Latest / Becker’s Healthcare Podcast / Bridging Technology, Trust, and Access in Rural Healthcare with Dr. Marquita Lyons-Smith & Dr. W. Andre Walker

Transcript

Bridging Technology, Trust, and Access in Rural Healthcare with Dr. Marquita Lyons-Smith & Dr. W. Andre Walker · Becker’s Healthcare 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 they go to
• 0:21
  - 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.
• 0:50
  - This is Laura Dierda with the Becker's Healthcare
• 0:52
  - podcast.
• 0:53
  - I'm thrilled today to be joined by doctor
• 0:55
  - Markita Lyons Smith, health administration program director at
• 0:59
  - North Carolina Central University
• 1:01
  - and doctor Andre Walker, assistant professor with health
• 1:04
  - administration program at North Carolina Central University.
• 1:07
  - Doctor Lyons Smith, doctor Walker, it's a pleasure
• 1:09
  - to have you on the podcast today.
• 1:11
  - Thank you for having us. Thank you. Thank
• 1:12
  - you. Yes. Thank you very much.
• 1:15
  - Absolutely. Now I'm excited for our conversation because
• 1:17
  - we're gonna be talking through some really important
• 1:19
  - things today, looking at how
• 1:22
  - you can really
• 1:23
  - move forward in serving underserved or rural populations,
• 1:26
  - technology coming in through the rural health transformation
• 1:29
  - program, and whether that's enough to really,
• 1:32
  - get to the bottom of what the challenges
• 1:33
  - are in access to care, health literacy, and
• 1:35
  - more. So,
• 1:37
  - I'm excited for the conversation. But before we
• 1:40
  - dive in, can you tell us a little
• 1:41
  - bit about the program at North Carolina Central
• 1:43
  - University and, some of the the things that
• 1:46
  - you're doing within your community,
• 1:48
  - to really improve access to care?
• 1:51
  - Sure. So North Carolina Central University, our health
• 1:54
  - administration program, we're definitely interested in rural health
• 1:58
  - and how we can expand our resources to
• 2:00
  - help our rural community.
• 2:01
  - And so our focus is reaching out to
• 2:04
  - some of the health administrators,
• 2:07
  - especially those that perform in rural areas and
• 2:09
  - seeing how we can assist them because they
• 2:11
  - give us so much of an overarching
• 2:14
  - macro view
• 2:15
  - of, what they're exposed to in the community
• 2:18
  - and how we can help our students be
• 2:20
  - the answer for the future.
• 2:22
  - But besides that, North Carolina Central University also
• 2:25
  - has a rural health hub
• 2:27
  - that is housed. It's a 5,000 square foot
• 2:30
  - building that is, in Halifax County and actually
• 2:34
  - has a broad outreach to seven 17 different
• 2:37
  - communities in the area. So and we also
• 2:40
  - have a mobile health clinic at North Carolina
• 2:42
  - Central University that collaborates with that rural health
• 2:45
  - hub in order to,
• 2:46
  - go out into the community and serve them
• 2:49
  - where they are. So those are, some of
• 2:51
  - the few things that we're doing, kind of
• 2:52
  - taking the the faculty, taking the nursing students
• 2:56
  - to the,
• 2:58
  - community and to the underserved where they are
• 3:01
  - and giving them multiple different types of services
• 3:03
  - that might not be readily available in their
• 3:05
  - community.
• 3:07
  - That's really helpful background to understanding and such
• 3:10
  - important work to do within the community and
• 3:12
  - improve the health and wellness of all those,
• 3:15
  - within the broader population.
• 3:18
  - Now, from your perspective, I know there's been
• 3:20
  - a lot of talk about the rural health
• 3:22
  - transformation program, the firms coming from that, and
• 3:25
  - dedicated to a variety of things,
• 3:27
  - based on the states and institutions across the
• 3:29
  - country. But in your experience, I know a
• 3:31
  - lot, has
• 3:33
  - a focus has been placed on the technology
• 3:35
  - side. So can you talk a little bit
• 3:36
  - about how you're seeing these funds and what
• 3:39
  - you really,
• 3:40
  - you know, are are,
• 3:42
  - thinking about them and how you're seeing them,
• 3:44
  - being used and and planned for,
• 3:46
  - in the future?
• 3:48
  - Well, from the North Carolina perspective, it is
• 3:50
  - exciting to know that there has been $213,000,000
• 3:53
  - that has awarded, and the technology
• 3:55
  - piece in rural health care is a huge
• 3:58
  - component.
• 3:59
  - But,
• 4:01
  - I have to go back and say that
• 4:02
  - this is an important conversation
• 4:04
  - because rural health care sits at the intersection
• 4:07
  - of access, equity, technology,
• 4:10
  - but also trust. And while the RHT program
• 4:13
  - expands funding for technology, and that's very, very
• 4:16
  - encouraging,
• 4:17
  - I don't believe this innovation alone is gonna
• 4:20
  - really close the gap that's necessary in rural
• 4:23
  - communities.
• 4:24
  - It's a tool, an excellent tool. It's just
• 4:26
  - not a solution
• 4:28
  - alone and by itself.
• 4:30
  - In any many of my writings in rural
• 4:33
  - health or on rural health, I have emphasized
• 4:36
  - that,
• 4:37
  - the rural community often faces
• 4:40
  - layered barriers that extend far beyond the availability
• 4:44
  - of new health care technology.
• 4:47
  - We do have to remember that many rural
• 4:50
  - patients already they're navigating
• 4:52
  - provider shortages,
• 4:54
  - transportation limitations.
• 4:56
  - You know, they're they're living much further from
• 4:58
  - the hospitals than they did before because of
• 5:01
  - hospital closures and things of that sort,
• 5:04
  - financial hardship, chronic disease burn, so many different
• 5:07
  - things they're already dealing with. So when
• 5:10
  - you add innovative technology into that environment
• 5:15
  - without addressing some of those foundational
• 5:17
  - issues, you we can unintentionally
• 5:20
  - widen the disparities
• 5:22
  - because those who already have are ready to
• 5:25
  - absorb and use those resources,
• 5:27
  - whereas the underserved
• 5:28
  - are not ready. They don't have the foundation
• 5:30
  - necessary to really
• 5:32
  - absorb and benefit from the technological
• 5:35
  - resources and advancement.
• 5:37
  - That makes a lot of sense. You know?
• 5:38
  - And it seems like it would be a
• 5:40
  - a huge challenge,
• 5:41
  - when going into the communities and trying to
• 5:43
  - figure out how you're going to,
• 5:46
  - share these services and and get to a
• 5:48
  - place where, you're able to connect with them
• 5:50
  - and and,
• 5:51
  - work with them
• 5:52
  - on developing the programs that they need in
• 5:55
  - order to have healthy lives.
• 5:58
  - Now I'm curious. What has been your experience
• 6:01
  - as you've been going out into the field
• 6:02
  - and trying to create more accessibility, what are
• 6:05
  - you finding that,
• 6:07
  - you know, the community really needs, and what's
• 6:09
  - been most effective in reaching them? Well, I
• 6:12
  - would probably say just going and doing,
• 6:14
  - outreach to some of the community members. If
• 6:16
  - they don't feel connected to you, there's always
• 6:19
  - this hesitancy about receiving information.
• 6:22
  - So I think that's where we need to
• 6:25
  - start from a grasp groups level
• 6:27
  - to kinda establish that trust.
• 6:29
  - Because if you're coming to rural areas,
• 6:31
  - there's always this challenge. Like, who is this
• 6:33
  - guy coming to visit me? What information are
• 6:36
  - you sharing? So that's where I'll start with
• 6:38
  - that, and I'll lean back into doctor Lyons.
• 6:40
  - She's so great with this so far, and
• 6:42
  - I appreciate her. She's she's covered it. So
• 6:45
  - I'm I'm just gonna chime in and just
• 6:47
  - support what she's saying, and then I'll give
• 6:49
  - some, some input on how we can close
• 6:52
  - that gap that we see that's so prevalent
• 6:54
  - in these rural communities and some some suggestions
• 6:56
  - in that space.
• 6:58
  - Lots of teamwork in this awesome health administration
• 7:01
  - program.
• 7:02
  - But, yeah, I I agree with doctor, Walker.
• 7:05
  - One of the biggest lessons that we have
• 7:06
  - learned,
• 7:07
  - in health care that innovation has to be
• 7:10
  - human centered. That's always gonna be more effective.
• 7:13
  - Correct. Rural communities value relationships.
• 7:16
  - They value trust, and so we want technology
• 7:19
  - to ship support those relationships and not to
• 7:22
  - replace them. That's never gonna work. And so
• 7:25
  - nurses,
• 7:26
  - community health workers, primary care providers, such as
• 7:29
  - myself, I am a pediatric nurse practitioner,
• 7:32
  - faith based leaders, educators,
• 7:34
  - local organizations,
• 7:36
  - all of these, they're very essential
• 7:38
  - in helping our patients to understand that their
• 7:40
  - health conditions
• 7:42
  - are actually helping to kind of break down
• 7:44
  - their health care conditions
• 7:45
  - and navigate the increasingly complex health care systems.
• 7:49
  - If they see you multiple times solving their
• 7:53
  - problems, being present,
• 7:56
  - helping them, and not using them just, you
• 7:58
  - know, for research or,
• 8:00
  - just not following up in the way that
• 8:03
  - makes them feel comfortable.
• 8:04
  - The technology
• 8:06
  - is going to be ineffective, and it's gonna
• 8:08
  - be unused.
• 8:10
  - Another concern I have
• 8:12
  - is the hesitancy
• 8:14
  - that happens with not just the underserved,
• 8:17
  - but the older adults.
• 8:19
  - They don't there's a there's a digital device
• 8:22
  - still here, and it's widening more
• 8:25
  - because,
• 8:26
  - some of the young people and even people
• 8:28
  - our age, we're starting to see
• 8:30
  - how AI and digital,
• 8:33
  - you know, interfacing is helpful for us. But
• 8:36
  - some of the older communities still look at
• 8:38
  - it and say, I don't trust it. What
• 8:40
  - is this AI? Who am I talking to
• 8:43
  - on this, computer screen?
• 8:46
  - That that's that's a barrier. Right? But not
• 8:48
  - only is that a barrier to digital hesitancy,
• 8:52
  - but what if you don't have the broadband
• 8:54
  - that's necessary
• 8:55
  - to have,
• 8:56
  - and you you have the device, you don't
• 8:58
  - have the broadband, and so you can't even
• 9:01
  - engage in a way that is going to
• 9:03
  - be helpful on a consistent basis. What are
• 9:06
  - we doing about that infrastructure
• 9:08
  - to make sure that that's not a barrier?
• 9:10
  - And what are we doing about the
• 9:12
  - hesitancy with a digital device so that intergenerationally,
• 9:17
  - everybody is a bit more comfortable with using
• 9:20
  - the technology that will be afforded them?
• 9:23
  - That's such an excellent point. And, you know,
• 9:25
  - really, I appreciate you bringing up the this
• 9:28
  - topic of the, digital ascendancy in technology because,
• 9:31
  - it can make a big difference, even from
• 9:33
  - person to person in many respects.
• 9:36
  - And as technology continues to evolve, certainly, you
• 9:40
  - don't wanna leave anybody behind. So,
• 9:42
  - from your perspective, is there anything that you
• 9:45
  - have seen on, the health literacy side or,
• 9:48
  - technology literacy too that has been effective in,
• 9:51
  - connecting with these folks and really bringing them
• 9:54
  - into the fold? And,
• 9:55
  - you know, if you were looking at the
• 9:57
  - funds today,
• 9:58
  - in getting funds to do anything, what would
• 10:01
  - you really put them towards, or what would
• 10:02
  - you, suggest having them used for that would
• 10:05
  - be more effective than some of the things
• 10:07
  - that you're seeing right now, being put into
• 10:09
  - play?
• 10:10
  - Yeah. There are two things. One thing I'm
• 10:12
  - thinking about is,
• 10:14
  - making sure
• 10:15
  - that innovation and technology is not just designed
• 10:18
  - from the urban perspective.
• 10:21
  - Using funds to kinda go out into the
• 10:23
  - community
• 10:24
  - and having people that live in those rural
• 10:27
  - areas
• 10:28
  - help you to design some of these technological
• 10:31
  - models, AI applications,
• 10:33
  - health care technologies,
• 10:35
  - so that they'll be able to help us
• 10:37
  - translate this information for their community.
• 10:41
  - The other thing is we have to continue
• 10:43
  - to go back to the foundation. Right? Health
• 10:46
  - literacy
• 10:47
  - is especially
• 10:49
  - crucial
• 10:50
  - because we can have all of the technological
• 10:52
  - advances that we want. But if the patients
• 10:54
  - don't know what to do with the information
• 10:56
  - that we're providing them doing these virtual encounters,
• 10:59
  - nothing is gonna be solved. And so we
• 11:02
  - really need to make sure that we still
• 11:04
  - concentrate
• 11:05
  - on helping our patients to understand their, chronic
• 11:08
  - conditions,
• 11:09
  - how they manage them, how they interpret medical
• 11:11
  - information.
• 11:12
  - And if we continue to improve with this
• 11:14
  - literacy
• 11:15
  - and using our technology to help us to
• 11:18
  - understand how to do it, that is going
• 11:20
  - to be and that's proven to be more
• 11:22
  - effective
• 11:23
  - because we're still engaging. We're still educating
• 11:26
  - in plain language so that we can get
• 11:28
  - the outcomes and buy in we need.
• 11:31
  - Yes. Yes.
• 11:32
  - Absolutely. I I love that. Doctor Walker, is
• 11:35
  - there anything that you want to add there
• 11:37
  - from some of your, experience? It's so much
• 11:39
  - it's so much I I I would like
• 11:41
  - to say, but I think to doctor Lyon's
• 11:43
  - point, everything is so,
• 11:45
  - so on point. Educating and empowering, giving them
• 11:48
  - that confidence. I would probably say just continue
• 11:50
  - to boost
• 11:51
  - the rural tech's confidence. You know, rural residents
• 11:54
  - need support, not just devices, but we need
• 11:56
  - to train our local helpers, our community health
• 11:59
  - workers, our librarians, our clergy, those people they
• 12:02
  - have relationships with,
• 12:04
  - and walk people through,
• 12:05
  - phenomenons like telehealth, teledentistry,
• 12:08
  - and apps and digital tools,
• 12:10
  - that make these technologies feel so use usable
• 12:13
  - and not overwhelming.
• 12:15
  - Because that relationship is already theirs. They wanna
• 12:18
  - stay in that same cadence, the same pace
• 12:20
  - with them. We also wanna build tools that
• 12:22
  - work with, lowering resource
• 12:24
  - settings. You know, innovation
• 12:27
  - must match rule realities. That means that that
• 12:30
  - tools must work with a low
• 12:33
  - bandwidth, you know, have simple infrastructures
• 12:35
  - and interfaces
• 12:36
  - that offer online low literacy options so everyone
• 12:40
  - can access the same care regardless of connectivity.
• 12:44
  - I think those are two things. And,
• 12:46
  - lastly, I think just we need to equip
• 12:48
  - our rural
• 12:49
  - clinicians
• 12:50
  - to use new tech very well. You know,
• 12:53
  - technology,
• 12:54
  - only helps clinicians that can integrate it into
• 12:57
  - their workflow. That means we need to provide
• 13:00
  - training,
• 13:01
  - protect learning time, so they can learn the
• 13:03
  - new new that's going on, that's this changing
• 13:06
  - episode in our new health care system.
• 13:08
  - And, regional support hubs that provide rural providers
• 13:12
  - providers
• 13:13
  - with confidence in using various apps, telehealth and
• 13:16
  - teledentistry, because things are changing. Now AI is
• 13:19
  - in that space too as well too. So,
• 13:21
  - you know, I'll lastly say this, and I'll
• 13:23
  - leave it at that, because doctor Lyons Smith
• 13:25
  - has been so on point. Innovation is so
• 13:27
  - powerful,
• 13:29
  - and it's not the magic wand. But rural
• 13:31
  - communities,
• 13:32
  - just don't need
• 13:34
  - new tools. They need support. They need training.
• 13:37
  - They need systems designed
• 13:39
  - with them and not for them. That means
• 13:42
  - we need to compare, combine technologies,
• 13:46
  - and,
• 13:47
  - human connection.
• 13:48
  - And that way, we can kinda close this
• 13:50
  - gap that is so prevalent.
• 13:52
  - So the the data is there.
• 13:55
  - Doctor Walker, I completely agree with you. You
• 13:57
  - summed it up so well. I just wanted
• 13:59
  - to chime in and say that workforce development
• 14:02
  - piece is key.
• 14:03
  - Yes. I know HRSA used to really help
• 14:07
  - prepare,
• 14:08
  - providers to work in the rural community.
• 14:11
  - And we still need support for providers that
• 14:15
  - are living in a rural community, want to
• 14:17
  - stay there, know the language, know the community.
• 14:20
  - They need that support. You know? And, you
• 14:22
  - know, with the student loans that they're having
• 14:24
  - to pay back or any other financial investment
• 14:27
  - and these providers that know the language and
• 14:30
  - it can affect outcomes
• 14:32
  - because we're putting,
• 14:33
  - our resources back into that workforce development.
• 14:38
  - That makes a ton of sense. And I
• 14:39
  - know,
• 14:40
  - the workforce challenge is one across the board,
• 14:43
  - but especially acute within the rural space. And
• 14:45
  - so to have, you know, leaders, physicians, and
• 14:49
  - clinicians who want to be within those communities
• 14:51
  - and and continue to thrive there. That support,
• 14:54
  - I can imagine, is so, so critical. I'm
• 14:56
  - curious. Before we wrap up this discussion,
• 14:59
  - when you look over the next two to
• 15:01
  - three years or so, what are you most
• 15:03
  - excited about, and what makes you nervous?
• 15:06
  - I am most excited
• 15:08
  - about the decrease in cognitive
• 15:11
  - overload
• 15:12
  - that AI will bring
• 15:14
  - to some of these health care providers
• 15:16
  - so they can be more
• 15:18
  - more patient facing, patient
• 15:21
  - focused
• 15:22
  - as long as we learn how to use
• 15:23
  - it well. Of course, what makes us more
• 15:26
  - nervous,
• 15:28
  - on many different realms is how AI
• 15:31
  - can prevent you from getting the care you
• 15:33
  - need by denying some of the claims
• 15:36
  - that are made
• 15:37
  - because AI is going in and saying, this
• 15:40
  - should be, this is good and this is
• 15:42
  - not. Those those are the type of things
• 15:44
  - where the human
• 15:46
  - element
• 15:47
  - still needs to be prevalent so that whether
• 15:49
  - you are in a rural community or urban,
• 15:51
  - you still get the care that you deserve
• 15:53
  - and need. Yes.
• 15:55
  - And I would I would probably say,
• 15:58
  - the escalating behavior and social needs when it
• 16:01
  - comes to rural health facing,
• 16:04
  - pediatric and adult behavior crisis,
• 16:07
  - you know,
• 16:08
  - without inpatient beds and crisis stabilization units and
• 16:12
  - community based,
• 16:14
  - support systems
• 16:16
  - that is continuing to, to make its to
• 16:19
  - rear its head, is to be prevalent,
• 16:21
  - and how these rural systems and health care
• 16:23
  - systems are addressing those needs
• 16:25
  - of patients that are coming to the emergency
• 16:28
  - department and the emergency
• 16:30
  - hospitals,
• 16:31
  - with escalating behavioral needs and social needs as
• 16:34
  - we live in this this new present date
• 16:36
  - and time.
• 16:38
  - Absolutely. All very important things to,
• 16:40
  - keep working towards and figuring out how we
• 16:43
  - can, leverage all the resources we have in
• 16:46
  - order to make those communities,
• 16:48
  - healthier and and improve that access to care.
• 16:51
  - Thank you both so much for joining the
• 16:53
  - podcast today. This has been such a valuable
• 16:56
  - discussion. I really appreciate you being candid about
• 16:58
  - the things we were addressing today, and, look
• 17:01
  - forward to connecting with you again soon as
• 17:03
  - we continue this journey on how we can
• 17:05
  - better support rural health care and,
• 17:07
  - make sure that we have those access to
• 17:09
  - care needs met.
• 17:11
  - Thank you so much for having us. It
• 17:12
  - was a pleasure to be able to engage
• 17:15
  - on such an important topic.
• 17:17
  - Likewise.