Powering Rural Health Transformation with guest Mark Johnston

In our very first episode of Avel eCare: Virtual Health Connections, we sit down with Mark Johnston, Vice President of Government Affairs at Avel eCare, to explore what it really takes to transform rural healthcare.

Mark shares his journey from working in Washington, D.C. to returning home and stepping into a leadership role at Avel, bringing a unique perspective on policy, access, and the future of care delivery. Together, we dig into the challenges rural communities face, from workforce shortages to limited access, and how telemedicine is stepping in as a powerful solution.

This conversation goes beyond theory. It highlights how virtual care is supporting EMS teams, hospitals, and providers in real time, improving outcomes and expanding access where it is needed most. Programs like Avel’s telemedicine support are already connecting frontline teams with board-certified clinicians to elevate care in rural settings .

If you care about the future of healthcare, policy, or innovation that actually makes a difference, this is the place to start.

Listen now and join the conversation on how we are redefining healthcare delivery.

Thank you for listening to Avel eCare: Virtual Health Connections. To learn more about how Avel is expanding access to care and supporting healthcare teams nationwide, visit www.avelecare.com .

Be sure to subscribe, share this episode, and join us next time as we continue redefining healthcare delivery.

Follow us on:

Facebook

LinkedIn

YouTube

Transcript

SPEAKER_00 0:05

Welcome to Aval Ecare Virtual Health Connections. I'm Jessica Gaikowski. Across the country, rural health care is at a critical moment. Communities are facing workforce shortages, hospital closures, and growing challenges in accessing care. At the same time, we're seeing something we haven't seen in decades. Significant federal investment aimed not just at stabilizing rural health care, but actually transforming how care is delivered. Today we're talking about what's changing, what funding opportunities exist, and what ruralcare leaders should be thinking about right now. Joining me today is Mark Johnston, Vice President of Government Affairs at Aval E Care. Mark brings nearly 30 years of public service experience, including military service, leadership in the South Dakota legislature, and senior staff roles in the United States Senate. Today, he works with policymakers and healthcare leaders across the country on some of the biggest challenges facing rural health care. Mark, thanks for joining us today.

SPEAKER_01 1:05

Jess, what an absolute pleasure to be here. And this is this is so fun. We're kicking off the first uh first episode.

SPEAKER_00 1:13

Yeah, absolutely. Before we really dive in, can you kind of give us a little more about your background and what really led you from working with policymakers and government officials, legislature, and now you're out of LE Care.

SPEAKER_01 1:24

Yeah, it's been great. You know, and when you were in during your opening, I just had to take a minute to pause. And, you know, it's uh it's been fun. I mean, uh, you know, from my military background, you know, retiring as a colonel over almost 30 years to, you know, transitioning from a full-time soldier uh to become a governor's press secretary during the Rounds administration, and then uh getting elected to the state legislature myself, uh serving uh District 12 here in South Dakota, uh, to then um becoming a senior staffer for my old boss, our former governor Mike Rounds, uh, you know, working both here in the state and in DC. It's just it's been I've been beyond blessed with a whole lot of uh great opportunities, but as my wife reminds people regularly, I can't keep a job. And so uh it's it's been it's been a lot of fun. You know, then a few years ago, Aval was looking for uh someone to do government stuff, and uh I was working in DC and um you know just figured it was time to come home. And uh I've known Avel for years. Um actually uh their headquarters was in my legislative district, so I would regularly do meetings and briefings and and get updates about the company. So it was it was really comfortable for me uh to think about coming and joining the organization and you know just think it's it's just been a whirlwind these last few four years for us uh as a company. Um so yeah, it's been it's been great and just continues to grow and and thrive, and uh really grateful for the opportunity to serve in leadership for the organization and especially during this time. Uh, you know, there's so much going on in the government space, federal, state, local. Um, and you know, considering the the uh high number of communities uh that we serve uh with various uh uh virtual care solutions, it's it's just it's great to be at Aval right now.

SPEAKER_00 3:41

Yeah, it is. When you kind of hit on this, that there's a lot going on right now, a lot of changes going on, a lot of cool new initiatives going on. When you're from your perspective working with policymakers, why does this moment feel a little bit different right now?

SPEAKER_01 3:56

Yeah. Um, you know, coming out of COVID, uh, telemedicine was kind of the hot topic. Um, but then even even this past week when uh I was traveling and and uh maybe explaining more about who Avell is uh to someone that uh wasn't necessarily as familiar uh with the company as as others, but it's um we've really just kind of exploded after COVID.

SPEAKER_03 4:27

Yeah.

SPEAKER_01 4:28

And uh but be we we're exploding because we're different.

SPEAKER_00 4:32

Absolutely.

SPEAKER_01 4:33

We don't do any direct to consumer. Um somebody can't just call us up and want to schedule anologist appointment. Um we're you know, our with our model being a business-to-business model supporting hospitals, health systems, and government uh directly. Um we've just really been fortunate to to have a real strong growth spurt right now across our service lines.

SPEAKER_00 5:04

Yeah. Absolutely. So we've been talking about rural health care challenges for a long time. That's basically why Avel was developed in the first place. But many leaders now are saying that the pressure on them feels different and it feels like it's heightened over the last few years. So, from your conversations with hospital leaders, government officials, et cetera, what are these biggest pressure points that these rural communities are really facing right now?

SPEAKER_01 5:30

You know, it's it's it's complicated.

SPEAKER_00 5:32

Absolutely.

SPEAKER_01 5:32

You know, and it depends. Uh, every, you know, like I talked about earlier, if you've dealt with one state, you've dealt with one state. If you deal with one hospital, we deal with one hospital. But I think there's, you know, there's an underpinning of of just some of those core things like uh financial sustainability is key. And that's why having a virtual partner to help uh those hospital leaders, you know, do more for their patients uh through a virtual partnership like ours is is really key. Uh workforce uh sustainability is huge in almost every part of the country, you know, especially when you're talking about rural and and um you know there's many, many, many parts of this country that you know struggle to recruit, retain, uh, and and keep providers uh to take care of the population. That's that's where we being a uh virtual health system that supports these local healthcare entities or supports a government uh with with one of our out-of-hospital services, uh, that's key. You know, the other real impacting element is our rural communities are aging. Uh and so, you know, you've got a population that is, you know, probably born and raised and lived in these rural communities their whole life. And now as they get older, they they require uh more access to healthcare services. And and that's across the continuum of what Avel provides for a lot of these rural communities, um, that's attractive.

SPEAKER_00 7:14

Yeah. Um can you go in a little bit more to access and what does that really mean? I feel like sometimes when people think of access to care, it's like, oh, I just don't have someone in my community, but sometimes it's the distance of that. So can you talk a little bit about what access to care really means?

SPEAKER_01 7:29

Yeah, you know, and and that's really if you want to get to the core of what uh Avel began as, and that was that was delivering specially care out into the country that uh created an environment so citizens didn't have to drive into the metropolitan to get access to a cardiologist or a dermatologist or a rheumatologist, you know, pick picanologist. And and and that's you know, all the way dating back to 1993, that's our core. And so, you know, now, you know, all th more than three decades later, it's been even more exacerbated.

SPEAKER_03 8:13

Yeah, absolutely.

SPEAKER_01 8:14

You know, and I think about um uh uh we've got such a strong relationship with the Indian Health Service. You know, super, super um grateful for the opportunity to support um the mission of the IHS and in the upper plains. And you know, you know, you want to talk about rural, you want to talk about frontier.

SPEAKER_00 8:40

Absolutely.

SPEAKER_01 8:40

Uh there's a lot of miles between access points. And so a lot of the tribal communities in this in the upper plains, they don't know a provider, especially in the specialists, other than a vowel. You know, we've had rel our we have physicians and who have supported uh those communities for you know almost seven or eight years, bumping up to a decade, where they've had this patient uh provider relationship. It's all been virtual, but that's all they know.

SPEAKER_03 9:17

Exactly.

SPEAKER_01 9:18

And um, and it has been absolutely warming to hear some of those um testimonials from patients uh about the value that that virtual physician uh or virtual nurse practitioner has on the the life of those folks in in rural and frontier parts of the country.

SPEAKER_00 9:41

Absolutely. When you've kind of hit on like the different areas, so does rural health care like the premise of this look different in different regions and states, or is the challenges that we're seeing all the same across, or do they look different based upon their territory and region?

SPEAKER_01 9:56

Yeah, uh you know it's it's a great question. I and and I suppose it boils down to the rurality. I don't even know if that's a word, but um, you know, how you know for for some people in some parts of the country, Sioux Falls is rural.

SPEAKER_00 10:14

Absolutely.

SPEAKER_01 10:15

You know, and we're 260,000 people in the metro. Yeah. Uh, but then uh, you know, it's it's it's different, but uh, you know, we're we're pretty uh fortunate to live where we live here here in in uh the Sioux Empire and and but able to radiate those services, you know, being connected to uh communities um throughout the country um with virtual services.

SPEAKER_00 10:45

Absolutely. So if we are looking at all these different challenges, I know they we started off with looking at the different pressures of them and they've been increased right now. If we don't do something right now to help alleviate these pressures, what does that look like?

SPEAKER_01 11:02

You can't open your news browser on any given day and and read stories, especially in the healthcare space, about um the economic challenges that rural hospitals and healthcare providers experience on a day-to-day basis.

SPEAKER_03 11:18

Yeah.

SPEAKER_01 11:19

And you know, going forward uh to continue to grow and provide support to those, uh, a virtual uh partner has to be part of the equation. And you know, that's probably why we've experienced so much growth lately, you know, over these last few years is is uh because of that reality that that all healthcare is local. You know, it's it's relational, but having a partner like like a bell to provide that greater access to care and and you know provide uh pretty decent support to those local communities is is imperative.

SPEAKER_00 12:01

Absolutely. In 2025, we passed this beautiful thing that everyone likes. Talk about the one big beautiful bill.

SPEAKER_02 12:08

Yeah.

SPEAKER_00 12:09

So if people aren't paying attention to healthcare policy, they they may have heard of it, but they don't really understand it. Could you kind of give us a little insight into what that really evolved? Because it's the biggest federal investment that we've had in decades. So, what does that really look like, or what does that mean right now when they're saying we have this big beautiful bill?

SPEAKER_01 12:28

What is that? And did you know that the one big beautiful bill is a nickname?

SPEAKER_00 12:33

Mm-hmm. I sure did.

SPEAKER_01 12:34

You did?

SPEAKER_00 12:35

Yes.

SPEAKER_01 12:35

So but that's how everyone refers to it. And that's that's the commonly understood name. Absolutely. But um the actual legislation was the Working Families Tax Cut Act of 2025. Yeah, but because it was so large and so encompassing, uh it uh earned the moniker of one big beautiful bill, but it's the Working Families Tax Cut Act. Yeah. And because of that, you know, historically, um, you know, and I I'm not gonna get into the politics of the whole thing, and because that's not this isn't the time or the place. But the reality is, you know, it's it's about it's about the the strategy around how um funding was uh calculated and budgeted for, especially around Medicaid. And you know, given the um uh economic dynamics of the country at the time and budgets, you know, historically Congress had funded Medicaid year over year at about a five percent increase.

SPEAKER_02 13:40

Okay.

SPEAKER_01 13:40

Well, um actually and from from a from a policy perspective, Congress uh made the decision to dial that back to two and a half percent.

SPEAKER_03 13:53

Okay.

SPEAKER_01 13:54

So uh naturally that would mean reduced funding for Medicaid because you know, in theory, there would be a reduced need for Medicaid in the States. Okay, but that caused a divide that caused uh challenges, especially in rural America, that rely on Medicaid uh funding for sustainability. Hence, a a group of um uh folks in Congress got together and came up with this concept uh to try to offset some of those reductions. Hence, we got uh what we now know as a $50 billion appropriation uh called the Rural Health Transformation Fund uh to go directly to the states, five years, $10 billion per year, allocated um not on a per capita basis, but um similar. Yeah, but uh because there are rural states, you know, smaller populations that got uh as much money as a large state like Texas, yeah, with a with a large population. So uh there is a difference uh on a per capita basis, but um yeah, that's how that's how it came to be.

SPEAKER_00 15:14

So when we're looking at the by state kind of difference of that, how how do we or how did the states kind of come up with what they're looking for? Like what did that process and planning look like? Because you can't just get a load of money for nothing. How did they put some initiative or strategy around those?

SPEAKER_01 15:30

Yeah, that's been that's been fun. Um I've had the really, really good fortune of of uh engaging with many states um directly. And you know, if if you look at look at a Bell as a company, you know, we you know, we're based here in the upper Midwest, but we support uh hospitals, health systems, governments in 46 states today, you know, from the state of Washington, California, all the way down to Texas, all the way up to New Hampshire, Vermont, and Maine, and all across. So there's really, you know, we've we've got such a huge footprint. But if you focus on our core, um, you know, it's that 21, 22 states right down the middle of the country where, you know, historically we have have been so, so, so strong. And so, you know, in short, to answer your question, it depends. But, you know, there have been some states that have taken a really centralized look at this, a centralized approach, led by a governor, uh led by the governor's office, and then deployed it out. Other states, they've taken a more uh by committee approach, uh, organizing advisory committees of stakeholders in that state to help uh shape the plan. Uh and so it's it's just been a wide, wide variety of strategy that the states have gone through. And you know, some states uh really their hospital association or organization of hospitals has had a significant role in building that plan. Um, you know, so it it just depends. There's you know, some states are totally hospital-based. Uh there are some states that are more balanced, there are some states that are more um structured, more less structured. Again, if we if we deal with one state, we deal with one state.

SPEAKER_00 17:32

Absolutely. So what when we're thinking of when they came out with rural health transformation, what was their original goal with that? I know we talked about, you know, it came from the one big, beautiful bill, but now what is their true goal? What are they trying to shape here?

SPEAKER_01 17:46

Well, uh, and I'm just gonna use the vernacular of the day, make America healthy again and make rural rural America healthy again. And that's that's really that's really uh a lot of the emphasis of of improving healthcare outcomes for a part of the country that needed better access to care.

SPEAKER_00 18:05

Yeah. And I think it goes into the challenges that we talked about a little bit before, access to care, looking at the workforce shortages and all of those other components as well.

SPEAKER_01 18:14

Yeah.

SPEAKER_00 18:15

Yeah.

SPEAKER_01 18:15

You know, as as a company, we you know, we I think we did like 41 or 42 state uh we answered 40 41 or 42 requests for information.

SPEAKER_00 18:30

Yep.

SPEAKER_01 18:30

Uh, which is amazing. Huge. Yeah. Uh it's it's been a whirlwind. And and going back, I and I should have and I should have uh uh qualified, you know, this legislation was signed into law in July of last year. Yeah. And then a notice, you know, uh really the notice of funding opportunity came out in September, yeah, and states were required to submit their original uh strategy, their their verbiage in November.

SPEAKER_02 19:01

Okay.

SPEAKER_01 19:01

And um it was limited, it can only be so many pages long, so many words. And so, you know, it's this has just been a sprint uh over the last number of months to get us to this point where you know budgets were finally approved by the Centers for Medicare and Medicaid Services just a few weeks ago. And so it's time to go.

SPEAKER_00 19:25

Yeah, time to get to work. So, what does that look like now when we're saying it's time to go? You know, the funding has been allocated, but now how how do we get started? What are those next steps?

SPEAKER_01 19:36

Well, um a lot of these strategies are hinged on state procurement um rules. So um again, and every state is different. So, you know, it's been a significant investment to uh put a team together to uh really manage this process to help help our customers, help our the states that we serve uh to get uh new, fresh, uh transformative ideas into the marketplace on how uh a virtual health system could help them um achieve their goals. You know, also there's another element, and I I touched on it earlier about about speed and about time and and uh because these states need wins. You know, it's uh as we record this, it's the middle of March, and you know, um you know the federal fiscal year is coming up at the end of September. There's thresholds there, and then additional thresholds over the next year, and so you know it's it uh needing to find partners that can implement shovel ready projects.

SPEAKER_03 20:58

Absolutely.

SPEAKER_01 20:59

You know, that's that's a construction term, obviously, but you know, it's it's it's germane to this discussion because um you know we can we can implement quickly.

SPEAKER_00 21:09

Absolutely. When you hit on the transformation, that's been a huge word that is not that it's new, but it's definitely been utilized in a new perspective, I would say, in the last few years. And you know, how has Aval Ecare really now, or how do we want to play a part in this transformation of the funding? How do we become a partner with some of these communities and sites?

SPEAKER_01 21:30

Yeah. If you really want to be candid, we've been doing rural health transformation since our inception in nineteen ninety three. That's how we got to be who we are. And as we have as technology is advanced, as services have advanced, you know, you think about starting out in specialty care and doing those virtual consults to school health, to EMS, to Crisis care. The list just goes on and on and on. So you want to define transformation? Do a case study on a vow because that's what we've been doing for our entire existence. And not only on a services perspective, but from a technology perspective. And so yeah, it's uh it's a good time to be here.

SPEAKER_00 22:24

Well, I appreciate you going down the list of all of the different services that are provided. Because what does that mean? You know, some sites have one service line and some have multitude. What does that mean for someone to really have the full continuity of care with a Vell? What does that really look like and what does that mean?

SPEAKER_01 22:43

Yeah, that's uh that's a great question. It's really, you know, that really um validates that virtual health system concept that has become so prevalent uh in being able to support our customers, having an entire platform uh of services available to them and being, you know, in in many, many shapes and form technologically agnostic uh to whatever that customer has uh made a decision around for an electronic medical record. You know, we I think I was talking to one of our providers recently, and I think she said she had 27 different EMR passwords. Wow. Just just because that's the many variations of of EMRs that were out there. And so um, yeah, that's uh that's a great question and and and something to just uh to ponder about. Just we're just so different.

SPEAKER_00 23:43

Yeah, absolutely. So now kind of going back to with rural health transformation, when we're looking at everything that Avel provides and offers, how do we now implement some of that into you know, getting into the funding and working with the states to really help them meet their initiatives that they've put forward?

SPEAKER_01 24:01

Yeah, that's a great question. Um that keeps me up at night, to be real honestly. Uh you know, and and uh sleep is a premium anymore. But um, you know, a lot of the RFPs are starting to come out because CMS approved the funding, and I and I mentioned it now a lot of this depends on state procurement laws. And so, you know, there are um there's been a great deal of of um learning that has gone into those processes, but also there are just some states, it's hard um to um it's it's gonna take a while for them to act on the uh premise of rural health transformation because in in a lot of cases they've got really arcane um procurement laws. Uh there are some really big states out there that it's gonna take months and months for them to uh uh get some of these uh dollars to work, yeah. You know, that they've been appropriated or not appropriated, but they've been uh granted uh by the federal government. And so I'm concerned about that. And there's some states uh where we have a big presence and support lots and lots of hospitals that that may just not um see some of the the uh fruits of their labors as quickly as as maybe they had hoped.

SPEAKER_00 25:39

Yeah. One part of that too, looking at you know, telemedicine as a whole, as a part of some of these initiatives. I know we talked a little bit about, you know, before COVID, no one really talked about telemedicine and the impact that it made, and then it blew up. But we've always been around and we've done this before. So, what is that when we're talking to different healthcare leaders? How does telemedicine play a role into that now versus what it used to be? And how does that play a role into this funding?

SPEAKER_01 26:07

Yeah. I'm going to reflect back on my military career. And what were those, you know, tactical advantages that we had as an organization to help us uh accomplish the mission? I really look at telemedicine as that combat multiplier. You know, it's it's this it's a strategy and it a strategy with years and years of proven performance to help a uh a uh community, uh healthcare provider or a government to meet their goals uh and do it on time, on budget, and and really, you know, be there to uh help them achieve their mission.

SPEAKER_00 27:00

Yeah.

SPEAKER_01 27:00

That's really how I think about it.

SPEAKER_00 27:02

That's a cool way to think about that.

SPEAKER_01 27:04

Yeah, it's just uh you know that's kind of how I was raised. Uh, you know, I did that for a long time. So how do we accomplish the mission? And I think for a lot of these folks, telemedicine has a key role to that.

SPEAKER_00 27:18

So for those that are still a little iffy about this, which you don't see that as often anymore, but there's still some that don't love the full aspect of that. How do we get to them and say, how do you prove that telemedicine can be part of the solution as a whole?

SPEAKER_01 27:33

Yeah, that's great. You know, and and one thing that really sets us apart from a virtual health system is our joint commission accreditation. You know, getting that uh seal of approval and and recognition uh from a quality perspective that we're we're um you know a very attractive option. Yeah. Uh, you know, super proud of our team and and the folks that uh work really hard every day to uh make sure that we uh provide the best uh best care, best service possible. Yeah. And and that's that's significant. Um, you know, and and talking to somebody recently uh who in the government space and they had no uh previous knowledge of us. Uh I had never met this person, but explaining to him uh uh who we are, he he and again it's a government official, and he looked me straight in the eye and said, Sounds like we need to be more like you.

SPEAKER_03 28:37

Yeah.

SPEAKER_01 28:38

And uh, and so I invited him to come for a visit and and uh kick the tires and and meet the folks just to be able to show him and show his team uh just what a uh virtual health system looks like.

SPEAKER_00 28:54

That's amazing.

SPEAKER_01 28:55

Yeah, it's a pretty fun combo.

SPEAKER_00 28:56

Absolutely. Well, when you get to see it, it's a whole new ballgame.

SPEAKER_01 28:59

Yeah.

SPEAKER_00 28:59

Yeah. So let's talk a little bit more about workforce, as that's one of the bigger challenges. And I think, you know, we talked about people are stretched completely thin, recruitment is hard, is what we talked about earlier. And how do we now use telemedicine to help extend and support everybody rather than you know the opposite?

SPEAKER_01 29:21

Yeah, that's uh that's a super important conversation to have because you know, the first thing uh that a lot of people think about is replacing.

SPEAKER_03 29:34

Yeah, absolutely.

SPEAKER_01 29:37

You know, I'm gonna do a telemedicine partnership and I'll that'll replace, you know, and I won't need ABC or whatever, whoever. And that's 180% from the truth.

SPEAKER_02 29:49

Yeah.

SPEAKER_01 29:50

You know, we are a support system. We provide um, you know, that's that's the whole premise that this organization was built on. But yeah, you're right. There's just uh not enough people to take care of the people, yeah, especially in rural America.

SPEAKER_03 30:05

Yeah.

SPEAKER_01 30:06

Um, and there's if you look across the different services that we provide, uh, it's even more exacerbated, especially. Well, I'll just use behavioral health for an example. There's nowhere that I go around the country. Uh, even this week, uh earlier this week, when I was, you know, everybody wants to talk about you know behavioral health services. You know, we're super blessed to have a pretty robust uh team uh supporting some of the smallest and some of the largest, uh, smallest community hospitals, the largest uh tertiary, quaternary medical centers in the United States, uh supporting cities, counties, states, uh across the care continuum. Yeah, you know, and and that team's absolutely amazing. Yeah. Um recently I was uh having a discussion with a policymaker about crisis care.

SPEAKER_03 31:06

Yeah.

SPEAKER_01 31:07

And it was in a higher populated state, and there was some concern about uh workforce, our workforce being able to uh have enough people to care for their people.

SPEAKER_03 31:22

Okay, yeah.

SPEAKER_01 31:22

And I gave the example, and uh you know, we had uh recently an opening, we had a job posted for uh a couple of um behavioral health nurses to support our crisis care uh service line. And over the period of a week, a week, we had almost 500 applications for those two jobs.

SPEAKER_03 31:46

Yeah.

SPEAKER_01 31:47

I mean, that's that was pretty that was pretty telling. You know, and um, you know, is there risk? Does that uh you know there's also that takes somebody away from a potential bedside uh job, but but it also kind of speaks to the uh attractiveness of you know being a part of the Aval team uh and being able to take the knowledge, skills, and clinical capabilities of those individuals and spread it out uh to an even uh bigger um population. So yeah, workforce is is um a big, a big topic of conversation.

SPEAKER_00 32:28

Yeah. I kind of want to dive a little bit more too about the extension of becoming part of their team and what that means. Because I feel like sometimes when we have had an encounter, we have a lot of off-putting people that are like, you're gonna capture everything I'm doing and you're gonna tell me what I'm doing wrong, or you're gonna be my big brother, and I don't want you to be my big brother. So what is that what when we say we're an extension of your team, what does that really mean?

SPEAKER_01 32:53

Yeah, that's you know, uh a couple of things. First of all, and I and and and as I explain it to a lot of folks in the in in the government space or even in the in the uh hospital space, you know, our providers become your providers.

SPEAKER_02 33:13

It's that simple.

SPEAKER_01 33:14

Yep, you know, they become part of your team, um, licensed, credentialed, privileged in your facility, regardless of whether it's a federal, state, irrespective of that. And so um that helps. Yeah. Um, but also um, you know, we've got a phenomenal uh implementation process, but even better implementation team. And one of the key elements of that whole implementation process is change management. And, you know, across our organization, helping those local partners to um because we've been doing it for so long across so many, you know, we've got so much experiential um knowledge out there to help um those local champions that saw fit to have a partnership with us and uh to take that those learnings and really help um get those services implemented in that local community.

SPEAKER_00 34:22

Absolutely. When we're looking at you know all the things from rural health transformation, we're looking, we just talked through many of the ways that Avel can be a part of that solution. As now a government leader, a policy leader, a healthcare leader, what am I thinking about right now for my next steps? Like what's going through my head about what do I need to do right now?

SPEAKER_01 34:45

Yeah, that's that's a great question. And uh I uh I have those conversations um multiple times a week. I recently got just a text, uh a random text, and hey, do you have a second to talk? And I said, of course. And so I uh I uh gave him a call and he wanted to know more about rural health transformation in his state. Okay, and the topic had come up around um behavioral health in particular, and one of the services that we provide in a in a number of states around the country, and and uh supposedly there was a conversation about lack of access to care, local, you know, not enough people to care for the people. Yeah, and so you know, those types of questions are are happening. But yeah, you know, the other side, you know, from a rural health transformation, a lot of these policy makers are fatigued. Okay, and they're fatigued because there's been such a short window uh from when the legislation was signed in July, the notice of funding opportunity came in in September, the applications had to be in in November, and then they were they got their initial response back at the end of the year, but also at the same time, everybody's calling. Everybody wants to set up meetings to talk about A, B, C, or D. And um, yeah, and so there's a lot of public folks that have just kind of they won't respond to their emails. They and I've and I've heard this locally and nationally that uh because it is a public procurement process to follow the process, you know, they they need to stay um to follow those guidelines. And so yeah, there's there's a little bit of fatigue because it's such a big topic. Yeah. And there's such so broad uh pockets that that organizations and communities can can act upon. And you know, like uh there's a state yesterday that um they had a large RFP uh package come out, but it was rural hospitals, federally qualified health centers, uh not-for-profits, and one other um um one other group of organizations that that's all that they were going to fund with that one. So I mean they're just setting the rules and and and and expectations.

SPEAKER_00 37:26

Yeah, absolutely. Well, and I can see why it'd be fatigued because it probably feels lonely too. Like you don't really know how to do this. So what is what when we are looking at this, what does the partnership level look like? Or how do we make sure that people can work together to truly get what's out of this funding?

SPEAKER_01 37:43

Yeah. Sustainability is key and having a good partner is wildly important.

SPEAKER_03 37:50

Yeah.

SPEAKER_01 37:51

And you know, we you know, we've got some great not only hospital partners that we work with all every day, but we also have some great cohorts that we built. Um, like Sabolo Health, um, uh phenomenal little organization that is um you know really working about changing um payment methodologies, you know, how uh rural healthcare organizations can grow and thrive and survive in these times. And you know, fortunate to be their uh telemedicine partner, and you know, they've got a big footprint and growing every single day. And so, you know, that's just one example of collaboration and building cohorts um to not only um build on that relationship, but also for their members. Yeah. And so that's an important piece of this too, yeah, is is not only that direct stuff that uh we work with uh every every day with with governmental entities, but it's it's those uh uh collaborations that's gonna be key because uh again, it's all about sustainability. Yeah. And um you know, being able to, once the federal funding shuts off in five years, yeah, you know, continue to grow and thrive from there.

SPEAKER_00 39:19

Yeah. So let's look ahead now that we're talking about sustainability in the future, and we have to keep that in order to keep moving forward. What does that look like if everyone is successful with rural health transformation in the next three to five years? What does that look like?

SPEAKER_01 39:34

It'll be a celebration, first of all. Um, that'll um you know, uh but again, it depends. It's uh, you know, I was reading recently about um like the state of Wyoming. Um, they are looking at a strategy to essentially uh take the funding and endow it.

SPEAKER_00 39:58

Okay.

SPEAKER_01 39:59

So it resides investing those funds, make investing the funds into a government, one of their government vehicles, but then using the proceeds to fund uh activities in their state not only over the next five years, yeah, but also potentially um further down forever. Yeah, okay if they invest make their investments right. That's a that's a a really interesting strategy. I I know it's being um uh strongly looked at. I haven't uh checked this week on on the status of that, but you know, that's that's a very uh thoughtful way to to consider um the long long game and how that plays out. Uh, but also you know, it involves you know different uh you know, like the work that our partner Sabolo does about um payment methodologies and value-based um uh care uh uh methodologies for sustainability after the fact. And so you know, I think going back to you know, way at the beginning of this, we talked about infrastructure. Yeah. And you know, virtual infrastructure is just as important as as brick and mortar, and be in in reality, there's not a lot of brick and mortar in the um uh rural health transformation can make upgrades, but you can't build new stuff. Exactly. And uh and so you know that virtual brick and mortar, if you will, uh is a key part of that.

SPEAKER_00 41:34

Absolutely. So when you've talked to all of these different policymakers and you yourself in this realm, what has made you optimistic about this opportunity that we have right now?

SPEAKER_01 41:50

A lot of things. Um you know, going back and looking at all those state responses that we as an organization have responded to now starting to see uh some requests for proposal, uh requests for more information come out. Um, that's um I'm really warmed by the fact that uh we um you know have a a system of care, a platform, you know, across the care continuum, you know, from all the way from an ambulance pre way pre-hospital, all the way out to post-acute in the uh senior care space. Yeah. Um you know, there's there's a lot of ways in that whole continuum that we have the ability to impact care. Absolutely. And uh that's really that's really um warming, especially, you know, all the results that we've been able to achieve over the last few years and being able to educate policymakers about, you know, whether it's you know, yes, senior care, whether it's um school nursing, because a lot of states have uh some element of school-based care in their plans. Yeah. Because interesting statistic. And and this came to light uh when we were doing an RFI recently for for a state. 67% of the kids in K-12 in this country don't have a primary care provider.

SPEAKER_00 43:30

67%.

SPEAKER_01 43:32

67%. And so um that was really a light on because if you you know the importance of our school nurse is their primary care. Bingo.

SPEAKER_00 43:42

Yeah, yeah.

SPEAKER_01 43:44

Yeah, that's huge. That's yes. You know, and if we want to truly improve access to care in rural America and K twelve, um, you know, virtual could be a uh way to uh have. That strong impact. You know, the same way along with behavioral health. Yeah. Being able to provide those uh kiddos uh access to scheduled therapy appointments via telemedicine, but in the safety and and uh and uh safe surroundings of of their school where they're comfortable.

SPEAKER_00 44:19

That's awesome, very cool. Well, you've given us a lot to think about today. It's been really fun speaking with you, but before we wrap up, we like to do really quick questions of just give me your shortest answer to the question, okay?

SPEAKER_01 44:32

So what's short?

SPEAKER_00 44:34

Short. We gotta keep it nice to be. How long have we known each other? Too long. So very quick, with what's off the top of your head. So, what's one misconception people have about rural health care or telemedicine that you wish more people understood?

SPEAKER_01 44:51

Um, we're a partner. We um we are a partner in care. Um we um accentuate and we're that combat multiplier, yeah, we're that uh tactical advantage uh to help uh uh win this uh battle to improve healthcare in rural America.

SPEAKER_00 45:15

I love that. So if you could change one thing about how rural health care kind of operates today, what would that be?

SPEAKER_01 45:23

Oh boy. Was that in your pre-notes or is this something you just came up with?

SPEAKER_00 45:32

You'll never know.

SPEAKER_01 45:34

Is there one thing that I can change? I think the one thing if I had if I was in the legislature again or if I was uh um doing one of those old roles uh in my old life, I would want to change payment methodology for EMS. You know, EMS in this country is woefully underfunded. Um it costs, you know, and I've seen some statistics three to four times what it actually uh gets in reimbursement. Yeah. And and EMS is such a strong part of the healthcare continuum. Um if if if I had one subject area that I needed to focus on, I would probably probably do something about around EMS.

SPEAKER_00 46:30

That's interesting.

SPEAKER_01 46:31

Yeah.

SPEAKER_00 46:32

I never dived into that. Yeah. No, we'll have to talk about that another time.

SPEAKER_01 46:35

Well, and it's and it's important because you know, as we you know support so many, you know, communities around around the upper plains with uh telemedicine and and talk more about sustainability. Yeah, um, that's that's an important piece of it.

SPEAKER_00 46:50

Absolutely. Well, it's been a pleasure to speak with you today about all things rural healthcare, all things that are kind of in the government space right now to impact that. If there's one takeaway that policy leaders, healthcare leaders are listening to today, what would that what would you want to give that as a takeaway?

SPEAKER_01 47:06

Yeah, I'm gonna go back to telemedicine is a strategic advantage. You know, having a virtual health partner with with a full continuum of services across the healthcare ecosystem, across the lifespan. Yeah. Um, that is uh that that is um that is transforming rural healthcare. And and you make fun of me, I know you do when I talk about rural vitality. Yeah. Because I talk about it regularly.

SPEAKER_02 47:34

Yeah.

SPEAKER_01 47:35

But that's that's uh a key part of this whole uh our whole being is rural vitality, you know, giving citizens in rural America, you know, better access to care, better outcomes, better value to the taxpayer at triple A. And so uh, you know, having a virtual health system partner like Bell with that uh breadth and depth of services that we have, um that is um a strategic advantage.

SPEAKER_00 48:07

Mark, well, it's been a pleasure. Thank you for joining us today. All of your perspectives and your background just really brings light to everything that's going on and appreciate you sharing all that knowledge with us.

SPEAKER_01 48:16

Well, great to be here. Great to uh be a part of the initial uh uh version of of the um our new podcast. And so happy to help you uh whenever I can. And uh really looking forward to to learning from other uh leaders and and uh stakeholders through the organization as we uh grow this new brand.

SPEAKER_00 48:40

Absolutely. Thank you so much, Mark.

SPEAKER_01 48:41

Yeah, appreciate you.

SPEAKER_00 48:42

Yeah, and thank you for joining us on Avel Ecare Virtual Health Connections. If you found the conversation helpful, we'd love for you to subscribe, share it with your colleagues, and stay connected with us as we continue exploring telemedicine and the future of healthcare delivery. To learn more about Avel ECare and how we're supporting care teams across the country, visit Avelecare.com. Thanks again for listening. Until next time, stay connected,