ICYMI: Rural Health Transformation 2026: Turning Policy into Scalable Innovation

Health Innovation Summit ICYMI episode, features a panel on Rural Health Transformation, moderated by Avery Muse, following a DocuSign/Microsoft “Medicare Connect” demo showing verified digital ID, secure record access, consent signing, appointments, claims status, and transportation support. Panelists from HHS, CMS, cybersecurity, and DocuSign discuss rural challenges: 20% of the U.S. is rural, staffing can be 60% or less, 180+ rural hospital closures since 2010, and one-third of rural patients drive 25+ miles for care, with rural areas leading in chronic disease. They explain the $50B CMS-managed program, state applications and allocations, CMS oversight via a PMO, spending guardrails across 11 categories, and clawback authority. 

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Intro/Outro Music: See a Brighter Day/Gloria Tells
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(Episodes 1-159: Intro/Outro Music: Focal Point/Young Community
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Transcript

Yohanna: [00:00:00] A few weeks back ACT IAC held our 2026 Health Innovation Summit. On this episode of the Buzz, we showcase the discussion from that summit on Rural Health Transformation with panelists from the H-H-S-C-M-S cybersecurity and DocuSign. They highlight rural challenges like how 20% of the US is rural.

Yohanna: Staffing can be 60%. Or less. There have been 180 plus rural hospital closures since 2010, and one third of rural patients drive 25 plus miles before care. In case you missed it. Here it is. 

Ratima: And hello everyone again. Hope you all had an awesome time at the round tables. Really appreciate you being here. And, uh, hope you have also grabbed a cup of coffee or something.

Ratima: Our next panel is on Rural Health Transformation, moderated by my former [00:01:00] HHS colleague and a great friend, Avery Muse, CEO of the Muse Group. Please welcome Avery and the panelists. Take it away.

Video: Meet Julie. Julie. She's active, independent, and generally healthy. So when a hospital visit reveals a diagnosis of type two diabetes, it's a lot to take in. Overwhelmed, she turns to a new tool, the Medicare Connect app logging in via her verified ID e account. Julie instantly sees her discharge summary securely pulled from hospital records.

Video: She asks, I just got home from the hospital and have been diagnosed with type two diabetes. What should my diet and exercise look like for the next few days? Medicare Connect not only responds with evidence-based guidance, but provides a personalized wellness plan offering lifestyle tips, medication guidance, prescription updates, appointment follow-up reminders, and even a list of local [00:02:00] specialists and community resources.

Video: As she reviews her plan, an alert pops up. Her prescription is ready at CVS. At the pharmacy, Julie uses ID me to help CVS confirm her information and she pays via her digital wallet motivated. She adds a water and protein bar to her cart, a small step toward better health. Later, Julie is reminded to schedule her endocrinologist follow up.

Video: What's usually stressful is now simple. She compares providers chats with support and requests her appointment. All within the app. Sharing records is also easier. Julie opens her consent wallet where she reviews and signs to consent to share her information, including medical records, VA history, and CMS claims.

Video: No paperwork needed. The next morning. The app nudges Julie to take a short walk and suggests a healthy breakfast to pair with her medication. While eating, she sees her claim is submitted, her copay is [00:03:00] $25, and her provider has received all her records with her claim approved. The app confirms her appointment and even suggests Lyft as transportation.

Video: Parking is expensive and hard to find. Julie arrives feeling confident and prepared. Her vitals are reviewed. She's already improving as she discusses her diet and habits with the doctor. Julie admits she's been stressed at work and hasn't exercised much as they set new health goals. Julie opens her care plan.

Video: The doctor is thrilled with her progress and suggests small tweaks, more exercise supplements, and a nutrition coach. Julie updates her plan in real time, right in the app. She leaves hopeful and heads to CVS to pick up her new vitamins. Since it's close by, she decides to walk. Julie logs her activity, feeling proud, supported, and empowered with Medicare Connect.

Video: Julie's care journey is guided, personalized, and connected. [00:04:00] This is the future of healthcare, powered by data, driven by empathy, and made possible through partnership with Microsoft.

Avery Muse: All right. All right, well thank our, you guys hear me? There we go. We thank our friends for DocuSign and Microsoft for that video. Um, and we are gonna start, um, our panel will be on Rural Health Transformation. You guys heard, um, and I think one of the earlier panels, they had a few questions on rural health transformation.

Avery Muse: But we have a, a, a pretty, uh, diverse panel here to kind of look at the rural tra the impact of rural health transformation from different angles. So in, uh, if you're not tracking in July of, uh, 2025. Last year, um, a part of the big beautiful bill was $50 billion allocated for rural health transformation.

Avery Muse: So it was a part of the big beautiful bill. And today what we are gonna do is we are gonna [00:05:00] go through and kind of introduce it, dissect what that means to, um, this community. What it really means to the patients that are out there in those rural areas that are, are not, um, able to get that treatment that they need today.

Avery Muse: And, um, and just as a, we do have a, a pool going so you can dial fando how many different pronunciations of role you're gonna have today. Right. So you are gonna have, it's gonna be, it's gonna vary. But before we get started, I want the, our, um, esteem panel to, um, take 30 seconds to kind of introduce yourself.

Jennifer Wendel: Good afternoon everyone. My name is Jennifer Wendell and I am the CEO of JCW Strategic Consulting. I was previously the CIO for the Department of Health and Human Services, and prior to that the deputy CIO. I spent, um, be since 2026. I had been at the FBI for about, uh, 26 years and worked [00:06:00] through a variety of scientific and technology positions where I left there before coming to HHS as the deputy CIO.

Kate Wetherby: Hi, uh, I'm Kate Wetherby and I work at CMS. Uh, many of you know me from working for healthcare.gov. Right now I am on detail to, uh, Patrick Newbold, um, and working in his shop on it consolidation and governance processes. Um. My background is actually, I'm a clinician by trade. Um, I've been a fed, I was just talking to somebody about since 2012.

Kate Wetherby: Um, but most of my background is actually in the private sector working for private communities as well as hospitals. 

La Monte Yarborough: Uh, good afternoon. My name is La Monte Yarborough. I'm the, uh, founder and president of Chance Technologies, LLC. Um, primarily focusing on IT and cybersecurity service delivery. Uh, prior to that few months back, I was the Chief Information Security [00:07:00] Officer of Health and Human Services, as well as his acting Deputy, CIO.

La Monte Yarborough: Prior to coming into that job, I was also a CIO and, uh, acting CIO for the H-H-S-O-I-G. But prior to coming to HHSI spent some time at Department of Homeland Security at the headquarters, and I was. Sizzle there. Um, and during my tenure at h uh, DHS rather, I was also the sizzle of fema Once upon a time prior to that, I was an active duty member of the United States Army, uh, also in IT and cybersecurity.

La Monte Yarborough: I ended my career back at Fort Bel War, uh, helping to run the, uh, army, uh, emergency response team. 

MJ Jackson: Alright. And that's tough to follow. So I went to preschool in Baltimore.

MJ Jackson: Oh. My name is Michael Jackson, uh, affectionately known as mj. That really is my name. Uh, I am the global head of industries at DocuSign, uh, where we work closely with many of the agencies who are represented on this. Stage. [00:08:00] We have close relationships with every one of the federal executive departments, uh, in every one of the 50 states.

MJ Jackson: Uh, in addition to that role, I also chair the board of directors for an FQHC or federally Qualified Health Center up in Baltimore called Healthcare for the Homeless. So this topic of equitable access and improved outcomes is one that's near and dear to my heart. And I also am a proud veteran of the US Coast Guard.

MJ Jackson: So happy to be here. 

David Siegrist: Good afternoon everybody. My name is David Siegrist. I am currently the acting director for Operations Management Division for Health and Human Services, office of the Inspector General. I also work for General Services Administration as a cloud infrastructure and cybersecurity engineer.

David Siegrist: I've been involved in federal healthcare, uh, since my career began in federal government in 2005. Uh, working through State Department, providing services there, uh, VA for a number of years. Um, and I'm happy to be here to talk about, uh, how rural healthcare challenges and modernization, [00:09:00] uh, and security, uh, impact almost every citizen out there.

David Siegrist: Thank you. 

Avery Muse: All right. All right. Thanks for that introduction and, and based on our prep session, this is gonna be a lively bunch here. So if I, if I can't co control 'em, don't blame me. So, but before, before we get started, we, I want to paint a picture for you guys. So we, we hear the term role and, but do we know 20% of the nation is considered role?

Avery Muse: 20% of the US is considered role. And then staffing levels. At the rural health hospitals are often at 60% or less, 60% or less. In fact, in, uh, since 2010, over 180 hospitals have closed, rural hospitals have closed since 2010. That's how thin the operating margins are, um, at those, um, rural hospitals. And then one third of the patients.

Avery Muse: In rural areas have to drive at least [00:10:00] 25 miles for any, to get any care. So I'm, I'm just trying to paint that picture. And then, so with that, the rural, rural America leads the nation in chronic diseases. So, um, so given that, Jen, so, and I know you've been following this, uh, rural health transformation pretty closely.

Avery Muse: Um. For those hearing about it for the first time, can you explain to them in like plain terms, what is rural health transformation and uh, why did CMS create it? 

Jennifer Wendel: Definitely. So as Avery said, it was part of the big beautiful bill. It was 15 $50 billion over the next five years that CMS is responsible for managing the program across the nation.

Jennifer Wendel: So what was asked for each state throughout the United States was to put in an application. Based on their priorities and what they're seeing within their states that need to drive change and innovation for the rural [00:11:00] health community. And so the applications, they had about 52 days, I think, to write those applications and put them in for CMS to take really strict.

Jennifer Wendel: Guidelines or requirements that each state had to meet in order to determine if funding was given. So on December 29th, each state found out how much funding was. Allocated to them. And it, it was about an average of $170 million from, I think it was $147 million over to two, 280 or so million dollars for Texas.

Jennifer Wendel: And um, so right now then what happens is CMS, they set the standards and they are partnering. So this is really where there's a critical difference on how other grants have been done is CMS is set up a. Program management office, and they're partnering with the states to make sure that the initiatives that they're driving [00:12:00] forward are patient outcomes.

Jennifer Wendel: That they're focused on helping the patients in transforming rural health care so that after this funding is gone and finished in the five years, that they have SU sustainable innovation to really keep driving change. 

Avery Muse: Alright, thanks. Thanks. And, and Kate, um, you mentioned you were, um, a clinician by trade.

Avery Muse: You're c in CMS. Can you give us your perspective on, um, rural health transformation and what the program is and means from, from your viewpoint? 

Kate Wetherby: Yeah. Um, I mean, as we said, you know, rural health is so important when you think about it. I just, I actually just read something on LinkedIn that said primary care is dead.

Kate Wetherby: Which everybody here should be really scared about because when you think about rural health, and I'm the one that said I couldn't say rural, so just ignore me. Um, I'm from the Midwest man. Um, so when [00:13:00] you say, when, when you go into that situation, you already have a lot of people and we, we don't see this here, here, you know, you can walk down the street and go to CVS.

Kate Wetherby: When I am at home, when I go to visit my in-laws, they just got high speed internet. Five years ago. So how are you going to provide telehealth? You have to have, and then, and then you're saying primary care is dead. Okay. I hate to break it to everyone, but if you are a doctor in rural health, you do their primary care and you do their specialty care, and you do pediatrics, and you do trauma, and you do emergency room and you are treating your neighbor.

Kate Wetherby: Which is a really uncomfortable place to be. But you know, the picture is, is that we have to look at rural health almost in the same way we look at at underserved areas. 'cause when we think about Baltimore and we think about federally qualified health centers, it's the same kind of thing. You've [00:14:00] got patients who don't have access to a car.

Kate Wetherby: You have patients that may be unhoused. You have patients who have. Large problems, psychiatric problems, other types of problems, and they don't realize they need care. So they are not going to their primary care physician. They are getting a, you know, a trip in the ambulance to the emergency room. 'cause Friday night they didn't wanna be home alone like it is.

Kate Wetherby: It's a completely different situation than a lot of us are used to seeing. And then we're partnering with states, which is extremely important. But everybody has to remember that states. They, they've already planned all of their stuff. I mean, when I do stuff on on healthcare.gov, I have to give states an 18 month lead time.

Kate Wetherby: Wow. Yeah. For them to be able to implement the changes that I need to make when it comes to anything around Medicaid or anything where they're connecting to our systems. So we are talking about helping [00:15:00] a vulnerable population. That doesn't have a lot of help and doesn't have a lot of trust in the federal government to begin with, with states that are already overwhelmed, and, and when you, let's just talk tech for a second.

Kate Wetherby: That tech goes in the entire bucket. So everybody has to be prioritized at the same time, and we're gonna transform care. Go team. 

Avery Muse: Yeah. Yeah. That, that's good. I mean, it's, it's interesting and when we look at it, we say here in the DMV, we, we have kind of some glasses on. We see raw, we picture it a certain way, but as we, I've been engaging with some of the, the health systems out there, especially one that comes to mind in, uh, in Arizona.

Avery Muse: In the, uh, grand Canyon region, they would talk about how patience has to be transported via helicopter or mules. Right? That's not a picture you get. Right. You, we think that like, tech could solve it, all of that stuff. So, but um, so the next question is, this is kind of like a, [00:16:00] a cooperative like agreement.

Avery Muse: So the. CMS is organizing, they're standing up a whole PMO shop to be able to track it. The dollars have been as, um, you heard, will be allocated to the states, and then they also will be from the providers. So the, uh, nonprofits or health systems, different organizations will be, um, leveraging this money. So, um.

Avery Muse: For you, mj, how, how does that cooperative agreement work and what responsibilities would stay at the federal level and, and then what goes to the state and what goes to the third level in that? 

MJ Jackson: Yeah, so thank you for the question. So. I guess at the core of your question is agreement. Yeah. Right. And DocuSign.

MJ Jackson: At DocuSign, that's what we focus on. And I promise this won't be a, an infomercial, but when you think about agreements, it's really multiple parties coming together at a point in time on a set of terms. Right. And so our goal is to remove [00:17:00] the friction, remove the friction of the physical, as we call it. So all of the, the obstacles that Kate so eloquently laid out, right?

MJ Jackson: You've got providers who are under-resourced, you've got patients who are underserved and that exists everywhere. But then you add the complexity of being in a rural environment where broadband isn't accessible and, and there's just a lot of exacerbation. Of deteriorating factors that exist everywhere else, but in rural America it's even more.

MJ Jackson: It's even more so, right? Yeah. So when we come in and we say we wanna remove the friction of the physical, what we're saying is, let's take that last mile and make it as easy as possible. So the federal, obviously the federal role is to provide the funding and the resources the state comes in to. Um.

MJ Jackson: Equitably and effectively distribute those funds, and then providers take the funds and, and that's the last mile. Even if everything works in an ideal situation, what you don't want is [00:18:00] the tech to work. You don't want everything to work. But then the administrative burden not only exists, but is exacerbated when you have providers who are treating their their neighbors.

MJ Jackson: You have patients who are being transported on mules. It's very, um, it's a very sticky, a very unfortunate situation. But compliance isn't lessened. The need for consent doesn't go away. Um, enrollment is still there, right? So all of the bureaucratic administrative processes don't go away. They are also exacerbated.

MJ Jackson: And so what we say is when you. Create agreements, um, and create, I could go into a, a whole talk on that, but create means, you know, putting within parameters the fields that are necessary and easing friction so that those fields can be completed. Oftentimes, the data lives in backend systems, and so we wanna remove the friction by importing the data.

MJ Jackson: So forms are pre-populated and instead of entering data manually over and over [00:19:00] again, physicians. Who in rural areas are often also the administrative assistants or the executive assistants. Physicians can just review and confirm rather than, than pivot from one screen to another. That's creating the agreement.

MJ Jackson: Uh, and then there's committing to the agreement, right, or signing or executing. And we wanna remove friction there by ensuring that we can minimize or reduce fraud, waste, and abuse. We want signers to validate who they are before they are even given the opportunity. To sign, whether it's through a PIV card, a CAT card in the federal government or in civilian environments.

MJ Jackson: We have partners like Microsoft or id.me or Clear we want, before the screen is even presented to sign. We want to ensure that the individual is who they say they are. So these cooperative agreements, whether we're talking about. A BAA is an agreement or a consent form, or an enrollment form or an application.

MJ Jackson: We just want all agreements to be as frictionless as possible and as secure as possible so that not only are the terms agreed to, [00:20:00] but the individuals who sign them. Are who they say they are. There's more, but I'll, I'll save it for later. 

Avery Muse: Alright, thanks. Uh, Jen, so what do you, from, from your engagements, what are you saying around that?

Avery Muse: So from the agreements, as they go from the state, federal, state to local organizations and what flexibilities there at each level. 

Jennifer Wendel: Right. So I heard a saying the other day, and I thought it was really relevant to this. It was said it's the federal picks, the destination, the state picks the root in the providers.

Jennifer Wendel: Figure out how to get there. Right. So that to me is a really good way to think about it. So the, the CMS is really, they put the nofo together, they figured out the requirements. They wanna make sure how states are allocating the funds, are they, how, what outcomes are coming at it. The states have flexibilities.

Jennifer Wendel: Every state and every rural population are different, and they have different needs and different priorities and different requirements. As Kate said, they've already figured those out [00:21:00] a long time ago. So. CMS the way they wrote it gives the states the flexibility to, to, to do what they need to do in order to help their rural community in the most effective and efficient way through innovation and, and changing that.

Jennifer Wendel: And then the providers are given the accountability and the execution role, right? Like they have to make sure that they're reporting. Up to the state and to CMS to make sure that as they are implementing this, that they're not just taking dollars and falling behind schedule. Right. Every, everybody in this room has been on a project that's been behind schedule, right.

Jennifer Wendel: Or has gone off the rails. Right. If you're in it, it's happened. If you haven't, then if you're lucky. Um, but right. Like, but they really wanna make sure that. The states that CMS gives the support to the states. The states give the support to the providers so that overarchingly, it's the successful transformation and there's ways for everybody to [00:22:00] learn from one another and to have solutions that can be used across multiple health systems in multiple states.

Jennifer Wendel: Right? So that it's solution oriented. 

Avery Muse: Alright. Alright. Thanks Jen. So, Lamont, um, why does this, why does role health transformation. Raise, rise to the national infrastructure and modernization issue and not just a healthcare delivery issue? 

La Monte Yarborough: Uh, well, well, is this thing on? Can you hear me? 

Avery Muse: Yeah. 

La Monte Yarborough: Yeah, you can hear me?

La Monte Yarborough: Okay. Well, first and foremost, I, you know, rural healthcare is not insured. It's part of, uh, critical infrastructure. Uh, I think in, in many of my travels, I, I would always mention that, uh, you know, critical infrastructure is. Part of six. There are 16 critical infrastructure sectors within the United States, and the government deems tho those as anything that impacts national security, uh, national economic security, or the safety and wellbeing [00:23:00] of all Americans.

La Monte Yarborough: So if any of those sectors are impacted, um, there's a problem that we want to address. So. Within the health and public healthcare sector of which rural communities are a part of, we want to ensure that they have the re, the meaningful resources they have to solve their care concerns. So when you talk about some of the things that you mentioned before, we started, um, 140 hospital, rural hospital shutdown since 2010.

La Monte Yarborough: So where do those people go? Those people will go to their nearest, cosmopolitan and or urban community, which will use those resources. And even though those urban communities are, have more capacity or more resources, they reach maximum saturation as well. So that's an additional burden on the Cosmopolitan communities.

La Monte Yarborough: Um. As, as well as this notion of we have loved ones in rural communities, we travel through rural communities. What happens that we, if we were to travel through a community, needed healthcare [00:24:00] and it wasn't available. So that's part of the reason why notwithstanding the big, beautiful bill and the, you know, the $50 billion that are allocated to addressing this problem, this problem has existed for a very long time.

La Monte Yarborough: And I'm happy to see that things are taking place to solve the problem. 

Avery Muse: Alright, um, Kate, same question, but which your clinician had on. So that same question. Why does this rise to a national infrastructure issue versus just a healthcare, um, s delivery issue? 

Kate Wetherby: Well, because I mean, if you think about it.

Kate Wetherby: Clinicians, I mean, everywhere. Clinicians are overburdened. We've just been talking about all of that stuff. And so, but if you think about the fact that, like you said, you might have to write a donkey. I, I have never had somebody ridden a donkey to see me, but. Yeah, riding a donkey, but having to take an ambulance.

Kate Wetherby: Um, I, I worked a lot with federally qualified health [00:25:00] centers, and I know I keep bringing that up, but when we talk about rural populations, there's a lot around federally qualified health centers because what a federally qualified health center will do is it will provide complete, uh, care for that patient.

Kate Wetherby: So it will get you an Uber. Okay, we're in the middle of a rural area. We're in Appalachia, or we are in like rural Vermont. Um, again, where am I in-laws love. There might not be infrastructure, right? If there's mountains, if there's a lot of, um, you, you know, you can't lay that fiber. You don't have the infrastructure, so you can't do telemedicine.

Kate Wetherby: You live far away. You live on a ranch, you live in a tribal area, and you don't have access to an Uber or a Lyft or other types of ways where you can get to a provider. Um, so the reason that all of this is really important is because if we are talking about the health of our [00:26:00] nation, the health and safety of individuals, we start talking about chronic care, chronic conditions, a lot of things that we're seeing across a lot of individuals, just basic stuff, diabetes, heart conditions, all of the types of things that we look at care for and we see as a regular, everyday kind of situation.

Kate Wetherby: And they don't have access to those same services. So now as we look at the infrastructure across the United States, we have these places where it's completely bare. People are not getting the same types of services. They don't have the same types of opportunities. They don't have the same types of everything.

Kate Wetherby: And so. As we look at this from the federal government, we really do have to look at the infrastructure and the work across everything that we're doing to give everyone the same types of opportunities. 

Avery Muse: Alright. Alright, thank you. So, um, David, um, inevitably [00:27:00] we are in, you heard, I think throughout the day a lot of we are gonna be, technology is gonna be needed to help improve this situation, right?

Avery Muse: So, um. But technology, we, as we all know in this room, the health sector is the most susceptible to cybersecurity incidents, um, ransomware attacks. And we are going to expand that digital footprint by, with the use of technology, right? Without, you know, stopping the bleeding already, that's already, um, occurring.

Avery Muse: So where would the, the cybersecurity responsibilities lie at? At the federal, state and health system level, where do you see that? 

David Siegrist: Well, at the federal level, the federal level sets a set of standards and that the state, local and, and territorial, uh, stilt level, um, there's controls that they need to have in place to secure their areas, um, because the government can't be everywhere all at once.

David Siegrist: Uh, so the responsibilities fall down [00:28:00] onto those localized levels that are. Extremely resource constrained. That physician may not only also have to submit the information, but be responsible for ensuring the insecurity and integrity of that information being submitted at the same time. And that's a challenge for a lot of the rural areas and making sure that there is a minimal set of security standards that are applied, which is, you know, at the federal level.

David Siegrist: Here's the enclave that. The, uh, state, local, and territory levels should follow, and it's incumbent upon those localized levels to ensure that they have that in place, uh, to make sure that the, uh, information is being protected so that there is not a compromise, uh, occurring. I think at, at one point, you know you have, um, data integrity as well.

David Siegrist: Uh. To make sure that that occurs. Uh, you heard a lot about, you know, access to rural, rural healthcare. I recently turned from an overseas trip where I saw doctors actually go into [00:29:00] people's houses and treating patients. Uh, that's a thing of the past. My mom lives in a rural he healthcare area. It's 200 miles away to get to the hospital.

David Siegrist: Uh, so, uh. You need access to the right resources at the right time, and also making sure that the right people have access to it, that they're authorized access to it. So you're not providing healthcare to ineligible individuals. Uh. Where, where the biggest case for fraud is. Uh, recently in the state of Maine, there were $56 million in payments made, uh, overpayments made to ineligible individuals, uh, because of procedures that may or may not have been followed at the localized level because those controls fundamental, uh, cybersecurity controls weren't in place because, uh, the local level did not have them in place.

David Siegrist: So it's, it's, it's imperative that you look at it from a top down, bottom up approach, uh, to ensure that you have that. Available. 

Avery Muse: Alright. Alright, thank you. So Lamont, I'm pretty sure seeing and understanding [00:30:00] what's about ready to happen probably will keep you up at night as your former role as the CSO of HHS.

Avery Muse: So how would you kind of give us your perspective on. Kind of the cybersecurity challenges and how that, how we best address 'em in this scenario. 

La Monte Yarborough: Um, we, we pray, uh, I, I, I mean it, it, it may be a known within, within the health and public health care space. Um, more security events happen in that space than any other critical infrastructure.

La Monte Yarborough: The point. In my mind at least. The point being is, you know, practitioners aren't technologists, right? They're doctors and nurses and et cetera, and they are not, you know, trained in these, in these things. Not saying that they're not concerned about them. And I think there will be some degree of technical debt that hopefully education takes place at all levels.

La Monte Yarborough: Um, but there's gonna have to be a state of mindfulness to ensure that folks are at least reasonably comfortable with the technology that. That [00:31:00] they are, are leveraging. I think, um, I, I think the last metric I saw within the health and public healthcare space, every security event costs somewhere in the magnitude just shy of $12 million to clean up and, and, and being that it happens so much in that space, it's a very expensive proposition that.

La Monte Yarborough: Likely to become, you know, more expensive. But we need to keep reiterating, you know, constantly training and understanding the implications of the technologies that are being leveraged and the implications of, of not ensuring that controls are in place, uh, the kind of limit things from, from going bad. I mean, I would hope to see to the extent possible that there's some idea of a, a, a kind of foolproof measure by which.

La Monte Yarborough: Tech, uh, medical personnel can access certain, you know, technology and, and, and leave it on the technology as opposed to them having to figure out what to do and what not to do. But it's going to be a work in progress and it's gonna take a collective effort to reach that level [00:32:00] of understanding and consistency to limit, uh, you know, cybersecurity events from happening.

Avery Muse: Yeah. 

MJ Jackson: Hey, can I, sorry, can I tack on to that? Go. I think Lamont just mentioned something that's really important. When you said physicians. Are not technologists, right? And so oftentimes in rural environments, these physicians are wearing multiple hats. Like I said earlier, they, they are their own administrative assistant.

MJ Jackson: They are the clinician. They are, you know, transportation in times of house calls. And so what the worst thing that we could do is add additional layers of complexity when we are trying to simply improve outcomes. And I think one of the best things that we can do is allow processes and workflows for these clinicians.

MJ Jackson: And, and other stakeholders to leverage investments that they've already made, use tools that they're already used to using. If we can build integrations into these front, uh, application layer processes and workflows so that they don't have to learn a new system, they don't have to understand how to code in order [00:33:00] to, uh.

MJ Jackson: Pull data out of a stack of, or a repository of signed agreements or, or consent forms. I think that's one of the best steps that we can take. 

La Monte Yarborough: And part of this transformation, uh, from a federal level are baseline metrics and require reportable metrics and requirements of which cybersecurity is a prominent factor in the reporting measures, uh, as this moves forward.

La Monte Yarborough: Yep. 

Avery Muse: Alright, that's, that's a good segue into the next question. So, so guardrails. So thinking of guardrails, so typically funds like this flow to the states and they may be reallocated for, you know, other purposes other than what they were intended to. Right? So, Jen, can you talk to us about what guardrails that CMS is putting in the nofo that, um, will prevent that and what kind of measurable outcomes, what types of things they're looking for?

Avery Muse: To, um, to achieve with this? 

Jennifer Wendel: Yes. So the way the Nofo was written, there are 11 different [00:34:00] categories that the funding can be spent on. So some examples are to prevent chronic disease, to assist in workforce. Workforce shortages, it, te, and technology, which encompasses cybersecurity is one of the different categories.

Jennifer Wendel: So there's 11 different categories that the states had to write to in their application. Right? So I think what's really critical is that when those states wrote those applications, they really sort of signed the map. Right. They might not have put all the details exactly how they're gonna get there, but they basically committed to say, these are the priorities that we wanna focus.

Jennifer Wendel: And part of that is the guardrails now that CMS has to say, okay, now we know from a state perspective, how do we need to mo, sorry, from a federal perspective, how do we need to monitor the states? And right now. All of the states have now determined how much money that they have to allocate to the health systems.[00:35:00] 

Jennifer Wendel: They are putting their own guardrails in place in order to ensure that the money is spent to drive outcomes for patient care. But when you actually think about it, we, we, they can't just focus on patient outcomes, right? Because they has to focus on helping the operators. And MJ mentioned this earlier, it has to focus on.

Jennifer Wendel: The operators. The clinicians, and the patients. Because if you are now putting technology out there, that is a burden to the clinicians or to the operators. They're not gonna wanna use it and then therefore it's not gonna help the patients. But you also can't put the burden on the patient in order to drive the outcomes.

Jennifer Wendel: Right. So it's a really big balance. And so part of those guardrails is really making sure that there's a strategy and. And, and initiatives that align to those 11 categories with the oversight, and of course, of course is CMS having that PMO [00:36:00] working with the states to make sure that they are spending the money where they say they're going to, they're meeting their KPIs, they're meeting their timelines, they're measurements, and, um, that it's really driving that process.

Jennifer Wendel: And I have to just also, we talked about it earlier as. Is doing it with cybersecurity in mind, right? That's really critical that you can't think about cybersecurity at the end. It's gotta be really at the front end of the process. You know, secure by design is gotta be part of that, those overarching solutions, because if not, you're gonna fall, fall behind and you're gonna have to spend more money, which now means you're off plan, which means you're not meeting the KPIs and therefore you're in a vicious cycle.

Jennifer Wendel: A state might not be able to get the money next year. And on top of it, the way it's written, they can actually claw back money. Yeah. Which is really different aspects. So following those expectations and knowing exactly what those requirements are in the NOFO is critical for any state or any. [00:37:00] Um, company that's working in this space.

Avery Muse: Yeah. And, and thanks. And Jeanette aligns with, I think Patrick, which talks about the, the total package. So looking at it from that total experience, total package lens, um, Lamont. So the similar question, but let's dig down a little bit on the cybersecurity piece and, and get a little more specific. So you were over, it's some resources out there, right?

Avery Muse: Some programs. Um. HC three hiccup and Sure. In, in, in the C CSPs or whatever. Uh, well talk about, talk about those resources that are available that could help aligning the capabilities to, so it will help kind of prevent. Sure. People from going outta whack. 

La Monte Yarborough: Sure. I, I think the, the primary ones specifically for, and, and this includes practically everyone in the, in the public healthcare space and and beyond.

La Monte Yarborough: Uh, HHS runs what's called the Health Cybersecurity Coordination Center. It provides threat [00:38:00] intelligence, timely threat intelligence that people can track, can sign up for, um, can be part of, uh. Quarterly meetings and others, uh, that, that kind of keep you abreast of what's happening in the space by way of cybersecurity, uh, occurrences, um, and as well as the 4 0 5 D program, which is an output of the cybersecurity Act of two, uh, thousand 15.

La Monte Yarborough: Um, and it's, it's a public private. Partnership, if you will, uh, including a number of, of stakeholders to kind of discern at what level of maturity you are from a cybersecurity perspective within your environment and how you can approach it from a, from a growing and learning perspective, um, on things to track for both from a.

La Monte Yarborough: Non-technical perspective. And then there are capabilities that a more inclined technologist can, can be included in and partake in. You can even join it. Um, if you go to 4 0 5 d.gov, you can get more information. Um, we ran it for years. It's a very mature model, um, and it is [00:39:00] worthwhile for anybody in the, in the public healthcare space and and beyond, I would argue.

Avery Muse: All right, thanks. Thanks Lamont. So Kate, this for you. So from a oversight perspectives, what are the early signs on whether the execution is on a sustainable path versus creating downstream risks?

Kate Wetherby: I mean, that's a loaded question. Um, you know, I think that it, it goes to what everybody on this stage has been saying, right? Is the whole package. The problem is, is that, you know, there is this vision and there is this expectation that the federal government has put out there and states are going to create this roadmap.

Kate Wetherby: Um, and as we know. You know, some states are very big. I mean, let's take Texas, right? And you've got all of these Texas legislation is going to come up with this way of, of introducing all of these healthcare models. Um, but it depends on where you are [00:40:00] in Texas of whether it was going to work or not, right?

Kate Wetherby: Yeah. And so the really being on board and understanding what types of outcomes they are pushing towards seeing. Whether these outcomes are happening with patients, are patients being seen? You know, are the chronic conditions that we're looking for being addressed? Is the infrastructure being put in place across the entire ecosystem?

Kate Wetherby: So it's, it's really looking at it from these three different levels and saying, yes, is the outcome that the federal government is looking for happening. But you can't just look at that outcome. You have to look at those individual patient responses and the clinician responses to see if this is something that's really actually being adopt, adopted, utilized, and.

Kate Wetherby: And put in place for, as we said, the long-term transformation for the state. Because the goal is obviously to put this money out there and the state's to use this money and then have [00:41:00] something that is reusable and can be, you know, provide better patient outcomes across the entire nation, you know, continuously without having to continue to feed money into it.

Kate Wetherby: Um, and so I think that us getting it out into the states. People starting to adopt it. I mean, this is the first step, but this first year is really going to be critical in looking at these patient outcomes, looking at the clinical outcomes that we're getting to see what those adoption rates look like and whether this is actually a repeatable, usable process across the entire state and, and the outcomes that they've written.

Avery Muse: Okay. Thank you. Thank you. So David. David. So for health systems, technology partners, service providers, what does responsible execution look like in a public led partnership like RHTP? So from a technology perspective, [00:42:00] 

David Siegrist: not ending up with healthcare being compromised, I mean, uh, one of the things that we're seeing about in the news and reading about is healthcare, uh, data.

David Siegrist: Being obtained by nefarious players out there being exfiltrated to, uh, different, uh, terrorists, known terrorist organizations, uh, or for exploitation of personally, uh, personal information from people out there. Um, by a show of hands, how many people know or, or know of someone that has, has been notified of, uh, their healthcare information potentially being compromised.

David Siegrist: Okay. Pretty big show of hands out there. 

Avery Muse: Yeah. Yeah. 

David Siegrist: How do you know it's effective? You don't see those hands anymore. 

Avery Muse: Oh, alright. That's good. Good, good, good stuff. Mj, same question for you with your, um, industry hat on and, and your, uh, your, your. Fqhc, [00:43:00] FQHC, I always get the, the, the acronym messed up. But yeah, 

MJ Jackson: so I would say with both hats, the goal is to improve outcomes and then you work backwards from there.

MJ Jackson: So how do you improve outcomes without. Uh, vulnerabilities or without exacerbating existing vulnerabilities. So where we play, where DocuSign specifically plays and where we look at even at the FQHC is to eliminate administrative burdens so that the clinicians and the other stakeholders can spend their differentiated time where it matters most.

MJ Jackson: Right? And so, even though every organization is different, every rural environment is different. There are certain things that everybody is going to find benefit in having in common. One is the standardization that comes with the guidelines from the feds, right? If everybody can agree to those guidelines, whether it's cybersecurity or metrics to measure success, if we can agree to those standardizations, then I think that's a good first step.

MJ Jackson: And then next is [00:44:00] the autonomy or the flexibility to deliver care in a way that is uniquely, uh, qualified or needed in a locality. Right. And so what that looks like from a technology perspective is first, if we're, if we're gonna remove the friction of the physical, let's digitize content and workflows.

MJ Jackson: Because if the content or the the forms or agreements are digital, it's easier to store, it's easier to access, it's easier to secure, it's easy to share. And from that comes coordinated care. Uh, the next tranche is creating a single source of truth. So now that we have all of these workflows feeding into a singular repository, and against that repository, multiple stakeholders can access the data that they need when they need it, after verifying who they say they are.

MJ Jackson: And in the third tranche is to leverage. Some sort of intelligence, whether it's basic analytics or something as uh, proven ai right? To pull insights out of the aggregated repository. [00:45:00] And so that's how, from a technology perspective, we measure effectiveness. Uh, does it work? To what degree does it work?

MJ Jackson: And if you know sooner than later, if it's not working, you can shift your ali your, the allocation of your resources accordingly. 

Avery Muse: Alright. Alright. So we are coming down to our last five minutes and. I want to, I want to end it on a question of what does success look like in two or three years down the line, if the program it and gets at what it's intended to get after, what does success look like?

Avery Muse: And, and I know Jen and I, we often, often talk about having that ripple effect, right? The horizontal effect that. When you implement something for that's gonna improve patient care, it doesn't adversely impact the clinicians or the system in general. So having that horizontal impact and being able to touch, uh, the technology solution to touch four or five of [00:46:00] those 11 categories, if the solution is right, so not just, it shouldn't just check box F because for technology.

Avery Muse: So we are gonna start with David and work our way down the line, and that's where we are gonna end at. So we have, we have three, three minutes and I don't want Tima not to invite me anymore.

MJ Jackson: Good. 

Avery Muse: David, on you, what does success look like? At the end of it, two or three years would let us know that, that it's been delivered. Delivered as promised. RHDP. 

David Siegrist: L less incidents of, of healthcare being compromised from the perspective of, um, individuals not having to worry about their data right now. A lot of people are suspicious or apprehensive at, uh, their information going into some portal.

David Siegrist: And where is that information go? Once it hits the portal, uh, and is it secure? Where is my information being utilized? And I think in three years, [00:47:00] uh, de demonstrative reductions in showing how, um, the state local levels have worked with the federal government to ensure that there's more compliance and it's easier at.

David Siegrist: The physician and the clinician level for them to be able to submit that information without needing an IT degree. I think from the perspective, you know. Using commercial off the shelf systems products to enable the use of technology techno, there's people, process, and technology out there. It starts with the people in the process for the end user impact.

David Siegrist: So if you start seeing that end user impact where people are adopting the technology and adopting the processes more, there are a lot of apprehensive clinicians and doctors out there like, no, I'm not gonna use it. And to go to the local patient level, they're apprehensive about even submitting their information into any kind of portal.

David Siegrist: Uh, we've, if we've learned anything from COVID days, submitting that information and how's it being used, who's collecting [00:48:00] it? Is big brother watching me? Um, and, and what is it being used for? I think in two to three years, standardizing on those formats. Uh, utilizing and bringing rural healthcare and getting the rural healthcare areas, the support that they need to be able to do that without needing an IT degree.

David Siegrist: I think that's where you see that demonstrative progress from an IT perspective. Alright, make technology work for you, not you. Work for the technology. 

Avery Muse: Yeah. Yeah. Thanks for that, David. So, look, we have it 30 seconds each. David, then use half of you guys time. So 30 seconds, 30 seconds each down the line. Mj.

MJ Jackson: Alright, I'll, I'll quickly say, um, success looks like this, where you live shouldn't determine how long you live. Um, and what we want to do is just improve experiences and we define experiences in three discrete categories. Engagement. Engagement means, uh, intuitive experiences. It should just work. You shouldn't need a telephone book sized manual to figure out how to, how to leverage these applications.

MJ Jackson: Engagement behind the scenes, automating [00:49:00] processes and streamlining workflows. And the third is effectiveness, or more specifically concrete metrics to measure almost in real time. How effectively you are allocating your resources. 

La Monte Yarborough: Sure. I think, I think to learn from that, uh, defined outcomes, measurable outcomes, if it can't be measured, it didn't happen by and large, right?

La Monte Yarborough: So there needs to be from a, perhaps from a PMO perspective, some measurable outcomes, reporting requirements, et cetera. Um, and from a cybersecurity perspective, cyber safety is patient safety. So I hope they, they move forward with that effect. 

Kate Wetherby: They said what they said. Close this out, Jen. 

Jennifer Wendel: All right. I'll just say that patients are getting the care where they are.

Jennifer Wendel: Doctors and clinicians are not being overworked and innovation drives. Return on investment so that it can be sustainable. 

Avery Muse: Alright, thank you. And, and for [00:50:00] the record, for the record, this is probably the only panel you'll see today that did not mention the two word, two letters, ai. I did not hear it. I did not hear it.

Avery Muse: Not once today. Alright. 

Video: Thank you guys. 

Yohanna: If you're passionate about technology and eager to explore more incredible events, make sure to visit act iac.org/upcoming-events. Keep your curiosity sparked and your calendars marked. Until next time, stay inspired and connected.