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What About Rural Health?™ is a rural health and global health podcast exploring how healthcare is accessed, financed, governed, and delivered in rural and underserved communities.
Hosted by Chinasa U. Imo, a global health policy strategist, researcher, and rural health advocate, the podcast brings together policymakers, healthcare professionals, researchers, community leaders, innovators, and people working directly within health systems to examine the decisions, structures, and conditions shaping rural healthcare.
Each episode combines first-hand accounts, expert insights, policy conversations, and research to explore issues such as rural healthcare access, health systems strengthening, health financing, workforce shortages, public health, health policy, technology and innovation, community health, and the institutional factors that determine who receives care, where, and when.
With perspectives from the United States, Africa, and other parts of the world, What About Rural Health?™ connects local experiences to larger questions about how health systems are designed, funded, and implemented. From deep-dive interviews to field-based storytelling, the podcast brings rural health into global/local focus and examines both the gaps and the solutions shaping care in underserved communities.
Whether you are a health professional, student, researcher, policymaker, advocate, or simply curious about how health systems work beyond major cities, What About Rural Health?™ invites you to rethink global health through a rural lens.
Hello, welcome to today's episode on rethinking rural health financing. You are listening to
the podcast that asks the question too many people forget. What about rural health? I am
your host, Chinasa Imo. Together we'll be uncovering the stories,
chat,
challenges and innovations that are shaping healthcare in overlooked communities.
In this series we ask hard questions about how money moves, who get funding, who get
served and who get excluded from policy to practice, we explore what health financing
should look like for everyone.
One thing that has fascinated me over a couple of years now is that some of the biggest
breakthrough that we have seen in rural healthcare has not necessarily been the one that are most
sophisticated or that have the most sophisticated technology.
more often than not, there have been the simplest ideas that are built around one question.
How do we take life saving care to where people live instead of expecting rural communities to come to healthcare?
So, a couple of months ago, I was watching a conversation
station where Bill Gates was talking with Ratu Narain about his wearable device that
he developed with his team at BEMPU.
It looks almost like a baby wristwatch, but it is designed to continuously monitor newborn
temperature and immediately.
a lot care give us when these babies become hypotemics.
Statistically, hypotemia has remained one
of the major contributors to newborn illnesses
and deaths, particularly in low resource communities.
Such a simple idea is now being studied.
around the world in places like India and Ghana because dictating hypothermia
Alienov gives Kei give the opportunity to intervene before it's too late.
Around the same time we've also studied the impotable ultrasound devices that are small enough to fit into the world.
to a healthcare workers' pocket.
Suddenly, nurses and midwives can perform ultrasound scan
in communities that have never had access
to conventional ultrasound machines.
Humanitarian organizations like Med Global
have shown how this portable technology
can support live-saving medical missions in how to reach communities and humanitarian settings
by taking this care directly to the people who need it most. Now that got me thinking.
As we continue to reject and redesign rural healthcare,
Maybe the future of rural health is not simply about building bigger hospitals anymore.
Maybe it's about building smarter, more affordable and portable way of delivering healthcare.
And my guest today is Katik Ganesh.
Here's the CEO of...
on me and he has spent much of his career thinking about this very question that we show up in this
episode. He has gone beyond asking how do we improve healthcare to ask him how do we redesign
healthcare delivery so that geography would no longer be the decided.
in fact, or for whether people receive care or not.
And to my listeners, if there's one thing
that I hope that you walk away from today's conversation
we could take is that innovation is not
valuable just because it is new.
It is valuable because it solves real problem.
We'll see you next time.
spent decades trying to bring rural patients to healthcare.
So I think that pivoting to thinking about creative ways
to deliver healthcare model that saves life to rural community
is the best way forward.
So, Katik, thank you so much for our question.
joining me today on what about rural health.
Before we dive into the nitty gritty of the conversation,
I'd love for you to introduce yourself
to our listeners, tell us about your journey,
what drew you to healthcare
and what continued to drive your passion in this space.
- Chana, I suppose thank you for that.
having me on, 26 years in healthcare, I came into healthcare purely by happenstance.
The first consultant job was in healthcare and I felt this was exactly where the universe
wants me to be. If most things in life gravicate towards health and wealth, there is nothing
more meaningful to a purpose-driven life than the future.
being able to bring healthcare to people. So being a part of the healthcare system, especially
here in the United States, has been absolutely a privilege. It has also been a privilege because
we have a lot of problems. And the richest country on the planet has 120 million Americans
without viable care.
80% of US counties with multiple care deserts.
So we've got some very significant problems.
And as incredible as my healthcare journey
has been over the years,
the work that I've been doing with OnMed
and what we've been doing very specifically focused
on underserved communities.
and rural communities as a part of the subset of those underserved communities.
It's been incredibly gratifying and just truly a blessing.
We're making a difference and I love the way you kicked off the conversation.
Innovation for innovation's sake is meaningless.
If innovation does not move the needle in terms of making a difference in people's lives,
It's pointless. I agree with you on that. That's where we're at right now.
Thank you so much. So you mentioned on med. Could you talk us a little bit so that my listeners
will know what that is about? Absolutely. So the easiest way to think about on med is
the core product is an eight feet by 10 feet.
care station that's now been deployed across rural communities, suburban communities, urban
communities with one very consistent feature. It has been focused on underserved communities.
The only exception to that rule is probably employers where you could also say by virtue
of just the lack of primary care access, employees tend to be a little underserved as well.
So outside of employers where this has shown up really as an on-site clinic, our primary focus
across the country has been underserved communities. And the base construct is again,
I love the way you set the self right, because if we look at brick and mortar,
brick and mortar has hit a very natural ceiling. We have one to expense at the standup. Two,
we're just running out of clinicians or physicians as a country. We're producing 18,000. We needed
200,000 about four years ago, 43% of all independent physicians
have basically fallen off. They've left their practices. We continue to have fewer physicians
and just assuming that you're going to have a brick and mortar solution where you can throw
more physicians at it has hit a ceiling that's dead. It's not happening anymore.
Telemedicine lived its promise through COVID and we got
excited about it. It's been around for about 18 years, but it has some very natural barriers,
not just from the US but globally. In the US, very specifically, 43 million Americans have no
broadband. 75 million Americans have less than viable broadband where you don't get video.
And without vitals, scans, basically,
biometrics, the telemedicine consult just ends up being more of a chat with a physician
or a clinician versus a real clinical visit. And that's the problem that on medicine solving.
Both traditional brick and mortar care and virtual care via telemedicine and hit
clear ceilings. You cannot do it.
the baby out of the bath water. Anyone who says if we had to completely redesign healthcare,
how would it look like? What would it look like? I think, especially in the US, is completely
missing the point where a $5.1 trillion healthcare industry, you can't just completely turn it over
and say, let's start from scratch. What we have done with the carestillation is we have taken the
best of the psychological comfort that comes with in person,
written motor care, the comprehensiveness of the visit,
the scans, the biometrics, the devices.
We have married it with the rapid scalability of telemedicine.
Eight by 10 feet care stations,
we are now especially as this is the rural health conversation.
Chinasa, we're across West Alabama, we're across West Texas.
We have deployed this inside of correctional facilities.
We've deployed this in children's centers.
It has been incredibly gratifying Puerto Rico, which is not brutal, but it's naturally extremely
underserved in partnership with one of our partners there.
We have now gone.
In the next three months, we will have 10 care stations across the island.
We've already got seven in the ground with more coming through the end of the year.
So we are coming back to again the way you started it off,
which is a very meaningful kickoff to a podcast.
We are bringing innovation that is making the difference,
but this is a very important thing.
not game changing. It's not let's completely break the mold. I've always thought to myself, right?
Apple never invented mobile music. Sony did that with The Walkman. But Apple built the iPod that
allowed you to put 10,000 songs on it and just walk around. We have taken things that already
existed and we
We have created an ecosystem that is relevant to these communities where care just isn't
reaching them.
I like the way that you describe your technology because when I was looking through what this
technology does, it was quite impressive.
Like I would always say, I'm originally from...
Nigeria and when I look through and I've been in the health sector for a very long time,
for over 15 years now, doing development work across Africa. And when I look through the model,
I kind of like see in Nigeria, we do have health posts as part of our minimum package structure.
of our primary health care.
So the heart post could be anything,
just be a dispensary.
I mean, it's also in Kenya,
where you just have these health posts,
where people can go and see a basic,
maybe a health volunteer that is trained
to dispense the first point of care.
And then I look at the technology
of the combination of the Hobart's book. I know we're going to talk about that.
Hobart's book was the drones in Rwanda. The combination of a Hobart's book and the drone.
Just expanded. So when I look at this, I feel like let's pick this health post model that I see in case.
in Nigeria where a health person, whoever that person, depending on the kind of training,
is situated at a little bit technology to it and then have something that combines all
of that to deliver care in a high technological environment.
US we cannot even with all of the statistics, when we compare the US and other countries,
the US is still a country that enjoys high technology and broadband network distribution
across countries, comparative to other countries.
But let us go for a quick break when we come back with dive more into this conversation.
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Welcome back.
You are still listening to what about rural health with Chinas at Imo.
So Katie, thank you so much. I mean,
listening to your journey is obvious that you've done so much within this space at least in strategizing
how this adaptation of technology could improve healthcare access or is improving healthcare
access for underserved communities. But one thing that keeps coming back to me
And I know you mentioned that when you were introducing yourself is just the situation of the US being one of those countries that is in the top action of advanced healthcare institutions with medical technologies that they even export across the world.
rural communities. He has struggle. I don't even live in a rural environment, but I live in a
borderline between a desert is connected, urban enclaves and a high brew urban area. And I know
what it means for those who live in those low resource environments.
in the south side of Chicago go through just to receive access to healthcare. They are not even
in rural space. They are just in an urban enclave and yet they suffer in receiving access to healthcare.
How did the US, how did we get here as a country that is advancing in healthcare technology?
How did we get here?
It is, in my humble opinion, there's a number of different things.
If we look at the last 60 years, most healthcare policy has been about either cost or access,
and we haven't sold either.
And we haven't prioritized medical education.
I look at India, right, where I grew up for the longest time, and maybe even till today.
As you grew up, you either become an engineer or you became a doctor.
Because you understood fundamentally that a healthy, thriving,
advancing society needed engineers and doctors.
For as incredible of a country as we are, we have not prioritized medical education.
incentivized it, we have not produced enough physicians.
And here's the thing,
technology is a double-edged sword, Chinasa.
Technology for technology's sake is the wrong answer,
especially in healthcare.
Technology needs to be an enabler.
Technology needs to be a means to an end.
But the end and the priority of that end needs to be extremely clear.
And I believe we have been inconsistent as a country in terms of what our
not star is as it pertains to healthcare.
And then over the years, it has just become a little too politicized.
And as a result,
So no one got anything done, which is also an unfortunate byproduct of where we are.
But with all that being said, I am just extremely excited about a number of different things
that we're doing and the opportunities that we have to do things differently given where
we are as a country.
I agree with you.
I mean, we can sit and talk about it.
about all of the things that is not going right.
It's a lot to look forward to.
Yeah, there's a lot to look forward to and there are pockets of innovations that are also lifesaving.
Are they advancing at this scale that we would want them to?
Probably no.
Are we paying attention like when you mentioned health education?
And I've had some.
or that gets coming to a hay until we prioritize basic health care in the US.
Right now we are so high up there thinking about all of the ways that we can build cutting
each things, right?
And be up there but the base of
privilege and preventive care, health education, and all of these things that help maintain
human beings and their wellness is still being deprotised. And that takes me to my second question.
Do you think that one of the challenges
is because we haven't quite spent enough time trying to figure out holistically how to improve
rural health care, not just within hospital, but in the community. Community health is a big
aspect of public health. Do you think that would be the problem?
or that we'll just focus on thinking about medicalization of care.
Yeah, that's a great question.
We've clearly done more of the same.
We have continued to gravitate towards the fact that we have to solve the problems of
rural hospitals versus trying to actually take a step back across the board and say,
what's the right answer for the next question?
these communities. And I've always maintained the job of a rural hospital CEO has got to
be one of the toughest jobs in this country. Margins are shrinking. The communities are
not getting to them because of transportation issues. The distances are too long. And they
They got into rural healthcare to be able to
to improve lives. And it's a tough job. It's incredibly tough. I feel we have an opportunity
to fundamentally pivot away from the way we have talked about things because the way we
have talked about answers has not worked. 30% of Rooru hospitals are at risk of shutting
down or in the process of shutting down. We talked about the fact that in the
number of independent physicians fell by 43% in the last five years. 43%. All of these
independent physicians are the ones that you would have expected to see in rural communities
because they were the one doctor in the town who took care of people and showed up for
home health visits, so on and so forth, and they either...
left their practice or retired and moved someplace else and now those towns are
without care. We have ruled out care stations in towns where that was the
exact same situation. In our rural health towns that we have rolled out the
care stations, 78% of the people walking into the care station tell us
that we are their medical home. They have no place else to go.
So with all that being said, what excites me, and this, I am saying this, there is no political construct to this,
because I feel health care is nonpartisan.
But what?
What we are trying to do right now with the rural health transformation and the $50 billion
being pumped into rural America right now needs to be looked at as an incredible gift
horse.
It needs to be taken seriously.
People need to embrace it.
I think the states are doing quite frankly a phenomenal job.
no job of trying to marshal their troops around it because they understand the problems of
rural healthcare for most part. They understand this is a gift that is your mark. It doesn't
require congressional approval year after year. It doesn't need to be appropriated. They want to
be squarely in the middle of it and do something with it at the grassroots level.
hospitals need to embrace it differently. They are not embracing it differently consistently.
So, we have an opportunity to rethink it because I look at the money, right? I mean, what's
fascinating, Chena, so about the money that's being pumped in is depunking a number of things
that we know have struggled. It basically says, if you're looking to spend the money
money and brick and mortar, not going to give it to you. If you're looking to spend the money
on pure telemedicine, not going to give it to you. If you're looking to use the money
to just pay salaries without really transforming the way you deliver care, not going to give
We've tried to care it, it hasn't been.
work. We're now offering a carrot with a stick. And I think there is a level of brilliance to it,
because if we don't fundamentally as a country and as rural hospitals across the country and
not just hospitals, but rural health systems and health care delivery vehicles, if we don't
fundamentally take this.
opportunity as a wake up call to say, all right, if we don't fundamentally do some things very,
very differently, we're always going to be left behind. The 30% of brutal hospitals will be 50%
of brutal hospitals and the media will say, oh my God, look at the fact that all these
brutal hospitals are shutting down. 50 billion dollars being pumped in.
then take a different, change your strategy and change the lives of these communities.
Thank you for bringing that up. Because when you were talking, I wanted to throw in the
question, but you went ahead of me and started the conversation about the transformation
have fun. Because I have been...
putting an eye and studying a little bit and see what individual states are doing with
especially now that the rule they'll call for application for people to have access to
the money or the grant.
And the only thing that worries me, I mean, I love the phone, it's nonpartisan for the
first time that I...
I'm seeing the fun that is nonpartisan,
removes a lot of bottlenecks that makes it difficult
for people to be creative,
because it's actually asking organizations
and service providers to be creative
in bringing out innovative solutions that should work.
So it's beyond, let's keep complaining.
about why things are not working. I always believe that if you have money, you've solved
50% of your problem, right? Because when you're looking at the budget, you can be expensive
in the ideas that you want to put in because you have a budget for it. Now we have that budget.
How do we creatively solve Europe challenges? But the
think that worries me is what do you think that at the end of that? I mean, I know we're
going off course, but this is very important.
That's a good conversation, tell me.
Yeah. What do you think that should be done intentionally, because everyone is still
pivoting around how this and being teetering about how this money would be useful depending
on the estate issues. How do you think that we can intentionally use this as an opportunity
to bridge the disconnect between the way we see
medical delivery and community health and well-being. How do you think this money can
bridge that gap? Because that's what I think is always missing.
Healthcare, it doesn't matter where in the world, but especially in the United States,
Chanasa has never been a field of dreams. If you build, they will not come. You have
healthcare to where people need it because they don't have the transportation in a lot of cases to
show up where you need them to come. The second thing I would say is the way to do this differently
now is another of different things. I would say one, stop thinking about monolithic solutions and
build hub and spoke monies.
everything does not have to be solved in the same place. We have to fundamentally, you know,
telling someone just this morning, because there's a lot of states that are not, not of hospitals
across this country that are not applying for rural health, transformation money, which just blows
my mind quite frankly. We get caught up in whether or not we're going to be able to get a lot of
we are blue or red. America is green. The dollar goes a whole. If you have the money,
you can change lives. You are being given money. Let's do it differently. Make primary
care a priority again. Make primary care as a quarterback.
becomes the hub. The spokes are where the specialist care delivery takes place. Invest
in modalities of care that engage the person physically, personally, but are yet scalable
from a technology standpoint.
Technology...
has to be what drives scale, but people still want the human interaction when it comes to healthcare.
Blend the human interaction with scalable technology that brings comprehensiveness into these communities,
not away from these communities where they need to travel to it.
it. Bring it into these communities, bring it into places where communities naturally
gravitate schools, religious institutions, community centers, bring it into these communities
where people naturally go any way and make a difference. The strategy right now and the
thinking and the community constantly.
and the where people showing up is as important as the solution that is going to power it.
Too many ideas come from urban America. And as a result of that, people think, wow, listen,
we're in the world of AI bots, we're in the world.
world of, you know, wearables. We are transforming healthcare. 80% of US counties have multiple
care deserts. You talked about South Side of Chicago. No difference. You're exactly
right. The South Side of Chicago incredibly dense from an urban standpoint underserved.
The Bronx, New York City, incredibly dense.
You cannot find the clinician at your life dependent on it.
So these are problems.
If we start thinking on these lines, we not only in terms of the communities, how do we
bring healthcare in?
How do we make it practical?
How do we create hub and spoke models?
How do we make it?
How does tech enable? How does AI power?
But how do you still deliver with human humanity at the end of it?
We start solving for not just rural health.
We start solving for underserved health.
>> Yes.
>> If one thing can gravitate towards solving a much bigger problem,
that becomes not just the model in the US,
but that becomes a model that
that the US has historically done an incredible job of doing certain things, packaging it and
taking it to the rest of the world.
Let's package this underserved health construct and then tailor it to global health.
I absolutely agree with your response and I like the closing that you have given.
I think that is the thing with the fact that you have given the most important thing.
Global health struggles and people have asked me with the way that funding is
Dimination in global development, especially ODA funding and like yeah
It's one thing to throw money through bilateral relationships
But if we don't have a clay strategy of
for what that money is, they'll continue to be this dependency accusation. And this back
and forth thing of you say you do and we will not be solving anything. And this is 50, yes,
plus and global development is not solving anything yet because, yeah, because we are not
thinking,
from the ground up yet. So I like the way that you've said it. Let's look at what works
first. Let us try what works first and then begin to package them as models. Then if this
model fits into your environment, then let's talk business. Instead of let's talk business
and begin to figure out what to discount the
money for, which is what many of us that have been complaining about. But let's take this to our
listeners. I would like to ask, when you sit and talk about improving healthcare or rural
healthcare, do you automatically think about?
hospital or should we start asking the different questions like
Katik is mentioned and well I'll leave it to you but whatever it is that you think
should be the path forward drop us a comment in the comment session. So Katik
I want to bring you back in because this is way I appreciate your work.
and how you challenge the traditional ways of thinking about healthcare infrastructure.
But before we continue this conversation, let's go for another quick break.
We want to hear from you.
So share your story on our website at whataboutruralhealth.com/stories
and help us amplify the realities behind the data.
Someone from our team will contact you with details on how to get your story published on our website and other media platforms.
Welcome back.
are still listening to what about rural health with Chenasa. So let's imagine that today
right now here and then we could redesign this rural health care thing that we have been talking
about and do our strategic lead and painting this picture. What could you add to your
advice broadly that we should start picking out, stop doing change or stop entirely. What
are those things when you look at rural, okay, in America? What are those things that we should
stop doing immediately? The things that we should change and the thing that we should
continue with. I would say
a couple of things, and some of those I mentioned,
were bring them up again, Chinasa,
but I would say one rural hospitals have over the years
built tremendous level of respect
and credibility in their communities.
So while I say we need to think about hospital infrastructure
I am by no means saying the rural hospital needs to go away.
That doesn't make any sense at all.
The opportunity is for rural hospitals to take a step back
and think about what just in time infrastructure
looks like in the community.
at least they serve. They know they've got some fundamental challenges. Their financial
resources are challenged to meet with me. But how do they use new models of care to bring
their brand? So I'm now thinking green, right? I'm thinking, what does this mean to their
pocketbook? What does this mean to their financials? How did they bring their brand
into these communities. How did they create captive patient bases as a result of that,
where, let's say the take a care station, we see hospitals doing this today, with
take a care station, you put it into a rural community, you brand it as your
hospital.
They come there, others both come there, first level of care.
They come to your facility for specialist care.
It allows you to now think about your facility a little differently.
You now deprioritize primary care because you want to get primary care out into the
communities.
You want a special...
on specialist care. You've got fewer beds. Don't spend money putting more beds in.
Make sure that you're optimizing how the beds are being used. How do you now bring technology
into these communities that are not overwhelming? Because you know as well as I do,
you know, as a technology is not necessarily a friend in underserved communities. Right?
Yeah.
Technology has to be
right-sized. You have to make the technology just enough that the community feels comfortable
using it, but not too much that they feel well is the thing now going to take over my life.
It can't overwhelm them. How do hospitals and how do health care delivery systems now delivery
vehicles start looking at technology again as an enabler. How do you take
real AI into the equation not as the destination? I see so many people say, "Wow,
you know what AI, we're gonna roll out these bots and they will go into these communities."
I mean, I don't. We spend a lot of time in underserved
communities and we spend a lot of time in rural America. These are not bought communities. If I
am working three jobs a day, three shifts a day, trying to just make ends meet, transportation was
a challenge and I have to go 45, 50 miles in some case to get to work.
I'm trying to figure out how I'm going to pay my mortgage or my rent.
I'm trying to figure out how I'm going to pay my utility bill.
Am I going to be able to refill my prescription?
So maybe I don't go to the doctor because I can't fill a prescription or refill my prescription.
It's another thing altogether that I don't have to wear without to get to a doctor's office to begin with.
You have to fundamentally, we, we, this is not about,
I wouldn't even call this redesigning, right?
I would literally, I'm saying we need to introduce
a very healthy dose of pragmatism into our healthcare system.
The most pragmatic perspective on running a business.
is two things, actually three things.
One, what's my north star?
Why am I in this business to begin with?
If I am a rural delivery vehicle or care hospital,
whatever it might be, I am in this business
to be able to improve the lives of the communities
that I serve.
Second, am I making money and am I actually improving loves?
If I am not, I should be willing to tear down whatever I'm doing today and think of fresh
or tweak until I get it right. And three, when I get it right, monetize the heck out. I said,
listen, we are a captain.
We should monetize these things.
But how incredible is it if we can make a lot of money and do the right thing?
Yeah, and that should be the end goal if we can see consistent with the fact that we will
We will be willing to disrupt ourselves
in the spirit of doing the right thing.
I think every problem is too small of a problem.
We could solve anything.
- Thank you very much.
- I'm very passionate about this, Chinasa.
You can tell.
I mean, listen, we haven't...
(laughs)
I will tell you Chinasa, you know,
I was one of my team members.
I will never forget that she was in West Alabama
at one of our stations and one of the other stations.
the town. She was out there and someone heard that there was someone from Ahmed at the station.
They came running over, gave her a giant hug, burst into tears and said, "I haven't seen a doctor
in 25 years and you guys saved my life." She had stomach ache for five years straight. She didn't know
was it was progressively getting worse. We basically diagnosed the chinese legal
oncologist and she was definitely somewhere in grade on the cancer spectrum.
She's getting care now and she would have ignored it because she would have
taught me stomachache. Big change does not mean big technology and big money.
I agree.
I absolutely agree with you.
And I was actually coming to that point, but there was something that you said that got
me thinking and I want to put that out very clearly to my audience that I think the biggest
challenge is...
that we consider rural healthcare to be primary health.
Very basic.
And I like the way that you put it, say it.
Take primary healthcare closer to the community
because that's basic healthcare.
Then build a specialist infrastructure within the rural health.
rural healthcare system. Because that is the thing that's always missing. And when we
congratulate primary healthcare, we especially scared then, the specialists care get deprotheised
and move to urban area. And then you see a lot of rural people travelling,
Terriman!
50 miles, what 50 miles flying helicopters and airplanes to get to the specialist care
because it never went away. It's just the design that we put in that diminished the
importance of specialist care. So I wanted to make sure that I brought that because that's
the essence of like my big argument.
all the time that rural health is not primary health care.
It is the whole shabam of health care in the rural environment.
And then the story you just told me now just got me thinking that we do have health care providers.
And at least in where I come from.
from Indonesia, one of the biggest challenges that care providers often complain about is
possible technologies to support diagnosis, right? Are they willing to work? Yes. But
do they have diagnostic tools? Sometimes no. And obviously,
In a place where technology is not advancing as much as urban area, portable technologies
like portable test kits and the rest of them has become important.
And incorporating these into a care delivery model makes it easy for diagnosis as simple
us what we want.
you would have just said, oh, I have stomach pain. And also, Dr.
Meleuk, you and just give you a pain relief, right? But if
that no sir, doctor is coming with a technology that can help
them to advance diagnosis, then the care moves away from that
basic primary that we often talk about to really
consider, let's expand the agnostic methodology that we can adopt in the same
patient. So thank you so much for bringing that story up because I would
have missed this part of the conversation and it is very important in rural health.
Let's go for a quick break and then we'll come back and
continue. Do you want to help drive rural health forward? We're looking for passionate
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Welcome back!
Let's talk this money because I know we've talked about the problems, we've shared, we
understand the model.
I think at this point my listeners have got to the chase of what the conversation is about,
but there's that central part that has to do with money because the challenge I always
Here in complaints from both patients and care providers is who pays for it.
Every innovation is promising.
Even yours, I see the live seven model in built-in a total who pays for it.
So from a financial standpoint of innovation, what is the biggest challenge?
that is there in terms of funding itself. Does it come from policy or just other things? What is
that biggest funding challenge? While healthcare at the end of the day is about the patient,
highly innovative companies in healthcare fail, but in America healthcare,
of healthcare companies fail or don't live up to their promise because they make the patient
pay for it. B2C has not worked in American healthcare. That is not a way to fund the system
because that's not how the system works. If we look at how the system works at large,
it's not a way to fund the system. If we look at how the system works at large, it's
80% of commercial premiums in the country are picked up by employers.
70 to 75% of Medicare and Medicaid premiums are picked up by the government.
And what every healthcare economist in the US tells you is 25% of all healthcare
spend $5.1 trillion of it, 25% of all healthcare spend is waste. You put all of these together
and you realize that what you have to be able to create to build a thriving public health
system because this is more than just a rural health process.
problem. This is a public health problem. The way you solve for it is you create highly
incentivized public private partnerships to be able to fund healthcare across the board.
because healthier communities are wealthier communities. I mean, it's been proven time and
time again, there's just no doubt about that, right? This is not a catchphrase. The research
proves itself out and it requires a different way of thinking around public-private partnerships.
That's the other thing that I am especially enthused about
the $50 billion that have been pumped in right now.
Chinasa, because this is government money that's being given to the states,
for the states to go and find private players who will receive the funds initially,
but then create, after the first five years,
create sustainability vehicles to
continue delivering that care. There is again, not a political thing because I think everything
in this world today gets politicized. I think there's a simplicity to it. There is an elegance
to it. And there's a brilliance to it. The government says, I'm going to give you money
up front to basically give.
you and give you enough breathing room to create sustainability with this and at the end of that,
take it and run with it privately. In my mind, that's how it's supposed to work.
And I'm really hoping it does because this rural health transformation money, especially for America,
is a transformational fund. It's a transformational grant that every
single state and every single rural hospital in those states should maximize. There's a number of
states where our rural hospital partners have come together, cleanly, assertively, to make a
difference. Virginia, Georgia, Arkansas, states that really need this level of care there. The
associations have come together, they have brought their hospitals together, they've
embraced the different modality of care, they want to do things differently. We are seeing
as a part of this rural health transformation, we're seeing Indian health services, we're
seeing the tribal communities jumping in beautifully to embrace it as a part of it. There's still
a lot of people.
sitting on the sidelines.
So, Chinasa, with your permission,
I would actually like to say something to them.
- Go ahead.
- Okay.
This is for every rural hospital CEO in this country
who is not participating or applying
for rural health transformation money,
we get the fact that you have an incredibly tough job.
But if your reasons do not apply ideological political or strategic. I'm sorry but shame on you.
Your entire reason to be is to lift these communities. You have done a magnificent job
thus far of trying to make it happen. Don't take
your legacy by not capitalizing on this once in a lifetime opportunity with this grant
to make a difference for your hospital and these communities because they need it. It is shameful
if the money is there for the taking and people don't take it to make a difference.
It's shameful and that is not the America I believe I know.
Thank you so much for the way that you respect this and I want to also go practical with you.
Of course.
One thing that I have learned as a policy student is that
Sometimes people don't latch onto policies, not because they don't want to, but because
between the original and the intent meaning of the letters of those policies, something gets lost in
transit.
or the capacity to translate it.
It's not that high enough to understand the insecurity of it.
So I'm going to bend a picture and this is my last question to you.
Sure. Go for it. I'm a very forward looking person.
I place you in a state in Alaska, right?
You are now invited by the Alaskan government to say, "Come help us. Bring those and the sidelines, but also us the government because we don't have technicalities to navigate all of these things, even though we know this money is here."
contrast states this. And you are sitting with all of these people. What is that one thing
that you would ask them to start doing right now? What is that one thing that you would
use to convince the sidelines to join the movement? And what is that strategy that you
design clear enough to get the latest of the policy clearer and digestible to
everyone irrespective of their understanding capacity.
Such an awesome way to say two things. One, people buy into policy, buy products, buy
anything, even your interaction with your kids, your first step is, am I emotionally
connected to what I'm trying to solve? If I'm not emotionally connected to the problem,
I'm not going to solve it.
So step number one, bring the loudest voices into the room
and ensure we're all aligned in terms of what our collective
north star is.
If I'm running health for Alaska,
I've gotten the obscenely tough job
because some of those communities are so far out there,
you are cold, tough to get,
That too, for anything, including even basic postal services,
that bring the loudest voices to the table,
the most influential voices to the table,
and agree on one first,
that is are we all aligned that we want to solve this problem?
And the solving this problem
is the right thing for all of us together.
Because,
If we're not all aligned, but this is a real problem, we're never going to solve it.
That's one.
The second thing is, the thing you said it well, I would just add sometimes even when
the policy is well drafted, are ideological and political leanings.
make us read between the lines when the lines don't exist.
I would say the second thing is the most constructive way to solve problems is to stop
whining about what got us here.
whining about who is presenting the solution and focus on the
fact that having the solution is better than not having one. If we can agree on the fact
that we want to solve this problem and we want to figure out how to take this money as
an example that's been given to us and solve it using that money, I feel everything else
from that point onwards is a detail.
because fundamentally you're bought into the fact that I don't care if I'm blue, red, purple.
Good ideas can come from all places. Policies, blue policies come in, red policies come in,
policies change, don't get hung up on it. It's the thing that's being presented.
to you, going to improve your community or not.
If it is as simple as a question as that, just embrace it.
This $50 billion as an example is, has the potential,
if money can solve a lot of things,
this $50 billion is being put on the table
to shake trees and say, do something different.
If you do the same thing, I'm not gonna give you money.
It's okay.
And two, I am creating a path with this 50 billion
of a truly scalable national public-private partnership.
I think after that, everything else.
is a detail that can be worked through.
I absolutely agree with you and thank you for the way you put it.
I just want to add that the money doesn't have color
and I like the way that Americans usually talk about their money when they say,
"Well, our tax pay us money, our tax dollar." So it doesn't really matter.
with a blue or red that will make us our tax money. When they are taxing us, they don't look at blue
or red and taxes. It's just terms of and it's a pool of public funds that is being redistributed
to say use this specifically to improve and transform blue.
rural healthcare in America. I think that is the best way to close out this conversation,
Katik. Thank you so much for joining us today. You've given us a lot to think about as we
consider how rural healthcare improvements can become affordable and then include
with innovations and technologies that really matter
for rural community, but most importantly,
for pioneering the work that you do with OM-MADE
with your case station.
Thank you for sharing your perspective with us.
It's a pleasure having you at What about rural health?
Thank you, Chlassen.
Appreciate being here.
You're welcome.
or any of your favorite podcast platform.
As always, we'll continue to ask the question,
what about rural health?
Until next time, I'm still your host, Chinasa Imo.
Bye for now.
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