Latest / Becker's Healthcare Behavioral Health / Kari-Beth Law, MD, Associate Chief Medical Officer and Board Member of the West Virginia University Health System, Professor of Adult, Child/Adolescent and Forensic Psychiatry, Vice Chair of Clinical Services, and Director of Telepsychiatry for the W

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Kari-Beth Law, MD, Associate Chief Medical Officer and Board Member of the West Virginia University Health System, Professor of Adult, Child/Adolescent and Forensic Psychiatry, Vice Chair of Clinical Services, and Director of Telepsychiatry for the W · Becker's Healthcare Behavioral Health

• 0:00
  Welcome to Becker's Healthcare Podcast. I'm Ella Reuter,
• 0:03
  your host, and I'm thrilled to be introducing
• 0:05
  our guest today, doctor Carrie Law. She is
• 0:08
  associate chief medical officer and board member of
• 0:12
  the West Virginia University Health System.
• 0:15
  Clinically, she is a professor of adult, child,
• 0:17
  and adolescent, and forensic psychiatry,
• 0:20
  vice chair of clinical services, and director of
• 0:23
  telepsychiatry
• 0:24
  for
• 0:25
  the WVU
• 0:27
  School of Medicine,
• 0:28
  Department of Behavioral Medicine and Psychiatry.
• 0:31
  Doctor Law, thank you so much for joining
• 0:33
  us today.
• 0:34
  For our audience who may not be familiar
• 0:36
  with you and the work you do, could
• 0:37
  you please introduce yourself and tell us a
• 0:39
  little bit more about your background?
• 0:42
  Absolutely. Thanks, Ella, and and thank you so
• 0:44
  much for the invitation.
• 0:46
  It's truly an honor to share the good
• 0:48
  work that we're doing to serve our state
• 0:50
  and region, so I'm I'm happy to.
• 0:53
  My name is Carrie Beth Law. I was
• 0:55
  born and raised in Southern West Virginia in
• 0:58
  Bluefield,
• 0:59
  and this state has always been home to
• 1:02
  me.
• 1:03
  I completed my medical training at West Virginia
• 1:05
  University
• 1:06
  with additional training in South Carolina,
• 1:09
  but, really, I felt a strong pull to
• 1:11
  return.
• 1:12
  And I've been back at West Virginia University
• 1:15
  since 2011
• 1:16
  building my career.
• 1:18
  I've spent much of my clinical career serving
• 1:20
  West Virginia communities
• 1:21
  through telepsychiatry.
• 1:23
  I've had the opportunity to support and expand
• 1:27
  telebehavioral health services
• 1:29
  through both federal and state grant funding,
• 1:31
  and I've also taken on administration and leadership
• 1:34
  roles at the department and health system levels.
• 1:37
  But at the core of all of this
• 1:38
  is really my passion for rural care and
• 1:41
  advocacy.
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  Telebehavioral health sits right at the intersection,
• 1:46
  of those,
• 1:48
  both expanding access,
• 1:50
  meeting people where they are, and helping ensure
• 1:53
  that geography
• 1:54
  doesn't determine the care that someone receives. So
• 1:57
  I'm happy to be here today.
• 1:59
  Wonderful. Thank you so much for that introduction.
• 2:02
  First, I'd really like to set the stage.
• 2:04
  Can you briefly describe the behavioral health landscape
• 2:07
  in rural West Virginia
• 2:09
  and what makes access so challenging there?
• 2:12
  Sure. So if you've ever been to West
• 2:14
  Virginia,
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  you understand,
• 2:17
  the state slogan,
• 2:18
  wild, wonderful, West Virginia.
• 2:21
  West Virginia really epitomizes beauty from mountains and
• 2:24
  forests to the people in the communities,
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  but, really, that natural beauty contributes to some
• 2:30
  of the access challenges that that you mentioned.
• 2:34
  So when we talk about behavioral health in
• 2:36
  West Virginia and even across Appalachia,
• 2:39
  we're really talking about the intersection of geography,
• 2:42
  workforce shortages,
• 2:44
  stigma,
• 2:45
  and socioeconomic
• 2:46
  stressors.
• 2:48
  When I zoom out a little bit, nationally,
• 2:51
  65%
• 2:51
  of rural US counties have no practicing psychiatrist.
• 2:56
  And so while it's a national crisis, it
• 2:58
  really is amplified in Appalachia and in West
• 3:01
  Virginia.
• 3:02
  Our numbers here in West Virginia are pretty
• 3:04
  staggering.
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  50 out of our 55 counties are federally
• 3:08
  designated mental health professional shortage areas.
• 3:12
  We have among the lowest per capita availability
• 3:15
  of child adolescent psychiatrists in the country.
• 3:18
  And then for some families, accessing specialty care
• 3:21
  historically meant
• 3:22
  driving long distances. That could be two hours
• 3:25
  up to four hours one way, and that's
• 3:27
  if care was even available at all.
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  So when you think about that, that distance
• 3:31
  really hits children and adolescents especially hard.
• 3:35
  For both
• 3:37
  children as well as families, we've seen high
• 3:39
  rates of depression,
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  anxiety,
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  substance use,
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  trauma.
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  But
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  with fewer child and adolescent psychiatrist per capita
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  almost anywhere in the country,
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  that presents
• 3:52
  a huge issue.
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  And then if you add to that the
• 3:55
  Appalachian context,
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  multigenerational
• 3:58
  poverty,
• 3:59
  higher rates of chronic illness,
• 4:01
  the legacy of the opioid epidemic,
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  and
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  really a cultural tendency,
• 4:06
  to handle problems privately.
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  It becomes clear why access gaps persist and
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  it is so deeply tied to where people
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  live.
• 4:15
  Of course. Thank you so much for sharing
• 4:17
  that perspective.
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  And as a lot of us know, telehealth
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  really expanded nationwide during COVID,
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  but in West Virginia, it really took hold.
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  What were the key moments that made virtual
• 4:28
  behavioral health not just helpful but essential in
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  those moments?
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  Sure. And and, you know, I think we
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  we think about
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  the pandemic as really a a a pivotal
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  scenario,
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  for virtual health care.
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  Even before the pandemic, though,
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  many communities,
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  nationally but certainly here, were facing long wait
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  times,
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  provider shortages,
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  and, as I mentioned, kind of hours long
• 4:58
  drives for behavioral health care. So here
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  in West Virginia, we've been using telehealth as
• 5:04
  a modality for care for years.
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  But
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  the COVID nineteen pandemic
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  really seemed to accelerate that for the entire
• 5:12
  nation, including West Virginia.
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  When you think about it, in person services
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  all but shut down.
• 5:19
  Telebehavioral
• 5:20
  health became the only viable way to maintain
• 5:23
  treatment access and connection.
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  Both of those are really critical for those
• 5:27
  who are suffering with mental health or substance
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  use disorders.
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  And so when I think about some key
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  issues and key moments,
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  one,
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  West Virginia is a state with heavier health
• 5:39
  burden
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  and fewer resources.
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  COVID provided an opportunity
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  to demonstrate
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  both the independent spirit of our state's people,
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  but also the innovative minds of our treatment
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  providers.
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  I think
• 5:53
  about another key moment being related to relaxation
• 5:56
  of regulatory barriers and reimbursement rules.
• 6:00
  Though nationwide, we saw something surprising.
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  There had been assumptions from some that rural
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  patients wouldn't or couldn't
• 6:08
  use or access,
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  technology due to broadband
• 6:11
  difficulties and otherwise.
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  We also presumed many of our providers wouldn't
• 6:16
  try virtual care, whether because of their own
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  personal preference
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  or because of the type of care that
• 6:22
  they provided.
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  And what we realized was that many of
• 6:26
  those assumptions were wrong.
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  Patients showed up.
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  Engagement improved.
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  And for many families, actually, virtual visits were
• 6:34
  easier and less disruptive.
• 6:37
  That's something we'd seen in West Virginia for
• 6:39
  years,
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  and
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  the pandemic allowed for this to flourish.
• 6:44
  You imagine a family here in a pretty
• 6:47
  mountainous area.
• 6:50
  Having the access to virtual visits was the
• 6:52
  difference between getting care or skipping it, whether
• 6:55
  that was because
• 6:57
  you had been exposed
• 6:58
  to COVID and were in isolation,
• 7:01
  because you were snowed in or because of
• 7:03
  a a weather event,
• 7:05
  because your parent or your guardian couldn't afford
• 7:07
  to miss work, had a broken down car,
• 7:09
  and you had no way to get there.
• 7:12
  So
• 7:13
  I think that's
• 7:15
  absolutely,
• 7:17
  a few of the key moments. And lastly,
• 7:19
  you know, pediatric demand has been rising nationally.
• 7:22
  Rural states like West Virginia
• 7:24
  have experienced severe workforce constraints
• 7:27
  pre pandemic.
• 7:29
  And so telepsychiatry
• 7:32
  has allowed us to extend the expertise of
• 7:34
  a limited number of specialists
• 7:36
  across a pretty large footprint,
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  and that's critical both in allowing better access
• 7:41
  to limited resources, but then also to supporting
• 7:43
  and collaborating with our community providers.
• 7:47
  Of course. I love that collaboration piece. Of
• 7:49
  course. And and in terms of execution,
• 7:53
  how did your team actually operationalize
• 7:55
  virtual behavioral health in a rural setting?
• 7:59
  Sure.
• 8:00
  So I am proud to say that WVU
• 8:03
  Medicine has been a leader in virtual care
• 8:06
  for decades.
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  That originally began,
• 8:09
  with Mountaineer Doctor of Television or MDTV,
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  which
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  initiated in the the early nineteen nineties.
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  We approached telebehavioral health and the Department of
• 8:19
  Behavioral Medicine and Psychiatry
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  as a pilot
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  in 2009.
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  And then this quickly evolved into a system
• 8:27
  strategy when we recognized the value that access
• 8:30
  to care brought for our patients at all
• 8:32
  ends of the state for mental health services.
• 8:35
  And that included seeing adults and children, whether
• 8:38
  it was for diagnostic or ongoing treatment, medication
• 8:41
  management,
• 8:43
  individual therapy, group therapy, addiction treatment, and and
• 8:46
  so on.
• 8:47
  But I think a few of the pieces
• 8:49
  that are that are important when we think
• 8:51
  about how we operationalized it was we leveraged
• 8:55
  our academic medical center as a hub, and
• 8:58
  we extended care outward.
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  And that was we were nonselective with that.
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  So this was to community mental health centers,
• 9:05
  federally qualified health center clinics,
• 9:07
  critical access hospitals, emergency departments, schools, and then
• 9:11
  ultimately,
• 9:12
  after the pandemic, into patients' homes.
• 9:15
  That required some pretty intentional design, though.
• 9:19
  We partnered closely with
• 9:22
  local primary care providers, pediatricians,
• 9:25
  and emergency departments. It was important that they
• 9:28
  felt that the telebehavioral
• 9:31
  health services were integrated
• 9:33
  and not external, both for the providers, but
• 9:36
  also the patients.
• 9:37
  We invested heavily in workflows and scheduling and
• 9:41
  trainings,
• 9:42
  both for clinicians, but also for patients and
• 9:44
  families.
• 9:45
  It was really
• 9:47
  important for us that this was not just
• 9:49
  giving them
• 9:51
  a virtual link and calling it a day.
• 9:54
  It was about building relationships and buy in.
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  It was about identifying a champion at each
• 9:59
  site who believed in the modality,
• 10:02
  and that is both
• 10:03
  before and and during and after the pandemic.
• 10:07
  You know, I think about
• 10:10
  some of the broadband and technology literacy challenges,
• 10:13
  and they were they were very real.
• 10:15
  Some families did not have reliable Internet or
• 10:17
  had never used video visits before.
• 10:21
  If if families didn't have Internet access, we
• 10:24
  had to be really creative with them. And
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  I remember,
• 10:27
  a family that would regularly drive to their
• 10:30
  local McDonald's parking lot because that was the
• 10:33
  place locally that had Wi Fi,
• 10:36
  and they joined their appointment from there.
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  So
• 10:40
  during COVID, we leaned on much of the
• 10:42
  experience that our team had had over the
• 10:44
  prior decade. We converted nearly all of our
• 10:46
  visits within our department to virtual within about
• 10:49
  two weeks,
• 10:51
  and and that's pretty impressive in a time
• 10:53
  when community supports were limited, people were isolated
• 10:57
  and scared.
• 10:58
  Overdose deaths were nearly doubled.
• 11:00
  It was important to meet our patients where
• 11:02
  they were. Mhmm. We, We, at that time,
• 11:05
  offered phone based visits when they were needed,
• 11:07
  used clinic based telehealth rooms,
• 11:09
  and had staff walk family through the technology
• 11:12
  step by step.
• 11:14
  So the goal
• 11:16
  when we think about operationalizing
• 11:18
  and executing even now is to reduce friction
• 11:22
  points
• 11:22
  Mhmm. By being creative and flexible
• 11:25
  while still adhering to an evidence based care
• 11:27
  model.
• 11:28
  And would you be able to share an
• 11:30
  example or two that really show what this
• 11:33
  model has changed for patients?
• 11:36
  Absolutely.
• 11:37
  You know, I think
• 11:39
  this is the best part. We could talk
• 11:41
  about this,
• 11:42
  for days. I mean, we've seen stories of
• 11:44
  children
• 11:46
  with
• 11:47
  with symptoms that receive specialty evaluation and treatment
• 11:50
  instead of waiting months
• 11:51
  or longer,
• 11:53
  and and adults
• 11:55
  who have really complex comorbidities
• 11:58
  that have been able to finally establish continuity
• 12:02
  and and maybe for the first time feel
• 12:04
  like they've been consistently connected.
• 12:07
  So I think about
• 12:08
  there are two that really stand out.
• 12:11
  One, and this was actually one of my
• 12:13
  clinical patients.
• 12:16
  This was
• 12:17
  a child who had a neurodevelopmental
• 12:20
  disorder
• 12:21
  that had been diagnosed
• 12:24
  as a very young child,
• 12:25
  but because of where they lived in a
• 12:28
  very rural county, they had minimal access to
• 12:30
  treatment providers
• 12:32
  who could help with
• 12:34
  management of their,
• 12:36
  their symptoms.
• 12:39
  It was
• 12:40
  so severe that they were on the verge
• 12:43
  of being unable to attend school
• 12:46
  even in a self contained classroom.
• 12:49
  Their
• 12:50
  parents were at their wit's end,
• 12:53
  and they
• 12:55
  saw
• 12:56
  a person who
• 12:57
  you know, for myself as a provider with,
• 13:00
  child adolescent psychiatry training,
• 13:03
  they were able to
• 13:06
  meet with me
• 13:07
  regularly,
• 13:09
  provide some diagnostic clarification, but, ultimately,
• 13:12
  treatment
• 13:13
  that,
• 13:14
  unfortunately, their their
• 13:17
  primary care provider just at the time didn't
• 13:19
  feel comfortable with,
• 13:21
  but also assistance with recommendations for the school.
• 13:24
  This child
• 13:26
  stayed in school.
• 13:28
  They began to do better,
• 13:30
  and and it was a huge relief for
• 13:32
  the family and for the patient.
• 13:35
  So that was pretty exciting.
• 13:37
  And I think,
• 13:39
  on the other end of the spectrum,
• 13:41
  we had a patient with
• 13:44
  substance use disorder who actually was admitted here
• 13:47
  at our academic medical center for an infection
• 13:50
  in their heart valve that was related to
• 13:52
  drug use. That it required surgical interventions. It
• 13:55
  had required IV antibiotics for a long time,
• 13:58
  and and so
• 14:00
  pretty significant
• 14:02
  comorbidities
• 14:03
  related to their substance use.
• 14:05
  They ultimately were discharged.
• 14:07
  When they were discharged from our academic medical
• 14:10
  center, they were to return to their home
• 14:12
  community,
• 14:13
  and they happen to live in a community
• 14:15
  where we were providing virtual addiction treatment.
• 14:18
  So they
• 14:20
  were able to transition from
• 14:22
  inpatient consult psychiatric services
• 14:25
  to outpatient care
• 14:28
  where
• 14:29
  they participated in treatment,
• 14:31
  they maintained their sobriety,
• 14:33
  And interestingly, this patient got pregnant and because
• 14:36
  of that, moved to be near to their
• 14:38
  family in another location.
• 14:40
  In that second location,
• 14:42
  we also were providing treatment in that community.
• 14:45
  So they were able to transition care from
• 14:48
  one community clinic
• 14:50
  to another community clinic,
• 14:53
  deliver their child
• 14:55
  their child in their custody,
• 14:57
  and continue to have treatment within their community,
• 15:01
  which is is really critical. So it these
• 15:04
  are are two of of many stories that
• 15:06
  we have, but it's just it's really powerful
• 15:09
  to see how that translates for patients and
• 15:11
  families.
• 15:12
  Of course. I feel like that is a
• 15:13
  huge part of behavioral health is the stories
• 15:16
  behind
• 15:17
  the care that you're giving. So thank you
• 15:19
  so much for providing those examples and and
• 15:22
  opening up.
• 15:23
  I'm curious too, what are you seeing on
• 15:25
  the data side of things?
• 15:28
  The data is exciting.
• 15:30
  And so just to provide some some,
• 15:34
  reference points,
• 15:35
  when I think about the last three years
• 15:38
  in terms of
• 15:40
  just our volumes, the number of patients that
• 15:43
  we're seeing
• 15:44
  virtually
• 15:45
  in our clinic within,
• 15:47
  within the department of behavioral medicine and psychiatry,
• 15:51
  total
• 15:52
  visits
• 15:53
  are are still lingering a little over
• 15:56
  a little over fifty percent.
• 15:58
  And that's
• 16:00
  with having
• 16:02
  about a 100,000
• 16:03
  patients per year
• 16:05
  theme.
• 16:06
  And with kids
• 16:08
  that
• 16:09
  they're a little bit less, but still at
• 16:11
  around
• 16:12
  a third of our patients, our children are
• 16:15
  seen,
• 16:16
  are seen virtually.
• 16:17
  And
• 16:18
  and I say that just to sort of
• 16:20
  share that this isn't,
• 16:21
  you know, this isn't a small one off.
• 16:24
  What we're seeing internally really mirrors the national
• 16:27
  trends, and it's exciting.
• 16:29
  So across the country, studies have shown that
• 16:33
  telepsychiatry
• 16:34
  produces outcomes that are comparable to in person
• 16:37
  care,
• 16:37
  and that's for multiple conditions.
• 16:40
  There's lower no show rates
• 16:43
  and higher patient satisfaction.
• 16:46
  One of those studies was conducted here, and
• 16:48
  it's been replicated nationally.
• 16:50
  So it's it's really, really amazing.
• 16:54
  In our system, we've seen improved access,
• 16:58
  faster time to first appointment, and better continuity
• 17:01
  of care, particularly for pediatric patients and those
• 17:04
  in remote areas.
• 17:07
  No show rates are often lower for virtual
• 17:09
  visits, especially in rural populations,
• 17:12
  where, as I said before, transportation
• 17:14
  and weather
• 17:15
  are
• 17:16
  and can be major barriers.
• 17:19
  And engagement improves when the care fits into
• 17:22
  people's lives
• 17:23
  rather than requiring them to reorganize their lives
• 17:26
  around care.
• 17:28
  And I think finally and equally important,
• 17:30
  we're seeing gains in health care equity.
• 17:34
  So we're reaching patients who previously would not
• 17:36
  have accessed specialty behavioral health services at all.
• 17:40
  So really, really exciting times, and I think
• 17:42
  that that's only going to to continue.
• 17:46
  And in terms of, like, policy or reimbursement
• 17:48
  factors,
• 17:50
  that help make this work,
• 17:52
  can you kinda describe those and what still
• 17:54
  creates
• 17:55
  friction in spots?
• 17:57
  Sure. Policy matters, and it matters enormously
• 18:01
  in rural telebehavioral health.
• 18:03
  I am excited to say that West Virginia
• 18:07
  really has long since been a leader in,
• 18:10
  telebehavioral health care
• 18:12
  long before,
• 18:14
  COVID. And and, again, I think that speaks
• 18:16
  to
• 18:17
  the rurality of our state and the need
• 18:19
  to be innovative with how our our patients
• 18:22
  receive care,
• 18:23
  Allowing patients
• 18:25
  a patient home to be an appropriate,
• 18:28
  originating site is is one of the the
• 18:31
  legislative pieces that has recently been passed here,
• 18:35
  and will continue to be maintained post pandemic,
• 18:37
  which I think is really impressive, specifically for
• 18:40
  behavioral health care.
• 18:42
  So, certainly, Medicaid policy has always played a
• 18:44
  critical role in sustaining access for children and
• 18:47
  families.
• 18:48
  During the pandemic,
• 18:50
  expanded reimbursement parity
• 18:53
  and then licensing flexibility
• 18:55
  made rapid scaling possible. Without that, we really
• 18:58
  could not have done,
• 19:00
  what was done and what was needed.
• 19:03
  Expanding reimbursement for services that previously hadn't been
• 19:06
  covered, such as collaborative care or behavioral health
• 19:09
  integration, really was essential.
• 19:11
  And and that's one aspect that's
• 19:14
  vital to maintaining
• 19:15
  the access that was created
• 19:17
  into post pandemic virtual behavioral health care.
• 19:20
  But there's still uncertainty
• 19:22
  around long term reimbursement, and that remains a
• 19:24
  challenge.
• 19:25
  I think other flexibilities,
• 19:27
  including online prescribing of controlled substances
• 19:31
  to appropriate patients in an evidence based way,
• 19:34
  is really,
• 19:36
  this is something that
• 19:37
  is
• 19:39
  a a daily issue, particularly
• 19:41
  for those who do not have local access
• 19:44
  to care.
• 19:45
  But,
• 19:46
  the
• 19:47
  the deadline
• 19:48
  for
• 19:49
  the national level to to identify a policy
• 19:52
  both for DEA and, health and human services
• 19:56
  has been extended through the 2026.
• 19:59
  And we certainly have hopes that they will
• 20:02
  be able to navigate how to allow appropriate
• 20:04
  safeguards while also minimizing access issues.
• 20:07
  The relaxation of and the allowance
• 20:09
  of virtual supervision
• 20:12
  was really critical.
• 20:14
  So when you think about,
• 20:16
  licensure requirements
• 20:18
  and what's needed
• 20:19
  for
• 20:20
  specific types of health care providers, whether that
• 20:23
  be,
• 20:24
  providers in training like residents or fellow physicians
• 20:28
  or
• 20:29
  even advanced practice providers,
• 20:31
  counselors, and therapists.
• 20:33
  Supervision,
• 20:35
  plays a large role in this.
• 20:37
  And during
• 20:38
  the pandemic,
• 20:39
  virtual supervision was allowed,
• 20:42
  meaning
• 20:43
  you may be able to have a very
• 20:45
  highly trained,
• 20:47
  specialist who is able to provide supervision to
• 20:51
  one of your,
• 20:52
  one of your providers
• 20:54
  without even being in the same state.
• 20:57
  Mhmm. We took advantage of that here at
• 21:00
  WVU and and really have found that it
• 21:02
  has
• 21:03
  been, a hugely positive,
• 21:06
  a hugely positive variable when it comes to
• 21:09
  training as well as as helping
• 21:12
  to, improve access.
• 21:14
  And then I think,
• 21:15
  finally, health systems really need clarity and stability
• 21:19
  to be able to invest in technology, staffing,
• 21:21
  and training.
• 21:23
  But I think
• 21:24
  going forward,
• 21:26
  we need to continue to engage and engage
• 21:28
  early with state policymakers and payers,
• 21:31
  align telehealth strategy with population health goals, and
• 21:35
  continue to track outcomes rigorously so that we
• 21:38
  can continue to demonstrate the value that that
• 21:40
  we have done thus far that virtual care
• 21:42
  has allowed.
• 21:44
  Wonderful.
• 21:45
  And for our last, like, minute thirty seconds,
• 21:49
  I'm wondering if you can
• 21:51
  give a few takeaways for behavioral health leaders,
• 21:55
  especially those in rural systems.
• 21:58
  Absolutely.
• 21:59
  You know, I think telebehavioral health isn't about
• 22:02
  replacing in person care.
• 22:04
  It's about matching the right modality to the
• 22:06
  right patient at the right time.
• 22:09
  And rural health systems
• 22:11
  don't need to wait for perfect conditions to
• 22:13
  improve access.
• 22:15
  And whether that's starting by integrating with local
• 22:18
  primary care or focusing on relationships with local
• 22:21
  providers,
• 22:23
  exploring collaborative care models,
• 22:26
  and beginning to develop
• 22:28
  to engage in workforce development, those are all
• 22:30
  critical.
• 22:31
  I think extending
• 22:33
  scarce specialty expertise while also supporting local providers
• 22:37
  through consultation
• 22:38
  and education is so important.
• 22:41
  For rural states, sustainability
• 22:43
  is going to depend upon policy alignment, on
• 22:45
  broadband investment,
• 22:47
  and continued invested innovation.
• 22:49
  But the foundation is firmly in place.
• 22:52
  And so
• 22:54
  while our experience is rooted in Appalachia, I
• 22:56
  think these lessons are applicable everywhere.
• 22:59
  As workforce shortages grow nationally, what we've learned
• 23:02
  in rural West Virginia really has relevance for
• 23:04
  urban and suburban systems alike throughout the nation.
• 23:08
  Wonderful.
• 23:09
  Well, doctor Cary Law, thank you so much,
• 23:12
  for being here and sharing how telebehavioral
• 23:14
  health is expanding access in rural Appalachia
• 23:18
  and for the practical lessons leaders can apply
• 23:20
  elsewhere.
• 23:21
  Thanks, to all of our listeners for tuning
• 23:23
  in to Becker's Healthcare Podcast.
• 23:26
  We'll see you next time.