00:00:04:03 - 00:00:30:03 Adam Hocking Welcome to The Rounds, a podcast of Marshfield Clinic Health System. I'm your host, Adam Hocking. The Rounds brings together medical experts to discuss fresh, fascinating and important topics from the world of health care. Most of what keeps a person healthy happens outside a doctor's office. Things like affordable housing, access to healthy food, the quality of schools and having places to build social connections all factor into the health of a community and its residents. 00:00:30:13 - 00:01:06:18 Adam Hocking But what does that mean for the providers and the health systems that care for those communities? From working to improve farm safety to partnering with schools to shape curriculum and fighting the opioid epidemic, Marshall Clinic Health System is doing more than ever to build health, education and health services directly into the fabric of its communities. Listen as we discuss this groundbreaking work with Marshfield Clinic Health System, Vice President of Community Health and Wellness, Jay Shrader. 00:01:07:01 - 00:01:08:22 Adam Hocking Jay Shrader, Vice President of Community Health and Wellness for Marshall Clinic Health System. Thank you for joining us on the podcast today. 00:01:09:05 - 00:01:10:05 Jay Schrader Thank you for having me. 00:01:10:16 - 00:01:29:00 Adam Hocking So I think we've got an interesting topic here today, one that is sort of growing in the health care sphere when we're talking about health care that's determined outside of the traditional health care space of a doctor's office or provider's office. First, can you talk about what your role is as vice president of community health and wellness? 00:01:30:00 - 00:02:02:19 Jay Schrader So I actually have a really exciting and interesting role. It's relatively new within the health system, although community health is not new itself. Public health is has been around for a long time and in health settings and in communities. My role has been relatively new in the last year and a half. Basically, my job is to work with our communities across our service area to work on improving the overall health and well-being of the communities we serve as part of our mission and vision that we have here at the health system. 00:02:03:20 - 00:02:36:19 Jay Schrader Beyond that, working with our communities, which I can talk about a little bit, what that really means. I also have this component of wellness, which is really focusing on our patients and our security health plan members and working through various aspects of of making individuals healthy through prevention and health coaching services, making sure they're getting the right preventative care, working on lifestyle modifications and behavior modifications and so forth and so on. 00:02:37:08 - 00:03:03:22 Jay Schrader The community health side is extremely exciting for for me and the health system. It is relatively new and I think it's been it's a very hot topic because of the aspect and the component that it can bring. For example, you know, looking at county health ranking models, we know that and social determinant health models. We know that, you know, 20% of an individual's health is actually impacted. 00:03:03:22 - 00:03:32:12 Jay Schrader And within the clinical care model, the rest is where people work, live and play the environment that they live in, the behaviors that they have when they're outside the walls, such as smoking, tobacco, diet, etc.. And hereditary is a piece of that as well. The exciting thing about community health is it really does focus in on, you know, zip code is a better predictor of your health than actually your your genetics. 00:03:33:06 - 00:03:55:00 Jay Schrader And I think that that's something that people are starting to understand. We have example after example of of what that means. So for me, the you know, I started here in the health system eight years ago with security health plan and was hired to build a community health program for the health plan, which was very innovative at that time and still is today. 00:03:55:12 - 00:04:37:04 Jay Schrader Many health plans don't have that aspect security, health plan. As a family member of the health system has really taken the lead and in my opinion, across the state in terms of doing community health work. And so through the health plan, you know, the program was developed. And while at the health plan, I had some opportunity to oversee care management, disease management, chronic care, some small steps in pharmacy and all those pieces along the way to my job today actually just layered on and provided me even more of an insight of health care and how community health plays into that. 00:04:37:04 - 00:05:09:11 Jay Schrader So I'm very thankful for that year and a half ago. The system as as it continues to transform, decided that a position that oversees all aspects of community health was important to make sure that we're coordinating, collaborating, that we have strategies and a strategic approach as a system. So the position was born. And today, beyond the health plan and our community efforts and our clinical sites throughout our service area, we also have the hospitals which are, you know, becoming more and more. 00:05:09:12 - 00:05:25:23 Jay Schrader And with those hospitals there are IRS and ACA requirements associated with delivering community health. So we always say that those requirements will naturally or organically be met if we're just delivering good community health services with our community partners. That's my job. 00:05:27:00 - 00:05:56:10 Adam Hocking You talked about zip code being a predictor of folks health outcomes and their overall health. We're in a rural health care environment here in central Wisconsin, northern Wisconsin, and even western Wisconsin. And we know the Marshfield Clinic health system patient population is typically older than state and national averages has more and more chronic illness. Can you talk about what the extra challenges are in a rural health care environment? 00:05:56:10 - 00:05:59:05 Adam Hocking What challenges does that present from a community health perspective? 00:06:00:01 - 00:06:27:14 Jay Schrader I mean that I love the way you frame that. There are certainly challenges, and I would opine that they're more significant in a rural setting than urban. That's just me. But they're really around the social determinants of health. So to your point, you know, we are looking at an older population typically, you know, less income barriers such as transportation are significant when you're talking about health care. 00:06:27:15 - 00:06:47:06 Jay Schrader So the idea that somebody will jump in a vehicle and travel an hour and a half, 2 hours to get to one, our facilities may not work like it used to anymore. And that's where telehealth and other services are so invaluable. But, you know, the rural health care setting, you know, we deal with a lot of different things besides transportation. 00:06:47:21 - 00:07:17:04 Jay Schrader You know, we lack technology, we lack broadband Internet. So those services that urban areas can take advantage of, of of for their patients and our communities, we just have that extra challenge of trying to reach out those individuals in a different way. Besides that, you know, being rule. There's a number of things related to social isolation for a number of our members, and that's a critical component of overall health and well-being. 00:07:17:23 - 00:07:46:10 Jay Schrader You know, there's not the the next door a place to gather in a lot of our communities. You know, we preach on a clinical side that people need to move more and exercise more. That's not always feasible in a rural setting. I, for example, I live in the country. And so, you know, if I wanted to go for a run or a walk or a bike, I'm forced to do that outside on county roads that are very narrow and they're not safe. 00:07:46:10 - 00:08:04:23 Jay Schrader And it doesn't always work for people. So, you know, the model of saying, well, you need to move more and you need to exercise more and you need to eat healthier, isn't that simple? You know, a large portion of our region is really a food desert, which means we don't have access to healthy foods. You can't just walk to the farmer's market. 00:08:05:08 - 00:08:26:16 Jay Schrader So that works in some urban areas. But a chunk of our a big chunk of our service area, it doesn't allow those things. If you wanted to get support for quitting tobacco use, that's another challenge. So you take all those combined and you you have a kind of a recipe that we have to think differently about how we deliver health care. 00:08:27:09 - 00:08:47:14 Jay Schrader Telehealth is one of those, and other one is really going back to an old school model of, you know, home visits in our service area or trying to best leverage technology so we can do it efficiently and effectively for our our patients and our communities. So, you know, those are just a few of the challenges that I see off the top of my head. 00:08:47:14 - 00:09:06:14 Adam Hocking And it's interesting, you know, I used to live in the Twin Cities and you talked about the food desert piece. And that really just struck me now is that, you know, my wife and I used to be able to walk down the street and go to a Whole Foods where there's all kinds of fresh organic food or even quick in and out restaurants that are that are selling healthy options. 00:09:06:14 - 00:09:23:01 Adam Hocking Really here, the only place to go get quick food is it's probably a fast food restaurant, I would suppose, is that, you know, how do you work on that? How do you look at that? What is your role? And in advocating for for change in that area? 00:09:23:03 - 00:09:51:14 Jay Schrader Right. So if you think of the food piece of it, you know, it's a significant contributor to health care. And the reason I say that is down in upstream implications around obesity, which we are one of the largest state in the nation. No pun intended, but also, you know, pre-diabetes and diabetes. You know, the last report from the American Diabetes Association, I believe, predicted within the next ten or 15 years that 50% of our state would be either pre-diabetic or diabetic. 00:09:52:08 - 00:10:15:14 Jay Schrader And the health care cost of working with individuals that have diabetes, especially if they're uncontrolled diabetes, is you know, in 20, $25,000 a year. So, you know, working on nutrition is one aspect of it and medical management's another aspect of it. But back to your point, you know, you do have to think differently. So, you know, examples of things that we have tried. 00:10:15:19 - 00:10:35:23 Jay Schrader There's always that go to the schools, you know, curriculum development and try to work with the schools and implementing school based gardens. We've done all that. Schools are tapped, you know, so there's only so much bandwidth the school has in terms of being able to allow you to come in and do these type of things. We've been successful in some of those because of the partnerships and relationships we formed with schools. 00:10:36:17 - 00:11:00:09 Jay Schrader You know, we've invested in the school based gardening system, which is in a number of communities, is extremely successful in those models. You know, there we've we've we've invested in the facilities, the curriculum. And so actually there's some really cool models where the kids actually are part of the growing season. They help harvest the food. The food gets implemented and in the school cafeteria system and so there's a learning component. 00:11:00:09 - 00:11:29:08 Jay Schrader But then the children also benefit from the nutritional component of it as well. Beyond that, you know, there's some new technology that we're looking at in terms of for year round growing with some of the new gardening systems. We just had some really cool, exciting meetings with some local partners that are showing us this technology and how we can have produce harvest food all year round that's green and make that available to students or in long term care facilities. 00:11:29:16 - 00:11:55:05 Jay Schrader You name the population that you really want to focus in on and then thinking differently about how you bridge or pull together health care with our community partners. You know, we we're currently in the midst of close to launching our I believe it's the state's first food pharmacy. So in that model we've partnered with Feed My People Food Bank out of Clare. 00:11:55:12 - 00:12:29:05 Jay Schrader They serve 19 counties. They actually produce or serve the local food banks, food pantries, and I believe they serve, you know, up to 20 different food pantries or more and £7 million of of food per year. So with our model of looking at how do you prevent diabetes and their model of trying to reduce food insecurity. We brought it together, signed a partnership in which, you know, they're going to provide food to our health system and their patients. 00:12:29:05 - 00:12:56:04 Jay Schrader So we'll provide healthy, nutritious food via the food bank, and it'll be provided to individuals on a pilot level basis, patients of ours that are diabetic. And then we wrap that all round, wrap it all together with a registered dietitian and and health coaches to really help people get control of their diabetes or point of it is is that there's a category of interventions you can provide. 00:12:56:04 - 00:13:17:13 Jay Schrader Some are very simple. Some are just investing in communities that have ideas or thoughts or need help all the way to the more complicated ones where we're trying to integrate health care and communities together. But there's really, you know, the way that we approach everything is it's pilot. It's a proof of concept. If it works, we we move it out and and move it to communities that need it. 00:13:17:13 - 00:13:32:23 Jay Schrader And if it doesn't, then we try something different. So that's just one one, you know, idea in terms of actually our strategy around trying to address both, you know, the diabetes epidemic and obesity and food insecurity and kind of all rolling it together. 00:13:33:11 - 00:13:55:02 Adam Hocking I'm interested in the social isolation piece of rural health care. You talked about folks, you know, if they want to go exercise, they have to go do it on unsafe roads. We know that a lot of our patients have long drives for health care, which presents costs and convenience barriers. I've also read some articles recently about the health effects of loneliness. 00:13:55:14 - 00:14:02:03 Adam Hocking Is that something that you guys look at, think about? Is that a topic that's sort of on your mind? 00:14:02:05 - 00:14:26:13 Jay Schrader It's always on our mind, period, but it's not something you just come up with a strategy on. How do you address loneliness or social isolation? So typically on topics like that that we know are extremely important, we tried to bake it into everything we do, so it's never forgotten about. But there's not a single strategy that says this is what we're doing on loneliness. 00:14:27:13 - 00:14:53:22 Jay Schrader Trying to connect people is can be a challenge, especially in rural health systems or rural geographies such as ours. You know, in that case, you have to try to work with community partners that have networks already in place with a lot of these people and try to figure out not how to replace but enhance their work. Example would be, ah, an amazing partner. 00:14:53:22 - 00:15:16:15 Jay Schrader Our addressees within our service are they serve a number of our patients. They offer amazing programs, they're good partners or regional and even sometimes county based. But our goal is not to come in there and and, you know, do something that is already being done by them. We want to talk with them. And this is not uncommon for us to sit down with community partners and say, how how can we do this together? 00:15:16:21 - 00:15:36:09 Jay Schrader This isn't you know, there's a marshall health system way, but there's also a way to work with community partners. And so, you know, it is a new area for us to say, you know, to sit down with communities and say, how can this work? Could it work as opposed to saying, we're just going to offer this program? So, yes, there's a lot of literature on that. 00:15:36:12 - 00:15:59:21 Jay Schrader Technology is absolutely a big piece of that. There's a lot of programs that are popping, whether it be us or us being a part of it or just we're watching programs occur. The simple things like adopt a grandparent programs or programs where individuals in a long term care facilities can come into schools or childcare programs and read to the children. 00:16:00:19 - 00:16:19:18 Jay Schrader Those are the type of things that you're not going to see a direct impact on health. You're just not going to see somebody's blood pressure reduced. There's no quality metric associated with this work. But you know, based on to your point, Adam, that there's research that supports that this is an important component of somebody's overall health and well-being. 00:16:20:11 - 00:16:28:22 Jay Schrader So, you know, there's inferences that it's going to do something, but those are the type of programs that we're constantly looking for and seeing if we can integrate them into our existing work. 00:16:29:13 - 00:16:51:19 Adam Hocking That's interesting because I think about, you know, when people think about the traditional health care model, at least in my mind, it's a patient provider kind of back and forth. But I think you said and we know from the literature, 80, 85% of somebody's health is determined outside the clinical space. And and especially in a rural environment, like you said, I would imagine partnerships are more important than ever. 00:16:51:20 - 00:17:00:23 Adam Hocking Is that something that's that's growing or evolving? Has there been a recognition recently, or is that kind of always been in place how important those community partnerships are? 00:17:01:11 - 00:17:32:20 Jay Schrader I think it's always been there, but I don't know. I think we've always treated it differently. I think we've seen community partners more about optional. Now I think we see them as a necessity there. You know, the best thing that has come out in the last decade is really the social determinant health model. And the county health ranking model and really simplifying it to health care executives, community partners around that 2080 rule and saying that we need to think differently about how we deliver health care. 00:17:33:07 - 00:17:51:22 Jay Schrader Community partnerships are critical. They're just absolutely essential. Matter of fact, we won't do anything unless there's a community partner involved, and there's a lot of reasons for that. One is sustainability. Two is synergy. You know, if there's no synergy, we can have the best program in the world and go and try to deliver it or implement it in a community. 00:17:51:22 - 00:18:08:16 Jay Schrader If a community is not ready or willing or wanting it and there's no synergy and we haven't built a rapport, that program will fail. So those community partnerships are extremely important. That being said, community partnerships aren't just born. They don't take a week. You don't write a check and say, Now we're a partner. You have to build that relationship. 00:18:08:16 - 00:18:29:04 Jay Schrader And so that takes time. So, you know, at any one time I would say we have probably a couple hundred bona fide community partners within our program inventory that we're working with on a constant basis. There's more to be out there, and I think we do a good job. We're getting better at trying to gauge those probably nontraditional community partners that we haven't thought of yet. 00:18:30:05 - 00:18:43:03 Jay Schrader But, you know, bottom line is that we cannot be successful in in changing health care unless those community organizations have bought in and see us as as an important partner of theirs. 00:18:43:20 - 00:19:09:21 Adam Hocking Later today, there's a dedication for the new Marshall Clinic Health System YMCA, which is a beautiful new facility. The YMCA, for folks that don't know, has been in Marshfield for decades. But recently went underwent a huge renovation. And there's beautiful new facilities for exercise. But there's also going to be an expansion of of programing. I kind of think of it as a community health hub. 00:19:10:02 - 00:19:16:23 Adam Hocking I wonder if you can talk about the importance of that project and what it can mean to a community's overall health. 00:19:17:04 - 00:19:40:03 Jay Schrader So I would say the YMCA is symbolic of that. It's a hub. It's a place where people can go. It's iconic for a community like Marshfield to say, you know, that the YMCA is representative of things besides exercise equipment, and that's why the health system chose and the YMCA chose together to partner. And now it's the Marshall Clinic Health System, YMCA. 00:19:40:21 - 00:20:02:22 Jay Schrader There's a lots of opportunity, obviously, for the YMCA and our and with our health system, a lot of it we haven't even uncovered yet because the doors are just relatively new and opened. But on a ground level, I remember those conversations several years ago about, you know, being approached about what this could look like. And it was really exciting at that time. 00:20:02:22 - 00:20:38:16 Jay Schrader And the idea of, you know, from birth and to kind of that grave concept and and co bringing together organizations that serve children makes all the sense in the world. You reduce overhead, expands you, you can create efficiencies. There's organic ways of connecting on programs and services. So you have the alternative school, you have the Head Start program, you have our our youth in that program, and then you have an amazing childcare program out there that now serves a couple of hundred children, which all of these address the needs of the community. 00:20:39:21 - 00:21:00:19 Jay Schrader Side tangent is we're not doing stuff that isn't addressing the needs of the community. So this is a result of that of the community saying we need something and and a personal level. My child attends the YMCA and their program. I sit on their board of directors. I absolutely 100% believe in what the YMCA is doing. It's an amazing model. 00:21:01:11 - 00:21:21:20 Jay Schrader We have so much more we can learn from it and one of the things that I really enjoy about my position as because it covers such a large service area, is we have an opportunity, I would say almost an obligation and to figure out what works and communities pick it up and transplant it in the communities that may not have that benefit of knowing it. 00:21:22:04 - 00:21:40:03 Jay Schrader And so that's agreed. And we've done that over and over again to say that's working here. Have you thought about it here? That's a responsibility that we have. But the YMCA is really, you know, if we could have wise in every community, that would be amazing. They do offer great programs. They're a community based partner of ours. We really enjoy working with them. 00:21:40:09 - 00:22:01:15 Jay Schrader But there's much more than just the YMCA we have. Our United Way is a great organizations. HRC is our community foundation here in Marshfield. It really steps up to the plate time and time again. So I would say, you know, if you look to the Y, it's an amazing, beautiful building. It's it's a building. It's what's inside. It really counts. 00:22:02:18 - 00:22:19:04 Adam Hocking We've probably been talking about a lot of the things that the Center for Community Health Advancement does, but we haven't kind of named it. Can you talk about because I know that's a huge proportion of of your work and what you do, what the Center for Community Health Advancement is and sort of what the focus area is of that. 00:22:20:13 - 00:22:38:05 Jay Schrader So we did go through some transformation several years ago. A year and a half ago, it was the Center for CME Outreach. We felt we needed to refresh that title. We wanted to you know, we wanted to announce to our communities that we're really about advancing health. We wanted that verb in there. And this the former title center for me outreach. 00:22:38:05 - 00:23:02:10 Jay Schrader And really it it really didn't tell the story about community health and that's what we're really about. So the name change was monumental for us because it kind of transformed a lot of different things besides just the title of it. And we spent a lot of time, you know, working through this. One of the first things that I did in my position was to go out and talk to community partners, spent weeks upon weeks just meeting with community partners. 00:23:02:10 - 00:23:20:08 Jay Schrader We we did a key informant interview. We went around to our local, regional and statewide partners, and we actually partnered with another organization out of Stevens Point to do this for us. We didn't want any bias in the answers. We wanted to know what they liked about us, what they were getting from us, what they weren't getting from us. 00:23:20:08 - 00:23:50:03 Jay Schrader And we learned a whole lot about what communities and community based partners thought of of our work. And so from that, you know, that was one component of our effort. The other component was then to take a look at the data, what are the communities telling us they need? And that's where we need to be. And then, you know, exponentially you would say, you know, so the communities have identified this as a need and we had to do a lot of juggling to find that sweet spot for us about what our priorities would be. 00:23:50:10 - 00:24:14:15 Jay Schrader Then you overlay the data, you know, the public data and the community that our patient data and allowed us just to keep fine tuning it to the place where we're at today, which is, you know, besides the Center for Community Advancement and our partnerships, we have our first 3 to 5 year plan that never existed before. And we have four priorities, nine goals, 22 objectives. 00:24:14:15 - 00:24:45:21 Jay Schrader That's what we've committed to. We're successful in terms of securing grant dollars, which helps the system as well. But those those priorities are affectionately known as our ABCs. And when we roll those, our we knew that there needed to be some marketing involved in this. So it's not like we chose those priorities and said ABCs. But I'm convinced now with even our steering committee, which is new and so they hold us accountable and we're responsible to, to our efforts to that steering committee. 00:24:47:01 - 00:25:09:19 Jay Schrader I'm fairly confident that if we said what does ABCs mean that every executive in this health system would be able to listen. And so that ABCs is alcohol and substance abuse, behavioral health, chronic disease and social determinants of health. Those are the are the four areas we've committed to the next 3 to 5 years. And in underneath those obviously are our goals and tactics that we're working through. 00:25:09:19 - 00:25:34:03 Jay Schrader So that allows us to be transparent with both internal and external partners. It allows us to communicate to folks where we're going and opportunities to collaborate. It gives us discipline to say no, which is sometimes very difficult to do. I think we have a tendency to want to do everything, but this gives us discipline and the courage to say no to those different things. 00:25:34:20 - 00:26:03:04 Jay Schrader They're they're very audacious goals to say that we're going to do focus on ADA, which is in Wisconsin's, you know, we're one of the largest binge drinking states in the nation or on the behavioral side to say, you know, we have some of the highest suicide rates in our communities or chronic disease when we're up against obesity and tobacco and pre-diabetes and diabetes and social determinants of health, which in itself is huge. 00:26:03:10 - 00:26:22:10 Jay Schrader So, you know, that's where the goals come into place and allow us to kind of target where we think the biggest opportunity is to move those levers. One of the things that we were able to do too, is we reviewed every county in our our service area changes. If you use the health plans footprint, it's bigger, the clinic's footprint, it's all over. 00:26:22:22 - 00:26:43:00 Jay Schrader But we did sit down with nearly every health department and engage them in some way. We reviewed every one of their community health needs assessments and we ended up as a litmus test almost aligning with 95% of our communities. So that was reassuring that we did our own due diligence, but still lined it up where they needed us the most. 00:26:43:19 - 00:27:12:11 Jay Schrader Behavioral health is listed as if you look at one service area, you know, behavioral health is listed as a top priority and 47 of the 49 counties. Interesting. And they looked at the health system to say how well, how can you help? You know, the answer isn't always about bringing in providers. It's about trying to get far as far upstream as we possibly can so that someday there may not be as big a need for a provider. 00:27:13:07 - 00:27:36:12 Jay Schrader So that's type of the type of work that we're we're moving forward with. So the Center for Health Advancement is what I call our own systems public health department. It's the best way I can put it. Public Health has been doing this work for centuries. We're just now getting in a game and trying to align a little bit more with what the communities are needing and providing our own public health type of programing. 00:27:36:12 - 00:27:56:11 Adam Hocking The binge drinking piece is interesting to me. I think even W PR is doing a series right now on the impact of alcohol and binge drinking on Wisconsinites. It's so culturally ingrained here. Can you talk about the scope of the problem and and how you guys frame it and what what can be done about it? 00:27:57:22 - 00:28:26:22 Jay Schrader So, you know, the culture in Wisconsin is very interesting. There's no doubt about it. We do have one of the highest binge drinking states in the nation. We have one, if I recall, one of the largest alcohol taxes in the nation. We have one of the highest drunk driving rates in the nation. There's been programs along the way, you know, that have really attempted to address a number of those factors. 00:28:27:05 - 00:28:55:19 Jay Schrader Safe and sober cabs, last call type of programs. We have responsible server courses. Even within our own health system. We have 88 treatment facilities that are being popped up on the prevention side. We continue to work with schools on a number of their initiatives, Some of the things that are relatively new that we're trying to focus in on is aid, recovery, worksites. 00:28:56:01 - 00:29:21:02 Jay Schrader So as these individuals are recovering, trying to get them back into the mainstream with work sites that would employ these individuals and work with them, we're using volunteers to help help people go through recovery to provide that social support. Bottom line on this one, it's a cultural thing. It really is. We can put a lot of money towards stigma and trying to change that culture. 00:29:22:07 - 00:29:42:23 Jay Schrader This is an one that's I mean, frankly, is not going to go away any time soon. The closest I can compare it to is tobacco. How did the state become? How did the state do so well? And seeing a reduction in tobacco use. They increased attacks significantly. Policy change is the most effective way to reduce any behavior. That's not going to happen in Wisconsin. 00:29:43:10 - 00:29:51:13 Jay Schrader So this is one, I think, that out of all of them that we have in our portfolio, it's just going to take some time chipping away on a little at a time. 00:29:52:02 - 00:30:08:04 Adam Hocking And similarly, the opioid epidemic is obviously something that nationally and statewide is. There's no shortage of headlines, and I know we're doing a lot of work related to that with our communities. Can you talk about some of the efforts to curb that epidemic? 00:30:08:06 - 00:30:37:16 Jay Schrader Yeah, I think that as a health system, we've done a good job with looking internally and externally. So, you know, before I speak about opioid in our efforts, you know, it's always important for us as we go into the communities that we always look internally. First, we'll get called on a carpet every time. If we're not doing what we're supposed to be doing with our own 10,000 plus employees or not having policies in place, or if we're not focusing on anything, and then we go into the communities and say, we think it's important that you do it. 00:30:38:02 - 00:31:05:05 Jay Schrader And then they ask, Well, what are you guys doing for that? It's never boards. Well, so, you know, in terms of opioid, internally and externally, we've done a good job internally. Pain medicine and taking a look at efforts around there and reducing prescriptions and dose and limit prescriptions. I know the health plan with our pharmacy benefit manager. I had put in a number of checks and balances in terms of prescribing. 00:31:05:05 - 00:31:29:21 Jay Schrader So there needs to be overrides. Now at the pharmacy level, if a certain prescription level is prescribed, you can only it's monitored a lot more closely now. So you can't just go from pharmacy to pharmacy and pick up scripts because that's all managed now. And the override feature enforces the pharmacist to actually make a conscious choice to do something if they know it's not right. 00:31:30:20 - 00:31:55:18 Jay Schrader And then of course, you have, you know, our, you know, our treatment facilities that he oversees. Doctor LA seminar Choirs, the pain medicine doc they've done a lot of work not just within our service area and have seen significant results, but also at a state and national level. So it's nice to be recognized from there. Our partners and equips have done some really great things as well, so we weren't slow to respond. 00:31:55:23 - 00:32:14:00 Jay Schrader I just don't think we knew what was coming. And I do believe that we're one of the state leaders in that effort. As as a parent, and you've been a part of this where we've been asked to put together white papers and etc., for folks in DC and that are all very interested in the work we're doing on the community side. 00:32:14:07 - 00:32:46:02 Jay Schrader You know, we've been fortunate to receive some federal dollars from DOJ, from her son and others around Drug-Free Communities. We on a regular basis do drug takeback events which have been extremely successful. Again, not one initiative is solving this, but it's a compilation of a lot of them that help out. We we more recently and more recently now because time flies but several years ago purchased drug drop off kiosks for all of our sites throughout our health system. 00:32:46:02 - 00:33:03:07 Jay Schrader We felt it was an obligation, a responsibility to our communities, that if we're prescribing that, we better set up a mechanism for people to safely return prescription drugs. So, you know, we worked with the company and had those brought in so people can safely dispose their medications any time. They don't have to wait for a drug takeback event. 00:33:04:11 - 00:33:33:06 Jay Schrader Our recovery program, which is part of our AmeriCorps suite of programs, more recently was selected as the Governor's Program of the Year to the service community service programing. And so that program basically to me is an amazing model. Individuals can join AmeriCorps, which they receive an educational stipend, they get health insurance, they get a regular paycheck per se. 00:33:34:02 - 00:33:52:12 Jay Schrader And then we we train them. So it's a workforce competency, workforce development thing, and then they become recovery coaches. And so in order to become a recovery coach, you yourself had to have gone through recovery or you must have known somebody, a family member, etc., that somehow you're impacted in that model. It's not clinical. Most of this work isn't clinical. 00:33:52:12 - 00:34:15:16 Jay Schrader It doesn't have to be. And so these individuals provide care, coordination, link services. They they're there to help to listen to the individual as they're going to recovery. They're make sure that they have transportation and they're there to make sure that, you know, that they're avoiding risky behaviors. It's not clinical. They just need that extra hand as they're going to recovery themselves. 00:34:15:16 - 00:34:47:07 Jay Schrader So and we continue to look for other programs that help with both the prevention side, but also the recovery side. You know, we've invested in our CAM and programs such to help with cut offs of different opioid initiatives. The schools are always interested and willing to do stuff. We provide funding a grant program on a regular basis to our communities so that they can apply on topics that are important to them. 00:34:47:07 - 00:35:10:00 Jay Schrader We want to make sure we're not too prescriptive in the programs and services because we know each community is local and they have local needs. So we've got a lot going on in this area. I mentioned drug free recovery, drug free worksites and working with communities or employers on policies so they feel comfortable and confident of bringing people back into the workforce. 00:35:10:10 - 00:35:32:05 Jay Schrader So there's just a plethora of different initiatives that we have some are simple, like I mentioned earlier, some are more complicated and complex. You know, Ryan asking his team and Brad, they do a great job monitoring legislation that we would be interested in both at a state and national level and making sure that we're in the game in terms of driving policy. 00:35:32:14 - 00:35:36:21 Jay Schrader All those things are extremely important. So lots going on in that area for sure. 00:35:38:10 - 00:36:02:03 Adam Hocking I'm interested in the behavioral health piece too. I want to revisit something you said. I think you said for 87 out of 49 counties. Maybe I'm getting that number wrong. But nearly every county that you've gone out and talked to, as has talked about, that being sort of a top need and, you know, I know there's barriers in terms of stigma surrounding behavioral health, in terms of people coming forward and being able to talk about mental health issues. 00:36:02:03 - 00:36:18:08 Adam Hocking I know there's there's funding shortages. Can you talk about and one of the things I know you guys are doing is is embedding with the schools. I believe it's through your best program. Can you talk about what that is and your overall efforts in the behavioral health space? 00:36:19:00 - 00:36:47:04 Jay Schrader Sure. So there are a number of things we're doing. This is the area I'm probably the most proud of because it's relatively new to the center. We had always dabbled in this space, but now we have a more comprehensive strategy around it. And so there are a number of things again, back to that, more simple interventions where we more recently facilitated the, you know, the look up initiative here in Marshfield, which is, you know, set your phones down, engage with your kids. 00:36:47:04 - 00:37:11:17 Jay Schrader That's a simple behavioral health initiative, but it's actually highly effective to public showings of different videos in the community that engage and spark communication and conversation among parents and teens. So the ripple effect would be one that we've had here in Marshfield, had an amazing showing in that since we've rolled it out, we're rolling it out to all of our communities that have hospitals. 00:37:11:17 - 00:37:35:02 Jay Schrader We made it available, will pay for well facilitated, etc.. Other initiatives, as you know, the whole concept of internal and external. So we know that we do have some high rates of suicide in some of our communities. You know, the data and I don't have it in front of me, but from the Youth Risk Behavioral Survey here in Marshfield, we're showing that 7% of children had attempted to commit suicide. 00:37:35:03 - 00:38:15:06 Jay Schrader And that's not a national fact. That's a Marshfield statistic. And I believe it was somewhere around 15 or 16% had contemplated. So, you know, there's some there are some real root cause issues here that we're trying to solve and work through. But to that point, you know, the system has has been so supportive with, you know, Dr. Dissanayake and Dr. Shu Line, Dr. Shane, Sandy Bomp, our staff, and we're actually doing the internal part of this program called Zero Suicide, and it's a large, very large lift and initiative and it's really meant for our internal look at our own policies. 00:38:15:06 - 00:38:45:23 Jay Schrader It's a nationwide campaign to Wisconsin hospitals. Those are the national hospitals Association, and really it's a mental look at what we're doing inside our walls to prevent suicides, in particular among our patients. Some I'm going to mess up the statistic exactly, but it's I want to say 70 to 80% individuals that have committed suicide had seen their health care provider within 90 days previously that. 00:38:45:23 - 00:39:04:06 Jay Schrader So looking for those warning signs and asking the right questions and having policies in place to help support that. That's what zero serious zero suicides all about. It's about making sure people are trained. And so it's a heavy lift. And I'm very proud of that initiative. You know, Jody Janaki is our lead here. She's got an amazing background in this area. 00:39:04:14 - 00:39:24:18 Jay Schrader So that's a huge love for us and will be. And that's something we're proud to share with our communities, that that's our part in working on reducing suicide among our communities, which is falls within that behavioral health bucket. You know, other things we've done is we've committed to train as many people as we can and QPR, which is quest and persuade and refer and. 00:39:24:18 - 00:39:53:00 Jay Schrader It's a highly effective process in terms of identifying people and making sure they're getting the right help they need as soon as they can. And so examples of that is, you know, training a number of school districts and their staff. We more recently with the technical college just signed an agreement that will train and invest in their programing, but they will train everyone that goes to their technical college. 00:39:53:00 - 00:40:18:07 Jay Schrader I'm beginning this fall. So thinking about not just us having to deliver and train people, but in this model and sustainable where they're going to train every fire person that comes through EMS, law enforcement on how to be a QPR certified, that's significant. That's a thousand people per year that will be trained and and can move that forward and can help with, you know, helping prevent suicide youth. 00:40:18:07 - 00:40:40:14 Jay Schrader And that's another one youth that's been around marshals since the 1980s. It focuses on afterschool programing for what you would consider at risk children. You have to be referred into the program. There's some criteria and eligibility. We know it's a good program. And so we've committed to moving that program out into our communities to at least to new communities by the end of our five year plan. 00:40:41:05 - 00:41:04:01 Jay Schrader So, you know, today we're having a dialog with the city of Managua to say, is this community ready for a program like this? They have no after school program. They certainly don't have a forum that addresses at risk youth. It seems like a good fit, but before we offer a program, I go back to my original comments earlier, which is we don't just bring the program to the community. 00:41:04:01 - 00:41:23:15 Jay Schrader We're going through a pretty exhaustive feasibility conversations with them to say, What does this look like here? Managua? Are you interested? Who would be involved? How would this be sustainable? It can't just be another Marshall clinical system program. That's not how programs are sustainable or own. They're going to be community owned. So, you know, youth, that's a great program that falls in that bucket. 00:41:23:21 - 00:41:44:15 Jay Schrader You know, Randy Neave has done a great job around adding layers to that social emotional support and learning groups. We do trauma informed care training. John Smith is seen as a national expert. She's gone Alaska, Iowa. She's going all over the place because of the expertise she provides. And, you know, so there's all these components around behavioral health. 00:41:45:03 - 00:42:06:15 Jay Schrader You mentioned bass ambassadors, probably the one that has in our in our center probably has the largest reach and dose in terms of impacting people. This is a program that's another partnership started five years ago, I believe, with a community grant program. We roll out and we try to invest in our communities. We see these as almost pilot sites and petri dishes to say, go out to give it a try. 00:42:06:15 - 00:42:29:23 Jay Schrader And if it works, we were interested in talking more. It was a grant that Dr. Hartwig, who was the executive director or a special a marathon county special education program, had developed. He wanted to try it. After the first year we were hooked. We didn't even we didn't even talk to him about a grant where we show us this is a partnership for us. 00:42:30:11 - 00:42:56:12 Jay Schrader So it has truly been one of the best partnerships we've ever had. Dr. Hartwick is amazing. It's about people. And this year alone, we've we've grown this program so much that this year alone, I think we're going to be in over 50 school districts, not schools, districts. I think we've screened over 125,000 children for behavior and emotional traits. 00:42:56:12 - 00:43:17:13 Jay Schrader So this is thinking upstream and stocking, not diagnostic. We're not saying that you have a condition. We're just saying that there's something there. There's 26 risk factors that we look at. And what it allows us to do is to help not just identify those kids and do interventions with them and then reassess. But a big component of this is really around training educators. 00:43:17:18 - 00:43:49:14 Jay Schrader They don't go to school to learn about how to be behavioral health people. And so in this case, Dr. Hartwig provides hands on consultation trainings to these school districts about how to deal or work with parents and children who have high risk behaviors. Simple things, simple things, as I'm not going to get any of this because, you know, it's more on, you know, he's the expert in this area, but simple tools that they can use for redirection or to work with the child to bring their anxiety down. 00:43:49:14 - 00:44:11:19 Jay Schrader He recognizes that, you know, in his 40 year career that teachers get upset. You know, they see Johnny as a troublemaker or or Johnny may be an introvert, and you just need to work with Johnny differently. So the best program has really opened the doors for a lot of different things, a lot of partnerships that we had not planned for unexpected partnerships with school districts. 00:44:13:01 - 00:44:41:16 Jay Schrader In just a few weeks, we'll hold our first ever best institute here on our campus in Marshfield, where over 100 educators, counselors, Beaver Health people from schools will be onsite for two full days, receiving training from Dr. Hartwig and others on best expectations, how to use the tool and more of that wraparound education to help build some of their knowledge and expertise in this area. 00:44:41:16 - 00:45:06:12 Jay Schrader So the program continues to grow. It's an amazing program. But beyond that, as I mentioned, I think five or six examples, the work that we're doing in behavioral health on the community side is pretty fascinating. And I know there's a lot more examples I'm missing, but clearly we hear from our communities that we're stepping up to the plate in response to doing work and strategies on behavior health in the community. 00:45:07:13 - 00:45:26:17 Adam Hocking If we were going to talk about all the issues in public health and everything that the health system is doing, this would probably be the never ending podcast, which I don't think anyone wants. So I'd like to close on a sort of a personal note and and ask you why did you sort of want to be involved in in community and public health in the first place? 00:45:26:17 - 00:45:28:17 Adam Hocking And why is it something you're so passionate about? 00:45:30:02 - 00:45:59:02 Jay Schrader Well, I can share that. So there's a there's a personal reason why I, I ended up getting involved in health period and it just kind of took a life of its own. And I think I was fortunate and lucky through various mentors along my career that help guide me, which is very near and dear to me as an executive now, to make sure that people leave the center and are better than when they came here. 00:45:59:02 - 00:46:27:13 Jay Schrader Actually, I take no better pride than when somebody leaves our center and takes a better job that actually feels really good to me. But in terms of how I got into public health, so my father, who is an amazing man and himself, you know, growing up had, I want to say, four heart attacks. He has 11 stents in his body. 00:46:27:23 - 00:47:10:20 Jay Schrader He has a pacemaker. He's got like 70% capacity. And his heart never worked out since he was 15 years old from Chicago and then from Chicago, smoke non filtered cigarets even after the first heart attack and after the second heart attack, he abused his body. And I watched this going, What did you what's going on, man? I mean, you know, you can see what you're doing to yourself and even to the point I remember as a as a child in the back of an aisle today, driving down the road and it's the middle of winter and the cars fill a smoke. 00:47:11:14 - 00:47:44:17 Jay Schrader And I remember saying, can you crack the window a little bit maybe? And that would be a nice thing for him to do because you would say it's cold outside. But we didn't know what we know today. And so all those behaviors were extremely interesting to me, not just on the outside, but human behavior. And so I started my career and in going down cardiac rehab and then it changed a few times and I was turned on by a professor in my undergrad program that exposed me to population health and community health. 00:47:44:17 - 00:48:15:15 Jay Schrader And I thought, why would I want to impact one person at a time where I can impact 10,000 people? That doesn't make sense. I mean, that to me is just a no brainer. And so from that, I started learning more about community health. I did some interns and I just absolute really loved them, loved it. And then more recently and I would say in the last decade, as health systems started to look at this going, Huh, look at that, you can actually get some stuff here with that population health thing and community health if we're doing it right. 00:48:16:03 - 00:48:37:23 Jay Schrader And so that was exciting. And I'm watching this, you know, as as I as I was in governmental public health for a decade, I'm watching this and I thought I should go to school and get at my health care degree, which I did. So I had a master's in health care administration. And honestly, they were just born. I would like to say that I had mapped this all out in a perfect sequence. 00:48:38:06 - 00:48:58:03 Jay Schrader I'd be lying to you, I think, through some mentors and some people pulling me under their wing and, you know, pushing me in areas. This is where I ended up. And I absolutely love this work and I can't think of another job that I'd rather do more. It's about engaging people. It's about working with communities. It's about doing good things. 00:48:58:03 - 00:49:08:17 Jay Schrader It's about being, you know, innovative and trying new things. So, yeah, it's an interesting story how our ended up where I'm at, but I'm super happy to be here. 00:49:09:06 - 00:49:21:19 Adam Hocking Jay Shrader is the vice president, Community Health and Wellness for Marshfield Clinic Health System. Jay, thank you for sharing some time and your knowledge with us today. I think it's a fascinating topic and only wish we had more time. Thank you. 00:49:21:21 - 00:49:23:01 Jay Schrader Thank you, Adam. Appreciate it. 00:49:23:01 - 00:49:51:11 Adam Hocking Anytime. You can subscribe to The Rounds and download episodes via iTunes or by visiting Shine365.MarshfieldClinic.org, thank you for joining us tonight. I'm Adam Hocking and I hope you'll join us next time on The Rounds.