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Science by the Slice
Science by the Slice
Rural Community Health Science, Policy, and the Future: Episode 2
The 2024 State of the Science Meeting from the Southeastern Coastal Center for Agricultural Health and Safety brought together several researchers and Extension professionals working at the intersection of agricultural health and safety research, policy, and outreach communication. In this episode, two speakers from the meeting reconvene to share a conversation about innovative rural health initiatives. Dr. Holly Cost, assistant vice president for University Outreach and Public Service at Auburn University, and Dr. Mark Holmes, director of the University of North Carolina at Chapel Hill’s Cecil G. Sheps Center for Health Services Research, explore the challenges and disparities in healthcare access between urban and rural communities, touching on issues like hospital closures, limited specialty services, and the importance of local leadership. They emphasize the need for tailored healthcare solutions to address the unique needs of rural populations.
Holmes/Cost: Rural Health
Initiatives
Phillip Stokes: [00:00:00] Hello everyone and welcome to Science by the Slice.
My name is Philip Stokes, Education Coordinator with the UF IFAS Center for
Public Issues Education in Agriculture and Natural Resources. And for today's
episode, we are bringing an episode in conjunction with the Southeastern
Coastal Center for Agricultural Health and Safety, one of our partner centers.
And we're really going to be talking about rural health initiatives. And, um,
specifically we're speaking with some experts that were, that attended and spoke
at our state of the science meeting earlier this spring, uh, Dr. Mark Holmes and
Dr. Holly cost. And I'll give them a chance to introduce themselves in just a
second.
Phillip Stokes: Um, but we wanted to, we had some really great conversations
at that meeting and we wanted to follow up in a podcast format to share some of
their work and really just some of the movement. Um, That we're seeing
between, uh, urban audiences and rural audiences and some of the healthcare
needs [00:01:00] and differences there.
Phillip Stokes: So, uh, at this point, I just want to let our guests introduce
themselves, tell us a little bit about who they are and where they're from, and
then we'll, we'll kick off a conversation. So, um, Dr. Holly cost, do you want to
just quickly introduce yourself?
Holly Cost: Yes. Thank you so much. I'm Holly cost. I'm the assistant vice
president for university outreach and public service at Auburn university. And I
lead our rural health initiative here on campus, very committed to health in my
previous life. I was the mayor of a city in small town, Alabama, and that's where
my passion really for healthy initiatives and healthy lifestyles.
Phillip Stokes: Great. Thank you so much. And Dr. Mark Holmes.
Mark Holmes: Hi, Philip. Thanks. Um, I'm Mark Holmes. I'm a faculty
member at the UNC Gillings School of Global Public Health, and I direct the
Cecil G. Shep Center for Health Services Research, both at the University of
North Carolina, uh, where I lead a, um, rural health research center. This is
funded by the Health Resources and Service Administration to conduct
[00:02:00] policy relevant research.Mark Holmes: Like Holly, I have a passion for rural health. I grew up in the
thumb of rural Michigan, uh, de tasseled corn growing up and have been
committed to rural health ever since.
Phillip Stokes: Great, great. Thank you so much. And my co host for today's
episode is Dr. Lisa Lundy, uh, from the University of Florida. We work together
in the Southeastern Coastal Center for Ag Health and Safety. So I'm going to let
her introduce herself and then kick things off.
Lisa Lundy: Okay, um, like Philip said, I'm Lisa Lundy. I'm a professor in the
Department of Agricultural Education and Communication here at Florida, and
I'm excited, just excited about this conversation today when we have the state of
the science meeting, I thoroughly enjoyed hearing from both of you, and I know
that our listeners are going to enjoy hearing what you have to say about rural
health care.
Lisa Lundy: So. We're gonna kick it off with a question really for both of you.
Um, and thinking about rural health care and local health care. How do you,
how do you define that? What [00:03:00] does that mean to you? Um, when you
think about local health care and how you talk about it with your stakeholders?
Um, and Holly, I'll, I'll let you kick us off and then we can kind of go back and
forth a little bit.
Holly Cost: Okay. Thanks so much for this question. Um, I grew up in
Alabama. I've always lived in Alabama. It's a two year stint in Texas. But when
I think about local health, I really think about my neighbors. I think about the
people across our community who really need the health and the support and the
access. Alabama, There are so many who are disenfranchised for a number of
different reasons.
Holly Cost: A lot of it is distance from health care. We have hospitals that are
closing down all over our state right now. Very challenging for someone to go
and give birth in a hospital right now if they live in a rural area. So we really
drilled down into these small communities. In fact, in one of our communities,
the population where we have our health initiative is 75.
Holly Cost: That's the population. Now, the broader population is bigger than
that, about 70, 000. 10, 000, but we look at where the needs are, and we also
look at where [00:04:00] the access, um, lacks in order to concentrate our
efforts and just really getting to know the people in the community. That's what
I've enjoyed the most about this and identifying.Mark Holmes: What I really liked about Holly's answer is the notion of being
tailored to the specifics of that particular community. As a policy researcher, we
often have to define a community and we'll pick counties or something like that.
But people travel across county boundaries all the time, or maybe a county is
large enough to in the South counties tend to be smaller.
Mark Holmes: But if you're in the West, you got this huge county and that's
too big to be local. So when you say local, Lisa, I think about, you know, Um,
something that's tailored to how the people in that community define it. Um,
and think about the assets there and how their, um, what works for that. And for
some places that might mean 50 miles, for some it might mean 12 miles. Uh,
depends on whether you're in, surrounded by snow covered mountains or in the
eastern coastal plain. Um, so it is going to [00:05:00] vary tremendously based
on the circumstance of the community and the particular healthcare you're
looking for. Local for primary care is going to be a lot different from local for
maternity care, for example.
Lisa Lundy: Yeah, and I think that just to follow up on that question, High
points or big ticket items in terms of health care needs. What are both of you
seeing, um, at the, at the local health care need level in terms of like how you
mentioned, um, you know, being able to deliver a child prenatal care. What are
some of the other, you know, primary health care needs that you're seeing?
Holly Cost: Yeah, well, we're seeing particularly across Alabama as we have
very high rates of diabetes and obesity in particular, so we're looking at those
areas, cardiovascular health, we have a high incidence of individuals who have
strokes, and so we're really trying to drill down into those areas and identify
how can we meet the needs of these individuals, not just through the care, but
also through the health and wellness [00:06:00] education.
Mark Holmes: Seeing generally an erosion of specialty services, particularly
those based in hospitals, but that. So it's everything from the well documented
maternity care deserts that have developing services are getting harder to access
oncology services, but also long term care facilities and your nursing homes and
even pharmacies are tending to disappear from rural America.
Mark Holmes: And if we want to address these. Uh, one great strategy is to
think about training people that are, you know, rural aware, um, and by that I
mean, um, we know that, uh, physicians who have a rural upbringing and are
trained in rural communities are far more likely to stay and practice in rural
communities and, and addressing that gap of, of the services erosion, uh, we, we
have some proven policy, uh, approaches that can be taken.Phillip Stokes: You know, you both touched on something, uh, the fact that it
seems like in [00:07:00] healthcare, our professionals, I mean, they work so
hard, but they get trained. kind of in a one size fits all approach, right? And you
just mentioned that, Mark, uh, that, that if, if they're raised in a rural
community, they, they have that perspective and they know what some of the
needs are.
Phillip Stokes: And what we talk about a lot in our center is a
Phillip Stokes: of migrant workers. And so, I mean, that's just a you know,
people coming from, uh, You know, different countries and working different,
you know, language barriers and other types of barriers, their economic barriers.
And so, I mean, what, what are some of those, um, what are you seeing
between, you know, the health care that is currently being provided and some of
the needs in these rural communities?
Phillip Stokes: I'll start with you, Mark.
Mark Holmes: Yeah, um, I think as uh, as distance gets farther and farther, uh,
as services are disappearing, um, we have this promise of telehealth, which we
saw really kind of help a lot [00:08:00] during Um, but, um, It's only so useful if
you don't have reliable broadband. Um, and, you know, for example, one
solution that's often given for the dearth of mental health professionals in rural
areas as well, we can do telepsych. But if you're Um, if your best broadband or
the only reliable broadband in the, in the community, um, is to, is in the parking
lot of the local library. That's not really the kind of privacy that most of us want
for something like that. And so we have this often this gap between what the
needs are and the solutions that, you know, may work in urban settings, but
don't always translate to rural. Um, there's this history generally of. Trying to
solve rural health care, um, gaps or challenges by taking urban and tailoring that
a little bit. And rural is not small urban. It's often a completely different, uh,
[00:09:00] approach that needs to be taken by people who understand their
community and, and, uh, understand what local means.
Holly Cost: Oh, man, you totally set me up, Mark. This is good. Um, because,
uh, what our model is centered around at Auburn University is this telehealth
model. And so we've identified these telehealth. There's the opportunity and to
increase access. We can use telehealth. But just like Mark said, you go into so
many of these homes, they don't, they either don't have good Internet service.
Holly Cost: They can't necessarily afford the Internet. Or they have this
resistance to using anything electronic. And so one of the models that we'relooking at is that we have this, um, this telehealth technology called on med, it's
a standalone telehealth station that we're able to install in areas where there are
these gaps in services.
Holly Cost: And so, Catherine, Alabama, with a population of 75, it's in the
shock community center, and that shock community centers where they do the
feeding programs. It's where they vote, it's where they do after school
programming for kids. from time to time. Um, in Chambers County, [00:10:00]
it's in a building that's in Alabama, rural Alabama, East Alabama.
Holly Cost: It's in a building that's a vacated health clinic, but it's right beside
the Department of Human Resources in a grocery store. So it's in a location
where people can go. But even still, they may not want to go because they get,
they get nervous about using telehealth. And so what we do is we do multiple
demonstrations in that area.
Holly Cost: We want to make sure that people come in and they feel
comfortable. So I've actually driven a van load full of people from a church to
the telehealth station and to have them go in and press the button and talk to
clinicians. And that really increases their comfort level there. Plus, we've also
identified that the gaps in, uh, the gaps in internet services, they still apply to us.
Holly Cost: So, in this building in Catherine, Alabama, we thought, great, we
have internet service. We go there, it's not strong enough. There's an AT& T
tower right beside us. It's not strong enough. we partnered with the university of
West Alabama. They have this grant for Starlink internet. And so now at two of
our sites, we're using Starlink [00:11:00] and it is killer.
Holly Cost: I mean, the bandwidth is fantastic. We have no problems with that.
So we're able to overcome some of the challenges, but then there's still the
transportation barrier. Even if it's right down the road, how does some people
get there, particularly if you're sick. And a lot of times it's neighbor helping
neighbor, but we're creating a network of community health ambassadors.
Holly Cost: So people can go out and then they can help their neighbors to get
to these places and they're committed to do it and committed to this healthy
lifestyle. So we have a lot of different facets of what we're doing. Um, we
definitely haven't mastered it yet. We're constantly learning from others. I really
appreciate Mark and that, um, just the comments he's making and I'm learning
from him even on this podcast.
Holly Cost: So thank you.Mark Holmes: And what I really like about the model that Holly's describing
is, It recognizes that, um, you know, my, my, um, I have family who lives
outside of rural town in rural Michigan, and they could barely get their audio to
work. And there's no way they could support video. [00:12:00] Um, and so
there's some more centralized location where you can really, you know, boost
up that bandwidth to get the connection, but it's not terribly.
Mark Holmes: You know, you're going in the town anyway for groceries and
whatnot. what's really attractive about this model is it's surrounded by other
supports. And so when you're hanging up, you're not by yourself in your family
room or. You know, in the, in the quiet room in the library kind of thing, you
walk out and there's a community health, uh, ambassador or worker right there
to say, okay, what'd you hear?
Mark Holmes: I said, well, they said this and I don't know what that means.
And they said that, you know, I need to cut back on this, but you know, we got
the fair this weekend and I really want to go and say, well, what if you
substitute this for that? All that kind of stuff that really helps translate, um, um,
that, that information. There's a similar model or, um, another telehealth model,
uh, that I'm really excited about in southern Georgia, where, uh, it's addressing
the maternity care desert and same idea, uh, taking high risk, uh, you know, uh,
pregnant people, connecting them with a maternal and fetal medicine [00:13:00]
provider, but putting them in local health departments.
Mark Holmes: So they hang up with the physician and then they walk out and
the nurses, all right, I've got your notes already. Let's follow up. What did you
hear about your blood pressure and what do you have to do so you have that
immediate reinforcement rather than hanging up and going on with your day. So
I think that's a really exciting development that Holly's model is doing as well
as others across the country that I think really has some promising potential.
Lisa Lundy: Yeah, I was going to ask. I'm so glad you said that because I was
going to ask, um, in terms of follow up or what comes after. That, um, know,
your, your turn with on med is, um, what sort of, do people come away from
that with a handout or sort of a next steps cared, you know, of some sort?
Because I'm thinking about a lot of our, Agricultural workers that we
communicate with, with our center, if there are things that would help them in
communicating to their supervisors, [00:14:00] you know, individualized risks
and needs that they may have for their health.
Holly Cost: Thanks. That's a really good question. Um, so what happens in our
center is we're pretty resource rich. For one thing, we're right next to theDepartment of Public Health. And so we have, uh, or to the Department of
Human Resources. So we have a lot of resources there as far as health and
handouts that folks can have access to as soon as they walk out of that station.
Holly Cost: But what we also have. Is from on men. They provide us with a
monthly report. They don't provide us with individual patient information
because that's protected and it's private, but they provide us with this
information so that we can then host these different community conversations
and we can host different workshops surrounding the particular health needs
that we see an example, we have nutrition needs.
Holly Cost: So we have different workshops there. To promote healthy living,
healthy eating. We also have extension that's closely aligned with us. Um, they,
they helped to manage these locations and they end up bringing in healthy foods
and we have recipe [00:15:00] cards that teach people how to give them
different ideas of how to, how to cook some of these foods they may not be
familiar with.
Holly Cost: other thing that I think has been really impactful is if we have
somebody with a lot of needs. Um, that come out of that telehealth station, they,
because of the state law in Alabama, they can only go into telehealth four times
for the same condition before they have to see somebody face to face. So now
we have these IPE clinics.
Holly Cost: It's interprofessional education. And so then we'll have a number of
different professionals that will meet with them for primary care. Um, and then
we have some folks in there from pharmacy. We'll have people in there from,
From, um, physical therapy, also speech and hearing, also nutrition, dietetics,
and that we schedule those appointments.
Holly Cost: And so I think the last time we had one of these clinics, we had 30
people signed up, but then they're not just meeting with one primary care
provider. They're meeting with a whole team that they're to support them. And it
seems a little intimidating at first, but we're. We have these relationships form
and these [00:16:00] relationships developed.
Holly Cost: And I think what you said about the folks who may be non English
speaking, we have great relationships in the communities. Also going out to, for
example, the folks at the Mexican restaurant, they are some of our best
customers best patients that they're also sharing the information with the people
that come in, letting them know this is a safe space to go.Holly Cost: And as far as the barrier for, um, paying, uh, for the funding needs,
we, we don't charge anything for folks to come in and use the services in the
telehealth station. That's all sponsored, but then for the IPE clinics, there may be
a sliding scale fee for some of the services if they're connecting with primary
care.
Lisa Lundy: I think back to something that Mark said at the beginning of our
conversation about students that are rural aware. Um, has there been any, um,
Has there been any incorporation of this into medical training? I'm thinking
especially of maybe medical students that are training for, you know, internal
medicine, [00:17:00] primary care that this would be a really amazing
opportunity to interact with patients and, and, and, you know, do some
rounding, so to speak.
Holly Cost: Now Auburn University, we don't have a medical school here, but
we are affiliated and closely associated with a college of osteopathic medicines
called BCOM. And so those students do come over regularly for oral medicine.
For training, so they are able to get out there and do the training in the
community and they're part of these at the clinics as well.
Phillip Stokes: So, Mark, I did want to ask you a question because I know a lot
of your research, um, goes back to some of the disparities and outcomes and
health outcomes. And maybe we I'm taking kind of a step back. Um, but I was
just wondering if you could share, um, about what some of these are, maybe
provide some examples about, um, Um, Um, you know, you know, we've been
talking about all this great development and addressing some of these needs,
which is fantastic.
Phillip Stokes: Um, and, and Holly, you've, [00:18:00] uh, the work that you're
doing there is just phenomenal. But like, what are some of these disparities and
what are some of these differences in outcomes that we're seeing among
patients? yeah,
Mark Holmes: um, that question is a very depressing one because if you have
100 different outcomes, probably about 95 of them, uh, rural populations, um,
have lower outcomes, worse performance, higher risk picket. Um, it's rare that
there's, um, many places where many areas where rural populations, um. Are
having better outcomes. Um, and that sort of outlines the challenge. Um, and it's
multifaceted and the causes are things, uh, as basic as, uh, the social economics
of the community and what we've seen over the last, you know, 2, 3 decades in
particular is a real changing of the economic circumstances facing a lot of rural
America. Uh, with some exceptions, obviously, but overall, um, and, um, healthcare, uh, [00:19:00] health care providers. So, I mean, by that, you mentioned, I
guess Holly mentioned, uh, you know, hospital closures. We talked about the
erosion of services. We've talked about gaps in access to primary care providers
and pharmacy and nursing facilities, all those kinds of, and home health. Um,
you're, you know, you have two people who to the same condition, one to an
urban hospital, one to a rural hospital, the urban patient is more likely to get
home health care and have an easier transition to home, whereas the rural is
often kind of sent home. There's no home health that can get out there often.
They're sort of left to figure it out by themselves. Um, probably their follow up
care with their provider that they saw in the hospital, um, might be harder to get
to. And so they're missing that follow up visit, uh, which puts them at higher
risk for readmission. Um, and so they're back in the hospital, they're more likely
to be back in the hospital. Um, One where, you know, the couple places where
populations end up doing better. And one is something that if you grew up in
rural areas, you're probably not surprised by, and that [00:20:00] is the social
connectedness. Uh, we can measure that in a lot of different ways, but it's
people looking out for each other. It sounds, uh, pretty Americana and apple pie
kind of stuff, but that is a real fundamental issue.
Mark Holmes: The smaller communities, um, that local means, um, a number
of advantages. It's, um, easier to rally community support around something. If
you have, uh, an issue, like we've heard, some communities, you know, have
three, uh, drunk driving deaths by, you know, adolescents in a two year period
or something like that.
Mark Holmes: And that's it. We've had enough. And within three days, they
can get basically everyone in the community together at the hospital boardroom
on a Tuesday night and start, you know, rolling up their sleeves and making a
difference. And to make that work in larger areas as well. So understanding that
and really leveraging the ability of rural communities to be nimble, um, and,
um, you know, not listening to those who tell them it can't be [00:21:00] done,
um, is one of the, uh, real strengths of rural, um, communities and their ability
to make a difference.
Phillip Stokes: and I'll just follow up. Um, Um, you know, one of the things,
uh, Mark that you highlighted, um, at the state of the science meeting, um, and
I'll open it up for both of you, but of course the COVID 19 pandemic had pretty
drastic impacts on healthcare. Um, Holly, you mentioned hospital closures, uh,
but what, I mean, what has changed since the pandemic, good or bad or neutral
for healthcare?Mark Holmes: Holly and I are both playing chicken. I guess I'll go first. Um, I,
I think, um, what we really understood from that was the fragility of the
healthcare system writ large, and it's everything from how the one respiratory
[00:22:00] therapist that was working in the rural hospital when, um, Her family
member got sick.
Mark Holmes: All of a sudden, there was no care being done at the hospital
that depended on that R. T. Um, it showed the, um, of the system in many
states. What we were seeing where the urban hospitals getting overcrowded,
um, particularly during peaks and the rural hospitals often saying we have
excess capacity and they would work together to manage that, um, that surge.
And the rural would, in some places, took COVID positive, uh, patients and sort
of specialized in, in managing COVID and others took the lower risk, um, or
the, the more, um, you know, pneumonia, for example, and, and, um, uh, and
brought them into the rural so that the urbans could do the more complex, um,
um, uh, care.
Mark Holmes: So it was a, it was a really nice example of how Um, the
healthcare system, I guess that's a big S or smallest, I [00:23:00] don't know, but
probably a big S writ large could really, uh, work together and, and understand,
you know, often under the guidance of state health departments, um, and
community health directors to, to roll up their sleeves and figure out how to get
it done. Unfortunately, I think we saw a real spike in the distrust of science that
we're still sort of recovering from. Um, and I think there were a lot of lessons
learned from that about messaging and how we can, um, uh, do better next time.
And, uh, we can't say if there is a next time, but we'll say when, um, you know,
we, I think as we understand that there were, um, You know, the likelihood of
similar events is probably higher than it was in the past due to a number of
circumstances, and we have to be ready for it. Um, and there are investments,
um, that states and federal partners are putting in to be better prepared. Um, for
example, CDC has invested in creating, um, Uh, an infrastructure that
[00:24:00] is already working to figure out how can we communicate better to
all our stakeholders, including rural populations, rural health directors, um, so
that we're better able to tailor the message and, and understand, um, how all, all
parties can, uh, get on board with the interventions that need to be done in the
face of the next pandemic or other public health emergency.
Holly Cost: I think Mark covered it. You really, you really nailed it. Um, I
think as far as with Auburn, what we identified is that this is a space that we
want to be in. Not necessarily to deliver health care, but as far as to look at the
innovations out there. I mean, we found a telehealth technology that we felt like
could work.Holly Cost: And because of covid people are a little more open to trying new
things now, and they understand that there is no such thing. status quo anymore.
Um, we have to think outside the box and that's, that's one positive outcome is
that we, we realize there are other ways to bring [00:25:00] healthcare to the
person that people don't necessarily have to come to the healthcare.
Holly Cost: So what are, what are our opportunities for healthcare delivery? So
we may have telehealth in these areas, but also we have telemetry kits that we'll
be able to send home to these patients. And then these patients can then share
their, share their health statistics and, um, uh, their numbers with their clinician.
Holly Cost: And so people seem to be a little more open to that as long as they
have the guidance and they have the quality of care and the continuity of care.
So that's what we've seen around here. And it's, um, I'm happy that Auburn
University is willing to get into this space. And then also we leverage our
relationship with the extension system.
Holly Cost: We have one office in every single county. In the community and
people already have relationships with extension. You think extension, you
think, um, they, they go to them already. And so they're able to really
communicate with the campus at large about what they see as the needs in the
community. And then the community is willing to trust them because they have
been there.[00:26:00]
Holly Cost: Like there's to the test of time, really.
Mark Holmes: Yeah, those are great points, Holly. Um, I think glad you
mentioned telehealth because there's two things I want to say about that. The
first is, um, pre pandemic, I was always using the phrase the promise of
telehealth because I think it, you know, it was exciting, but we hadn't really seen
it take off as much as we had thought it should, um, and then during the
pandemic, paradoxically, and ever since, I think we still see this, that urban, uh,
populations are using telehealth more regularly than rural.
Mark Holmes: And we've talked about the broadband, uh, limitation for that. I
mean, when I transitioned, it was easy to fire up my, uh, or to pull up my laptop
and launch zoom. I'm on zoom eight hours a day. What's it's easy to connect
with your provider that way. Um, and I am on Google fibers. So the connection
was valid.
Mark Holmes: But, you know, take that away and it's a much harder gap. And
so I am. Concerned, wary, [00:27:00] notwithstanding the wonderful project ofOnMed and others like it that, you know, Holly's been speaking about
nationally, we still, we have this reversal, which is paradoxical. And I would
love to figure out, I mean, we know some of the barriers, but address these
barriers and find the solutions to giving that telehealth option to more, uh, rural
members. Holly also mentioned, um, telemonitoring, which I think is, uh, really
exciting. Um, we're, we have a project at my center that is, um, remote
monitoring blood pressure using cuffs that link to the cell, uh, system. So rather
than the past, it used to be, you know, that that's a next generation. A lot of the
existing work had been, you have the cuff and then you have to Bluetooth it to
your phone and, I can never get my headphones to connect on the first three
tries.
Mark Holmes: But, um, so that was a challenge and now it's just done, you
know, without even knowing about it and the light blinks and it's already
uploaded. And so imagine again. You're a, uh, provide healthcare provider.
[00:28:00] You wake up in the morning, you fire up your patient panel and
there are three people who have a red line or red shaded, uh, row from that
morning's data. much better are we able to address that? You know, um, in near
real time as close as we'll ever get, uh, without asking them to come in and get
checked out. We can have a risk based model and say, all right, we're Let me
call these three people on the phone and figure out what we need to do about
this and how, what's going on, you know, take it again, uh, what were you doing
when you took it?
Mark Holmes: Did you have pizza last night? Which has all which assault or
whatever it is. Um, and again, that's a way to really, uh, lower those access
barriers that we have.
Phillip Stokes: So I, um, I want to ask a question to Holly, um, but what I'm
getting at is, um, I'm hearing about all these changes. And sometimes change is
hard and comes with, uh, a bit of, uh, kind of an aversion to, to going into
something new, but also, kind of to counter that a little [00:29:00] bit, we've
heard about how rural communities have a, a strong sense of community and,
and really, um, you know, they, they can uh, I'll, I'll take all this out, but they
can, uh, they can, uh, kind of harmonize quickly around challenges.
Phillip Stokes: Right. So what I want to ask Holly is what have you seen with
the OnMed program? As far as it's, it's change, it's new, but it's also, are you
seeing community members reaching out and saying, no, actually this is really
helpful. Like this is great. Uh, this is something that's new and, and kind of this
word of mouth that's happening.Holly Cost: You know, it's funny because when we first started introducing this
in the communities, uh, people were saying, Oh, the older people won't want to
do it. They're going to be resistant. And, and what we found is it's been the
opposite. They love it. They go in and it's this private environment where they
meet face to face with this clinician.
Holly Cost: The clinician is lifestyles and all they have to do is press a button.
So they go in, they press this button says start [00:30:00] and then the clinician
actually fills out all of the paperwork for them. They don't even have to fill out
any paperwork. So we have to sign things on the screen, but then on to type in
their name and type in their address 100 different times.
Holly Cost: It's really, um, much more efficient for people. But what we also
realize is you. You have to, um, you know, what is the, you can lead a horse to
water, but you can't make him drink. You have to, you have to make a drink to a
certain extent. So we have it out there. It's free. It can do 85 percent of what you
can do in an office.
Holly Cost: But still, if someone, I mean, I'd be nervous if I'd never been in. So
what we're doing with these demonstrations, as I mentioned, we bring the
churches in. So we go out, we take the van and we bring people to the center
and have them Try it out. So we have the, we've had senior center, um,
individuals come before they're sick.
Holly Cost: That's when you need to catch them. Don't wait till they're sick. I
mean, you don't want to go to a new place when you're sick. You want to
already feel comfortable going into this place. So we've had Rotary club,
Civitan club, our main street organization. We've had a county [00:31:00]
commission members, city council members, um, I mentioned senior center
nurses, uh, uh, a nursing group.
Holly Cost: And then also, um, the. Uh, just any kind of churches, but so that's
been really helpful in it. But what we're finding is you have word of mouth.
We've just added another question on our survey that folks use when they come
in about the quality of their services, asking how they heard about us. I don't
have the data for you yet, but we're, I'm interested.
Holly Cost: What is, what is working in my guess will be word of mouth. I
think one of the most impactful things we've done is we've created this network
of health ambassadors. And I mentioned them earlier, we have 33 health
ambassadors in Chambers County, in the city of Lafayette. And these are
mainly, it's kind of interesting.Holly Cost: We have youth, high school students, and we have retirees. So
they're both out there spreading the gospel and they're getting their friends to
come in and they're making it feel like a safe space. And they're out there
promoting [00:32:00] all the good things. So that's what it takes. It doesn't take
Holly costs from Auburn university saying this is a good thing.
Holly Cost: They don't know me and trust me yet. but it really takes the people
in the community. And that's what I've been pleasantly surprised about. it takes
a lot of work. It doesn't just happen overnight. You have to really get out there.
that's been, it's worked.
Phillip Stokes: Yeah, no, that's, um, that's really cool to hear. And, um, yeah, I
can, uh, I can hear kind of the, the excitement and the passion when you're
sharing that, which is, is really great. Cause you know, I, I know that there's a,
just a huge impact that's being made. Um, I, I really, I think we're kind of
starting to wrap up.
Phillip Stokes: I know we can, uh, kind of have one more question for both of
you, but, uh, Lisa, did you have anything you wanted to add?
Lisa Lundy: Well, I was just thinking as you were talking, Holly, that a lot of
the things that I hear you saying about, you know, we go get [00:33:00] them,
we provide transportation, we work with the churches. lot of those are things
that we've talked about, uh, in terms of community health with agricultural
workers in so many different ways. Um, so I can see a lot of crossover in terms
of what you all are offering and the approach that you're taking and how that we
Um, try to think about how we can just make sure that those opportunities are,
are something that agricultural workers know about and, um, can take
advantage of, uh, and especially as, as those networks grow across the South.
Um, and they, a lot of our agricultural workers don't necessarily stay in 1 place
throughout the year. And so hopefully that that would be a way that as you
maybe move through a growth through growing seasons, you might. Develop
trust with this, with this way of getting healthcare. And then when you find
yourself in a new location, you think, okay, yeah, I know.
Lisa Lundy: I know about that. I already did that before. And, [00:34:00] and I
know that that's trustworthy place to go. So that's great.
Mark Holmes: Can I ask Holly what might be a softball question?
Holly Cost: Please!Mark Holmes: you know,
Holly Cost: I
Mark Holmes: Holly, I'm really interested in, um, the OnMed model and how
you, um, what, how you've been tailoring it, or maybe not the model itself, but
how you've been tailoring the talking about it, uh, for rural populations. And
what have you learned and what have you had to adjust in order to, uh, increase
its acceptability, uh, by your target population?
Holly Cost: think the best way I could answer that question is to say we wade
into the water gently. And so when we're looking at communities, you know,
talk about this health outcomes and those health factors. I'm looking at these
maps right now of Alabama, and I see the dark counties. They're all really rural.
Holly Cost: They're in West Alabama. And so what we do is we identify
communities that have that we know have the health needs. They have the poor
health outcomes. Core health [00:35:00] factors. And then we start by talking to
their community leaders. And these are the official leaders. We'll talk with the
county commissioners, we'll talk with the um, hospitals, we'll talk with the, um,
the city council members, and we bring 'em in, all in as a group.
Holly Cost: Talk to them about. our model is, and then we ask them, what do
you see as your needs and your priorities? And is this something you'd want to
partner with us on? And if they do, then our next step is to have a community
conversation. So then we bring in a broader group of stakeholders, about 20 to
30 say again, what are the barrier?
Holly Cost: What are your health priorities? What are your barriers to access?
This is this health care station. Who's going to use it? you interested in using it?
Do you want to jump on a van and go and see an existing care station? Um, and
we'll go check that out. And so just introducing it over and over to multiple
groups and then, and being real open to whatever questions or hesitancy they do
have.
Holly Cost: But I [00:36:00] guess that's my best answer is just, we do wait into
it, but we have a pretty lockstep model because meet with these leaders. They
like it. We meet with the community members. We find out where we want.
Where's the best place to locate this? How are they gonna have to buy in and
then from there we do the implementation that it's continual improvement.Holly Cost: We're always evaluating and assessing Just the the patient
satisfaction and then the impact what we are hoping is to see these Better health
outcomes, but you know, that's going to take a while to see
Phillip Stokes: Yeah, and actually, Mark, you kind of, uh, asked a really great
question to sorta, uh, as, as we're wrapping up. Um, I did want to ask, uh, both
of you and, and Holly, I think you kind of addressed it here, uh,
recommendations, uh, that you have for novel or adapted healthcare delivery
models. And it sounds like from what you said, it's really, um,
Phillip Stokes: uh, you know, going in slowly. Getting [00:37:00] community
feedback, evaluating, uh, adapting as needed, right. Addressing some of those
concerns as needed. Um, but yeah, do either of you have any other
recommendations for, uh, just, just ways to, to reach some of those, um,
populations that have previously not been reached as much? Mm
Mark Holmes: I think that as some of the work that I've done is really shown
unsurprisingly that local leadership is usually the secret sauce and what makes a
difference and and empowering them to address their priorities rather than
coming in and saying, hey, I'm from UNC and I've got the solution for your
behavioral health needs.
Mark Holmes: And they say, yeah, that's great. We're more interested in
diabetes
Phillip Stokes: hmm.
Mark Holmes: great. I'm here with a behavioral health solution. Um, and so
that, that means listening to them, empowering them. What I really liked about
what Holly's model is, is not only is it, um, listening and really engaging
[00:38:00] the community, but it's tailoring it. And I can't remember the
particular places, but in one place, we put it in a senior center and another place
we put it somewhere else because that's what they wanted and that's what they
needed. And that's what they thought would, would work best. Um, not super
scalable, but it really is the solution to, um, recognize that innovation is going to
happen in that, in that local area. Uh, hearse has been doing this. There's a
program called our moms, which, um, is designed to let local communities
innovate around. Their maternal health solution, uh, and our corp, which is, uh,
addressing their opioid, uh, crisis, allowing the communities to come up with
what they want to do, um, and what they think their priority is, and then
learning from those and building a, you know, here's one general model that you
can tailor to, to what's going to work for your, uh, community.Mark Holmes: That I think is probably the best path forward.
Holly Cost: Yeah, I appreciate that. And one [00:39:00] population haven't
mentioned and I did touch on just the health care professionals that we are
connecting well with the hospitals. So we're getting input from the hospitals and
in one community, a hospital was even hesitant about how what we're doing
might impact. Um, just their, their services and their, their patient base that
comes in because you know, we don't charge, they do charge.
Holly Cost: And so what we're looking is how can we intersect those? So how
could possibly their nurses or their nurse practitioners. Be a part of the on med
network so they can deliver services across the county where folks may not
necessarily be able to drop all the way to the hospital. But then if they meet
their healthcare professionals through telehealth, then they're able, then they
say, okay, well, I know you're just 20 miles away.
Holly Cost: Now I'm going to ride there because I met you and you're not
scary. And I know you care. And then the other population that we're working
well with is, uh, EMS, um, our emergency management services. So in two of
our communities, we have the fire chief. Okay. Who is working very closely
with us and they're able to tell us, okay, this is what we're seeing from our
[00:40:00] frequent flyers, people that call in and that we see them all the time.
Holly Cost: And this is what we need help with. And so we're taking some of
that off of them. And again, they're the trusted people in the community, so they
can say, all right, Miss Jones, next time you need help with this, you need to go
over to this station and I'm going to make you. I'm going to get you to have a
visit over there to try it out first and it works.
Holly Cost: People trust chief duty, you know, people trust chief Gibson. So,
uh, that's another population that we've really gotten on board as partners. And I
really liked what Mark was saying. We do not profess to know all we, we don't
know all. And that's one of the first things I say about them. I can't tell you what
you need.
Holly Cost: You tell me what you need. We don't have all the answers, but let's
figure them out together. So I'm really, I love that, um, just the relationships that
have been formed in these communities. It's been fantastic. And yeah, I do get a
little excited. Oh,
Lisa Lundy: your tagline for your marketing campaign is, uh, we're not scary.
We really [00:41:00] care.Holly Cost: I like that. Oh, I like it. I'm writing that down.
Mark Holmes: I think I'll use that for our faculty as well.
Holly Cost: Oh, good.
Lisa Lundy: That's right.
Holly Cost: I'm not scary. That's great. I love it. Thank you.
Phillip Stokes: That's great. That's great. Um, well, I want to thank, um. Mark
and Holly, I want to thank you both so much for coming on Science by the Slice
and sharing today. Um, what a great conversation, uplifting conversation,
challenging conversation, but, um, you know, it's so crucial and so critically to
have in the work that you're both doing, uh, is amazing.
Phillip Stokes: And of course, uh, Lisa, thank you so much for co hosting and
sharing all that you bring in today. So, um, yeah, I, I think we can go ahead and
wrap up, but, um, it's, it's been a great episode. Any final thoughts before we
close out?
Holly Cost: Appreciate the opportunity.
Mark Holmes: for
Lisa Lundy: Yeah, thank you both.
Mark Holmes: Yeah.
Phillip Stokes: All right. Goodbye.