March 31, 2026 • 49 mins
In our very first episode of Avel eCare: Virtual Health Connections, we sit down with Mark Johnston, Vice President of Government Affairs at Avel eCare, to explore what it really takes to transform rural healthcare.
Mark shares his journey from working in Washington, D.C. to returning home and stepping into a leadership role at Avel, bringing a unique perspective on policy, access, and the future of care delivery. Together, we dig into the challenges rural communities face, from workforce shortages to limited access, and how telemedicine is stepping in as a powerful solution.
This conversation goes beyond theory. It highlights how virtual care is supporting EMS teams, hospitals, and providers in real time, improving outcomes and expanding access where it is needed most. Programs like Avel’s telemedicine support are already connecting frontline teams with board-certified clinicians to elevate care in rural settings .
If you care about the future of healthcare, policy, or innovation that actually makes a difference, this is the place to start.
Listen now and join the conversation on how we are redefining healthcare delivery.
Thank you for listening to Avel eCare: Virtual Health Connections. To learn more about how Avel is expanding access to care and supporting healthcare teams nationwide, visit www.avelecare.com .
Be sure to subscribe, share this episode, and join us next time as we continue redefining healthcare delivery.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:05):
Welcome to Aval Ecare Virtual Health
Connections.
I'm Jessica Gaikowski.
Across the country, rural healthcare is at a critical moment.
Communities are facing workforceshortages, hospital closures,
and growing challenges inaccessing care.
At the same time, we're seeingsomething we haven't seen in
decades.
Significant federal investmentaimed not just at stabilizing
(00:26):
rural health care, but actuallytransforming how care is
delivered.
Today we're talking about what'schanging, what funding
opportunities exist, and whatruralcare leaders should be
thinking about right now.
Joining me today is MarkJohnston, Vice President of
Government Affairs at Aval ECare.
Mark brings nearly 30 years ofpublic service experience,
(00:48):
including military service,leadership in the South Dakota
legislature, and senior staffroles in the United States
Senate.
Today, he works withpolicymakers and healthcare
leaders across the country onsome of the biggest challenges
facing rural health care.
Mark, thanks for joining ustoday.
SPEAKER_01 (01:05):
Jess, what an absolute pleasure to be here.
And this is this is so fun.
We're kicking off the first uhfirst episode.
SPEAKER_00 (01:13):
Yeah, absolutely.
Before we really dive in, canyou kind of give us a little
more about your background andwhat really led you from working
with policymakers and governmentofficials, legislature, and now
you're out of LE Care.
SPEAKER_01 (01:24):
Yeah, it's been great.
You know, and when you were induring your opening, I just had
to take a minute to pause.
And, you know, it's uh it's beenfun.
I mean, uh, you know, from mymilitary background, you know,
retiring as a colonel overalmost 30 years to, you know,
transitioning from a full-timesoldier uh to become a
(01:49):
governor's press secretaryduring the Rounds
administration, and then uhgetting elected to the state
legislature myself, uh servinguh District 12 here in South
Dakota, uh, to then um becominga senior staffer for my old
boss, our former governor MikeRounds, uh, you know, working
(02:11):
both here in the state and inDC.
It's just it's been I've beenbeyond blessed with a whole lot
of uh great opportunities, butas my wife reminds people
regularly, I can't keep a job.
And so uh it's it's been it'sbeen a lot of fun.
You know, then a few years ago,Aval was looking for uh someone
(02:32):
to do government stuff, and uh Iwas working in DC and um you
know just figured it was time tocome home.
And uh I've known Avel foryears.
Um actually uh theirheadquarters was in my
legislative district, so I wouldregularly do meetings and
briefings and and get updatesabout the company.
(02:54):
So it was it was reallycomfortable for me uh to think
about coming and joining theorganization and you know just
think it's it's just been awhirlwind these last few four
years for us uh as a company.
Um so yeah, it's been it's beengreat and just continues to grow
and and thrive, and uh reallygrateful for the opportunity to
(03:16):
serve in leadership for theorganization and especially
during this time.
Uh, you know, there's so muchgoing on in the government
space, federal, state, local.
Um, and you know, consideringthe the uh high number of
communities uh that we serve uhwith various uh uh virtual care
(03:37):
solutions, it's it's just it'sgreat to be at Aval right now.
SPEAKER_00 (03:41):
Yeah, it is.
When you kind of hit on this,that there's a lot going on
right now, a lot of changesgoing on, a lot of cool new
initiatives going on.
When you're from yourperspective working with
policymakers, why does thismoment feel a little bit
different right now?
SPEAKER_01 (03:56):
Yeah.
Um, you know, coming out ofCOVID, uh, telemedicine was kind
of the hot topic.
Um, but then even even this pastweek when uh I was traveling and
and uh maybe explaining moreabout who Avell is uh to someone
(04:16):
that uh wasn't necessarily asfamiliar uh with the company as
as others, but it's um we'vereally just kind of exploded
after COVID.
SPEAKER_03 (04:27):
Yeah.
SPEAKER_01 (04:28):
And uh but be we we're exploding because we're
different.
SPEAKER_00 (04:32):
Absolutely.
SPEAKER_01 (04:33):
We don't do any direct to consumer.
Um somebody can't just call usup and want to schedule
anologist appointment.
Um we're you know, our with ourmodel being a
business-to-business modelsupporting hospitals, health
systems, and government uhdirectly.
(04:54):
Um we've just really beenfortunate to to have a real
strong growth spurt right nowacross our service lines.
SPEAKER_00 (05:04):
Yeah.
Absolutely.
So we've been talking aboutrural health care challenges for
a long time.
That's basically why Avel wasdeveloped in the first place.
But many leaders now are sayingthat the pressure on them feels
different and it feels like it'sheightened over the last few
years.
So, from your conversations withhospital leaders, government
(05:24):
officials, et cetera, what arethese biggest pressure points
that these rural communities arereally facing right now?
SPEAKER_01 (05:30):
You know, it's it's it's complicated.
SPEAKER_00 (05:32):
Absolutely.
SPEAKER_01 (05:32):
You know, and it depends.
Uh, every, you know, like Italked about earlier, if you've
dealt with one state, you'vedealt with one state.
If you deal with one hospital,we deal with one hospital.
But I think there's, you know,there's an underpinning of of
just some of those core thingslike uh financial sustainability
is key.
And that's why having a virtualpartner to help uh those
(05:54):
hospital leaders, you know, domore for their patients uh
through a virtual partnershiplike ours is is really key.
Uh workforce uh sustainabilityis huge in almost every part of
the country, you know,especially when you're talking
about rural and and um you knowthere's many, many, many parts
(06:18):
of this country that you knowstruggle to recruit, retain, uh,
and and keep providers uh totake care of the population.
That's that's where we being auh virtual health system that
supports these local healthcareentities or supports a
government uh with with one ofour out-of-hospital services,
(06:42):
uh, that's key.
You know, the other realimpacting element is our rural
communities are aging.
Uh and so, you know, you've gota population that is, you know,
probably born and raised andlived in these rural communities
their whole life.
And now as they get older, theythey require uh more access to
(07:04):
healthcare services.
And and that's across thecontinuum of what Avel provides
for a lot of these ruralcommunities, um, that's
attractive.
SPEAKER_00 (07:14):
Yeah.
Um can you go in a little bitmore to access and what does
that really mean?
I feel like sometimes whenpeople think of access to care,
it's like, oh, I just don't havesomeone in my community, but
sometimes it's the distance ofthat.
So can you talk a little bitabout what access to care really
means?
SPEAKER_01 (07:29):
Yeah, you know, and and that's really if you want to
get to the core of what uh Avelbegan as, and that was that was
delivering specially care outinto the country that uh created
an environment so citizensdidn't have to drive into the
(07:51):
metropolitan to get access to acardiologist or a dermatologist
or a rheumatologist, you know,pick picanologist.
And and and that's you know, allthe way dating back to 1993,
that's our core.
And so, you know, now, you know,all th more than three decades
later, it's been even moreexacerbated.
SPEAKER_03 (08:13):
Yeah, absolutely.
SPEAKER_01 (08:14):
You know, and I think about um uh uh we've got
such a strong relationship withthe Indian Health Service.
You know, super, super umgrateful for the opportunity to
support um the mission of theIHS and in the upper plains.
And you know, you know, you wantto talk about rural, you want to
(08:37):
talk about frontier.
SPEAKER_00 (08:40):
Absolutely.
SPEAKER_01 (08:40):
Uh there's a lot of miles between access points.
And so a lot of the tribalcommunities in this in the upper
plains, they don't know aprovider, especially in the
specialists, other than a vowel.
You know, we've had rel our wehave physicians and who have
(09:01):
supported uh those communitiesfor you know almost seven or
eight years, bumping up to adecade, where they've had this
patient uh providerrelationship.
It's all been virtual, butthat's all they know.
SPEAKER_03 (09:17):
Exactly.
SPEAKER_01 (09:18):
And um, and it has been absolutely warming to hear
some of those um testimonialsfrom patients uh about the value
that that virtual physician uhor virtual nurse practitioner
has on the the life of thosefolks in in rural and frontier
(09:40):
parts of the country.
SPEAKER_00 (09:41):
Absolutely.
When you've kind of hit on likethe different areas, so does
rural health care like thepremise of this look different
in different regions and states,or is the challenges that we're
seeing all the same across, ordo they look different based
upon their territory and region?
SPEAKER_01 (09:56):
Yeah, uh you know it's it's a great question.
I and and I suppose it boilsdown to the rurality.
I don't even know if that's aword, but um, you know, how you
know for for some people in someparts of the country, Sioux
Falls is rural.
SPEAKER_00 (10:14):
Absolutely.
SPEAKER_01 (10:15):
You know, and we're 260,000 people in the metro.
Yeah.
Uh, but then uh, you know, it'sit's it's different, but uh, you
know, we're we're pretty uhfortunate to live where we live
here here in in uh the SiouxEmpire and and but able to
(10:36):
radiate those services, youknow, being connected to uh
communities um throughout thecountry um with virtual
services.
SPEAKER_00 (10:45):
Absolutely.
So if we are looking at allthese different challenges, I
know they we started off withlooking at the different
pressures of them and they'vebeen increased right now.
If we don't do something rightnow to help alleviate these
pressures, what does that looklike?
SPEAKER_01 (11:02):
You can't open your news browser on any given day
and and read stories, especiallyin the healthcare space, about
um the economic challenges thatrural hospitals and healthcare
providers experience on aday-to-day basis.
SPEAKER_03 (11:18):
Yeah.
SPEAKER_01 (11:19):
And you know, going forward uh to continue to grow
and provide support to those,uh, a virtual uh partner has to
be part of the equation.
And you know, that's probablywhy we've experienced so much
growth lately, you know, overthese last few years is is uh
because of that reality thatthat all healthcare is local.
(11:44):
You know, it's it's relational,but having a partner like like a
bell to provide that greateraccess to care and and you know
provide uh pretty decent supportto those local communities is is
imperative.
SPEAKER_00 (12:01):
Absolutely.
In 2025, we passed thisbeautiful thing that everyone
likes.
Talk about the one big beautifulbill.
SPEAKER_02 (12:08):
Yeah.
SPEAKER_00 (12:09):
So if people aren't paying attention to healthcare
policy, they they may have heardof it, but they don't really
understand it.
Could you kind of give us alittle insight into what that
really evolved?
Because it's the biggest federalinvestment that we've had in
decades.
So, what does that really looklike, or what does that mean
right now when they're saying wehave this big beautiful bill?
SPEAKER_01 (12:28):
What is that?
And did you know that the onebig beautiful bill is a
nickname?
SPEAKER_00 (12:33):
Mm-hmm.
I sure did.
SPEAKER_01 (12:34):
You did?
SPEAKER_00 (12:35):
Yes.
SPEAKER_01 (12:35):
So but that's how everyone refers to it.
And that's that's the commonlyunderstood name.
Absolutely.
But um the actual legislationwas the Working Families Tax Cut
Act of 2025.
Yeah, but because it was solarge and so encompassing, uh it
uh earned the moniker of one bigbeautiful bill, but it's the
(12:57):
Working Families Tax Cut Act.
Yeah.
And because of that, you know,historically, um, you know, and
I I'm not gonna get into thepolitics of the whole thing, and
because that's not this isn'tthe time or the place.
But the reality is, you know,it's it's about it's about the
the strategy around how umfunding was uh calculated and
(13:22):
budgeted for, especially aroundMedicaid.
And you know, given the um uheconomic dynamics of the country
at the time and budgets, youknow, historically Congress had
funded Medicaid year over yearat about a five percent
increase.
SPEAKER_02 (13:40):
Okay.
SPEAKER_01 (13:40):
Well, um actually and from from a from a policy
perspective, Congress uh madethe decision to dial that back
to two and a half percent.
SPEAKER_03 (13:53):
Okay.
SPEAKER_01 (13:54):
So uh naturally that would mean reduced funding for
Medicaid because you know, intheory, there would be a reduced
need for Medicaid in the States.
Okay, but that caused a dividethat caused uh challenges,
especially in rural America,that rely on Medicaid uh funding
(14:15):
for sustainability.
Hence, a a group of um uh folksin Congress got together and
came up with this concept uh totry to offset some of those
reductions.
Hence, we got uh what we nowknow as a$50 billion
appropriation uh called theRural Health Transformation Fund
(14:39):
uh to go directly to the states,five years,$10 billion per year,
allocated um not on a per capitabasis, but um similar.
Yeah, but uh because there arerural states, you know, smaller
populations that got uh as muchmoney as a large state like
(15:04):
Texas, yeah, with a with a largepopulation.
So uh there is a difference uhon a per capita basis, but um
yeah, that's how that's how itcame to be.
SPEAKER_00 (15:14):
So when we're looking at the by state kind of
difference of that, how how dowe or how did the states kind of
come up with what they'relooking for?
Like what did that process andplanning look like?
Because you can't just get aload of money for nothing.
How did they put some initiativeor strategy around those?
SPEAKER_01 (15:30):
Yeah, that's been that's been fun.
Um I've had the really, reallygood fortune of of uh engaging
with many states um directly.
And you know, if if you look atlook at a Bell as a company, you
know, we you know, we're basedhere in the upper Midwest, but
we support uh hospitals, healthsystems, governments in 46
(15:55):
states today, you know, from thestate of Washington, California,
all the way down to Texas, allthe way up to New Hampshire,
Vermont, and Maine, and allacross.
So there's really, you know,we've we've got such a huge
footprint.
But if you focus on our core,um, you know, it's that 21, 22
(16:16):
states right down the middle ofthe country where, you know,
historically we have have beenso, so, so strong.
And so, you know, in short, toanswer your question, it
depends.
But, you know, there have beensome states that have taken a
really centralized look at this,a centralized approach, led by a
(16:38):
governor, uh led by thegovernor's office, and then
deployed it out.
Other states, they've taken amore uh by committee approach,
uh, organizing advisorycommittees of stakeholders in
that state to help uh shape theplan.
Uh and so it's it's just been awide, wide variety of strategy
(17:00):
that the states have gonethrough.
And you know, some states uhreally their hospital
association or organization ofhospitals has had a significant
role in building that plan.
Um, you know, so it it justdepends.
There's you know, some statesare totally hospital-based.
Uh there are some states thatare more balanced, there are
(17:23):
some states that are more umstructured, more less
structured.
Again, if we if we deal with onestate, we deal with one state.
SPEAKER_00 (17:32):
Absolutely.
So what when we're thinking ofwhen they came out with rural
health transformation, what wastheir original goal with that?
I know we talked about, youknow, it came from the one big,
beautiful bill, but now what istheir true goal?
What are they trying to shapehere?
SPEAKER_01 (17:46):
Well, uh, and I'm just gonna use the vernacular of
the day, make America healthyagain and make rural rural
America healthy again.
And that's that's really that'sreally uh a lot of the emphasis
of of improving healthcareoutcomes for a part of the
country that needed betteraccess to care.
SPEAKER_00 (18:05):
Yeah.
And I think it goes into thechallenges that we talked about
a little bit before, access tocare, looking at the workforce
shortages and all of those othercomponents as well.
SPEAKER_01 (18:14):
Yeah.
SPEAKER_00 (18:15):
Yeah.
SPEAKER_01 (18:15):
You know, as as a company, we you know, we I think
we did like 41 or 42 state uh weanswered 40 41 or 42 requests
for information.
SPEAKER_00 (18:30):
Yep.
SPEAKER_01 (18:30):
Uh, which is amazing.
Huge.
Yeah.
Uh it's it's been a whirlwind.
And and going back, I and Ishould have and I should have uh
uh qualified, you know, thislegislation was signed into law
in July of last year.
Yeah.
And then a notice, you know, uhreally the notice of funding
(18:51):
opportunity came out inSeptember, yeah, and states were
required to submit theiroriginal uh strategy, their
their verbiage in November.
SPEAKER_02 (19:01):
Okay.
SPEAKER_01 (19:01):
And um it was limited, it can only be so many
pages long, so many words.
And so, you know, it's this hasjust been a sprint uh over the
last number of months to get usto this point where you know
budgets were finally approved bythe Centers for Medicare and
Medicaid Services just a fewweeks ago.
(19:22):
And so it's time to go.
SPEAKER_00 (19:25):
Yeah, time to get to work.
So, what does that look like nowwhen we're saying it's time to
go?
You know, the funding has beenallocated, but now how how do we
get started?
What are those next steps?
SPEAKER_01 (19:36):
Well, um a lot of these strategies are hinged on
state procurement um rules.
So um again, and every state isdifferent.
So, you know, it's been asignificant investment to uh put
(19:57):
a team together to uh reallymanage this process to help help
our customers, help our thestates that we serve uh to get
uh new, fresh, uh transformativeideas into the marketplace on
how uh a virtual health systemcould help them um achieve their
(20:20):
goals.
You know, also there's anotherelement, and I I touched on it
earlier about about speed andabout time and and uh because
these states need wins.
You know, it's uh as we recordthis, it's the middle of March,
and you know, um you know thefederal fiscal year is coming up
(20:42):
at the end of September.
There's thresholds there, andthen additional thresholds over
the next year, and so you knowit's it uh needing to find
partners that can implementshovel ready projects.
SPEAKER_03 (20:58):
Absolutely.
SPEAKER_01 (20:59):
You know, that's that's a construction term,
obviously, but you know, it'sit's it's germane to this
discussion because um you knowwe can we can implement quickly.
SPEAKER_00 (21:09):
Absolutely.
When you hit on thetransformation, that's been a
huge word that is not that it'snew, but it's definitely been
utilized in a new perspective, Iwould say, in the last few
years.
And you know, how has Aval Ecarereally now, or how do we want to
play a part in thistransformation of the funding?
How do we become a partner withsome of these communities and
(21:30):
sites?
SPEAKER_01 (21:30):
Yeah.
If you really want to be candid,we've been doing rural health
transformation since ourinception in nineteen ninety
three.
That's how we got to be who weare.
And as we have as technology isadvanced, as services have
advanced, you know, you thinkabout starting out in specialty
(21:54):
care and doing those virtualconsults to school health, to
EMS, to Crisis care.
The list just goes on and on andon.
So you want to definetransformation?
Do a case study on a vow becausethat's what we've been doing for
our entire existence.
(22:16):
And not only on a servicesperspective, but from a
technology perspective.
And so yeah, it's uh it's a goodtime to be here.
SPEAKER_00 (22:24):
Well, I appreciate you going down the list of all
of the different services thatare provided.
Because what does that mean?
You know, some sites have oneservice line and some have
multitude.
What does that mean for someoneto really have the full
continuity of care with a Vell?
What does that really look likeand what does that mean?
SPEAKER_01 (22:43):
Yeah, that's uh that's a great question.
It's really, you know, thatreally um validates that virtual
health system concept that hasbecome so prevalent uh in being
able to support our customers,having an entire platform uh of
services available to them andbeing, you know, in in many,
(23:06):
many shapes and formtechnologically agnostic uh to
whatever that customer has uhmade a decision around for an
electronic medical record.
You know, we I think I wastalking to one of our providers
recently, and I think she saidshe had 27 different EMR
passwords.
Wow.
(23:26):
Just just because that's themany variations of of EMRs that
were out there.
And so um, yeah, that's uhthat's a great question and and
and something to just uh toponder about.
Just we're just so different.
SPEAKER_00 (23:43):
Yeah, absolutely.
So now kind of going back towith rural health
transformation, when we'relooking at everything that Avel
provides and offers, how do wenow implement some of that into
you know, getting into thefunding and working with the
states to really help them meettheir initiatives that they've
put forward?
SPEAKER_01 (24:01):
Yeah, that's a great question.
Um that keeps me up at night, tobe real honestly.
Uh you know, and and uh sleep isa premium anymore.
But um, you know, a lot of theRFPs are starting to come out
because CMS approved thefunding, and I and I mentioned
it now a lot of this depends onstate procurement laws.
(24:25):
And so, you know, there are umthere's been a great deal of of
um learning that has gone intothose processes, but also there
are just some states, it's hardum to um it's it's gonna take a
(24:47):
while for them to act on the uhpremise of rural health
transformation because in in alot of cases they've got really
arcane um procurement laws.
Uh there are some really bigstates out there that it's gonna
take months and months for themto uh uh get some of these uh
(25:12):
dollars to work, yeah.
You know, that they've beenappropriated or not
appropriated, but they've beenuh granted uh by the federal
government.
And so I'm concerned about that.
And there's some states uh wherewe have a big presence and
support lots and lots ofhospitals that that may just not
um see some of the the uh fruitsof their labors as quickly as as
(25:37):
maybe they had hoped.
SPEAKER_00 (25:39):
Yeah.
One part of that too, looking atyou know, telemedicine as a
whole, as a part of some ofthese initiatives.
I know we talked a little bitabout, you know, before COVID,
no one really talked abouttelemedicine and the impact that
it made, and then it blew up.
But we've always been around andwe've done this before.
So, what is that when we'retalking to different healthcare
(26:00):
leaders?
How does telemedicine play arole into that now versus what
it used to be?
And how does that play a roleinto this funding?
SPEAKER_01 (26:07):
Yeah.
I'm going to reflect back on mymilitary career.
And what were those, you know,tactical advantages that we had
as an organization to help us uhaccomplish the mission?
I really look at telemedicine asthat combat multiplier.
(26:30):
You know, it's it's this it's astrategy and it a strategy with
years and years of provenperformance to help a uh a uh
community, uh healthcareprovider or a government to meet
their goals uh and do it ontime, on budget, and and really,
(26:55):
you know, be there to uh helpthem achieve their mission.
SPEAKER_00 (27:00):
Yeah.
SPEAKER_01 (27:00):
That's really how I think about it.
SPEAKER_00 (27:02):
That's a cool way to think about that.
SPEAKER_01 (27:04):
Yeah, it's just uh you know that's kind of how I
was raised.
Uh, you know, I did that for along time.
So how do we accomplish themission?
And I think for a lot of thesefolks, telemedicine has a key
role to that.
SPEAKER_00 (27:18):
So for those that are still a little iffy about
this, which you don't see thatas often anymore, but there's
still some that don't love thefull aspect of that.
How do we get to them and say,how do you prove that
telemedicine can be part of thesolution as a whole?
SPEAKER_01 (27:33):
Yeah, that's great.
You know, and and one thing thatreally sets us apart from a
virtual health system is ourjoint commission accreditation.
You know, getting that uh sealof approval and and recognition
uh from a quality perspectivethat we're we're um you know a
very attractive option.
(27:53):
Yeah.
Uh, you know, super proud of ourteam and and the folks that uh
work really hard every day to uhmake sure that we uh provide the
best uh best care, best servicepossible.
Yeah.
And and that's that'ssignificant.
Um, you know, and and talking tosomebody recently uh who in the
(28:16):
government space and they had nouh previous knowledge of us.
Uh I had never met this person,but explaining to him uh uh who
we are, he he and again it's agovernment official, and he
looked me straight in the eyeand said, Sounds like we need to
be more like you.
SPEAKER_03 (28:37):
Yeah.
SPEAKER_01 (28:38):
And uh, and so I invited him to come for a visit
and and uh kick the tires andand meet the folks just to be
able to show him and show histeam uh just what a uh virtual
health system looks like.
SPEAKER_00 (28:54):
That's amazing.
SPEAKER_01 (28:55):
Yeah, it's a pretty fun combo.
SPEAKER_00 (28:56):
Absolutely.
Well, when you get to see it,it's a whole new ballgame.
SPEAKER_01 (28:59):
Yeah.
SPEAKER_00 (28:59):
Yeah.
So let's talk a little bit moreabout workforce, as that's one
of the bigger challenges.
And I think, you know, we talkedabout people are stretched
completely thin, recruitment ishard, is what we talked about
earlier.
And how do we now usetelemedicine to help extend and
support everybody rather thanyou know the opposite?
SPEAKER_01 (29:21):
Yeah, that's uh that's a super important
conversation to have because youknow, the first thing uh that a
lot of people think about isreplacing.
SPEAKER_03 (29:34):
Yeah, absolutely.
SPEAKER_01 (29:37):
You know, I'm gonna do a telemedicine partnership
and I'll that'll replace, youknow, and I won't need ABC or
whatever, whoever.
And that's 180% from the truth.
SPEAKER_02 (29:49):
Yeah.
SPEAKER_01 (29:50):
You know, we are a support system.
We provide um, you know, that'sthat's the whole premise that
this organization was built on.
But yeah, you're right.
There's just uh not enoughpeople to take care of the
people, yeah, especially inrural America.
SPEAKER_03 (30:05):
Yeah.
SPEAKER_01 (30:06):
Um, and there's if you look across the different
services that we provide, uh,it's even more exacerbated,
especially.
Well, I'll just use behavioralhealth for an example.
There's nowhere that I go aroundthe country.
Uh, even this week, uh earlierthis week, when I was, you know,
everybody wants to talk aboutyou know behavioral health
(30:29):
services.
You know, we're super blessed tohave a pretty robust uh team uh
supporting some of the smallestand some of the largest, uh,
smallest community hospitals,the largest uh tertiary,
quaternary medical centers inthe United States, uh supporting
cities, counties, states, uhacross the care continuum.
(30:53):
Yeah, you know, and and thatteam's absolutely amazing.
Yeah.
Um recently I was uh having adiscussion with a policymaker
about crisis care.
SPEAKER_03 (31:06):
Yeah.
SPEAKER_01 (31:07):
And it was in a higher populated state, and
there was some concern about uhworkforce, our workforce being
able to uh have enough people tocare for their people.
SPEAKER_03 (31:22):
Okay, yeah.
SPEAKER_01 (31:22):
And I gave the example, and uh you know, we had
uh recently an opening, we had ajob posted for uh a couple of um
behavioral health nurses tosupport our crisis care uh
service line.
And over the period of a week, aweek, we had almost 500
(31:44):
applications for those two jobs.
SPEAKER_03 (31:46):
Yeah.
SPEAKER_01 (31:47):
I mean, that's that was pretty that was pretty
telling.
You know, and um, you know, isthere risk?
Does that uh you know there'salso that takes somebody away
from a potential bedside uh job,but but it also kind of speaks
to the uh attractiveness of youknow being a part of the Aval
(32:10):
team uh and being able to takethe knowledge, skills, and
clinical capabilities of thoseindividuals and spread it out uh
to an even uh bigger umpopulation.
So yeah, workforce is is um abig, a big topic of
conversation.
SPEAKER_00 (32:28):
Yeah.
I kind of want to dive a littlebit more too about the extension
of becoming part of their teamand what that means.
Because I feel like sometimeswhen we have had an encounter,
we have a lot of off-puttingpeople that are like, you're
gonna capture everything I'mdoing and you're gonna tell me
what I'm doing wrong, or you'regonna be my big brother, and I
don't want you to be my bigbrother.
So what is that what when we saywe're an extension of your team,
(32:51):
what does that really mean?
SPEAKER_01 (32:53):
Yeah, that's you know, uh a couple of things.
First of all, and I and and andas I explain it to a lot of
folks in the in in thegovernment space or even in the
in the uh hospital space, youknow, our providers become your
providers.
SPEAKER_02 (33:13):
It's that simple.
SPEAKER_01 (33:14):
Yep, you know, they become part of your team, um,
licensed, credentialed,privileged in your facility,
regardless of whether it's afederal, state, irrespective of
that.
And so um that helps.
Yeah.
Um, but also um, you know, we'vegot a phenomenal uh
(33:35):
implementation process, but evenbetter implementation team.
And one of the key elements ofthat whole implementation
process is change management.
And, you know, across ourorganization, helping those
local partners to um becausewe've been doing it for so long
(33:57):
across so many, you know, we'vegot so much experiential um
knowledge out there to help umthose local champions that saw
fit to have a partnership withus and uh to take that those
learnings and really help um getthose services implemented in
(34:21):
that local community.
SPEAKER_00 (34:22):
Absolutely.
When we're looking at you knowall the things from rural health
transformation, we're looking,we just talked through many of
the ways that Avel can be a partof that solution.
As now a government leader, apolicy leader, a healthcare
leader, what am I thinking aboutright now for my next steps?
Like what's going through myhead about what do I need to do
(34:44):
right now?
SPEAKER_01 (34:45):
Yeah, that's that's a great question.
And uh I uh I have thoseconversations um multiple times
a week.
I recently got just a text, uh arandom text, and hey, do you
have a second to talk?
And I said, of course.
And so I uh I uh gave him a calland he wanted to know more about
(35:08):
rural health transformation inhis state.
Okay, and the topic had come uparound um behavioral health in
particular, and one of theservices that we provide in a in
a number of states around thecountry, and and uh supposedly
there was a conversation aboutlack of access to care, local,
(35:31):
you know, not enough people tocare for the people.
Yeah, and so you know, thosetypes of questions are are
happening.
But yeah, you know, the otherside, you know, from a rural
health transformation, a lot ofthese policy makers are
fatigued.
Okay, and they're fatiguedbecause there's been such a
(35:52):
short window uh from when thelegislation was signed in July,
the notice of fundingopportunity came in in
September, the applications hadto be in in November, and then
they were they got their initialresponse back at the end of the
year, but also at the same time,everybody's calling.
(36:13):
Everybody wants to set upmeetings to talk about A, B, C,
or D.
And um, yeah, and so there's alot of public folks that have
just kind of they won't respondto their emails.
They and I've and I've heardthis locally and nationally that
uh because it is a publicprocurement process to follow
(36:37):
the process, you know, they theyneed to stay um to follow those
guidelines.
And so yeah, there's there's alittle bit of fatigue because
it's such a big topic.
Yeah.
And there's such so broad uhpockets that that organizations
and communities can can actupon.
(36:57):
And you know, like uh there's astate yesterday that um they had
a large RFP uh package come out,but it was rural hospitals,
federally qualified healthcenters, uh not-for-profits, and
one other um um one other groupof organizations that that's all
(37:19):
that they were going to fundwith that one.
So I mean they're just settingthe rules and and and and
expectations.
SPEAKER_00 (37:26):
Yeah, absolutely.
Well, and I can see why it'd befatigued because it probably
feels lonely too.
Like you don't really know howto do this.
So what is what when we arelooking at this, what does the
partnership level look like?
Or how do we make sure thatpeople can work together to
truly get what's out of thisfunding?
SPEAKER_01 (37:43):
Yeah.
Sustainability is key and havinga good partner is wildly
important.
SPEAKER_03 (37:50):
Yeah.
SPEAKER_01 (37:51):
And you know, we you know, we've got some great not
only hospital partners that wework with all every day, but we
also have some great cohortsthat we built.
Um, like Sabolo Health, um, uhphenomenal little organization
that is um you know reallyworking about changing um
(38:16):
payment methodologies, you know,how uh rural healthcare
organizations can grow andthrive and survive in these
times.
And you know, fortunate to betheir uh telemedicine partner,
and you know, they've got a bigfootprint and growing every
single day.
And so, you know, that's justone example of collaboration and
(38:38):
building cohorts um to not onlyum build on that relationship,
but also for their members.
Yeah.
And so that's an important pieceof this too, yeah, is is not
only that direct stuff that uhwe work with uh every every day
(38:59):
with with governmental entities,but it's it's those uh uh
collaborations that's gonna bekey because uh again, it's all
about sustainability.
Yeah.
And um you know, being able to,once the federal funding shuts
off in five years, yeah, youknow, continue to grow and
thrive from there.
SPEAKER_00 (39:19):
Yeah.
So let's look ahead now thatwe're talking about
sustainability in the future,and we have to keep that in
order to keep moving forward.
What does that look like ifeveryone is successful with
rural health transformation inthe next three to five years?
What does that look like?
SPEAKER_01 (39:34):
It'll be a celebration, first of all.
Um, that'll um you know, uh butagain, it depends.
It's uh, you know, I was readingrecently about um like the state
of Wyoming.
Um, they are looking at astrategy to essentially uh take
(39:56):
the funding and endow it.
SPEAKER_00 (39:58):
Okay.
SPEAKER_01 (39:59):
So it resides investing those funds, make
investing the funds into agovernment, one of their
government vehicles, but thenusing the proceeds to fund uh
activities in their state notonly over the next five years,
yeah, but also potentially umfurther down forever.
(40:21):
Yeah, okay if they invest maketheir investments right.
That's a that's a a reallyinteresting strategy.
I I know it's being um uhstrongly looked at.
I haven't uh checked this weekon on the status of that, but
you know, that's that's a veryuh thoughtful way to to consider
um the long long game and howthat plays out.
(40:45):
Uh, but also you know, itinvolves you know different uh
you know, like the work that ourpartner Sabolo does about um
payment methodologies andvalue-based um uh care uh uh
methodologies for sustainabilityafter the fact.
And so you know, I think goingback to you know, way at the
(41:08):
beginning of this, we talkedabout infrastructure.
Yeah.
And you know, virtualinfrastructure is just as
important as as brick andmortar, and be in in reality,
there's not a lot of brick andmortar in the um uh rural health
transformation can makeupgrades, but you can't build
new stuff.
Exactly.
And uh and so you know thatvirtual brick and mortar, if you
(41:32):
will, uh is a key part of that.
SPEAKER_00 (41:34):
Absolutely.
So when you've talked to all ofthese different policymakers and
you yourself in this realm, whathas made you optimistic about
this opportunity that we haveright now?
SPEAKER_01 (41:50):
A lot of things.
Um you know, going back andlooking at all those state
responses that we as anorganization have responded to
now starting to see uh somerequests for proposal, uh
requests for more informationcome out.
(42:10):
Um, that's um I'm really warmedby the fact that uh we um you
know have a a system of care, aplatform, you know, across the
care continuum, you know, fromall the way from an ambulance
pre way pre-hospital, all theway out to post-acute in the uh
(42:36):
senior care space.
Yeah.
Um you know, there's there's alot of ways in that whole
continuum that we have theability to impact care.
Absolutely.
And uh that's really that'sreally um warming, especially,
you know, all the results thatwe've been able to achieve over
(42:56):
the last few years and beingable to educate policymakers
about, you know, whether it'syou know, yes, senior care,
whether it's um school nursing,because a lot of states have uh
some element of school-basedcare in their plans.
Yeah.
Because interesting statistic.
(43:17):
And and this came to light uhwhen we were doing an RFI
recently for for a state.
67% of the kids in K-12 in thiscountry don't have a primary
care provider.
SPEAKER_00 (43:30):
67%.
SPEAKER_01 (43:32):
67%.
And so um that was really alight on because if you you know
the importance of our schoolnurse is their primary care.
Bingo.
SPEAKER_00 (43:42):
Yeah, yeah.
SPEAKER_01 (43:44):
Yeah, that's huge.
That's yes.
You know, and if we want totruly improve access to care in
rural America and K twelve, um,you know, virtual could be a uh
way to uh have.
That strong impact.
You know, the same way alongwith behavioral health.
Yeah.
(44:04):
Being able to provide those uhkiddos uh access to scheduled
therapy appointments viatelemedicine, but in the safety
and and uh and uh safesurroundings of of their school
where they're comfortable.
SPEAKER_00 (44:19):
That's awesome, very cool.
Well, you've given us a lot tothink about today.
It's been really fun speakingwith you, but before we wrap up,
we like to do really quickquestions of just give me your
shortest answer to the question,okay?
SPEAKER_01 (44:32):
So what's short?
SPEAKER_00 (44:34):
Short.
We gotta keep it nice to be.
How long have we known eachother?
Too long.
So very quick, with what's offthe top of your head.
So, what's one misconceptionpeople have about rural health
care or telemedicine that youwish more people understood?
SPEAKER_01 (44:51):
Um, we're a partner.
We um we are a partner in care.
Um we um accentuate and we'rethat combat multiplier, yeah,
we're that uh tactical advantageuh to help uh uh win this uh
battle to improve healthcare inrural America.
SPEAKER_00 (45:15):
I love that.
So if you could change one thingabout how rural health care kind
of operates today, what wouldthat be?
SPEAKER_01 (45:23):
Oh boy.
Was that in your pre-notes or isthis something you just came up
with?
SPEAKER_00 (45:32):
You'll never know.
SPEAKER_01 (45:34):
Is there one thing that I can change?
I think the one thing if I hadif I was in the legislature
again or if I was uh um doingone of those old roles uh in my
old life, I would want to changepayment methodology for EMS.
(45:55):
You know, EMS in this country iswoefully underfunded.
Um it costs, you know, and I'veseen some statistics three to
four times what it actually uhgets in reimbursement.
Yeah.
And and EMS is such a strongpart of the healthcare
(46:17):
continuum.
Um if if if I had one subjectarea that I needed to focus on,
I would probably probably dosomething about around EMS.
SPEAKER_00 (46:30):
That's interesting.
SPEAKER_01 (46:31):
Yeah.
SPEAKER_00 (46:32):
I never dived into that.
Yeah.
No, we'll have to talk aboutthat another time.
SPEAKER_01 (46:35):
Well, and it's and it's important because you know,
as we you know support so many,you know, communities around
around the upper plains with uhtelemedicine and and talk more
about sustainability.
Yeah, um, that's that's animportant piece of it.
SPEAKER_00 (46:50):
Absolutely.
Well, it's been a pleasure tospeak with you today about all
things rural healthcare, allthings that are kind of in the
government space right now toimpact that.
If there's one takeaway thatpolicy leaders, healthcare
leaders are listening to today,what would that what would you
want to give that as a takeaway?
SPEAKER_01 (47:06):
Yeah, I'm gonna go back to telemedicine is a
strategic advantage.
You know, having a virtualhealth partner with with a full
continuum of services across thehealthcare ecosystem, across the
lifespan.
Yeah.
Um, that is uh that that is umthat is transforming rural
healthcare.
(47:27):
And and you make fun of me, Iknow you do when I talk about
rural vitality.
Yeah.
Because I talk about itregularly.
SPEAKER_02 (47:34):
Yeah.
SPEAKER_01 (47:35):
But that's that's uh a key part of this whole uh our
whole being is rural vitality,you know, giving citizens in
rural America, you know, betteraccess to care, better outcomes,
better value to the taxpayer attriple A.
And so uh, you know, having avirtual health system partner
(47:56):
like Bell with that uh breadthand depth of services that we
have, um that is um a strategicadvantage.
SPEAKER_00 (48:07):
Mark, well, it's been a pleasure.
Thank you for joining us today.
All of your perspectives andyour background just really
brings light to everythingthat's going on and appreciate
you sharing all that knowledgewith us.
SPEAKER_01 (48:16):
Well, great to be here.
Great to uh be a part of theinitial uh uh version of of the
um our new podcast.
And so happy to help you uhwhenever I can.
And uh really looking forward toto learning from other uh
leaders and and uh stakeholdersthrough the organization as we
(48:38):
uh grow this new brand.
SPEAKER_00 (48:40):
Absolutely.
Thank you so much, Mark.
SPEAKER_01 (48:41):
Yeah, appreciate you.
SPEAKER_00 (48:42):
Yeah, and thank you for joining us on Avel Ecare
Virtual Health Connections.
If you found the conversationhelpful, we'd love for you to
subscribe, share it with yourcolleagues, and stay connected
with us as we continue exploringtelemedicine and the future of
healthcare delivery.
To learn more about Avel ECareand how we're supporting care
teams across the country, visitAvelecare.com.
(49:04):
Thanks again for listening.
Until next time, stay connected,
Welcome to Aval Ecare Virtual Health
Connections.
I'm Jessica Gaikowski.
Across the country, rural healthcare is at a critical moment.
Communities are facing workforceshortages, hospital closures,
and growing challenges inaccessing care.
At the same time, we're seeingsomething we haven't seen in
decades.
Significant federal investmentaimed not just at stabilizing
(00:26):
rural health care, but actuallytransforming how care is
delivered.
Today we're talking about what'schanging, what funding
opportunities exist, and whatruralcare leaders should be
thinking about right now.
Joining me today is MarkJohnston, Vice President of
Government Affairs at Aval ECare.
Mark brings nearly 30 years ofpublic service experience,
(00:48):
including military service,leadership in the South Dakota
legislature, and senior staffroles in the United States
Senate.
Today, he works withpolicymakers and healthcare
leaders across the country onsome of the biggest challenges
facing rural health care.
Mark, thanks for joining ustoday.
SPEAKER_01 (01:05):
Jess, what an absolute pleasure to be here.
And this is this is so fun.
We're kicking off the first uhfirst episode.
SPEAKER_00 (01:13):
Yeah, absolutely.
Before we really dive in, canyou kind of give us a little
more about your background andwhat really led you from working
with policymakers and governmentofficials, legislature, and now
you're out of LE Care.
SPEAKER_01 (01:24):
Yeah, it's been great.
You know, and when you were induring your opening, I just had
to take a minute to pause.
And, you know, it's uh it's beenfun.
I mean, uh, you know, from mymilitary background, you know,
retiring as a colonel overalmost 30 years to, you know,
transitioning from a full-timesoldier uh to become a
(01:49):
governor's press secretaryduring the Rounds
administration, and then uhgetting elected to the state
legislature myself, uh servinguh District 12 here in South
Dakota, uh, to then um becominga senior staffer for my old
boss, our former governor MikeRounds, uh, you know, working
(02:11):
both here in the state and inDC.
It's just it's been I've beenbeyond blessed with a whole lot
of uh great opportunities, butas my wife reminds people
regularly, I can't keep a job.
And so uh it's it's been it'sbeen a lot of fun.
You know, then a few years ago,Aval was looking for uh someone
(02:32):
to do government stuff, and uh Iwas working in DC and um you
know just figured it was time tocome home.
And uh I've known Avel foryears.
Um actually uh theirheadquarters was in my
legislative district, so I wouldregularly do meetings and
briefings and and get updatesabout the company.
(02:54):
So it was it was reallycomfortable for me uh to think
about coming and joining theorganization and you know just
think it's it's just been awhirlwind these last few four
years for us uh as a company.
Um so yeah, it's been it's beengreat and just continues to grow
and and thrive, and uh reallygrateful for the opportunity to
(03:16):
serve in leadership for theorganization and especially
during this time.
Uh, you know, there's so muchgoing on in the government
space, federal, state, local.
Um, and you know, consideringthe the uh high number of
communities uh that we serve uhwith various uh uh virtual care
(03:37):
solutions, it's it's just it'sgreat to be at Aval right now.
SPEAKER_00 (03:41):
Yeah, it is.
When you kind of hit on this,that there's a lot going on
right now, a lot of changesgoing on, a lot of cool new
initiatives going on.
When you're from yourperspective working with
policymakers, why does thismoment feel a little bit
different right now?
SPEAKER_01 (03:56):
Yeah.
Um, you know, coming out ofCOVID, uh, telemedicine was kind
of the hot topic.
Um, but then even even this pastweek when uh I was traveling and
and uh maybe explaining moreabout who Avell is uh to someone
(04:16):
that uh wasn't necessarily asfamiliar uh with the company as
as others, but it's um we'vereally just kind of exploded
after COVID.
SPEAKER_03 (04:27):
Yeah.
SPEAKER_01 (04:28):
And uh but be we we're exploding because we're
different.
SPEAKER_00 (04:32):
Absolutely.
SPEAKER_01 (04:33):
We don't do any direct to consumer.
Um somebody can't just call usup and want to schedule
anologist appointment.
Um we're you know, our with ourmodel being a
business-to-business modelsupporting hospitals, health
systems, and government uhdirectly.
(04:54):
Um we've just really beenfortunate to to have a real
strong growth spurt right nowacross our service lines.
SPEAKER_00 (05:04):
Yeah.
Absolutely.
So we've been talking aboutrural health care challenges for
a long time.
That's basically why Avel wasdeveloped in the first place.
But many leaders now are sayingthat the pressure on them feels
different and it feels like it'sheightened over the last few
years.
So, from your conversations withhospital leaders, government
(05:24):
officials, et cetera, what arethese biggest pressure points
that these rural communities arereally facing right now?
SPEAKER_01 (05:30):
You know, it's it's it's complicated.
SPEAKER_00 (05:32):
Absolutely.
SPEAKER_01 (05:32):
You know, and it depends.
Uh, every, you know, like Italked about earlier, if you've
dealt with one state, you'vedealt with one state.
If you deal with one hospital,we deal with one hospital.
But I think there's, you know,there's an underpinning of of
just some of those core thingslike uh financial sustainability
is key.
And that's why having a virtualpartner to help uh those
(05:54):
hospital leaders, you know, domore for their patients uh
through a virtual partnershiplike ours is is really key.
Uh workforce uh sustainabilityis huge in almost every part of
the country, you know,especially when you're talking
about rural and and um you knowthere's many, many, many parts
(06:18):
of this country that you knowstruggle to recruit, retain, uh,
and and keep providers uh totake care of the population.
That's that's where we being auh virtual health system that
supports these local healthcareentities or supports a
government uh with with one ofour out-of-hospital services,
(06:42):
uh, that's key.
You know, the other realimpacting element is our rural
communities are aging.
Uh and so, you know, you've gota population that is, you know,
probably born and raised andlived in these rural communities
their whole life.
And now as they get older, theythey require uh more access to
(07:04):
healthcare services.
And and that's across thecontinuum of what Avel provides
for a lot of these ruralcommunities, um, that's
attractive.
SPEAKER_00 (07:14):
Yeah.
Um can you go in a little bitmore to access and what does
that really mean?
I feel like sometimes whenpeople think of access to care,
it's like, oh, I just don't havesomeone in my community, but
sometimes it's the distance ofthat.
So can you talk a little bitabout what access to care really
means?
SPEAKER_01 (07:29):
Yeah, you know, and and that's really if you want to
get to the core of what uh Avelbegan as, and that was that was
delivering specially care outinto the country that uh created
an environment so citizensdidn't have to drive into the
(07:51):
metropolitan to get access to acardiologist or a dermatologist
or a rheumatologist, you know,pick picanologist.
And and and that's you know, allthe way dating back to 1993,
that's our core.
And so, you know, now, you know,all th more than three decades
later, it's been even moreexacerbated.
SPEAKER_03 (08:13):
Yeah, absolutely.
SPEAKER_01 (08:14):
You know, and I think about um uh uh we've got
such a strong relationship withthe Indian Health Service.
You know, super, super umgrateful for the opportunity to
support um the mission of theIHS and in the upper plains.
And you know, you know, you wantto talk about rural, you want to
(08:37):
talk about frontier.
SPEAKER_00 (08:40):
Absolutely.
SPEAKER_01 (08:40):
Uh there's a lot of miles between access points.
And so a lot of the tribalcommunities in this in the upper
plains, they don't know aprovider, especially in the
specialists, other than a vowel.
You know, we've had rel our wehave physicians and who have
(09:01):
supported uh those communitiesfor you know almost seven or
eight years, bumping up to adecade, where they've had this
patient uh providerrelationship.
It's all been virtual, butthat's all they know.
SPEAKER_03 (09:17):
Exactly.
SPEAKER_01 (09:18):
And um, and it has been absolutely warming to hear
some of those um testimonialsfrom patients uh about the value
that that virtual physician uhor virtual nurse practitioner
has on the the life of thosefolks in in rural and frontier
(09:40):
parts of the country.
SPEAKER_00 (09:41):
Absolutely.
When you've kind of hit on likethe different areas, so does
rural health care like thepremise of this look different
in different regions and states,or is the challenges that we're
seeing all the same across, ordo they look different based
upon their territory and region?
SPEAKER_01 (09:56):
Yeah, uh you know it's it's a great question.
I and and I suppose it boilsdown to the rurality.
I don't even know if that's aword, but um, you know, how you
know for for some people in someparts of the country, Sioux
Falls is rural.
SPEAKER_00 (10:14):
Absolutely.
SPEAKER_01 (10:15):
You know, and we're 260,000 people in the metro.
Yeah.
Uh, but then uh, you know, it'sit's it's different, but uh, you
know, we're we're pretty uhfortunate to live where we live
here here in in uh the SiouxEmpire and and but able to
(10:36):
radiate those services, youknow, being connected to uh
communities um throughout thecountry um with virtual
services.
SPEAKER_00 (10:45):
Absolutely.
So if we are looking at allthese different challenges, I
know they we started off withlooking at the different
pressures of them and they'vebeen increased right now.
If we don't do something rightnow to help alleviate these
pressures, what does that looklike?
SPEAKER_01 (11:02):
You can't open your news browser on any given day
and and read stories, especiallyin the healthcare space, about
um the economic challenges thatrural hospitals and healthcare
providers experience on aday-to-day basis.
SPEAKER_03 (11:18):
Yeah.
SPEAKER_01 (11:19):
And you know, going forward uh to continue to grow
and provide support to those,uh, a virtual uh partner has to
be part of the equation.
And you know, that's probablywhy we've experienced so much
growth lately, you know, overthese last few years is is uh
because of that reality thatthat all healthcare is local.
(11:44):
You know, it's it's relational,but having a partner like like a
bell to provide that greateraccess to care and and you know
provide uh pretty decent supportto those local communities is is
imperative.
SPEAKER_00 (12:01):
Absolutely.
In 2025, we passed thisbeautiful thing that everyone
likes.
Talk about the one big beautifulbill.
SPEAKER_02 (12:08):
Yeah.
SPEAKER_00 (12:09):
So if people aren't paying attention to healthcare
policy, they they may have heardof it, but they don't really
understand it.
Could you kind of give us alittle insight into what that
really evolved?
Because it's the biggest federalinvestment that we've had in
decades.
So, what does that really looklike, or what does that mean
right now when they're saying wehave this big beautiful bill?
SPEAKER_01 (12:28):
What is that?
And did you know that the onebig beautiful bill is a
nickname?
SPEAKER_00 (12:33):
Mm-hmm.
I sure did.
SPEAKER_01 (12:34):
You did?
SPEAKER_00 (12:35):
Yes.
SPEAKER_01 (12:35):
So but that's how everyone refers to it.
And that's that's the commonlyunderstood name.
Absolutely.
But um the actual legislationwas the Working Families Tax Cut
Act of 2025.
Yeah, but because it was solarge and so encompassing, uh it
uh earned the moniker of one bigbeautiful bill, but it's the
(12:57):
Working Families Tax Cut Act.
Yeah.
And because of that, you know,historically, um, you know, and
I I'm not gonna get into thepolitics of the whole thing, and
because that's not this isn'tthe time or the place.
But the reality is, you know,it's it's about it's about the
the strategy around how umfunding was uh calculated and
(13:22):
budgeted for, especially aroundMedicaid.
And you know, given the um uheconomic dynamics of the country
at the time and budgets, youknow, historically Congress had
funded Medicaid year over yearat about a five percent
increase.
SPEAKER_02 (13:40):
Okay.
SPEAKER_01 (13:40):
Well, um actually and from from a from a policy
perspective, Congress uh madethe decision to dial that back
to two and a half percent.
SPEAKER_03 (13:53):
Okay.
SPEAKER_01 (13:54):
So uh naturally that would mean reduced funding for
Medicaid because you know, intheory, there would be a reduced
need for Medicaid in the States.
Okay, but that caused a dividethat caused uh challenges,
especially in rural America,that rely on Medicaid uh funding
(14:15):
for sustainability.
Hence, a a group of um uh folksin Congress got together and
came up with this concept uh totry to offset some of those
reductions.
Hence, we got uh what we nowknow as a$50 billion
appropriation uh called theRural Health Transformation Fund
(14:39):
uh to go directly to the states,five years,$10 billion per year,
allocated um not on a per capitabasis, but um similar.
Yeah, but uh because there arerural states, you know, smaller
populations that got uh as muchmoney as a large state like
(15:04):
Texas, yeah, with a with a largepopulation.
So uh there is a difference uhon a per capita basis, but um
yeah, that's how that's how itcame to be.
SPEAKER_00 (15:14):
So when we're looking at the by state kind of
difference of that, how how dowe or how did the states kind of
come up with what they'relooking for?
Like what did that process andplanning look like?
Because you can't just get aload of money for nothing.
How did they put some initiativeor strategy around those?
SPEAKER_01 (15:30):
Yeah, that's been that's been fun.
Um I've had the really, reallygood fortune of of uh engaging
with many states um directly.
And you know, if if you look atlook at a Bell as a company, you
know, we you know, we're basedhere in the upper Midwest, but
we support uh hospitals, healthsystems, governments in 46
(15:55):
states today, you know, from thestate of Washington, California,
all the way down to Texas, allthe way up to New Hampshire,
Vermont, and Maine, and allacross.
So there's really, you know,we've we've got such a huge
footprint.
But if you focus on our core,um, you know, it's that 21, 22
(16:16):
states right down the middle ofthe country where, you know,
historically we have have beenso, so, so strong.
And so, you know, in short, toanswer your question, it
depends.
But, you know, there have beensome states that have taken a
really centralized look at this,a centralized approach, led by a
(16:38):
governor, uh led by thegovernor's office, and then
deployed it out.
Other states, they've taken amore uh by committee approach,
uh, organizing advisorycommittees of stakeholders in
that state to help uh shape theplan.
Uh and so it's it's just been awide, wide variety of strategy
(17:00):
that the states have gonethrough.
And you know, some states uhreally their hospital
association or organization ofhospitals has had a significant
role in building that plan.
Um, you know, so it it justdepends.
There's you know, some statesare totally hospital-based.
Uh there are some states thatare more balanced, there are
(17:23):
some states that are more umstructured, more less
structured.
Again, if we if we deal with onestate, we deal with one state.
SPEAKER_00 (17:32):
Absolutely.
So what when we're thinking ofwhen they came out with rural
health transformation, what wastheir original goal with that?
I know we talked about, youknow, it came from the one big,
beautiful bill, but now what istheir true goal?
What are they trying to shapehere?
SPEAKER_01 (17:46):
Well, uh, and I'm just gonna use the vernacular of
the day, make America healthyagain and make rural rural
America healthy again.
And that's that's really that'sreally uh a lot of the emphasis
of of improving healthcareoutcomes for a part of the
country that needed betteraccess to care.
SPEAKER_00 (18:05):
Yeah.
And I think it goes into thechallenges that we talked about
a little bit before, access tocare, looking at the workforce
shortages and all of those othercomponents as well.
SPEAKER_01 (18:14):
Yeah.
SPEAKER_00 (18:15):
Yeah.
SPEAKER_01 (18:15):
You know, as as a company, we you know, we I think
we did like 41 or 42 state uh weanswered 40 41 or 42 requests
for information.
SPEAKER_00 (18:30):
Yep.
SPEAKER_01 (18:30):
Uh, which is amazing.
Huge.
Yeah.
Uh it's it's been a whirlwind.
And and going back, I and Ishould have and I should have uh
uh qualified, you know, thislegislation was signed into law
in July of last year.
Yeah.
And then a notice, you know, uhreally the notice of funding
(18:51):
opportunity came out inSeptember, yeah, and states were
required to submit theiroriginal uh strategy, their
their verbiage in November.
SPEAKER_02 (19:01):
Okay.
SPEAKER_01 (19:01):
And um it was limited, it can only be so many
pages long, so many words.
And so, you know, it's this hasjust been a sprint uh over the
last number of months to get usto this point where you know
budgets were finally approved bythe Centers for Medicare and
Medicaid Services just a fewweeks ago.
(19:22):
And so it's time to go.
SPEAKER_00 (19:25):
Yeah, time to get to work.
So, what does that look like nowwhen we're saying it's time to
go?
You know, the funding has beenallocated, but now how how do we
get started?
What are those next steps?
SPEAKER_01 (19:36):
Well, um a lot of these strategies are hinged on
state procurement um rules.
So um again, and every state isdifferent.
So, you know, it's been asignificant investment to uh put
(19:57):
a team together to uh reallymanage this process to help help
our customers, help our thestates that we serve uh to get
uh new, fresh, uh transformativeideas into the marketplace on
how uh a virtual health systemcould help them um achieve their
(20:20):
goals.
You know, also there's anotherelement, and I I touched on it
earlier about about speed andabout time and and uh because
these states need wins.
You know, it's uh as we recordthis, it's the middle of March,
and you know, um you know thefederal fiscal year is coming up
(20:42):
at the end of September.
There's thresholds there, andthen additional thresholds over
the next year, and so you knowit's it uh needing to find
partners that can implementshovel ready projects.
SPEAKER_03 (20:58):
Absolutely.
SPEAKER_01 (20:59):
You know, that's that's a construction term,
obviously, but you know, it'sit's it's germane to this
discussion because um you knowwe can we can implement quickly.
SPEAKER_00 (21:09):
Absolutely.
When you hit on thetransformation, that's been a
huge word that is not that it'snew, but it's definitely been
utilized in a new perspective, Iwould say, in the last few
years.
And you know, how has Aval Ecarereally now, or how do we want to
play a part in thistransformation of the funding?
How do we become a partner withsome of these communities and
(21:30):
sites?
SPEAKER_01 (21:30):
Yeah.
If you really want to be candid,we've been doing rural health
transformation since ourinception in nineteen ninety
three.
That's how we got to be who weare.
And as we have as technology isadvanced, as services have
advanced, you know, you thinkabout starting out in specialty
(21:54):
care and doing those virtualconsults to school health, to
EMS, to Crisis care.
The list just goes on and on andon.
So you want to definetransformation?
Do a case study on a vow becausethat's what we've been doing for
our entire existence.
(22:16):
And not only on a servicesperspective, but from a
technology perspective.
And so yeah, it's uh it's a goodtime to be here.
SPEAKER_00 (22:24):
Well, I appreciate you going down the list of all
of the different services thatare provided.
Because what does that mean?
You know, some sites have oneservice line and some have
multitude.
What does that mean for someoneto really have the full
continuity of care with a Vell?
What does that really look likeand what does that mean?
SPEAKER_01 (22:43):
Yeah, that's uh that's a great question.
It's really, you know, thatreally um validates that virtual
health system concept that hasbecome so prevalent uh in being
able to support our customers,having an entire platform uh of
services available to them andbeing, you know, in in many,
(23:06):
many shapes and formtechnologically agnostic uh to
whatever that customer has uhmade a decision around for an
electronic medical record.
You know, we I think I wastalking to one of our providers
recently, and I think she saidshe had 27 different EMR
passwords.
Wow.
(23:26):
Just just because that's themany variations of of EMRs that
were out there.
And so um, yeah, that's uhthat's a great question and and
and something to just uh toponder about.
Just we're just so different.
SPEAKER_00 (23:43):
Yeah, absolutely.
So now kind of going back towith rural health
transformation, when we'relooking at everything that Avel
provides and offers, how do wenow implement some of that into
you know, getting into thefunding and working with the
states to really help them meettheir initiatives that they've
put forward?
SPEAKER_01 (24:01):
Yeah, that's a great question.
Um that keeps me up at night, tobe real honestly.
Uh you know, and and uh sleep isa premium anymore.
But um, you know, a lot of theRFPs are starting to come out
because CMS approved thefunding, and I and I mentioned
it now a lot of this depends onstate procurement laws.
(24:25):
And so, you know, there are umthere's been a great deal of of
um learning that has gone intothose processes, but also there
are just some states, it's hardum to um it's it's gonna take a
(24:47):
while for them to act on the uhpremise of rural health
transformation because in in alot of cases they've got really
arcane um procurement laws.
Uh there are some really bigstates out there that it's gonna
take months and months for themto uh uh get some of these uh
(25:12):
dollars to work, yeah.
You know, that they've beenappropriated or not
appropriated, but they've beenuh granted uh by the federal
government.
And so I'm concerned about that.
And there's some states uh wherewe have a big presence and
support lots and lots ofhospitals that that may just not
um see some of the the uh fruitsof their labors as quickly as as
(25:37):
maybe they had hoped.
SPEAKER_00 (25:39):
Yeah.
One part of that too, looking atyou know, telemedicine as a
whole, as a part of some ofthese initiatives.
I know we talked a little bitabout, you know, before COVID,
no one really talked abouttelemedicine and the impact that
it made, and then it blew up.
But we've always been around andwe've done this before.
So, what is that when we'retalking to different healthcare
(26:00):
leaders?
How does telemedicine play arole into that now versus what
it used to be?
And how does that play a roleinto this funding?
SPEAKER_01 (26:07):
Yeah.
I'm going to reflect back on mymilitary career.
And what were those, you know,tactical advantages that we had
as an organization to help us uhaccomplish the mission?
I really look at telemedicine asthat combat multiplier.
(26:30):
You know, it's it's this it's astrategy and it a strategy with
years and years of provenperformance to help a uh a uh
community, uh healthcareprovider or a government to meet
their goals uh and do it ontime, on budget, and and really,
(26:55):
you know, be there to uh helpthem achieve their mission.
SPEAKER_00 (27:00):
Yeah.
SPEAKER_01 (27:00):
That's really how I think about it.
SPEAKER_00 (27:02):
That's a cool way to think about that.
SPEAKER_01 (27:04):
Yeah, it's just uh you know that's kind of how I
was raised.
Uh, you know, I did that for along time.
So how do we accomplish themission?
And I think for a lot of thesefolks, telemedicine has a key
role to that.
SPEAKER_00 (27:18):
So for those that are still a little iffy about
this, which you don't see thatas often anymore, but there's
still some that don't love thefull aspect of that.
How do we get to them and say,how do you prove that
telemedicine can be part of thesolution as a whole?
SPEAKER_01 (27:33):
Yeah, that's great.
You know, and and one thing thatreally sets us apart from a
virtual health system is ourjoint commission accreditation.
You know, getting that uh sealof approval and and recognition
uh from a quality perspectivethat we're we're um you know a
very attractive option.
(27:53):
Yeah.
Uh, you know, super proud of ourteam and and the folks that uh
work really hard every day to uhmake sure that we uh provide the
best uh best care, best servicepossible.
Yeah.
And and that's that'ssignificant.
Um, you know, and and talking tosomebody recently uh who in the
(28:16):
government space and they had nouh previous knowledge of us.
Uh I had never met this person,but explaining to him uh uh who
we are, he he and again it's agovernment official, and he
looked me straight in the eyeand said, Sounds like we need to
be more like you.
SPEAKER_03 (28:37):
Yeah.
SPEAKER_01 (28:38):
And uh, and so I invited him to come for a visit
and and uh kick the tires andand meet the folks just to be
able to show him and show histeam uh just what a uh virtual
health system looks like.
SPEAKER_00 (28:54):
That's amazing.
SPEAKER_01 (28:55):
Yeah, it's a pretty fun combo.
SPEAKER_00 (28:56):
Absolutely.
Well, when you get to see it,it's a whole new ballgame.
SPEAKER_01 (28:59):
Yeah.
SPEAKER_00 (28:59):
Yeah.
So let's talk a little bit moreabout workforce, as that's one
of the bigger challenges.
And I think, you know, we talkedabout people are stretched
completely thin, recruitment ishard, is what we talked about
earlier.
And how do we now usetelemedicine to help extend and
support everybody rather thanyou know the opposite?
SPEAKER_01 (29:21):
Yeah, that's uh that's a super important
conversation to have because youknow, the first thing uh that a
lot of people think about isreplacing.
SPEAKER_03 (29:34):
Yeah, absolutely.
SPEAKER_01 (29:37):
You know, I'm gonna do a telemedicine partnership
and I'll that'll replace, youknow, and I won't need ABC or
whatever, whoever.
And that's 180% from the truth.
SPEAKER_02 (29:49):
Yeah.
SPEAKER_01 (29:50):
You know, we are a support system.
We provide um, you know, that'sthat's the whole premise that
this organization was built on.
But yeah, you're right.
There's just uh not enoughpeople to take care of the
people, yeah, especially inrural America.
SPEAKER_03 (30:05):
Yeah.
SPEAKER_01 (30:06):
Um, and there's if you look across the different
services that we provide, uh,it's even more exacerbated,
especially.
Well, I'll just use behavioralhealth for an example.
There's nowhere that I go aroundthe country.
Uh, even this week, uh earlierthis week, when I was, you know,
everybody wants to talk aboutyou know behavioral health
(30:29):
services.
You know, we're super blessed tohave a pretty robust uh team uh
supporting some of the smallestand some of the largest, uh,
smallest community hospitals,the largest uh tertiary,
quaternary medical centers inthe United States, uh supporting
cities, counties, states, uhacross the care continuum.
(30:53):
Yeah, you know, and and thatteam's absolutely amazing.
Yeah.
Um recently I was uh having adiscussion with a policymaker
about crisis care.
SPEAKER_03 (31:06):
Yeah.
SPEAKER_01 (31:07):
And it was in a higher populated state, and
there was some concern about uhworkforce, our workforce being
able to uh have enough people tocare for their people.
SPEAKER_03 (31:22):
Okay, yeah.
SPEAKER_01 (31:22):
And I gave the example, and uh you know, we had
uh recently an opening, we had ajob posted for uh a couple of um
behavioral health nurses tosupport our crisis care uh
service line.
And over the period of a week, aweek, we had almost 500
(31:44):
applications for those two jobs.
SPEAKER_03 (31:46):
Yeah.
SPEAKER_01 (31:47):
I mean, that's that was pretty that was pretty
telling.
You know, and um, you know, isthere risk?
Does that uh you know there'salso that takes somebody away
from a potential bedside uh job,but but it also kind of speaks
to the uh attractiveness of youknow being a part of the Aval
(32:10):
team uh and being able to takethe knowledge, skills, and
clinical capabilities of thoseindividuals and spread it out uh
to an even uh bigger umpopulation.
So yeah, workforce is is um abig, a big topic of
conversation.
SPEAKER_00 (32:28):
Yeah.
I kind of want to dive a littlebit more too about the extension
of becoming part of their teamand what that means.
Because I feel like sometimeswhen we have had an encounter,
we have a lot of off-puttingpeople that are like, you're
gonna capture everything I'mdoing and you're gonna tell me
what I'm doing wrong, or you'regonna be my big brother, and I
don't want you to be my bigbrother.
So what is that what when we saywe're an extension of your team,
(32:51):
what does that really mean?
SPEAKER_01 (32:53):
Yeah, that's you know, uh a couple of things.
First of all, and I and and andas I explain it to a lot of
folks in the in in thegovernment space or even in the
in the uh hospital space, youknow, our providers become your
providers.
SPEAKER_02 (33:13):
It's that simple.
SPEAKER_01 (33:14):
Yep, you know, they become part of your team, um,
licensed, credentialed,privileged in your facility,
regardless of whether it's afederal, state, irrespective of
that.
And so um that helps.
Yeah.
Um, but also um, you know, we'vegot a phenomenal uh
(33:35):
implementation process, but evenbetter implementation team.
And one of the key elements ofthat whole implementation
process is change management.
And, you know, across ourorganization, helping those
local partners to um becausewe've been doing it for so long
(33:57):
across so many, you know, we'vegot so much experiential um
knowledge out there to help umthose local champions that saw
fit to have a partnership withus and uh to take that those
learnings and really help um getthose services implemented in
(34:21):
that local community.
SPEAKER_00 (34:22):
Absolutely.
When we're looking at you knowall the things from rural health
transformation, we're looking,we just talked through many of
the ways that Avel can be a partof that solution.
As now a government leader, apolicy leader, a healthcare
leader, what am I thinking aboutright now for my next steps?
Like what's going through myhead about what do I need to do
(34:44):
right now?
SPEAKER_01 (34:45):
Yeah, that's that's a great question.
And uh I uh I have thoseconversations um multiple times
a week.
I recently got just a text, uh arandom text, and hey, do you
have a second to talk?
And I said, of course.
And so I uh I uh gave him a calland he wanted to know more about
(35:08):
rural health transformation inhis state.
Okay, and the topic had come uparound um behavioral health in
particular, and one of theservices that we provide in a in
a number of states around thecountry, and and uh supposedly
there was a conversation aboutlack of access to care, local,
(35:31):
you know, not enough people tocare for the people.
Yeah, and so you know, thosetypes of questions are are
happening.
But yeah, you know, the otherside, you know, from a rural
health transformation, a lot ofthese policy makers are
fatigued.
Okay, and they're fatiguedbecause there's been such a
(35:52):
short window uh from when thelegislation was signed in July,
the notice of fundingopportunity came in in
September, the applications hadto be in in November, and then
they were they got their initialresponse back at the end of the
year, but also at the same time,everybody's calling.
(36:13):
Everybody wants to set upmeetings to talk about A, B, C,
or D.
And um, yeah, and so there's alot of public folks that have
just kind of they won't respondto their emails.
They and I've and I've heardthis locally and nationally that
uh because it is a publicprocurement process to follow
(36:37):
the process, you know, they theyneed to stay um to follow those
guidelines.
And so yeah, there's there's alittle bit of fatigue because
it's such a big topic.
Yeah.
And there's such so broad uhpockets that that organizations
and communities can can actupon.
(36:57):
And you know, like uh there's astate yesterday that um they had
a large RFP uh package come out,but it was rural hospitals,
federally qualified healthcenters, uh not-for-profits, and
one other um um one other groupof organizations that that's all
(37:19):
that they were going to fundwith that one.
So I mean they're just settingthe rules and and and and
expectations.
SPEAKER_00 (37:26):
Yeah, absolutely.
Well, and I can see why it'd befatigued because it probably
feels lonely too.
Like you don't really know howto do this.
So what is what when we arelooking at this, what does the
partnership level look like?
Or how do we make sure thatpeople can work together to
truly get what's out of thisfunding?
SPEAKER_01 (37:43):
Yeah.
Sustainability is key and havinga good partner is wildly
important.
SPEAKER_03 (37:50):
Yeah.
SPEAKER_01 (37:51):
And you know, we you know, we've got some great not
only hospital partners that wework with all every day, but we
also have some great cohortsthat we built.
Um, like Sabolo Health, um, uhphenomenal little organization
that is um you know reallyworking about changing um
(38:16):
payment methodologies, you know,how uh rural healthcare
organizations can grow andthrive and survive in these
times.
And you know, fortunate to betheir uh telemedicine partner,
and you know, they've got a bigfootprint and growing every
single day.
And so, you know, that's justone example of collaboration and
(38:38):
building cohorts um to not onlyum build on that relationship,
but also for their members.
Yeah.
And so that's an important pieceof this too, yeah, is is not
only that direct stuff that uhwe work with uh every every day
(38:59):
with with governmental entities,but it's it's those uh uh
collaborations that's gonna bekey because uh again, it's all
about sustainability.
Yeah.
And um you know, being able to,once the federal funding shuts
off in five years, yeah, youknow, continue to grow and
thrive from there.
SPEAKER_00 (39:19):
Yeah.
So let's look ahead now thatwe're talking about
sustainability in the future,and we have to keep that in
order to keep moving forward.
What does that look like ifeveryone is successful with
rural health transformation inthe next three to five years?
What does that look like?
SPEAKER_01 (39:34):
It'll be a celebration, first of all.
Um, that'll um you know, uh butagain, it depends.
It's uh, you know, I was readingrecently about um like the state
of Wyoming.
Um, they are looking at astrategy to essentially uh take
(39:56):
the funding and endow it.
SPEAKER_00 (39:58):
Okay.
SPEAKER_01 (39:59):
So it resides investing those funds, make
investing the funds into agovernment, one of their
government vehicles, but thenusing the proceeds to fund uh
activities in their state notonly over the next five years,
yeah, but also potentially umfurther down forever.
(40:21):
Yeah, okay if they invest maketheir investments right.
That's a that's a a reallyinteresting strategy.
I I know it's being um uhstrongly looked at.
I haven't uh checked this weekon on the status of that, but
you know, that's that's a veryuh thoughtful way to to consider
um the long long game and howthat plays out.
(40:45):
Uh, but also you know, itinvolves you know different uh
you know, like the work that ourpartner Sabolo does about um
payment methodologies andvalue-based um uh care uh uh
methodologies for sustainabilityafter the fact.
And so you know, I think goingback to you know, way at the
(41:08):
beginning of this, we talkedabout infrastructure.
Yeah.
And you know, virtualinfrastructure is just as
important as as brick andmortar, and be in in reality,
there's not a lot of brick andmortar in the um uh rural health
transformation can makeupgrades, but you can't build
new stuff.
Exactly.
And uh and so you know thatvirtual brick and mortar, if you
(41:32):
will, uh is a key part of that.
SPEAKER_00 (41:34):
Absolutely.
So when you've talked to all ofthese different policymakers and
you yourself in this realm, whathas made you optimistic about
this opportunity that we haveright now?
SPEAKER_01 (41:50):
A lot of things.
Um you know, going back andlooking at all those state
responses that we as anorganization have responded to
now starting to see uh somerequests for proposal, uh
requests for more informationcome out.
(42:10):
Um, that's um I'm really warmedby the fact that uh we um you
know have a a system of care, aplatform, you know, across the
care continuum, you know, fromall the way from an ambulance
pre way pre-hospital, all theway out to post-acute in the uh
(42:36):
senior care space.
Yeah.
Um you know, there's there's alot of ways in that whole
continuum that we have theability to impact care.
Absolutely.
And uh that's really that'sreally um warming, especially,
you know, all the results thatwe've been able to achieve over
(42:56):
the last few years and beingable to educate policymakers
about, you know, whether it'syou know, yes, senior care,
whether it's um school nursing,because a lot of states have uh
some element of school-basedcare in their plans.
Yeah.
Because interesting statistic.
(43:17):
And and this came to light uhwhen we were doing an RFI
recently for for a state.
67% of the kids in K-12 in thiscountry don't have a primary
care provider.
SPEAKER_00 (43:30):
67%.
SPEAKER_01 (43:32):
67%.
And so um that was really alight on because if you you know
the importance of our schoolnurse is their primary care.
Bingo.
SPEAKER_00 (43:42):
Yeah, yeah.
SPEAKER_01 (43:44):
Yeah, that's huge.
That's yes.
You know, and if we want totruly improve access to care in
rural America and K twelve, um,you know, virtual could be a uh
way to uh have.
That strong impact.
You know, the same way alongwith behavioral health.
Yeah.
(44:04):
Being able to provide those uhkiddos uh access to scheduled
therapy appointments viatelemedicine, but in the safety
and and uh and uh safesurroundings of of their school
where they're comfortable.
SPEAKER_00 (44:19):
That's awesome, very cool.
Well, you've given us a lot tothink about today.
It's been really fun speakingwith you, but before we wrap up,
we like to do really quickquestions of just give me your
shortest answer to the question,okay?
SPEAKER_01 (44:32):
So what's short?
SPEAKER_00 (44:34):
Short.
We gotta keep it nice to be.
How long have we known eachother?
Too long.
So very quick, with what's offthe top of your head.
So, what's one misconceptionpeople have about rural health
care or telemedicine that youwish more people understood?
SPEAKER_01 (44:51):
Um, we're a partner.
We um we are a partner in care.
Um we um accentuate and we'rethat combat multiplier, yeah,
we're that uh tactical advantageuh to help uh uh win this uh
battle to improve healthcare inrural America.
SPEAKER_00 (45:15):
I love that.
So if you could change one thingabout how rural health care kind
of operates today, what wouldthat be?
SPEAKER_01 (45:23):
Oh boy.
Was that in your pre-notes or isthis something you just came up
with?
SPEAKER_00 (45:32):
You'll never know.
SPEAKER_01 (45:34):
Is there one thing that I can change?
I think the one thing if I hadif I was in the legislature
again or if I was uh um doingone of those old roles uh in my
old life, I would want to changepayment methodology for EMS.
(45:55):
You know, EMS in this country iswoefully underfunded.
Um it costs, you know, and I'veseen some statistics three to
four times what it actually uhgets in reimbursement.
Yeah.
And and EMS is such a strongpart of the healthcare
(46:17):
continuum.
Um if if if I had one subjectarea that I needed to focus on,
I would probably probably dosomething about around EMS.
SPEAKER_00 (46:30):
That's interesting.
SPEAKER_01 (46:31):
Yeah.
SPEAKER_00 (46:32):
I never dived into that.
Yeah.
No, we'll have to talk aboutthat another time.
SPEAKER_01 (46:35):
Well, and it's and it's important because you know,
as we you know support so many,you know, communities around
around the upper plains with uhtelemedicine and and talk more
about sustainability.
Yeah, um, that's that's animportant piece of it.
SPEAKER_00 (46:50):
Absolutely.
Well, it's been a pleasure tospeak with you today about all
things rural healthcare, allthings that are kind of in the
government space right now toimpact that.
If there's one takeaway thatpolicy leaders, healthcare
leaders are listening to today,what would that what would you
want to give that as a takeaway?
SPEAKER_01 (47:06):
Yeah, I'm gonna go back to telemedicine is a
strategic advantage.
You know, having a virtualhealth partner with with a full
continuum of services across thehealthcare ecosystem, across the
lifespan.
Yeah.
Um, that is uh that that is umthat is transforming rural
healthcare.
(47:27):
And and you make fun of me, Iknow you do when I talk about
rural vitality.
Yeah.
Because I talk about itregularly.
SPEAKER_02 (47:34):
Yeah.
SPEAKER_01 (47:35):
But that's that's uh a key part of this whole uh our
whole being is rural vitality,you know, giving citizens in
rural America, you know, betteraccess to care, better outcomes,
better value to the taxpayer attriple A.
And so uh, you know, having avirtual health system partner
(47:56):
like Bell with that uh breadthand depth of services that we
have, um that is um a strategicadvantage.
SPEAKER_00 (48:07):
Mark, well, it's been a pleasure.
Thank you for joining us today.
All of your perspectives andyour background just really
brings light to everythingthat's going on and appreciate
you sharing all that knowledgewith us.
SPEAKER_01 (48:16):
Well, great to be here.
Great to uh be a part of theinitial uh uh version of of the
um our new podcast.
And so happy to help you uhwhenever I can.
And uh really looking forward toto learning from other uh
leaders and and uh stakeholdersthrough the organization as we
(48:38):
uh grow this new brand.
SPEAKER_00 (48:40):
Absolutely.
Thank you so much, Mark.
SPEAKER_01 (48:41):
Yeah, appreciate you.
SPEAKER_00 (48:42):
Yeah, and thank you for joining us on Avel Ecare
Virtual Health Connections.
If you found the conversationhelpful, we'd love for you to
subscribe, share it with yourcolleagues, and stay connected
with us as we continue exploringtelemedicine and the future of
healthcare delivery.
To learn more about Avel ECareand how we're supporting care
teams across the country, visitAvelecare.com.
(49:04):
Thanks again for listening.
Until next time, stay connected,
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