maybe it's hey, in another six months and another nine months. You know what? In 12 months, let's be back here and let's go ahead and make that happen.

00:12:16:28 - 00:12:39:22
Brent Davis
So we do that. Additionally, when you walk out, just like, you know, many other services, there's someone there to connect you to the next stop, not just to take your money, but hey, let's go ahead and add this on. Let's connect you to that next part of your care continuum. And so we now have referral coordinators in our primary care clinics that have the ability to direct book you into your specialist.

00:12:39:28 - 00:12:47:29
Brent Davis
Now we go ahead and make that easy. And they walk out saying, I have my three next appointments scheduled as well as my next touchpoint with my primary care provider.

00:12:48:00 - 00:12:51:07
Julia Resnick
I love that just reducing barriers that might prevent them from getting the care.

00:12:51:12 - 00:13:08:11
Brent Davis
That's it. Hold their hand. You know, like it's challenging enough. What a gift to be able to offer navigation and actual support, to say there's a plan that we've made together and we're going to make this easy for you.

00:13:08:15 - 00:13:16:16
Julia Resnick
Absolutely. So you've made all these changes. How are you? How are you measuring the impact that you're having? How do you know that this is the right direction?

00:13:16:17 - 00:13:41:13
Brent Davis
Sure. We've talked about the subsidy. So taking the support that the system has been putting into primary care. And that's cut in half. And we believe that there's more opportunities ahead, which allows for the amount of growth that we've already committed to. So really excited about just that cycle and the financial relationship and the resources that it takes to deliver this type of care at scale.

00:13:41:16 - 00:14:03:23
Brent Davis
Across other domains, we've looked at consumer engagement, consumer satisfaction, likelihood to recommend so are consumers happier in the new model compared to where they started? We were at the 51st percentile when we started this work. And that's right in the middle, right in that bell curve. And we had some locations that were good and some that weren't, but we were hovering right there.

00:14:03:27 - 00:14:29:12
Brent Davis
It's exciting that now we're consistently in the top quartile, sometimes even pushing mid 80, 85, 84 percentile. And that's really indicative of the of I think the solutions and the care models that has been brought to bear. From a clinical standpoint, we've really targeted blood pressure. That was something we said you know what can primary care own? There's so many content care conditions that are rolling through our clinics.

00:14:29:15 - 00:14:51:16
Brent Davis
Is there something that touches a large percentage of our population?. And blood pressure is one of those. And so we've been able to reduce high blood pressure and get people connected with that next step. It could be medication could be work with specialty. And so we've we feel like we've started to move the the dial on some clinical measures.

00:14:51:18 - 00:15:15:23
Brent Davis
We have some value based care measures that are headed in the right direction and starting to show it's starting to bear fruit. And, you know, the team engagement is really important too. So we've talked about consumer engagement, but the engagement of our physicians, our APPs and the front line practice managers practice the people that are picking up the phone, people that are building the building.

00:15:15:24 - 00:15:30:04
Brent Davis
All those team members are quantifiable, more engaged and happier with their time working with and for AdventHealth. And so I'm just very excited that across the domains, our work is continuing to bear fruit.

00:15:30:05 - 00:15:42:15
Julia Resnick
Amazing. It sounds like you're moving the needle in all the right dimensions. So to close, you've been doing this for a little while now. What words of advice do you have for other hospitals that are thinking about transforming how they're delivering primary care?

00:15:42:17 - 00:16:14:04
Brent Davis
When I think about the results that we've been able to drive across, the stakeholders that we've discussed for the consumer, for the physicians and APPs, for the team member and for the system at large, it really starts with the intention of the system to be a broader solution than we were before. As a hospital-centric system, before we had high performing hospitals and in great results to show for that.

00:16:14:04 - 00:16:43:06
Brent Davis
And yet we weren't able to show up as a more robust, full continuum solution. And so by giving primary health division the autonomy, the capital, the dedicated time and focus to create and deliver on a strategy to extend to those, whether you're in an urgent care or virtual care setting, all the way through end of life and hospice and all that in between, is what's been the unlock.

00:16:43:12 - 00:16:51:16
Brent Davis
And I'd encourage that systems and teams consider what that opportunity could potentially mean for their organizations.

00:16:51:18 - 00:17:01:29
Julia Resnick
Well, that is fantastic work. And I'm so just impressed with how you're reimagining what primary care can look like for your patients and for your communities. So thanks so much for chatting today. It has been an absolute pleasure.

00:17:02:04 - 00:17:04:10
Brent Davis
Pleasure is mine. Thank you.

00:17:04:12 - 00:17:12:28
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.

00:00:00:00 - 00:00:22:06
Tom Haederle
Welcome to Advancing Health. The leadership baton has passed into new hands at the American Hospital Association. In this month's Leadership Dialog podcast, Meet AHA President and CEO Steve Walsh, who describes his career path, his passion for health care, and his vision for supporting America's hospitals and health systems.

00:00:22:08 - 00:00:43:13
Marc Boom, M.D.
Greetings and thank you everyone for joining us today. I'm Mark Boom, I'm the president and CEO of Houston Methodist, and I'm the board chair of the American Hospital Association. As we continue our monthly discussions, we're going to shift our focus because today I am joined by AHA's new president and CEO, Steve Walsh. As you all know, Rick Pollack retired last month after several decades of wonderful leadership.

00:00:43:15 - 00:01:07:10
Marc Boom, M.D.
Rick reinforced AHA's strong foundation as a trusted voice and advocate for health care providers across the country. And as someone serving on the AHA board and participating in the selection of Rick's successor, I can tell you that the board has full confidence in Steve stepping into this role. And we're so excited about what is ahead for the AHA. Since Steve is now really entering, I guess, about his second month at the AHA

00:01:07:12 - 00:01:12:10
Marc Boom, M.D.
we thought this platform would be a great way to introduce him to all of you. So, Steve, welcome.

00:01:12:12 - 00:01:13:16
Steve Walsh
Thank you, Dr. Boom.

00:01:13:18 - 00:01:30:12
Marc Boom, M.D.
Steve, instead of me reading through what is a very impressive bio, I'd love to do this a bit less formally. Our viewers like to know a little bit about our guests, so I'd like to begin by asking to share a little bit about yourself, your career journey, what brought you this point, major influences, your life, etc.

00:01:30:14 - 00:01:48:18
Steve Walsh
Thanks. And you know, thanks to you and the board for the faith and the confidence in me, and certainly to my friend Rick for a tremendous career and would an exceptional person and benefit he's been to me through this transition. So appreciate all of his work and the legacy that he leaves behind at AHA. But, I'm excited to be here.

00:01:48:18 - 00:02:09:02
Steve Walsh
You know, as you well know, I'm from a a city north of Boston. A little gritty city called Lynn, Massachusetts. And, I grew up in a household that I, I felt like was at the intersection of health care and politics. You know, my mother was a nurse who then ultimately ran for city council, and she served for 22 years before moving on to work at our local health center.

00:02:09:04 - 00:02:28:13
Steve Walsh
And she really taught us the importance of health care, but also what it means to a community and the importance of public service. I was able to follow in her footsteps and run for a state representative, where I served six terms in the Massachusetts legislature and ultimately was honored to chair healthcare finance there. And our world kind of changed.

00:02:28:13 - 00:02:56:03
Steve Walsh
We had had one son, our oldest and then had twins and our twin B, Miles, was born with a heart condition. And that was really the change for me, where the public policy that I was working in healthcare became the vocation of healthcare and, ultimately left elected office to work with hospitals in Massachusetts and try to have a deeper understanding of the challenges that that all of our hospital leaders face.

00:02:56:03 - 00:03:19:12
Steve Walsh
I mean, thankfully, Miles is healthy 15 year old today. He's had ten open heart surgeries and, lived with him for 130 nights in the hospital he was born in. And kind of gave me a love of hospitals. I just kind of loved watching how they work and visiting them and really trying to understand how they best can serve patients and the communities that they reside in.

00:03:19:12 - 00:03:50:08
Steve Walsh
And so, you know, this has been really the honor of a lifetime to have an opportunity here. After the legislature, I served at the Massachusetts Health and Hospital Association for a decade and got to see firsthand the important work that all of you do each and every day. Having a chance to work with all of you and our local colleagues through the Covid 19 pandemic and our workforce shortage, financial pressures, it just shows what hospitals mean to their community and what can happen when we work together.

00:03:50:08 - 00:03:55:12
Steve Walsh
And that's just the kind of excitement and energy that, you know, I want to be able to bring to this role.

00:03:55:14 - 00:04:17:09
Marc Boom, M.D.
Well, I love your story. I'm so sorry you had to go through that 130 nights and that your son had to have ten, ten surgeries. But thank goodness for the amazing people in hospitals who were able to care for him and bring him to the point where he's now a thriving, healthy 15 year old boy, right? Probably making you pull your hair out a little bit like most 15 year-olds do, I suspect.

00:04:17:09 - 00:04:28:16
Marc Boom, M.D.
So love to have that story. And your grounding to the passion and purpose of why we're all in healthcare. That means a lot to us with you helping lead the hospital association.

00:04:28:18 - 00:04:49:14
Steve Walsh
Yeah. He's a goalie on his high school JV soccer team now, you know, couldn't be a happier kid. He reminds us every day the miracles that are that our members perform for the patients that they serve. So you're right. It keeps us grounded, puts everything perspective and, frankly, just shows how important it is that we preserve the mission of what all of our members are working towards every day.

00:04:49:16 - 00:05:13:03
Marc Boom, M.D.
Amen. And there's stories like him over and over and over, across our hospitals, across this great United States and these wonderful hospitals and teams. So we're so grateful to all of them. So speaking of that, then as we look to enhance our field, our profession, to really focus our sacred mission of caring for people like your son and so many others, what are your immediate priorities and goals that you have set as you step into this role

00:05:13:07 - 00:05:15:14
Marc Boom, M.D.
to lead the American Hospital Association?

00:05:15:16 - 00:05:36:15
Steve Walsh
Well, the first goal is really pretty simple is to continue to serve the mission of AHA and how hospitals do what they do best, serve the patients and communities. And, our members do it better than anyone else. But the priority to reach that goal is really to listen, listen to our members, listen to the AHA staff, our elected leaders in DC and around the country.

00:05:36:17 - 00:05:55:02
Steve Walsh
There are so many exciting opportunities ahead for our field and for our hospitals. But I'm trying to reduce that or I try to resist that initial temptation to move too quickly and really want to understand the pressures that all of you are facing so that we can craft a good strategic plan for our future.

00:05:55:07 - 00:05:58:17
Marc Boom, M.D.
So you've already been on a listening tour, I understand, right?

00:05:58:19 - 00:06:18:07
Steve Walsh
Yeah, I've done, Georgia, Wyoming. The team in Chicago, the team in DC, Ohio. And you know, it continues, on to California and Texas in the next couple weeks. And it's just so exciting to be able to see what's happening out in communities and how people are continuing to do extraordinary work each and every day.

00:06:18:07 - 00:06:31:17
Steve Walsh
And as you well know, and you've been in a number of and run them successfully, you've been in one hospital, you've been in one hospital. You know, they're all so unique in the services that they provide, the constituencies that they serve, and really how they run and operate within their local community.

00:06:31:19 - 00:06:46:13
Marc Boom, M.D.
Yeah, I know you and I were just a couple of weeks ago at the health systems meeting and that we had many leaders of a whole bunch of health systems there. I know you've already been to a couple of the regional policy boards as well, so if you haven't had a chance yet, people are listening today to meet Steve.

00:06:46:13 - 00:07:11:18
Marc Boom, M.D.
I know you will soon. And one of the things I love about you is how well you listen and, and are willing to hear differences of opinion and then embrace those differences of opinion, which there inevitably are. So, you know, there's many great things we do. There's also many challenges we face as a field. Talk about what you see right now as some of the greatest opportunities and also then some, some of the challenges.

00:07:11:20 - 00:07:31:04
Steve Walsh
It's a great question. And I you mentioned the difference of opinion. And, you know, I think similar to you and the team at AHA and the board that's currently comprised there, we love those differences, right? They make us better. I mean, those good conversations, that good dialog around the table, a little bit of healthy disagreement for the greater good.

00:07:31:08 - 00:07:59:06
Steve Walsh
It goes a long way to crafting better policy, better practices and ultimately better outcomes. You know, but we are facing challenges. I see the biggest challenge today is kind of creating the time and space for our hospitals to innovate and lead on what's next, right? There are so many challenges on the day to day among our hospital community, that I think the future of our health care delivery system is literally hanging in the balance.

00:07:59:08 - 00:08:19:23
Steve Walsh
But folks are so focused on the mission of the moment that it's really hard to look ahead and say how can we change the trajectory of healthcare? We all know it's expensive. We all know that it's crowding out other things for working families. And we all know our hospitals are under a lot of financial pressures and workforce pressures.

00:08:20:01 - 00:08:29:14
Steve Walsh
But I actually think our hospital community is the one that can solve it and innovative and create an opportunity for what the next generation of health care is going to look like in this country.

00:08:29:16 - 00:08:54:06
Marc Boom, M.D.
You say that very, very well. And there's sort of a balance of things that I hear in your statement for the hospitals themselves, ourselves. But also from the association standpoint, which is there's a blocking and tackling in the short term issues. We've got to deal with the, you know, the effects of and hopefully mitigation of the OBBA. We've got 340B to deal with if we get sight neutral, a bunch of other things like that that are dynamics that we're dealing with.

00:08:54:08 - 00:09:20:19
Marc Boom, M.D.
And we got to play long ball also at the same time, right. Because we all recognize that the system and I mean the broad US health care system as it's designed today and with some of the demographic changes that we're just seeing the beginning of right now and many other dynamics out there that probably this is not a sustainable structure and that I think I hear you say what I would say, which is the most logical conveners for that long ball, for that conversation, for that

00:09:20:19 - 00:09:31:22
Marc Boom, M.D.
how do you redesign things in a way that's sustainable are the hospitals and health systems and the clinicians who work within them. Because we are the people who are closest to the American people.

00:09:32:00 - 00:09:53:02
Steve Walsh
Yeah, there's no doubt about it. I mean, you know, you've heard me say before, the one thing that we all share in common is at some point, we're all patients. And so I have a firm belief that every person in an elected or appointed position of authority in this country wants the best for the patients that we serve. Might get mad at different ways and have different kind of approaches to it,

00:09:53:04 - 00:10:10:14
Steve Walsh
but this system was created 65 years ago, right? Where, you know, it hasn't necessarily evolved. And so there's going to be some fits and starts on the evolution of where we go from here. But the major difference, and this is the point that I think we have to convey to our elected leaders who I know want to do the right thing.

00:10:10:16 - 00:10:32:06
Steve Walsh
You all hospital leaders see these problems before anybody else does. You understand them better than anybody else. So it puts our hospital community in the best position to solve them. And I think AHA's job is to make sure that our members have the room and the resources and the voice to lead that conversation.

00:10:32:08 - 00:10:57:12
Marc Boom, M.D.
Perfect. Well, and within those members, we're very diverse. You know, all the way from rural to urban to safety net to governmental to, you know, many types of different hospitals, large, large systems, all the way down to tiny, small frontline critical access hospitals, etc., etc. and everybody in between. We all share the same common noble purpose, which is to care for humanity.

00:10:57:12 - 00:11:14:23
Marc Boom, M.D.
And so we have that in common. But sometimes there are differences and some things are good for some, not as good for others. How do you see that challenge, playing itself out? And how do we elevate our collective voice even when we have some of those differences?

00:11:15:01 - 00:11:36:14
Steve Walsh
This is the hardest question that we in the association world will ever answer. And I think that under your leadership and under the board's leadership, I see this board as a group that's ready to have that conversation. Access in the middle of the country might be that people can't get to care where access on the coast might be, that people can't get in to receive that care.

00:11:36:16 - 00:11:54:20
Steve Walsh
There are different problems, but we want the same thing. And I think for our hospital members, it's trying to recognize that having unity of the field doesn't necessarily mean we have consensus, right? It means that we're unified at our common goal. And I always, you know, talked about the four seasons principle. At the end of the four seasons,

00:11:54:22 - 00:12:18:12
Steve Walsh
are we better off than we were at the beginning? Every person might not win on every issue. But cumulatively, after we've run a cycle, can we say we're better off than where we started and kind of be in it for the common good and have people trust that, hey, if I'm going to give up a little something today, I know that tomorrow there may be an issue or might then it be more beneficial to me than it is some of my colleagues around the country.

00:12:18:12 - 00:12:47:08
Steve Walsh
And you talked about it at the system leaders retreat. We have a very real problem where we have some very large systems and some very small rural hospitals. They want the same things, but oftentimes are operating without the same resources. And that's going to be something we have to grapple with. But the major difference between all of the other folks that are coming into community to provide care that aren't connected to the hospital community, they don't have the same commitment to the city that they're in, the town they're in, the area that they're in.

00:12:47:10 - 00:13:14:02
Steve Walsh
They don't have the same philanthropic approach to the way they do business. They don't provide the same community benefit. And so we ought to make job number one, trying to preserve the way our hospitals have contributed and how our communities have benefited from their presence for 100 and something years. I mean, that's really the secret sauce that hospitals have that no one else will ever replicate. One: they don't want to, they're not willing to make that commitment.

00:13:14:04 - 00:13:32:23
Steve Walsh
It's a different goal. And I think our goal makes a lot of sense. And we start to explain that to the patients and the people that use our services. They get it. They know their local hospital community, they know their local hospital leaders. And I don't think anybody else can replicate that. And if that means we have to convince some of our colleagues that we have to play the long game and make some difficult choices for the greater good,

00:13:33:01 - 00:13:40:10
Steve Walsh
I know under your leadership, you'll work very hard to do that, and the rest of the board will as well. And I like our chances to get to a very positive place.

00:13:40:12 - 00:13:58:17
Marc Boom, M.D.
But the alternatives, of course, try to do nothing and just maintain the status quo. That probably is going to collapse under its own weight at some point in time. And so I think all of us are behind you in saying, let's find those proactive solutions that can help human beings that we care for. So you came from Massachusetts.

00:13:58:19 - 00:14:15:22
Marc Boom, M.D.
And, you know, Massachusetts is very different than how big, I don't know, Texas, for example, and very different than California and etc., etc.. right. We've got all the great states, yet you have quite a bit of national experience as well. Talk a little bit about being involved across the different state associations.

00:14:16:00 - 00:14:47:09
Steve Walsh
Yeah. Well, I've really learned so much from, from my colleagues in other state associations. We share a national group together and get together twice a year. And, you know, frankly, I've learned more from my colleagues around the country than from anyone else throughout my career. I mean, they're doing some amazing things. And when we think about some of the challenge federally, right, the only way to really make positive change is by creating allies and by having broad based groups that come together for the common good.

00:14:47:09 - 00:15:07:06
Steve Walsh
The same thing that I would ask of our members is what I would expect for myself. So when, you know, we were going through some of the challenges and looking at the impacts of federal changes, we're working with Colorado and Texas and South Carolina because, again, we all want the same thing. I said, you know, look, I fully appreciate I was born in Massachusetts.

00:15:07:06 - 00:15:25:04
Steve Walsh
You know, where were the first two places I went after I was, you know, fortunate enough to get this role? Georgia and Wyoming. We talked about that, I mean, I want to make sure that we're learning from all of our colleagues around the country. And I've worked really hard over the course of the last few years through our national group to make those connections and make those networks.

00:15:25:04 - 00:15:46:15
Steve Walsh
And I think the really good leaders, you certainly being one of them, understand a simple fact. We're in the people business more than anything else. It's about relationships. And I really have an intellectual curiosity about my colleagues, about the people that serve, about how they've achieved their success. And I think every conversation is an opportunity to learn. And so I love traveling around the country.

00:15:46:15 - 00:16:08:21
Steve Walsh
I love traveling and working with my colleagues on things that, you know, are interstate. I mean, the reality of care, and you see it with the payer groups, you see it with farmer, and you see with providers. We're not isolated to one state anymore. Things are happening over state lines. And, we have a responsibility to work with people around the country for success and ultimately for survival.

00:16:08:23 - 00:16:44:17
Marc Boom, M.D.
One of the things we did very significantly, is obviously check you out during the interview process, everything else. One of the things that always resonated with me a lot was as I talk to other leaders across multiple states, and very different states than, than, than Massachusetts, very similar in some ways to Massachusetts. To a "t" they told me how collegial you were, how able you were to work across party lines to see those differences, to embrace those differences of small state, big state, rural state, urban area, etc., etc., and embrace those and run with those and see those as a strength.

00:16:44:17 - 00:17:02:22
Marc Boom, M.D.
So I think the AHA under your leadership is going to be in a very, very good place going forward. So I want to bring things to a close, chat with you all afternoon here but I know people are going to need to move on. But I want to give you an opportunity to give me any of your final thoughts and particularly what excites you most as we look to navigate this future together?

00:17:03:00 - 00:17:23:17
Steve Walsh
Yeah. Well, first and foremost, just thank you again, both for the opportunity today and ultimately for, you know, this career opportunity which I'm so honored and privileged to be able to serve the AHA the and the board and your teams. You know, to think about the through line, about what really excites me about working in health care,

00:17:23:19 - 00:17:24:23
Steve Walsh
It's as I just said,

00:17:25:03 - 00:17:26:09
Marc Boom, M.D.
It's the people.

00:17:26:11 - 00:17:50:06
Steve Walsh
It's the staff at AHA. It's my colleagues around the country. It's you. It's the board of trustees. It's the people in our hospitals that show up every single day to care for our patients and live out the AHA mission. We always had a saying in my house growing up, always show up. And as you and I have talked about in a job of this magnitude, it means something different now.

00:17:50:06 - 00:18:11:22
Steve Walsh
It doesn't necessarily always show up in in person everywhere. It's too big, but it's always show up to bring our best for the people that rely on us every day to give them an opportunity to be successful. And I really believe if we keep investing in people, investing in our teams and showing up for people and really listening to them, that there's nothing we won't be able to do.

00:18:11:22 - 00:18:27:13
Steve Walsh
And I think the next iteration of health care is going to be done by us or to us. And I really trust the minds in the room at the AGA, the board of trustees and around the country that are delivering care every day to craft something that works for the people in this country and the patients that we serve.

00:18:27:13 - 00:18:52:02
Steve Walsh
And ultimately that makes healthcare, you know, the highest quality you possibly can at the most affordable price we can deliver it. I think that's our mission. That's our goal. And I think we're up for the challenge. And so I'm really excited about it. And I really, as I said to you, when you first called me about the role, you know, I want to go to work every day and work hard to be able to fulfill that mission for the AHA the people that rely on us for care because oftentimes they don't have anywhere else to turn.

00:18:52:02 - 00:19:12:14
Marc Boom, M.D.
That's a wonderful way to bring things to a close today. Really noble and magnificent aspirational goals there. And, and I have no doubt that under your leadership, the American Hospital Association is going to be wildly successful. And as you said, we're going to do things to help improve the care of people in the United States and beyond.

00:19:12:14 - 00:19:29:11
Marc Boom, M.D.
And I am just delighted to have spent this time with you, Steve. I know the rest of the field is so excited as well. So thank you to all of them and to our viewers. Thank you for finding the time to listen or watch today, and I'll be back next month for another leadership dialog conversation. Thank you so much.

00:19:29:13 - 00:19:37:21
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.