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

Transcript

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

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