Innovation, Feedback, and Care Transformation with guest Mandy Bell

What does healthcare innovation actually look like when it’s grounded in real clinical challenges, workforce realities, and the future of patient care?

In this episode of Virtual Health Connections, Mandy Bell, Vice President of Product Innovation at Avel eCare, joins the conversation to explore how healthcare innovation goes far beyond new technology. With decades of experience helping launch and scale virtual care programs, Mandy shares how Avel approaches innovation through collaboration, customer feedback, and a deep understanding of what care teams truly need to succeed.

From emergency medicine and rural hospital transformation to AI, workflow optimization, and workforce support, Mandy explains how innovation at Avel is focused on solving real problems — not chasing shiny ideas. She discusses how telemedicine can strengthen hospital sustainability, help care teams feel less isolated, improve patient outcomes, and create lasting change even when the camera isn’t on.

The conversation also dives into the future of rural healthcare, the pressures facing today’s health systems, and why healthcare leaders must think differently about access, staffing, and operational transformation. Along the way, Mandy shares powerful stories from the frontline that highlight the emotional impact virtual care can have not only on patients, but on the clinicians caring for them.

If you’re passionate about healthcare innovation, rural health transformation, telemedicine strategy, or the future of care delivery, this episode offers an honest and optimistic look at where healthcare is headed next.

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Virtual Health Connections is a podcast by Avel eCare, the nation’s largest and most comprehensive telemedicine network. It explores telemedicine networks, virtual integration, and what it takes to redefine healthcare delivery.

Each episode features leaders and clinicians from across Avel’s Virtual Health System, exploring the real challenges facing healthcare today and how innovative solutions are making a difference. From the care challenges rural and underserved communities face to the frontline perspectives of those delivering care every day, these conversations highlight how telemedicine is creating new possibilities.

Along the way, listeners gain insight into the advantages of virtual integration, the realities of today’s healthcare workforce, and the leadership decisions driving meaningful change, all while looking ahead to what the future of care can and should be.

Founded in 1993 as the nation’s first virtual hospital, Avel eCare continues to lead the way in virtual health services. This podcast extends that mission, connecting people, ideas, and innovation to improve outcomes and expand access to care across the U.S.

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.

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.

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Transcript

SPEAKER_00 0:05

Welcome to Avel Ecare Virtual Health Connections. I'm Jessica Gaikowski, and this is a podcast where we explore telemedicine and the future of healthcare delivery. At Avel, innovation isn't about chasing the next idea. It's about solving real problems for the communities and care teams we partner with and continuously getting better at how we deliver care. Today, we're talking about why innovation matters right now, how customer feedback shapes what Avel builds, and how efforts like rural health transformation are accelerating the need for practical outcome-driven change. Joining me today is Mandy Bell, Senior Vice President of Product Innovation at Avel ECare. Mandy oversees our product innovation efforts, leads team major service line development, and plays a key role in Avel's work around rural health transformation and emerging care models. Mandy, thanks for joining me today. It's good to see you. I'm happy to be here, Jessica. We're happy to have you. Before we dive into all of our conversation about healthcare innovation, can you just give me a little bit of your background and what your role is kind of today and kind of lead into what does healthcare innovation really mean at a Val?

SPEAKER_01 1:14

Yeah, I would love to. You know, I'm the person in healthcare that was never meant to be here. My whole family, they're nurses. My parents are nurses, my siblings are physicians. And I just thought patient care was beyond what I could manage. And so I was definitely not going into healthcare and somehow I'm here.

SPEAKER_02 1:31

Yes.

SPEAKER_01 1:31

But I think when you uh you get involved, there's so much to healthcare that's outside of the direct patient care episode, and it's really about how do you um connect those resources together to make sure people have access to care, have the best care possible. And that problem just never gets old. And we've never really solved it, so there's always more to do. And I find that um attacking those challenges every day is really exciting. My role at Aval really started as a grant writer, and we we loved grants. It was a great way for us to trial new things, to get funding for crazy ideas and then see if they worked. Um, and very early on, we were really fortunate to get some large uh private funding to really start what became Aval e care. And I was so attracted to it. I was like, I have to be a part of that. Even if I don't want to be in healthcare, I think I want to be a part of solving this. Uh and so it was very much a kind of startup mentality within a healthcare system. Um, how do we meet with our clients, which were at rural hospitals in our network, and understand their issues, how we can bring um specialty expertise in just in time to solve some of their problems. Um, one of my first roles was in uh quality, quality and quality assurance, and it was making sure that we were actually measurably um doing a good job at providing care. And then it was, are we doing a good job or are we doing a better job?

SPEAKER_02 2:48

Yes.

SPEAKER_01 2:48

And so it was always how do you move the needle and build systems around, you know, what some of our nurses and physicians were doing very naturally about coaching and um always elevating the bar. But how do you build systems so that you can replicate that success across more and more hospitals? And so it's just been a really fascinating place to work. It's been one where you're always waking up with we could do more, we can do more. Yes, what's next? And it's you know, healthcare is so personal. There's not one of us that hasn't been touched by it, and there's not one of us that hasn't experienced that time when, gosh, I wish, you know, I wish I would have had access to that expert that really knows how to treat my condition. Um, I wish there would have been um that just in time emergency service um during this, you know, this accident or during a stroke. Um, it's so personal. I I wish my grandmother in the nursing home would have better access to her physician. So when she has that fever, it's not escalating and becoming a serious condition, but something that we can treat right away. And so for me, there's always more opportunities to improve. And you see the passion that comes from our from our nurses, our physicians, and that they want to give the best possible care. And you know, how do we how do we get rid of the red tape and the friction between them and and that vision that they have so that they can actually do it? It's a really exciting place to work.

SPEAKER_00 4:03

Oh, it's amazing. Well, and you're in the perfect spot to see your passion coming through from operational and strategy to really bring into the clinical expertise. And I'm like, we need people like you in order to continue to drive innovation. So kind of going off of that, dive a little bit more about how we look at healthcare innovation at Aval.

SPEAKER_01 4:24

Yeah, and I think a lot of ways people think of innovation. And there used to be this commercial with IBM, I think, where there's people laying on the ground ideating, and uh and they can think of it as maybe whiteboarding or lots of sticky notes. And for us, it's really maybe some of that incremental improvement and as well. You know, you'll bring um, what's an example? You can bring a critical care physician into a hospital, but how do you make them most effective if you've got that distance of telehealth? How do you make sure we've actually tightly woven our work into the workflows of the hospital so that when the nurse you know turns to do the next activity, you know, we're right there and available to assist. You know, we're part of their usual way of working and we kind of fit naturally into the team. And that's really challenging to do when you're trying to work with 30 individual hospitals with their 30 individual ways of doing things and still be really integrated into their team. And we are working with very small hospitals. So I think some um telehealth groups are fortunate. They'll have one physician maybe working with one hospital and they could be very um intimately involved. We're working with these very small hospitals where those economics don't work. And so, how do we still get that sense of teamwork very quickly when we're working with, you know, a hundred or two hundred emergency hospitals, and we need to step into that very intense situation and be able to help and provide assistance, coaching, whatever is needed by the local team.

SPEAKER_00 5:49

Yeah. You kind of hit on this a little bit, but I want to dive a little bit deeper. So when we're looking at all of these different variations of individuals that we're supporting, whether it's a larger community, smaller community, the innovation looks a little bit differently. And good innovation from how you're talking right now is really seamlessly, you know, getting involved with the processes that are already in place. Can you kind of talk a little bit how we manage to really dive into whatever that health system is looking at and how we really seamlessly get into their processes and procedures to make sure it's successful?

SPEAKER_01 6:25

Yeah, that's a great question. And I think it's something that we're getting better at all of the time. You know, I often look at um what I do is I'm I'm not the innovator, right? Like I don't have the ideas. I'm more you hear other people's you hear other people's ideas and and you'll have a physician come to you with, you know, I think we can do better, or a nurse of, I'm really passionate about delivering this expertise in this situation, but you know, how to get that done. And so a lot of my work has been on the innovation side is to connect all the pieces together so we can we can actually get it done. So make this idea come to life in a lot of ways. Um, and so we're fortunate we work with people here at Aval that have worked in healthcare a long time and they really understand the differences that can happen from hospital to hospital, you know, what a nurse is really dealing with on a shift and what's most important to them. Um and so how we don't become extra and more, but really hopefully a benefit to that nurse on our shift to make her job just a little bit easier. So a lot of what we try to do is actually look for the wins and how to make that role easier. And then we know we can influence patient care by doing so. So, for example, and I and I'll give all the credit to some of our early um innovators on the emergency department, but one of the things that we do is help with a nursing documentation during an intense situation like a critical care code or um maybe um help with a transfer when there's a multi-victim car accident and there's all hands on deck. So we're taking these kind of administrative tasks off of the local care team so that they can keep their hands in patient care and and focus on the patient in front of them and not start to worry about you know who's documenting these pieces, you know, is somebody calling and relaying all the information we need to the transport? Do we have an accepting hospital? Yeah. All hands on deck, they're focused. They're here and they can be really, you know, in the moment and we can take that on for them. Now, does that actually like if you is that actually providing access if that's really our goal? Are we actually helping the patient in that moment? Um, in some ways we are, but what's most important for us is we're building a sense of team and we're giving a reason for that local care team to invite us into that scenario so we can help. And there's been times, I mean, our our emergency staff will tell you, well, we'll we'll come in and the you know, the physician's like, that's fine, you can help my nursing staff, but I've got it. I'm good. I'm good. And we have to respect that, right? They've been in practice a long time, and this is their patient, it it is their decision. Um, and it can be intimidating to have somebody kind of you know looking over your shoulder, and we we certainly never want to be thinking that there's big brother taking an eye on you, but I I think when you can be in that situation, you can kind of casually say, you know, hey, it looks like you got a tough situation, you're doing everything right, and you have you thought about this next, and sort of gently offer some suggestions and see how that plays out. Yes. Um, and start to become more and more of that care equation. So I so that is part of how we do innovation. It's a little bit um figuring out what's going to work at that hospital, but even in that situation, how can we add value? And it might just start with um, how do we support that nurse or physician? Yes. And then by extension, you can start to see how that supports patient care as well.

SPEAKER_00 9:35

Yeah. So throughout the years, have you noticed that the innovation looks more of just revamping things that have already been implemented, or have you seen like that we need to build something new? What has kind of been your landscape of that over the last several years at Aval?

SPEAKER_01 9:50

Yeah, that's a great question. I sometimes I worry like you've been in this career too long and maybe you're all your ideas are old and tired. But I also think they build on each other. So once we've kind of built a foundation for um, you know, hit a button on a wall and you'll get access to a board certified emergency physician in minutes. You can kind of start to layer on to that other innovation becomes so much easier. You know, can I bring in a uh a burn surgeon into that scenario then? Yes, we have all of that in place. And so the lift to get that next piece in is not as terrible. Not as terrible. And you have lessons you can learn. But I do think sometimes we get set in our ways as well. I know a few years ago we had um developed a hospital service line, and it was really well suited to a certain um segment of these hospitals that had a core group of physicians and nurse practitioners in that community. I always think of them as four two physicians, two nurse practitioners. Yeah. And they had worked out this great call rotation. You know, they each had their day of the week that they took call and then they would rotate, you know, each one would take the long weekend. Um and it was it was a beautiful thing. It was even, everyone felt like that was manageable. And so when we're coming with hospitals, it's like, how can we take a little bit of the load off your shoulders at night? So we'll take some of those um calls uh so you're not being woken up all night if you don't need to be. Yeah. And we'll be here. If you're busy in clinic, we can tend to the thing that's coming come up, and then when you're available, when you're rounding at lunchtime, you know, we'll give a report and we'll connect in that way. And it was, it's a good service. I still think it's a good service, but suddenly we were working with hospitals that didn't have that. You know, they had been told by their local um primary care team, you know, we can't round in the hospitals anymore. We're we're stepping back. And the hospital is suddenly without you know, physicians, without providers for coverage. And so they're in a totally different situation. You know, how can telehealth come in and really help run my inpatient department for me? How can you help me be the backbone so I can recruit maybe a nurse practitioner into this community, maybe a physician, so they feel like if I'm going to care for these patients, I'm not it. It's not just me. I'm not coming into a group that's completely run by um locums that are, you know, coming in and out of this community that don't know where things are, processes in place.

SPEAKER_00 12:05

Yes, all of them.

SPEAKER_01 12:06

Aren't dedicated, but I have this backup and I'm not alone. Um, I can take time off. You know, if I want to go on vacation, I have the peace of mind that I haven't just left all my colleagues in the dust. Yeah. And so um, really for us it was rethinking what should our hospitalist service line look like and how do you meet both needs. Those that, you know, the the physicians really want to own the patient care, they just need some support and backup. And then these other hospitals where they're really feeling like I I'm starting from scratch, please help me build up my hospitalist program again. We've had this huge amount of change and you know, we're not sure what the next best step is.

SPEAKER_00 12:46

Yeah. So, from your perspective, since you've had all this experience of helping really launch all of these wonderful service lines at Aval, what have you seen is one of the biggest challenges from both a rural perspective and a tertiary hospital perspective?

SPEAKER_01 13:02

Yeah, I think there's a lot of change hitting the health system right now. Um, we're looking at that one big beautiful bill act as a huge opportunity for you know five billion dollars worth of rural health care transformation at the same time, you know, facing some Medicaid cuts and a lot of pressure on insurance companies that we've got to keep the cost of healthcare down. And I think we all feel that. It's a huge part of our our national spending, it's a huge part of our personal spending. And and we want these innovations, right? We want these new drugs and procedures. We want to extend our life, but it comes at this tremendous cost. Yes. So, how do you keep bringing in these life-changing medications and surgeries and technology and robots at the same time like keeping the cost reasonable? So you're balancing this huge equation. Yeah. And I don't envy healthcare leaders that are having to make those difficult decisions. You know, when you look at a healthcare budget though, the vast majority of our spend is still on our people, which is which is important. It's it's on our um clinicians, it's on the support staff behind them, you know, it's on the administrative team, but it is people driven. Yeah. And so when I think about challenges, you come back to that workforce. And unfortunately, because of COVID, we've had, you know, we still have these ripple effects. There were lots of departures from healthcare, it was burnout, there was, you know, fear maybe early on, and some early retirements or people leaving the field completely. You've had a shift and uh and a quite a bit of expansion in the um advanced practice providers like nurse practitioners and physician assistants and trying to step into their role and and state revisions around independent practice and things like that. So it's a lot of change coming at the same time you have, you know, trying trying to optimize EMRs still and trying to figure out what does AI mean and how is is it an ROI that we can show for a facility? Is it is it yeah, you know, what are the risks, what are the benefits? Yes. Um, you've got a lot of uh medication supply costs that you're trying to keep down. And it's you know, there's just so many things to continue to look at improvement. And when you look at, especially in real health care, margins are tight. And so to make a mistake is so costly. There's just not enough room to do some of this experimentation. You are in retirement, one accident away from losing your provider, that's that huge economic driver for your community. Um, and so you're always kind of on that razor's edge. And yet you look out there and you think, gosh, you know, what could AI integration into my billing operation do for me? And but do I have the team that can implement it on top of everything else that they're doing right now? Yes. Um, and so I'm I'm sure that's not different from any other industry in a lot of ways. But healthcare has that special challenge that, you know, we're dealing with, you know, patient health, you know, patient lives. And so we can't afford to make too many errors on the um, any errors really on the AI side. And we we can't afford to put our clinicians in the backseat behind um some of these technology changes, and so you've got to advance it all at once. All at once, yeah. And so I think the pace of change can feel slow. And I think you can see these um, you know, big operators come in and think, you know, I can solve this challenge, you know, if it's Amazon and Walmart. And and in some ways I certainly hope so. But yeah, I also know at the end of the day, it's gonna come back to these people in this workforce. And so that to me is still the number one challenge. There's just never going to be enough um physicians, enough specialists where and when and where we need them. We're never gonna have enough nurses to do all the heavy lifting we want. Um, we're never gonna have the pharmacists um optimized to take care and review all the medications and and do all the counseling that we would like them to. And so it's really how do you stretch everybody and kind of use technology then to bridge some of those gaps in the meantime?

SPEAKER_00 16:53

Yeah. So when you're looking at these challenges throughout the years, have you seen this workforce challenge throughout, you know, from the beginning, starting in 1993 with rural health care, to looking at COVID and finally the blinders came off of people realizing telemedicine can play a role into the field, even though we've been doing it for several years, and to now almost going back to helping rural health facilities with this rural health transformation initiative. Do you feel like the challenges have really remained the same throughout the years or have they shifted a little bit?

SPEAKER_01 17:25

I you know, I do think that uh the challenges over time seem to be getting greater. And um, I wish I knew if the data actually back that up. But it it seems like the workforce shortages are becoming more acute. And you see that not only in the availability of people, but then the cost um to recruit and retain individuals into your community. Um so those challenges do seem to be getting bigger. And I think that the um amount of health care we're probably needing as a nation is getting greater as well. We've got a population that's aging, and as we age, um, our bodies need more and more um tending to, and so that means more specialty appointments. Yep. I think what we see too is that when you get into that um a part of life where you're needing multiple specialists, the care that you're receiving is so complex. Um and you can be kind of bounced around and and if you're hospitalized, you've got many medications that you're coming in on, many conditions for people to understand and and support you with. And so I do feel like the problem is getting harder. At the same time, we've we've had huge advances in lots of care. And so things like hip surgeries, you know, are are you know the the the people in the hospital are much sicker than they used to be because anything that's been kind of um optimized now is an outpatient procedure or you're going home the same day, one night stay. And so these nurses are still maybe dealing for uh maybe a similar number of patients, but they have more needs. And we especially what we saw during COVID um is really stretching like how far can we um have our staff cover this census? And I don't know that the census in hospitals has really gone down since then. It feels like many of the hospitals we work with are just bursting at the seams. Um they're looking for ways to you know keep lower acuity patients out in maybe rural facilities or community hospitals. Those community hospitals are trying to figure out can I can I care for that next level acuity patient? Yeah, or am I having to transfer them out? Yeah. Yes. I mean, you think about that in behavioral health as well. You see throughout the country, you know, there are pockets where patients are waiting or getting boarded in the emergency room for days because there's not an inpatient uh bed to take them. It's just not a good healing environment. And you can you can put yourself into the shoes of that patient or their loved one and that the desperation that you feel of how can I get actual care for myself or for my family member when they're in this crisis. I know it's not happening here in the emergency room.

SPEAKER_02 20:00

Yeah.

SPEAKER_01 20:00

I talked with a physician last week that said they had opened a new hospital in the urban center, and within like hours of opening, you know, they had expanded all these beds. They were already having patients again in the hallway. And so, you know, they had all these hopes. We're adding beds, we're adding capacity. We're not gonna be full the first day. And they were full. So I it almost feels like we have an unsatiable appetite for healthcare, and it's you know, how to get smart at how to how to bring that. I think telehealth is a huge part of that solution because hopefully we can be smart and you know, both collaborating with a primary care physician who can serve as that um quarterback for all the health care and kind of bring in the specialists as needed and be really efficient with that expertise. Um, I also think we can make sure that patients aren't having to travel to get that care or often not travel and not get that care. And so you can treat a condition more effectively in its early stages rather than letting it advance to part to a point where it's very complex.

SPEAKER_00 20:59

Yeah.

SPEAKER_01 21:00

Oh, that's amazing.

SPEAKER_00 21:02

So your role, you you very much set at an intersection of strategy, operations, clinical and uh innovation, of course. But from a healthcare perspective and leaders listening in, how should they be thinking about healthcare innovation today and what they should be doing to help perceive the innovation to continue to be better?

SPEAKER_01 21:23

Yes, I think we all know that innovation is necessary. And I'm guessing for many people it's just the thing on the list that we never quite get to. Um, and it can feel a little maybe frivolous when you're dealing with, you know, I'm short staffed today, or uh, the water main broke, or you know, I've got this other urgency, I've got a board meeting coming up, I've got to get prepared for.

SPEAKER_02 21:46

Yeah.

SPEAKER_01 21:47

Um, so it is how do you invest and and kind of make people explicitly responsible for innovation so there's time carved out in the day.

SPEAKER_02 21:54

Yeah.

SPEAKER_01 21:55

And then tie it really directly into um uh issues that you need. To solve. And so I remember in our early days, we used to have people that would go to trade shows and they would get out and there'd be vendors showing their latest and greatest technologies. And they would come back with, We've got to have this gadget. You know, this is the thing that's going to that's going to take us to the next step. Yes. And I think that's not the kind of innovation we're talking about, where somebody says, AI is so awesome. We need to bring AI into our hospital. I think it has to be, you know, gosh, this process feels broken or it feels unnecessarily burdensome. How can we make it better? And then what are our tool sets to do that? And that's maybe when AI comes up and you're looking for a really specific solution to solve that problem rather than responding to the ad you just got served up on social media, right?

SPEAKER_00 22:49

Yes. That sounds pretty cool. Yeah, it does sound pretty cool. That's awesome. So how does the customer feedback, you've talked a little bit about this, but when you're looking at the customer feedback, bringing that into healthcare innovation, what role does that play when we're looking at deciding, you know, new innovation is a good way to do that? Or like you just said, this is a process that needs improvement, and where do we implement ourselves in this?

SPEAKER_01 23:13

Yeah. For us, really, most of our work should come from our customers or they should be involved pretty early on. Yeah. I think we've all been in that situation. We have a great idea and we're so excited and we present it to somebody and they look at us like, what? That's not really that great. That's not how that's not how it really works in the real world. Um, and so part of our team's job is is really to take um to spend time talking to clients and see, you know, what what else could we help you with or what other issues are you having? And from a process improvement perspective, you know, you know, where is this not quite working today? You know, we would have expected maybe you would call us on, you know, three to five percent of your emergency patients, but that's not what's happening. Can we dive in and figure out what's happening in your facility and really understand um what the gap is from where we want to be and where we're at today? And uh customers have the answers to all that. And sometimes, you know, they're reluctant to give that feedback. It's easy to say it's all fine, you know, it's a quick answer and move on with their day. So you look for those people that are really interested in um having that maybe that uncomfortable conversation about you know where we could get better, or you look for those innovators that are thinking, you know, I've dealt with this uh annoyance, this you know, friction in my whole career, and I'm gonna step back and think, do I need to? You know, or is there a better way uh to solve this problem? And so I'm always looking for those people too that you know can kind of poke their head up every once in a while and think, is there, do I have to keep putting up with this, or is there a better way to solve this problem?

SPEAKER_02 24:49

Yeah.

SPEAKER_01 24:50

And and I like to also think like, can we think way outside the box? And so sometimes, you know, you'll get people that are very focused on our current reimbursement models, you know, how does this replicate the current reimbursement model? I think for us, a lot of the solution has been to put that to the side.

SPEAKER_00 25:05

Yeah.

SPEAKER_01 25:05

I mean, we had some grant funding to help us get there initially and think what's the actual problem we need to solve, and then figure out how to build an ROI, an ROI around that, how to, you know, build a revenue model to make that make sense. So I look at our senior care business as an example. Yeah. Um, a lot of times these seniors are cared for by, you know, the same staff day in and day out, and they kind of know if they have a change in condition and they kind of know when they need more help. Um, the traditional model for telehealth would be maybe to bring in a physician to do a full visit on that patient. But often we're able to accomplish some of the same things with just, you know, a quick look or a quick phone call and really help them get better. Does that translate into a reimbursable visit? You know, unfortunately not. Um, but it does have a huge impact on that patient in that moment. And it helps that nurse get on with their day and taking care of the next patient and the next patient. And it's a really effective way to deliver health care and keep seniors in space in place. And so then you're looking at an entirely different economic model of how we can support the nursing home, but maybe support the primary care physician as well that's taking care of that patient that can't be there every minute of the day. So rather than focus on um, you know, the traditional way of doing things, it's also talking with clients, what's the actual burden you're you're facing, and then how can we help you solve that?

SPEAKER_00 26:27

So, from a Vell's perspective, how do we get our current customers and partners to be involved with that process? Like, what are steps that Avell does to really get the feedback? Because sometimes people don't even have time to provide feedback. So, how do we work through that process to be like, what are the things we're doing? How do we get these answers to really build upon what we're providing?

SPEAKER_01 26:47

That's a great question. I mean, we are kind of reliant on people giving us a bit of their time to give us that feedback. And so, I mean, fortunately, today a lot of that can be done over a quick uh video call. You know, you don't have to um get on site and be very disruptive and feel like they have to roll up the red carpet for you. So that has helped a lot. Um, we also um try, and I think this is something we can continue to get better at, but get that just-in-time feedback after an encounter. Um always giving people the opportunity to send a quick comment and and they do. Um they let us know we're doing well and and when we're not doing well. And I think uh that kind of feedback helps us, you know, especially over time, collate like what are the themes that we're doing well with? I just looked at our emergency survey data, for example, and I was astonished at like the themes that were coming forward, you know, have having not spent so much time looking at the data, it was really about the nursing support. And so we talk a lot about bringing this emergency physician into the scenario and you know, helping coach through maybe some of the most difficult procedures these individuals ever do. I think that is extremely valued. But what you hear coming forward is you just took care of me. Like you took care of the busy work and administrative work, so I could just be there. Focus, yeah. And the power of that, like seeing that in writing, is really helpful to make sure then um as a service line that we're continuing to invest in taking care of our bedside team because this is so valuable to them.

SPEAKER_00 28:15

Yeah, that's amazing. Well, and I love hearing those stories from the clinical team because they're like, this is just what we do every single day. And I'm like, did you read that statement? It it's a huge difference. You've made an impact not only on the patient's outcome, but all of the team that's working with them. Or when we've had situations where it's not been a positive outcome and the reassurance to that team saying, You did everything you could at the bedside. Like that means more than anything else. Yes. Yeah. So obviously, we're a telemedicine company and that's at the core and looking at new technologies, but healthcare innovation in telemedicine means more than just that technology piece of things. How do you think about that as an advantage to what FL is doing, looking at more than just technology, bringing in that clinical expertise, et cetera?

SPEAKER_01 29:05

Yeah, I think we're fortunate in we live in a time, especially post-COVID, where the technology side of telehealth has kind of gotten um so much more affordable, so much more robust than it ever was before. Yes. I think um when we first started, there's this, and it was a little bit of my time. Um, but one of our physicians, Dr. Jacobs, will say, Yeah, that unit costs us like $100,000 the first uh telehealth cart we put in place, which is just amazing to think about. Wow. And now um, you know, for a thousand dollars, a couple thousand dollars, you can get a really robust um piece of technology. Wow. And so for us, the technology has kind of gone to the side in a lot of ways. And now all my technology partners at a bell are gonna be giving me the side eye because they work so hard to make sure that all works in the background. Yes. But it's really about the the process innovation and the business innovation and like leveraging this powerful technology that we have and these platforms that we have, then to make sure we can be where we need to be just when it's appropriate. And so when we're in an emergency room, it's that idea of I need help now and I I just need help. Like I just want to say, I need help, and it's in the room. And so we've made that as as easy as possible with the push of a button. Um, but it's really about making sure then you have all of the pieces behind the scenes, um, the people ready to go to take that call, um, the physician ready to understand which community they're working in and what capabilities they have, who they're talking with on the other side, so they can have that quick connection and step in and support. Um, so for us, the technology has been like an important piece of the pie. But I really look at my team sitting in the middle of, you know, you know, what can we do clinically? And then from a compliance perspective, what compliance um pieces do we have to keep in mind? And you know, so we're making sure we get consent and we're documenting and we've got a secure flow of information. Um, you know, what from a contracting perspective do we need to consider? You know, what are the state licensure or prescribing laws? And so it's pulling on all these different um kind of functions or departments within a Vell to actually create that innovation and make it possible. You know, how can we do all this affordably? There's that you know, you can do anything with enough time and money, but what we know is that our customers want this to be cost effective and it has to be cost effective. So, how do we do it at a um resource level that's going to be efficient for everybody involved? And and I think of that as really truly the the innovation piece. It's it's pulling all that together. And sometimes I think of it as a spider web, literally, where you're kind of tugging on all the strings, like how do you find the right balance? So you've got the the cost point where it's sustainable for everybody, but you've got enough uh of service and that you know um warm human touch um involves that it's going to make a huge impact.

SPEAKER_00 32:03

Yeah. When you talk about keeping patients in the hospital, what does that mean for a community or for a rural health facility?

SPEAKER_01 32:11

We estimate that the average revenue associated with one inpatient stay is about $10,000. And when you look at a hospital whose budget may be fairly modest, some of our smallest hospitals, it's you know, maybe maybe even less than $5 million. That $10,000 goes a long way to being able to keeping their nursing staff uh fully fully staffed to making sure that they've got training and resources available to their team. But every patient that stays in that community is a financial benefit to that hospital. But you think about that patient. Most certainly they have a spouse, uh a family member, or a daughter that is in that community. And if they're leaving and going 60 miles, 120 miles to the nurse tertiary care center, it's very disruptive for everybody in their life. And they may find themselves healing in a hospital bed very far from family and alone. Yep. Alone. And so being able to stay local is is huge for everybody involved. We also know that uh as you begin to care for sicker patients, you're getting that confidence, you're getting competence, and so that next patient that is admitted, you're more ready for that patient as well.

SPEAKER_00 33:17

So when you're looking at the bedside team and the workforce shortages and the retention piece of it, how is our healthcare innovation playing a piece into that? Or how can we help get that word across that it is an enabler to help with that team better, their quality outcomes or measures or whatever that may look like?

SPEAKER_01 33:37

Yeah. Um I always think of most of our services being designed first and foremost for the workforce that we're supporting. And I think um sometimes that takes people by surprise. You know, aren't we here to improve patient care? And I think Yes, that's a piece of the puzzle. But absolutely, that's why we're probably all here is for patient care and to take care of patients. But we do that by taking care of our workforce, um making sure that they'll come back to work uh the next day, the next week, the next year, um, that we have uh provided uh enough tools and resources and that kind of peer network, that phone a friend, so that they don't feel completely isolated and burnt out, but want to come back um and take up the next shift. And I don't think that can be underestimated in some of these very isolated communities about how lonely it can be to work there or to be in a middle of an urban hospital um in a busy ICU in the middle of the night and feel like I'm it. You know, who am I gonna turn to? Um, who's gonna support me? And I think of telehealth as being that support network for these clinicians. I I always want to be that um resource that they can count on to take a load off or confirm that they're doing everything that they can do, um, you know, coaching them if they've got questions, uh just being right there at their elbow to make their job a little bit easier so that they can get on to the next patient. I also think about telehealth as, and we did a study on this, which was really interesting, as a way to help people level up their skills.

SPEAKER_00 35:08

Yeah.

SPEAKER_01 35:09

So when um we first started providing our emergency service, we really focused on acute conditions like heart attack, um, stroke, uh, trauma, uh, and making sure that we were kind of programming our services that we want to be there for the worst cases that you have coming into your emergency room.

SPEAKER_02 35:27

Yeah.

SPEAKER_01 35:28

And I remember being in ear early on in the quality manager role thinking, they're only calling us on like a third of their heart attacks and half of their strokes. You know, what are they doing the rest of the time? And so we partnered with the University of Iowa and they actually came in and did a study that was really interesting. And what they found is you kind of using some standard CMS benchmarks for quality, that there was a before e-care level, and then there was this after e-care level. And what they had found is that when we when we had um our emergency service up on the camera, we were more likely to hit, you know, certain parameters, you know, make sure every patient's getting aspirin, getting that really quick EKG, you know, if they are candidate for lytics, that they're getting that, that we're transferring them as as quickly as possible. So we're hitting all these metrics. But what we found is that they were also now hitting them more often when we weren't involved. And so you think about how powerful that is. Yes. There's those moments in your life that are just like burned into your memory, but the the most powerful education is when it's like in the moment, you got you got your adrenaline going, it's real time, and and that becomes a really um sticky nugget of information. And so it makes a lot of sense to me that you know, if we've helped this general nurse that's you know, rounding on inpatient floor in the emergency room, maybe called other duties as well, suddenly gotten really good at um remembering all the things that they need to do for STEMI care because they've been you know practicing. And now they don't even need to call us. Like that patient's getting that care. So to me, that was so powerful that we're helping, not even when we're when we're not even in the room. Yes. And and from a skills perspective, you have better skills, you have that competence that that nurse is like, I got this, I know what to do. Um, and that makes them more likely to stay in that um role where they're uh many wearing many hats in the hospital.

SPEAKER_00 37:18

That's amazing. I've not heard that story before. That's so cool to hear. I'm like, we got to do another study on this. So I'm gonna shift gears just a little bit. So rural health transformation initiative is massive right now, and you've played a huge role into kind of the strategy of what Avella's doing. So let's talk about that from a frontline perspective and what that really means and why is rural health transformation so important right now.

SPEAKER_01 37:44

Yeah, I think um ever since I've started my career, actually in the the Avera Rural Health Institute, you know, rural health has been a focus of ours and understanding the differences in in how those communities are set up. And um, you know, they they face a higher disease burden. Often the patient population is a little older. Um they may have less access to insurance over um more poverty, and so there's some barriers to getting health care as well. Um and then they're facing uh dwindling volumes because you see more and more patients or more and more people, excuse me, just moving into urban areas. So those communities are you know slowly shrinking as well. And it's hard to operate a hospital or a clinic when you don't have the volume. Yes. Um and I think it kind of demands a different kind of business model. Um it really um it it does offer some true economic challenges. And I think what we've seen even lately is still that these hospitals are struggling. I think half of them are operating with negative margins, and so it's just a matter of how long are they going to continue to survive. Um, and yet they could be very critically important to that community. Um, they may be the only health care for an hour drive or a half hour drive. And being there and not being there probably means the difference between patients getting regular care and not. You know, in the golden hour of a trauma or a STEMI, you know, getting rapid access to the therapy to help reverse your your stroke or um mitigate your heart attack. I mean, all of that is in jeopardy. Um and so we haven't found a good solution for how to operate all these organizations and and keep them viable as um the the volumes shrink, as health care becomes more expensive, you know, the the work or labor rates go up, the supply costs have gone up. And then we see as a nation that we also need to be cost effective. And so you use a crunch crunch from the payer side as well. So it is a concerning um outlook for many of these hospitals, and so I mean, innovation becomes that imperative. What are you going to evolve to so that you can survive? Because continuing on this path is not going to be sustainable. Yeah. Um, and so we're really fortunate that we have got this uh $50 billion coming out to support these transformation efforts. And it looks like many different things in many different ways. You know, there's um funding for food pantries and walking paths and uh workforce training programs. And parts of those um really come um kind of into our area of expertise, which is how do you provide access and how do you make sure that the technology investment is available for these hospitals so they can modernize their operation. And so I'm hopeful too, is you know, there's some ideas about payment reforms and how we look at how um how these services are paid for, yeah, that all of that can occur within this five-year period so you can make some meaningful change. Um, you know, $50 billion is so much money. So much money. We don't even know what to do with all of it. Yeah. Once in a lifetime kind of investment in healthcare. And so it's going to be really interesting to see what changes and what doesn't. I think in this first um iteration of funding, you see an emphasis on, you know, those shovel ready projects are ready to go. And so to me, I'm like, are these innovative? Or, you know, is it just like the low-hanging fruit? And so I'm almost excited to get past this first wave a little bit and see if we have time to settle into these true conversations about what kind of radically more radically new innovations can we bring about. Um, you know, how can we support uh patients in ways that we never would have dreamed because of all the uh bureaucracy and kind of red tape around how healthcare is delivered. So um I'm super excited about it. It has re-energized a lot of people. I've seen many companies thinking, how can we work together? I mean, those conversations probably wouldn't have happened without this this funding available.

SPEAKER_00 41:47

Yeah. Well, and I think seeing other people wanting to be innovative has been interesting and positive. So when we're looking at that, how do you know if it's a good innovation versus okay, people are just using the money to just try something? How can we play a part in that conversation when people are looking at that?

SPEAKER_01 42:07

Yeah, I think we have to be realistic that there's going to be some projects that don't work out. And I think there had been when I was in school, I remember uh there was some um professor talked about maybe one in ten ideas worked out. So you you're playing with $50 billion. We surely hope it's not that one in ten. But I think some things that people are really focused on, which is exciting, is measuring that you're actually making an impact and quickly. Yep. And so there's definitely um CMS saying if you're not making your measurements, yeah, we're taking the funding back. And I think we all should love that as taxpayers, and you want to make sure that you know these dollars are being put to good use. But I also think when you're doing innovation, there's going to be things you try that are just fails. And hopefully you are learning from those and you're taking something and moving forward quickly. Um in healthcare, I feel like the quick part is always a little more difficult. And um I I know like that fail fast um maxim can be a struggle if that's not the culture you're in. So I'm I'm I'm optimistic that we're gonna get um a lot of movement with transformation, but I do know there's gonna be projects we look back on and be like that. That was not it. That was not it. Oh my gosh.

SPEAKER_00 43:23

So, from a market perspective, what is kind of the biggest area that we're trying to evolve into right now from a healthcare innovation perspective?

SPEAKER_01 43:30

Yeah, I'm glad you asked about our next big innovation. I think often we've been focused on how do we get a physician or a nurse into the right place at the right moment. But we're starting to see how we can help outside of that moment as well. How can we help a hospital or clinic understand best practices and how they're designing their workflows and how they're delivering care to patients outside of just bringing in our expertise when and where it's needed? And that's really exciting for me. We have emergency providers that are working in over 250. Emergency rooms. So they've seen 250 ways of how to do things and really learned a lot about what can work or many flavors of what can work. And working with the hospital hasn't figured it out, you can take that learning to them and help them understand the changes that they can make, coach their team, bring in new resources. It's really exciting. We can help even when the camera's not on.

SPEAKER_00 44:21

Wow, amazing. So looking ahead, if innovation, healthcare innovation and transformation, all efforts continue kind of in that right direction simultaneously, and maybe we have three out of the 10 that are wins. What does better care or more innovative care look like in the next five to 10 years?

SPEAKER_01 44:40

Yeah, that's a great question. You know, one of the things I think about is is still this access issue and almost that there's no amount of telehealth technology that can really solve it. I've had quite a few people in my life lately that are in pain. You know, they're or they've gotten a devastating diagnosis and they the specialty appointment's not available for weeks.

SPEAKER_00 45:01

Yeah.

SPEAKER_01 45:01

And so they're sitting there, you know, what do I do? Their primary care provider is a little like, I'm doing the best I can. What you know, for me, what would look like if you're getting that diagnosis, if you've been sitting in this pain that cannot be, you know, mitigated, um, if you're worrying that there are some quicker answers for you, and maybe we still can't solve the issue of you know, not enough MRIs or surgical suites or surgeons to get everything done as quickly as we want to, but to get some answers and make sure you're getting the best answers for your condition. And so I'm excited about the combination of these large language models and you know, being able to absorb so much information and help people navigate to the right solutions. I would rather it be coming through the lens of a you know a clinician with all the training rather than uh through a quick uh kind of query on your on your favorite AI model to see what might be the best solution for you. I I think that could be um just a really powerful solution. And so partnering that the well, the wealth of knowledge from all of these individuals and studies and journals um with um the specialists available anywhere from a virtual perspective to get some of these more real-time answers to patients. I think that's just so exciting. And it feels like the promise of healthcare in a lot of ways. I also think about then how information flows. And we really struggle in healthcare that we've got these billion-dollar EMRs that we've invested in that can feel like silos and just um really hard to move information in and out of because we want it to be secure, because it has to be accurate. Um, and we want it to be actionable, so we want it in the right place. So, you know, as you're going to give that care of the information, the allergies, the um past conditions, and history are all right there so that you can make the best choice. Um, but bridging that gap is very difficult. And so, again, you know, I don't know this, but I'm hoping there are again AI models that can help us get the information to flow back and forth a little easier so that when you're sitting with your primary care provider, they do have your whole picture of health in front of them and they can make the most informed decisions and help you get onto health faster. The other piece I've been thinking about too, yeah, is just the coaching aspect of patient care. Um, I think you know, we we ask our providers to do so many things. And as individuals, we all might need to get that tough message sometime. Like, um, you know, it would be good if you got up and moved more, you know, you're you know, it'd be good for your joints. It would be good if you lost a few pounds, you know, it would be great if you took better care of your teeth. Like all these things are really important, but they can be hard messages to deliver in the busyness of a clinic. And so I think how do you partner all the care we're getting with these self-management tools that can give patients that tough advice and maybe keep sprinkling in uh the tips for how to um help with self-management better so that you know you when you're in that visit with your your provider, it's that just-in-time information that you need, they can be really intentional about talking with you and then kind of leave some of the rest of that to these support tools. So make that visit that much more effective.

SPEAKER_00 48:21

Absolutely. You're so optimistic and positive about all things that are coming or that have happened to, like you said, grow upon. If you could say in one line, what is your optimistic philosophy or feeling about healthcare now and today, what would that be?

SPEAKER_01 48:37

Yeah, I think the last couple decades have been about modernizing healthcare with the EMR infrastructure and some of the knowledge sharing and tools to make our jobs easier. I'm so optimistic about the future and be able to take that next step and really leverage analytics, um, really bring together the power of the network so that we can share better information with our clinicians just when they need it.

SPEAKER_00 49:01

Yes. Well, that was great. Okay, so what we like to do is we kind of like to ask a few quick questions. So just in uh one to two lines, what is one misconception people perceive about innovation within the healthcare field?

SPEAKER_01 49:16

Yeah, I think people know healthcare is a difficult industry, and so they might think that innovation has to be difficult as well. And I think there are places where that's definitely true. But I hope people will jump in and try some of these quick process innovations that can make a huge amount of difference for people.

SPEAKER_00 49:31

That's awesome. From a customer perspective, when we're receiving um their intel of how we could be better or do things differently, what grabs your attention when you're looking at these? Like what is a little flag that you're like, oh, we got to jump on that now?

SPEAKER_01 49:47

Yeah, I think it's probably the novel insights that come from people. Sometimes you get um kind of similar themes, which are great and actually probably very important from an overall perspective. But when somebody really comes up with that new idea, you you can tell who they are that they've been thinking about the problem differently. That's exciting.

SPEAKER_00 50:05

Oh, that's wonderful. What tells you something needs to be built this instant? What's an emergent thing that comes forward versus something that, okay, maybe we can pilot for a little bit and we need to do this? How does that play a difference?

SPEAKER_01 50:18

Yeah, when you can see that it's going to make an obvious immediate impact, it feels like the right place to jump in and start. Um, also, I always think anything that's truly broken, I mean, that's the where you got to start. You got to fix what's broken first and then working on leveling up your game.

SPEAKER_00 50:34

Yeah. From your experience, is there one story or testimony that comes to mind when you're thinking that a Val really made an impact or improved a process that made a big difference?

SPEAKER_01 50:48

Yes, there's one, and sometimes I get a little teary-eyed when I talk about it. But one of our um first emergency sites, they had a a terrible case of a gunshot victim that came into their emergency room, and the and the physician that was treating that case actually knew the patient. Um, and unfortunately it was not a a good outcome. Um, but some days or weeks later, that physician came and he expressed just how impactful Avel had been because he said that night I went home when I actually slept. And we were like, What? What what do you mean? Yeah. It's like usually I would go home and I would replay that case over and over and over in my head, and I think, what did I do wrong? What did I miss? Yes. If this person had been in an urban hospital, what different care would they have gotten and would they be alive today? Yeah. And that day I knew we had done everything. Everything. Wow. And that makes you come back to work. You know, that makes you want to come back to work the next day. Yeah. Keep caring for that community and not feel like this job's too much. You know, what if there's a better person? Maybe I'm not the right person, I gotta move on. And so we helped that doctor that day. But I think if he had another 10, 20 year career in that community, we helped 20 years worth of patients after that.

SPEAKER_00 51:52

Wow. That's a great way to end thinking about the innovation perspective and how Avell has truly, you know, gone from 1993 starting from a rural community and specialty consults to where we are now. It's just, it's amazing. It's so cool. And it makes me optimistic and want to keep coming to work every day.

SPEAKER_02 52:09

Yeah.

SPEAKER_00 52:10

So thank you for sharing that story. But it's been a great conversation today, Mandy, about innovation, about customer feedback bringing into that and what it really takes to move care forward, looking at quality initiatives, looking at the processes and improvements that we can help from a clinical perspective. If there's one takeaway that you'd want to tell healthcare leaders today or have them remember from an innovation, healthcare innovation perspective, what would that be?

SPEAKER_01 52:36

Yeah, I would say look back and think how far we've come. And even if it feels hard, I mean you've gotten so much done, and we can keep doing this. Um, it's an exciting time to live in with AI and the way data is coming together. Um, it's only going to make our lives easier. And there's there's more work to do, and that's why you're all here. So keep at it.

SPEAKER_00 52:56

Wow, that's amazing. Well, thank you for your time today, Mandy. It was a pleasure talking to you. Oh, yeah, it was great to talk with you as well. And thank you for joining us on Avel ECare Virtual Health Connections. If you found this conversation helpful, we would love for you to subscribe, share it with your colleagues, and stay connected with us as we continue exploring telemedicine in the future of healthcare delivery. To learn more about Avell Ecare and how we're supporting care teams across the country, visit Aveltecare.com. Thanks again for listening. Until next time, stay connected.