The following transcript has been edited for length and readability. Listen to the entire discussion here on The Broadband Bunch. The Broadband Bunch is sponsored by ETI Software.
Joe Coldebella:
Hello and welcome to another episode of The Broadband Bunch. I’m Joe Coldebella, and we are at SRC Live. This event is hosted by the NTCA–The Rural Broadband Association. And joining me is the CEO of the National Rural Health Association, Alan Morgan. Alan, welcome to The Broadband Bunch.
Alan Morgan:
Joe, it’s great to join you today.
Joe Coldebella:
It’s great to have you. It’s been an absolutely fantastic fun event. What are your general impressions of it?
Alan Morgan:
Well, I think it’s an outstanding opportunity to bring together leaders from across sectors here to talk about broadband, and most importantly, how we improve the health of rural communities and communities in Rural America in general.
Joe Coldebella:
No, I totally agree. It’s one of those things where I like the fact that you are put in the sort of like in front of these folks so there is sort of an opportunity for them to get educated.
Alan Morgan:
Oh my gosh, absolutely. And I think too many times we stay within our sector, our policy bucket, and we don’t get outside and talk about education, business, telecommunications, and healthcare. I mean this is bringing them all together.
Joe Coldebella:
No, that’s the great thing about the SRC Live event. So before we dive deeper into that, I was wondering if you could sort of first give a little bit of background about yourself because I would love for the listeners to sort of learning about your journey in terms of where you are.
Alan Morgan:
Oh, absolutely. I’m originally from a small town in Northeast Kansas, Holton Kansas. Born and raised there, the fifth generation. After graduating from the University of Kansas, I worked with-
Joe Coldebella:
With the Jayhawks?
Alan Morgan:
Yeah. Thank you very much. I worked for the governor of Kansas for a couple of years and worked for a member of Congress for a couple of years. I lobbied for 10 years for healthcare interests. But for the last 20 years, I’ve been with the National Rural Health Association. I’ve really found a home with the organization.
Joe Coldebella:
And so could you sort of give us a broad brush in terms of what the organization does, who you interact with, and sort of your mission?
Alan Morgan:
Oh, absolutely. So the National Rural Health Association is really a diverse membership of individuals and organizations that all care about improving health and healthcare within Rural America. And so when I say a diverse group of individuals, I’m talking about more than 95% of the nation’s rural hospitals, rural health clinics, and rural community health centers are members. We’ve got educators that focus on rural education. We have researchers that focus on rural policy. We’ve got long-term care executives, small hospitals, CEOs, and clinicians. Literally, if you care about rural health, there’s a home for you in the National Rural Health Association.
Joe Coldebella:
That’s great, because so with such a diverse group, does that allow you to sort of find best practices that you can sort of spread to folks?
Alan Morgan:
Yeah, it’s spectacular. I like to talk about the fact that on all of my board of trustees, I have a rural nurse seated next to a hospital administrator, seated next to a state employee, and seated next to a researcher. And honestly, they may not actually like each other, but they all have a shared common interest in improving rural communities. And because of that diversity, they’re able to take on tough issues, find common ground, and really develop policies solutions, and practices going to help Rural America.
Joe Coldebella:
That’s awesome. If we could sort of taking a step back, could you sort of frame I guess where we are in regards to rural health? Are we in a good place? Are we in a bad place? Is broadband going to be a part of it? I would love for you to give a little bit of a snapshot of that.
Alan Morgan:
Wow, Joe. So it’s the best of times, but it’s the worst time in Rural America. And that’s an honest assessment. What I like about rural health today is innovation begins in these rural communities, because of a really tough patient population. They’re an older population, they’re a sicker population, they’re a poorer population, and with a higher percentage of them not having health insurance. So those most in need of healthcare services really have the fewest options available. They’re in these small towns where the healthcare system is set up for primary care and general surgery. And as a result of this, because of these pressures, you see all the innovation, which is happening in our nation’s healthcare system beginning in these rural communities. The tough situations that small towns are faced with across the country are driving innovation. So you’re seeing some amazing solutions that are going to be really rolled out and implemented across the United States as we move forward. So again, it’s a challenging time, it’s a tough time, but it’s driving amazing innovation.
Joe Coldebella:
And you know, it’s so true that rural communities are the sort of like roll up your sleeves and find an answer kind of communities. And so when you first said that, I was a little bit surprised. But then on sort of a reflection, it’s like it makes total sense. Rural communities figure out a way.
Alan Morgan:
Oh, absolutely. And let’s be honest. It doesn’t matter what you’re involved with. If you’re making a great profit margin and things are going great, you’re not going to innovate. If you’re struggling to keep your doors open and you’re really dealing with health disparities within your communities, you’re going to innovate. So you see great opportunities for expansion, broadband, and the utilization of telehealth. You see new modes and modalities for delivering healthcare. It’s just a lot of great stuff that’s happening in these small towns.
Joe Coldebella:
So obviously this is a whole new sort of area of medicine. What’s sort of been the reception? Because you hear that since it is an older community, for the most part, they might not be as open to adopting new technologies. So what’s sort of been, I guess, some of the wins and then maybe some of the challenges?
Alan Morgan:
Yeah. Yeah. And I think there’s a mixed message about adoption. I think it’s generally acknowledged by a lot of the older clinicians that are working in these small towns. They’re a little slower to adopt the technology. Let’s be honest. Is that being said, gosh, who doesn’t have an aunt or an uncle that is on Facebook nonstop posting?
I mean, everyone in Rural America that’s over the age of 60 is utilizing technology, or on Facebook or FaceTime talking to their kids somewhere else. So on one hand, you do have a community in Rural America that will try new technologies. But seeing the uptake, seeing the adoption, that being said, is still been slow going until the pandemic.
Joe Coldebella:
Well, listen, I just had a chat with Shirley. Shirley Bloomfield the CEO of NCTA. She was saying that one of the surprising results was that they thought that telemedicine was going to… They were going to see a decline. And it’s actually been the complete opposite. It’s one of those things where people are embracing it because instead of going into traveling five hours to a hospital or whatever and having a five-minute conversation with a doctor, you can be in the comfort of your home and have a 20-minute conversation and really talk about health problems or health issues.
Alan Morgan:
Yeah, yeah. It’s tough to find a silver lining to a global pandemic. Let’s be honest there. But that being said, it really has driven the change in healthcare. We’ve seen a dramatic increase in telehealth utilization and adoption. That’s great. The important thing is, are we able to maintain it going ahead? And that’s what we’re all working out right now.
Joe Coldebella:
I think that’s a reason why we’re here. That’s why I think that the NTCA is doing Smart Rural Communities. Is it because it gives these ISPs an opportunity to go to these help providers and say, “Hey, listen, we can be a conduit for you guys to serve the community better, but also to be sustaining in terms of keeping the businesses active and profitable”?
Alan Morgan:
Yes, yes, yes. How’s that for a good answer?
Joe Coldebella:
I love it. I love it.
Alan Morgan:
Yeah. Well, I mean, the challenge is… And let’s be honest, no matter what your background, you’re comfortable in what you know. The challenge that I think we have in Rural America is to make rural communities successful and viable. It means that we have to get out of our comfort zone. And so, I always say that if I’m at a rural health conference and the topic of broadband, education, housing, and transportation are not mentioned, I’m at the wrong conference. It takes all of those sectors working together. And that’s challenging. I know healthcare. I don’t know the details of broadband. Shirley does, and her members know it. Conversely though, wow, I can speak it all day long about telehealth applications and what we’re seeing in small rural hospitals and the challenge of clinical care. So how do we bring these two knowledge bases together to improve the situation among rural towns?
Joe Coldebella:
And in terms of situations, is telehealth also an opportunity to expand the opportunity for doctors or healthcare providers to reach out to specialists that patients normally wouldn’t have access to? So you’re basically making it a worldwide thing in terms of just solving problems.
Alan Morgan:
Yeah. That’s such a good point. Thank you for bringing that up, Joe. I appreciate that. I think sometimes people see telehealth as, “Well, this is a bandaid to a bad situation.” And I can’t stress enough. There are multiple situations where utilizing telehealth, you have better quality outcomes, and better patient outcomes than if you did not have that available. And so let’s unpack that a little bit. Let’s start with teleradiology. Almost every rural hospital uses teleradiology.
Joe Coldebella:
Could you expand on that? I’ve never heard that before.
Alan Morgan:
Yeah. Yeah. So whenever you see a… I mean, when you’re going in for a diagnostic procedure at a small rural hospital, they just don’t have the volume to be able to keep a radiologist on their full time.
Joe Coldebella:
Sure.
Alan Morgan:
But by using tele radiologists, they can do the diagnostics, they knew if for their community, but not have to keep full-time specialty care. And I think that’s what a lot of people, we all think about the specialty-care access where you have only 9% of the nation’s specialists practicing in Rural America where you have 20% of the population. So that’s problem number one. But number two, what I think we all want to talk about is what we think about as Jetsons healthcare, the small town doc in your home talking about primary care. That really is the change that we saw within the pandemic. How do small-town doctors be able to meet their patients in their own homes? I’m hopeful that is what we see a lot more of going forward in the future.
Joe Coldebella:
I think that is a phenomenal point because I think that we’re focusing on health, but it’s just not physical health as well. I think mental health is one of the areas that we definitely need to… Especially now, especially the way that there’s a bit of a mental health crisis. And I was talking to Shirley and she was like, “You know, sometimes folks in small communities don’t naturally want to get mental health because they don’t want other folks to see them at the office.” So telehealth opens that up for people to get help and not feel any sense of shame, which is critical.
Alan Morgan:
Oh yeah, absolutely. And really there are two issues here. One is, as you mentioned, the culture in Rural America, you just don’t want to share with your family, your friends, and your neighbors that you’re dealing with behavioral health, or mental health issues, which is a different culture than you have in urban areas. This telehealth allows you the privacy to be able to seek this care that is so, so needed right now. Number on. Number two, I will say this. Looking at the clinical outcomes, behavioral health is one area where people are more forthcoming when they’re talking to a screen.
Joe Coldebella:
Interesting.
Alan Morgan:
Actually, you can see better quality outcomes on behavioral health when you’re doing it from a telehealth perspective. They’re just open up more, they feel more comfortable. And so that’s another area where I think it’s not a replacement or not a less than. You can actually improve the quality by using this telebehavioral health.
Joe Coldebella:
That’s fascinating. Is it also maybe because you get a little bit more FaceTime with your doctors as well? So it’s not just, “Hey, let me give you a pill.” Let’s really talk about the problem because sometimes the best solution is that you just talk through it.
Alan Morgan:
Oh, absolutely. And not just a clinician to patient. This whole group therapy works spectacularly when you’re talking about telehealth applications as well too. The prevalence of behavioral health specialists in Rural America is just horrific. The fact of the matter is, you’re never going to get a board-certified psychologist into one of these small towns. You just don’t have the volume for it. But through telehealth, you can have one of the state’s top healthcare professionals beam right there to you in a small town and you’re getting a better quality of care than you would normally get.
Joe Coldebella:
Right. And then also in terms of… It’s so funny. As I’m listening to you, I’m like, “Oh, I never thought of that. I never thought of that.” So it really is we do have a greenfield opportunity here in terms of all the different things that folks can do to make telemedicine a part of rural communities.
Alan Morgan:
Oh, absolutely. Let me give one more example, but then I’ll give the cautionary tale behind this.
Joe Coldebella:
Okay. Absolutely. That’s the best way to do it.
Alan Morgan:
Yeah, I think so. One other good example is when you’re talking about diagnostic procedures like cancer screenings. The ability to use a high definition camera there in a clinic with a nurse, applying it with the cancer doc remotely, being able to actually filter out the high definition of video. You can actually get a better diagnostic impression in many cases. Number on. So that’s great. I’ve talked about how this can be as good or better. The challenge though is we don’t want to replace the current clinicians. We’re talking about expanding care. I think that’s a concern we all have going forward. We don’t want to have a situation where you have primary care clinicians beaming into a small town. And those primary care clinicians in the small town now have to lead because they don’t have the volume to stay there. At the end of the day, we have to have boots on the ground for 24/7 emergency room service. You have to have that.
Joe Coldebella:
No, that’s a fantastic point. I think with everything that we’re talking about here at the SRC Live conference, is that we need to make sure that broadband is part of the solution, not the solution. I think that you’ve done a great job of sort of like laying out, “Hey guys, this is a great opportunity, but there are also some things that we need to watch out for.” Because from your talk earlier today, it’s like there’s a bit of a crisis in terms of hospitals as well as other services. Could you talk about that a little bit, please?
Alan Morgan:
Yeah. Well, the challenge we’ve always had is the workforce in a rural component. That almost defines Rural America’s workforce shortages. On top of that, we have a rural hospital closure crisis. We’ve had 138 rural hospitals close in the last 10 years.
Joe Coldebella:
Staggering.
Alan Morgan:
It really is. And unfortunately, looking ahead the numbers, the numbers just don’t add up. And it’s important to know we’re moving out of this pandemic and we’re moving back into a situation where we were before, which is not sustainable for the future. It just isn’t. And so we have to look at options such as expanding broadband, and the utilization of telehealth to be able to bridge this gap in many cases.
Joe Coldebella:
Yeah, that definitely is daunting. In terms of your organization, obviously, you’ve got all across the country. Are you guys sort of the A/B testing? Are you doing different things? What are some of the things that you and your organization are doing to help move this problem along? Because it seems like if you’re saying we’re going to have additional closings, I think this is going to be a mission-critical problem moving forward.
Alan Morgan:
Absolutely. The problem that we face is I know this is happening in small towns across the US. But we have to understand that among these small towns, 70% of the patients that show up at the hospital are either Medicare, Medicaid, VA, or Indian Health Service. What I’m saying is you have to have a great local, state, and federal partnership here when you’re talking about these patients. No one wants a government system. But we’ve got a government system when you’re talking about 70% of the patient volume already on one of these government programs.
Joe Coldebella:
So are you saying that we almost have to adopt, and please correct me if I’m wrong, almost like triage in terms of, so you don’t stress the systems out? So before someone decides to go to the hospital, there’s a little bit of a pre-interview, so to speak, to allow a better assessment. So it’s one of those things where, “Oh, I don’t feel good.” “Well, actually this is the problem. You don’t need to go in.” Or, “Oh, I don’t feel good.” “No, you need to come straight in.”
Alan Morgan:
Yeah, I would say that. And I would expand upon that. I think there are a lot of innovative approaches that we’re working on right now across the US in involving community health workers in partnership with primary care clinicians working together with the patients. I think having trusted resources that may not have full medical certification, then partnering with the primary care clinician to say, “Do you need to go to the ER? Have you got your medicines all up to date? Do you need transportation to your checkup?” That does a better job of triage in it. But on top of that, I’m just saying that we have to make sure that both the state governments and the federal governments understand their role in making sure that we ensure access to healthcare in these small towns.
Joe Coldebella:
That’s a fantastic point. Since we’re at SRC Live, ISPs are here. What’s one or two things that you would say to those folks for them to engage with hospitals? What are some of the things that you would tell them to do?
Alan Morgan:
Oh gosh, there are so many. Okay. Let me start with three, I think, easy ones. Number one, I’m not sure that everyone recognizes that in all 50 states, there are 50 state offices of rural health. These are state employees whose only job is to ensure access to high-quality service within the rural communities in their state. They need to be reaching out, introducing themselves to the state offices of rural health so that they’re our resource. Number one. Number two, there are 43 state rural health associations. Now the state offices are state employees. They can’t lobby. The state associations lobby. And they can be lobbying on their behalf, working together towards improving state regulations and legislation to help these small towns. Number two. Number three, earlier you also had the USDA on this program. USDA has a vested interest in the future of maintaining rural hospitals across the US. And I think it’s a great opportunity for them to work both with the USDA and with the National Rural Health Association in making sure that these rural hospitals are viable and access points of care as we’re moving forward. So collaboration with USDA, my organization, the local rural hospitals, state rural health associations, and state offices of rural health, it’s all about partnerships.
Joe Coldebella:
And I think that what the ISPs, you guys, need to understand is that you’re the experts for this stuff. It’s like you’re an important cog if we’re going to solve this problem. And so it’s one of those things where don’t be afraid to be an advocate for this because it’s going to be critically important in the next few years.
Alan Morgan:
Yeah. I want to emphasize that very point. One thing that came up in the opening session where we learned that from the school administrators, the average tenure is 2.8 years. And from the hospital CEOs, it’s 2.5 years. Almost everyone in that room raised their hand earlier when I ask, “Have any of you been at your job longer than three years?” So you’re identifying who are leaders in this community that has been there for a long time. And they can serve as conveners to bring together educators, small businesses, hospitals, and elected officials to solve these problems.
Joe Coldebella:
Well, that’s a phenomenal point. Alan, it’s been so much fun just learning about it. The different points you’re bringing up, it’s really amazing how much is out there and how much… I mean, we need to educate ourselves because this problem is paramount. This, along with education are two pillars that we definitely need to focus on.
Alan Morgan:
Yeah. I appreciate the opportunity to be here. The one message I want to leave with is I really see rural communities as incubators for great models going forward. I see them being the leaders in seeing how our healthcare system is going to be structured for the future. And recognizing, yeah, they have a lot of challenges in there, but you’re going to see innovation begin in these small towns.
Joe Coldebella:
That’s great. That’s fantastic. All right. So what we like to do as we wind down the episodes is I like to ask two questions to our guests. The first question is our Back to the Future question. So, Alan, I’m going to give you the keys to the DeLorean, which I give to everybody so I’ve been-
Alan Morgan:
Oh, that’s exciting.
Joe Coldebella:
And you get to go back in time and you get to go back 5, 10, 15 years. If there was something you could tell yourself or someone else to make this journey of telehealth in rural communities a little bit easier, what’d you tell yourself?
Alan Morgan:
Oh, wow. Oh, wow. All right. So I tell myself two things. First of all, I would say, “Hey, focus on promoting, and grow your own programs in these rural communities.” And sharing the story of communities and how they need to promote healthcare as a field for kids that are in high school to get them to come back. Now, I wish I would’ve promoted that a lot more. I wish our association would’ve promoted that a lot more. On the telehealth component of it, wow. I wish I would’ve known ahead of time that a lot of the financial barriers would be removing themselves over time. And I sure wish that we would’ve done a better job on promoting regulation changes to the program. It just feels like we’ve lost 10 years that the pandemic rescued us from.
Joe Coldebella:
Right. No, those are great insights. And so I would love to ask the converse. So if I give you the crystal ball, if you could look into the future 3, 5, 7 years down the line, what do you see telehealth in Rural America? How do you see that rolling out?
Alan Morgan:
That’s a tough one. That’s a tough one. Do you know what I really think? I will be dumbfounded 10 years from now if the discussion isn’t on empowering patients to take care of their own health. I just think we’re going to see a tremendous reliance on wearable devices to allow people to monitor their own health easily. And other apps on our cell phones that don’t cost anything, don’t cost a lot of money to allow people to take ownership of their own help. And then working through broadband applications to better manage their own healthcare to really make sure that we’re keeping healthy communities and not just dealing with sick care.
Joe Coldebella:
I love that last point because I think, right, exactly. We got to make sure that when you go to the doctor, you want to be preventative care as opposed to getting instant care for a problem that you have. So a phenomenal point. And I think you’re right, that technology is going to lead the way in terms of just informing people. All the different things that are popping up are just fascinating.
Alan Morgan:
Yeah. Yeah, absolutely. Well, let’s hope. Let’s hope. Let’s check back in 10 years and see how close I was.
Joe Coldebella:
Right. Right. So what ways can folks get a hold of you if they want to learn more about yourself or your information about your organization?
Alan Morgan:
Oh, thank you for asking. Yeah, let’s do this easily. Go onto any internet search engine, Google, Yahoo, or Bing. Type in the words rural health. My organization is always the first or second site that pops up.
Joe Coldebella:
Good ranking.
Alan Morgan:
Yeah. I really like that. And on there, you can have policy, tools, resources, research, and the ability to contact me. Please, don’t hesitate to reach out to us. We want to work together to improve these rural communities.
Joe Coldebella:
Alan, this has been an absolutely phenomenal visit. Thank you so much for joining us. Thank you for coming to this event. Thank you for sharing your knowledge with these folks. And I’m really optimistic about telehealth in rural communities.
Alan Morgan:
Well, I appreciate being here and appreciate everything that everyone is doing to try to improve rural communities and rural populations. So I’ll just close by saying, go rural.
Joe Coldebella:
Hey, that’s going to do it for this episode of The Broadband Bunch. Until next time, we’ll see you later.
