Latest / Becker’s Healthcare Podcast / Expanding Rural Access and Strengthening Community Health with Kelly Macken Marble

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Expanding Rural Access and Strengthening Community Health with Kelly Macken Marble · Becker’s Healthcare Podcast

• 0:02
  This is where health care leadership comes together.
• 0:04
  Becker's sixteenth annual meeting brings more than 3,500
• 0:07
  hospital and health system executives and nearly 800
• 0:10
  speakers to Chicago April.
• 0:14
  This year's event includes keynote conversations with Dallas
• 0:17
  Cowboys legend Troy Aikman and former president George
• 0:20
  w Bush. For the agenda and event details,
• 0:22
  visit beckershospitalreview.com
• 0:25
  and click on the events tab in the
• 0:26
  upper right. We're looking forward to hosting you
• 0:29
  in Chicago.
• 0:31
  This is Lauren Dierda with the Becker's Healthcare
• 0:33
  podcast. I'm thrilled today to be joined by
• 0:36
  Kelly Mackin Marble, chief executive officer at Osceola
• 0:38
  Medical Center. Kelly, it's a pleasure to have
• 0:40
  you on the podcast today. Well, thanks so
• 0:42
  much for having me. Absolutely. Now I'm excited
• 0:45
  for our conversation because I know there's so
• 0:46
  much happening in the health care space and
• 0:48
  particularly,
• 0:49
  you know, looking at how, hospitals and systems
• 0:52
  are staying transformative
• 0:53
  and, you know, really,
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  meeting some of the the big demands and
• 0:57
  needs in health care today. But before we
• 0:59
  dive into that discussion, can you tell us
• 1:00
  a little bit more about yourself as well
• 1:02
  as Osceola Medical Center?
• 1:05
  Absolutely. So,
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  again, Kelly McNamara, CEO here at Osceola Medical
• 1:10
  Center.
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  I've been in health care leadership now for
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  close to thirty five years, so a very
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  long time.
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  Started out in nursing and in Michigan and
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  have sort of made my way,
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  along and most of my career spent in
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  the Twin Cities,
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  Minneapolis, Saint Paul area,
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  as well. And I've been in my current
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  role for about, three years and really enjoying
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  it. It's been,
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  for me, a nice,
• 1:37
  opportunity to come back to my roots in
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  population health, which is an area that I
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  have,
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  a lot of passion around. So excited to
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  to be here.
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  Osceola Medical Center is a critical access hospital
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  and also a rural health clinic,
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  and we are located in Northwest Wisconsin.
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  We're literally just a bridge away from Minnesota.
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  So we sit right on the Wisconsin, Minnesota
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  border,
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  and we are,
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  less than an hour away from,
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  the Twin Cities.
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  So we're really in a nice place geographically
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  that, while we're a critical access hospital that,
• 2:12
  our patients have access to, tertiary care centers,
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  pretty close to us as well.
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  That's great to hear. And and definitely, you
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  know, so appreciate,
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  that perspective because I know a lot of
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  our listeners are covering similar communities in areas,
• 2:26
  within their own regions. So, this will be
• 2:29
  a great conversation.
• 2:30
  Now
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  could you tell us a little bit more
• 2:32
  about the last year or so? What was
• 2:34
  an initiative that you led? What did you
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  do? And what were there was
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  So we have some
• 2:39
  big expansion work happening in the organization. We're
• 2:42
  in the middle right now
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  of adding,
• 2:44
  about 20,000 square feet onto the facility. This
• 2:47
  is all about improving access to care. I
• 2:49
  would say
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  some of the most important work,
• 2:54
  for the community and really a big part
• 2:56
  of our mission,
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  was focused on our community health needs work
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  and increasing
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  and expanding
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  our work in the mental health and substance
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  use treatment areas.
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  We added new members to the team,
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  really worked on growing that part of our
• 3:13
  service.
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  We are now,
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  treating
• 3:17
  patients that need help with substance use withdrawal,
• 3:20
  in the hospital currently.
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  There are not a lot of resources
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  for that type of service in our region,
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  so this is really important.
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  One thing that we saw in our data,
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  in our county data is that,
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  substance use,
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  in addition to mental health, really sort of
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  hit
• 3:38
  the the highest need,
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  for people that are in our communities.
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  So that was our focus
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  and significant work on expanding those services.
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  And it's been exciting to watch,
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  and to see the increases in the number
• 3:53
  of patients that we're caring for. We have
• 3:55
  all kinds of outcome measures. It's gonna take
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  a while to to see that. Obviously, our
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  goal is to reduce,
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  the number
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  of people in our region that,
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  need that type of support. That's there's a
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  long play, I think, in that work, but,
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  right now, we're just really focused on sort
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  of meeting those immediate needs for patients and
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  then making sure they get,
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  handed
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  to appropriate,
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  treatment options.
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  This year, we will add to that, an
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  outpatient,
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  treatment program as well. We do have some
• 4:26
  outpatient services today, but a more intensive
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  outpatient treatment so that we're fully able to
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  manage
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  supporting patients who need substance use help once
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  they've gone through withdrawal,
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  and are out of the hospital. So that's
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  been exciting work for us and I think
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  really meaningful again
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  in rural health,
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  very population health focused.
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  That is an opportunity
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  that is, part of our mission is to
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  improve the health and well-being of the communities
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  we serve and,
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  this ties network ties directly,
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  to to that part of our mission.
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  Got it. That makes a lot of sense.
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  And, you know, it is really cool to
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  hear being able to grow that type of
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  service line and,
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  have, those services available for the community because
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  it's so so much needed. And, you know,
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  when you look at bringing in more of
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  that substance withdrawal, abuse,
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  and and, you know, really,
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  services for the community, what does it take
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  to build that type of program?
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  How do you go about doing that, within
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  your organization and and making sure you have
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  the right resources allocated to it so that
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  you can build something that is efficient and
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  effective,
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  for treatment?
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  Yeah. It's a great question. We are incredibly
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  fortunate. We have a chief medical officer, doctor
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  David Frenz, who is,
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  board certified in addiction medicine. So that,
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  very helpful, and he's worked for a long
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  time in the region,
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  in caring for patients,
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  who have substance use needs. So very helpful.
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  And he sort of led the charge in
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  bringing in,
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  skilled and qualified team members that can help
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  us, create the service and now expand the
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  service. So for us, I think, foundationally having
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  experts,
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  in the field of mental health and substance
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  use is critically important,
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  and he continues to help us sort of
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  lead the charge with that.
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  I love it. That's so helpful to have
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  a leader that takes, the lead there and,
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  can really push those things forward. Now looking
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  ahead, what are some of the big priorities
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  and headwinds that you're focused on for 2026?
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  Yeah. And as I mentioned, you know, we
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  are in the middle of this expansion and
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  our expansion
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  is really focused around, again, tying back to
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  our mission, improving health and well-being.
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  We had an access problem and part of
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  our access problem was not only clinicians,
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  but having the physical footprint, to care for
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  more patients.
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  So, the growth
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  that we're experiencing in the construction and expansion
• 6:49
  we're going through,
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  is a part of that. And so that
• 6:53
  is we've got a big construction project right
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  now adding 35 exam rooms, specialty space, new
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  rehab space, a new rehab pool,
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  that will all open by the end of
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  this year.
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  In addition to that, we're opening a second
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  clinic,
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  in Minnesota,
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  that we consider part of our service area.
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  It was a underserved
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  area, had a
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  deficit of clinicians to support them. So that,
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  new clinic will also open later this year.
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  So we're excited about that. That's a big
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  focus for us. But I would say the
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  other
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  work,
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  is really just making sure we're staying focused
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  on some of the other big headwinds that
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  are facing, I think, everyone in health care
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  and
• 7:35
  impacts critical access rural health in a different
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  way.
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  So we've all been paying close attention to
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  what's happening with Medicaid.
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  We're still,
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  waiting to hear and understand more about how
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  that's gonna impact us here in Wisconsin.
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  And, also,
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  there are potential changes to how
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  rural health clinic reimbursement works in our state.
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  So paying very close attention to that for
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  those listening that have
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  rural health clinics understand that that's a big
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  part of the your margin in a critical
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  access rural health environment.
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  So any significant changes to how we're,
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  paid and reimbursed for for that care is
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  gonna be difficult.
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  And then always on the list,
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  is three forty b,
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  funding. And that is a hot topic across
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  the country and,
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  for pharmaceuticals.
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  And so if that program were to go
• 8:28
  away or change significantly,
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  it would have a a pretty significant
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  impact on our bottom line,
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  at a time. Again, all health care margins
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  are very thin,
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  in rural health and and critical access. You
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  know, our our margins are also thin, and,
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  you know, we're not, attached to a a
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  large system.
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  So we're independent and and trying to work
• 8:53
  through that and would have to manage that,
• 8:55
  on our own. So those are some of
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  the big headwinds I would say that we're
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  just paying very close attention to. There's still
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  a lot that's unknown,
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  but, you know, that that will be part
• 9:05
  of the the work we're focused on this
• 9:07
  year, and I I assume into 2027.
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  That makes a lot of sense. And, you
• 9:12
  know, I appreciate everything you mentioned there, whether
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  it's looking at expanding access to care, bringing
• 9:17
  in clinicians in underserved areas, and then two,
• 9:20
  trying to figure out how you're gonna have
• 9:22
  those financials work and make that work. I
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  think especially on the three forty b funding
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  side,
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  what is top of mind for you when
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  you think about
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  that potential challenge and and changes coming down
• 9:34
  the pipe? How do you prepare for, some
• 9:36
  of the unknowns with three forty b and,
• 9:39
  while still, you know, taking care of the
• 9:41
  day to day to make sure things are
• 9:42
  are functioning the way you need them to,
• 9:45
  in the current
• 9:46
  atmosphere.
• 9:48
  It's a really difficult balance is what I
• 9:50
  would say. You know, at the at a
• 9:52
  time where we are experiencing growth,
• 9:54
  which is exciting, we also have to really
• 9:56
  balance,
• 9:58
  potential reimbursement changes. And so,
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  for us, I think that is being really
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  smart about what we add and when we
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  add it, making sure that we are just
• 10:08
  very fiscally responsible,
• 10:10
  bringing services to the community that the community
• 10:12
  really needs, but,
• 10:14
  also being really careful that we don't overextend
• 10:16
  ourselves so that if we do experience
• 10:19
  a reduction in reimbursement
• 10:21
  or,
• 10:21
  we end up paying more for the procurement
• 10:24
  of medications,
• 10:26
  with the three forty b potential changes,
• 10:29
  that, you know, we've got the financial,
• 10:32
  bandwidth to manage that. So I think right
• 10:35
  now, it is just this,
• 10:37
  balancing
• 10:38
  act, and we're just, watching that. But I
• 10:40
  think we just have to be really smart
• 10:42
  about,
• 10:42
  where we invest
• 10:45
  and making sure, again, that we're
• 10:47
  financially in a position that we could weather
• 10:50
  any reduction,
• 10:51
  in reimbursement. So it's it's tricky.
• 10:54
  Absolutely.
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  I I think there's so many that are,
• 10:57
  you know, walking that line or or doing
• 10:59
  that balancing act. And so to understand how
• 11:01
  you're thinking about it and what it means
• 11:03
  for you is really helpful.
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  What do you think the hardest thing you'll
• 11:06
  have to do in the coming year will
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  be?
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  Yeah. I think, you know, that
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  financial viability work is gonna be incredibly hard
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  and critical,
• 11:17
  just for survival. It also makes me think
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  about,
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  you know, the other thing happening, not just
• 11:22
  in Wisconsin, but across the country is small
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  critical access hospitals,
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  ceasing to deliver babies. And so this balancing
• 11:29
  act is also in part to make sure
• 11:31
  that we can keep doing that,
• 11:34
  for women in our area if we were
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  to stop delivering,
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  babies. You know, they're driving close to an
• 11:40
  hour away to find,
• 11:42
  OB care. So it's a big deal. So
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  that that to me, just maintaining financial viability
• 11:47
  is gonna be critically important. I would say
• 11:50
  the other
• 11:51
  and I I don't know that I would
• 11:52
  describe it as hardest, but I think,
• 11:54
  incredibly important work for us is increasing our
• 11:58
  focus on
• 11:59
  team member and caregiver
• 12:01
  well-being.
• 12:02
  You know, we
• 12:04
  went all went through COVID and and watched
• 12:06
  clinicians,
• 12:08
  and caregivers and staff really burn out.
• 12:11
  I think there's a whole lot of things
• 12:13
  that, contribute to that,
• 12:16
  including some of the administrative burdens that our
• 12:18
  teams carry
• 12:19
  that we,
• 12:21
  as an organization,
• 12:22
  need to put more focus on. So we've
• 12:24
  got a couple initiatives,
• 12:26
  one around moral injury, which really starts to
• 12:29
  address what are the things that are happening,
• 12:31
  sort of day to day,
• 12:33
  responsibilities that our staff and physicians
• 12:36
  and and
• 12:37
  clinicians overall are having to take on that
• 12:39
  are just administrative burden and not really,
• 12:43
  focused on, you know, caring for the patient
• 12:46
  necessarily.
• 12:47
  And how can we eliminate those break down
• 12:49
  those barriers so they can focus on the
• 12:51
  most important work of patient care?
• 12:54
  So moral injury is a focus for us.
• 12:56
  And then, we're participating
• 12:58
  in a Wisconsin initiative around,
• 13:01
  caring for caregivers.
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  And that really looks at all kinds of
• 13:05
  things. One, reducing the stigma, seeking mental health
• 13:08
  or substance use for clinicians.
• 13:10
  And, you know, some don't do that because
• 13:13
  they're afraid of what would happen, you know,
• 13:16
  loss of licensure,
• 13:17
  those kinds of things. So it's a,
• 13:20
  exciting project. There's a couple phases to it.
• 13:22
  It sort of starts out with this reducing
• 13:24
  stigma,
• 13:25
  for licensing and credentialing. And then the next
• 13:28
  two parts really focus on,
• 13:30
  creating an infrastructure,
• 13:32
  to support,
• 13:33
  team member well-being, caregiver well-being,
• 13:36
  and then just making sure that we
• 13:38
  require that into our organization,
• 13:41
  operational improvements that reduce that administrative burden that
• 13:44
  I mentioned. So, as I think about all
• 13:47
  the things that are on our plate,
• 13:49
  we need to take care of our teams,
• 13:51
  first and foremost so they can take care
• 13:53
  of patients. And so that,
• 13:56
  will be challenging and rewarding and,
• 13:59
  exciting all at the same time.
• 14:02
  Absolutely. I I think, you know, there's so
• 14:05
  much opportunity and possibility,
• 14:07
  when you look at ways to continue to
• 14:09
  boost your workforce and staff and especially for
• 14:11
  clinicians,
• 14:13
  you know, coming into,
• 14:15
  the work every day that they're doing with
• 14:17
  patients. So I I really, you know, think
• 14:19
  that is so, so important. And as you
• 14:21
  mentioned too, you know, looking at the work
• 14:23
  that you've been doing,
• 14:24
  around the financial viability and keeping services in
• 14:28
  particular that OB care, locally in the community
• 14:31
  makes a big difference for women,
• 14:33
  and their families. And so,
• 14:35
  I I know a lot going on there,
• 14:37
  but I think I I wanted to wrap
• 14:39
  up before we, finish our conversation here in
• 14:42
  looking at some of those growth opportunities you
• 14:44
  mentioned
• 14:45
  as well. Could you talk just a little
• 14:47
  bit deeper on those best opportunities
• 14:50
  that you're seeing,
• 14:51
  and how you're, you know, planning for those
• 14:54
  and and really,
• 14:55
  what you're excited about for the future?
• 14:58
  Yeah. We are excited. And like I said,
• 14:59
  we, are going through a growth phase, and,
• 15:02
  that isn't happening everywhere.
• 15:04
  So,
• 15:05
  we feel really grateful for that and we
• 15:07
  see it as an opportunity, to care for
• 15:08
  more
• 15:09
  people in our service area and our service
• 15:11
  area is actually growing, which is also exciting.
• 15:14
  So, we've been really focused on making sure
• 15:16
  that we have enough in the way
• 15:18
  of primary care clinicians to, meet the needs
• 15:21
  of the community. So we've been recruiting like
• 15:23
  crazy. We've added,
• 15:25
  10 clinicians in the last,
• 15:28
  year and a half or so, which is
• 15:29
  really great.
• 15:31
  In addition to that, looking at demand forecasting
• 15:33
  data to tell us,
• 15:35
  what other types
• 15:36
  of specialty care
• 15:38
  would be helpful to have here to keep
• 15:40
  as much care,
• 15:41
  close to home for people.
• 15:43
  So, you know, some of the subspecialty areas
• 15:46
  in primary care like pediatrics,
• 15:48
  we added, additional,
• 15:50
  o by OB GYN care here,
• 15:53
  and then also looking at specialty care. So,
• 15:56
  some of the,
• 15:58
  hot areas for us that we're continuing to
• 16:00
  recruit recruit for will be adding,
• 16:02
  additional dermatology,
• 16:04
  which is not always easy to find. Would
• 16:06
  love to have,
• 16:08
  some specialties like rheumatology and gastroenterology
• 16:10
  here.
• 16:12
  These are very hard to recruit specialties,
• 16:14
  but those are that's the type of growth,
• 16:17
  that we have potential for here.
• 16:20
  As we look at, you know, what additional
• 16:22
  specialties that
• 16:23
  is needed in our community based on kind
• 16:25
  of what we see,
• 16:27
  what we're sending out, and then also,
• 16:29
  what we see in demand forecasting data that
• 16:31
  our patients are looking for.
• 16:33
  So, yeah, it's an exciting time. Again, we're
• 16:35
  experiencing growth
• 16:37
  in, services like primary care and specialty care.
• 16:40
  I would say the other focus, from a
• 16:42
  growth perspective would be looking at, some of
• 16:45
  the subspecialty
• 16:47
  type of care
• 16:48
  that we could bring to the organization
• 16:50
  that would,
• 16:52
  help our doctors and, EPCs take care of
• 16:54
  patients locally.
• 16:56
  So partnerships,
• 16:58
  is, important to us. So we have a
• 17:00
  partnership with Children's Hospital in Minneapolis,
• 17:04
  and we have a tele
• 17:05
  NICU,
• 17:06
  service that we just added.
• 17:08
  We're in the process of adding a telestroke
• 17:10
  program as well,
• 17:12
  and all of that just expands,
• 17:15
  the types of care that we can provide
• 17:16
  locally, helps us provide more emergent care,
• 17:20
  for babies and for those that may be
• 17:22
  experiencing strokes and symptoms.
• 17:24
  So in addition to sort of our core,
• 17:27
  primary care services, specialty care services, we're looking
• 17:30
  at,
• 17:31
  what other partnerships can we add to help
• 17:33
  us grow and care for,
• 17:35
  more patients close to home. And then, of
• 17:37
  course, you know, sending,
• 17:39
  patients to a tertiary care center when needed.
• 17:42
  Absolutely. That is so helpful to understand and
• 17:44
  really cool that you are in a position
• 17:46
  to be in this growth phase to add
• 17:48
  services to, look out into the community and
• 17:50
  see what they need, and then being able
• 17:52
  to bring that, through partnerships
• 17:55
  in other,
• 17:56
  resources that you're bringing in is so amazing.
• 17:59
  Kelly, thank you so much for joining us
• 18:00
  on the podcast today. This has been such
• 18:02
  a a fun conversation, and I look forward
• 18:03
  to connect with you again soon as well
• 18:05
  as seeing you in April at our annual
• 18:07
  meeting. I know you'll be speaking on a
• 18:08
  panel, and so it'll be a lot of
• 18:10
  fun to catch up there.
• 18:11
  Yeah. Thank you so much, Laura.