Latest / Becker’s Healthcare - Clinical Leadership Podcast / Jeremy Cauwels, MD, Chief Medical Officer at Sanford Health

Transcript

Jeremy Cauwels, MD, Chief Medical Officer at Sanford Health · Becker’s Healthcare - Clinical Leadership Podcast

• 0:02
  - There's a small circle of people who truly
• 0:04
  - understand what it takes to lead a health
• 0:05
  - system right now. The decisions are enormous.
• 0:08
  - The variables are constantly shifting, and the stakes
• 0:11
  - of getting a call wrong don't stay contained.
• 0:14
  - That's not a complaint. It's a structural reality.
• 0:17
  - And it's why the most effective c suite
• 0:19
  - leaders are deliberate about where do they go
• 0:21
  - to pressure test their thinking.
• 0:22
  - Becker's fourteenth annual CEO and CFO roundtable
• 0:26
  - brings together more than 1,500
• 0:28
  - executive level attendees
• 0:30
  - and nearly 400 speakers for four days built
• 0:32
  - around growth, financial sustainability,
• 0:35
  - workforce strategy, and the leadership questions that don't
• 0:38
  - have easy answers.
• 0:39
  - Join us November second through the fifth in
• 0:41
  - Chicago.
• 0:42
  - For the agenda and event details,
• 0:45
  - visit beckershospitalreview.com
• 0:47
  - and click on the events tab in the
• 0:49
  - upper right.
• 0:51
  - Hello. Hello. This is Francesca Matthews with the
• 0:54
  - Becker's Clinical Leadership podcast.
• 0:56
  - I'm thrilled to be joined today by doctor
• 0:58
  - Jeremy Cowles, Chief Medical Officer of Sanford Health.
• 1:01
  - Doctor. Cowles, thank you so much for being
• 1:03
  - here today. Thanks for having me.
• 1:05
  - Absolutely. And let's just jump right in here.
• 1:08
  - Sanford Health has been a leader in using
• 1:10
  - AI and virtual care to expand access across
• 1:13
  - rural America.
• 1:15
  - How are those innovations changing care today, and
• 1:17
  - where do you see the greatest opportunity in
• 1:19
  - the years ahead?
• 1:21
  - So I think overall, it's important to recognize
• 1:23
  - that we're...
• 1:25
  - As Sanford Health, we're doing our best to
• 1:27
  - try to solve the unique challenges of delivering
• 1:29
  - high quality care across all of rural America
• 1:32
  - by using technology when necessary to overcome distance,
• 1:36
  - building the next generation of health care workforce
• 1:38
  - in a rural setting,
• 1:39
  - and trying to engage our clinicians in changes
• 1:42
  - that make care safer and more accessible,
• 1:45
  - and if we can, even more proactive.
• 1:48
  - I think one of the biggest areas for
• 1:50
  - us recently
• 1:52
  - has been expanding,
• 1:53
  - you know, AI and virtual care to help
• 1:55
  - out with access.
• 1:57
  - And for us, what that means is,
• 2:02
  - first, who are we serving and how are
• 2:04
  - we serving? And I'll and I'll start it
• 2:06
  - with this.
• 2:07
  - Two thirds of our patients live in rural
• 2:09
  - areas.
• 2:10
  - We serve communities across a geography of more
• 2:13
  - than 300,000
• 2:14
  - square miles.
• 2:15
  - Geography is one of the biggest barriers to
• 2:17
  - accessing care in rural America,
• 2:20
  - and our approach really starts,
• 2:22
  - with trying to solve problems at the level
• 2:24
  - of our patients and clinicians.
• 2:26
  - How do we bring them closer together?
• 2:29
  - How do we do a better job of
• 2:30
  - extending our clinician reach? And how do we
• 2:32
  - identify disease earlier to keep people healthy?
• 2:36
  - All told, we've invested more than $350,000,000
• 2:38
  - in virtual care because we believe where you
• 2:41
  - live shouldn't determine the quality of care you
• 2:44
  - can access.
• 2:45
  - We provide virtual care,
• 2:47
  - across more than 80 specialties.
• 2:49
  - Two thirds of those patients,
• 2:51
  - live more than 30 miles from a Sanford
• 2:53
  - facility,
• 2:54
  - and each virtual visit saves patients an average
• 2:57
  - of a 176
• 2:58
  - miles
• 2:59
  - and $273
• 3:01
  - in associated costs.
• 3:03
  - And so as we do that, I think
• 3:05
  - it's critically important to recognize that what we're
• 3:07
  - actually trying to do is do a better
• 3:09
  - job of reaching our patients and allowing our
• 3:11
  - patients to reach us.
• 3:13
  - One of the interesting things we've done,
• 3:16
  - lately is actually stand up a satellite clinic
• 3:19
  - in Lidgerwood, North Dakota. And if anybody's listening
• 3:21
  - to this online, I would absolutely encourage you
• 3:23
  - to Google Lidgerwood, North Dakota and figure out
• 3:26
  - about where it's at. It's a community of
• 3:28
  - about 600 people.
• 3:30
  - The nearest medical center is a little more
• 3:32
  - than an hour away.
• 3:33
  - And by combining an on-site nurse with virtual
• 3:36
  - clinicians, we've been able to expand access not
• 3:38
  - only to primary care,
• 3:41
  - in a community that couldn't support primary care
• 3:43
  - five days a week, but also some specialty
• 3:45
  - care as well.
• 3:46
  - The patients can come into a local clinic,
• 3:49
  - have the nurse perform the hands on components
• 3:51
  - of the exam,
• 3:52
  - and virtually connect with a physician or APP.
• 3:55
  - And instead of asking the patient to travel
• 3:57
  - to care, we're actually using technology to bring
• 4:01
  - care to the patient.
• 4:03
  - Specialty care actually works the same way. As
• 4:06
  - anyone who's ever been through a a busy
• 4:09
  - specialty clinic, can recognize,
• 4:11
  - Sometimes after the initial procedures, for instance, if
• 4:14
  - you had a cardiac cath,
• 4:15
  - or sometimes,
• 4:17
  - if you've had, you know, chronic diseases like
• 4:20
  - cystic fibrosis and you're in the pediatric pulmonology
• 4:22
  - clinic, many times the doctor already knows your
• 4:25
  - story well enough that a fifteen minute check-in
• 4:28
  - doesn't have to necessarily be face to face.
• 4:30
  - And in those times where we believe the
• 4:33
  - safest and easiest option is to make sure
• 4:35
  - that we're connecting with people, not necessarily bringing
• 4:38
  - them all the way to our clinics,
• 4:39
  - we can arrange virtual care in places like
• 4:42
  - Lidgerwood or sometimes in your own living room,
• 4:45
  - to make sure that we're connecting with patients
• 4:47
  - in a way that makes the most sense.
• 4:50
  - This allows,
• 4:52
  - you know, different connections that we never thought
• 4:54
  - possible.
• 4:55
  - One of my other favorites is our virtual
• 4:57
  - OB hospitalist model, which is actually giving rural
• 5:00
  - hospitals
• 5:01
  - access to specialized
• 5:03
  - obstetric expertise when they need it and allowing
• 5:06
  - those local care teams that may have previously
• 5:09
  - delivered babies but don't deliver babies anymore or
• 5:11
  - may have lost a a family practice physician
• 5:14
  - who had delivered babies for many years and
• 5:16
  - isn't isn't practicing that way any longer
• 5:19
  - to make sure that an obstetrician has a
• 5:22
  - chance to evaluate the patient and decide whether
• 5:25
  - the correct answer is to transfer them the
• 5:27
  - miles they need to to be safely in
• 5:29
  - the out of... In that obstetrics...
• 5:31
  - Obstetrician's care. Sorry.
• 5:33
  - Or if it... The right answer is to
• 5:35
  - observe them in the hospital that they're in
• 5:37
  - where they don't have to travel, they don't
• 5:38
  - have to put themselves or their baby through
• 5:40
  - stress,
• 5:41
  - before the baby is born simply because it's
• 5:44
  - time that the right answer is to rest,
• 5:46
  - relax, and be appropriately observed from what could
• 5:49
  - be a 100 miles away.
• 5:52
  - Absolutely.
• 5:53
  - Some amazing,
• 5:55
  - innovations and and work there, especially in regards
• 5:57
  - to specialty care.
• 5:59
  - Sanford has also made made significant
• 6:01
  - significant investments in graduate medical education to strengthen
• 6:04
  - the physician workforce.
• 6:05
  - How are those programs helping address workforce shortages,
• 6:08
  - particularly in rural communities
• 6:11
  - and preparing the next generation of physicians?
• 6:14
  - So one of the areas, as you mentioned,
• 6:17
  - is graduate medical education. We have put,
• 6:20
  - a $300,000,000
• 6:21
  - philanthropic gift to work in that space.
• 6:24
  - That philanthropic gift actually came with some
• 6:27
  - conversation about the fact that we were going
• 6:30
  - to grow programs and grow it more quickly
• 6:32
  - than really anybody else is in the nation
• 6:35
  - right now.
• 6:36
  - Not because we wanted to set a record
• 6:37
  - for how fast we could grow, but because
• 6:40
  - we recognize the fact that the draw from
• 6:42
  - a physician in New York City or Los
• 6:46
  - Angeles
• 6:47
  - isn't particularly high to set up shop in
• 6:49
  - North Dakota or South Dakota.
• 6:51
  - And so as we thought about our footprint,
• 6:53
  - as we went all the way from the
• 6:54
  - Upper Peninsula Of Michigan over to Montana and
• 6:57
  - South as far as Nebraska and Iowa,
• 6:59
  - we needed to train people locally that understood
• 7:02
  - how things work.
• 7:04
  - Where we're at right now is working towards
• 7:06
  - 40 residency programs, fellowship pro... And fellowship programs
• 7:10
  - by roughly 2027,
• 7:11
  - and we'll have more than 400 residents and
• 7:13
  - fellows training across Sanford.
• 7:16
  - What I think is important about that
• 7:18
  - is that's a sustainable pipeline for us. It
• 7:21
  - allows communities to have physicians for decades to
• 7:24
  - come. What we know already is that approximately
• 7:27
  - 40% of the residents and fellows we train
• 7:29
  - ultimately choose to practice within Sanford,
• 7:31
  - and roughly 70% of them remain in the
• 7:34
  - Midwest, which means we're not only feeding
• 7:37
  - our own clinician needs but we're feeding the
• 7:39
  - clinician needs of many other places around us
• 7:41
  - as well.
• 7:43
  - Practicing medicine in rural America requires physicians to
• 7:47
  - understand
• 7:48
  - the unique needs of those communities.
• 7:50
  - Long distance travel, as we talked about before,
• 7:52
  - aging populations,
• 7:54
  - higher incidences of chronic disease,
• 7:56
  - and limited access to some specialties.
• 7:59
  - While we're doing that, the other thing that
• 8:01
  - we wanna continue to do
• 8:03
  - is engage the next generation of things like
• 8:06
  - virtual care, AI, and other things that are
• 8:08
  - gonna be involved in clinical care to make
• 8:11
  - sure that our clinicians,
• 8:13
  - a, know how to use those tools appropriately,
• 8:16
  - and also that they can maintain the clinical
• 8:18
  - judgment relationships and trust that are fundamental to
• 8:21
  - medicine.
• 8:22
  - As we as we built those partnerships,
• 8:24
  - exposing medical students and residents to rural practice
• 8:27
  - earlier
• 8:28
  - helps create pathways,
• 8:30
  - when,
• 8:31
  - communities that need them most.
• 8:33
  - We don't want our physicians to practice
• 8:36
  - just in rural America, but what we wanna
• 8:38
  - do is give them the opportunities to train
• 8:40
  - in rural America so that when they graduate
• 8:43
  - from their medical education program, they can make
• 8:45
  - a decision. And they can make a decision
• 8:47
  - whether or not they become part of our
• 8:49
  - access strategy for all of our patients or
• 8:52
  - whether they want to go on and work
• 8:54
  - in some some additional place. But it gives
• 8:56
  - them that background for what does it look
• 8:58
  - like to work in rural and how do
• 8:59
  - we do it well.
• 9:02
  - Mhmm. Absolutely. That rural retainment component just being
• 9:05
  - so important and really resonant with things I
• 9:08
  - hear reporting on physician leadership and rural health
• 9:10
  - systems all the time.
• 9:12
  - And in that reporting, it's it's, you know,
• 9:14
  - evident that health care is evolving rapidly from
• 9:17
  - new technologies to changing care models.
• 9:20
  - I'm wondering how do you lead change across
• 9:23
  - a large integrated rural health system while keeping
• 9:26
  - physicians engaged
• 9:28
  - and maintaining a relentless focus on safety,
• 9:30
  - quality, and the patient experience?
• 9:34
  - Well, I think the most important part is
• 9:37
  - making sure that
• 9:39
  - I as an individual and our system as
• 9:41
  - a whole,
• 9:43
  - maintains the appropriate focus.
• 9:45
  - Really, what we should worry about every day
• 9:47
  - is waking up and understanding, number one, are
• 9:50
  - we serving the patients?
• 9:52
  - And number two,
• 9:54
  - what are the problems we're trying to solve?
• 9:56
  - I think it's critically important that we understand
• 9:59
  - that the
• 10:00
  - health care has no shortage of new ideas
• 10:02
  - and new technologies,
• 10:04
  - but our goal isn't to see how much
• 10:06
  - technology we can adopt.
• 10:07
  - Our goal has to be how do we
• 10:09
  - identify
• 10:11
  - things that need change
• 10:12
  - to solve meaningful problems for patients and clinicians.
• 10:16
  - As a physician,
• 10:18
  - I strongly believe that clinicians need to be
• 10:20
  - involved in designing change rather than just being
• 10:22
  - asked to adopt it.
• 10:24
  - The people closest to the patient
• 10:26
  - and closest to the work are the people
• 10:28
  - that often understand where the friction exists and
• 10:31
  - where the best opportunities are to improve.
• 10:34
  - That's especially important in AI.
• 10:37
  - Our approach is clinically led,
• 10:39
  - but it has strong governance behind it where
• 10:41
  - the clinical, operational, and technology
• 10:43
  - expertise
• 10:44
  - comes together to evaluate where AI can add
• 10:47
  - value and where it can be implemented both
• 10:49
  - safely and responsibly...
• 10:51
  - Or... And responsibly.
• 10:53
  - Physician engagement for us comes from demonstrating,
• 10:57
  - that a change makes their work better.
• 10:59
  - Ambient listening is a good example when clinicians
• 11:02
  - see that the technology can reduce the burden
• 11:04
  - of documentation
• 11:06
  - and allow them to spend a little more
• 11:07
  - time focused on their patient.
• 11:09
  - Adoption isn't hard. They do it on their
• 11:11
  - own.
• 11:14
  - I think it's important to recognize the fact
• 11:16
  - that our goal isn't to adopt more technology.
• 11:19
  - Our goal is to make care better.
• 11:21
  - Every change that we make has to come
• 11:23
  - back to the decision of, is this allowing
• 11:26
  - our clinicians to provide safer, higher quality care,
• 11:29
  - and is it making sure that we deliver
• 11:32
  - a better experience to our patients?
• 11:36
  - Absolutely.
• 11:37
  - And that is actually all I have for
• 11:39
  - you today, doctor Cowles. Thank you so much
• 11:41
  - for being with us.
• 11:42
  - Thanks for having me. Appreciate it. Yeah. It's
• 11:44
  - been a pleasure speaking with you, and I
• 11:45
  - look forward to connecting with you again in
• 11:47
  - the future.
• 11:48
  - Alright. Thank you.