Alan Helgeson (announcer):
“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.
In this episode, Courtney Collen with Sanford Health News talks with Dr. David Gifford, chief medical officer for AHCA/NCAL (American Health Care Association and National Center for Assisted Living), on the topic of how the association is advancing quality care for seniors.
Courtney Collen (host):
Dr. Gifford, it's so nice to have you.
Dr. David Gifford (guest):
Nice to meet you, Courtney.
Courtney Collen:
I'd love to start by learning more about your role as chief medical officer at the American Health Care Association and National Center for Assisted Living, and then some of your background up to this point.
Dr. David Gifford:
Well, my son often says when asked what do I do, I spend most of my time in meetings and doing email and phone calls. But really I'd say a lot of time is spent really trying to focus on how to help members address quality. And that's either through payment, regulatory measurement or quality improvement efforts.
Courtney Collen:
You recently co-authored a book about successful long-term care providers. What was your biggest takeaway or “aha” moment, if you will, that you experienced while writing this book?
Dr. David Gifford:
It was a lot of fun writing this book. And you don't get to go up and talk to people who are really doing very well and say, “Why are you so good?” And so that was a lot of fun. And you know, Good Sam was one of those in there.
The take-home message was discipline to the mission, being very mission driven and letting the mission really drive all the things you do. I conceptually understood that before the book, but it really came through in talking to everyone.
Courtney Collen:
Yeah, certainly. Thank you. What are the American Health Care Association and National Center for Assisted Living's priorities around quality care?
Dr. David Gifford:
We look at how quality of care is delivered and achieved through a wide lens. So how do we address payment policy? Because that affects quality. How do we address regulatory issues? Because that affects quality. How do we address the public reporting and five star (CMS Five-Star Quality Rating Program)? Because that affects quality. How do we do educational programs? Because that affects quality.
So we really focus on all those different areas to try to address it. Some are more directly impactful in the sense that they work closely one-on-one with a member and others. We’re working with federal agencies to try to make the changes.
Courtney Collen:
What innovation or action do you think will move the needle the most on expanding access to high-quality care?
Dr. David Gifford:
You know, what came out in the book and also in the keynote we just heard, right? The inspirational speaker Chad Foster, who's blind. It was mindset, actually. It's the mindset of how are we going to try to achieve quality and that it is achievable. And when you sort of set that aside, you're able to sort of come up with new and innovative ways to address it and how do you really use the mission and the IDT team (interdisciplinary team), the team that we have working together to address that.
And when you do that, sort of everything else sort of suddenly figures out ways to overcome all these external challenges. That as Chad Foster said in his speech, often is used as crutches to explain why we can't do what we want to do. And that really came through in the book.
Courtney Collen:
What in your eyes is the biggest threat, especially to rural communities?
Dr. David Gifford:
I think the biggest threat to rural communities, well, I'll answer it in two ways.
One is I think staffing. You know, there has been an inward migration from rural areas into cities. And the pandemic helped slow that down a bit. So I think it staved off some of the challenges in rural areas.
But I would say the other threat in the rural areas with staffing, and it's related to that, is that we're all –the different health care providers in the rural community are competing with each other for staffing and competing with each other for resources. And there needs to be a way to really come together and collaborate, to work together to try to address that and overcome some of the regulatory payment silos that have been created. And there are ways to overcome that. And I think that the biggest challenge is overcoming the sort of the siloed nature of health care and that we have.
Courtney Collen:
I appreciate that insight. Do you see access to rural care, rural health care specifically as a public health issue?
Dr. David Gifford:
Absolutely. I mean, the public in rural areas need access to care and it is threatened with closures. It's threatened with not having enough staff or qualified staff in the area. It's threatened by not having access to, you know, high bandwidth Wi-Fi that you could use telemedicine to overcome. And so I think all of those things need to sort of be addressed.
And I see the health care not as an individualistic approach where I just sort of wait for someone to come to me for care, but more as how do we take care of the whole population and then how do we design the system to do that. When you do that, it changes the dynamic and it makes it more of a public health issue than just a health care clinical issue.
Courtney Collen:
Sure. Despite the challenges of the last few years, how have you seen organizations like Good Samaritan innovate and continue to raise the bar on quality care?
Dr. David Gifford:
I think that those that are being successful, A, are really looking back and relying on their mission. And I think Good Sam has got a great mission and we actually highlight in the book a lot of what Good Sam does with their mission and everything else. So you all have it right.
I think the others, the other way is to begin to think beyond what I would term a fee for service, a per diem sort of payment approach, and begin to think about it in a more of a population health approach. So, like with Good Sam, with I-SNP (Institutional Special Needs Plan) development we've been pushing the networks and bringing providers together so we could work collaboratively together, because that's what's going to take to address the problems beginning to sort of diversify.
And I think Good Sam even did that with a partnership with Sanford and a number of other issues. So I think Good Sam is really well-positioned and is not an organization I'm actually worried about going into the future because you all really sort of get it and are always thinking about innovative ways to approach the situation.
Courtney Collen:
Wonderful to hear, Dr. Gifford. Lastly here, are you optimistic about the future of senior care? What would you say are the biggest opportunities to improve?
Dr. David Gifford:
Well, the growth of older Americans, particularly over 80, who utilize a lot of our services, is going to double or triple in the next five to 10 years. So, the demand is going to be huge. So, in that sense, there's going to be huge opportunities. And I think it's going to cause us to think about different ways of providing the care. Which I think will, in the long run will be good for that.
So I'm very sort of bullish on the future for geriatric care in America. There will be challenges but there will be high demand. And with high demand, it usually brings innovative opportunities, which are always just exciting to see.
Courtney Collen:
Absolutely. Well, we really appreciate your insight here and your time, Dr. David Gifford and all that you do. We appreciate you.
Dr. David Gifford:
Well, thank you, Courtney. Thank you.
Alan Helgeson:
You've been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series wherever you get your podcasts and at news.sanfordhealth.org.
