From Policy to Patient: Closing the Gap in Rural Health Transformation

What does it actually take to turn a $50 billion federal investment into better health outcomes for rural Americans? In this episode of the Mood Health Early Innovator Podcast, host Jim Murray sits down with two leaders who have shaped technology and digital infrastructure at the highest levels of the federal government: Jennifer Wendell, former Chief Information Officer at the U.S. Department of Health and Human Services, and Avery Muse, former Executive Director of IT Services at HHS and veteran of the U.S. Capitol Police, U.S. Marshals, and the Department of Defense.

Together, they unpack the realities behind the Rural Health Transformation Program, one of the most significant federal health investments in a generation, and why funding alone won't move the needle. From the gap between policy intent and frontline execution, to the compounding challenges of data interoperability, cybersecurity risk, workforce constraints, and fragmented technology adoption, Jenn and Avery bring a rare boots-on-the-ground perspective informed by decades of operating inside the systems that others only study from the outside.

The conversation covers what makes a technology platform strategically essential versus just another point solution, why proactive population engagement is foundational before any advanced tool is layered in, and how states can avoid the pitfalls, including CMS clawback provisions, that could derail even well-intentioned transformation efforts. If you're a health system leader, state administrator, or digital health innovator trying to understand where this historic investment will succeed and where it will struggle, this episode is essential listening.

About Moodr Health

Moodr Health is an enterprise engagement platform purpose-built for Medicaid plans, rural health systems, and safety-net providers managing high-risk populations. Moodr helps care teams reach the right members at the right time through a HIPAA-compliant platform built on a healthcare CRM that integrates seamlessly with existing care delivery systems and workflows. From reducing avoidable readmissions and administrative burden to improving care plan enrollment and supporting value-based reimbursement, Moodr turns real-time insights into measurable outcomes at scale.

Learn more at www.moodrhealth.com

Transcript

SPEAKER_01 0:11

Introducing the Mooter Health Early Innovators Campaign. Innovation in healthcare doesn't just happen in boardrooms. It happens on the front lines, where organizations are doing more with less and pushing boundaries to better serve their communities. That's why Mooter Health is proud to launch the Early Innovators Campaign, a series spotlighting forward-leaning organizations and individuals who are shaping the future of behavioral health and care delivery. Over the coming weeks, we'll be featuring podcasts and conversations with leaders who are redefining what's possible. Stories from innovators in health systems, higher education, and recovery support. And insights on how new models of care are being built for equity and impact. Our early innovators are proving every day that change is possible, and we're excited to share their stories with you. So stay tuned, follow along, and meet the leaders building what's next. Welcome to Mooter Health, Early Innovator Podcast, where we highlight health leaders and stories shaping the future of digital health. I'm excited that today we will be speaking with two leaders who have deep experience overseeing technology and digital infrastructure across federal health systems. First, I'll be joined by Jennifer Wendell. Jen Wendell previously served as Chief Information Officer at the U.S. Department of Health and Human Services, where she helped oversee the department's multi-billion dollar technology portfolio and modernization strategy. Prior to that, she was a senior technology leader at the Federal Bureau of Investigation. Her career has excelled at the intersection of technology, cybersecurity, healthcare, and government operations. Jen is now using her executive technology leadership to help organizations modernize, secure, and transform their mission-critical operations. I'll also be joined by Avery Mews, who served as executive director of IT services at HHS, leading enterprise IT service delivery and operational transformation across the department. Prior to that position, Avery held roles as Deputy CIO for the U.S. Capitol Police, Chief Service Management for U.S. Marshals, and Chief Strategic Plans and Programs Integration for Defense Information Systems, which is a U.S. Department of Defense Combat Support Agency serving warfighters and national leaders. Having led digital transformation in multiple sectors, including defense, law enforcement, health, executive and legislative branches, my name's Jim Murray. I've spent a career in and around the adoption and scale of consumer technologies, and I'm currently leading commercial growth at Motor Health in provider and payer communities, engaging high-need patient member populations through proactive SMS outreach. And Motor Health's HIPAA compliant platform built on the backbone of a healthcare CRM integrates seamlessly with existing care delivery systems and workflows to enable care teams to deliver scalable, data-driven engagement across patient populations, turning real-time insights into measurable outcomes. And what we're hearing across the industry is that accelerated achievement of downstream quality, reimbursement, and health equity initiatives are interconnected and required. We found meaningful ways Motor Health helps health systems increase revenue via value-based care incentives while simultaneously reducing financial penalties surrounding avoidable readmissions. With the scale of digital health transformation efforts happening now, especially through programs like the Rural Health Transformation Program, we're trying to understand where policy investments translate into operational change and where they struggle to. We're excited to have Jen and Avery join us today to unpack what it takes to turn federal infrastructure investment rather into measurable outcomes for rural communities. After all, funding doesn't transform rural health, partnership and execution does. And why scaling these tech solutions to benefit underserved populations really matters. Jen, I'm going to start with you. And I'd love to hear from you. As far as in a system as large as HHS, how did leadership determine which populations or programs required the most urgent engagement or intervention? What data signals actually drove those priorities?

SPEAKER_00 4:47

Well, so I think one of the parts to recognize that priorities uh really across the government, HHS in particular, were not set by a single data set, right? They emerged from multi-signal issues, uh basically a model that was combined the data funding mechanism, the political alignment, and a delivery for the pathway for success. And the programs that rose to the tops where there there were multiple signals that converged simultaneously and where intervention was feasible within the policy and funding constraints, right? So multiple factors, such as did it align with the administrative priorities, was really high for making the determination uh to drive change, as well as the cost impact. And also visibility from Congress and the media. Was this a problem that was getting attention from multiple avenues and constantly getting questions uh about it? And the other area that I think is really important to focus on was the speeds for measurable impact. Often they had to take a look to see when there was an issue or a problem that needed to be addressed, how fast could there be measurable i impact, how quick or what was the ease of implementation, and how confident were they in the data that they had at hand? Right? All of those different data points played an integral part to determine what the priorities were. And they were constantly shifting, right? As you can imagine, depending on what was happening in the world, priorities had to shift, and often projects that were started had to be paused, or often projects that might not have had funding today were funded very quickly in order to drive improvement or change depending on the environment in areas of intersection that helped us drive the priorities for an organization as large as HHS. If you think about that from a perspective of working across an organization as large as HHS, there was constant change going on. And as the CIO, you had to make sure that you understood where those changes were happening and what the priorities from the administration and the political appointees were at the time that you were driving the change.

SPEAKER_01 7:09

Well, I think today we're gonna address a number of those intersections where those transition points occurred. Federal investment for sure. It's a great opportunity, I think, for us to shift to Avery then and talk about operational reality versus the policy design. Avery, when large federal programs design engagement or care workflows, where have you seen the biggest gap between what leadership intends and what frontline teams can realistically execute? I'd love to hear your perspective on how these types of initiatives actually play out on the ground. And if you can tie it into the rural health systems, given the program that's at foot right now, specifically, what tends to be the biggest constraints on delivering care at scale?

SPEAKER_02 7:55

Yeah, thanks, Jen. And thanks for having us then. Again, as Jen mentioned, as you mentioned in our introduction, being at HHS at the department level, and just a slight adjustment to what you said there. So HHS, most people don't realize that HHS is the largest organization, federal organization has the largest operating budget of all federal government. And actually, the IT enterprise that Jen, who was our overseeing and I was kind of charged with operating is a $9 billion IT enterprise. So lots of change, lots of policy there. And what you commonly see there when it comes to kind of the policy when it the rubber meets the road with the execution of it, is that you you see there's always a tension between what's intended and what's the how to execute it and get it done. So throughout my career, I operated from this like basic framework that I learned from an army colonel that I work for, and it's understanding the specified outcome. So what's the commander's intent, what's specified, but then you have to go a step further when you look at executing. You look at the implied steps that you need to take to get to that end state, right? So a lot of times those things aren't spelled out, and you have to understand like what are the realities on the ground, right? Versus kind of what the vision is from the policy or from the legislators, right? So understanding that and being able to tie those together by understanding the specified and implied tasks is key. And that helps you develop kind of an execution strategy from my perspective. So from raw health transformation perspective, we've been meeting with the states and health leaders in health systems. And a lot of what we're seeing is the, of course, the common thing is resource constraints, uh, technical debt that's been built up over years. So in the elephant in the room is really policy that there's also policy out there that's made some significant cuts to Medicare and Medicaid, right? So everyone's saying, okay, it's a $50 billion rural health transformation, dollars for rural health transformation, which is great, right? It's a once-in-a-lifetime opportunity. But on the other hand, you have these Medicare Medicaid cuts. So what we're finding is uh people are somewhat paralyzed, right? They're paralyzed, they're they're spending, or in the rural community, they're spending their time keeping the lights on, right? Keeping the patients alive, and they don't have time to pivot and understand kind of the requirements from the federal program to get the implement it, to get to implementation. So we are uh here to help with some of that, right? Help translate what the federal government uh is looking for to how the states operationalize it and then how the uh health systems execute it.

SPEAKER_01 11:07

So as far as then the rural health systems, uh would you say that it's not necessarily one thing that coordination, funding, resource, how about data visibility?

SPEAKER_02 11:19

Are they all compound this yes, it's it's all compounded. So when you uh based on my background, so I look at things from a total experience lens, right? So and that's one of the reasons why we um develop rural health unlocked, right? Unlocked is the you is for unified experiences, right? So where you look at the clinician experience, the patient experience, and the system experience. So making sure that anything that we implement should not uh adversely impact another area, right? So we have to look at it holistically across the board and then with all of those things together. So you have to look at the data, you have to look at cybersecurity, right? So as technology is being rolled out to help these rural communities, one of the things we can't lose sight of is that the health sector is the most vulnerable sector from cybersecurity perspective, right? So that has to be first and foremost. So if it's already most vulnerable, and then we're gonna um expand in that, then that's gonna get exacerbated, right? So how do we make sure that um solutions are secure by design and that we understand the impact horizontally and not just from a vertical stovepipe? And I also look at, so with the funding, there's 11 use of fund categories, right? And only one F, letter F is for IT technology, for technology innovation. But we shouldn't be just checking that box F. Anything technology that's to be delivered should have a horizontal impact and should check multiple boxes, right? So and from the Muse group, they should check five or six of those boxes from the impact perspective, not just the technology box.

SPEAKER_01 13:08

Then again, if I could come back to you, um, cross-HHS ecosystem, how connected are the systems that are responsible for identifying needs and triggering outreach, tracking outcomes? Is that true?

SPEAKER_00 13:22

So the challenge isn't whether they can identify the needs, right? They can. I think HHS holistically is really good from an ecosystem perspective at detecting high-risk populations using the claims data, the public health signals, and program reporting. You think about all the different operating divisions within HHS from CMS and CDC. And so from the outside, it really looks like a highly connected ecosystem. And there are integrated dashboards that track cost trends and outcome gaps and access issues. But that integration layer often is um at a reporting layer and not at an at an operational layer, which means that it relies on coordination. And so with the rural health transformation program, what I think CMS is doing is try they're trying to do that differently from the connection and the connectivity and the engagement piece. They are really working with the states and the public health stations to make sure that this effort is happening through a coordinated effort. They identify the need and the gap, but they're also making sure that through reporting requirements, that the program is has outreach, it has engagement, it has follow through, previously had been fragmented, but and you know, that fragmentation led to delays or duplicated re-outreach or missed engagement entirely. And so through this RHTP and the way they wrote the no-fo, I think they're really trying to change the game on how they're tracking the outcomes and how they're working with the states. They're giving the states the ability to make the change that's needed with their own environment. Um, so they're giving them flexibility, but then they're also making sure that they're held accountable to show that outcome difference. Because when you think about the ecosystem from the Department of Health, that really is every American, right? And how their health is affected through the service that that the health facilities provide.

SPEAKER_01 15:29

Do we is it a risk? Do we risk having 50 states doing things 50 different ways?

SPEAKER_00 15:37

Well, I think that is definitely an area that with us, with the Muse Group, we've we're having rural health unlocked the national strategy with our Dell Partnership and other partnerships like we have with Mooter, where we want to make sure that every state has the flexibility to meet the needs that they have, but that each state isn't recreating the wheel their own independent way, right? That they are using solutions that are proven, that are really helping the rural health transformation, that they have that flexibility to do it. So I think it would be a risk as every state went out and did it independently on under their own umbrella. But the fact that CMS puts the how the funding needs to be used in place that they know will drive transformation in the rural health commun communities, the states are held accountable to reporting to that. Um that's gonna help reduce the risk immensely across the board.

SPEAKER_01 16:38

Okay. Then is it fair to ask looking backwards, but where for integration to be occurring, to your point, at a reporting level, but not necessarily at a coordination level, where does the system potentially have capacity to break then that aren't initially visible at the reporting or dashboard level?

unknown 17:01

Yeah.

SPEAKER_00 17:02

I think it's making sure, like so if you know, like I said, each state has the flexibility, but right, that puts also a lot of responsibility on them as well. And for them to make sure that at the state level they have a coordinated effort and that they're working really closely with their health systems and their health centers in order to drive that transformation and ensure that the funding is being used, and that the health centers also understand that they're accountable for those results, right? And I think part of that is how they implement it. And coming from a tech background, often you would hear people say, Oh, I have the right KPIs in place, my system's up 99.9%. It's really focused on the technology. The way these outcomes are being driven is how is the patient care or the workforce within the hospital setting or the healthcare settings being improved, right? And so that's a big piece of how they want to drive that change. And so making sure that's coordinated at the state level. And then I think a big part of that is sharing the successes, right, that hospital centers and states are seeing with the other states and making sure that that's communicated so people know, wow, this really works, and this really is a successful strategy or solution. But when you have a program that already has proven solutions, it's probably best to start there and build from that over the five-year roadmap of the funds that are available.

SPEAKER_02 18:31

Yeah, so I think what Jen was definitely talking about, and then also the possibility of a lot of one-off solutions being adopted, right? So unintegrated one-off solutions that aren't, as Jen alluded to, not aren't proven, right? But making sure because it's gonna run the risk. So let I think that's a big risk. That's what I say is a big risk because you you get you have the teeth in it, you have some report reporting back, but and some of the states are trying to mitigate this by coming up with like some common provider kind of list, right? So some that they vetted the providers in each health system or state office that are looking to leverage these dollars is not going out on their own to have to find like the tech to solve their problem.

SPEAKER_01 19:24

So as far as then 50 states receiving significant funding, and for those of our listeners that may not be aware of this, there's a recent program that surfaced with significant five-year funding from the federal government called the Rural Health Transformation Program. It's a pragmatic community-first initiative that helps rural health systems modernize care through improving access, outcomes, and financial sustainability by aligning technology, workforce, care models around what patients actually need. Jen, you mentioned a moment ago best practices shared. What connects those 50 states and what bubbles up? How does one state learn what's working elsewhere?

SPEAKER_00 20:06

Yes, a lot of the CMS has done a great job of setting up some programs differently than they've done in the past, where they have a rural health transformation program. Just last week they actually held their first all-statewide summit where they brought all the states together as where they're sharing that information. And then I think a big part of it is groups like the Muse Group, or that we're working together to really share that information across through podcasts, speaking at events, basically allowing us to come in and talk to them about what has worked and what hasn't worked or what we recommend and and also where where to start, right? Often I think what happens is people see this funding and they want to maybe right away. I want to put an AI tool in, I want to put the gold shiny object that they're hearing in the news. Um, we have to remind people that that might not be always the best place to start. You have to make sure that your infrastructure is set up accordingly and that you have that capability. And then, you know, Avery mentioned it earlier, cybersecurity, like secure by design. It's gotta be part of every conversation. And if anybody's trying to sell a hospital system and they're not talking about cybersecurity, that should be a bell that rings for them as a warning sign because cyber is really critical in this environment. And so sharing lessons learned, the states they have there's tons of communities, right, for them to share that information and listen to podcasts, listening, reading up on it, and really making sure when they are thinking about a solution that they have that they're asking the tough questions. Like it's not just the shiny object, they're not just trying to sell tech to sell tech and say we're gonna sell you this and we're gonna walk out the door. How is it gonna be implemented? How are you gonna align it? To the outcomes required by CMS? All of those different areas are critical as they're making the determination of what to put in for a grant request.

SPEAKER_01 22:11

So, Avery, if I we can take it for absolute that many rural systems struggle with limited workforce capacity. If programs then like the Rural Health Transformation Initiatives, how important is technology then in helping small care teams manage larger populations?

SPEAKER_02 22:29

So if you look at fit, all each state submitted an application. So each state's participating in this program. They had the um option to opt in or not. All states said we're opting in. And we did a, we looked at each of the state applications and did an analysis on it, and 30% of all states combined, average 30% of the initiatives and funding is going towards technology. So that'll tell you how important that technology is going to be, and they see that technology is going to be for the success of this program. Rural health, everyone knows these communities, they don't have enough providers out in the rural communities. And 20% of the U.S. or 20% of the country is rural. So and we will never be able to create enough clinicians to go out there to go and be at all of these places. Like with platforms like Mooter Health, so those are engagement platforms, or the technologies that bring the patient virtually to the clinicians, right? So you can look at a ratio. You can have one specialist, let's say it's the neurologist or cardiologist or prenatal or whatever that you can bring the patient to. So that's gonna be key. I think technology is gonna be the success or failure of the rural health transformation program, is gonna be heavily dependent on how well and integrated and smartly technology is being utilized to help solve some of these problems. And it's not and not from a case I know it's always some tension between, oh, is technology, is AI coming and take somebody's job or whatever. You have to think of it as an augmentation because it's it's just no mathematical way that we're gonna create enough. And then I mean they're gonna still, and each of the applications had a all of them have workforce component too, right? So how to retain workforce, how to recruit workforce, how to build workforce. I would say at least 30-some percent of the all applications had the workforce component, and that is key too. But you have to be able to marry both that shortage with technology to help bridge the gap.

SPEAKER_00 25:06

Yeah. Uh could I add something to that? What I think is really critical, and Avery hit on this earlier, but it's also from a technology perspective, it's bringing in both the patients and the workforce to help drive the technology solutions that are gonna be implemented, right? Because technology is not gonna solve the problem by itself. And if they don't have the buy-in from the patient or the workforce to use it, then it's just gonna be a wasted effort, right? And I and I think that's really critical. Um I think any, again, most people who've worked in technology have probably either built something or been part of a team where, oh, that's not what I wanted when it gets delivered, right? But in this case, with the money being so tight and the resources of the clinician being so constrained, getting their buy-in at the very beginning and bringing having them be part of that the solution of what they see is going to actually help them is gonna make sure that the right technology is implemented for to help with workforce shortage as well as patient care delivery.

SPEAKER_01 26:19

You say then that it's not just about caring for patients or more patients, it's not just about recruiting and retaining, but also improving employee experience. It has to be a partnership.

SPEAKER_02 26:33

That's why we one of our goals is from this is an extension of public service to Jen and I. So it's really an extension of our passion for public service. So we want to be able to use our knowledge and resources to be able to bring the best products to bear. And that's why partnerships like Mooter Health, where under one platform, you could have you have the um patient impacting piece, right? From the patient engagement, making sure they get the right care. So if they leave from the emergency department, ensuring that they follow up on the follow-on construction. So increasing that probability from the standard 30% engagement level to 75 to 85% engagement level. So that reduces the it takes burden off of the staff, right? From readmissions, recurring incidents, or people getting severely worse, right? And when they come back, it's going to be harder to treat them. But then it also helps with that one platform, also helps with the payer side, right? So it helps with them, those engagements, being able to, with all of those follow-on appointments and meetings and short and treatment, the patients are being taken care of. And then that could also is dollars that have not been act been able to be accessed in the past because of the lack of follow-through on some of these actions that now systems will have access to. It will unlock that for them. So it takes some of the workload off. Someone on the uh a couple of people making a hundred phone calls a day, trying to contact someone where they could be have a like a regular and plain SMS text over a platform being able to communicate with multi hundreds, 10x times individuals. So it's really leveraging things like that, right? When you look at the litmus test, if the technology is good enough, it should not just check box F for technology. It should have a lateral, horizontal impact across multiple other so work, it should touch workforce, it should touch innovation of care, it could touch behavioral health.

SPEAKER_01 28:44

I know that when we uh first sat down together, you had mentioned that, oh my gosh, this company, Mooter Health, actually checks off so many of those boxes. And uh now I'm really seeing through this conversation why that was so significant in a head turner. Janet, what I'm curious about then is when evaluating new technology across a massive agency like HHS, what makes a platform strategically important versus just another tool? Does it have to check off all those boxes?

SPEAKER_00 29:16

Let's so let's go back to a care provider in a rural community, right? If they want to apply for grant money through the state, in that which they've received through CMS, the federal level, it should be, it's basically showing that it's not just one small piece of the pie, right? Like it really is a holistic approach to helping patient care, whether it's at the point of care, whether it's from the workforce structure, whether it's from the payee pers perspection, from its preventing chronic conditions, right? So by having solutions that meet those different criteria, that's much more likely that a state and then CMS is going to approve the funding for those solutions. As compared to just a shiny belt, that's most likely not going to be funded in the long term because it's not going to provide the outcomes that CMS has outlined in their notice of funding opportunities. So through this grant process, they were very clear that this must be outcome-driven, and outcome-driven from a patient perspective, right? So if you are helping the workforce and you're reducing their burden, what does that mean? That means they have more time to care for the patient, right? So therefore they're going to see patient outcomes are um enhanced. And so by checking those boxes from a solution perspective, it's it's critical um for the success of the program. And the way they have the program set up is they have really clear metrics through quarterly and annual reporting that they want to show that that money is spent, how they say it was going to be spent, and that it's driving towards the outcomes. CMS is, you know, they don't expect everything to be changed overnight, but they do expect to see continuous improvement as the new technology is being implemented. And that's what they're going to be measuring from the HHS perspective to show success in this program.

SPEAKER_01 31:23

Very good. So the program we're talking about here, transforming rural health, it emphasizes data, digital tools, care coordination. The biggest challenge could certainly be in turning insights into action. So Avery, where do you see the biggest gap between today, between having data and actually triggering operational action in rural care delivery?

SPEAKER_02 31:50

Yeah, so that we think of health, we just zoom out a little a little bit. When you think of the data in healthcare, so it's studies are out there to show statistics that show that healthcare data is one-third of the data in the world. One third of the world's data is healthcare data. So pretty substantial amount of data. So and it is this one uh when I was studying up on it um previously, it is it's also a study that shows that says between the start of civilization to 20, I think, 10, 2010-ish, it was like maybe four, four or five exabytes of data. So that is because most of it's not being, we have all the we it's a lot of data out there, but it's not being utilized because of the different formats and exchange and some progress being made in that area. So from HHS ONC in their TEFCA efforts, so they their health information exchange, they are improving on that. But still in the rural communities, if you look at the they have a higher rate of deaths, a higher rate of just mental health issues, so everything is higher. And I heard just saying recently that where your zip code is shouldn't dictate how long you live, right? So, and being able to get that data from those rural communities into the places that need them, not just for the treatment. So the treatment for the individuals is key, but then also the research and the and the studies for all of these uh scientific organizations and research organizations that need to be able to look at that data and say, okay, based on these environmentals, these are some treatments and services that we need to offer to kind of address this this higher rate of health issues and health challenges in those communities. So data is definitely important, definitely a key asset for what we need today to improve healthcare across the board, but even more so in rural opinion.

SPEAKER_01 34:06

So if we're inundated with this infusion of data on a daily basis, uh what's the biggest challenge, would you say, is to actually uh use that to our benefit, turning it into actionable uh change?

SPEAKER_02 34:20

Interoperability of the data and the different systems being integrated together is so much technology. You could do anything with technology these days, but is it gonna be integrated? Is it gonna be interoperable with the systems that exist, right? Is it gonna be in our and be able to share that data between systems? And we've all had to go to a doctor's appointment. Your primary care doctor says, hey, I need you to go to this specialist. But before you go to the specialist, you gotta go get this x-ray. And then you gotta, you when once you take get the the x-ray or this this lab done, you have to go and so oh, give me the disc so I can sneaker and at it over to the person, right? So then they have to look, they look at it right five minutes before you go in there, instead of in advance, so they can really say, okay, what do I need to talk to Jim about when he comes next week or next? So how do we just start with sharing of data that could help alleviate a lot of that? And then what it ultimately, and as Jen alluded to, is the health outcomes. The outcomes are better the more seamless the data is transferred and the more access that others have to.

SPEAKER_01 35:35

So, Jen, similar question then, to get your perspective. What tends to determine whether these sorts of large federal programs actually translate into operational change at the provider level?

SPEAKER_00 35:50

I do think it's outcome-based. And I do think that this is a change we're seeing with the the way the grant is being done, right? There is CMS is a partner in this, right? As in before, maybe a lot of grants were given. But there might have been a reporting requirement. They might have had to, you know, to let the government know how that program was going, but it wasn't as structured as this program is. And I think it's because they didn't see the outcomes that they wanted to see or were expecting to see based on these large uh large federal programs like the rural health transformation program. So I do think that this is a new effort that they are focusing on through this reporting ability, right? So the way I thought about it was CMS is telling the states this is the destination, right? They have to, this is where you need to get, but we're gonna let you figure out how to get there. Then the states are saying, well, this is the route you're gonna take, we're gonna take as a state. This is the route we're gonna take to get to the destination. But then they're telling the healthcare providers, here's the destination, here's the route, you are responsible for implementing the on how to get there, and you're accountable for getting there. The the providers are responsible to the states as well as the states now responsible to CMS. And CMS is being a partner, right? They they're setting up offices to work with the states where they can really every initiative is going to be covered along the way. It's not just going to be a touch and go, where are you in six months, where are you in a year, and hope it works. There's gonna be a lot more interaction and coordination throughout this effort, which I think is, you know, the accountability piece all the way down to the providers. But at the same time, what's really critical is CMS didn't tell them how they have to get there, right? So allowing that flexibility is critical because another reason it fails is because the federal government wants to tell the rural community how to solve their own problems, right? And they might, they might not know, right? They're sitting in DC and they're sitting in a bubble and they don't understand what it's like to have the rural have the challenges the the rural community is facing. So by allowing them to really frame and strategize on their best out their best solutions, but making sure that it's outcome-driven, I think it's a difference in the approach, and I'm excited to see. I really think it's going to be outcome-based, and the rural community is going to see a change through this program.

SPEAKER_02 38:36

Yeah. One of the things Jen and I, as we've been engaging with these the health systems, and we've been learning. So she brought up a great point of like when you sit here and you're in the the DMV and National Capital region, we don't necessarily appreciate the constraints that these um rural communities are having, right? So we we were on with one health um organization out of Arizona, out of the Grand Canyon region, and they were talking about how patients have to get transported by so and that's that's something that that's like you don't that's not in a we you look going back to the first question he asked. We when you look at policy and how to operationalize that policy, right?

SPEAKER_01 39:21

Yep.

SPEAKER_02 39:22

It's a difference between doing that and just throwing, like, okay, I'm gonna throw an AI thing at it. Right. Right? So it's really getting boots on the ground and understanding what are the challenges there in technology, inevitably is going to be in the mix somewhere, but not it's not always the silver bullet for everything.

SPEAKER_01 39:44

Well, Avery, if you could redesign then the digital infrastructure for engaging high-risk populations, especially in rural communities, what capabilities do you think you would build? What would be the most important thing that you'd build into the systems that don't exist today?

SPEAKER_02 40:01

Yeah, I I think leveraging tech that's already out there, right? So not what what I mean by that is not just going it's gonna be application fatigue, right? If you have all these different, it's an app for that, there's an app for that, there's an app for that piece of it. And it and it's not integrated. And so if you like Motor Health, like this straight over plain SMS text. You could have the best UI design and everything, but if it's what I use every day in my day-to-day life, then I'm more likely to respond to it and more likely to uh to be, it's more likely to be adopted and successful, right? So when you think of that tech, and I think Jen mentioned it, proven technology, and then having the space. So there's definitely should be a space there for some innovation, right? To get some thought leaders out there that are thinking through, like, okay, how do I solve this hard problem? And it may be a small like startup somewhere, having a pathway for that too, right? So having a pathway for it, but and and understanding that it's a five-year roadmap, right? Let's look at some foundational things first in year one. But when you talk about cybersecurity, as we we mentioned, by cyber secure by design. You talk about access, the left, the connectivity. If you don't have connectivity, then under stuff will work it, right? So we come up with all these fancy things. Somebody I was meeting with last week, they was talking about drones, delivering, um, pharmaceutical stuff, and they could order. I was like, man, like my old colonel used to tell me, that briefs well. It all briefs well until the rubber meets the road, you actually have to execute it. And they used like, wow, I don't have no connectivity out here. What how's the how am I gonna communicate with the with the drone? So you start with those foundational pieces, build on it, and then you get to the more advanced stuff over time.

SPEAKER_01 42:06

Early days of the pandemic, speaking with a health system specialized in pediatric behavioral health, and the wait list times. As a parent myself, I was marveled, disappointed, blown away, saddened. The average wait list was over six months. Um, so that becomes pretty devastating. So when you say briefs, that kind of resonates. How about we fix the simple things first?

SPEAKER_02 42:32

Yeah.

SPEAKER_01 42:33

Before we have a a fleet of drones dropping off my CVS order. Yeah. Jen, if the rural health transformation program succeeds, what do you think technology-driven metrics would expect to move first? Do you see any signal that says, yeah, this I know it's too early right now, but if it if there's success, are there signals that say, yep, this is the right program?

SPEAKER_00 43:00

Yeah, be early signs for outcomes that matter, right? And that could be that there is connectivity now in rural health communities that there never were. Right now, if you have the connectivity and all of a sudden now mobile care is much more practical, much more available in the rural health community. Telehealth is much more available. So you're able to see more patients through telehealth. You're able to get those specialists, you know, where they have a specialist, maybe like like Avery said, a cardiologist, right? Instead of that cardiologist having to spend one day driving to a rural community, they now can see maybe 15 more patients in a day because the technology and the connectivity is there for those patients to actually have really good care that may. Maybe people just don't quite understand how that will work, but there are proven methodologies and technologies already out there that you can have a nurse do the put the stethoscope on where the doctor's actually listening, right? That the telemetry data is actually being, you know, shared with the doctor or the specialist at a centralized hospital. And so, you know, metrics where all of a sudden there's more patients that can be seen, they're reaching more communities, there's larger engagement. I think those are going to be early warning uh warning signs, early positive signs, I should say, to really show that the program is doing what it was set out to do. And I I'm hoping each year, through each initiative, every state is seeing those signs and showing more and more successes to for an outcome-based um strategy.

SPEAKER_01 44:55

So, Avery, assuming that we're on the pathway to the this the success that Jen just mapped out what that would look like. If you're advising, and I know you are, advising states and health systems designing their rural transformation plans today. And at the Muse Muse Group, you're doing just that. Do you prioritize certain uh uh digital infrastructure elements? Do you recommend things such as proactive population engagement? Are there things that you say this is where we have to start?

SPEAKER_02 45:28

Yeah, so access cybersecurity. So that's assume that that's there, right? So then I think proactive engagement is also key. So being able to engage with those communities to increase the percentage of engagement, right? So you talked about workforce. If you're having someone spending the eight hours a day or their 90% of their day on the phone trying to cold call people to get them um motivated, well, you could you have technology that can do that, like Motor Health on platform that can engage them across the continuum of care to get the patients what they need and get them motivated to do what they need to do for their health, right? So it's just another way of doing that and not waiting for them to return to the merry the ER again. So if they return to the ER again, and also I think aside looking bigger pictures, is a lot of these smaller, what we've seen is a lot of smaller organizations, and they all have the similar challenges and all trying to solve like the same problem. If they would regionalize and kind of join with each other, and like what Jim was talking about, uh the platform where we could just bring all of the data from the bedside, right? From the bedside to a central location that has the specialist there that can apply that that you administer the treatment and observe the patients and things like that, that would be huge. But I don't think organizations are thinking like that. Everyone is looking at, okay, how do I solve my problem? You you're mature in this area, I'm mature in this area, with other partners mature in that area. Let's, instead of us all trying to create maturity in the areas where we don't have it, let's kind of combine resources. And I know it's the the details are in like, okay, who's getting paid for what or whatever, but it's ways to work through that, right? So it's it's and I think working through those hard problems will benefit the the patients that need it, right? Other than that, the impact of that is greater than the pain that it'll take to get there.

SPEAKER_01 47:49

Jen? You answered the last question I posed in one aspect, success. But if you were to share your perspective with us, where might states struggle turning this federal policy goal into operational technology?

SPEAKER_00 48:07

Yeah. They're gonna struggle if they don't have champions, right? If they don't have leadership engagement, this isn't something that you can do as a side job, right? It's not something you can give somebody as a collateral duty and say, go make this work. You're gonna need dedicated people who want to see it succeed, who are leaning in to see it succeed. I think the leaders need to want to make sure it succeeds, right? They need to be driving the signal to the rest of their staff that we want to show success here, we want to show those positive outcomes. So I don't think if you don't have leadership engagement, leadership driving it almost on a daily basis, then that's a real chance of failure. If you use that funding a different way and not how you aligned with the funding categories or not aligned to your initiatives, or you can't show that you use that funding in that same the manner that you outlined in your plan, then that's another area that a state will be setting themselves up for failure because the reporting requirements are so are so strict, right? And then I think the other areas if you're not coordinated across the state, right? If you are not trying to be proactive in this, really already thinking about what are we gonna do in 27 and 28, 29, 30, there's a good chance you're gonna fail and you're not gonna get the money allocated in the out years. And even worse, CMS has clawback provisions, right? So if you don't do some of the initiatives that you have written out in your plan and agreed to do, they can actually claw back the money, right? And now all of a sudden the state has to pay money from someplace else that they allocated to this. So those are just a few areas that I think states really need to be have their finger on the pulse, be constantly monitoring, constantly coordinating across the healthcare providers within their states, as well as what CMS is asking, and having those dedicated resources to drive the success of the program so that it is successful.

SPEAKER_01 50:17

Abra, what are your thoughts? Same question. Where are these technology investments most likely to fail?

SPEAKER_02 50:25

So uh yeah, I think to me, and the whole interoperability piece of it is really it's gonna be it's a fast turn on these dollars, especially year one. Year one, I think most of the dollars have to be spent by the end of this fiscal year. The states have to get it through their legislation, legislative process, right, to get it in the authorization to even be able to spend the dollars, right, and get it that appropriated. And then so we're seeing like some of them, some because it's in their acquisition process of 18 months, right? So to even to get the RP out and all that, so they're like some of the states are giving it to nonprofits to get the money. So really, I think having buying down the risk of being able to get cap approved capabilities quickly, get them on contract, get them implemented, and start to measuring those outcomes that Jim gets with. So that's where I think in some cases the newer technologies may suffer in this in this first wave or or may not, but I think that's where the risk is. The risk is gonna be like how do you execute those dollars the right way quickly, knowing that you're gonna be measured on the outcome on the back end. So if you you know those decisions you make today could um make or break you in in the future for future um funding decisions. And as Jen mentioned, they could even claw back the dollars.

SPEAKER_01 52:01

I know the Muse Group has a number of technology partners and has your finger on the pulse nationwide as far as where these technology solutions can have optimal success. Jen, what separates platforms that become infrastructure from tools that never scale?

SPEAKER_00 52:19

I it's already been proven. It's proven to help in the rural health communities, right? I think that's a distinguishing factor. We know that if we're gonna go to a health center, we wanna make sure that that the outcomes that we can already sh demonstrate these are how the health systems outcomes um beneficial. More importantly, how patient care can be improved, right? Of course it's the outcome, but it's really about the patient care. And so I think that's really just a critical piece for the platforms that we're partnering with, is that they've demonstrated success already in the rural health community.

SPEAKER_01 53:01

Very good. Avery, coming up with the last question here, we're at time here, but want to squeeze in one more. Uh if you could rebuild one piece of the digital infrastructure across all of federal health, you both have had such an impact through your career. But you could pick one piece that you could rebuild. Maybe you don't want to be anywhere close to rebuilding any of it. But where what would it be if you could rebuild one part? Yes.

SPEAKER_02 53:29

The interoperability for the data exchange would have to be the most important aspect of it is being able to get the useful data to the people that need it when they at the point of the need. So whether it's the patient needing to review their own documents or the um providers having it. Um I think the data is key. And when you think of how complex it's getting with the Internet of Medical Things, I have a friend whose uh mom was still having uh some challenges with AFib, right? She was having some Afibulation issues and her smartwatch. She downloaded and provided that to her doctor, and the they were able to analyze that data and that informed the treatment to save her life. But it had to come from her watch. It didn't come through like the system. It wasn't something someone was monitoring or anything like that. They had to do it outside of the system manually to get it there. So imagine if all of that was integrated into the proper ecosystem that the data was shared and was available at the point of care, at the time of care. And then, secondly, would be the access piece, right? So you can't get the data if you don't have the access into those communities that have those access challenges. We have technology out here today that can help with that. We we send military forces in the most austere conditions possible, and they could communicate, right? So, how can we leverage some of those technologies and get them to the communities that need them? That 20% of Americans that need that technology.

SPEAKER_01 55:21

I don't normally hear the why behind that expectation, but it is table stakes. The idea of wearable data integration into our mooter health platform was one of the earliest aspects that was built into that. And and you can use technology for that, right?

SPEAKER_02 55:39

So we can't you can't hide behind that. Oh, well, I have to find are you multilingual, bilingual, or then I'll hire you guys. I mean, that's that could be a thing, but you could it's plenty of use cases out there with putting digital assistants in front of it that could switch languages on a dime, right? So technology can help not replace, but help augment those experiences so you and then free up time, what I I call like to call minutes to the mission, frees up time for those work workers, clinicians, and the systems to do other work, other meaningful work, right?

SPEAKER_01 56:20

There a lot of complexity still exists. Um and I have to tell you, we're at time together. I've uh truly enjoyed our time together here. Thank you for sharing your expertise and perspectives. I look forward to our paths crossing again soon. If our listeners to the podcast have more questions for our guests, you can find them on LinkedIn as well as themusegroup.com. Thank you so much. Really appreciate hearing from you both. And uh until next time. Thank you. Thank you.

SPEAKER_00 56:49

Thanks.

SPEAKER_02 56:53

Yeah, yeah, yeah. I told Jim that like earlier. We had a whole five-minute conference, though. I've been walking.

SPEAKER_01 57:07

I can read like a champ. I can read reading, but I can't read writing. I was like, yeah, you're right. Your email is.net, the website.com. It seems disconnected. We're at time, and I want to thank you both so much. Thank you for sharing your expertise and perspectives. I look forward to our paths crossing again soon. And if our listeners have more questions for our guests, you can find Jen and Avery both on LinkedIn as well as at the Musegroup.net. Thank you.

SPEAKER_00 57:36

Thank you.