Advancing Health Podcast

00:00:00:29 - 00:00:26:09
Tom Haederle
Welcome to Advancing Health. As America's population ages, hospitals and health systems are working to meet the evolving needs of older patients and provide care that enhances quality of life. Today, we highlight how West Health Institute and Sharp HealthCare are partnering to advance older adult care and the power of asking one simple question: what matters to you?

00:00:26:12 - 00:00:50:04
Marie Cleary-Fishman
Hi, everybody. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Marie Cleary-Fishman, the vice president of clinical quality for Health Research and Educational Trust. And I'm here today with Doctor John Zifferblatt, chief strategy officer at West Health, and Dr. Diane Wintz, the trauma program director, critical care specialist at Sharp Memorial Hospital in California.

00:00:50:06 - 00:01:00:15
Marie Cleary-Fishman
John, I'd like to start with you a little bit, and if you could tell me a little bit about your role at West Health and, and just a little bit of what West Health is all about.

00:01:00:18 - 00:01:30:03
Jon Zifferblatt, M.D.
Sure. Thank you too, Marie. Thank you for having me here. So, I'm the chief strategy officer at West Health. West Health, you know, named for Gary and Mary West, our founders. We are here in San Diego, but it is named for founders Gary and Mary West, who have also given us our mission, which is to advance affordability and models of health care that promote independence, high quality of life and dignity for older adults, and ultimately for us all.

00:01:30:06 - 00:02:01:00
Jon Zifferblatt, M.D.
My role is to overlook the portfolio work that we do and make sure it ladders up to create impact at scale. And when we say West Health, what we really mean is the several organizations that all work together. There is the West Health Foundation, but largely that foundation does its work through, funding and arms, legs and brains of the West Health Policy Center in Washington, D.C., where we advance smart policy, and the West Health Institute here in San Diego, where we collaborate with health systems.

00:02:01:00 - 00:02:11:18
Jon Zifferblatt, M.D.
There's just 40 of us. So we can only be a catalyst and work with health systems to work together with them, and try to effect change at scale.

00:02:11:25 - 00:02:29:20
Marie Cleary-Fishman
That's great, John. And that's, that's really important information and very important to how we get work done in hospitals, in health systems and in health care today. So share with me a little bit about your connection and tie to Sharp. And what does that look like?

00:02:29:22 - 00:02:53:13
Jon Zifferblatt, M.D.
Absolutely. We worked with Sharp and other systems here in San Diego. We originally did some work  - we have a body of work in geriatric emergency departments, and we did some wonderful work with the county of San Diego, where every health system in San Diego other than military, was accredited as a geriatric emergency department. And we obviously know Sharp by its reputation.

00:02:53:15 - 00:03:11:18
Jon Zifferblatt, M.D.
And, in the wake of that work, Sharp approached us, Diane approached us with some really exciting possibilities. And she'll share more I'm sure, about the details of that, but I just want to share at a high level. When we spoke with Sharp and Diane, it was clear that they had their ducks in a row.

00:03:11:18 - 00:03:29:08
Jon Zifferblatt, M.D.
They had buy in, they had metrics that they wanted to advance. They had a passionate and capable champion and really support from the clinical staff all the way up to the carpeted part of the hospital. So that's how we came to advance this work that we'll be talking about today.

00:03:29:11 - 00:03:51:01
Marie Cleary-Fishman
John, those are really important things to point out. And I think that the governing board, the C-suite, and I like how you said the carpeted areas of the hospital. So thank you for pointing that out. Diane, I'm going to ask you to tell me just a little bit about the journey that Sharp Memorial has been on and how you got to where you are today.

00:03:51:03 - 00:04:18:25
Diane Wintz, M.D.
Like John said, we presented to West Health back in 2021. And at the time, the country was going through Covid pandemic as the entire world was going through. And we had a durable, sustainable program that we were running. It had started on trauma, I'm the trauma medical director at Sharp Memorial Hospital, which is a level two ACS verified Center.

00:04:18:27 - 00:04:51:20
Diane Wintz, M.D.
But what we had seen similar across the country is that the number of patients 65 and older is growing, and I think it's going to continue that way for some time. And we needed a way specifically on trauma to manage the acute process of injury. And that potential threat to functional independence. And so we began a small pilot or soft launch program on a single unit in our hospital.

00:04:51:22 - 00:05:22:14
Diane Wintz, M.D.
It was the trauma unit, and we targeted patients who are 65 and older for very aggressive, functional and cognitive rehabilitation after injury. And that program enrolled 83 patients, and it had significant results with delirium mitigation, sleep/wake hygiene, out of bed mobility and discharge back to home, which is what people want. They don't necessarily want to be out of their homes to recover.

00:05:22:16 - 00:05:56:00
Diane Wintz, M.D.
And once we saw those results, we were able to take this and say, well, maybe there's a pathway for medical patients and maybe there's a pathway for surgical patients. And we begin to grow those things with our collaboration through West Health. And so for the past three years, we've been completing national level milestones to complete these very aggressive but also very durable and sustainable processes that could be used anywhere.

00:05:56:03 - 00:06:21:29
Marie Cleary-Fishman
I've done some homework over the weekend, and so I had a chance to go to your website and really look at some of the information and the materials that's there. So your generational health program, Sharp Memorial has that in place. And I wonder if you could describe that a little bit and help our audience understand what is that cover, what is it involving and...

00:06:22:01 - 00:07:10:16
Diane Wintz, M.D.
Yeah, it's really amazing at this point, what we've been able to accomplish, because where we started as just a little program on a trauma unit is now a hospital wide and going system. So generational health is an umbrella term. It encompasses all the pieces of the program that we do from the very beginning in the geriatric accredited emergency department that John mentioned, all the way through community. It includes advanced illness management, which is a nursing team that comes and talks about goals of care, advance care planning processes or future hospitalizations, or how to prevent it, and ensuring that your needs are met, and that we really heard and understood what matters to you.

00:07:10:18 - 00:07:39:17
Diane Wintz, M.D.
We have an appropriate care committee that deals with families, patients, where there might be a misunderstanding about the level of care or what's being offered. We have geriatric surgery which is another American College of Surgeons verified level one program. So this addresses surgical patients with vulnerability or social determinants of health who are going for operations. And they are age 75 and older.

00:07:39:23 - 00:08:14:15
Diane Wintz, M.D.
We also have a community piece where we go out. We provide education resources to all of our community partners. And then most importantly is the healthy aging, which is the inpatient program. This is an age friendly program. It was modeled after John A. Hartford Foundation, IHI. And it really prioritizes what we call 4Ms: mobility, medication management, mentation, which includes like the aspiration precautions and the cognitive and the delirium mitigation.

00:08:14:18 - 00:08:25:04
Diane Wintz, M.D.
And then what matters most? What are we doing in this hospitalization? What's important to you? What goals are you trying to accomplish, and how can we help you get there?

00:08:25:06 - 00:08:57:26
Marie Cleary-Fishman
That's amazing. I know that Sharp Memorial has a track record of coming up with innovations and for creating innovation that helps advance patient care. So I'm not surprised to hear you have such a comprehensive of approach to the area of aging. And as you rightfully said, the number of aging in our country is growing significantly. And so things that our hospitals and health systems can put in place to help integrate these pieces and really look at things through that lens of what matters, is so important.

00:08:57:27 - 00:09:21:06
Marie Cleary-Fishman
It really is important so that that care that we give to those older Americans really is focused on what's important to them and what matters in their life. And it helps us, as caregivers provide care that is something that advances and helps their life and makes them feel better. So, kudos to that broad perspective that you're bringing. That's really amazing.

00:09:21:13 - 00:09:33:12
Marie Cleary-Fishman
Maybe Dr. Wintz, you can talk to this just a little bit. And it's the idea of the medical inflection point of care. If you can give us a little bit of your insight and thought around that concept and what that might mean.

00:09:33:14 - 00:10:04:05
Diane Wintz, M.D.
Yeah. Well, I think you made a great point. You know, it comes down to what's important to someone. So medical inflection is the time on the health care journey where the hospital doesn't offer a therapeutic or diagnostic solution. That the needs or the interests of that person are to remain in place, to age in place. And the hospital doesn't really enhance that quality or quantity of life.

00:10:04:05 - 00:10:17:20
Diane Wintz, M.D.
And it's different for everybody. It's not based on age. It's not even based on frailty. It's based really on what matters to you and what can be accomplished in your current environment.

00:10:17:22 - 00:10:41:08
Marie Cleary-Fishman
That is so important. And I have used that. I can't even begin to tell you all of my dad's stories, but, we have used that to make care decisions, to help him make his care decisions because he is cognitively intact and capable of making those decisions himself. But I think that's a concept we really do need to focus on in health care, and that is through that lens of what matters.

00:10:41:11 - 00:10:50:20
Marie Cleary-Fishman
John, can you give us a little of your thoughts on that concept? Because, as the what matters comes so important and I know it's important to West Health as well.

00:10:50:22 - 00:11:16:06
Jon Zifferblatt, M.D.
Absolutely. And I think, you know, I'll take the perspective that it's kind of a beautiful thing. Because what matters to patients and practitioners, I daresay, is really also greatly overlaps with what matters to health systems, right? You know, older adults and all of us want to walk into the hospital if we have to walk in and we want to walk out. And we'd like to do that in an expeditious manner. And we'd like to do it as healthy as possible.

00:11:16:08 - 00:11:37:28
Jon Zifferblatt, M.D.
That's what health systems want. I mean, when we think about what's on the minds of those that run health systems and health systems leadership, it's to think about things like length of stay. Especially these days where you see the how many systems lines out the door in the ED. People waiting for beds, transfers, scheduled procedures having to be rescheduled or delayed.

00:11:38:01 - 00:12:03:08
Jon Zifferblatt, M.D.
Everybody would love to see beds being used in the optimal manner. And part of getting that right, part of getting a good case mix index and really tuning length of stay is allowing older adults the ability to really have that stay be optimized for them, and that gets them out and back in an independent life, in their community sooner and happier with greater satisfaction.

00:12:03:08 - 00:12:05:28
Jon Zifferblatt, M.D.
So wonderful to see the concordance of what matters.

00:12:06:00 - 00:12:30:23
Marie Cleary-Fishman
I love what you just said, the concordance of what matters. That's just perfect wording for that concept. And really, I've been in the position of having those conversations with caregivers. So Diane, help me think about or understand how you at Sharp Memorial, how you create the environment, how you create the culture within a system.

00:12:30:23 - 00:12:43:19
Marie Cleary-Fishman
And you clearly have a system, a continuum of care that you're working for. So how do you look at building systems that make it easier for those that are providing care to really understand the what matters?

00:12:43:25 - 00:13:15:23
Diane Wintz, M.D.
Well, it starts at the top, but we have a very receptive administration. We have an administration that's very accessible and also goes on a first name basis. So it's very comfortable to voice a concern or to be interested in something. And I think this collaboration with West Health is one of the best examples of how administrations really drive ships by stepping back and allowing leaders to take the reins.

00:13:15:29 - 00:13:44:11
Diane Wintz, M.D.
This is what happens, is that, you know, we had stories, we had patient examples that were really critical where we could have done better, and we shared those stories. And then we engaged frontline staff who had interest in what we were doing, self-identified, and we welcomed them onto their team to start that planning process. So that we could move forward with a bigger picture.

00:13:44:13 - 00:14:10:27
Diane Wintz, M.D.
One of the examples that I give is the gentleman who fell in his garden, and he was the family patriarch. And he came in with a few rib fractures, a minor injury and in most cases. And for him, unfortunately, he got into this cycle where he needed pain medication and then he was too groggy to participate. And then because he didn't participate, he was in bed.

00:14:10:27 - 00:14:31:08
Diane Wintz, M.D.
And because he was in bed, he lost strength. And this just- it was a cat chasing its tail, trying to get on top of the problem so that we could get him better. And based on his outcomes, you know, we took that back to the group and we said, we have to do better. We have to already be prepared for what's going to happen.

00:14:31:08 - 00:15:12:28
Diane Wintz, M.D.
We have to be ready to manage pain in such a way that we don't get into this cycle, that this doesn't happen to someone. It's a lot of things that we talked about on this call. It's bringing those personal examples and making that impact. And someone saying, you know, that resonates with me because I took care of someone and they have this story and, and really using those stories to build that impact, to build that need to build the interest and then to come up with a product that is really doable, doesn't take a ton of extra time, doesn't need a lot of extra training to do it.

00:15:13:00 - 00:15:16:15
Diane Wintz, M.D.
It's just really a shift of mindset.

00:15:16:17 - 00:15:38:03
Marie Cleary-Fishman
I think you're so right. And I think we have opportunities to bring the family caregivers, whoever that might be, and the clinicians and the clinical teams sort of together looking through that what matter lens, right? Because, you know, one thing might matter to the caregiver, one thing might matter to the clinicians. Well, do they - is that checkpoint of what matters-

00:15:38:03 - 00:16:06:00
Marie Cleary-Fishman
do they align with what that patient person who's in the bed wants? And I think that's something that's really important. John, West Health is really committed to this and really believers. We had another panel with you and we talked about the C-suite, the board involvement, and how important that is to going forward. Can you talk a bit about the sustainability of this model or the spread of it?

00:16:06:00 - 00:16:08:19
Marie Cleary-Fishman
And how does West Health look at that?

00:16:08:21 - 00:16:30:12
Jon Zifferblatt, M.D.
Sure. Happy to share. And I'll also add an observation about the wonderful work going on in Charlotte. When you heard Diane talking about the things that they've brought to bear and the multifaceted components they put into that product, if you will, there wasn't a new drug that they needed to have been discovered. There wasn't some new miraculous technology that didn't exist a year ago.

00:16:30:14 - 00:16:53:22
Jon Zifferblatt, M.D.
This is about operational innovation, right? This is about bringing together pieces that already exist, putting it together in new ways, doing some, you know, staff training. There's you know, and culture change, as you said. But all of these things are there. They need to be catalyzed. The incentives have to be in the right place. But this is not net new technology, new innovation.

00:16:53:22 - 00:17:12:18
Jon Zifferblatt, M.D.
We have the pieces now and we can do them. And that's part of how we think about catalyzing the scale and spread of this. There's multiple ways we can do it. One of the, you know, more simple and straightforward ways is we amplify the work. We take beacons of success and houses of excellence like Sharp Memorial and Sharp Health

00:17:12:18 - 00:17:39:07
Jon Zifferblatt, M.D.
that are doing it well. And share and spread that, break it down into the components that allowed for that success and enable those that are leading that success to share that as well. So obviously there's vectors to do that. And then there's other ways that we can try to catalyze that success. We can do it at a policy level, but we also can create the right environment where things like this can take root and spread.

00:17:39:09 - 00:18:03:12
Jon Zifferblatt, M.D.
And we're big believers in the marketplace. So how are the things that we're discussing here business friendly? How do they support hospitals as they move forward with their missions? How is there a marketplace of vendors? We were recently at a meeting and you were there, Marie, where we were talking about things like this and we had participation from technology vendors, large and small.

00:18:03:14 - 00:18:24:18
Jon Zifferblatt, M.D.
And not, you know, it wasn't a sales platform for them, but it was really a way for them to understand what is necessary. How does technology enable these things? Some of the things that Diane's been talking about have been greatly enabled by EHR builds and configurations. Other technologies, algorithms that identify the right patients to select for these interventions.

00:18:24:20 - 00:18:47:27
Jon Zifferblatt, M.D.
All of these things require a robust and healthy marketplace of technology. No philanthropy is going to come up with the right puzzle pieces, or even a single health system won't. The market will create them. But I think it's helpful to provide to the market: what does success look like? What are the guardrails? How are we who are delivering care of those who are delivering care, doing it?

00:18:47:27 - 00:19:06:05
Jon Zifferblatt, M.D.
And how are we who are enabling them thinking about this? And so for West Health, I think we're, you know, an honest broker, a neutral party, you know, we're nonpartisan, we're not a vendor. And so we try to showcase all of these things to allow both policy and the marketplace to come together to move these things forward.

00:19:06:08 - 00:19:25:06
Marie Cleary-Fishman
Well that's great, John, I love that. And yes, that was an amazing conference, an opportunity to see all of this in action. So that was really great.
Diane, thank you so much. And John, thank you for all of the things West Health does and the opportunity that we get to work with both of you.

00:19:25:08 - 00:19:33:19
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:27 - 00:00:28:25
Tom Haederle
Welcome to Advancing Health. Changes and challenges. That pretty well sums up the state of American health care in the last quarter of 2025. In this month's Leadership Dialog podcast hosted by Tina Freese Decker, president and CEO of Corewell Health and the 2025 Board Chair of the American Hospital Association, we get a briefing from Stacey Hughes, AHA’s executive vice president of government relations and public policy, on the outlook for ending the government shutdown that began October 1st...

00:00:28:27 - 00:00:40:19
Tom Haederle
insights on what's expected on the legislative front for the remainder of the year...and an update on a host of issues important to the field.

00:00:40:22 - 00:00:59:26
Tina Freese Decker
Thank you, everyone for joining us today. I'm Tina Freese Decker, president and CEO of Corewell Health and the board chair for the American Hospital Association. I did my first leadership dialogue with Stacey Hughes, and there have been so many new changes and challenges, opportunities, developments since January that I felt that it was the right time to bring Stacey back for an update.

00:00:59:29 - 00:01:21:17
Tina Freese Decker
I can't wait to hear your insights, Stacey, on all that is playing out in Washington, D.C. and how the American Hospital Association is continuing to advance this work on behalf of our field. So, you and I have had lots of conversations over the past year. I am so grateful for your expertise. And just understanding what it feels like, what it's about, and what we should be doing as we go forward.

00:01:21:19 - 00:01:35:22
Tina Freese Decker
So let's start with what is top of mind for many of us, the current federal government shutdown. Can you give us a sense of how this government shutdown is the same or different from previous times? What do you think's going to happen?

00:01:35:24 - 00:01:55:22
Stacey Hughes
I'm so grateful that you invited me, and it's so fun to talk to you always and appreciate your leadership through all these different this this year for sure and heading into Q4, which is nice, but still a lot of challenges. So yeah, to your point, the shutdown, what is different? One, it's a full shutdown. The last shutdown in 2018 and 19, Tina, was a partial. And HHS was funded.

00:01:55:23 - 00:02:19:23
Stacey Hughes
Department of Defense was funded. This is a 100% shutdown of full government. And so that's really different.  I think second, one of the reasons a government shutdown, which I know we'll talk more about, is the concern Democrats have and want to use this opportunity to have leverage to get Republicans to support extending the EPTCs. I say that's a second difference in that this is going to play out in real time.

00:02:19:24 - 00:02:39:18
Stacey Hughes
You know, as we're speaking now and 21 days from now during this shutdown, or maybe it reopens, people are going to get their notices about their premium subsidies and those that have gone away during this time. So you've got sort of this dramatic dynamic that Democrats are kind of banking on so that people, everyday Americans, understand what a shutdown is.

00:02:39:18 - 00:02:57:13
Stacey Hughes
So for those two reasons it's very different. I will say in a lot of people ask me, how will it end? And, really nobody knows. I'll just add a few more facts about kind of this particular shutdown. You know, in terms of where we are, they've got about five payroll periods that are going to be coming up that are important.

00:02:57:13 - 00:03:20:17
Stacey Hughes
One I think it's been highly reported, which is the active military paycheck stops on October 15th. The second full government federal government employee paychecks stops between the 20th and 31st. Senate employees stop the 20th. You know, go down the line.  October 31st, the House employees stop receiving their paycheck. So that's kind of a an important mash up right there in terms of will that be impactful?

00:03:20:24 - 00:03:40:25
Stacey Hughes
They are moving money around to try to protect the WIC program. That funding is also expired. So there could be some action forcing events. I will say the president is going to be in Israel this weekend, rightly so, for an important ceasefire. And that's going to really occupy the news cycle till Tuesday. So I think we get back here Tuesday and we're kind of still stymied, Tina.

00:03:40:28 - 00:03:53:13
Stacey Hughes
So I don't know how this ends, but both sides feel like they're doing well. And I think frankly starting Tuesday it's a test of political stamina. You know, which party can withstand the things we just talked about.

00:03:53:15 - 00:03:56:24
Tina Freese Decker
Right. And it's challenging because all of those impact people.

00:03:56:26 - 00:03:57:09
Stacey Hughes
That's right.

00:03:57:16 - 00:04:01:25
Tina Freese Decker
The people, the federal workers. So on. And so what's a way to get unstuck from that?

00:04:02:01 - 00:04:27:08
Stacey Hughes
For sure. And I think for us, you know, because it is the Department of HHS, we also have some things that are affecting rural patients, in particular the telehealth pieces. As you know, that program expired September 30th when the CR was unsuccessful. And so did hospital at home. And, you know, that does affect real lives. According to CMS, there are about 1200 patients that were in the system during that month, between about 419 hospitals.

00:04:27:08 - 00:04:39:26
Stacey Hughes
And those patients, almost all had to be moved under the fact that the program was no longer authorized. So we feel it a little bit more than we normally would acutely. And with some of these programs not on the mandatory side, but it is real life implications.

00:04:39:28 - 00:04:56:11
Tina Freese Decker
True. So you mentioned this before. One of the sticking points is the enhanced premium tax credits, which, you know, expire at the end of the year. Why is extending those tax credits so important for hospitals and our members people? And what do you think is going to happen with those?

00:04:56:13 - 00:05:23:01
Stacey Hughes
Yeah. Boy, that's there's a great question. A couple things. Certainly we just came off the OBBA debate, right? And that already includes scoring estimates that up to 10 million people will be displaced from coverage over the next ten years. If you were to lose the enhanced subsidies which were part of President Biden's Inflation Reduction Act, as well as his American Rescue Plan, if those were to expire, you would see at least another 5 million individuals that would go from insured to uninsured status.

00:05:23:03 - 00:05:46:03
Stacey Hughes
But in addition, you know, under the four years of these enhanced subsidies, about 10 million people have come on the rolls and it's a substantial part of their ability to afford their care. 19 or 20 million people will see some reduction in their actual subsidy to pay for their premiums. And even if you get some of it, some people say a $12 differential to be the choice of staying covered or not covered.

00:05:46:06 - 00:06:06:19
Stacey Hughes
So that's number one was to create more people who are uninsured that would come through our doors. But importantly, also in terms of our own fiscal health, you know, we would estimate that's about a $28 billion loss of our ability to continue to provide services over the next ten years. So it's very real to hospitals in terms of what it would mean to our overall day-to-day ability to serve patients.

00:06:06:21 - 00:06:31:29
Tina Freese Decker
Right. And it is impacting in communities where we have payers offering the products and some not offering the products. So it's a very dynamic time happening on the ground. But then also what will happen in D.C. So thanks for that update. There are some more things from a comprehensive health care package that come together, such as structural changes to how pharmacy benefit managers operate or changes to Medicare Advantage.

00:06:32:02 - 00:06:36:24
Tina Freese Decker
What do you think is going to be put together in that sort of comprehensive package?

00:06:36:27 - 00:06:56:13
Stacey Hughes
Let's talk about the health part first. I guess I'll say that's where the PBM reform really does lie, and there's probably a combination of MA with regulatory and Hill. But right now is so acrimonious, Tina, I think while there was a lot of bipartisan support for both of those, I think that until they resolve this issue, it is going to be very difficult to restart those bipartisan conversations.

00:06:56:13 - 00:07:19:13
Stacey Hughes
And frankly, the longer this goes on, I think the more it will, you know, spoil the waters for those kind of conversations. In terms of, you know, is there an opportunity in December, you know, we would hope so. As you know, there was some significant proposals, ones that you mentioned, that were left on the cutting room floor last December when we had the health care, you know, end of year package and some other priorities on community health centers in May, as you mentioned.

00:07:19:13 - 00:07:43:15
Stacey Hughes
And so I think there's an opportunity, but it may actually bleed into next year. It's going to be solely dependent on the appropriations process. And once we open the government back up and there's a bipartisan solution for that, the question is how long, right? Is it a bipartisan solution just till next March? And normally our priorities and those types of priorities tend to travel just the length of the amount of time of the continuing resolution.

00:07:43:15 - 00:07:58:07
Stacey Hughes
So I'm not so sure when we'll be at that point of having more permanent PBM reform or MA reform. But the good news is I think the commitment to those are high. So we'll see if they revisit it. But I think they'll pick up where they left off once we can get the appropriations settled.

00:07:58:09 - 00:08:17:15
Tina Freese Decker
Okay. So you talked a little bit about December. I know the American Hospital Association has a full end of the year list of priority items. What are some of those other key issues that your team is tracking? And, you know, immigration, H-1B visa exemptions, maybe some of those. What are you thinking about that that we should be mindful of?

00:08:17:22 - 00:08:41:12
Stacey Hughes
There's no shortage of issues and it's real diverse. You know, I'll start with immigration. You know, I think everyone saw tension around the president's proclamation a couple weeks ago around adding a $100,000 fee going forward, the companies who are sponsoring H-1B visa applicants. And so on that one, we're looking and working very hard with the administration to try to seek exemption for health care workers. And that would be every clinical aspect, right?

00:08:41:12 - 00:09:02:26
Stacey Hughes
It would be lab technicians, physicians, nurses. You know, we are probably only 4.2% or 5% of the total of H-1B visas. So we're hopeful with the demonstrated workforce shortages that exist that we can have a good chance of leaning on the administration to be thoughtful about the exemption process for health care workers, that's number one. Tariffs,

00:09:02:26 - 00:09:29:05
Stacey Hughes
I think you mentioned to me that continues to be an area of concern. You know, we've engaged very significantly with some of the other stakeholders, obviously  AbbeMed and some of the other organizations. But for us, you know, a significant part of our PPE, which the president has now threatened a tariff on. Medical devices, which he's just renewed, a threat that an investigation about foreign and national security around tariffs, all of those really impact our domestic supply chain, our ability to access products.

00:09:29:05 - 00:09:48:07
Stacey Hughes
So those two are, you know, I wouldn't say left field, but they continue to occupy a lot of our bandwidth in trying to get some remedies for those two issues. Not to mention we're in that statutory rulemaking season. You know, we're in the part of this of the rule-making process. Our comments have been submitted but the government shut down. But the statutory rules still need to be addressed and worked on.

00:09:48:07 - 00:10:06:27
Stacey Hughes
This is when we spend our time with all the agency leaders, both political and career, and make our case coming off of our submitted comments and the field's comments. So a lot of challenges there, including some proposals on price transparency, obviously 340B, 340B obviously separate from the rule. There's the rebate model.

00:10:06:27 - 00:10:13:05
Stacey Hughes
So a lot is going to occupy our time and trying to influence these next 2 or 3 months for the year , Tina.

00:10:13:07 - 00:10:36:06
Tina Freese Decker
So, Stacy, my final question for you is, you know, you've been in this field for a long time. You know the players, you know the process. What advice can you give to our members as we're hearing about it, navigating through it, trying to be active with our government relations teams and legislative leaders and administrative leaders. What advice can you give to us that we should be doing?

00:10:36:09 - 00:10:53:02
Stacey Hughes
I just think it's engage. Engage, engage, engage. And I think that, you know, while it's a new, you know, group of single party leaders that are in town, I think everyone appreciates being able to hear our story and telling it well and telling it well with data, with real life consequences. And so I think just don't take your foot off the pedal on that.

00:10:53:02 - 00:11:09:12
Stacey Hughes
You know, the whole field really rose up in a way to tell Congress and the executive branch about the impact of the Medicaid cuts that were being considered. And I think we've got to continue to do that as we try to mitigate some of these issues and also make sure we're telling our story where we're innovating. Where we're creating efficiencies.

00:11:09:15 - 00:11:19:11
Stacey Hughes
What we're doing that is helpful in chronic disease. You know, we have a positive story to tell as well. And I think you'll find some, some people are really interested in what we can be doing to help improve health care.

00:11:19:14 - 00:11:38:26
Tina Freese Decker
I think that's a great reminder, Stacy. Of all the positive stories that we have, I was just rounding in one of our hospitals and I'm so impressed by what is happening. There's so many things that are happening to improve patient care that many people, including our legislative leaders, need to understand and recognize and know that they impact that our ability to provide that.

00:11:38:29 - 00:11:51:16
Tina Freese Decker
So thank you so much, Stacy, for your time today, for all of the work you and your team do on behalf of our field. And thank you so much for finding the time to listen to us. We'll be back next month for another Leadership Dialog conversation.

00:11:51:18 - 00:11:53:18
Stacey Hughes
Thank you Tina, appreciate your time.

00:11:53:21 - 00:12:02:03
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:02 - 00:00:23:18
Tom Haederle
Welcome to Advancing Health. The impact of philanthropy can be a difference maker for a hospital or health system's mission of great patient care. In this episode of a four part podcast series, two experts from a leading health system share how philanthropy empowers clinical excellence and improves patient outcomes.

00:00:23:21 - 00:00:50:19
Sue Ellen Wagner
Hi everyone. Welcome to Advancing Health. I'm Sue Ellen Wagner, vice president of trustee engagement and strategy with the American Hospital Association. I'm happy to be joined by the leadership of Inova Health today. I'm happy to introduce Toni Ardabell, chief of clinical enterprise operations at Inova Health System and Sage Bolte, chief philanthropy officer and president of the Inova Health Foundation.

00:00:50:21 - 00:01:14:14
Sue Ellen Wagner
My first question: philanthropy can have a huge impact in helping a hospital or a health system achieve its mission and caring for our patients of our community while also supporting our operations. Can you talk about the role that philanthropy is playing right now on health care, and can you also talk about some of that broad, high level role that philanthropy is playing in Inova?

00:01:14:16 - 00:01:16:17
Sue Ellen Wagner
Toni, let's start with you.

00:01:16:19 - 00:01:52:01
Toni Ardabell
Philanthropy is extremely important to health care, and what it helps us do is provide services that we could not provide otherwise. And at Inova in particular, it works with our mission and it works with our priorities. We have three year priorities and annual priorities, and Sage makes sure that the fundraising is actually meeting those priorities. It helps us develop our service lines and our service lines, our specialty, for instance, neurosciences, pediatrics.

00:01:52:04 - 00:02:07:13
Toni Ardabell
And it really helps program development in those service lines so that we can offer extremely high acuity care and care that the community just wouldn't have without the help of philanthropy.

00:02:07:15 - 00:02:10:05
Sue Ellen Wagner
Thanks, Toni. Sage?

00:02:10:07 - 00:02:37:26
Sage Bolte, Ph.D.
Yeah. I think, you know, philanthropy across the nation right now is critical. We know that we are facing headwinds that some of us have really never faced before, and the opportunity for philanthropy to come forward - our community to come forward and support their local health system or hospital is critical. Right now, philanthropy is going to help keep the lights on for some health systems.

00:02:37:28 - 00:03:03:28
Sage Bolte, Ph.D.
Philanthropy in many systems are going to help extend care to areas where care might be minimized currently. The other aspect that philanthropy helps, at least at Inova, it really helps accelerate the things that we want to do but may not be able to do today, tomorrow, or five years from now, but with the support of philanthropy, allows us to accelerate on the work that we're committed to doing.

00:03:04:00 - 00:03:24:19
Sage Bolte, Ph.D.
The other aspect I think of philanthropy, at least at Inova, is, as Tony alluded, philanthropy follows strategy. And that's really critical because we don't want philanthropy starting and stopping. We don't want it to start something that then can't be sustained. We really want the investment of our community to be a legacy of the investment of the community.

00:03:24:19 - 00:03:42:28
Sage Bolte, Ph.D.
And that's really where I think currently and in the past and the future, philanthropy has such an opportunity to make an impact on the health of our communities and really connect people's hearts to the health and health outcomes of our community.

00:03:43:00 - 00:04:03:10
Sue Ellen Wagner
Thank you both. I think it's really important that connection to community because that really connects to the mission. Next question, I'm sure you've heard a lot about this before. Why is cancer and heart getting all of the support and the dollars? How do you begin to approach answering that question when folks ask you that from the community?

00:04:03:12 - 00:04:40:06
Toni Ardabell
They're getting all of the dollars because many people use those services. Many families have people who've had heart issues or who've had cancer, and so people's hearts are already tied to those two service lines. The other thing about those service lines is they are sort of image makers for health care systems. People think if you can do heart transplants or you can do the most sophisticated oncology like Car-T, then everything you do must be really good

00:04:40:06 - 00:05:07:01
Toni Ardabell
and you have a very high level of care in your organization. I also think a certain type of physician is attracted to those two specialties, and they are not shy about going out and working for philanthropic dollars. They will work with the foundation, they will show up at events. They will go to national meetings. And so they're very involved in that fundraising as well.

00:05:07:01 - 00:05:33:12
Toni Ardabell
It helps support their research. It helps support, special programs like We Have a Wonderful Life with cancer program that was started by philanthropy and continues to get supported by not 100%, but does get supported by it every year. And so they actually are two service lines that understand the importance of philanthropy to what they're able to do for their patients.

00:05:33:15 - 00:05:39:00
Sue Ellen Wagner
Yeah, I think the physician point is a really critical one that most of us probably don't think of.

00:05:39:01 - 00:06:06:23
Sage Bolte, Ph.D.
We have to remember that more than 85% of philanthropic support comes from grateful patients. And that is an important statistic, because when you think about the gratitude of patients and where the highest volume of patients live, it often is in those two areas in cancer and in heart. And beyond that, the relationships that they establish - because these are not short term

00:06:06:26 - 00:06:40:23
Sage Bolte, Ph.D.
you know, two visit relationships - these are relationships that they build over months, over years, sometimes over decades. And so the gratitude that these patients feel and their families feel for the care in which they receive, it shows up in the way that they provide philanthropic dollars. And to Tony's point, because many of these physicians, nurses, APPs, social workers like myself, I'm an oncology social worker, went into the field with the intention of those longer term relationships.

00:06:40:28 - 00:07:00:18
Sage Bolte, Ph.D.
I think they understand that, and they are capable and more willing to connect when they hear, "Thank you so much. Thank you for saving my mom's life. What can I do for you?" They're not shy to say, would you be willing to talk to one of my colleagues on the foundation team, right? Would you tell your story?

00:07:00:23 - 00:07:29:23
Sage Bolte, Ph.D.
Would you be willing to support the research that saved your mom's life, right? Those kinds of conversations they don't shy away from. The other piece of that, though, that I think it took me a while to understand, is when cancer is supported, at least at Inova, when cancer is supported, our musculoskeletal team is supported because what happens when a philanthropic dollar comes is it does offset the operational investment.

00:07:29:23 - 00:08:00:23
Sage Bolte, Ph.D.
So it frees up additional operational investments to be able to support something that might not have had philanthropic support or might not have had the operational dollars. And that's something that Tony and myself and the rest of cabinet are really working on creating that culture and that mindset of: we all win when a philanthropic gift comes in. We all win when a philanthropic gift comes in to any service line because it does support something that otherwise would have either had operational dollar support or wouldn't have happened.

00:08:00:23 - 00:08:04:25
Sage Bolte, Ph.D.
And would have waited for, you know, months to years. So we all win.

00:08:04:27 - 00:08:30:23
Sue Ellen Wagner
Yeah, very important points. Thanks so much. And that leads to my next question. You know, when people think of philanthropy and donations, they tend to focus on those large donors from the community. But there's really, you know, so much more than that. Can you both talk a little bit about the successes that you've had when creating philanthropic initiatives, and then the balanced donor audience?

00:08:30:26 - 00:08:41:10
Sue Ellen Wagner
We talked a little bit about that. You both did with the physicians, and then, you know, the community members who have that heart and cancer connection. But can you elaborate a little bit more on that?

00:08:41:12 - 00:09:14:28
Sage Bolte, Ph.D.
You know, again, I think what's really important in order to be successful in fundraising for a health system is that you have clear focus on your mission and you have clear alignment with the strategic priorities of the organization. That is critical. And when you do that, and when everyone in leadership is able to articulate what your mission is, what your strategic priorities are, and where the philanthropic alignment is with those strategic priorities, you're able to tell a really powerful story to the community.

00:09:15:00 - 00:09:41:24
Sage Bolte, Ph.D.
And that story in many what we call segments in philanthropy is critical. So, yes, a lot of health care right now is winning with the larger donors who are coming and giving substantial what we would call transformational gifts, right? Multimillion dollar gifts. And those are truly transformational and life giving to an organization. And there's only so many of those.

00:09:41:24 - 00:10:07:10
Sage Bolte, Ph.D.
So to be successful in philanthropy, you really have to look at a wider scope of donor opportunities. So those we call those mid-level giving donors, those annual donors, the people that are willing to give you $100 a month or $100 a year, those opportunities to keep them connected, that $100 is so valuable to them, and they're giving it to you.

00:10:07:13 - 00:10:14:25
Sage Bolte, Ph.D.
And our opportunity as an organization is to ensure that they feel that $100 matters.

00:10:14:28 - 00:10:46:02
Toni Ardabell
So what I would say from an operations perspective, I've learned over the years how important it is to take every gift seriously. I would also say we need to role model giving to our own organizations. If we believe in the work we're doing as executives, then we need to step up and donate ourselves. I also know, I tell Sage this, I have the experience of one family

00:10:46:05 - 00:11:08:13
Toni Ardabell
when I was in charge of women's and children's services, sent me a check out of the clear blue sky because their baby was in the NICU, had never really been involved with Inova. It was maybe a $10,000 check and I called them to thank them and asked if they would like to be recognized in some way. They're like, no, no, we don't want to get involved,

00:11:08:13 - 00:11:34:18
Toni Ardabell
we just want to give you money. And every year that increased. For the 6 or 7 years I was in that job, the check kept getting more every year. And I've learned it's important to let people give to where their hearts are. And if you've been a patient of ours, maybe it was the NICU, or maybe it was the pediatric floor or maybe it was the cardiac ICU.

00:11:34:21 - 00:11:54:21
Toni Ardabell
Whatever you give is meaningful. And folks need to know that their giving makes a difference. And when you believe that and your heart's in it already, then you're willing to give the larger and larger gifts that you can afford to give and know that it's appreciated.

00:11:54:23 - 00:12:21:26
Sue Ellen Wagner
Thank you both. A lot of really great important points. I really like the fact that no matter of the dollar amount of the gifts that you need to make everyone feel important, that they're contributing to their local hospital. So I think that's a really important takeaway. And that leads to my last question. Do you both want to share any final thoughts with our members on the philanthropy strategy that they should be looking at today?

00:12:21:28 - 00:12:55:03
Toni Ardabell
Hire a Sage Bolte! No, actually your leader is very important. It helps if you're a clinical leader in health care for fundraising because Sage understands the organization and what we do here in a way that a non-clinical leader may not understand. There are good non-clinical leaders in philanthropy but I think it is even better for the team to have a clinical leader there.

00:12:55:06 - 00:13:04:19
Toni Ardabell
And there needs to be total integration between philanthropy, strategy and operations. I think that's the secret.

00:13:04:22 - 00:13:44:13
Sage Bolte, Ph.D.
Where health systems have an opportunity is just to reinforce what Tony said. Your chief philanthropy officer should be at the table with the executives, issued a report to the CEO. And I'm fairly biased on that because I've seen the success that can be had when your CEO is highly integrated into the philanthropic strategy and opportunities. When you see your CEO giving others gifts, creating a culture of philanthropy, not just externally, where people around the health system have the opportunity to give, but those inside the health system, those who are caring for patients. When they give

00:13:44:17 - 00:14:17:15
Sage Bolte, Ph.D.
they also are, more connected to how the gifts have impact. They're more connected to the work of philanthropy, and they're more willing to tell their own story of gratitude, of where they've had impact. So giving, as Tony said, at the highest level, down to our frontline staff. And again, that could be $5 a year. But knowing that they're giving to the organization,  that culture of philanthropy, of both giving but also connecting people to the opportunity to give is really, really important.

00:14:17:18 - 00:14:35:26
Sue Ellen Wagner
Toni and Sage, thank you so much for joining me on this podcast today to discuss the impacts that philanthropy has had on your community and your employees. We really can't wait to hear what's next for Inova and appreciate all that you're doing for your community.

00:14:35:29 - 00:14:44:11
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:02 - 00:00:29:13
Tom Haederle
Welcome to Advancing Health. October is Breast Cancer Awareness month. Each year more than 300,000 women in the U.S. are diagnosed with breast cancer. And like most cancers, the earlier it's detected, the better the prognosis. In today's podcast, we learn how one hospital has increased the reach of its mammogram screenings by sending a state of the art mobile unit out to communities - making care accessible where people are.

00:00:29:15 - 00:00:45:03
Julia Resnick
Hi, I'm Julia Resnick, senior director of health outcomes and transformation here at the American Hospital Association. I'm really happy to be here today with Dr. Lindsey Fauveau, the medical director of breast surgical oncology at Women's Hospital in Baton Rouge. Lindsey, thank you so much for joining me.

00:00:45:06 - 00:00:46:24
Lindsey Fauveau, M.D.
Thank you for having me.

00:00:46:26 - 00:01:10:04
Julia Resnick
You know, the timing for this really couldn't be better because to all our listeners, I just turned 40. And two days after turning 40, I got a nice message for my health system saying it's time for a mammogram. So what a great opportunity to talk about mammograms and how the important they are for women. Can you start by telling us a little bit about Women's Hospital in the community you serve, and really what the breast cancer landscape looks like in your region?

00:01:10:06 - 00:01:44:25
Lindsey Fauveau, M.D.
Absolutely. Women's Hospital is a woman dedicated, very woman centric hospital located in Baton Rouge. We serve not only the greater Baton Rouge community, but, pretty much statewide. I love as a breast surgeon, we have a really focused, breast centric workplace here. We have dedicated surgeons, as well as medical oncologists and radiation oncologists, who lead to a very wide breadth and depth of expertise when it comes to taking care of not only breast cancer. But because this is a women's hospital

00:01:44:25 - 00:02:13:04
Lindsey Fauveau, M.D.
we also are dedicated to gynecologic cancer and obviously having babies. So premium obstetric care and the thing that I really like to put in the forefront is that our radiologists, our mammography, is the most important to this hospital. They are really skilled. They are supreme with regards to what there is offered in Louisiana. So they're very talented and they catch a lot of things that otherwise wouldn't be noticed

00:02:13:04 - 00:02:14:24
Lindsey Fauveau, M.D.
if you were somewhere else in the state.

00:02:14:26 - 00:02:27:07
Julia Resnick
Amazing. Your community is really lucky to have you. And I know that you're based in a pretty urban area, but serve rural communities. So are you seeing differences in breast cancer rates and treatment between urban and rural communities?

00:02:27:09 - 00:02:55:06
Lindsey Fauveau, M.D.
There is really a great depth of data, not only with regards to the cancer community in Louisiana, but as you well know, there's a lot of barriers to care for access if you are not close to of a comprehensive center like Women's Hospital. So unfortunately, what that does is it leads to an increased incidence of cancers in rural areas as compared to urban areas like Baton Rouge or New Orleans or Lafayette or Shreveport.

00:02:55:06 - 00:03:07:18
Lindsey Fauveau, M.D.
But ultimately, what we're trying to do here at Women's Hospital is to increase access, increase our availability to outlying communities to decrease barriers to care and to lead to better outcomes throughout the state of Louisiana.

00:03:07:21 - 00:03:15:21
Julia Resnick
Wonderful. So I think that transitions us nicely to talking about your mobile mammography program. So can you tell me about the coach and how it came about?

00:03:15:23 - 00:03:43:21
Lindsey Fauveau, M.D.
So the mobile mammography coach started in 1995, actually, really in its inception started out pretty basic. It was ultimately a van that traveled to outlying areas in Louisiana. And back then we did in the 90s, mammography was on, actual like paper. And so it's this big kind of black chart that had your image of your breast on it.

00:03:43:24 - 00:04:12:02
Lindsey Fauveau, M.D.
And they took it in two views. So it was very simplistic. It could be transported, but as we have progressed into digital, that required a transition. So they upgraded to digital mammography in 2005. And so our first coach was born in its inception there, which then led to it opening its arms to see more people, have more availability for the radiologists to read digitally, remotely.

00:04:12:04 - 00:04:39:23
Lindsey Fauveau, M.D.
And so as the technology has increased to our current state, we do 3D mammography on our brand new coach. We're able to give communities who otherwise would have prior availability of updated technology, access to something that's right here in Baton Rouge. And so it's really changed the game and giving the greater community of Louisiana as much of what we have, as if you walked in the door of women's campus.

00:04:39:26 - 00:04:57:16
Julia Resnick
Yeah. And that access piece is just so key because, you know, if your mammogram is not convenient, it will be hard to get people to want to do this. So can you walk me through how the program extends care? Like where do you typically meet patients, and how do your community partners support that?

00:04:57:18 - 00:05:28:10
Lindsey Fauveau, M.D.
So the way that the mammography coach works is that they have dedicated schedules. So if, a particular community or a company or whatever it may be wants to offer this service to their patrons or their church family or, you know, whatever it may be, they reach out to Women's Hospital, they have a dedicated trip. So that helps that community then advertise because you would think that that if you build it, they will come is a pretty transparent thing.

00:05:28:10 - 00:05:46:21
Lindsey Fauveau, M.D.
But no, the world we live in today, if you build it, they might come. So you have to tell them. So we want it to be scheduled so that we have as much people that take advantage as possible. And so there are 15 minute appointments where you are scheduled and it goes through your insurance if you have insurance. There's outreach programs

00:05:46:21 - 00:06:09:06
Lindsey Fauveau, M.D.
if you don't have insurance. But the mammography techs are on the unit. So you are having the same techs that are in the hospital do your mammogram on a scheduled time so you can go at a very predictable time and live your life. And that mammography image digitally goes to our radiologists here at Women's Hospital. And they get real time feedback on if they need additional images.

00:06:09:06 - 00:06:28:15
Lindsey Fauveau, M.D.
And so it's really nice to upgrade the system, have a brand new coach and provide that kind of experience, remotely, which is when you think about it, where we came from, where you're driving around in a van with paper mammography charts that have to then be put up on walls with like, backlighting for them to look at.

00:06:28:15 - 00:06:32:00
Lindsey Fauveau, M.D.
It's just amazing to think where we've come from, where we've started.

00:06:32:03 - 00:06:50:26
Julia Resnick
Yeah, that's a huge upgrade. And getting state of the art medical equipment anywhere and everywhere, is incredible. I wonder how you all manage, like the stigma or reluctance around mammography, because some people are just...there are remaining concerns about if they should do this and why.

00:06:50:29 - 00:07:10:20
Lindsey Fauveau, M.D.
I think that that is something that's very important to touch. In addition to the obvious barriers to care being the fact that you have to either if you're not near a coach, you have to physically go to a hospital, which to some people is not ideal. They also are more acutely aware in the current climate of what am I doing to my body?

00:07:10:20 - 00:07:35:08
Lindsey Fauveau, M.D.
What am I putting in my body? What is this going to do in the long run? And I think that's very important. But I think that there's a lot of disinformation and misinformation on the internet that can lead you to not doing something that actually the benefit outweighs the risk. So with a singular mammogram, that equates to three months worth of your exposure to background energy of the Earth.

00:07:35:11 - 00:07:57:06
Lindsey Fauveau, M.D.
So things like uranium, things that are in the dirt that we are physically standing on. If you are standing on this earth for three months, you've got your milligram. So it's really like a drop in the bucket when you think about it. And then the benefits that you would gain or that it can change your life, it can cause you to have an early detected breast cancer that's going to have a better prognosis, may even get you out of some treatments like chemotherapy.

00:07:57:06 - 00:08:01:23
Lindsey Fauveau, M.D.
And so the benefits tremendously outweigh the risk of having a mammogram.

00:08:01:25 - 00:08:10:13
Julia Resnick
And I'm sure that as you've been doing this work, you have a lot of stories that kind of illustrate the impact of the mobile coach. Are there any of those you'd be willing to share?

00:08:10:15 - 00:08:33:25
Lindsey Fauveau, M.D.
I am a very big proponent of knowing your medical history, knowing not only yours, but your family history. I consider this a miracle, but it's not as, granular as, like, you went from a very poor prognosis to like, surviving. But in my own experience with this particular patient, I do consider it one of the miracles that I've witnessed.

00:08:33:25 - 00:08:55:14
Lindsey Fauveau, M.D.
So within the realm of breast surgical oncology, we not only take care of cancer patients, but we take care of those that are high risk of breast cancer. And so knowing your mammogram density is part of that risk factor. And so sometimes your ObGyn or your mammogram can prompt you to knowing that your high risk of breast cancer.

00:08:55:14 - 00:09:15:14
Lindsey Fauveau, M.D.
And if that's the case and you're lucky enough to go to a high risk clinic, then you'll be met with a surgeon who's going to do a risk assessment and then potentially genetic testing. So the patient that I have in mind was identified through her mammogram as being high risk. She came to see me. She had a stark family history.

00:09:15:17 - 00:09:38:15
Lindsey Fauveau, M.D.
She was recommended for genetic testing. She ended up having a mutation that was going to really tremendously increase her risk of having breast cancer. And so she elected to do risk reducing surgery with her particular mutation. And I don't like surprises personally as a surgeon. So I want to have breast imaging prior to going to the operating room.

00:09:38:17 - 00:09:57:23
Lindsey Fauveau, M.D.
And so we set her up with some imaging approximately a week before her planned surgery. And lo and behold, it diagnosed her with early stage breast cancer. So she went into that same surgery, which is supposed to be risk reducing and then became curative. And so it really shows like the full depth and breadth of everything that we do.

00:09:57:23 - 00:10:19:05
Lindsey Fauveau, M.D.
So this isn't just a cancer service. We do preventative, we do treatment. We see everything from benign all the way up to the most aggressive cancer that there is. And all of it truly matters because it's so circular. Right? So my patient who has cancer has family members who are high risk. And so we have to take the whole patient into consideration.

00:10:19:07 - 00:10:43:08
Lindsey Fauveau, M.D.
And I love that patient story, particularly because it highlights the importance of not just having the program, getting the diagnosis. It shows that like what we do in continuity can change the outcome. And she is just - she's thriving. It did not cause any anxiety because everything was already set up. I mean, it was kind of pretty remarkable about how that worked out.

00:10:43:10 - 00:10:58:24
Julia Resnick
That so beautifully illustrates the power of prevention and why it's just important to know before things go downhill. So as you've been doing this for a few years and are like looking ahead, what lessons have you learned, that you think other hospitals could apply?

00:10:58:26 - 00:11:18:25
Lindsey Fauveau, M.D.
I think that you have to have awareness and outreach that's ongoing. You know, again, the idea that if you build it, they will come just doesn't quite work. You really need to consistently engage with your community and make sure that the education that they need to have people show up for themselves medically is there.

00:11:18:25 - 00:11:21:05
Julia Resnick
Fantastic. And what's next for you in all of this work?

00:11:21:08 - 00:11:48:13
Lindsey Fauveau, M.D.
I ultimately get the pleasure to oversee a lot of this as the medical director. So I head the accreditations for Women's Hospital. The acronym is NABCC, but it's national associations of breast cancer centers as well as we are CoC, which is Committee on Cancer certified. And so there's lots of national checkpoints that Women's Hospital exceeds and really excels at.

00:11:48:13 - 00:12:12:02
Lindsey Fauveau, M.D.
And so I dive deep into that because I feel like not only Louisiana, but the Baton Rouge community deserves the best. I think that was the idea in forming Women's Hospital, born and bred in its inception with the ObGyns, who thought my deliveries, my OB patients deserve the best and I think that we carry that mentality through to cancer.

00:12:12:02 - 00:12:41:17
Lindsey Fauveau, M.D.
And so I am very happy that we have a brand new mammography unit. I think we're going to be able to reach a lot of people in the state of Louisiana. Gearing up for October, my hopes are that our good work that we've done here will be expanded throughout the state. But as well as taking care of our house, you know, I really want to make sure that the Baton Rouge community continues to have good access and quality driven care.

00:12:41:17 - 00:12:54:12
Lindsey Fauveau, M.D.
And so we've got a great team of marketing as well as business development. And I love that Women's Hospital really only focuses on women because it allows us the power to do that.

00:12:54:14 - 00:13:06:14
Julia Resnick
Fantastic. Well, thank you so much for all the work that you do to serve your patients and to serve all the women in Baton Rouge and Louisiana. Really fantastic work. And just thank you for joining us today and for everything you do.

00:13:06:17 - 00:13:08:24
Lindsey Fauveau, M.D.
It was good to see you. Thank you for having me.

00:13:09:01 - 00:13:10:21
Julia Resnick
Likewise.

00:13:10:24 - 00:13:19:06
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00;00;01;02 - 00;00;28;12
Tom Haederle
Welcome to Advancing Health. An effective cyber attack against a large hospital, especially a ransomware attack, often has a cascading effect on nearby hospitals as well, who may depend on the operational readiness of their bigger brethren. Experts call it a regional blast radius, and in this podcast, we learn how the Texas Hospital Association has stepped up with its members to meet that challenge.

00;00;28;15 - 00;01;01;01
John Riggi
Hello, everyone. Welcome to Advancing Health. This is John Riggi, your National Advisor for Cybersecurity and Risk at the American Hospital Association. I am so pleased and privileged to be here with my good friend and colleague, Fernando Martinez. Fernando is the Texas Hospital Association's chief digital officer. Fernando is also a former hospital CIO and chief information security officer. He's a certified IT security professional and a professional educator who's worked with some of the largest health care systems in the country.

00;01;01;04 - 00;01;19;17
John Riggi
Fernando has been with the Texas Hospital Association for over 11 years, and he's been an adjunct professor at Florida International University College of Business for over 15 years. Fernando, as I mentioned, so great to have you here, be on this podcast with me and talk about a great partnership.

00;01;19;20 - 00;01;21;00
Fernando Martinez, Ph.D.
Thank you John. My pleasure.

00;01;21;03 - 00;02;03;16
John Riggi
We've worked so closely with the Texas Hospital Association over the years with doing workshops, regional tabletop exercises and other educational events. And as we often discuss and as you've heard me say many, many times, cyber risk is an enterprise risk issue. But first and foremost, it is a risk to patient care and patient safety. We emphasize that hospitals should prepare for clinical continuity to mitigate the impact of a cyber outage, but also to understand what the regional impact would be to care delivery and the disruption to care delivery if a particular hospital is struck with a ransomware attack.

00;02;03;19 - 00;02;23;21
John Riggi
So our joint events focused on regional cyber incident response scenarios, just as we would all prepare for a regional physical disaster. From your perspective, how does this partnership enhance hospital resilience and patient safety across Texas?

00;02;23;24 - 00;02;55;20
Fernando Martinez, Ph.D.
Well, I have to tell you, I recall the first time that I heard you use the phrase "regional blast radius" I think this is the way you refer to it. And I thought to myself, well, you know, much of what we're doing to help our member hospitals prepare is really focused on individual hospital performance and intra-hospital performance, but really not something looking at the true operational impact to hospitals that would result as a result of a cyber incident.

00;02;55;22 - 00;03;24;12
Fernando Martinez, Ph.D.
And it's such an appropriate way to look at it, even more importantly than an individual hospital being prepared for incident response. It's really important to consider the impact that a hospital would have to endure, should they be the ones that are impacted or should any of the adjacent or in the same catchment area of patient care hospitals be affected the same way.

00;03;24;12 - 00;03;48;08
Fernando Martinez, Ph.D.
So they could be the source of the disruption and they could be the downstream recipients of the disruption. So the whole approach is quite brilliant, and I'm glad that we've been able to take that model to our hospitals in Texas. This is especially true because Texas has a lot of areas that are generally referred to as white space.

00;03;48;10 - 00;03;57;27
Fernando Martinez, Ph.D.
You'll have one level two or level one trauma hospital and ten, 12, or 15 smaller hospitals dependent on it.

00;03;58;00 - 00;04;30;03
John Riggi
Appreciate that, Fernando. And yes, unfortunately we have learned from the hundreds, hundreds of cyber attacks, but particularly the ransomware attacks, which caused victim organizations to disconnect from the internet and shut down their networks, ultimately resulting in, yes, as you indicated this is what we call ransomware blast radius. Victim is hit, but then there are cascading shockwaves throughout the entire region as patients and ambulances are diverted to surrounding hospitals.

00;04;30;06 - 00;05;00;02
John Riggi
And again, some of these surrounding hospitals, as you said, depend on the availability of the technology, whether it's the electronic medical record or linear accelerators that deliver radiation oncology of that victim organization. And with your help, we came to understand that, you know, we don't really need to develop a whole new series and set of rules and structure to develop cyber incident response plans on a regional basis.

00;05;00;02 - 00;05;25;19
John Riggi
They already exist to a certain extent. And, Fernando, your example of that white space. Unfortunately, we've had a couple of major ransomware attacks against level one trauma centers in Texas within in the past year. And I recall speaking to the CEOs and saying they were very concerned, saying, John, the next nearest level one trauma center is 400 miles from here.

00;05;25;21 - 00;05;46;29
John Riggi
So really placing not only just the patients, but entire communities at risk, really becoming a state issue as well. In Texas, again, very forward leaning on a lot of cyber issues and best practices. I understand Texas has established a cyber command. What does that entail and how does it support hospitals?

00;05;47;01 - 00;06;25;20
Fernando Martinez, Ph.D.
The Cyber Command was established in Texas, very forward looking position that the state of Texas government took, which is to build a consolidated  - at a state level - a consolidated threat intelligence, cyber readiness incident response organization that would support all of the government activities of the State of Texas. Texas has always had a cyber response organization but it's been part of the larger Texas Department of Information Resources organization.

00;06;25;22 - 00;06;59;05
Fernando Martinez, Ph.D.
What this piece of legislation, which was signed into law by the governor in June of this year as a result of the legislative session - House Bill 150...What they did is they appropriated, and this is all public domain information, they appropriated $135 million and took the cyber resources that are spread across several organizations, including Texas DIR, consolidated them into one cyber command for the state of Texas.

00;06;59;05 - 00;07;35;04
Fernando Martinez, Ph.D.
And so the idea here is to provide a baseline for cyber preparedness, for cyber threat analysis and threat intelligence and incident response. And then in doing so establish policy standards. That body is actually empowered with rulemaking. The chief is appointed by the governor. So it's a very forward thinking governance architecture and structure around cyber. Although it's initially the scope of command is limited to state government.

00;07;35;06 - 00;08;10;00
Fernando Martinez, Ph.D.
It does incorporate services that can be used in public sector education, higher ed in particular, but also public sector education and other public sector organizations like municipalities, city governments, down to and extending to critical infrastructure vertical departments that might be water power, a number of other sectors. So very forward leaning, forward thinking steps being taken to approach this at a state level.

00;08;10;02 - 00;08;36;25
John Riggi
Really a model for all states. And again, Texas being leader in this area. So Texas and through the Texas Hospital Association is leading in other ways, and with our work at the American Hospital Association we have joined forces with you to develop these regional tabletop exercises. Fernando, from your perspective, could you tell us what these regional tabletop exercises look like?

00;08;36;27 - 00;09;04;24
Fernando Martinez, Ph.D.
Sure. So the idea that you take a regional hospital, a level two, level one, trauma hospital that has a community relationship with ten, 12 or 15 smaller critical access or rural hospitals. We converge them. We bring them together into a day long activity, where is the primary dependency being the level two or the level one trauma center

00;09;04;26 - 00;09;41;07
Fernando Martinez, Ph.D.
suffers an incident, a cyber incident of some sort that interrupts the service that these downstream hospitals need that are required for life safety care to patients in their communities. And these are primarily non-IT executives that are brought together, operational clinical operations, hospital operations, emergency preparedness. By bringing those individuals from all the different hospitals together, they have an opportunity to flesh out the circumstances that they might have to confront.

00;09;41;09 - 00;10;07;27
Fernando Martinez, Ph.D.
You mentioned earlier, the fact that if a level two or a level one trauma center goes down, now you're talking about potentially transporting patients instead of transporting them 45 minutes, 30 minutes or an hour away. Now you've he's looking at 2 or 3 hours, which in the cases that that would have catastrophic consequences in terms of patient outcomes and clinical care and clinical safety.

00;10;08;00 - 00;10;32;11
Fernando Martinez, Ph.D.
They have been very effective in bringing those individuals together to talk about how it is that they would work together. What are the alternatives? How would they address incident response? How would they leverage each other's resources? As simple as how would they communicate with each other? That's proven to be very effective. The exercise we did last year was remarkable

00;10;32;13 - 00;11;04;09
Fernando Martinez, Ph.D.
inasmuch as there actually was two days before the exercise, there actually was a level one trauma center hospital upstream that went down and affected the actual host hospital that was in fact upstream from the small hospital. So we know that the threat is real. And we know that this is a very effective way to bring many hospital executives together to consider obstacles that they would not necessarily contend with during their traditional

00;11;04;15 - 00;11;09;19
Fernando Martinez, Ph.D.
standalone emergency preparedness exercise. Brilliant approach on the part of AHA.

00;11;09;21 - 00;11;32;14
John Riggi
Thank you for that, Fernando, truly a great partnership with THA. And you know, when we did that exercise, many thought that the exercise and the news of the ransomware attack upstream was all somehow connected. Very unfortunate coincidence that it happened at that time. But talk about a sense of realism to really conduct an exercise during the heat of battle

00;11;32;14 - 00;11;49;03
John Riggi
in a sense. What do you think, Fernando? Again, having been there now for several of these exercises, helping me moderate these, what do you think some of the key lessons learned are from these exercise? And how do you think these exercise build trust and coordination across the attendees?

00;11;49;05 - 00;12;17;22
Fernando Martinez, Ph.D.
Well, first of all, communication was the key takeaway. A lot of the hospital executives, from a risk averse point of view, a lot of the hospital executives look at cyber incidents as something that they don't want to communicate to anyone else for a variety of reasons, many of them prompted by being legally discreet and not disclosing information that might jeopardize the organization.

00;12;17;24 - 00;12;56;09
Fernando Martinez, Ph.D.
Unfortunately, when you look at emergency preparedness, other types of emergency response circumstances, whether it's mass casualty or acts of nature, the communication protocols were all there so that organizations can notify each other. But where cyber incidents are concerned, something as simple as just communicating indicators of compromise, right? Techniques and tactics. Those are bits of information that would help downstream organizations potentially identify if there was a threat that was being directed at them, so that they would avoid the same set of circumstances.

00;12;56;12 - 00;13;30;08
Fernando Martinez, Ph.D.
And that's not there. So one of the big takeaways was hospitals need to develop these communication pathways that will allow them to share a small amount of information, just sufficient information without disclosing more detail than they need, disclosing the fact that there is an incident underway, that there are some of the indicators of compromise are XYZ, so that the adjacent hospitals have the opportunity to prepare to look for and potentially avoid being victims.

00;13;30;10 - 00;13;42;26
Fernando Martinez, Ph.D.
I can assure you that the bad guys are sharing information the moment that they exploit one organization, then they know regionally that they can go to other organizations with similar success.

00;13;42;29 - 00;14;18;09
John Riggi
Communication, within the organization with their peer organizations in region, with the federal government, with the state. Really crucial during these exercise, although there is this tension between trying to preserve confidentiality, risk of civil liability and potential regulatory liability, all these factors tend to shape an organization's outlook. But with education they understand they can mitigate all those risks and develop these trusted relationships which will not expose them to legal and regulatory risk,

00;14;18;09 - 00;14;45;07
John Riggi
again, if they have these preexisting relationships in agreements in place. Fernando, I view the work being done at the Texas Hospital Association quite frankly as a model for other states. And I just want to let you know I value your partnership and your capabilities and all that you do, not only for all the hospitals in the state of Texas, how you've been contributing on the national level as well, helping me, helping AHA to do our job for national benefit.

00;14;45;10 - 00;15;03;28
John Riggi
So thank you again, Fernando, your partnership, your friendship and all that you do. And thanks to all our listeners for all that you do every day to defend networks, care for patients and serve your communities. This has been John Riggi, your National Advisor for Cybersecurity and Risk.

00;15;04;00 - 00;15;12;11
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.