Today’s guest is Dr. Elisha Yaghmai, CEO of FreeState Healthcare, formerly known as Vigilias Telehealth.
Born in California, Dr. Yaghmai has lived in every major region of the United States, and logged time in Africa and Asia. He went into medicine to change the world, but found medicine changed him instead. FreeState Healthcare is his way of fighting back by bringing doctors to Rural America via telemedicine.
“How do we take the one doc and multiply their force to make them available to 20 communities simultaneously? How do we do that? Telemedicine seemed to be the answer to that question.”
Dr. Yaghmai is double-boarded in Internal Medicine and Pediatrics, and has worked in both rural Kansas and multi-hospital, tertiary referral centers. He has experience as an adult and pediatric hospitalist, urgent care physician, emergency medicine doctor, and rural primary care provider – all part of his informal master plan to learn as much as possible about as much as possible the better. Elisha believes telemedicine has the power to fundamentally change healthcare delivery for Rural America.
He completed his undergraduate work at Harvard University, earned his Masters of Public Health and Tropical Medicine at Tulane University School of Public Health and Tropical Medicine, and went to medical school at the University of Texas Southwestern Medical School of Dallas.
In this week’s episode of Rural Health Leadership Radio, we’re having a conversation with Dave Pearson, President & CEO of the Texas Organization of Rural & Community Hospitals, also known as TORCH.
TORCH is a professional association whose members consist of acute care hospitals with under 150 beds.
“…exciting things going on here and a lot of it is pointed toward that future where we're not all just doing fee-for-service healthcare anymore, we're doing something that's much larger…”
Before becoming CEO, Dave served as VP of Advocacy and Communications for six years. Prior to coming to TORCH, Dave was Director of Operations for the State Office of Rural Health. Before that he held management positions at a rural hospital co-op in Kansas and a major medical center in Kansas City.
Dave holds a Bachelors in Healthcare Administration and a Master’s in Public Administration from Texas State University. He is an ACHE Fellow and Board Certified in Healthcare Management.
Dave, his wife Laura and their two sons, David and Will, reside in Cedar Park, Texas.
In this episode of Rural Health Leadership Radio, we’re having a conversation with Lynn Barr, CEO of Caravan Health. Lynn is an energetic entrepreneur with thirty years of experience in healthcare, where she has shepherded four start-ups and twelve medical inventions through research, the FDA and on to worldwide markets.
Through Caravan Health, Lynn is a recognized leader in the development and execution of national scale programs that bring better care to patients and help health care practices succeed. Caravan Health supports more than 17,000 independent primary care providers making the transformation to value-based payments with affordable, simple solutions that achieve outstanding results. In 2015, Caravan Health ACO participants outperformed all other Medicare Accountable Care Organizations in reducing costs and improving quality.
“Leadership has a lot to do with courage. It's really about the courage to stand up and say what you believe, and to pick a path, and hope people will follow.”
While pursuing her Master’s Degree in Public Health, Lynn led the California Health IT and Exchange Strategic Planning Team under California Health and Human Services, formed the Rural Health Information Technology Consortium and assessed HIT status of California Rural and Critical Access Hospitals. She developed a $20 million rural hospital loan program with United Health Group and led 13 rural hospitals through vendor acquisition to meaningful use. While acting as the CIO of a critical access hospital, she created the National Rural Accountable Care Organization to overcome barriers for rural providers to participate in innovative payment models under healthcare reform.
The 2017 TORCH Annual Conference & Trade Show (TORCH = Texas Organization for Rural and Community Hospitals) was held in Dallas, TX, April 18 - 20. The title of the meeting was New Directions in Rural Healthcare.
“The environment for rural health, as you know, is very challenging. We have a lot of issues and things we need to think about.”
- Dave Pearson, CEO, TORCH
During the meeting, Rural Health Leadership Radio roamed the meeting rooms, hallways and exhibit hall, approaching attendees and simply asking what their key take-a-way was for the meeting. As you might imagine, there were a variety of comments from a variety of people. I hope you enjoy today’s special episode or Rural Health Leadership Radio.
You can learn more about TORCH by visiting www.torchnet.org.
Bill Jolley is Vice President for Rural Health Issues for the Tennessee Hospital Association (THA). In this role, Bill is responsible for the development and implementation of the Medicare Rural Hospital Flexibility Program and for expanding services, such as technical assistance and training, to rural hospitals.
He has won several awards, including the National Rural Health Association’s Rural Quality Award in 2007, the Rural Health Association of Tennessee’s Special Exemplary Project Award in 2006 and the Presidential Award in 2014-16. He was also presented with the Carl E. Carpenter Award by the Tennessee Primary Care Association.
“I think our rural hospitals are the cornerstones of their communities. They're such an integral part of our state's healthcare system and our healthcare system nationally.”
Bill also serves as the Executive Director of the Tennessee Rural Partnership (TRP), a subsidiary or THA. TRP’s mission is to maximize access to primary healthcare in rural and underserved areas of Tennessee through the recruitment of primary care providers and other support services.
John Barnas serves as the Executive Director of the Michigan Center for Rural Health (MCRH), a non-profit organization affiliated with Michigan State University. He has held this role since February of 2000. He also serves on the National Rural Health Association Government Affairs Committee and Medicaid Task Force.
In his current role as Executive Director of MCRH, John is responsible for the coordination of the State Office of Rural Health Program, the Flex and SHIP programs, policy, recruitment and retention services, distance education and other rural primary care and value-based programs.
“On a national level, I think with the guidance and support of NRHA, AHA, and NOSORH, we have a real good shot at continuing to be a part of the reform initiatives, improving our healthcare, succeeding in reducing costs and improving the quality of outcomes.”
Prior to working at MCRH, John was Director of Program Development at a Federally Qualified Health Center in Battle Creek, Michigan. He is also a past-president of the Technical Assistance Service Center (TASC) Advisory Council and National Organization of State Offices of Rural Health (NOSORH), and is currently a NOSORH board member.
Chris Clayton appeared as a guest on Meet the Press with Chuck Todd after the last presidential election to help explain how Donald Trump became the 45th President of the United States of America. Rural America made the difference. Chris is the Policy Editor and Interim Markets Editor for DTN/The Progressive Farmer, where he has worked since 2005. He has been recognized as writer of the year and won story of the year multiple times by American Agricultural Editors’ Association. He also won the Glenn Cunningham Agricultural Journalist of the Year Award from the North American Agricultural Journalists and served as the group’s president in 2012-13. Both The National Farmers Union and American Coalition for Ethanol have named Chris as communicator of the year.
If you close a hospital in a small town somewhere, it has a big drag on economic development, property values, things of that nature, that you're maybe not thinking about. And then just simple fact, that any kind of emergency now becomes even worse when you've got to drive longer to get some help.
In 2015, Chris self-published an e-book on Amazon entitled The Elephant in the Cornfield, the politics of agriculture and climate change, which details the debate in rural America around renewable energy, climate volatility, greenhouse gas emissions and cap-and-trade.
Joy Williams has spent the last six years working with a faith-based organization that helps improve health capacity in rural areas. Now she is writing a book about faith and patient advocacy while completing her Master’s of Divinity at Wake Forest University in Winston Salem. She has hands on experience educating rural populations on healthier living by teaching them how to grow their own food and other ways to make healthy food choices.
“I think, again, rural health is something that is a growing trend these days within public health because there's such a great need, but I know that I am invested in rural health because of what it reminds me of my childhood and of my family.”
Joy currently holds a Master’s Degree in Public Health from the University of North Carolina, Chapel Hill. Her passion for supporting people in rural areas stems from her childhood, where she grew up in farmland and helped her dad grow vegetables in their garden as a child.
Peggy Wheeler is the Vice President of the Rural Healthcare Center at the California Hospital Association. Peggy also serves on the National Advisory Committee on Rural Health and Human Services, which is an independent advisory body to the Department of Health and Human Services on issues related to how the department and its programs serve rural communities.
“Rural healthcare is an integral, vital component of all healthcare. You don't have urban healthcare without rural healthcare. It's an integral component of all healthcare in California and in the entire country.”
As Vice President of the Rural Healthcare Center at the California Hospital Association, Peggy develops, advocates and executes public policies, legislation and regulations on behalf of rural hospitals at the state and national levels. Peggy also serves as the Issue Manager for Language Access and Governance Issues, as well as Hospital-Prison issues.
Pat Schou is the Executive Director of the Illinois Critical Access Hospital Network and the Illinois Rural Community Care Organization. She was recognized for being among the Top 25 Women in Leadership for Peoria, Illinois in 2013, received a Women of Distinction award in Illinois Valley in 2013, and was recognized as the 2014 Illinois Rural Hero by the National Center for Rural Health Professions, University of Illinois School of Medicine, Rockford.
“I think the CEOs that are really excelling has to do with that they have a strong board support, they have good connectivity with their board in their community, and they have good connectivity with their medical staff.”
Pat also serves on the National Rural Health Association (NRHA) Rural Congress and Government Affairs Council, and was recently elected as NRHA Secretary. Additionally, she serves on the Accreditation Association for Hospitals/Health Systems Board, was recently Chair of the Technical Advisory Services Committee for National Rural Resource Center, and served as Co-Chair of Illinois’ State Health Improvement Plan Implementation Council from 2010-2015. She has served as Chair of the local health board for over 20 years, and is a Fellow member of the American College of Healthcare Executives.
Toniann Richard is the CEO of Health Care Collaborative of Rural Missouri (HCC). HCC is a rural health network dedicated to developing and implementing programs to respond to the health needs of local residents. Toniann also serves as the President of the Missouri Rural Health Association. Among many accomplishments, Toniann has raised more than $12 million in grant funding since 2008, that money going toward providing healthcare access to underserved populations.
“You can drive so much momentum and spirit, and sustainable systems, leadership programs and leadership teams, just by getting out of your office.”
Toriann grew up on a cattle farm in Central Kansas, which is still run by her father and brother to this day. She is an active member of her church, and a strong proponent for women in leadership. Her passion for rural health stems from roots working in the non-profit world and a desire to serve those in need.
Nikki King is an Administrative Fellow at Margaret Mary Health, a critical access hospital in Batesville, Indiana. She was raised in the coalfields of Central Appalachia, and graduated with a degree in Economics from the University of Kentucky. Nikki has combined her life experiences with formal training to help communicate the challenges facing rural America on both the regional and national stages. Recently, she has done quite a bit of research into the opiate epidemic.
“A lot of the doctors were operating under the information that it was not addictive, or at least not very addictive, so they were giving it out hand over fist, because this was the miracle pain relief, and they got a bunch of people addicted.”
Nikki recently completed her formal studies in the Masters of Health Services Administration program at Xavier University in Cincinnati, Ohio. Before entering the healthcare industry, Nikki worked for the Center of Business and Economic Research, studying economic development in Southeastern Kentucky.
Joanie Perkins serves as the Chief Compliance Officer at North Sunflower Medical Center, a critical access hospital in Ruleville, Mississippi. Her love for medicine stemmed from her mother, who worked as an emergency room registered nurse in Dayton, Ohio, and would come home and tell her children stories about what had transpired throughout her day. This sparked a love of medicine in Joanie and her 10 brothers and sisters, about half of which went into medicine themselves.
“Once I learned about the special nuances of rural healthcare and how important it was, especially across the heartland in the Midwest, I was hooked.”
Joanie has focused on rural health for the past 20 years, specializing in rural health clinics and critical access hospitals, and she has worked in healthcare management for 37 years. She formed J.P. Consulting in 1987, an organization specializing in outpatient billing and clinic start-ups. As the need for rural consulting grew, Joanie divided the business off, and now acts as the principal consultant for J.P. Consulting, working with clinics and critical access hospitals nationwide.
Joanie serves rural areas by participating in the National Rural Health Association (NRHA) Congress, the primary care Health Resources and Service Administration (HRSA) committee and the Centers for Medicare and Medicaid Services (CMS) rural focus committee.
She has presented as a rural expert on multiple subjects at the NRHA, the National Rural Health Clinic Association, the New England Rural Roundtable Conference and several state rural associations. She is a past board member and president of the Mississippi Rural Health Association, and has enjoyed facilitating a series of workshops for rural health clinics across the state of Mississippi.
Dr. Mark Hamed serves as Medical Director of the Departments of Emergency and Hospitalist Medicine at McKenzie Health System, a critical access hospital in Sandusky, Michigan. He made a huge impact on the local community when he spearheaded an “Oxy-Free” ED initiative in 2013 to combat the opiate abuse epidemic.
“You have to have a vision and a passion for what you believe in.”
Dr. Hamed serves as a faculty member at three medical schools, including Michigan State University, Central Michigan University and Wayne State University.
Raised in Metro Detroit, he attended the University of Michigan, earning a Bachelor’s Degree in Pre-Medical Biology and Health Policy Studies. He then went on to complete his Doctor of Medicine (MD), while simultaneously earning a Master of Business Administration (MBA) degree with a focus in Healthcare Management.
He completed his residency at Henry Ford Hospital in Detroit and, while he is still employed there, has decided to direct the majority of his focus toward the McKenzie Health System after gaining a great respect for the hardworking community members of the Sandusky area.
Gordon Bonnyman is co-founder of the Tennessee Justice Center, a non-profit public interest law firm serving vulnerable Tennesseans in cases involving healthcare and individual clients, many of whom reside in rural areas. Gordon has represented thousands of individual clients, and has written and lectured extensively on health policy. He has testified before Congress, argued before the Supreme Court and advised governors and legislators in several states concerning issues of health access and healthcare financing.
“It’s been a tremendous privilege to serve families that deal with just terrible misfortune, and in many cases, injustice. And the clients I serve have impressed me with their courage and their generosity of spirit, and it’s just been a great blessing. I feel like I get more from it than I put into it.”
Prior to co-founding Tennessee Justice Center, Gordon began working with the Legal Aid Society in Nashville, and has been practicing law since 1972. The Tennessee Justice Center stemmed from a Congressional action 21 years ago that prevented organizations who receive federal funding, such as the Legal Aid Society, from doing several things, including class action lawsuits or advocating on behalf of migrant workers or others who receive public assistance. This action left many vulnerable people, many of whom reside in rural America, without legal representation. As a result, the privately funded Tennessee Justice Center, along with several other independent firms throughout the country, were founded to support vulnerable populations and hold public institutions accountable.
Craig Webb is Chairman of the governing board of Kirby Medical Center, a 16-bed critical access hospital in Monticello, Illinois. Craig is originally from Springfield, Illinois, and has an extensive background in retail, holding many positions including management, marketing and ownership. Currently, Craig works in engineering, and has been on the board of Kirby Medical Center since 1993, when he was asked to join when another board member retired. He has held the role of Chairman for the past three years.
“The thing that we look forward to is people taking charge of their own healthcare, and we can help them do that.”
Kirby Hospital was originally built in 1941 when locals John and Mary Kirby left money and property to build a medical facility. It first started in an old mansion, and the new Kirby Medical Center was built in 2011. Today it is the smallest critical hospital in the state of Illinois, with two successful satellite clinics in Atwood and Cerro Gordo, Illinois.
David Frum is the CEO and president of both Bridgton and Rumford Hospitals, two critical access hospitals in Maine. Both hospitals earned the recognition of being among the top 20 critical access hospitals in 2016 by the National Rural Health Association (NRHA).
Additionally, Bridgton Hospital was named a top hospital in the small and rural category at the end of 2016 by The Leapfrog Group, an honor given to only 21 hospitals across the country. Bridgton was also the only hospital in the state of Maine to achieve top quartile performance in all four quadrants of their balanced scorecard. David emphasizes cross training and using employee’s complete skillsets to achieve organizational greatness.
"I really think, if there's a core to the secret sauce, a key ingredient, that's probably it - just thinking about who you have at the table, who's working for you and what are the skills that they might bring to the table that are over and above the department they currently sit in."
Prior to his current role, David has held multiple leadership positions. David was president and CEO of St. Catherine Regional Hospital in Charlestown, Indiana, a 96-bed facility just north of Louisville, Kentucky. David was also the Vice President of the Baptist Healthcare System in Louisville, Kentucky and Regional Vice President at CHRISTUS Spohn Health System in Corpus Christi, Texas. David has experience in hospital management, medical staff relations, business development and strategic planning. He holds a Masters in Hospital Administration from the University of Alabama at Birmingham and a Masters in Public Administration with a focus on health policy from Louisiana State University.
Les Lacy currently serves as the Vice President of Regional Operations at Great Plains Health Alliance. Great Plains Health Alliance is a non-profit organization of leased, managed and affiliated hospitals in Kansas and Nebraska committed to rural healthcare and the management of rural hospitals.
“Healthcare is a really important component for the quality of life in these small areas. It's a piece of community. It supports the economy.”
He has worked in the healthcare industry since 1977, and has worked in every area of the hospital throughout his career. Among several positions, Les has been a Registered Nurse since 1982, and operated as the Administrator of Cheyenne County Hospital for almost 20 years prior to accepting his current position. Additionally, Les has served as an examiner for the Kansas Award for Excellence, the Kansas version of the Baldridge Program and the American Hospital Association’s Regional Policy Review Board.
Michael Glasser, PhD, serves as the Associate Dean for Rural Health Professions, and is a Research Professor of Medical Sociology at the University of Illinois College of Medicine at Rockford. He helped establish the internationally recognized Rural Medical Education Program at the Rockford campus, and the interdisciplinary National Center for Rural Health Professions, a designated center of the Illinois Board of Higher Education. In 2013, he was named the George T. & Mildred A. Mitchell Endowed Professor in Rural and Family Medicine.
“In this day of technology and distance learning and all that, which is great and does help, you also have to go out into the community and actually meet the people and work with them directly.”
Dr. Glasser has served as Principal Investigator on many grants, including Export Center for Rural Health, funded by the National Institutes of Health (NIH). He has extensive research experience in the fields of rural medicine and pharmacy students’ career pathways.
Currently, Dr. Glasser directs the National Center for Rural Health Professions, and is co-director of the University of Illinois College of Medicine at Rockford Public Health Program. He is also a Co-Editor of Education for Health, an international health sciences journal. Additionally, Dr. Glasser is Co-Investigator for the University of Illinois College Hispanic Center of Excellence, created to examine and develop career opportunities in health for youth in rural areas. He has also been instrumental in establishing the Native American Pathways Program in Rockford, encouraging and supporting Native American Youth and the pursuit of health careers.
Leslie Marsh is the CEO of Lexington Regional Health Center, a critical access hospital in Lexington, Nebraska. Under Leslie’s leadership, Lexington Regional Health Center has expanded services and won numerous national awards for quality and patient satisfaction. She has led the hospital through many changes, including the addition of urgent care and family medicine clinics.
“I think that leaders must model the way, and they have to drive change.”
Leslie is a Registered Nurse with a Bachelor of Science degree in Business, a Master’s Degree in Business Administration and in Management and Health Policy from Yale University. In 2015, she was awarded the 2015 Nebraska Rural Health Achievement in Excellence and was also recognized as one of 130 “Women to Know in Hospital and Health Systems” by Becker’s Hospital Review.
Manu Khare, PhD, is a re research assistant professor at the University of Illinois College of Medicine at Rockford’s Department of Family and Community Medicine, with specific interests in obesity and chronic disease risk reduction in underserved populations and women’s health. Her research uses community-based behavioral lifestyle change interventions to motivate women by providing them with skills to increase physical activity and approved eating behaviors.
“There is a give and take between the two sides, and we are actively consciously trying to listen to what the community is saying.”
Martin MacDowell, DrPH, is a research professor at the University of Illinois College of Medicine at Rockford’s Department of Family and Community Medicine. In that role, he guides curriculum development evaluation and student education in the rural physician and pharmacy programs, and is also a faculty member in the public health program. His scholarly and consulting interests focus on program evaluation, health services research and population health epidemiologic research, and he has published over 40 peer-reviewed articles and presented at many national meetings. Prior to working for the University of Illinois, Dr. MacDowell was a tenured faculty member in Xavier University’s graduate program in health services administration.
“You begin to get this culture of health going, where people think about the importance of their behavior in relation to what happens. For a long time in the U.S., we sort of left that to the medical community, and now, a lot of evidence shows that what you do yourself has a big impact on your health.”
Together, Dr. Khare and Dr. MacDowell created Win with Wellness, a multicomponent, collaborative, community-based initiative formed to address obesity and chronic disease risk in two rural Illinois counties.
Glenn Robinson has been the President of Baylor Scott & White Medical Center – Hillcrest since September 2007. He previously held several CEO positions at hospitals in Texas, Oregon and South Carolina.
“You have got to be willing to learn from others, and then you've got to be able to pass it along.”
A Georgia native and graduate of the University of Alabama, Glenn completed graduate school at Trinity University in San Antonio, Texas.
He has more than 30 years’ experience in hospital and healthcare management, is a Fellow of the American College of Healthcare Executives, has received several professional awards and serves on a number of national and state healthcare policy boards. He also serves as an Adjunct Lecturer for both Baylor University and Trinity University and is involved in several non-profit organizations and community councils.
Terry’s role as Senior Advisor is focused on Rural Health Leadership and Policy. Terry has more than thirty years’ experience in rural health care working with rural health leaders in 47 states. He has facilitated seven national summit meetings, written dozens of published articles, led eleven national demonstration projects in rural health and helped to develop three national health care delivery models: critical access hospitals (CAH), frontier extended stay clinics (FESC) and frontier community health integration models (FCHIP).
“It's become very clear over the course of my career that leadership is the single most important determinant of success for virtually any endeavor for any organization.”
Terry served as president of the Minnesota Public Health Association, twice as president of the National Cooperative of Health Networks and was Executive Director of both the National Rural Health Resource Center and the Minnesota Center for Rural Health. He testified on a variety of health topics at Congressional committees and subcommittees at the White House and participated in numerous rural health research projects. He has been teaching management and leadership for the MBA program at The College of St. Scholastica for eleven years, and previously lectured at the University of Minnesota Medical School. Terry received the 2014 Presidents Award from the National Rural Health Association. He currently serves on the Board of Directors of the National Rural Health Accountable Care Organization.
Mike Huff is the CEO of Olney Hamilton Hospital, a critical access hospital located in Olney, Texas, which is in the north central part of Texas, about half-way between the Dallas and Amarillo. Mike has been the CEO there since 2011. Prior to that he was the President of the East Georgia Division of St. Joseph’s Health Systems in Atlanta, GA, and President & CEO of St. Joseph’s at East Georgia, a critical access hospital.
“Yogi Berra used to say, "when you come to the fork in the road, take it". That's kind of the way I feel now in this environment.”
Under Mike’s leadership, Olney Hamilton Hospital has been recognized as
In 2016 Olney Hamilton Hospital was recognized as a Top 20 Critical Access Hospital for the second year in a row.
Dr. James Michael Keegan is an infectious disease specialist with more than 25 years of experience in the medical field and serves as the PYA’s Antibiotic Stewardship Program Service Line Leader. Throughout his career of practicing medicine, Dr. Keegan has taken an active role in improving the quality of healthcare and patient outcomes by serving in numerous medical director and hospital executive leadership positions. Dr. Keegan has taken special interest in solving the negative impact of the over reliance on broad-spectrum antibiotics and has designed and implemented numerous and successful antibiotic stewardship programs (ASPs) that have shown to decrease the incidence of drug-resistant bacteria.
“When we interact with rural hospitals, particularly critical access hospitals, there’s an opportunity to influence the prescribing patterns of the whole community."
Some of the titles Dr. Keegan has held include Medical Director of Antibiotic Stewardship, Medical Director of infection control, Chief Medical Officer, & Chief Executive Officer at healthcare facilities in South Dakota. He founded a healthcare consulting firm centered around the provision of antibiotic stewardship programs for hospitals and communities across the country and is a consultant to the South Dakota Department of Health regarding antibiotic stewardship. Dr. Keegan has also served as a Clinical Associate Professor at University of South Dakota School of Medicine and authored multiple articles and publications related to antibiotic stewardship and other infectious disease-related topics.