Episode 10

Rural Health and Health Equity with Tim Putnam

Published on: 1st July, 2022

Today Cam speaks with Dr. Tim Putnam about Health Equity and Rural Health. Tim served as a CEO of a rural hospital in Indiana for several years and served on the COVID-19 Equity Taskforce. Tune in to hear about some of the challenges rural communities face, how rural communities can address health equity concerns, and learn why health equity is important.

Transcript
Tim Putnam:

I think it's more than getting people to trust the healthcare system.

Tim Putnam:

It's getting every group to be the healthcare system

Tim Putnam:

and be represented in it.

Tim Putnam:

I think that'll move us farther ahead than what we realize.

Triston:

Welcome to a virtual view where we talk about tele-health

Triston:

healthcare and everything in between.

Triston:

Our guest today is Dr.

Triston:

Tim Putnam who has served as the CEO of a rural hospital in

Triston:

Indiana, and most recently on the COVID-19 equity task force.

Triston:

Today we will be speaking with tim about health equity and rural healthcare

Cameron Hilt:

So Tim, just thank you so much for joining a virtual view,

Cameron Hilt:

and we're just looking forward to have the opportunity to just pick your brain

Cameron Hilt:

and just hear about your experiences in rural healthcare as well with telehealth.

Cameron Hilt:

And so just for some of our audience members who maybe aren't familiar with

Cameron Hilt:

you, or maybe are hearing from you for the first time, why don't you tell us a

Cameron Hilt:

little bit about your background in, he.

Tim Putnam:

with you or maybe are hearing from you for the first time.

Tim Putnam:

Why don't you tell us a little bit about your background?

Tim Putnam:

Well, thank you.

Tim Putnam:

I appreciate the opportunity to be here and look forward to the discussion.

Tim Putnam:

My background's a little bit different.

Tim Putnam:

Grew up in a very small town outta high school right after star wars came out.

Tim Putnam:

I ended up getting a degree in lasers and optics because it was just exceedingly

Tim Putnam:

cool and was lucky enough to work with a father of laser medicine, Leon Goldman.

Tim Putnam:

and laser research and development.

Tim Putnam:

And once I got a chance to work in healthcare I.

Tim Putnam:

Found the field rewarding was excited about working every day.

Tim Putnam:

Then that led to, research and development led to leading a

Tim Putnam:

department, leading a division.

Tim Putnam:

Eventually you start to think you can run the show better than the people in charge.

Tim Putnam:

So I applied for CEO positions with have 20 years background as a hospital CEO, but

Tim Putnam:

in rural hospitals came back to my roots where I really Really enjoyed working

Tim Putnam:

with people and being in small towns.

Tim Putnam:

A little bit of my background and maybe some things, people

Tim Putnam:

that know me don't know about me.

Cameron Hilt:

Yeah.

Cameron Hilt:

Thank you, Tim.

Cameron Hilt:

It's it.

Cameron Hilt:

Interesting to see just your career progression as you said started in

Cameron Hilt:

a very different spot and then moving more into kind of, the healthcare

Cameron Hilt:

administration field with that.

Cameron Hilt:

Working with hospitals and rural communities has its own sets

Cameron Hilt:

of, very rewarding, but also very challenging pieces of that.

Cameron Hilt:

So can you tell us just a little bit about your experience in just working

Cameron Hilt:

with a hospital and a rural community?

Tim Putnam:

Yeah.

Tim Putnam:

If you do healthcare leadership and rural communities you become.

Tim Putnam:

so ingrained in the community, you start to care about the community and the

Tim Putnam:

people so much that every patient that comes through the ER, that's scared that

Tim Putnam:

needs your help really matters to you and you become devoted to their outcome.

Tim Putnam:

Every conversation you have on the street is as someone at the hospital

Tim Putnam:

and in my job, I always wanted.

Tim Putnam:

The community to be proud of the work.

Tim Putnam:

The hospital did that everybody that worked there to be proud of it, wear the

Tim Putnam:

t-shirt and really realize we're making a difference for people we love and

Tim Putnam:

people we know and people we care about.

Tim Putnam:

I had the pleasure of training a few years ago to become an EMT and ran 9 1 1 for

Tim Putnam:

several years, you get to see people in their homes and you you get a chance to

Tim Putnam:

really make a difference for them and get.

Tim Putnam:

Personal touch and there just isn't anything like it.

Tim Putnam:

My peers that are professionals in urban areas make a big difference in

Tim Putnam:

people's lives and they do some things we can't do in small communities, but

Tim Putnam:

they don't know the people that come through the door on a regular basis.

Tim Putnam:

It's just unique in the world of healthcare and unique in

Tim Putnam:

career choices in general.

Cameron Hilt:

Yeah, absolutely.

Cameron Hilt:

You get the benefit of.

Cameron Hilt:

Living and working in the place that you're providing care and just being

Cameron Hilt:

able to be a part of a close knit C.

Tim Putnam:

a close knit community.

Cameron Hilt:

Cuz you have opportunities to really rub shoulders

Cameron Hilt:

with other people that are there which to your point, is unique.

Cameron Hilt:

And that can be both a blessing and a challenge too, cuz you

Cameron Hilt:

know, people are coming to a hospital to receive healthcare.

Cameron Hilt:

So you know, those are people that, that are going there to receive care

Cameron Hilt:

for whatever they're going through.

Cameron Hilt:

And so that's, there, those are some huge things that are a blessing,

Cameron Hilt:

but also some difficult parts about working specifically in that context.

Tim Putnam:

It is hard.

Tim Putnam:

You ha all of our patients are mortal.

Tim Putnam:

There's no way we can save everyone's life and extend

Tim Putnam:

their lives to be 150 years old.

Tim Putnam:

And everyone that passes away at our hospital or after they receive care at

Tim Putnam:

our facility, you sit there and wonder what could we have done different?

Tim Putnam:

What could we have done better?

Tim Putnam:

And it drives you.

Tim Putnam:

It motivates you.

Tim Putnam:

But it also, is a real challenge because it hurts a lot.

Tim Putnam:

It's it becomes very personal.

Tim Putnam:

And then you take that into picking your kids up from school or going to the

Tim Putnam:

grocery store, going to the ballgame.

Tim Putnam:

You don't escape.

Tim Putnam:

There's no way to get away from it or turn the page.

Tim Putnam:

And okay.

Tim Putnam:

Now I'm just a dad because as a rural hospital leader in your own hometown,

Tim Putnam:

you're never just an anonymous person.

Cameron Hilt:

you don't have some of the benefits of the.

Cameron Hilt:

Living in a bigger place where perhaps, the individuals that you're

Cameron Hilt:

interacting with that may have multiple sources of care may not be with the

Cameron Hilt:

hospital that you're directly serving.

Cameron Hilt:

Or perhaps, don't even know that you are, the CEO of that hospital, cuz

Cameron Hilt:

there's multiple hospitals in that area.

Cameron Hilt:

And so yeah, it is hard to, be able to turn things off when

Cameron Hilt:

you're working in that setting.

Cameron Hilt:

And so I think.

Cameron Hilt:

That kind of brings up a question of, during this season, it existed before

Cameron Hilt:

the pandemic, but the pandemic has only amplified it of, experiencing

Cameron Hilt:

burnout from healthcare professionals and healthcare administrators.

Cameron Hilt:

So I guess from your experience, what are some ways that you can help

Cameron Hilt:

cope and prevent burnout when you're working in a healthcare organization,

Tim Putnam:

what are some ways you kinda helped cope and burnout

Tim Putnam:

when you're working in healthcare?

Tim Putnam:

with it's always difficult over the last couple of years, it's

Tim Putnam:

been particularly challenging.

Tim Putnam:

I think one of the things is being able to develop that network of people

Tim Putnam:

that you trust, that you can lean on.

Tim Putnam:

That are really fighting the same challenges and

Tim Putnam:

battles that you're fighting.

Tim Putnam:

I always think if you're dealing with a difficult issue you can reach out

Tim Putnam:

to people that may have solved it, but the very least someone that's beat

Tim Putnam:

their head against the wall, trying to solve the same challenge you're facing.

Tim Putnam:

And.

Tim Putnam:

Having the network of people you trust that can empathize.

Tim Putnam:

That not that many people can empathize with the pressures

Tim Putnam:

that come in, rural healthcare leadership and how personal it is.

Tim Putnam:

So it's really important.

Tim Putnam:

You're not out there alone.

Tim Putnam:

There's a lot of people, there's 1300 critical access hospitals and

Tim Putnam:

700 other rural hospitals in the country in, in very small communities.

Tim Putnam:

And there's a lot of leaders in those trying to do the right things

Tim Putnam:

and make their community healthier.

Tim Putnam:

So reach out to those folks.

Tim Putnam:

The other pig.

Tim Putnam:

I have to go for very long bicycle rights and clear my head and just

Tim Putnam:

work hard and, think about nothing other than keeping the bicycle up.

Cameron Hilt:

Exactly.

Cameron Hilt:

Yeah.

Cameron Hilt:

You need to have a mixture of, things that you enjoy, things

Cameron Hilt:

that help clear your head.

Cameron Hilt:

But also having a community of individuals that can empathize or

Cameron Hilt:

are going through something similar.

Cameron Hilt:

We talk a lot about opportunities for collective impact and how you can

Cameron Hilt:

work with other organizations that are maybe experiencing similar issues

Cameron Hilt:

or going through similar pain points on how you can partner with them.

Cameron Hilt:

But that's a great point of, you you need those connections you don't

Cameron Hilt:

want to be operating on an island you really want to be working with other

Cameron Hilt:

people that are doing similar work or experiencing some of the same problems

Cameron Hilt:

and, putting your heads together to see how you can, move forward from there.

Tim Putnam:

Yeah.

Tim Putnam:

There's an old saying that we have in rural hospital leadership, if you've

Tim Putnam:

seen one rural hospital, you've seen one rural hospital, but if a program works.

Tim Putnam:

in one area, one rural community in the east coast, west coast on the planes.

Tim Putnam:

There's a possibility it can work at another.

Tim Putnam:

It will not be the same thing.

Tim Putnam:

It will not work the same way.

Tim Putnam:

You've got different physicians.

Tim Putnam:

You've got different rules and regulations, but that's part of what

Tim Putnam:

leadership is to take something that works in one place and then try and

Tim Putnam:

modify it to fit your organization and not everything will, but.

Tim Putnam:

Every time I go to Indiana rural health association conference, or a national

Tim Putnam:

conference or regional education session.

Tim Putnam:

I come home with ideas and sometimes they're not implemented.

Tim Putnam:

Sometimes they are.

Tim Putnam:

But many times the concept of it starts to discussion in the community.

Tim Putnam:

It starts discussion in the leadership and with the clinical

Tim Putnam:

staff and many times that's what.

Tim Putnam:

Yeah, absolutely.

Cameron Hilt:

Yeah, absolutely.

Cameron Hilt:

And at, to your point every community is gonna have their own nuances and

Cameron Hilt:

things that make them, unique from other communities, but being able to

Cameron Hilt:

see some of those successes and how you can, modify that to be a success.

Cameron Hilt:

Even from.

Cameron Hilt:

My own personal experience, working with the crossroads partnership

Cameron Hilt:

for telehealth, where we've worked with nine rural hospitals to

Cameron Hilt:

implement new telehealth programs.

Cameron Hilt:

Each one's very unique.

Cameron Hilt:

Their patient population's very unique.

Cameron Hilt:

Their providers are unique the way their leadership structure looks like.

Cameron Hilt:

So each one is always gonna have to be we're implementing the same service

Cameron Hilt:

across all of those hospitals, but there's gonna be nuance amongst all of them to

Cameron Hilt:

modify it and make it work for them.

Tim Putnam:

That's a really strong point, Cameron, that a lot of times.

Tim Putnam:

We, we always hear pediatricians say that children are not small adults.

Tim Putnam:

And I think it applies to rural as well.

Tim Putnam:

That rural is not small urban what works in an urban area.

Tim Putnam:

you can't just downsize it and make it work in rural.

Tim Putnam:

You've gotta, you've gotta modify it.

Tim Putnam:

It's there's gotta be twists and turns and changes and adaptations.

Tim Putnam:

And I think that's one of the things where the franchise model

Tim Putnam:

of delivering care, where it's just, let's treat all these rural

Tim Putnam:

hospitals the same just doesn't work.

Tim Putnam:

You can't optimize the kind of care patients receive just by giving

Tim Putnam:

us these tools or technologies.

Cameron Hilt:

that's a great point.

Cameron Hilt:

Rarely within any.

Tim Putnam:

any context

Cameron Hilt:

you're always gonna have to adapt it to, whatever's gonna work

Cameron Hilt:

best for that population or group.

Cameron Hilt:

And that goes for rural or urban.

Cameron Hilt:

No urban community is exactly the same as the rest.

Cameron Hilt:

Indianapolis is maybe different from Chicago.

Cameron Hilt:

Or Detroit there's significant differences even amongst those urban communities.

Cameron Hilt:

And so rural is gonna experience, a lot of those same issues that come with that.

Cameron Hilt:

And I wanted to ask when it comes to rural and some of your experience

Cameron Hilt:

with that there are particular issues that rural communities face that are

Cameron Hilt:

unique when it comes to the social determinants of health that they face.

Cameron Hilt:

As far as barriers to health equity.

Cameron Hilt:

And so what would you say is, an advice to healthcare organizations on how

Cameron Hilt:

they can begin to work towards health equity in their patient populations.

Cameron Hilt:

And maybe before that, actually why should you work towards health equity?

Tim Putnam:

Let me give you a little background.

Tim Putnam:

I probably should have added this in my introduction, but over the past year

Tim Putnam:

or so, I've been lucky to be named by president Biden to the white house.

Tim Putnam:

COVID 19 health equity task force.

Tim Putnam:

A group of people we've been working on.

Tim Putnam:

We've seen a lot of disparities in health, specifically tied to COVID and

Tim Putnam:

challenges in delivery of healthcare.

Tim Putnam:

So I've been immersed in this topic quite a bit over the last year, and

Tim Putnam:

we've seen tremendous inequities.

Tim Putnam:

We've seen a lot of, haves and have nots to quote the old George

Tim Putnam:

Orwell phrase everyone's equal some more equal than others.

Tim Putnam:

So the challenge is.

Tim Putnam:

tied a lot to what you're saying on social determinants of health.

Tim Putnam:

Sometimes it's access to acute care who can get to cardiac surgery, who

Tim Putnam:

can get to stroke care rapidly, who can see an endocrinologist and who

Tim Putnam:

can't and our rural areas struggle with that access to acute care.

Tim Putnam:

Every endocrinologist is 150 miles away.

Tim Putnam:

And how do you get the care that you need?

Tim Putnam:

The other aspect.

Tim Putnam:

It's tied to the social determinants of health.

Tim Putnam:

A lot of rural communities have become food deserts.

Tim Putnam:

The small town grocery store has disappeared, and now it's

Tim Putnam:

replaced by a convenient store where you can buy everything in a.

Tim Putnam:

In a package or off the roller grill.

Tim Putnam:

And we don't, how far you live from fruits and vegetables and

Tim Putnam:

transportation is a challenge.

Tim Putnam:

We have no public transport system, so you have to have your own vehicle.

Tim Putnam:

And some people can't drive.

Tim Putnam:

Some people don't have their own vehicle, so it creates this real issue.

Tim Putnam:

And that ties to education and everything else.

Tim Putnam:

I, I think rural.

Tim Putnam:

organizations.

Tim Putnam:

And I specifically mean rural hospitals are in a position where they're delivering

Tim Putnam:

acute care, but they're responsible for their health of their communities.

Tim Putnam:

So I see many of them getting stronger in the social determinants.

Tim Putnam:

What can we do to prevent diabetes?

Tim Putnam:

From progressing as opposed to treating it when it gets vastly out of control and

Tim Putnam:

having those discussions, community needs assessments are bringing up issues like

Tim Putnam:

mental health and behavioral health, where just 10, 15 years ago, rural hospitals

Tim Putnam:

turned their back on those and said, no, we're about pneumonia and broken bones.

Tim Putnam:

But now just to really improve the health of a patient, you've got to address

Tim Putnam:

the social determinants of health.

Tim Putnam:

And you've got to address the behavioral, mental health component.

Cameron Hilt:

a great point.

Cameron Hilt:

And

Cameron Hilt:

one of the things that kind of sticks out with what you just shared there is.

Cameron Hilt:

Really having this approach of, we want to be able to, preemptively

Cameron Hilt:

connect patients to these different care modalities before, it becomes a

Cameron Hilt:

significant concern or it gets worse.

Cameron Hilt:

So using to the example, so with stroke especially in rural communities

Cameron Hilt:

where access to our neurologist may be limited being able to have.

Cameron Hilt:

Telehealth consultation to be able to bring some of those, that

Cameron Hilt:

specialty knowledge in that community.

Cameron Hilt:

Can't be a, for something that is that severe in nature, being able

Cameron Hilt:

to have access to that care in a quick and timely manner can make

Cameron Hilt:

a huge difference for a patient.

Tim Putnam:

I do think it is that access point of, when someone's having

Tim Putnam:

an acute stroke bringing a neurologist in to that organization 24 hours a day

Tim Putnam:

really means a lot, but also starting to get the community to think about.

Tim Putnam:

How many strokes are we having?

Tim Putnam:

How many people are dying of strokes?

Tim Putnam:

What could we do to prevent it?

Tim Putnam:

I think when you look at a rural facility, the chief of staff who sits

Tim Putnam:

on the board or part of the leadership is more likely to be a family physician

Tim Putnam:

than a cardiovascular surgeon.

Tim Putnam:

And the concept is how to keep my patients healthier, how to keep

Tim Putnam:

them from going down that road.

Tim Putnam:

So I think rural hospitals have really been leaders.

Tim Putnam:

In this we've seen some really good successes.

Tim Putnam:

I've worked with ACOs and on the transition from volume to value and

Tim Putnam:

the farther you move down the line, the sooner you can get that, I, the old

Tim Putnam:

saying of, improving your diet and, eat your food like medicine, or later in

Tim Putnam:

life, you'll eat medicine like food.

Tim Putnam:

We want to be able to prevent the disease.

Tim Putnam:

And I think as you focus on your mission in rural communities, how do

Tim Putnam:

you improve the health of the community?

Tim Putnam:

You cannot ignore that.

Tim Putnam:

Absolutely.

Tim Putnam:

Yeah.

Tim Putnam:

That prevention piece is gonna be a huge part of it.

Cameron Hilt:

Being able to.

Cameron Hilt:

Some of these partnerships, which may mean, working outside of

Cameron Hilt:

the, typical hospital setting.

Cameron Hilt:

So working with, local churches, food banks, all these other organizations

Cameron Hilt:

that may be able to help, connect your patients to some of these resources

Cameron Hilt:

that maybe you can't provide as a healthcare professional or organization.

Cameron Hilt:

But you can help connect patients or facilitate some of those

Cameron Hilt:

connections to your point.

Cameron Hilt:

Help prevent some of those issues where they would end up

Cameron Hilt:

coming to need to receive care.

Tim Putnam:

Yeah.

Tim Putnam:

And you're right.

Tim Putnam:

That is, that's one thing in a small town.

Tim Putnam:

We don't have.

Tim Putnam:

many, any of the resources that urban facilities do, but we work together.

Tim Putnam:

You look at the local physicians, the local healthcare leaders they are not

Tim Putnam:

very far removed from the ministers or from the mayor or from the public

Tim Putnam:

health department or local EMS.

Tim Putnam:

We all see each other, we all know each other.

Tim Putnam:

We can solve the problems.

Tim Putnam:

It's one thing that we can do it and do it much more quickly than the

Tim Putnam:

cumbersome larger organizations can.

Cameron Hilt:

absolutely.

Cameron Hilt:

And so with that point when, and staying on the health equity topic.

Cameron Hilt:

What benefits do you feel like technology like telehealth has in

Cameron Hilt:

increasing health equity for populations?

Tim Putnam:

what I've seen in a lot of rural areas is.

Tim Putnam:

patients can't physically get to where they get the care that they need.

Tim Putnam:

If you think about the patient that the young mom who needs a prenatal

Tim Putnam:

visit the logistics of getting into some urban area, that's 70 miles

Tim Putnam:

away for a 9:00 AM appointment and a place that they never go.

Tim Putnam:

Transportation that's unreliable.

Tim Putnam:

It just becomes very difficult to accomplish.

Tim Putnam:

If we can do things and a stroke is the perfect example.

Tim Putnam:

I'm so proud of what we've done in rural areas with stroke programs and

Tim Putnam:

telestroke networks to be able to get care of patients any, but we haven't

Tim Putnam:

gone to the point of getting that move to prenatal care or diabetes

Tim Putnam:

visits or endocrinology or things that don't require that patient to

Tim Putnam:

physically come to a physician's office.

Tim Putnam:

There's a lot we can do through video, through connections, through

Tim Putnam:

shared information that they don't have to physically travel.

Tim Putnam:

And if we can avoid that, then that mom gets more prenatal care, better

Tim Putnam:

prenatal care than they could have.

Tim Putnam:

Without it, they may not get any at all.

Tim Putnam:

So I think it's tapping into technology.

Tim Putnam:

Now you have to realize this is a guy that got excited about.

Tim Putnam:

Going and studying lasers when he was a teenager.

Tim Putnam:

So I'm pretty exposed to like technology and use it to the best of our

Tim Putnam:

ability to improve the lives we live.

Tim Putnam:

So I'm for using that.

Tim Putnam:

A lot of people are resistant to it, and I think that's one thing leaders

Tim Putnam:

need to realize is the physician will feel more comfortable that patient's

Tim Putnam:

in front of them almost always.

Tim Putnam:

So you've gotta get through that.

Tim Putnam:

You gotta get over that.

Tim Putnam:

And how do we make that happen now that there's always resistance

Tim Putnam:

from the physicians, the providers.

Tim Putnam:

And you're gonna have to anticipate that, but sometimes they can

Tim Putnam:

really see the value of it.

Tim Putnam:

Then you have another barrier with regard to payment comfort with the

Tim Putnam:

patients and the technology are typically easy to clear the payment method

Tim Putnam:

and the providers being comfortable.

Tim Putnam:

And you have to empathize with the provider's issue too.

Tim Putnam:

They're saying.

Tim Putnam:

I'm responsible for this patient.

Tim Putnam:

And if I'm seeing them on video or not getting a clear message, I might

Tim Putnam:

miss something and that's not a responsibility I'm comfortable with.

Tim Putnam:

See, we really need to empathize with them.

Tim Putnam:

From that perspective, some will be very comfortable with it and some

Tim Putnam:

will not be comfortable at all.

Tim Putnam:

We've seen that over the last several years, several people are really

Tim Putnam:

comfortable with video meetings.

Tim Putnam:

Others are like, as soon as I can end these things, I will, I

Tim Putnam:

have no desire to ever be on a video call the rest of my life.

Cameron Hilt:

Those are some of the things that in one of our recent

Cameron Hilt:

podcasts, we had actually talked with someone and he was mentioning during the

Cameron Hilt:

pandemic, , we are having the largest use cases of lots of different service

Cameron Hilt:

lines and different applications for telehealth that we've never had before.

Cameron Hilt:

Some , very clear examples of that is, occupational therapists

Cameron Hilt:

and physical therapists.

Cameron Hilt:

We've really never had many opportunities to see what it's like to

Cameron Hilt:

deliver telehealth via these options.

Cameron Hilt:

And.

Tim Putnam:

And so

Cameron Hilt:

We're being able to try out all of these different

Cameron Hilt:

service lines and different services.

Cameron Hilt:

Maybe that we didn't get the chance to prior because of, reimbursement

Cameron Hilt:

barriers or other policy and restrictions that just limited.

Cameron Hilt:

The ability to be able to do that.

Cameron Hilt:

What will be really interesting?

Cameron Hilt:

With what you said is, I think we're gonna see people that will be in a variety

Cameron Hilt:

of different camps because now a lot of patients and providers have been able

Cameron Hilt:

to try telehealth for the first time.

Cameron Hilt:

It's pretty unavoidable.

Cameron Hilt:

If you're a provider.

Cameron Hilt:

You provided telehealth at some point over the past two years, if you're a patient,

Cameron Hilt:

maybe, perhaps you didn't engage with it.

Cameron Hilt:

But still lots of patients still needed to engage in telehealth at

Cameron Hilt:

some point over the past two years.

Cameron Hilt:

And so I think we'll see some of these camps of, maybe some that were like, I

Cameron Hilt:

would never want to do this and they do it for the first time and really love it.

Cameron Hilt:

Or maybe some that are like, I really wanna do this.

Cameron Hilt:

Try.

Cameron Hilt:

It, they don't like it as much, but we're getting this first taste of,

Cameron Hilt:

organizations really getting to try it on a large scale, understand for themselves

Cameron Hilt:

versus, just making assumptions of what it would look like or how do you do it.

Cameron Hilt:

So that's one huge benefit to your point of, regardless of what can't people

Cameron Hilt:

fall into, they've at least have been able to try it in the past few years.

Tim Putnam:

I think we've proven that it can work.

Tim Putnam:

It's what I look forward to in the future is now that we've learned all

Tim Putnam:

this and how, what works, what doesn't the big concern from the payment

Tim Putnam:

side is the potential for abuse.

Tim Putnam:

One physician just set on the screen and see 250 patients in a

Tim Putnam:

day and, just bill for all that and not provide the level of care.

Tim Putnam:

And I think we'll get over that.

Tim Putnam:

It'll take a little bit to get over that, but I think, we've

Tim Putnam:

learned some hybrid programs work.

Tim Putnam:

I'm familiar with a program where a school nurse has access through telehealth

Tim Putnam:

equipment to be able to connect with a physician, to assess the child,

Tim Putnam:

is this something really going on?

Tim Putnam:

And she's got the capability using the video otoscope and send.

Tim Putnam:

Video capabilities on everything we can do.

Tim Putnam:

I think sometimes we need to look at hybrid options where a patient goes into

Tim Putnam:

an office with a primary care physician and sees a specialist, or goes into an

Tim Putnam:

office with a medical assistant that can do basic assessments and draw blood.

Tim Putnam:

And then the video and.

Tim Putnam:

Conversation happens in a, an evaluation, happens with a physician.

Tim Putnam:

I think there's a lot of solutions out there.

Tim Putnam:

It's difficult because the payment models don't work for it.

Tim Putnam:

But there's a lot of rural communities that are really distant.

Tim Putnam:

And you start talking about on islands and long drives down

Tim Putnam:

dirt roads to be able to get out.

Tim Putnam:

What can we do?

Tim Putnam:

There's a lot that's happening.

Tim Putnam:

We saw with the.

Tim Putnam:

The task force that I worked with on broadband, having broadband

Tim Putnam:

access everyone having that and their home is important but also

Tim Putnam:

even into small towns, so you can go someplace and get access and that

Tim Putnam:

just doesn't exist across the country.

Tim Putnam:

So I think there's a lot we've learned and we'll just be piecing

Tim Putnam:

it together over the next few years.

Cameron Hilt:

Yes, absolutely.

Cameron Hilt:

And I think it will be, every organization will just have to figure out what works

Cameron Hilt:

best for them and what works best for their particular patient population.

Cameron Hilt:

We've already talked about, there's not really a good one size fits all

Cameron Hilt:

type of approach and telehealth service delivery is really no different.

Cameron Hilt:

So figuring out what, makes sense and especially in some of these

Cameron Hilt:

areas that you're talking about that are very low access there.

Cameron Hilt:

Those may be areas where just getting any sort of access is

Cameron Hilt:

gonna be better than nothing.

Cameron Hilt:

And so even if there's something that perhaps in another setting, if it was

Cameron Hilt:

possible would be conducted in person, at least telehealth is giving the option

Cameron Hilt:

to be able to provide the care at all.

Cameron Hilt:

And especially in some of these very more remote rural areas and that's

Cameron Hilt:

something across the United States.

Cameron Hilt:

And I think.

Cameron Hilt:

Communities that are, on mountainside and some of these more difficult

Cameron Hilt:

places to reach and, broadband is its own issue with that.

Cameron Hilt:

And so I always have to note that, but I won't dive down that particular rabbit

Cameron Hilt:

hole at this moment, but but being able to get access to any of that care, if

Cameron Hilt:

they have literally zero access outside of that is always gonna be preferential.

Tim Putnam:

And that, that leads to that equity standpoint.

Tim Putnam:

How can we deliver equitable care or become more equitable

Tim Putnam:

in the care we deliver?

Tim Putnam:

We saw so much of the people who have and have not The death rate for

Tim Putnam:

people that had uncontrolled chronic disease in the pandemic was far higher.

Tim Putnam:

So if you had diabetes that was uncontrolled CF, C O P D high blood

Tim Putnam:

pressure, uncontrolled obesity and you never had access to care

Tim Putnam:

that really created a problem.

Tim Putnam:

And your survivability was much lower with COVID and we just have

Tim Putnam:

to have a discussion in the country.

Tim Putnam:

Is health equity important to us?

Tim Putnam:

Does everyone having access to healthcare regardless of how we have to deliver it?

Tim Putnam:

Make us a stronger nation.

Tim Putnam:

I personally believe it does.

Tim Putnam:

I devoted my life to it but I think that's a discussion we

Tim Putnam:

really need to have as a nation.

Tim Putnam:

Is this important?

Tim Putnam:

Can we face a pandemic?

Tim Putnam:

Can we face an economic crisis?

Tim Putnam:

Can we face a large scale war better?

Tim Putnam:

If everyone has access to healthcare and we have more equity in that world.

Cameron Hilt:

That's a great question.

Cameron Hilt:

And that question that you have is the question that drives.

Cameron Hilt:

Everything.

Cameron Hilt:

It, it drives policy.

Cameron Hilt:

It drives, legislation, it drives, what are the services

Cameron Hilt:

that are offered to patients?

Cameron Hilt:

That question is a huge question to ask and really does impact the future

Cameron Hilt:

direction of healthcare outside of telehealth, just in general healthcare.

Cameron Hilt:

The direction that it would go.

Cameron Hilt:

That, that very question that you just asked.

Tim Putnam:

Yeah, telehealth has a great, is a great tool to be

Tim Putnam:

able to improve health equity.

Tim Putnam:

But it's one of the many tools we've gotta have that broader

Tim Putnam:

discussion about what do we do?

Tim Putnam:

We've got 20% of the population that lives in rural areas and less

Tim Putnam:

than 10% of the physicians we don't have enough physicians to go around.

Tim Putnam:

And the other thing is that 20% of the people live in 90% of the country.

Tim Putnam:

So it's a lot of ground to cover with the few bodies.

Tim Putnam:

We've got to do it.

Tim Putnam:

What tools concepts we can do to be able to deliver equitable healthcare

Tim Putnam:

needs to be part of the discuss.

Cameron Hilt:

Absolutely.

Cameron Hilt:

And so as just a closing point, Tim since we're talking about the health

Cameron Hilt:

equity piece, is there any kind of, I guess closing thoughts or any advice that

Cameron Hilt:

you have for individuals who are really looking within their organizations?

Cameron Hilt:

Whether it be in a healthcare organization or looking more from like a legisla.

Cameron Hilt:

Standpoint on how they can really be an advocate for health

Cameron Hilt:

equity in their communities.

Tim Putnam:

I think understanding the situation every rural community

Tim Putnam:

is different, so they've got different challenges, but where are

Tim Putnam:

the inequities in the community?

Tim Putnam:

Is it access to health insurance?

Tim Putnam:

We've got several states that have expanded The Medicaid program to be

Tim Putnam:

able to cover more people in several states that haven't how's that

Tim Putnam:

impacting people in your community and what story needs to be told on that.

Tim Putnam:

There's a lot of this of really understanding and opening our eyes.

Tim Putnam:

We get a lot of data.

Tim Putnam:

CDC produces a tremendous amount of data on the gap between rural and

Tim Putnam:

urban and life expectancy, which has expanded tremendously 25 years ago.

Tim Putnam:

There was very little gap and now it's nearly two years.

Tim Putnam:

What's causing that what's causing that in your community.

Tim Putnam:

There's an inequity between rural and urban.

Tim Putnam:

There's an inequity between African American, Hispanic,

Tim Putnam:

native American and others.

Tim Putnam:

And how do we serve that?

Tim Putnam:

Unfortunately, it's not a franchise answer.

Tim Putnam:

It's individually.

Tim Putnam:

Doing that, but I think it's taking community needs assessments, seriously.

Tim Putnam:

Understanding the individual challenges.

Tim Putnam:

I'm a big advocate for getting the healthcare system

Tim Putnam:

to reflect the community.

Tim Putnam:

Having more kids that grow up in rural areas become physicians.

Tim Putnam:

Become nurses, become therapists, become technicians having more African

Tim Putnam:

American, Hispanic individuals, native Americans have a pathway

Tim Putnam:

to become healthcare providers.

Tim Putnam:

So many times, what young people understand about healthcare is really

Tim Putnam:

what they see on Grey's anatomy.

Tim Putnam:

And it's not exactly the same.

Tim Putnam:

If you have a parent or an aunt or an uncle in healthcare, your

Tim Putnam:

ability to get into healthcare is greatly increased because there's

Tim Putnam:

a, you understand the reality of it.

Tim Putnam:

You, they understand the pathway, but if we've got so few people.

Tim Putnam:

In certain demographic groups that are in healthcare and they've got

Tim Putnam:

no one to look up to, to be able to understand how they can become the

Tim Putnam:

greatest physician in the world.

Tim Putnam:

Coming from a rural community when you didn't have an advanced biology

Tim Putnam:

or advanced chemistry class that's a challenge and we need to look at

Tim Putnam:

how we solve that, how we get more rural kids into healthcare, how we get

Tim Putnam:

more African American kids into he.

Tim Putnam:

That'll make us stronger.

Tim Putnam:

That's the strength of our nation is our diversity.

Tim Putnam:

We have not tapped into it in healthcare.

Tim Putnam:

Like we.

Tim Putnam:

And

Cameron Hilt:

That's great, Tim.

Cameron Hilt:

And yeah, I think, what you said there is great of kind of just summarizing it.

Cameron Hilt:

Really educating yourself and understanding what the needs

Cameron Hilt:

of your community are first.

Cameron Hilt:

So that what resources to really, focus on as well as, finding

Cameron Hilt:

opportunities to improve representation in the healthcare field of, we want

Cameron Hilt:

patients to be able to receive care.

Cameron Hilt:

People who understand their cultural context and to be able to provide

Cameron Hilt:

culturally competent care to patients.

Cameron Hilt:

So finding opportunities for, more representation within the healthcare

Cameron Hilt:

field as a whole and really, to your point, the future of our workforce, making

Cameron Hilt:

sure that the future of our workforce is diverse and can help meet the needs for a

Cameron Hilt:

variety of different patients, regardless of their background or upbringing.

Tim Putnam:

Yeah, we saw this was a trust factor.

Tim Putnam:

Certain populations, rural being one of them.

Tim Putnam:

Other demographic segments did not trust what the healthcare system was

Tim Putnam:

telling them during the pandemic.

Tim Putnam:

And to a certain extent, you can understand that.

Tim Putnam:

Why do I.

Tim Putnam:

trust someone who doesn't look or sound like me, that doesn't

Tim Putnam:

have the same background.

Tim Putnam:

If everyone in my small community came from someplace else to, I really trust

Tim Putnam:

them when I'm getting so much conflicting information about this disease.

Tim Putnam:

So I think it's more than getting people to trust the healthcare system.

Tim Putnam:

It's getting every group to be the healthcare system

Tim Putnam:

and be represented in it.

Tim Putnam:

I think that'll move us farther ahead than what we realize.

Cameron Hilt:

Absolutely Tim.

Cameron Hilt:

I just wanna thank you so much for your time and just for giving us the

Cameron Hilt:

opportunity, just to pick your brain and to just dive in a little bit more

Cameron Hilt:

about your experiences in rural as well as in telehealth and in health equity.

Cameron Hilt:

So just want to thank you just for coming on our show today and we look

Cameron Hilt:

forward to future conversations.

Tim Putnam:

I look forward to Cameron.

Tim Putnam:

Thank you very much.

Tim Putnam:

It's a pleasure being.

Cameron Hilt:

Thank you, Tim.

Tim Putnam:

You're welcome.

Caroline Yoder:

Thank you for listening to a virtual view.

Caroline Yoder:

You can find more information about today's episode in the show notes below.

Caroline Yoder:

If you would like to support our podcast, please rate and review us

Caroline Yoder:

on your favorite podcast player.

Caroline Yoder:

Do you have any questions or topics you'd like us to discuss?

Caroline Yoder:

If so, contact us at info at UMTRC dot org or through the

Caroline Yoder:

form found in the show notes.

Caroline Yoder:

Also, we'd like to give a special thanks to our editor.

Caroline Yoder:

Finally a special thanks to the health resources and service administration.

Caroline Yoder:

Also known as HERSA.

Caroline Yoder:

Our podcast series of virtual view is sponsored in part by hearses telehealth

Caroline Yoder:

resource center program, which is under hers is office of the administrator and

Caroline Yoder:

the office for the advancement of tele.

Caroline Yoder:

The content and conclusions of this podcast are those of Cameron hilt of the

Caroline Yoder:

UMTRC and should not be construed as the official policy of, or the position of

Caroline Yoder:

nor should any endorsements be inferred by HERSA, HHS, or the U S government.

Caroline Yoder:

Thanks for listening and have a . Great day.

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A Virtual View
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As a federally funded program of the Indiana Rural Health Association (IRHA), the Upper Midwest Telehealth Resource Center provides a comprehensive set of telehealth clinical and technical assistance services leveraged into products of lasting value to rural providers. Many of the resources found on the website are related to reimbursement and the development of sustainable telehealth programs. The UMTRC region encompasses the states of Illinois, Indiana, Michigan, and Ohio. We have created this podcast as an additional outreach tool for savvy individuals like yourself to assist you in learning more about access to healthcare, telehealth, and virtual visits.

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