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RESOLVE-ing rural health care · A New Angle

• 0:00
  [music]
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  SPEAKER_02: This is A New Angle, conversations about how we're doing and where we're going.
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  SPEAKER_02: I'm your host, Justin Angle.
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  SPEAKER_02: This show is supported by the Headwaters Foundation,
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  SPEAKER_02: First Security Bank, and the University of Montana College of Business.
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  [music]
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  SPEAKER_02: Hey folks, welcome back, and thanks for tuning in.
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  SPEAKER_02: Today, I'm speaking with Danny Spoon,
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  SPEAKER_02: Bill Wright,
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  SPEAKER_02: Matt Fate,
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  SPEAKER_02: and Steph Goebel about a new initiative to improve rural
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  SPEAKER_00: healthcare in Montana.
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  SPEAKER_00: We're in a moment of significant transformation in healthcare.
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  SPEAKER_00: Every healthcare system is scrambling to transform itself into what
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  SPEAKER_00: the future is going to look like.
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  SPEAKER_02: The Resolve collaboration is a partnership between Providence and the University
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  SPEAKER_02: of Montana College of Health.
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  SPEAKER_02: Hey, thanks everyone for being here.
• 0:57
  SPEAKER_02: Thanks for having us.
• 0:58
  SPEAKER_02: Yeah, it's great to be here.
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  SPEAKER_02: We have a full house.
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  SPEAKER_02: Our first question is always, where did you grow up and what did your parents do?
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  SPEAKER_02: Steph, let's start with you.
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  SPEAKER_02: Yeah, I'm a Gray Falls girl, a Montana native, born and raised.
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  SPEAKER_02: And I grew up with a father that came to law school at the University of Montana
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  SPEAKER_02: after going to Berkeley, dragged my mom up from Berkeley.
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  SPEAKER_02: My dad's been a lawyer for ever since, loves it, will die at his desk.
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  SPEAKER_02: My mom has tried anything and everything under the sun.
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  SPEAKER_02: So I'm a mix of the two.
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  SPEAKER_00: Very good.
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  SPEAKER_00: Bill?
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  SPEAKER_00: I grew up in a town called Sturgis,
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  SPEAKER_00: South Dakota, which is a town of about 5,000 people for 51 weeks out of the year.
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  SPEAKER_00: Oh yeah, the bike rally.
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  SPEAKER_00: And 500,000 people for one week out of the year during the bike rallies, yes.
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  SPEAKER_00: My mother worked in retail and my dad was an installer of alarm systems.
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  SPEAKER_02: Matt?
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  SPEAKER_03: Yeah, I'm from St. Louis, Missouri, born in St. Louis.
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  SPEAKER_03: My dad is a pediatrician who indebted himself to the American Medical Association.
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  SPEAKER_03: So quickly after birth,
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  SPEAKER_03: a couple of years after birth,
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  SPEAKER_03: we moved to Utah, where he served out as a pediatrician in rural Utah.
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  SPEAKER_03: And my mom is a nurse.
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  SPEAKER_03: Excellent.
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  SPEAKER_03: It's a deep roots
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  SPEAKER_02: in health care.
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  SPEAKER_02: Danny.
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  SPEAKER_01: Yeah, born and raised in Missoula, Montana.
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  SPEAKER_01: My parents met at the University of Montana.
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  SPEAKER_01: My dad did law school here and my mom did pharmacy school here.
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  SPEAKER_01: So dad's a lawyer, mom's a pharmacist.
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  SPEAKER_02: We should probably just acquaint the audience to what you all do for work.
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  SPEAKER_02: Danny, let's start with you.
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  SPEAKER_02: Practicing physician, but also active in the leadership at Providence, right?
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  SPEAKER_01: Yeah.
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  SPEAKER_01: A day job is an interventional cardiologist.
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  SPEAKER_01: And then for the last year,
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  SPEAKER_01: I've been the acute chief medical officer for the Montana service area.
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  SPEAKER_03: Okay.
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  SPEAKER_03: Yeah, Matt Fate.
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  SPEAKER_03: I serve as the University of Montana's Dean
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  SPEAKER_00: for the College of Health.
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  SPEAKER_00: Bill.
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  SPEAKER_00: I'm the Chief Research Officer for the Providence System,
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  SPEAKER_00: so I oversee research and innovation for Providence Healthcare.
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  SPEAKER_00: Steph, you run philanthropy, right?
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  SPEAKER_02: I do.
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  SPEAKER_02: I'm a nurse by training and will always be.
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  SPEAKER_02: I think my husband will tell you I can't ever turn that off,
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  SPEAKER_02: but I am the chief philanthropy officer for Providence of Montana.
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  SPEAKER_02: Excellent.
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  SPEAKER_02: Okay.
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  SPEAKER_02: So before we get into Resolve and what that collaboration is all about,
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  SPEAKER_02: I'd love to just acquaint the audience to the problem that you all are trying
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  SPEAKER_02: to solve.
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  SPEAKER_02: Bill, let's start with you.
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  SPEAKER_02: Give us the state of play for rural healthcare.
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  SPEAKER_00: Yeah, rural healthcare is facing a structural crisis.
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  SPEAKER_00: We have supply and labor shortages.
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  SPEAKER_00: Healthcare is too expensive.
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  SPEAKER_00: We have a really hard time getting access to people,
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  SPEAKER_00: and that's especially true in rural communities.
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  SPEAKER_00: It's true everywhere, but it's really exacerbated in rural communities.
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  SPEAKER_00: And even beyond just those basic access pieces,
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  SPEAKER_00: I think a lot about like when I grew up in a rural community and
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  SPEAKER_00: when people got sick and neighbors would show up and they might show up with
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  SPEAKER_00: a casserole or they just come and plow your driveway.
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  SPEAKER_00: But whatever the space was that they thought you needed help, they just showed up in that space.
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  SPEAKER_00: And healthcare doesn't do that for our rural communities.
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  SPEAKER_00: We are not good at showing up in the way that those communities need us to show up.
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  SPEAKER_00: And so when we think about our ability to do like really great innovative things,
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  SPEAKER_00: we can do amazing things in healthcare in this country.
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  SPEAKER_00: But we're not good at doing them everywhere and we're not good at showing up in
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  SPEAKER_00: the way that every community needs us.
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  SPEAKER_00: And so that's a space that we're looking to try to bridge with resolve.
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  SPEAKER_02: So let's break that down a little bit.
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  SPEAKER_02: What's the nature of the problem?
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  SPEAKER_02: Is it simply access?
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  SPEAKER_02: People are spread out?
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  SPEAKER_02: Is it the supply of providers?
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  SPEAKER_02: What are some of the key variables that describe the crisis?
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  SPEAKER_01: Rural healthcare is out of crisis because of funding.
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  SPEAKER_01: Work power, recruitment, retention.
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  SPEAKER_01: It's lonely in a lot of areas to practice rural medicine.
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  SPEAKER_01: And the collaborations that you get
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  SPEAKER_01: at large academic centers aren't inherently present in rural communities.
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  SPEAKER_01: And so it's sometimes harder to get and keep people in those areas.
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  SPEAKER_01: You know,
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  SPEAKER_01: we're always talking about one of the things is that you're never going
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  SPEAKER_01: to hire your way out of the crisis in rural America.
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  SPEAKER_01: And so we've got to be creative and we've got to be very collaborative.
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  SPEAKER_01: And that's sort of the center of what RESOLVE stands for.
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  SPEAKER_02: And Matt,
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  SPEAKER_02: as somebody who leads an institution that produces a ton of clinicians,
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  SPEAKER_02: is keeping the graduates of all the different programs in the College of Health in
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  SPEAKER_02: the state of Montana a challenge?
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  SPEAKER_03: It is a challenge, and it's also a priority, and we do a really, really good job at that.
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  SPEAKER_03: If you look across the state to see who's leading in healthcare,
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  SPEAKER_03: whatever field,
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  SPEAKER_03: whether it be pharmacy,
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  SPEAKER_03: physical therapy, medicine, they're They're oftentimes UM grads.
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  SPEAKER_03: As a matter of fact, most of the time they're UM grads.
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  SPEAKER_03: And so Montanans care a lot about Montana and our students generally come to
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  SPEAKER_03: the University of Montana to practice in Montana.
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  SPEAKER_03: And most of the students we educate are from Montana.
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  SPEAKER_03: So it's a natural fit.
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  SPEAKER_03: Part of that educational enterprise includes Providence.
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  SPEAKER_03: St. Pat's in particular Provides experiential rotations and clinical training
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  SPEAKER_03: for almost all of our students.
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  SPEAKER_03: And so this sort of next step where we do health care together
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  SPEAKER_03: and do research what's really, really important for rural communities is natural.
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  SPEAKER_02: We've referenced resolve, but let's just define it.
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  SPEAKER_01: You know,
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  SPEAKER_01: I was fortunate to spend a large portion of my training,
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  SPEAKER_01: I don't know,
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  SPEAKER_01: about 15 years at the Mayo Clinic,
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  SPEAKER_01: and we came home after that because Montana matters.
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  SPEAKER_01: What does the University of Montana,
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  SPEAKER_01: Providence St.
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  SPEAKER_01: Patrick Hospital in collaboration look like,
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  SPEAKER_01: and how can we do more using that for the people of Montana?
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  SPEAKER_01: And so that's how it started.
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  SPEAKER_01: And then it really didn't take off until we got the horsepower of
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  SPEAKER_01: the Providence system and Dr.
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  SPEAKER_01: Bill Wright and philanthropy and all of the things that are really unique
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  SPEAKER_01: that you've got to bring together to create the infrastructure.
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  SPEAKER_02: So Bill, describe the opportunity as you see it.
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  SPEAKER_02: My understanding is there's a data exchange,
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  SPEAKER_02: there's some supply of clinicians, there's access to clinical trials.
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  SPEAKER_02: What is the nature of the collaboration?
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  SPEAKER_00: How do you scope it?
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  SPEAKER_00: We have over a million patients who are rural patients across our seven-state footprint.
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  SPEAKER_00: We see a lot of patients every day who live in these communities,
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  SPEAKER_00: and every day we try different things.
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  SPEAKER_00: There are natural experiments happening every day out in those communities.
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  SPEAKER_00: Doctors are working with patients to solve problems,
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  SPEAKER_00: to address health challenges in those contexts.
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  SPEAKER_00: And data is being produced about it worked, it didn't work, it went well, it didn't go well.
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  SPEAKER_00: And one of the things we realize is that we are sitting
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  SPEAKER_00: on this incredible learning engine about what can work and what doesn't work well
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  SPEAKER_00: for rural communities.
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  SPEAKER_00: But most of the folks who work in Providence have full-time jobs delivering care.
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  SPEAKER_00: So we needed a partner who could take a look at that and say,
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  SPEAKER_00: what lessons can we extract out of that that are helpful lessons for what works?
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  SPEAKER_00: We also needed a partner who could engage in those authentic conversations
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  SPEAKER_00: with those communities about what problems they needed to solve and to help us kind
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  SPEAKER_00: of really think about how to work In collaboration with those communities closely
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  SPEAKER_00: to put the data to work to answer questions that actually matter on the ground
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  SPEAKER_00: for those communities.
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  SPEAKER_00: And that's where this relationship has been such a transformative one because all of
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  SPEAKER_00: that expertise exists in the Montana University System and the College of Health
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  SPEAKER_00: at U of M.
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  SPEAKER_01: So one of the big things about rural healthcare is there's an enormous amount
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  SPEAKER_01: of untreated disease existing out in these communities.
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  SPEAKER_01: So how do you diagnosis,
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  SPEAKER_01: access it,
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  SPEAKER_01: and then get it treated so we can continue to provide a really good quality of life
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  SPEAKER_01: and increase the length of life to just some really amazing people
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  SPEAKER_01: that don't really complain.
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  SPEAKER_01: It's a large population of people that only come to you when something's really wrong.
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  SPEAKER_01: So how do we access them sooner?
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  SPEAKER_02: That would seem like a huge part of the plot here, this idea of preventative care.
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  SPEAKER_02: If there's fewer providers and the distance between providers is greater,
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  SPEAKER_02: then it just ...
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  SPEAKER_02: Yeah, the opportunities for folks to interact with a provider are just so fewer.
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  SPEAKER_02: And that would eliminate so many opportunities for detection,
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  SPEAKER_02: preventive care alert,
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  SPEAKER_02: early diagnosis,
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  SPEAKER_02: the sorts of relationships I assume clinicians encourage in their patients.
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  SPEAKER_02: What are some innovations that you dream about that this partnership could create
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  SPEAKER_02: to address some of those challenges?
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  SPEAKER_01: So in healthcare, touch points matter.
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  SPEAKER_01: So how many times you touch the system?
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  SPEAKER_01: Is it a blood pressure draw?
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  SPEAKER_01: Is it a pharmacy visit?
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  SPEAKER_01: So the more you can engage and touch the system, the better we can do.
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  SPEAKER_01: And you're exactly right.
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  SPEAKER_01: In our rural communities,
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  SPEAKER_01: and it's getting scarier because a lot of critical access hospitals are on
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  SPEAKER_01: the brink.
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  SPEAKER_01: You don't have those touch points.
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  SPEAKER_01: And so I think you just nailed that.
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  SPEAKER_01: And then I'll defer about some of the technologies.
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  SPEAKER_00: Sure.
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  SPEAKER_00: I mean, so then taking advantage of whatever information you can collect
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  SPEAKER_00: at those touch points and getting the most information you can about what people are
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  SPEAKER_00: at risk for and what you need to do about it is really important
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  SPEAKER_00: because people aren't going in as often, right?
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  SPEAKER_00: So one example that we've been working on is a project And it's an AI-assisted model
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  SPEAKER_00: that takes EKG data,
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  SPEAKER_00: which is the sort of like heart monitor that everybody sees on TV all the time.
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  SPEAKER_00: And it looks at the underlying electronic signals that those scans represent.
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  SPEAKER_00: And it's able to see things in that data that humans can't see when they look at that data.
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  SPEAKER_00: And one of the things we've been able to show is that it's able
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  SPEAKER_00: to predict how likely you are to die of an unexpected heart attack in
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  SPEAKER_00: the next six months, right?
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  SPEAKER_00: So if you go in for a checkup, And you get a regular checkup.
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  SPEAKER_00: We may not know that you have risk.
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  SPEAKER_00: You may be getting care, and that's great.
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  SPEAKER_00: Or you may have undetected risk.
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  SPEAKER_00: These models can see what's going on structurally in the heart that might predict
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  SPEAKER_00: that you're at risk and can tell you, like, This is information you should have.
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  SPEAKER_00: You're at accelerated risk and we can then divert you into a program
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  SPEAKER_00: that might be able to prevent that heart attack from happening in the first place.
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  SPEAKER_00: So if we can get more information out of the visits we do have through tools like
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  SPEAKER_00: that,
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  SPEAKER_00: we're able to understand which patients are at risk and let them know early so
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  SPEAKER_00: that they can take proactive action
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  SPEAKER_00: or alternately let them know like things look pretty good,
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  SPEAKER_00: you know, go back to work on the ranch and don't worry about it.
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  SPEAKER_02: Is that something that can be deployed remotely,
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  SPEAKER_02: or do you have to be in a specific place to have access to that sort
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  SPEAKER_02: of intervention, if
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  SPEAKER_00: that's the right term?
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  SPEAKER_00: We're working on strategies to take it out into communities.
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  SPEAKER_00: Right now,
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  SPEAKER_00: the version that we have is something that might happen in a doctor's office or
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  SPEAKER_00: an ED.
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  SPEAKER_00: But we're also working on a version of that same model and that we could put
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  SPEAKER_00: in place as a community screening device using something as simple as an iPhone and
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  SPEAKER_00: a little thing you plug into it at a very low cost.
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  SPEAKER_00: You can get the device on Amazon for under $100.
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  SPEAKER_00: We could imagine a future where you put those in libraries and other places and communities.
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  SPEAKER_00: People can come in,
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  SPEAKER_00: get a quick scan,
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  SPEAKER_00: get some information about their risk level that can go to their doctor
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  SPEAKER_00: and they can take action if necessary.
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  SPEAKER_02: It's empowering the patient.
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  SPEAKER_02: It's giving that the little black bag back to the patient in some sense.
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  SPEAKER_02: But it's also as a provider that might have a 2 a.m.
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  SPEAKER_02: shift with two other,
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  SPEAKER_02: you know, maybe a physician on call and one other nurse in the clinic.
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  SPEAKER_02: The idea that you have the safety net of AI to help you.
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  SPEAKER_02: I have too many friends across the state in the nursing field who have left it to go
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  SPEAKER_02: into other things because they lost a patient because they didn't have
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  SPEAKER_02: that safety net.
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  SPEAKER_02: They had to make somewhat of a subjective It's not replacing the providers themselves.
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  SPEAKER_02: It's giving them a network,
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  SPEAKER_02: an invisible network of safety, which is pretty incredible for rural communities.
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  SPEAKER_02: That's a particularly sanguine frame for AI, but I get it and I'm on board in this context.
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  SPEAKER_02: So thank you for sort of lifting my spirits around AI.
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  SPEAKER_01: Well, no,
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  SPEAKER_01: and I think what I love about that is we talk a lot about the democratization
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  SPEAKER_01: of health care.
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  SPEAKER_01: How do we provide everybody the same level of tools that you would get at a Mayo Clinic?
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  SPEAKER_01: And that's where technology, we think, becomes very important.
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  SPEAKER_01: But it's not technology built outside and then handouts.
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  SPEAKER_01: And so when we look at AI, AI can be everything and nothing.
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  SPEAKER_01: But when we started talking about this,
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  SPEAKER_01: we said, you know, we're never going to hire our way out of
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  SPEAKER_01: The crisis in rural healthcare.
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  SPEAKER_01: So it is a particularly useful tool as can we use large data models to help
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  SPEAKER_01: with make decisions in communities that normally don't have access to
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  SPEAKER_01: that knowledge.
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  SPEAKER_01: That's where we get really excited.
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  SPEAKER_03: And AI can't do healthcare, right?
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  SPEAKER_03: And so this is a tool that later bears human contact.
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  SPEAKER_03: And so the other thing we talked quite a bit about is,
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  SPEAKER_03: what is the medical contact point post innovation?
• 13:26
  SPEAKER_03: Sure.
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  SPEAKER_03: And there's great opportunities for that.
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  SPEAKER_03: Telemedicine, remote care.
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  SPEAKER_03: And the human doesn't have to be in place, but there has to be access to expertise in place.
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  SPEAKER_03: And there's so many different ways to do that today.
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  SPEAKER_00: If you think about what it's really doing and what we're trying to do when we think
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  SPEAKER_00: about AI,
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  SPEAKER_00: you're making the collective wisdom of all of those humans delivering care
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  SPEAKER_00: in all those communities available to every other caregiver, right?
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  SPEAKER_00: So if you had a patient in front of you,
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  SPEAKER_00: like Steph was just describing,
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  SPEAKER_00: and you could call every other doctor in our system and say, hey,
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  SPEAKER_00: when you've had patients who look like this patient,
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  SPEAKER_00: what did you do next and how did it go?
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  SPEAKER_00: And then put all that together and understand what that tells you about what to do
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  SPEAKER_00: with this patient.
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  SPEAKER_00: If you could do that, that'd be a very powerful thing.
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  SPEAKER_00: That's the kind of thing AI can do.
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  SPEAKER_02: We'll be back to my conversation with the Resolve team after this short break.
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  SPEAKER_02: A New Angle would not be possible without the generous support of
• 14:22
  SPEAKER_02: the Headwaters Foundation,
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  SPEAKER_02: working side by side with Western Montanans to improve the health
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  SPEAKER_02: of our communities.
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  SPEAKER_02: And you can't do that sort of work without access to capital and education,
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  SPEAKER_02: two critical catalysts offered by First Security Bank and the University
• 14:37
  SPEAKER_02: of Montana College of Business.
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  SPEAKER_00: Hi, this is Joe Anderson.
• 14:41
  SPEAKER_00: I am the CEO of Reflex Protect, and you're listening to A New Angle.
• 14:50
  SPEAKER_02: Welcome back to A New Angle.
• 14:51
  SPEAKER_02: I'm speaking with a team leading Resolve, an effort to improve rural healthcare.
• 14:56
  SPEAKER_02: The word human has come up a few different times in the last few moments,
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  SPEAKER_02: and that seems like a really important concept in the sense of you have
• 15:05
  SPEAKER_02: to build trust for this to work.
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  SPEAKER_02: Our group here, we're in Missoula, one of the larger cities in Montana.
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  SPEAKER_02: We're talking about helping communities of tens or hundreds of people.
• 15:18
  SPEAKER_02: Talking about tribal communities, how do you build trust with those communities?
• 15:23
  SPEAKER_02: What aspects of resolve are designed to address that question?
• 15:27
  SPEAKER_03: I would say the people in place are our people.
• 15:31
  SPEAKER_03: They're UM graduates.
• 15:35
  SPEAKER_03: You mentioned tribal communities.
• 15:37
  SPEAKER_03: There's a great percentage of our residents who graduate from
• 15:42
  SPEAKER_03: the Family Medicine Residency of Western Montana who serve in tribal communities.
• 15:50
  SPEAKER_03: We have the Native American Center for Excellence in our School
• 15:53
  SPEAKER_03: of Pharmacy very focused on graduating pharmacists who return to Native communities.
• 15:59
  SPEAKER_03: And so UM is just embedded in Montana.
• 16:04
  SPEAKER_02: Resolve is an open door policy.
• 16:06
  SPEAKER_02: So if we have a provider who's working out in Browning,
• 16:11
  SPEAKER_02: Montana,
• 16:11
  SPEAKER_02: wants to be part of the Resolve network to build,
• 16:14
  SPEAKER_02: again, that support, They can join the team and start embedding.
• 16:18
  SPEAKER_02: And we're there to show up and listen,
• 16:21
  SPEAKER_02: not talk at them and figure out what specifically that community needs and how,
• 16:24
  SPEAKER_02: again, we build it to fit.
• 16:26
  SPEAKER_00: One of the things that Resolve is committed to is making sure
• 16:29
  SPEAKER_00: that those communities are not just downstream of innovation.
• 16:32
  SPEAKER_00: We are cultivating those ideas that they have and helping them find a path
• 16:37
  SPEAKER_00: to bringing that idea through,
• 16:38
  SPEAKER_00: getting the evidence behind it and scaling it out in order for it to have
• 16:41
  SPEAKER_00: an impact more broadly.
• 16:43
  SPEAKER_00: So it needs to be two directions.
• 16:45
  SPEAKER_00: And that way it's not an extractive relationship with those communities.
• 16:47
  SPEAKER_00: We're really going in to say,
• 16:49
  SPEAKER_00: we've got some stuff that can help you,
• 16:50
  SPEAKER_00: but also you've got a bunch of ideas that could help the world.
• 16:52
  SPEAKER_00: And like, how do we help you activate that direction as well?
• 16:55
  SPEAKER_01: The way that we've tried to build this is that we're not here to tell you what to do.
• 17:00
  SPEAKER_01: The content experts that understand the real struggles and the pinch points
• 17:03
  SPEAKER_01: in rural America are the people dealing with it every day.
• 17:05
  SPEAKER_01: But like we've said, they don't have enough human capital to even do all the work sometimes.
• 17:11
  SPEAKER_01: We look at Resolve as being the machinery that people can plug into that gives them
• 17:16
  SPEAKER_01: the horsepower to solve some of these things on their own and then translate that
• 17:20
  SPEAKER_01: through a system like Providence over seven states and an enormous amount
• 17:24
  SPEAKER_01: of rural communities.
• 17:25
  SPEAKER_02: So trying to drill down on this idea of innovation,
• 17:28
  SPEAKER_02: and Bill, you're describing sort of this top-down approach or a bottom-up approach.
• 17:33
  SPEAKER_02: Across the system,
• 17:34
  SPEAKER_02: since you look at research across the broad geography and many types
• 17:39
  SPEAKER_02: of institutions,
• 17:41
  SPEAKER_02: what's an example of a bottom-up innovation where somebody in
• 17:44
  SPEAKER_02: a rural community just figured out something new?
• 17:47
  SPEAKER_03: Maybe one of it is just who provides primary care.
• 17:51
  SPEAKER_03: The state of Montana is very progressive when it comes to who can take care of
• 17:56
  SPEAKER_03: a patient and what they can do.
• 17:58
  SPEAKER_03: And so one of the things we work on together
• 18:01
  SPEAKER_03: with Providence is collaborative practice agreements.
• 18:03
  SPEAKER_03: One of the proposals that has come through for A funding opportunity
• 18:06
  SPEAKER_03: through Resolve is can you put pharmacists in place and contact
• 18:10
  SPEAKER_03: with really expert specialty heart docs at Providence.
• 18:17
  SPEAKER_03: And so that doc doesn't have to be in place, but they have this very, very close relationship.
• 18:21
  SPEAKER_03: And so the pharmacist can treat as a primary care provider.
• 18:25
  SPEAKER_03: Physical therapists are receiving primary care providership in certain situations.
• 18:33
  SPEAKER_03: It's about networking.
• 18:35
  SPEAKER_00: Who is taking care of the patients?
• 18:37
  SPEAKER_00: So one of the things that we just started at Resolve was we want to be able
• 18:41
  SPEAKER_00: to make sort of seed funding available to innovators who are in communities
• 18:46
  SPEAKER_00: and invite them to send their idea to us and then be able To provide some support
• 18:49
  SPEAKER_00: to help them turn that idea into the next level of what it looks like to bring
• 18:52
  SPEAKER_00: that out and test it and take it through the model that gets it out into the world.
• 18:57
  SPEAKER_00: So we just put out our first call for proposals there.
• 19:01
  SPEAKER_00: We've got people submitting ideas and we want to be able to grow that program
• 19:05
  SPEAKER_00: over time so that it's not us deciding what are the projects that Resolve is going
• 19:10
  SPEAKER_00: to do.
• 19:10
  SPEAKER_00: It's the communities deciding what the projects are and bringing those in.
• 19:14
  SPEAKER_00: And then we're able to put some muscle behind the projects that That are gonna be
• 19:18
  SPEAKER_00: the most impactful for those communities.
• 19:20
  SPEAKER_02: I think a cool one that we've also resolves working on that did stem from
• 19:23
  SPEAKER_02: the field is pre-blood hospitalization.
• 19:27
  SPEAKER_02: And so we're working- Pre-blood hospitalization?
• 19:30
  SPEAKER_02: I don't know what that is.
• 19:30
  SPEAKER_02: Yeah, fair.
• 19:31
  SPEAKER_02: We are trying to get blood product out to those first responders.
• 19:35
  SPEAKER_02: Oh yeah, so like for transfusions and stuff.
• 19:37
  SPEAKER_02: Exactly.
• 19:38
  SPEAKER_02: So, I mean,
• 19:39
  SPEAKER_02: we have too many cases across the state of Montana
• 19:41
  SPEAKER_02: where we have these medical deserts and those patients
• 19:44
  SPEAKER_02: and those first responders We're working with bare minimal material,
• 19:47
  SPEAKER_02: maybe no cell phone connections.
• 19:50
  SPEAKER_02: And if we were able to get drones to deliver them because a helicopter can't get
• 19:54
  SPEAKER_02: through that snowstorm.
• 19:56
  SPEAKER_02: But if we could have drones drop off blood and start fusing,
• 19:59
  SPEAKER_02: the amount of lives and the status of the patient when they arrive to
• 20:04
  SPEAKER_02: the hospital just accelerates us to being able to literally save lives.
• 20:09
  SPEAKER_02: Fast forward five, 10 years.
• 20:11
  SPEAKER_02: What does a big win look like in your view, Danny?
• 20:14
  SPEAKER_01: I think we're seeing it.
• 20:14
  SPEAKER_01: We're building a community.
• 20:16
  SPEAKER_01: There's a lot of individual people out there in silos trying to do good stuff.
• 20:20
  SPEAKER_01: And so how do we bring those together under one architecture and inspire
• 20:24
  SPEAKER_01: So I think building that collaborative spirit with really the Rolodex of
• 20:26
  SPEAKER_01: who do I talk to and how do we connect is going to create the infrastructure
• 20:29
  SPEAKER_01: to do some really unique things.
• 20:49
  SPEAKER_03: Matt?
• 20:50
  SPEAKER_03: Anybody paying attention to federal health care right now,
• 20:52
  SPEAKER_03: there's a rural health transformation program that's $50 billion to the states.
• 20:59
  SPEAKER_03: And, you know, Montana got $233 million, which is the fourth most in the country.
• 21:03
  SPEAKER_03: For the next five years,
• 21:04
  SPEAKER_03: if we do rural health right,
• 21:06
  SPEAKER_03: we'll have an investment from the state to learn as much about and
• 21:10
  SPEAKER_03: to deliver rural health in the most exceptional way.
• 21:13
  SPEAKER_02: And is that federal funding mechanism part of the funding portfolio for Resolve?
• 21:17
  SPEAKER_03: Well, you know, the vision was we're going to do this no matter who funds it.
• 21:21
  SPEAKER_03: And they had great ideas on how to fund it.
• 21:23
  SPEAKER_03: And we funded the initial projects in that way.
• 21:26
  SPEAKER_03: And really it was philanthropy.
• 21:27
  SPEAKER_03: Montanans helping Montanans.
• 21:29
  SPEAKER_03: And we have taken that a long way.
• 21:32
  SPEAKER_03: But when opportunity presents, you have to grab a hold of that opportunity.
• 21:36
  SPEAKER_03: So we as a team can see what the state of Montana wants to accomplish for Montanans.
• 21:44
  SPEAKER_03: Just an incredible effect and opportunity to do that.
• 21:47
  SPEAKER_03: So it is now.
• 21:48
  SPEAKER_02: Steph, talk about the fundraising piece because that probably a lot of
• 21:51
  SPEAKER_02: that responsibility falls to you.
• 21:53
  SPEAKER_02: I joke that I have such an incredible job of getting
• 21:55
  SPEAKER_02: to connect these brilliant brains with the outer community who want to be inspired.
• 21:59
  SPEAKER_02: They want to give to a cause that's going to be multigenerational and huge impact.
• 22:04
  SPEAKER_02: I think the beauty of philanthropy being behind a lot of these projects is
• 22:08
  SPEAKER_02: that it is patient driven.
• 22:10
  SPEAKER_02: It doesn't have to be dependent upon commercial And industry driven,
• 22:15
  SPEAKER_02: it can be really what's best for the patients in those communities.
• 22:17
  SPEAKER_02: And we've been very,
• 22:18
  SPEAKER_02: very lucky that people are listening and they're raising their hands to be involved.
• 22:22
  SPEAKER_02: Excellent.
• 22:23
  SPEAKER_02: And Bill,
• 22:23
  SPEAKER_02: from a system wide standpoint,
• 22:25
  SPEAKER_02: what's the higher order view that Providence has on something like this?
• 22:30
  SPEAKER_02: I would imagine you have a pretty close eye on it.
• 22:32
  SPEAKER_00: We absolutely have a close eye on it.
• 22:34
  SPEAKER_00: In fact, we're in a moment of significant transformation in healthcare.
• 22:40
  SPEAKER_00: Every healthcare system is scrambling to transform itself into what
• 22:43
  SPEAKER_00: the future is going to look like,
• 22:44
  SPEAKER_00: and innovation is happening all over healthcare right now.
• 22:48
  SPEAKER_00: There's cell and gene therapies emerging,
• 22:50
  SPEAKER_00: there's AI coming in, there's all of these breakthrough things happening.
• 22:53
  SPEAKER_00: Health is going to look very different in five to 10 years than it does now.
• 22:57
  SPEAKER_00: And as we go through that transformation,
• 22:59
  SPEAKER_00: when we think about resolve,
• 23:01
  SPEAKER_00: this is actually the fabric of how we want to do that transformation.
• 23:04
  SPEAKER_00: Because we could do it the old way,
• 23:06
  SPEAKER_00: which is,
• 23:07
  SPEAKER_00: you know,
• 23:08
  SPEAKER_00: maybe it's universities and academic medical centers like playing with these ideas
• 23:11
  SPEAKER_00: or they get deployed in the specialty center in Seattle or Portland and
• 23:15
  SPEAKER_00: then slowly maybe make their way out into rural communities.
• 23:18
  SPEAKER_00: Maybe they fit, maybe they don't.
• 23:20
  SPEAKER_00: Or we could do it a different way where we design those things from day one,
• 23:23
  SPEAKER_00: from day zero in partnership with those rural communities so
• 23:27
  SPEAKER_00: that we know it's designed to fit and work with the way that real world care works
• 23:30
  SPEAKER_00: in those communities.
• 23:32
  SPEAKER_00: So when I think about Resolve,
• 23:33
  SPEAKER_00: I don't think of it as sort of an additional thing that we're keeping track of.
• 23:36
  SPEAKER_00: It's actually the fabric of how we're going to innovate as we move forward to build
• 23:41
  SPEAKER_00: the delivery system of the future.
• 23:43
  SPEAKER_02: If there's a clinician out there or a patient even or somebody that's just like,
• 23:47
  SPEAKER_02: hey, this is for me, I want to get involved, Matt, where would you point them?
• 23:51
  SPEAKER_03: You can come straight to me.
• 23:52
  SPEAKER_03: I'm easy to find.
• 23:53
  SPEAKER_03: You know, the last name is F-E-T-E. My email's online.
• 23:57
  SPEAKER_03: Please reach out and I can connect you to our group.
• 24:01
  SPEAKER_03: I chair the steering committee for Resolve.
• 24:03
  SPEAKER_03: I co-chair with a colleague at Providence.
• 24:06
  SPEAKER_03: And so we can hook them in right into Providence data very quickly and move
• 24:11
  SPEAKER_03: on together in collaboration.
• 24:13
  SPEAKER_02: Let's shift gears in our remaining moments here and just subject you to
• 24:17
  SPEAKER_02: the question we ask all guests to close and tell us about
• 24:20
  SPEAKER_02: the last time you changed your mind.
• 24:21
  SPEAKER_02: Danny, why don't you take that first?
• 24:23
  SPEAKER_01: You know, I think it's daily and I think you go into a patient room and you go into a procedure.
• 24:28
  SPEAKER_01: And you think you have a plan and then all of a sudden you need to do something different.
• 24:31
  SPEAKER_01: And so I think what we've tried to build is that mentality of we don't know everything.
• 24:37
  SPEAKER_01: We're going to put together a really good team.
• 24:38
  SPEAKER_01: And just like we take care of patients as you're going to make decisions that make sense.
• 24:43
  SPEAKER_01: And it requires you being pretty flexible and pretty understanding of different environments.
• 24:48
  SPEAKER_02: Wonderful.
• 24:49
  SPEAKER_02: Matt.
• 24:50
  SPEAKER_03: Yeah, I'll share a personal fun one.
• 24:52
  SPEAKER_03: My wife works at St. Pat.
• 24:55
  SPEAKER_03: She's a nurse, and she had to work at 7 this morning.
• 24:57
  SPEAKER_03: And we were in Grand Junction,
• 24:58
  SPEAKER_03: Colorado yesterday,
• 25:00
  SPEAKER_03: and she let me know we had to leave pretty early so she could get the proper amount
• 25:04
  SPEAKER_03: of sleep.
• 25:05
  SPEAKER_03: And so I changed my mind on leaving early and got a nice mountain bike ride in Grand Junction.
• 25:11
  SPEAKER_03: Oh, very good.
• 25:11
  SPEAKER_03: All right.
• 25:12
  SPEAKER_03: And so we got home later.
• 25:14
  SPEAKER_02: Is she speaking to you?
• 25:15
  SPEAKER_02: Yeah.
• 25:15
  SPEAKER_02: Yeah.
• 25:16
  SPEAKER_02: Yeah, she got to work on time.
• 25:18
  SPEAKER_00: She did, yes.
• 25:19
  SPEAKER_00: Yeah, very good.
• 25:21
  SPEAKER_00: Bill.
• 25:22
  SPEAKER_00: So some years ago, I'm a classically trained scientist, right?
• 25:25
  SPEAKER_00: So I did a study a number of years ago when I was still more active
• 25:28
  SPEAKER_00: in really doing research instead of in this current role where I'm
• 25:31
  SPEAKER_00: a little more administrative.
• 25:31
  SPEAKER_00: And I did a study a few years ago that I designed and I got funded.
• 25:37
  SPEAKER_00: And the funder said, look, great,
• 25:39
  SPEAKER_00: but we want you to have a community council of people in this community
• 25:43
  SPEAKER_00: that are going to participate in helping you do this study.
• 25:46
  SPEAKER_00: We want you to engage them and give them a meaningful role in designing the study
• 25:49
  SPEAKER_00: and implementing it.
• 25:51
  SPEAKER_00: I agreed,
• 25:51
  SPEAKER_00: you know,
• 25:52
  SPEAKER_00: I kind of wanted the funding and it sounded like a great idea,
• 25:53
  SPEAKER_00: but I was pretty sure I knew how to design this study.
• 25:56
  SPEAKER_00: Took it to this,
• 25:57
  SPEAKER_00: I put the group together,
• 25:58
  SPEAKER_00: they reviewed the plan,
• 26:00
  SPEAKER_00: and basically said after the first meeting, like,
• 26:02
  SPEAKER_00: your plan is great except that you're asking all the wrong questions
• 26:05
  SPEAKER_00: and collecting all the wrong data and doing all the wrong stuff,
• 26:07
  SPEAKER_00: but other than that, we love it.
• 26:09
  SPEAKER_00: I've gotten that type of review before.
• 26:10
  SPEAKER_00: And so they wanted to tear it down and completely do something different.
• 26:13
  SPEAKER_00: I was pretty resistant because I've been trained to do this.
• 26:16
  SPEAKER_00: I know how to do this work.
• 26:17
  SPEAKER_00: They wanted to do a very different work.
• 26:19
  SPEAKER_00: But I had agreed to give this group a meaningful role in approving their research.
• 26:25
  SPEAKER_00: So I did it the way they wanted to do it.
• 26:28
  SPEAKER_00: The study finished.
• 26:29
  SPEAKER_00: And at the end of the day,
• 26:30
  SPEAKER_00: every single thing that we found that was of any interest at the end of
• 26:33
  SPEAKER_00: that study was because of what they recommended.
• 26:36
  SPEAKER_00: And I had this moment of realizing,
• 26:39
  SPEAKER_00: Like there's a lot of different kinds of expertise in the world and you can't come
• 26:42
  SPEAKER_00: in thinking yours is the only special expertise that it takes to solve a problem.
• 26:46
  SPEAKER_00: It took the perspective and expertise they had in the lived experiences
• 26:49
  SPEAKER_00: that they brought to that table to change the plan in such a way that we were able
• 26:53
  SPEAKER_00: to actually produce something meaningful.
• 26:55
  SPEAKER_00: And that just completely transformed the way I approach doing this work.
• 26:59
  SPEAKER_00: Steph, you get the last word on this one.
• 27:01
  SPEAKER_02: I know.
• 27:01
  SPEAKER_02: And that's the worst spot to be because I was thinking
• 27:04
  SPEAKER_02: the last time I changed my mind was to be on this podcast with you all
• 27:07
  SPEAKER_02: because you're brilliant.
• 27:08
  SPEAKER_02: And I just like putting brilliant people in front of others.
• 27:11
  SPEAKER_02: But no, I think a real answer would be that I am very lucky that I fell into this role.
• 27:17
  SPEAKER_02: I never thought I'd be in the world of philanthropy.
• 27:19
  SPEAKER_02: I'm not classically trained.
• 27:21
  SPEAKER_02: But I get to learn from incredible people with inspiring ideas.
• 27:26
  SPEAKER_02: And it's really launched me to think about Where we will be as a society,
• 27:30
  SPEAKER_02: where we will be with healthcare in the next 10 years
• 27:32
  SPEAKER_02: and how my children will have better than what I have.
• 27:35
  SPEAKER_02: Excellent.
• 27:35
  SPEAKER_02: Well, that's a lovely tone on which to land this ship.
• 27:38
  SPEAKER_02: Probably mixed a few metaphors there.
• 27:41
  SPEAKER_02: Anyway, thanks to you all for conceiving of this project,
• 27:45
  SPEAKER_02: for executing,
• 27:46
  SPEAKER_02: for seeing a big problem and going after it,
• 27:48
  SPEAKER_02: and for telling us and the listeners about it today.
• 27:51
  SPEAKER_02: I really appreciate it.
• 27:52
  SPEAKER_02: And let's try to revisit a few years down the road to talk about some of
• 27:55
  SPEAKER_02: the great things you've cooked up.
• 27:57
  SPEAKER_01: Love it.
• 27:57
  SPEAKER_01: Thank you.
• 27:58
  SPEAKER_01: Thanks for the time.
• 28:03
  SPEAKER_02: Thanks for listening to A New Angle.
• 28:05
  SPEAKER_02: If you like what we do and want to support us directly,
• 28:07
  SPEAKER_02: please consider a subscription at anewanglepodcast.com.
• 28:13
  SPEAKER_02: A New Angle is recorded at Studio 49, a generous gift from UM alums Michelle and Lauren Hanson.
• 28:20
  SPEAKER_02: Our presenting sponsor is the Headwaters Foundation,
• 28:23
  SPEAKER_02: working side-by-side with Western Montanans to improve the health
• 28:26
  SPEAKER_02: of our communities.
• 28:28
  SPEAKER_02: We are also supported by First Security Bank and the University of Montana College
• 28:33
  SPEAKER_02: of Business, with additional help from CED, Drum Coffee, and Montana Public Radio.
• 28:40
  SPEAKER_02: Keely Larson is our producer.
• 28:42
  SPEAKER_02: John Brownell, Jeff Ament, and John Wicks made our music.
• 28:46
  SPEAKER_02: Thanks a lot, and we'll see you next time.