The case for big bets in rural healthcare

[upbeat music] Kenny, welcome to the Gist Healthcare podcast.

Thank you.

So Kenny, you recently wrote a blog post, uh, looking at the sort of big, hopefully transformative projects that could happen as a result or in tandem, uh, with the recent Rural Healthcare Transformation Fund that came out of the One Big Beautiful Bill or H.R.1 last year.

And you wrote that organizations that are beginning to work on Rural Healthcare Transformation Fund projects, um, that there's already a pattern emerging that many are trying to just do too much at once.

So how do you have that conversation with leaders, uh, especially those who are trying to put out multiple fires at their institution, to really narrow in and pick one or two projects that could be potentially transformative?

Yeah.

It, it's funny, I actually had two of these conversations today because the, the, the... it's heating up out there in, in terms of clients asking the question.

You have to point to value, and value in this case is clinical outcomes and sustainability, financial sustainability of the system.

As we move into this, um, era of rural transformation, we have to recognize that the skill set and capacity of these people out there trying to deliver care at the same time is limited.

So then when I have the conversation with clients on this, we have to recognize that capacity and skill set limitation and the fact that the population can only accept a certain amount of change at a time.

So therefore, what are your big value pots? Be it chronic illness, be it behavioral health, be it trauma, be it, be it whatever applies to your population.

And maybe you go for those couple of big things for your first two initiatives to create momentum, to get the flywheel moving.

So therefore, when you come up with the other ones that have been put into phase two, phase three, phase four, phase five, you're already got momentum to help them carry, but then you're showing that there's a significant value equation to delivering those first two.

You're arguing that rural organizations need to focus in, you know, choose one or two priorities and take that big bet that could be truly transformative.

But not to overly generalize, uh, but many of these organizations are operating within a very small margin of error, you know, financially, in terms of workforce, et cetera.

So how do you sit down with decision-makers and say, "You kind of have to go big here because that's how we get momentum"? You know, especially when leaders are also dealing with those smaller fires that they feel that they need to put out.

Yeah.

I mean, it's a really good point.

Um, the way I frame it sometimes is there are symptoms of the disease, and then there's the disease itself.

Um, some of the small fires are symptoms of the disease, whereas some of the bigger items are the actual disease itself.

So let me bring that to reality for you.

Um, when we think about chronic illness, the disease is the fact that chronic illnesses spends a significant amount of time being managed in an acute landscape, which is not where it should be.

We should be managing these, um, patients in their homes or in primary care so that they have a better quality of life, they get better outcomes.

But we're so stuck within the kind of construct we have just now.

The fact that you're not doing that is creating a lot of fires in your high-cost areas, your acute hospitals.