Bill Klaproth (host): This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth, and with me is Melinda Cooling and Colleen Klein. As we talk about Medicaid Innovation Collaborative, Innovating to Meet Patients' Needs. Melinda and Colleen, welcome.

Melinda Cooling: Great to be here. Bill. Thanks so much for having us.

Host: You bet.

Colleen Klein: Thank you. Yes, for having us here. We're excited to share our work with you.

Host: Absolutely. Well, thank you for being here. I appreciate it. So first off, Melinda, tell us what is the Medicaid Innovation Collaborative?

Melinda Cooling: Yeah, so this is a journey that OSF Healthcare started when the state of Illinois put out a request for Medicaid transformation. So really thinking about how do we care for this patient population differently, thinking about health disparities and how we meet some of those challenges. And so we applied, through a grant process for this collaborative, and it involves four of our FQHCs from our communities in the areas where we serve.

And so we're all working together to provide different services, very much focused around digital care and reaching these patients in very different ways than traditional models of healthcare. And so we started this journey along with the FQHCs about three years ago now and have continued to build those programs and are starting to think about how we scale those even to other populations that we need to serve as well.

Host: Yeah. Now was this born out of COVID-19? Did this idea formulate during that time?

Melinda Cooling: It did. So that really launched a lot of our thought process and really the operational sort of thought around how do we build programs like this in new and different ways. So I would say it took the model that we were really starting with as a healthcare organization around digital care and moved us forward probably five to six years accelerated.

So if there's, I always say if there's anything good that came out of COVID, it was really the pushing forward the digital care.

Host: Yeah, it really kind of kickstarted a lot of initiatives. Okay. So let me ask you this then, Melinda. How has the role of digital health evolved since the onset of the COVID-19 pandemic, particularly in managing chronic conditions and prenatal care?

Melinda Cooling: Yeah, so it's really been able to accelerate it at a fast pace and helped us deliver and develop programs around chronic disease monitoring. So I think about remote patient monitoring where if you're a hypertension patient, for example, where traditionally maybe you went in to see your clinician every three to six months.

And it's like, uh, yeah, your blood pressure's borderline, but I'll see you again in three to six months. Well, now we can put you on remote patient monitoring equipment and really understand like what is your blood pressure doing, which we know is going to impact the outcomes of those patients long term.

 Decreases the stroke risk, the other chronic conditions that come. So you think about COPD, diabetes, hypertension, heart failure, any of those chronic diseases, which we know we continue to see more and more of with the aging population, that we have some of these methods that we can control those better.

Host: It's kinda like real time monitoring.

Melinda Cooling: Yes. Yes.

Host: And that can be really beneficial if you see something, a spike or something that's not right, instead of, we'll see in three months, it's like, uhoh, this is happening now.

Melinda Cooling: Right, right. So, you know, the simple thing of using hypertension, the same type of idea is where that patient goes home and it's like, well, this wasn't just a fluke that you were borderline. You're staying like this and so we're going to initiate treatment, or we might need to change your medications or thinking about your medications differently. As well as integrating some ongoing education with those patients. So I always say, if you think about a primary care visit, they're 15 or 20 minutes long, and when you have two or three chronic conditions that you're trying to manage during that time period, it becomes very difficult.

So how do you integrate education along that patient's journey as well as some health and wellness? Same thing for pregnancy. You know, that's a time in a lot of women's lives, especially a first pregnancy where they have a lot of questions, they have a lot of doubt. An office is open, typically nine to five.

That's not when a lot of people have questions. Right? Right. So it's in the middle of the night. So we make sure that all of our services are available 24/7-365.

Host: Yeah, that makes sense. And obviously you get better outcomes that way too. Better health outcomes, which everybody's looking for. So, Colleen, let me ask you this. Can you share any early findings or insights from your study that highlight the value of virtual care or remote monitoring, like real world results?

Colleen Klein: Well, so our research is really in the stages of data collection and analysis, but when we look at it, we can see in terms of pregnancy, you know, we've been able to enroll over 5,000 women.

Our study was a little bit smaller because we looked just first at the first year for that. But we are seeing that they really were satisfied with the program and that they had some engagement with the program over time. And so when you're measuring digital health engagement, it's a little bit different, looking to see how often they're engaging with the program, talking to the staff, and we have found that, that access to care, as Melinda was talking about, being able to reach out when you have this question, or some of our nurses have said to us that it's different with digital health, that you're sometimes because it's an app-based program, but they can also have a visit virtually with the provider as well. But you may be chatting with a patient throughout the day, they might have a question, they're on their break from work and they're worried about should I climb a ladder or should I have this discomfort, cramping or whatever.

Is this normal? Yeah. So they can chat or we can ask them to say, Hey, maybe we better have you see someone and talk to them. So.

Host: Yeah. And, and the answer is always no. Do not climb the ladder. Do not get on the ladder. Yes.

Melinda Cooling: Even if you're not pregnant. Even if you're not. Do not. Yes.

Host: Hire somebody to clean the gutters. Please do not get on the ladder. This is our PSA, our Public Service announcement for this podcast. So you said 5,000 people. That's a big sample size.

Colleen Klein: Yeah, that's amazing. We didn't, didn't have that. Like I say, that was our enrollment. But then when you talk about research, we're really doing kind of some pragmatic research. We're looking to ensure that our data is accurate. And so I think we had in our study a little bit fewer than that. But again, those results have recently been published, so.

Host: So Melinda, I'm sure there have been some hurdles along the way that you've had to jump over. What are some of the biggest barriers to implementing a scalable team-based model for digital health in a hospital setting today?

Melinda Cooling: Yeah. I think, you know, in healthcare, change is always difficult, right? We've come from an era where things stayed very consistent for a very long time. And so sometimes when you're dealing with clinicians who have been in the field for a long time, getting that change management piece or them understanding how do you do an assessment on a patient that may not be right in front of you that you're physically touching, but how do you do a clinical assessment? How do you talk to a patient through a virtual means? Those are all learning things, which often causes them to sort of put their hands up and say, Ooh, you know, I don't, I don't know about this.

I don't know if we should be doing this. So I think as an organization, sort of that change management, the new models of care, making sure that you integrate it. One piece that we always really try hard to do is that if you don't make this work easy for the clinicians to see by embedding and integrating it in their workflow, you know, for us, we're an Epic shop.

And so if those clinicians, if that mom goes into labor and goes in the hospital, but they can't see any of the work that we've been doing, that's not very effective. So we're very adamant about making sure that we integrate that into our workflows for our nurses, our clinicians that are working with those patients, so it's easily visible for them to be cared for, and everybody has line of sight into the care that they've received.

Host: Kinda like a paradigm shift of care, not having that patient in front of you. But the more I would imagine you go through that process, the more you feel confident in it?

Melinda Cooling: Right? Yeah, I mean, for sure. And as we start to integrate digital health inside of even the academic setting, so you start to think about physicians being exposed to that more, building that into the nursing field and the curriculum so they get those experiences earlier on. Hopefully that'll make them more and more comfortable, as we start to drive those models of care. Our consumers, our patients want this, their patients and their families want this type of care at least available. They may not always choose if this is their preferred method for this preferred time, but they definitely want easy, accessible access to care.

Host: Yeah. Okay. So let's turn the tables a little bit and talk about nurses. How can nurse leaders advocate for and shape digital health strategies for addressing clinician burnout to improve access for care and nurse burnout? How can we use these same digital strategies to help our nurses?

Melinda Cooling: Yeah, I think that's a great question. You know, when we really think about the stress that are on our nurses at the frontline anymore, it's really important that we have innovative mindsets. I think if there's one thing that I can really encourage nurse leaders is sort of be open-minded, be able to say, let's try it. Let's see how this works.

It doesn't have to be wrapped up in a pretty bow and everything perfect. But how do we try this? I think that some of the success we've seen is sort of integration of nursing, having boots on the ground roles or bricks and mortar type roles where they're still at the bedside, but then having a piece of their role that maybe is digital.

And so they get a little bit of difference, which is exciting to them many times. They get to sort of, to flip their roles a little bit, practice in a different way. Where it doesn't feel like I'm doing the same thing every day. I think it sort of sparks the innovation in their mind, the creativity.

I think using those frontline nurses also for their voice is extremely critical. So thinking about nurse leaders, make sure that we're always listening to the voice at the bedside of those caring for those patients. I think, you know, that empowerment is an engagement tool for us.

Host: Yeah.

Colleen Klein: And I would say too that it's about supporting them, and encouraging them not to be afraid to try something new. I would say that their assessment skills become different when they are using virtual care. We've heard that from interviewing some of the patients as well as the providers and nurses, is that they have to think differently. You know, as I talked about, sometimes that conversation is different because you're having it with them, but it is about establishing still with nursing, that trusted relationship with the patients, and so how can we help support nurses as they're transitioning into these roles? There's actually, I think when we talk about competencies, there will be digital competencies for delivering nursing in that realm, so I think that's something. As far as burnout, we know that nurses need to feel supported by their leaders. That there are things that we can do to help them in terms of understanding their awareness, first of all, and then recognizing those symptoms and what can we do to support them as an organization. And, you know, our organization has done many things. We have a campaign that OSF Cares About You, and we're looking to do different things such as 40 hours that can be, I shouldn't say a work week, but could be up to a work week to support them with wellbeing time.

That they can take that day off if they need to, to go to a care visit with their loved one or to take a mental health day themselves. So thinking about ways that organizations and nurse leaders particularly can be connected with their staff and helping them to understand how it is, you know, nurses are notoriously not always taking care of themselves, but we have to care for ourselves first before we can care for others.

Host: Yeah. And when they see these new technologies being adopted and working, they do feel supported and like, Hey, I'm not stuck in the same old thing. They are thinking about me and looking out for me. And these new strategies are working. It's that whole being supportive and providing a healthy work environment and tools to make their life better. Is that be, would that be right?

Melinda Cooling: Oh, for sure. And I think about how AI is going to help with that even in the future. You know, you think about some of the ambient listening with documentation and how do you take some of that burden off of them a little bit with some of the AI that I think will continue to be developed and optimized.

I think again, the more that we can get our nurses back to dealing with the patients, which is what they love to do. That again is very engaging for them.

Host: Yeah. Alright, so let's stay on that. So, looking ahead, what does an ideal future look like for integrating digital health into everyday clinical practices and, and why do we need nurses to help us get there?

Melinda Cooling: Yeah. I mean, again, their voice is so important, right? They're the ones who have been at the bedside. They sort of understand the workflows the best, I would say, you know, and the nurse leaders really have to be open to that mindset, but really having them be innovative and creative. I mean, one thing I love to do with my teams is say the sky's the limit.

Like, let's have a discussion. Let's take the dollars off the table. Let's take the FTEs off the table. If we could make everything the way you wanted it, what would that look like? And I think sometimes we always think about, well, we can't do that because of this, but if we try to remove that and really encourage our nurses to think about how do we use digital health? How can AI be used in the future to help you care for your patients? It's not about removing the nurse from the scene. I think that's a really important message too. It's about saying, how do we get you to the front line of care to provide to those patients? How do we optimize the clinical care that we're providing?

How do we improve the quality of life of our patients and their families that we're serving? And I think the digital health piece, the AI piece, are all assistants. It's sort of surrounding them.

Host: So if you can align the digital health aspect with their goals of what they want for patient care, that's when it all works.

Melinda Cooling: Yes. Yeah. Yeah. I think, you know, every nurse really wants to optimize. We all want good outcomes for the patient. Yeah, right? Yeah. You know, when you're there for the patient and the family and you hear the many stories of the lives that they've touched, but having them there, their voice and saying, take all the barriers off the table and help us create and design.

Host: Yeah, I think that's great. Quick final thoughts. Thank you both for being here today. I appreciate it. Quick final thoughts. Any additional comments or thoughts you want to leave us with? Let's start with you, Melinda.

Melinda Cooling: Yeah, I would just say, you know, again, I can't stress how important it is to sort of go in with an innovative mindset. You know, I think that as leaders, healthcare leaders in general, I would say, is really helping make sure that nursing has a voice at the table of your organization is extremely important. They are frontline caregivers. I think, you know, there's lots of opportunities with digital care and the way that we can transform the care that we're giving to patients, but making sure that they have a strategic seat at the table of your organization will be very important as we try to drive these organizational changes.

Host: Yeah. Thank you for that. Colleen. Final thoughts?

Colleen Klein: Sure. I think we want to also partner with others. When we started, Melinda talked about our partnerships, you know, within our community and so particularly with our Medicaid Innovation Collaborative.

We've had multiple partnerships both within our collaborative with those communities, but within our healthcare team as well. We're doing our research with Interprofessionals. We have an anthropologist on our team. We have physicians, we have our nurse practitioner leaders. And we have our healthcare analytics and our statisticians, so that when you're looking to innovate, you also want to kind of study whether, as I said, it's a pragmatic trial, but looking to see does this work and how does it work and what can we do differently?

You want that data to show what you're doing. So I think it's that interprofessionalism and working collaboratively with your other partners. That too, it's not just nursing, none of us work in a bubble. Right? But we want to come together as a team because it's really what others think about. Right. That's where the creativity at the table makes a difference too.

Host: Absolutely.

Colleen Klein: And to support that work. I mean, it's amazing, when we talked earlier about that digital care. Those data elements that you want. They're coming from disparate sources. It might be a vendor that you're outsourcing some of the work to, but you want that all to come into your data warehouse.

 So how do you, yeah. How do you bring everyone together? Yeah. And that's been what we've done for the last couple of years and it's been really helpful. Very successful.

Host: Well, congrats on your mission. Thank you so much for stopping by today. Melinda and Colleen, thank you so much for your time. We appreciate it.

Melinda Cooling: Absolutely. Thank you so much. We're glad to be here and share our story.

Host: Absolutely. Yeah.

Colleen Klein: Thank you. We're we're delighted to be here.

Host: Absolutely. All right. Well, thank you again. Once again, that is Melinda Cooling and Colleen Klein. And for more information, please visit aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.

This is Today in Nursing Leadership. Thanks for listening.