UP NEXT ON "CYCLE OF HEALTH."

>> TONIGHT'S TOPIC.

RURAL HEALTHCARE.

WITH RURAL RESIDENTS FACING BARRIERS SUCH AS LACK OF PROVIDERS, LACK OF TRANSPORTATION, HIGH COSTS FOR CARE, PROGRESS NEEDS TO BE MADE TO HELP THESE FOLKS ACCESS HEALTHCARE.

>> GEOGRAPHY IS A DETERMINANT OF HEALTH.

WE SEE HIGHER RATES OF CHRONIC HEALTH CONDITIONS AND HIGHER RIGHTS OF MORBIDITY IN PEOPLE WHO LIVE IN RURAL AREAS.

♪ ♪ ♪ ♪ HELLO AND WELCOME TO CYCLE OF HEALTH.

I'M DR. RICH O'NEILL.

TONIGHT'S TOPIC: RURAL HEALTHCARE.

WITH RURAL RESIDENTS FACING BARRIERS SUCH AS LACK OF PROVIDERS, LACK OF TRANSPORTATION, AND HIGH COSTS FOR CARE, THERE IS MUCH PROGRESS THAT NEEDS TO BE MADE TO HELP RURAL PATIENTS ACCESS HEALTHCARE.

TONIGHT WE'RE JOINED BY THREE PANELISTS WHO ARE WORKING TO BRIDGE THE GAP IN RURAL HEALTHCARE.

LET'S MEET OUR GUESTS: DR. FREDERICK J BLOOM: CHIEF POPULATION HEALTH OFFICER AT GUTHRIE HEALTH MARY MARUSCAK: DIRECTOR OF COMMUNITY HEALTH AT RURAL HEALTH NETWORK OF SOUTH CENTRAL NEW YORK, AND HEATHER DRAKE BIANCHI: CHIEF EXECUTIVE OFFICER OF DRAKOS CLINICAL LABORATORIES SOUNDS LIKE SOMETHING OUT OF A SUPER MAN MOVIE, I HAVE TO SAY.

THANK YOU ALL FOR BEING HERE.

>> LET'S START WITH WHAT ARE SOME OF THE CHALLENGES FOR FOLKS LIVING IN RURAL AREAS AND ACCESSING HEALTHCARE?

>> WELL, I THINK WHEN WE ARE THINKING ABOUT HEALTH OVERALL, WE HAVE TO BE THINKING ABOUT ROOT CAUSES AND WE REFER TO THOSE AS THE DETERMINANTS OF HEALTH.

THE FACTORS AND CIRCUMSTANCES WE ALL HAVE IN OUR LIVES THAT ARE NON-CLINICAL BUT ULTIMATELY IMPACT OUR CLINICAL OUTCOMES.

AS YOU MENTIONED, DO WE HAVE PUBLIC TRANSPORTATION?

DO WE HAVE SAFE HOUSING?

DO WE HAVE WALKABLE COMMUNITIES?

WHAT IS OUR INCOME LEVEL?

WHAT IS OUR EDUCATIONAL LEVEL?

GEOGRAPHY IS A DETERMINANT OF HEALTH.

WE SEE CHRONIC RATES OF CHRONIC CONDITIONS AND HIGHER RATES OF MORBIDITY IN PEOPLE WHO LIVE IN RURAL AREAS.

>> MARY, I THINK ALSO IN RURAL AREAS, WE SEE OLDER AND SICKER PATIENTS AND SO THEY HAVE MORE CHRONIC CARE NEEDS THAT REQUIRES ADDITIONAL CARE AND ACCESS TO CARE.

AT GUTHRIE, WE STRIVE TO PROVIDE ACCESS TO PATIENTS ACROSS RURAL NORTHERN PENNSYLVANIA AND UPSTATE NEW YORK AND PROVIDING THAT CARE REQUIRES PHYSICIANS AND OTHER CAREGIVERS, IT'S HARD TO RECRUIT PHYSICIANS AND OTHER CAREGIVERS TO THIS AREA.

AND SO THAT'S ONE OF THE CHALLENGES IN ADDITION TO THE POPULATION, IS PROVIDING HEALTHCARE RESOURCES IN A RURAL ENVIRONMENT.

>> FRED, HOW IS GUTHRIE ADDRESSING THOSE CHALLENGES SUCH AS LACK OF PROVIDERS THAT YOU JUST MENTIONED?

>> SO TO REDRUT PROVIDERS TO AN AREA, YOU NEED TO PROVIDE THE SAME INNOVATIVE TECHNOLOGY THAT PROVIDERS AND PATIENTS USE IN URBAN AREAS AS WELL.

SO PROVIDING GREAT TECHNOLOGICAL INNOVATION AND ADVANCES SUCH AS THE GREAT ELECTRONIC MEDICAL RECORD, SUCH AS ROBOTIC SURGERY IN A SMALL HOSPITAL LIKE CORNING HOSPITAL, OR A BRAND NEW LINEAR ACCELERATOR AT CORTLAND AT THE CANCER CENTER.

THOSE THINGS ARE THINGS THAT HELP TO US BE ABLE TO RECRUIT THE VERY BEST PHYSICIANS AND CAREGIVERS TO OUR REGION, WHICH HELPS PATIENTS AND PROVIDERS.

>> ONE OF THE WAYS WE HAVE BEEN ABLE TO BRIDGE THE GAP IN THE STAFFING SHORTAGE IS BY UTILIZING OTHER HEALTHCARE WORKERS SUCH AS PARAMEDICS AND E.M.T.S.

ONE OF THE DISPARITIES IN ACCESSING HEALTHCARE THAT WE FOUND ISN'T JUST DISTANCE AND TIME AND MONEY, BUT IT'S ALSO UNDERSTANDING TECHNOLOGY SUCH AS TELEHEALTH.

NOT EVERYBODY INTUITIVELY UNDERSTANDS HOW TO USE THAT.

SO ONE OF THE THINGS WE ARE DOING AT DRADOS WITH OUR MOBILE LAB SERVICES, IN ADDITION TO COMING TO PEOPLE'S HOMES TO DRAW ROUTINE LABS SO THEY DON'T HAVE TO GO TO THE DOCTOR'S OFFICE, WE DRAW THEIR LABS AND WE TEACH THEM HOW TO USE THE TELEHEALTH PLATFORMS AND BRIDGE THE GAP THAT WAY.

ONE OF THE BENEFITS OF COVID IS WE ADVANCED 40 YEARS IN TECHNOLOGY IN A MATTER OF WEEKS AND MONTHS AND LEVERAGING TELEHEALTH AS MUCH AS POSSIBLE IS ONE OF THE WAYS WE CAN BRIDGE THE GRAP WITH THE RURAL COMMUNITIES.

>> AND EVEN WITH THE SORT OF MORE BASIC COMMUNITY LEVEL, COMMUNITIES ARE FINDING WAYS TO ADDRESS THAT ON THEIR OWN.

THERE IS A VERY SMALL TOWN IN OUR COUNTY IN BROOME COUNTY WHERE THE DIRECTOR OF THE LOCAL LIBRARY IS WORKING IN PARTNERSHIP WITH A SENIOR CENTER TO PROVIDE DIGITAL LITERACY COURSES TO EACH PEOPLE HOW TO USE TABLETS, HOW TO USE COMPUTERS, TO ACCESS THINGS LIKE TELEHEALTH.

BUT ALSO SOCIALIZATION BECAUSE THAT'S SOMETHING THAT IS REALLY MISSING FROM A LOT OF PEOPLE AS WELL.

>> SO MY KIDS WON'T HAVE TO GET MAD AT ME FOR CALLING UP EVERY TIME.

I MIGHT BE ABLE TO TAKE THAT CLASS INSTEAD OF SAYING HELP, HOW DO I DO THIS?

AS LONG AS WE ARE TALKING ABOUT TECHNOLOGY, FOR MANY INDIVIDUALS IN REMOTE AREAS, ACCESSING PROPER MEDICAL CARE CAN BE A MAJOR CHALLENGE BUT THANKS TO ADVANCEMENTS IN TECHNOLOGY, THE GAP BETWEEN URBAN AND RURAL HEALTHCARE IS STARTING TO CLOSE.

OUR CYCLE OF HEALTH TEAM VISITED GUTHRIE HEALTH'S NEW PULSE CENTER IN BIG FLATS, NEW YORK TO LEARN MORE ABOUT THE INNOVATIVE WAYS THEY ARE WORKING TO BRIDGE THE DIVIDE, BRINGING MUCH-NEEDED MEDICAL SERVICES TO UNDERSERVED COMMUNITIES.

LET'S TAKE A LOOK.

>> DIGITAL TRANSFORMATION IS REALLY ABOUT TAKING TECHNOLOGY AND THROUGH PROCESS AND PEOPLE AND ADDING ON THAT LAYER OF TECHNOLOGY IS ENABLING CARE DIFFERENTLY.

AS WE KNOW CARE CANNOT CONTINUE THE WAY THAT WE HAVE TRADITIONALLY DONE IT SO WE ARE REALLY LOOKING TO TRANSFORM HOW WE CARE THROUGH TECHNOLOGY ENABLED CARE.

>> MY NAME IS KRISTIN HALL, DIRECTOR OF THE PULSE CENTER.

THE PULSE CENTER IS A PHYSICAL LOCATION.

IT HOLDS MANY OF OUR REMOTE SERVICES FOR GUTHRIE.

THOSE REMOTE SERVICES INCLUDE TELESITTERS.

WE ALSO HAVE LAUNCHED OUR VIRTUAL ICU PROGRAM, AND WE ARE ALSO GOING TO HAVE VIRTUAL MED SURGERY NURSES AND OUR CENTER IS GOING TO MOVE FROM ROBERT PACKER TO HERE.

>> ONE OF THE ATTRIBUTES OF THE PULSE CENTER IS REALLY GOING TO SERVE AS A HUB FOR TELEMEDICINE, AND I THINK THAT TELEMEDICINE IS SO IMPORTANT WHEN WE THINK ABOUT DISPARITIES IN RURAL SETTING BECAUSE, UNFORTUNATELY, THE MORE RURAL YOU ARE, THE HARDER IT IS TO GET ACCESS TO THE CARE THAT YOU NEED.

AND TELEMEDICINE IS ONE STRATEGY THAT REALLY WILL ALLOW US TO GET THE RIGHT CARE TO THE RIGHT PEOPLE NO MATTER WHERE THEY'RE LOCATED.

>> THE BENEFITS RELATED TO THE PULSE CENTER REALLY IS NOT ONLY TO BRING CARE WHERE THE PATIENT NEEDS IT, BUT ALSO TO SUPPORT THE CAREGIVERS THAT ARE PROVIDING THAT CARE.

WE HAVE, SINCE COVID, THERE HAS BEEN A PRETTY TREACHEROUS WORKFORCE ENVIRONMENT AND THERE HAS BEEN A LOT OF BUSHOUT AND REALLY-- BURNOUT AND WE HAVE BEEN FOCUSING ON HAVING OUR VIRTUAL NURSES AND SOME OF THE OTHER ELEMENTS THAT WE ARE PUTTING INTO THE PULSE CENTER TO MAKE SURE THAT NOT ONLY CAN WE SCALE FOR ACCESS, BUT CAN WE SUPPORT THE CAREGIVERS THAT ARE ACTUALLY PROVIDING THAT ACCESS.

>> SO THE VIRTUAL ICU NURSES, THEY CAN BE SECOND SIGN-OFF ON HIGH ALERT MEDICATIONS SO THAT INCLUDES LIKE HEPARIN OR BLOOD, SOME OF OUR PAIN MEDICINES THAT ARE I.V., THOSE ALL NEED SECOND SIGNATURES SO THE VIRTUAL ICU NURSE HAS THE ABILITY WITH THE CAMERAS THAT ARE HIGH TECH, THEY CAN ZOOM IN AND SEE THE PUMP.

THEY CAN SEE THE PATIENT'S WRIST BAND SO THEY CAN BE THE SECOND SIGN-OFF AND WE HAVE A FULL ACCESS TO EPIC E.M.R.

WE CAN SEE LABS AND SEE EVERYTHING.

IT'S REALLY FOCUSED ATTENTION TO PATIENTS AND WE ARE ABLE TO QUICKLY IDENTIFY IF THERE IS SOMETHING NEGATIVE HAPPENING.

AND ALSO A BIG PORTION OF THAT PROGRAM IS JUST HELPING THE NURSES AT THE BED SIDE IF THEY HAVE QUESTIONS, HEY, JUST CALL US AND THESE ARE VERY EXPERIENCED ICU NURSES.

THEY ALL HAVE FIVE YEARS OR MORE EXPERIENCE AT THE BED SIDE.

SO THEY JUST ARE A RESOURCE FOR THE NURSES WHICH IS A GREAT THING.

>> GUTHRIE HAS MADE A LARGE INVESTMENT IN EPIC.

EPIC IS OUR PATIENT PLATFORM WHERE WE DO A LOT OF OUR DOCUMENTATION, WHERE THERE IS ORDER ENTRY, WE HAVE REV CYCLE ACTIVITIES AND IT IS OUR, THE PLATFORM THAT WE GO TO FIRST.

OUR PARTNERSHIP WITH EPIC HAS BEEN SUCH THAT WE HAVE STANDARDIZED ACROSS ALL OF OUR SYSTEMS SO NO MATTER WHERE THE CARE IS PROVIDED, EVERY NURSE INTERACTS WITH THE PRODUCT THE SAME WAY AND SO WE HAVE BROUGHT THAT INTO THE PULSE CENTER AND HAVE UTILIZED THAT SAME METHODOLOGY TO MAKE SURE THAT THE CARE IS IN ONE PLACE AND THAT IT IS ONE PATIENT RECORD.

>> SO ONE OF THE CRITICAL ASPECTS OF THE PULSE CENTER IS TO REALLY ALMOST FUNCTION AS A COMMAND CENTER, LIKE AIR TRAFFIC CONTROL.

WE NEED TO GET OUR PATIENTS INTO THE RIGHT HEALTH SETTING SO WE CAN PROVIDE THE OPTIMAL CARE AND THAT'S PART OF WHAT IT MEANS TO BE A HEALTH SYSTEM.

>> SO IN THE PACKAGE WE JUST SAW, THEY TALKED ABOUT THE VIRTUAL ICU, WHICH I NEVER HEARD OF.

TELL US MORE ABOUT THAT.

>> SO BY PUTTING CAMERAS IN PATIENT ROOMS SUCH AS IN THE ICU, WE CAN SUPPLEMENT THE STAFF IN THE ICU WITH ADDITIONAL NURSES AND PHYSICIANS SO THAT THERE IS EXTRA EYES ON OUR PATIENTS TO BE ABLE TO GIVE THE STAFF THAT'S PHYSICALLY PRESENT ADDITIONAL SUPPORT, ESPECIALLY IN OUR MOST CRITICALLY SICK PATIENTS.

WE'VE ALSO PUT CAMERAS IN OUR MEDICAL OFFICES SO A PATIENT AT CORTLAND COULD GO TO ONE OF OUR MEDICAL OFFICES AND BE ABLE TO ACCESS A PHYSICIAN WHO PERHAPS WASN'T IN THE COMMUNITY, A TELEROOM SPECIALIST SOMEWHERE ELSE IN THE GUTHRIE SYSTEM RIGHT FROM THEIR LOCAL OFFICE.

>> AND ALSO AT THE SAME TIME SOLVE THE PROBLEM OF NOT BEING ABLE TO FIGURE OUT HOW TO USE YOUR COMPUTER TO GET ON TO TELEHEALTH, RIGHT?

>> ABSOLUTELY.

OUR STAFF CAN THEN HELP THEM WITH ALL OF THOSE TECHNOLOGICAL CHALLENGES THAT THEY MIGHT HAVE, AND GIVE THEM A GREAT CONNECTION TO THE MOST ADVANCED HEALTHCARE RESOURCES.

>> SO SAY I, GOD FORBID, HAVE A HEART ATTACK AND I LIVE OUT IN THE COUNTRY, LIKE HOW DOES THIS-- WHAT DO I DO?

HOW DO YOU GUYS ALL INTERACT WITH THIS?

WHAT DO I DO?

WHAT IS THE FIRST THING I DO?

>> WELL FIRST YOU SHOULD CALL 911, EVEN IF YOU ARE NOT SURE IF THERE IS A PROBLEM.

>> BECAUSE THAT'S EVERYWHERE 911?

>> ABSOLUTELY.

IF YOU LIVE IN THE COUNTRY, IT'S REALLY IMPORTANT 1: TO TAKE A PROACTIVE APPROACH TO YOUR HEALTHCARE.

BY THE TIME YOU'VE CALLED 911, YOU HAVE ENTERED REACTIVE APPROACH.

BUT IN RURAL COMMUNITIES, BECAUSE THEY CAN BE SO FAR AWAY AT TIMES, IT'S IMPORTANT TO CALL EARLY ON, EVEN IF YOU ARE NOT SURE, JUST CALL AND THEN IF YOU END UP CANCELING 911 RESOURCES, IT'S REALLY NOT A PROBLEM.

PEOPLE ARE AWAKE AND WORKING ANYWAY.

AND THEY'RE HAPPY TO COME AND TALK TO YOU AND MAKE SURE THAT EVERYTHING IS OKAY.

ONE THING THAT WE FIND FROM THE MOBILE CAPACITY IS THAT PARAMEDICS, E.M.T.S AND EVEN FROM THE MOBILE LAB CAPACITY, WE WILL ENTER PATIENTS HOMES AND MAYBE WE ARE THERE FOR LABS OR PARAMEDIC FOR EMERGENCY SERVICES, BUT WE ALSO, IN ADDITION TO THE REASON THAT WE ARE THERE, ARE ABLE TO LOOK AROUND THE HOME OR THE OFFICE OR THE HOUSE OR APARTMENT AND TAKE A LOOK AS TO HOW THIS IS PERSON DOING BEYOND JUST WHAT THE REASON THAT WE ARE THERE IS.

WE ARE ABLE TO SEE IS THERE I HOME IN GOOD ORDER OR DO THEY NEED SOME ADVOCACY IN OTHER WAYS BEYOND THEIR ABEAUTY HEALTH NEEDS.

DO THEY NEED ADVOCACY FOR THEIR CHRONIC HEALTH CONDITIONS.

DO THEY HAVE HEALTHY FOODS, WHICH YOUR ORGANIZATION HITS ON BECAUSE THE WHOLE BODY IS SO IMPORTANT.

AND PEOPLE SHOULD ALSO KNOW THAT IN RURAL COMMUNITIES, THE FIRST PLACE THAT 911 RESPONDERS ARE GOING TO LOOK, IF YOU ARE NOT CONSCIOUS AND WE ARE TRYING TO FIGURE OUT WHAT MEDS YOU ARE ON, WHAT HEALTHCARE PROBLEMS DO YOU HAVE, WE ARE GOING TO GO TO YOUR FRIDGE AND LOOK ON YOUR FRIDGE TO SEE IF THERE IS A MED LIST.

>> ON YOUR FRIDGE?

>> SOME PEOPLE PUT IT INSIDE OF THE FRIDGE BUT RIGHT OUTSIDE OF THE FRIDGE, ANY DOCUMENTS THAT YOU WOULD WANT A PARAMEDIC TO KNOW ABOUT TO BRING WITH THEM TO THE HOSPITAL, THAT'S WHERE YOU PUT IT BECAUSE THAT'S WHERE WE ARE GOING TO LOOK.

AND THAT'S JUST ONE SMALL WAY THAT YOU CAN REALLY HELP US OUT SO THAT WE ARE NOT WASTING TIME SEARCHING AROUND YOUR HOUSE FOR YOUR MEDICATION BOTTLES.

>> THAT'S GOOD TO KNOW BECAUSE I WOULD HAVE NEVER THOUGHT-- ALL I HAVE IS PICTURES OF MY GRANDKIDS ON THE FRIDGE.

>> THAT'S ONE OF THE FIRST PLACES WE LOOK BECAUSE WE ARE NOT GOING TO KNOW WHICH DRAWER OR FILE THAT YOU KEEP IT IN.

BUT I THINK IT'S REALLY IMPORTANT THAT IF YOU ARE CONCERNED ABOUT YOUR HEART, FOR EXAMPLE, THAT YOU ARE TAKING A PROACTIVE APPROACH TO YOUR HEALTHCARE AND THAT YOU ARE GETTING YOUR LABS DRAWN, THAT YOU ARE SPEAKING WITH YOUR DOCTOR AND IF YOU HAVE A HARD TIME GETTING THERE, THAT YOU CAN UTILIZE TELEHEALTH SERVICES TO GET IN TOUCH WITH YOUR PRIMARY CARE PROVIDER OR WITH AN OUTREACH CENTER THAT'S A BIT CLOSER TO YOU.

AND IF YOU NEED SOMEBODY TO COME TO YOUR HOME TO HELP WALK YOU THROUGH HOW TO USE TELEHEALTH OR DRAW YOUR LABS AND SEND THEM TO YOUR DOCTOR, IT'S GOING TO COST YOU LESS MONEY THAN IF YOU ARE TRYING TO FIGURE OUT YOUR CAR AND THEN GAS AND DRIVING AN HOUR AND A HALF OR HOWEVER LONG TO THE DOCTOR, IF YOU CAN HAVE SOMEBODY COME TO YOU, ESPECIALLY THOSE WITH MOBILITY PROBLEMS, THAT IS A RESOURCE THAT EXISTS NOW.

>> AND I THINK THAT EDUCATION FACTOR IS SO IMPORTANT.

SO IN OUR ORGANIZATION, PRETTY MUCH EVERYTHING THAT WE ADDRESS IS RELATED TO ACCESS AND EDUCATION.

AND OUR RURAL COMMUNITIES ARE AGING.

WE HAVE BEEN SEEING THAT FOR A DECADE.

IT'S PROJECTED TO CONTINUE FOR THE NEXT COUPLE OF DECADES.

AND SO BEING ABLE TO PROVIDE THAT EDUCATION, EVEN THE VERY BASIC EDUCATION OF MAKING SURE THAT THERE IS A MEDICATION LIST OR EVEN PUTTING IT IN YOUR REFRIGERATOR BECAUSE KNOWING THAT THAT IS THE FIRST PLACE A PARAMEDIC MIGHT LOOK IS REALLY IMPORTANT FOR PEOPLE TO UNDERSTAND.

SOCIAL ISOLATION IS A REALLY BIG FACTOR IN RURAL COMMUNITIES AS WELL.

AND SO OFTEN, YOU KNOW, WHEN YOU'VE GOT THAT COMBINATION OF PEOPLE GETTING OLD OLDER AND ALSO BEING ISOLATED, IT CAN BE VERY DIFFICULT TO HAVE QUICK ACCESS AND SO WE KNOW THAT IN RURAL COMMUNITIES, IT CAN TAKE LONGER FOR THOSE PARAMEDICS TO GET TO YOU.

THE AVERAGE ARRIVAL TIMES ARE MUCH LONGER THAN THEY ARE IN URBAN AND SUBURBAN AREAS.

SO THOSE PROACTIVE APPROACHES AND THAT SORT OF SELF MANAGEMENT MIND SET IS REALLY IMPORTANT TO TALK ABOUT.

>> I THINK IT'S ALSO IMPORTANT THAT EMS AGENCIES AND CLINICS, WE ALL KNOW ABOUT EACH OTHER AND SO WE CAN LINK TOGETHER IN A FULLY INTEGRATED HEALTHCARE SYSTEM BECAUSE THE REALITY IS THAT HEALTHCARE IS MOVING BEYOND THE WALLS OF A FACILITY AND SO IF EMS IS AWARE OF SERVICES LIKE YOURS AND HOW TO GET IN TOUCH WITH OUTREACH CENTERS THAT ARE MORE LOCAL TO THE RURAL COMMUNITY, THAT'S GOING TO HELP LINK MORE RESOURCES TOGETHER BEYOND JUST GOING TO THE HOSPITAL.

>> I THINK YOUR POINT ABOUT THE CHRONIC CARE AND THE PROACTIVE A3R0E67 TO THESE PROBLEMS IS REALLY IMPORTANT.

TRANSPORTATION IS A HUGE ISSUE IN OUR AREA AND TELEMEDICINE IS A WAY THAT WE CAN SOLVE THAT PROBLEM.

NOT EVERY AREA IN OUR RURAL GEOGRAPHY HAS CELL PHONE ACCESS, BUT MORE AND MORE ARE.

AND MANY PEOPLE DO HAVE A CELL PHONE.

AND TO BE ABLE TO GET AHOLD OF YOUR PROVIDER AND HAVE VISITS WITH YOUR PROVIDER, WHETHER IT'S A PRIMARY CARE PROVIDER OR SPECIALTY CARE PROVIDER IS SOMETHING GUTHRIE IS REALLY FOCUSED ON.

>> SO IN A WAY, FRED, WHAT WE ARE TALKING ABOUT BEING PROACTIVE AND TAKING SOME STEPS IN ADVANCE LIKE PUTTING YOUR MED LIST ON THE FRIDGE, ET CETERA, GUTHRIE IS REALLY TRIED TO ANTICIPATE THOSE PROBLEMS, TO SOLVE THEM FOR PEOPLE IN RURAL COMMUNITIES.

THEY DON'T HAVE TO SOLVE THEM THEMSELVES.

WOULD THAT BE ACCURATE?

>> IT'S ABOUT CREATING A NETWORK THROUGHOUT A REGION SO THAT YOU HAVE A SYSTEM OF CARE FOR TRAUMA, TRAUMA RESPONSE SYSTEM.

BUT YOU ALSO HAVE THE ABILITY TO ACCESS PRIMARY CARE AND SPECIALTY CARE ACROSS OUR RURAL AREA UNIFORMLY AND THAT'S REALLY A CHALLENGE TO ALL HEALTHCARE SYSTEMS, BUT ESPECIALLY IN IN A RURAL ENVIRONMENT TO GET THE PEOPLE THAT ARE ABLE TO LIVE AND WORK AS A PART OF A SYSTEM LIKE THAT.

>> WHAT ROLE DO ECONOMIC FACTORS PLAY IN ACCESS TO HEALTHCARE?

HOW DOES THAT FIT IN?

>> THE DATA DOES TELL US THAT PEOPLE IN RURAL COMMUNITIES ON AVERAGE DO TEND TO HAVE LOWER HOUSEHOLD INCOMES THAN PEOPLE IN THE URBAN AND THE SUBURBAN COMMUNITIES.

AND INCOME IS ONE OF THE LARGEST FACT E-SCOOTERS IMPACTING OUR HEALTH BECAUSE IF YOU THINK ABOUT ALL OF THE THINGS YOU WOULD NOT BE ABLE TO ACCESS IF YOU DIDN'T HAVE SOME FORM OF INCOME, AND ALL OF THOSE THINGS, IN SOME WAY, DO AFFECT OUR HEALTH OUTCOMES AND WHETHER THAT'S OUR PHYSICAL HEALTH OR OUR MENTAL HEALTH.

>> AND I'M THINKING THAT SOME OF THESE ISSUES WOULD MAYBE NEED TO BE ADDRESSED AT THE POLITICAL LEVEL.

WOULD YOU AGREE?

>> I AGREE COMPLETELY.

I THINK THAT MANY OF OUR PATIENTS IN THE RURAL AREA HAVE MEDICAID AND MEDICARE, A GOVERNMENTAL PAIR.

AND WHEN MEDICARE AND MEDICAID ARE CUTTING BACK EVERY YEAR ON THE REIMBURSEMENTS TO HEALTHCARE PROVIDERS, IT'S PUTTING REAL PRESSURE ON NON-PROFIT ORGANIZATIONS AROUND FUNDING HEALTHCARE, NON-PROFIT ORGANIZATIONS ARE LOW MARGIN BUSINESSES.

THEY'RE BREAK EVEN BUSINESSES AND WHEN MEDICARE CUT BACK PHYSICIAN PAYMENTS 2% LAST YEAR, WHEN YOU START TO SEE CUTBACKS YEAR OVERYEAR, IT'S CHALLENGING HEALTHCARE SYSTEM TO REMAIN IN BUSINESS.

WE'VE RESEEN MORE RURAL HOSPITALS GO OUT OF BUSINESS OVER THE LAST YEAR THAN IN THE PAST.

AND IT IS A CHALLENGE FOR US THAT NEEDS TO BE ADDRESSED AT A FEDERAL, STATE LEVEL AROUND HOW ARE WE GOING TO FINANCE HEALTHCARE IN RURAL AREAS AND IT IS TRUE THAT RURAL COMMUNITIES DO RECEIVE AN INEQUITABLE AMOUNT OF FUNDING AND RESOURCES WHEN COMPARED TO URBAN AND SUBURBAN COUNTERPARTS.

AND SO AND THOSE CUTS CONTINUE TO HAPPEN.

AND IT STANDS TO REASON THAT FUNDERS WOULD LIKE TO SEE THEIR RESOURCES GO TO WHERE THEY CAN MAKE THE BIGGEST IMPACT AND THAT OFTEN WINDS UP BEING PLACES THAT ARE MORE POPULATION DENSE BECAUSE YOU CAN SERVE MORE PEOPLE BUT WHAT KINDS UP HAPPENING IS THAT PEOPLE IN THE RURAL COMMUNITIES WIND UP LOSING OUT AND LIKE YOU MENTIONED, THE DRASTIC INCREASE IN HOSPITAL CLOSURES THAT HAVE HAPPENED IN RURAL COMMUNITIES ACROSS THE COUNTRY, AND WE DO SEE MORE HEALTH PROFESSIONAL SHORTAGE AREAS IN RURAL COMMUNITIES ACROSS THE COUNTRY THAN ANYWHERE ELSE AS WELL.

>> I KNOW I'M A PSYCHOLOGIST AS SOME OF YOU MAY KNOW.

AND I KNOW WHEN COVID CAME, ACTUALLY THERE WAS ALMOST AN OVERNIGHT TRANSITION FROM NO TELEHEALTH TO EVERYTHING WAS TELEHEALTH.

SO IN A WAY, THERE HAS BEEN KIND OF A SILVER LINING.

AND I IMAGINE YOU FOLKS SEE THAT IN YOUR COMMUNITIES.

IS THAT RIGHT?

DO YOU SEE THAT MENTAL HEALTH ACCESS HAS INCREASED?

>> SURE.

SO OFTEN TIMES IN RURAL COMMUNITIES, THERE IS ONE PLACE TO GO FOR MENTAL HEALTH CARE.

IT'S USUALLY A COUNTY MENTAL HEALTH CLINIC.

PEOPLE CAN FEEL REALLY INTIMIDATED TO GO THERE BECAUSE IT IS THE ONLY PLACE AND-- >> EVERYBODY KNOWS IF YOU WALK IN THERE, THE STIGMA COMES IMMEDIATELY RIGHT ON YOU AND YOU DON'T WANT TO WALK IN THAT BUILDING BECAUSE PEOPLE WILL THINK... >> YOU DON'T WANT PEOPLE TO SEE YOUR CAR PARKED OUTSIDE.

SO WHEN PEOPLE WERE ABLE TO ACCESS MENTAL HEALTH SERVICES TELEPHONICALLY OR VIRTUALLY, IT CREATED A BIG CHANGE FOR PEOPLE.

IT REALLY ELIMINATED A LOT OF THE BARRIERS AND, YOU KNOW, MY COLLEAGUES IN MY REGION HAVE SAID THAT WHEN THEY OPENED UP THE PHONE LINES, THE NUMBERS OF PEOPLE WHO WERE REACHING OUT FOR MENTAL HEALTH CARE WHO NEVER HAD BEFORE, JUST BECAUSE THEY WERE ABLE TO PICK UP THE PHONE AND CALL AS OPPOSED TO GOING TO THE LOCATION FOR AN APPOINTMENT, REALLY CHANGED THINGS.

IT REALLY CHANGED THE CONVERSATION AROUND MENTAL HEALTH.

>> AND I THINK AWARENESS OF PEOPLE'S IMMEDIATE SURROUNDINGS ALL OF A SUDDEN WAS RECOGNIZED AS PLAYING A SIGNIFICANT FACTOR IN PEOPLE'S NOT JUST PHYSICAL HEALTHCARE BUT MENTAL HEALTH CARE AS WELL.

>> WE HAVE ABOUT TWO MINUTES LEFT.

IS THERE ANYTHING ANYBODY WANTS TO ADD BEFORE WE SAY GOODBYE FOR TODAY?

>> WELL, TO TOUCH ON THE DECLINING REIMBURSEMENT RATES.

ONE OF THE GOOD THINGS THAT'S HAPPENED IN REIMBURSEMENT RATES IS THAT PRIOR TO COVID, THERE WAS NOT EQUAL REIMBURSEMENT FOR TELEHEALTH AND THROUGH COVID AND THROUGH THE YEARS, NOW THE REIMBURSEMENT RATES ARE NEARLY EQUAL, IF NOT ALREADY.

AND SO WHAT I'M HOPING COMES NEXT IS EQUAL REIMBURSEMENT FOR SOME MOBILE OUTREACH SERVICES TO HELP BRIDGE THESE GAPS AND THESE DISPARITIES TO HEALTHCARE.

WE ALL KNOW THAT THE HEALTHCARE SYSTEM IS A BIT BROKEN AND SO WE HAVE TO COME UP WITH SOME NEW APPROACHES AND I THINK THE REIMBURSEMENT CATEGORIES REALLY NEED TO CATCH UP TO THAT.

WE ARE MOBILE SERVICES AND OUTREACH ARE ABSOLUTELY INTEGRAL TO KEEPING PEOPLE OUT OF HOSPITALS WHICH ARE MORE EXPENSIVE ANYWAY.

SO THERE IS A BIT OF INTRINSIC MOTIVATIONAL FACTOR TO UTILIZE MOBILE LABORATORIES AND MOBILE OUTREACH SERVICES ESPECIALLY IN THE RURAL COMMUNITY.

>> AND IT REALLY IS DRIVEN BY THE PAYMENT SYSTEM FOR THESE SORT OF THINGS.

OUR COMMUNITY PARAMEDICS ARE GLAD TO GO IN AND HELP PEOPLE-- >> WE ARE SO HAPPY TO GO, BUT THERE HAS TO BE THE PAYMENT SYSTEM FOR IT.

>> TO BE ABLE TO CARE FOR PATIENTS IN THEIR HOME RATHER THAN LOADING THEM UP AND TAKING THEM TO THE HOSPITAL EVERY TIME.

>> AND WHEN YOU HAVE A PROFESSION THAT IS SO USED TO SEEING-- USED TO ADVOCATING FOR PAWSHES AND BY LOOKING AROUND AND LOOKING AT THEIR HOME AND RELAYING TO THE DOCTOR, THE SOCIAL WORKER, HEY, WE PLIGHT HAVE A PROBLEM HERE, WE CAN GET THEM BETTER RESOURCES AND KEEP THEM HEALTHIER LONGER.

>> WELL PUT.

I THINK COVID ODDLY ENOUGH HAS RAISED AWARENESS ABOUT SOME OF THE ISSUES IN A WAY THAT WE WOULD NEVER HAVE ANTICIPATED AND THE OTHER THING TO ME IS HOW RAPIDLY WE CAN RESPOND TO THINGS WHEN THE NEED BE, RIGHT?

SO THERE WAS SUDDENLY THIS CATASTROPHE AND THE WHOLE WORLD WAS ABLE TO CHANGE, WHICH, TO ME, IS ONE OF THE SILVER LININGS OF THE COVID SITUATION SO ANYWAY, THAT'S ALL THE TIME WE HAVE.

I WANT TO THANK OUR GUESTS DR. FREDERICK J BLOOM: CHIEF POPULATION HEALTH OFFICER AT GUTHRIE HEALTH MARY MARUSCAK: DIRECTOR OF COMMUNITY HEALTH AT RURAL HEALTH NETWORK OF SOUTH CENTRAL NEW YORK, AND HEATHER DRAKE BIANCHI: CHIEF EXECUTIVE OFFICER OF DRAKOS CLINICAL LABORATORIES IF YOU'D LIKE TO SEE MORE OF OUR PROGRAM AND EXTRAS, VISIT OUR WEBSITE, WCNY.ORG/CYCLEOFHEALTH.

TO HEAR OUR NEW COMPANION COMMUNITY FM RADIO SHOW, CHECK UP FROM THE NECK UP, VISIT WCNY.ORG/COMMUNITYFM.

FOR CYCLE OF HEALTH, I'M PSYCHOLOGIST DR. RICH O'NEILL.

THANKS FOR CHECKING IN.

♪ ♪ NEXT WEEK ON "CYCLE OF HEALTH,".

>> TONIGHT'S TOPIC IS WASTE WATER SURVEILLANCE AND MAPPING.

IT MAY NOT COME TO MIND FOR MOST OF US WHEN WE THINK OF PUBLIC HEALTH, BUT COLLECTING AND ANALYZING WASTE WATER CAN DETECT TRENDS IN DISEASE IN COMMUNITIES ACROSS THE ENTIRE STATE.

TONIGHT WE ARE JOINED BY THREE EXPERTS IN THE FIELD WHO WILL HELP US UNDERSTAND HOW THIS ALL WORKS.