Ep. 1: Virtual care options help reach more rural patients

In this podcast episode, Brad Schipper shares vision for new virtual care initiative with host, Dr. Luis Garcia.

Brad Schipper and Dr. Luis Garcia in Sanford Health recording studio

Episode Transcript

Alan Helgeson (Host): Hello and welcome to the Reimagining Rural Health podcast series, brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country. From improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve. Today’s topic is on virtual care. Our guest is Brad Schipper, Sanford Health President of Virtual Care. Our moderator is Dr. Luis Garcia, President of Sanford Clinics.

Dr. Luis Garcia (Moderator): Well, Brad, how are you doing today? Great to have you here.

Brad Schipper (Guest): Well, thanks for inviting me. I’m doing well.

Dr. Luis Garcia: And thanks for joining us for this podcast. I’m excited to discuss this topic. And I, if it’s OK with you, I’ll just get to the meat of the questions. Brad, Sanford Health recently announced a $350 million virtual care initiative, and that included breaking ground of a virtual care center. So can you tell me a little bit about this virtual initiative and what does it mean for Sanford and, and why a building for a virtual initiative?

Brad Schipper: Yeah, you bet. Well, first of all, we’re so very fortunate for the generosity of Denny Sanford. And $350 million will absolutely help us reimagine how we deliver care for rural and underserved areas. And also areas in inner cities or more on reservations or everywhere. Frankly, the reason for the building is really multifaceted.

We need some sort of flagship command center to help drive all the activities that we do within virtual health care. And that doesn’t imply that all virtual care will only be done from this building. We’re doing it across our entire footprint. We’re doing it across the U.S. We’re doing it across internationally as well, as you’re aware. But the building helps to house a lot of the technological advancements in that backbone and infrastructure for the future of what we’ll be doing.

It also, importantly, houses our educational institute where we’ll train our future caregivers and our innovation center, where we’ll be able to vet out some of the new technologies. So no surprise to you as a practicing provider yourself, some of this still has to be done in person face-to-face. So we’ll have physicians and clinicians going there in person to provide care. Some will do it from their home, but we still do need that building for the backbone and for the education, the infrastructure. And, and frankly, we’ve been very successful in most of our markets that we’re out of space. So we do need additional space for that reason as well.

Dr. Luis Garcia: Yeah, thank you for that. I, I think for that clarification, Brad, and I think you used the word reimagine. How do we do this? And clearly these are not new activities for our clinicians and for our patients. We have been using some of these technologies in Sanford for, for quite a bit of time. But what do you feel are the greatest opportunities with this new reimagining or this new injection of resources to these strategies?

Brad Schipper: Well, there are multiple opportunities, but I do appreciate you pointing out the fact that we’ve been in virtual health care for a long time. We’ve already saved patients 20 million miles of travel, and we’ve had dedicated clinicians and physicians and administration folks, and information technology professionals that have just been extraordinary in doing this work. So first I want to point out that we’ve done incredible work, and it isn’t that we’re just starting.

There’s been people that have been very dedicated to this, the teams of individuals and what we really owe the ability to do this initiative to is those folks who have been doing all this work because they have proven that we have what it takes to be able to really transform health care as it relates to the greatest opportunities.

There are so many – a couple I’d point out is in the inpatient world, for example, if you’re in a small outlying facility and you have a stroke and you need to connect with some additional specialists, you’re able to do that virtually so that if you are a provider in one of those areas, or if you are a patient, going to those ERs distance is still a factor, but it’s a lot less of a factor because you’re connecting virtually with specialists that can help some of your treatment in your care.

If you can stay locally, where 40-some percent of our transfers do stay locally now because of virtual care, which is pretty great for the community and for the person and the care providers and the families. And if you do have to be transferred, then we have a better line of sight to what’s going on and what you need for care when you get to the new facility.

On the outpatient setting, there’s numerous examples, whether it be respiratory therapists out of Aberdeen helping the entire health system, or if it’s Dr. Jim Wallace and his team that’s helping with pediatric asthma around the whole enterprise. Fargo has people that are helping right now with gastroenterology. We have people in Bismarck which are helping with nephrology. So we have providers across our entire footprint that are providing services and allowing a patient to stay at home or to not have to take off work or to travel so many distances.

Or imagine if you’re a nursing home resident and you’re getting bundled up in the cold weather and a nursing home van to go see a physician, you can do that now virtually, and we make sure that it’s the right care at the right place at the right time. So there’s just so many opportunities now and, and it’s endless as it relates to the future. I think we’re just touching on things that can be done as it relates to the technology and the care processes that we have.

Dr. Luis Garcia: Brad, first of all, thank you for giving credit to those that have been pioneers in the use of these technologies. And, and just like the examples that you outlined, I mean, I heard about an example where a lady had to drive three hours for a routine prenatal care, and I think what we don’t take into account is what does it mean for a mother of two or three to have to pay day care and pay for gas and lose a whole day and not go to work just for a prenatal visit. You know, that can be done virtually. So I think those are some of those little things that sometimes we lose sight of.

But you know, to that point, these things have made Sanford the most-trusted health care system in our regions, in all the region regions that we served, said by our populations, by our communities, and a lot of that trust comes from the relationships between patients and physicians or clinicians, nurses, caregivers. Some believe that that relationship cannot be developed unless you are in a face to face or an in-person setting. What will it mean for our patients to have these options and still be able to develop these relationships?

Brad Schipper: Well, that’s the key, right? There’s nothing more sacred than somebody who entrusts their most important asset, which is their health or their life, or the life or the health of a loved one with us. So the key thing that we’re trying to do with virtual health care is making sure that we keep that important bond between the patient and the caregiver.

And that’s through education of how the technology works, through research to make sure that what we’re doing is safe and it’s effective. Because ultimately, as you know, what caregivers want to do is they want to satisfy a need. They want to try to heal and provide comfort and help for an individual. And what an individual wants is they want to be able to trust in that recommended plan of care or an ability to try to get to a state of health of whatever that may be.

So we do work with all of our providers, we work with our patients, and we try to educate on both sides what makes sense. Some things will not make sense for virtual care, but many things will. And there are multiple ways that we can build relationships like we used to do face to face via the use of our technology. But the one thing we’re not gonna take away is the personal nature of that interaction. We need to make sure that that’s still front and center for what we’re trying to accomplish.

Dr. Luis Garcia: Yeah, I appreciate that. And, and I think you highlight the importance that it, that this has for patients, but also for our clinicians, right? And the importance of that relationship. So what do you think this means for our physicians, nurses, and what kind of satisfaction does interacting with patients in this way brings to them?

Brad Schipper: Yeah. What we hope it means, and what we’re hearing that it does mean is it allows our providers of the care the same benefits, frankly, as the consumers of the care. Meaning it’s not overly efficient and it can be cumbersome and challenging for a provider to be on the road for three to four hours to see some patients or to be away from their family or to experience some burnout from the challenges of our geography.

So hopefully through the use of some of our intelligence built into some of our platforms that we have here and our technologies, it allows them to work smarter and not harder. It allows them to maybe stay off the road so that rather than driving in a car three to four to five hours or in a plane, they have an opportunity to do some other work or to see additional patients that are in need.

So we’re really trying to set this up in a way that can benefit our caregivers, just like it benefits those who receive our care. And those are just a couple of the examples of where this can really help for that type of care.

Dr. Luis Garcia: Thank you once again for recognizing that, Brad, because I think that it’s very clear that we’re clinicians continuing to be fully committed to our patients, and at times our own clinicians are also driving or transporting themselves long distances to provide that care. And this would certainly be an accommodating factor for them. So thanks, thanks for recognizing and pointing that out.

Brad Schipper: The other thing I’d point out, like I had done earlier, and like you’ve, so, like you’ve pointed out, is the providers have done so much as well. So I would hate for anybody to misinterpret to think, Wow, now we’re gonna try to be really convenient and patient-centric. We have been convenient, we have been patient-centric, but we’re trying to do it different, right?

We’re reimagining that, but there’s nothing more patient-centric than a provider who works a long day, gets in a plane, works even a longer day, drives in a car, gets back, does their charts, tries to have a professional and a personal life at the same time. So, you know, I would hate for anybody to lose sight of that. We use words like we want to be more patient centric, or resident centric, and by no means would I ever want somebody to misinterpret that people haven’t done what’s right. It’s just a way to do that maybe a little bit differently.

Dr. Luis Garcia: I appreciate that thought, Brad. You know, Brad, if we look at some statistics, national statistics we know that about 20% of Americans live in rural areas and pretty much all our footprint is rural by definition, but yet fewer than 10% of physicians practice in rural communities. So how do you feel that these virtual strategies and this virtual care center will support our own strategy to develop our own? You know, we rely a lot on developing our own workforce and our own physicians to satisfy that shortage and that need. So how do you feel this center will support that educational piece?

Brad Schipper: No different than in our personal lives, right? We want a sense of community, we want a sense of belonging, we want support. What I think the virtual initiative can help do for our caregivers and our physicians and other providers, is they don’t have to feel like they’re on an island of one anymore. They’re connected to a huge network of other caregivers and providers within our footprint in a real time way and in a meaningful way.

It can get very lonely if you’re a subspecialty of one or a family medicine physician, for example, of one or a nurse practitioner of one. This can take away some of that feeling. But, as importantly, it can provide some of that depth and breadth that can help them to feel comfortable and to be able to go to a site where they can have partners maybe a little bit differently, maybe their virtual partners, but it’s different than it was even five, 10 years ago when how that may feel.

So I think that can help us to recruit to some of these areas. I think by investing in the education and training to make people comfortable with the technology and to help our people and allow them to innovate some of this new technology and software and hardware and wearables and everything else, I think it’s super exciting for people to be part of something so different and so special. I know it was for me, that’s why I came back. Really, this is a once in a lifetime, a once in a career opportunity to really do something differently.

And I think that’s why we had such a successful summit, to be honest. We had people that came here that it wasn’t just out of self-interest, our self-promotion, it was truly because they saw that we have the potential to do something very different.

Dr. Luis Garcia: You know, Brad, you talk about moments of loneliness and moments of uncertainty, and I think the pandemic in the last couple of years brought enough of those moments to all of us, and it was just fascinating to see to the point that you’re making how our clinicians market to market or location to location collaborated virtually to really define the treatment of a disease that we had very little knowledge about. And, we all became students and teachers and researchers in a heartbeat. And the use of technology certainly facilitated all of that. So the pandemic accelerated a lot of this and the conversations have been elevated. How is Sanford right now training our existing providers to interact more with our patients virtually?

Brad Schipper: Sure. We’re doing that today as it relates to some of our medical residencies, our fellowships, or working with our medical schools and our universities. So, that’s occurring today as it relates to the things we’re doing in the future. That’s what we’re going to do a lot more of with the virtual care center.

And it can be done virtually as well as in that center, but we will be training the future generations on, on how to utilize our technology and the best practices of that so that people are comfortable, you know, we call it website manner, and it seems intuitive, but it’s not always intuitive.

How you experience that care on the other end of the video is different than face to face. So how you’re talking to somebody, if you’re multitasking, how you’re using the monitors, et cetera, are important to that, that sacred relationship that we can have. So that’s things we continue to work on, and it’s what we learned through the pandemic that, you know, you have some, some lessons learned and, and we did an extraordinarily good job, and most things were, were a great success. The silver lining was, it really pushed forward virtual health care. But one thing we did learn is you can’t just assume everybody’s comfortable using all this technology, whether they’re receiving the care or providing the care.

Dr. Luis Garcia: So to that point, you know, I mean, I talk to my 14 year old about technology and they embrace it like that, right? <Laugh> But you get an old fart like me <laugh>, and … they say, eh, I don’t know if I believe what you’re saying. So, you know, what do you tell those providers, clinicians, nurses who are hesitant about this virtual care?

Brad Schipper: Yeah, so I think the main thing, and it’s not a sell and it’s not a tell, the main thing is we are going to research and make sure that we are driven by outcomes of what’s best for the patient or the resident. And when that happens, people buy in really fast.

This isn’t about a quick return on investment or this isn’t about the new gimmick or the flashy thing. This is truly about impacting the lives of the people that we serve. And when you do that, people get a lot of buy in and they understand. And then when you parlay that with innovation and with education and with data and research it just makes it a lot easier. And, the reality of it is, although like you, my two daughters are much more advanced in the comfort level with all the new technologies, our market research is suggesting that people, regardless of age group, are starting to embrace technology in ways different than they ever did, somewhat facilitated by the pandemic.

And my bad joke I used just today in a meeting frankly, was normally I want to know the confidence intervals and what’s the margin of error. But the reality of it is, I had a sample size one, and it’s my father, he now has a smartphone and he asked about virtual care. So the world has changed.

Dr. Luis Garcia: <Laugh>. That’s, I agree with you. I communicate with my 82-year-old mother through WhatsApp. So that’s really cool. We talk a little bit about the processes and about the strategy, but let’s talk a little bit about the structure of this virtual care initiative and clinics. I heard that that we’re gonna have a concept of satellite clinics in, in very rural areas to provide care using virtual technology. Can you speak a little bit about what’s the purpose of that?

Brad Schipper: Yeah, this is super exciting. We’re trying to figure out is there a way to provide care in a community that otherwise does not have it, or a community that may lose it? We have a lot of interest in that.

So we’re trying to look around our entire footprint to see if there are places without a hospital, without a clinic, without a lab, without a pharmacy that somebody now has to travel for care. And if there is, are we able to provide a clinic staffed with maybe an RN or a nurse practitioner that can do some lab work in the clinic, some imaging work, maybe some pharmacy work, and connect virtually with multiple care providers to try to keep that care as close to home as possible?

So supplementing maybe just off your smartphone, this is yet another way to keep that care close. So we’re actively right now working with certain communities and economic development areas and other things to see where we could pilot these to see what ultimately may make sense.

And, we have right now interest across our entire footprint. I don’t have anything to share today of where the first one may or may not be, but we are excited about this concept to see what that means, what it looks like and what it could ultimately look like down the road.

But just imagine again, if you’re a person in a small community, there’s no health care, you work late, you can’t access anything. Maybe you do it via your smartphone. Maybe now you can go to one of these virtual clinics and you don’t have to take a couple days off work and drive into the city. And I think we underestimate, right, the stress of even just driving into some of our bigger cities if you’re not used to that from some of our rural environments. So that’s what we’re trying to work on and ultimately help the outcomes of the folks in those communities, because sometimes they do at a greater rate, bypass some of the preventative screenings and services because it’s just not convenient for ’em.

So maybe there’s an opportunity to do some of that as well. And, and we’re excited about trying to pilot some of these concepts and we just haven’t quite identified where it’s going to be yet. But, it’s gonna be fun. We got the right system to do it. We’re a provider with physicians. We have bricks and mortar of hospitals, clinics and nursing homes. We have a health plan that provides insurance. We have a research arm that looks at how we’re doing. And I think partnering all that integrated system, the integrated system pieces we have with, with some of these satellite clinics could truly prove to be revolutionary in what happens in some of our underserved areas down the road.

Dr. Luis Garcia: You know, and I appreciate the thoughtful concept of those satellite clinics, but, you know, Brad, I hear that as of 2021, an estimated 135,000 people, it’s equivalent to one in six South Dakotans, for example, and similar, you know, similar ratio in North Dakota, do not have adequate broadband access. So how do you navigate those challenges when you’re trying to bring services, much needed services to very rural communities, but there are external factors that do not depend specifically on Sanford?

Brad Schipper: Yeah, it, it is absolutely a challenge, and that’s why we’re trying to look at some public and private partnerships to be able to bring some of those solutions to those communities. We do believe as we invest in those communities, it will spur other investments in those communities, which can help with broadband. But without a public private partnership and, and working with multiple stakeholders, it will be difficult. At worst case, maybe we can put it in one of these satellite clinics, for example, that has greater connectivity than otherwise people would have within their homes. But ultimately we want to try to deliver it so that they have the, the connectivity that, that we, we all appreciate in more urban areas.

Dr. Luis Garcia: That makes sense. And I think that it’s also a reflection of what Sanford has been historically, right? It’s about relationships, it’s about partnerships and the tide rises for everybody. So I appreciate that comment.

You talk a little bit about your relationship with research, with our health plan, with innovation, and it is my understanding that the virtual care center will also house some research on innovation projects. Can you talk to me a little bit about that?

Brad Schipper: Our vision for the innovation center is really a place where people can think about what needs to be done. They can create what needs to be done, they can pilot and test in a safe environment. Does that ultimately achieve what we are trying to accomplish?

So we have those spaces within this facility that are designed. In addition to that, we will have different vendors or different startups that can have space within the facility to try to come in and try to provide solutions for what we’re struggling to accomplish. And some of these startups, as you know, may be in their garage, so they really don’t have space. Other ones don’t need the space, but, but we’re truly trying to have a space where we can look at software, hardware, and other technological advancements to make sure that we can do absolutely what’s the most convenient and world class for all of our patients.

So that’s part of this. And then it’s partnered with our education center and it’s partnered with our care delivery side. And that’s really the differentiator here. There’s a lot of people getting into this space, but very few are as intentional as we are with combining innovation and research with our education and with our care delivery and doing it as broadly as we are from birth to death. We’re not just gonna pick out one specialty or our one item. We’re trying to do it across all of our service lines and all of our age groups. And it does help that we can do that one because of, we’re an integrated health system and two because of Denny’s generosity, but we’re gonna do it anyway cuz it’s the right thing to do, and we’re gonna be here for life. We’re not gonna jump into this and jump out of this. This is what we do.

Dr. Luis Garcia: Yeah. I appreciate your thoughts very much. Brad and I tell you that, that reflects a lot of the nature of Sanford too. Sanford has been my only employer. And sometimes somebody asks me, How, how would you define Sanford? And I just say, We just hate this status quo, <laugh>, we just don’t like it. Correct. You know, and I think that that defines part of our nature.

And tapping a little bit on that, you know, even though we’re talking about these virtual initiatives, we have done more than 600,000 virtual care consults and visits over the last few years. And as innovators and as leaders in an industry, you know, there’s things that go bad and there’s things that go well. Can you share with us some of those things that have been learning opportunities for us where something just didn’t go as well as we expected, or that we could have done it differently?

Brad Schipper: Sure. I think one of the bigger learnings, and it’s part of having the educational institute in such a laser focus on that is, is we probably at times have underestimated the amount of ramp up or training or education it takes to provide some of these services virtually, whether it be for the patient to try to access these services or whether it be for the care providers to deliver these services. So I can’t say that there’s any one service that we went, Wow, we really shouldn’t have done that. But there were some services where I think if we just spent a little more time on the front end, and had the luxury of that, now the pandemic didn’t afford us all that luxury as we know. But everything we provided, fortunately, we feel was safe and effective, but we think we could even make it a better experience for the consumer of the service or the provider of the service with additional education.

The other thing that gets a little tricky in this, and one of the things that we learned is that, you know, payers and others, insurers treat virtual differently. And it’s really kind of tricky to figure out, well, who’s gonna cover this? Well, only if it’s in your home. Nope. Only if it’s in the clinic. Nope. Only if it’s for this level of service. Only if you’re this age. And those things get really, really kind of complicated to figure out. So we’re doing a lot of advocacy there with data and research to see what makes sense.

And again, we’re really fortunate that we have a health plan, so we sit side by side with a health insurer, us, that we can talk and say what makes sense. And ultimately what we’re going to do is what makes sense. This is, again, not gonna just be driven on all those payer provider discussions that I just said, but we’ll need to be cognizant of them so that we’re aware of how that all works. But if it makes sense at Sanford, we have a history of just doing it.

Dr. Luis Garcia: That speaks loudly about the commitment that we have with our communities, right? And the purpose of our mission where we’re gonna give you or provide care to you, and we’ll just figure out how do we get reimbursed or all those collaterals. So I think that speaks loudly about our commitment.

What does success look like for this center Brad? And this is gonna be my last question, I promise you.

Brad Schipper: <laugh> All right. I think a lot of people would say success is that we open the building on time and we get that built. And a lot of people would say, we maybe have an advancement in a technology that nobody has. And a lot of people may say that, you know, we have great patient or resident satisfaction, or we help some of our recruitment. Those are all incredible measures of success that we would want to celebrate and recognize. For me, it’s more simplistic than that. Did we ultimately improve the health and well-being in the human condition of those that we’re interacting with? We have an amazing privilege and amazing obligation and a challenge to care for those who are in need. So ultimately, if that doesn’t change or we don’t move the needle on that, I will not say that we have been successful in this arena despite the other things.

It’s the ultimate way that we’ll know if we’re successful, but we’re gonna have micro successes along the way. But I think you and I would both agree that those are exciting to celebrate, but if we can really improve the human condition, that’s a game changer.

Dr. Luis Garcia: That’s well said, Brad, and I said it was gonna be my last question, but I lied. This is my last question, <laugh>. OK. You’re a very accomplished professional. You’ve seen a lot of things in your life. What excites you personally about this opportunity?

Brad Schipper: Well, personally, I think it’s rare that you can have an opportunity to have such a global impact on health care that we have. And personally, I believe in it. Professionally, I believe in it. Health care is ripe for change and we need to change. And I just couldn’t be more excited to help be part of a team that has done so much work already and will do so much more work and have the opportunity to, to truly shape health care. And I, I, I just can’t overstate that enough. I mean, that gets me up and gets me excited every single morning that, like I said earlier, I do believe it’s a once in a lifetime and a once in a career opportunity. And I’m just fired up for it. It’s incredible.

Dr. Luis Garcia: I agree with you, Brad, and thank you. It is incredible. And let me just offer, if you allow me my gratitude to the leaders in Sanford that had this vision, and certainly to have the vision to include you in this project because you are the right person for that. So thank you, thank you for joining us on that journey.

My deep gratitude to our benefactors specifically Denny Sanford, who is making this possible, my most sincere gratitude to our clinicians. We have been talking about the tremendous amount of work that they execute every day. And this is just one more way in which they will satisfy that commitment.

And certainly the deepest of the gratitudes to our patients for considering us the most trusted system and continue to come back to us in their times of greatest need. And you’ve said it, you said it, it is a privilege, but at the same time, it’s an obligation and we love the privilege and we embrace that obligation. And this is just one more example in which Sanford will succeed. So thank you very much for joining me today.

Brad Schipper: Thank you so much for your time your kind words and your questions.

Alan Helgeson (Host): You’ve been listening to Reimagining Rural Health, a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson, and thank you for listening.

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