Training Future Healthcare Professionals with Geoffrey Roche, Director of Workforce Development in North America at Siemens Healthineers

[00:00:04] [SPEAKER_01]: Welcome to Think Oral, where we connect the unconnected between oral and physical health.

[00:00:11] [SPEAKER_03]: I'm your host, Dr. Jonathan Levine. And I'm your host, Maria Filipova. Let's get at it.

[00:00:23] [SPEAKER_02]: Hi everyone and welcome to the Think Oral Health podcast, where myself and Dr. Jonathan Levine

[00:00:30] [SPEAKER_02]: connect the dots between oral health and overall health. I am very pleased to introduce our

[00:00:37] [SPEAKER_02]: conversation partner for today's episode, Geoffrey Roche. Geoffrey is an inspiring and inspirational

[00:00:45] [SPEAKER_02]: leader who brings together the topics around leadership and culture when it comes to building,

[00:00:53] [SPEAKER_02]: training, and deploying the workforce of the future. He's a son of a nurse, he's a health care

[00:01:00] [SPEAKER_02]: expert, he's a hospital administrator, and a diversity advocate. And all of these hats are

[00:01:06] [SPEAKER_02]: the roles that we will draw in our conversation today. Currently, he serves as the inaugural North

[00:01:13] [SPEAKER_02]: America Director of Workforce Development at Siemens Healthineers. He is an accomplished

[00:01:19] [SPEAKER_02]: speaker, a well-recognized thought leader in healthcare. And we're very pleased to welcome

[00:01:25] [SPEAKER_02]: Geoffrey to the conversation today as one of those changemakers and builder of bridges

[00:01:31] [SPEAKER_02]: between silos and healthcare. So Geoffrey, welcome to the podcast.

[00:01:35] [SPEAKER_00]: Thank you for having me. So excited to be here.

[00:01:38] [SPEAKER_02]: So let's perhaps let's start with that. Tell us how you tell us a little bit about your

[00:01:44] [SPEAKER_02]: journey and what is your current role entail as advancing education and bridging silos

[00:01:53] [SPEAKER_00]: for Siemens Healthineers? Yeah. So obviously my journey really started as a hospital

[00:01:59] [SPEAKER_00]: administrator. That's when I started just under a decade for a healthcare system in

[00:02:03] [SPEAKER_00]: Northeastern Pennsylvania, which now is part of Lehigh Valley Health Network.

[00:02:07] [SPEAKER_00]: We were a standalone healthcare system for 100 years and then we were acquired by Lehigh Valley.

[00:02:12] [SPEAKER_00]: And that's really where I started. I was always on the external side, never clinical.

[00:02:15] [SPEAKER_00]: And I was part of both our president and CEO and our chief strategy officer,

[00:02:20] [SPEAKER_00]: worked really with them very closely in both strategic advisor roles and then also led all

[00:02:25] [SPEAKER_00]: our business development strategy, government affairs and all aspects of our community health.

[00:02:30] [SPEAKER_00]: Then I actually moved after that experience, moved into academia and served at two different

[00:02:34] [SPEAKER_00]: academic institutions and had the privilege of serving on the president's cabinet,

[00:02:38] [SPEAKER_00]: which was super helpful. It's also when I started also as an adjunct faculty member

[00:02:43] [SPEAKER_00]: in different institutions. And it was helpful because I was always focused on growing healthcare

[00:02:48] [SPEAKER_00]: programs, but it also gave me the opportunity to really understand the academic side of that.

[00:02:53] [SPEAKER_00]: Which was super, super cool. And then I actually was part of a founding leadership team at an

[00:02:58] [SPEAKER_00]: EdTech company all in the health education space and then was fortunately recruited to lead

[00:03:03] [SPEAKER_00]: workforce development at Siemens Health & Nears. And so in my current role, it's really broken

[00:03:08] [SPEAKER_00]: down on a couple facets. One is really thought leadership. How do we really,

[00:03:12] [SPEAKER_00]: from a global and from a North America perspective, contribute into this dialogue

[00:03:17] [SPEAKER_00]: on what's required for today, but also what's required for tomorrow? And how do we

[00:03:21] [SPEAKER_00]: leverage innovative partnerships with healthcare systems, with academic institutions, with

[00:03:26] [SPEAKER_00]: government, with philanthropy, with a whole host of different partners at the national and at

[00:03:31] [SPEAKER_00]: the state level to really advance equitable workforce development? And then the second

[00:03:35] [SPEAKER_00]: piece is really how can I be leveraged as a trusted advisor to healthcare systems to really

[00:03:41] [SPEAKER_00]: ensure they have the right ingredients to build a more sustainable healthcare workforce?

[00:03:46] [SPEAKER_00]: And so that's really the work that I'm doing at Siemens.

[00:03:49] [SPEAKER_02]: Great. I'll ask you probably to define a couple of terms for us because Jonathan and I have a

[00:03:54] [SPEAKER_02]: definition of the workforce, the healthcare workforce, and what it entails. It is a

[00:03:59] [SPEAKER_02]: leading question here, Jeffrey. There's no doubt about it. But how do you define

[00:04:07] [SPEAKER_02]: the healthcare workforce or the care team from your perspective?

[00:04:12] [SPEAKER_00]: Yeah. So the reality of it is if I go back to my work as a hospital administrator

[00:04:16] [SPEAKER_00]: and all the way today, I've always defined it the same. And it really starts with the idea that

[00:04:21] [SPEAKER_00]: to me it's a hundred percent interdisciplinary. It involves everyone from our allied health team,

[00:04:26] [SPEAKER_00]: which obviously are our medical assistants, our dental assistants, all the way to other members

[00:04:31] [SPEAKER_00]: of the team like Surge Tech and such. And then obviously getting into nursing and imaging

[00:04:36] [SPEAKER_00]: and then obviously all the way up to our nurse practitioners and our physician assistants and

[00:04:41] [SPEAKER_00]: our physicians and really the whole team of clinicians. And so it can be defined differently

[00:04:45] [SPEAKER_00]: in an academic medical center environment too, because they may have different roles from a

[00:04:49] [SPEAKER_00]: teaching and education perspective. But to me it's a hundred percent interdisciplinary.

[00:04:54] [SPEAKER_02]: And how, and I'm going to, I know Jonathan wants to jump in here. So,

[00:04:57] [SPEAKER_02]: Jonathan, how do you define healthcare team in your practice as somebody who is actually

[00:05:03] [SPEAKER_02]: running a healthcare, oral health practice in Manhattan?

[00:05:08] [SPEAKER_03]: Very similar to how Jeffrey just described it. We take a very interdisciplinary approach.

[00:05:13] [SPEAKER_03]: We have underneath the umbrella, it's a very comprehensive approach of dental specialists

[00:05:20] [SPEAKER_03]: from orthodontists. I'm personally a prosthodontist, team of prosthodontists that really handle

[00:05:27] [SPEAKER_03]: aesthetic structure, function and biology. This overview, especially with our new technology

[00:05:32] [SPEAKER_03]: and the advent of cone beams, which is the CAT scans for the jaws and teeth all the way to

[00:05:39] [SPEAKER_03]: diagnostics. It's an interdisciplinary approach where everybody meets as teams. I know Jeffrey

[00:05:44] [SPEAKER_03]: is deep into leadership, so I'm going to ask him some questions about that because that's near

[00:05:48] [SPEAKER_03]: and dear to my heart of how do we move the needle? How do you become change agents? Because

[00:05:53] [SPEAKER_03]: there's a healthcare system that we have great opportunity to improve it. But we're

[00:05:57] [SPEAKER_03]: very interdisciplinary within the field of dentistry. We like to think of ourselves as

[00:06:02] [SPEAKER_03]: oral physicians and our new focus is really helping to connect the dots between the oral

[00:06:08] [SPEAKER_03]: health and how it connects and really can enhance both longevity and your overall health.

[00:06:15] [SPEAKER_03]: Let's talk about that.

[00:06:16] [SPEAKER_03]: And interconnected is very much a part of our worlds. Yeah, so let's dive in on that. So,

[00:06:23] [SPEAKER_03]: Jeff, here we go. Healthcare system, 20% of our GDP is healthcare. We have a sickness

[00:06:30] [SPEAKER_03]: model. You live in this healthcare system. You're in the educational side, the leadership

[00:06:35] [SPEAKER_03]: side. You are like so the perfect person to ask this question, how do we fix this system?

[00:06:41] [SPEAKER_03]: How are we going to take a sickness model? How do we get upstream to wellness?

[00:06:46] [SPEAKER_03]: What's your philosophy on this? And if you thought about new technology and breakthroughs

[00:06:52] [SPEAKER_03]: in computational science and all of our new research, how long is it going to take

[00:06:57] [SPEAKER_00]: to get to a better place? It's definitely a good question on how long it'll take,

[00:07:00] [SPEAKER_00]: because in many ways we've been at this for quite some time. So I'm definitely of the belief

[00:07:05] [SPEAKER_00]: that we've got to shift the payer system for us to ever truly get to a model where we can make

[00:07:11] [SPEAKER_00]: true change. And I think we still sit at a time where we have such a disparate system,

[00:07:17] [SPEAKER_00]: but from a payer side, from a patient side. Marie and I have talked about in the past the

[00:07:21] [SPEAKER_00]: idea that if I go even tomorrow, I'm going to go see my primary care physician. He doesn't

[00:07:25] [SPEAKER_00]: have any clue when I saw my dentist last, what we talked about, what I may be dealing with from an

[00:07:31] [SPEAKER_00]: oral health perspective. Now I could tell him, right? But the reality of this is most patients

[00:07:35] [SPEAKER_00]: may not even have the health literacy to understand those things. And so I've always

[00:07:39] [SPEAKER_00]: believed that our healthcare system was really developed on the premise that if you have

[00:07:44] [SPEAKER_00]: means, you can understand it better. If you don't have means, you're really, you're up a

[00:07:47] [SPEAKER_00]: significant climb. And so we've got to build a system that's more people focused. And I

[00:07:53] [SPEAKER_00]: think that starts with, I'm not going to sit here and say that I know an all payer system

[00:07:57] [SPEAKER_00]: would be the solution. But I do think we have to have some semblance to understand that the

[00:08:03] [SPEAKER_00]: current way of how we go about this just does not work. It's hard for people to navigate.

[00:08:08] [SPEAKER_00]: We know there's been little to no true innovation. And frankly, if there has been,

[00:08:13] [SPEAKER_00]: it's more like innovation that benefits those who really don't need to benefit.

[00:08:17] [SPEAKER_00]: We have to be building this for the patients every day. In my opinion,

[00:08:21] [SPEAKER_00]: we've made it harder for the patients to understand things. The EMR should be easier,

[00:08:26] [SPEAKER_00]: but not everyone knows. For example, a lot of practices today, you've got to use the app

[00:08:30] [SPEAKER_00]: to book an appointment and they won't book it even if you call. We just have made it more

[00:08:35] [SPEAKER_00]: difficult for some patients to really understand how to do this. And to me, people always say,

[00:08:40] [SPEAKER_00]: do you change the whole system and start fresh? In some ways, I think we're going to

[00:08:44] [SPEAKER_00]: have to start to do that. And we've got to, I think, harness while at the same time,

[00:08:49] [SPEAKER_00]: we work to make these incremental steps. I think we have to harness the ingenuity that can

[00:08:55] [SPEAKER_00]: exist in our future healthcare professionals. When I think of medical schools, why do we still

[00:08:59] [SPEAKER_00]: have medical schools? We have nursing schools, we have dental schools. Why isn't there just one

[00:09:03] [SPEAKER_00]: that allows everyone to learn? Yes, you have to train them board certified, you've got to do

[00:09:07] [SPEAKER_00]: all those things. But why have all these separate disparate systems? Why do we have

[00:09:12] [SPEAKER_00]: schools of public health when every one of them are dealing with public health?

[00:09:16] [SPEAKER_00]: Now I know the answer, right? It's generally all about resources. It's all about money.

[00:09:20] [SPEAKER_00]: It's a whole host of things. But we've got to level the playing field. And I think ultimately

[00:09:25] [SPEAKER_00]: truly teach them interdisciplinaryly because we know that's how we should be practicing.

[00:09:30] [SPEAKER_00]: But yet we still have a disparate system that exists. And I think until we change that,

[00:09:34] [SPEAKER_00]: we're going to continue to have the same status quo.

[00:09:37] [SPEAKER_02]: I love the John at the one there because you touched even in that one question,

[00:09:40] [SPEAKER_02]: we touched on incentives, we touched on technology, we touched on education.

[00:09:46] [SPEAKER_02]: So we have plenty of things to unpack there. And I'll let Jonathan tell you his view of why

[00:09:52] [SPEAKER_02]: we ended with two separate schools, the medical school and the dental school.

[00:09:57] [SPEAKER_02]: I think there's a Netflix series in the making.

[00:10:00] [SPEAKER_02]: It's coming.

[00:10:02] [SPEAKER_02]: It's coming.

[00:10:02] [SPEAKER_02]: It's coming and it's on that one alone.

[00:10:04] [SPEAKER_02]: Oh, wait. It's coming.

[00:10:09] [SPEAKER_03]: Maria, truth be told Harvard is the only school that has the dental school within

[00:10:13] [SPEAKER_03]: the medical school.

[00:10:14] [SPEAKER_04]: That's right.

[00:10:14] [SPEAKER_03]: I will say my alma mater, Boston University, when I went there, my first two years was in

[00:10:19] [SPEAKER_03]: medical school. The PhDs, the med students, the dental students were all together and then

[00:10:23] [SPEAKER_03]: everybody. But what's missing, and it has to do with the grand rebuke of 1840 when

[00:10:29] [SPEAKER_03]: a couple of physicians knocked on the door and said we want to create a dental division.

[00:10:32] [SPEAKER_03]: They said, sorry. They put up the big hand. They said open up your own dental school.

[00:10:36] [SPEAKER_03]: And it's always been separate in the United States. Today we are learning so much.

[00:10:41] [SPEAKER_03]: 58 systemic inflammatory diseases are linked to inflammation in the mouth.

[00:10:46] [SPEAKER_03]: So many things, whether it's cancer, so many things show up in the mouth for

[00:10:51] [SPEAKER_03]: early diagnosis that end up becoming these systemic issues.

[00:10:56] [SPEAKER_03]: And so the ability for the doctors and dentists to really share information,

[00:11:00] [SPEAKER_03]: to work collaboratively, I think it really hit on Jeff when you got to start at the

[00:11:05] [SPEAKER_03]: beginning. It's got to be part of the educational process and you have to create

[00:11:09] [SPEAKER_03]: protocols and systems where they're talking to each other. But let's think about it.

[00:11:14] [SPEAKER_03]: There's the physicians can't get their act together with the universal health records.

[00:11:18] [SPEAKER_03]: So how's dentistry and medicine?

[00:11:20] [SPEAKER_02]: I love that point. That's right. I was going to go exactly where you're going,

[00:11:25] [SPEAKER_02]: and because technology on its own is not the panacea to interoperability.

[00:11:33] [SPEAKER_02]: And I love the statistics that came out that even in co-located clinics

[00:11:38] [SPEAKER_02]: that have the same EHR, let's say medical teams and dental teams co-located in the

[00:11:45] [SPEAKER_02]: same facility on Epic, even in those cases, 83% of the providers on the medical

[00:11:51] [SPEAKER_02]: dental side say that they don't read or they can't edit each other's notes.

[00:11:58] [SPEAKER_02]: And so all of a sudden, what is the benefit of having Epic or EHR, the same EHR,

[00:12:04] [SPEAKER_02]: if the behavior again, only 5% of medical on the medical side providers even open

[00:12:10] [SPEAKER_02]: the dental records. So the fact that it's the technology allows us to do it. Yes,

[00:12:15] [SPEAKER_02]: there's imitation. We need to make it much more integrated. But if we are not,

[00:12:19] [SPEAKER_02]: the mindset is that a primary care doctor who's treating a diabetic patient needs to make sure

[00:12:25] [SPEAKER_02]: that diabetic gets regular cleanings and the periodontal disease is under control.

[00:12:30] [SPEAKER_02]: If that's not ingrained as a mindset, an overworked PCP is just going to do what their

[00:12:35] [SPEAKER_03]: minimum and just move on to the next patient. That's right. And then the question is,

[00:12:40] [SPEAKER_03]: Jeff, to you, because you really understand this health care system that we have,

[00:12:45] [SPEAKER_03]: is how do we get upstream to wellness? How do we get prevented? Because you were saying,

[00:12:50] [SPEAKER_03]: why aren't the nurses together with the physicians, with the dentist, and learning together and

[00:12:54] [SPEAKER_03]: create that collaborative environment from day one when you're getting educated? Because then

[00:13:00] [SPEAKER_03]: you're going to bring that into your clinical practice. But how do we do it? Because we know

[00:13:05] [SPEAKER_03]: that if we can get upstream to a wellness model, we'll move away from the sickness model.

[00:13:10] [SPEAKER_03]: We're going to save billions of dollars as our functional medicine doctors talk about all the

[00:13:15] [SPEAKER_03]: time and they're spot on about it. How do we move this Titanic of a health care system

[00:13:20] [SPEAKER_03]: that's trillions of dollars in the United States? How could we change it if you had your wish?

[00:13:26] [SPEAKER_03]: What are like the top three things that you would say, this is what I hope for

[00:13:31] [SPEAKER_03]: in the next decade because of, Maria's talking about mindset. There's a mindset shift

[00:13:37] [SPEAKER_03]: because finally the physicians and the dentists say, we got to work together. We can't be

[00:13:43] [SPEAKER_03]: separate. We have to work together for the improvement of care of our patients, both from

[00:13:48] [SPEAKER_03]: inequality and an equality standpoint. People can afford it and also people who are outside of

[00:13:54] [SPEAKER_03]: that group that need us to really lean in and come up with ways to give them access to care.

[00:14:00] [SPEAKER_00]: The way I look at it is wellness also has a huge correlation to really advancing health

[00:14:04] [SPEAKER_00]: equity. And I think that if you look at the current model, it's going to be very challenging

[00:14:10] [SPEAKER_00]: for us to continue to do that within the current structure of our health insurance marketplace.

[00:14:16] [SPEAKER_00]: Despite all the attempts that were made with the Affordable Care Act, ultimately the industry,

[00:14:22] [SPEAKER_00]: as we always say in healthcare, follow the money. I had lobbyists and others who

[00:14:25] [SPEAKER_00]: were actively engaged to really make sure that their bottom line was healthy while at the

[00:14:29] [SPEAKER_00]: same time our patients weren't. We've got to change that trajectory of this. I look at it

[00:14:34] [SPEAKER_00]: the vantage point of how do we sit in 2024 and yet all the disparate trade groups that represent,

[00:14:41] [SPEAKER_00]: if you think about it, American Hospital Association, American Medical Association,

[00:14:45] [SPEAKER_00]: American Nurses Association. You could go on American Dentistry Association. Why is it

[00:14:53] [SPEAKER_00]: that we can't get all of them to agree on some of these core principles and ultimately

[00:15:00] [SPEAKER_00]: respectfully address that and be willing to put their money where their mouth is collectively

[00:15:05] [SPEAKER_00]: to really advance this? I think if we could get to a situation where that's the case,

[00:15:10] [SPEAKER_00]: follow the money when it comes to lobbying, we would see changes. At the same time,

[00:15:14] [SPEAKER_00]: I think we also have to have governors at the state level, at the health insurance levels,

[00:15:19] [SPEAKER_00]: who are willing to challenge them respectfully within their states. Yes, this is a federal

[00:15:24] [SPEAKER_00]: issue, but ultimately you've got to have some aspect that's addressing this. To your point,

[00:15:30] [SPEAKER_00]: if we can truly focus on these things and we train our future health professionals on it

[00:15:35] [SPEAKER_00]: collectively, we'll be in a much better situation than we are today. I look at it from the

[00:15:40] [SPEAKER_00]: vantage point of when I was a hospital administrator, we did oral health screenings

[00:15:45] [SPEAKER_00]: once a year. We did it during oral health month. And we always would talk about the

[00:15:50] [SPEAKER_00]: that it would be much better if we could have done it all the time regularly. But the challenge

[00:15:56] [SPEAKER_00]: was there was no reimbursement to do it regularly, and infrastructure from a staffing end would have

[00:16:01] [SPEAKER_00]: also been very challenging. But again, if we would have had a health payer who wanted to

[00:16:05] [SPEAKER_00]: partner in that case to do something innovative, but I'll tell you, we did that regularly for a

[00:16:10] [SPEAKER_00]: lot of screenings. We were a very robust screening type of system. Our payers were

[00:16:14] [SPEAKER_00]: lackluster frankly when it came to those things. There wasn't really that interest

[00:16:18] [SPEAKER_00]: to really truly dive into prevention and wellness.

[00:16:22] [SPEAKER_03]: And isn't it, Maray, you live in this world, incumbent upon the insurers

[00:16:26] [SPEAKER_03]: to figure out, hey,

[00:16:28] [SPEAKER_03]: Oh, I knew that was coming my way. I knew just

[00:16:30] [SPEAKER_03]: Well, come on, we got it.

[00:16:32] [SPEAKER_03]: How many years of school do you need to figure out the fact that if I can get to a mouth

[00:16:38] [SPEAKER_03]: and teach them how to brush and get them fluoride and give them some access to prevention

[00:16:43] [SPEAKER_03]: education, that downstream, they're not going to need decay. They're not going to end up

[00:16:48] [SPEAKER_03]: with some terrible infection in the mouth that actually becomes life threatening on and on.

[00:16:53] [SPEAKER_03]: How many years of education do you need?

[00:16:55] [SPEAKER_02]: I think there's a disconnect here and what Jeffrey is describing,

[00:16:59] [SPEAKER_02]: and let's give credit where credit is due, right? The American Heart Association

[00:17:03] [SPEAKER_02]: just came up with a partnership with Dr. Dan Crowley from the Delta Dental of California

[00:17:08] [SPEAKER_02]: Benefit Company to bring together new guidelines of treating patients with cardiovascular issues,

[00:17:17] [SPEAKER_02]: right? And that connection between oral health interventions and cardiovascular health.

[00:17:23] [SPEAKER_02]: The American Diabetes Association already has guidelines around diabetic care and oral health.

[00:17:30] [SPEAKER_02]: And there's like hundreds of clinical studies and peer reviewed publications that draw the

[00:17:35] [SPEAKER_02]: So I think if step one is credibly find those clinical connections,

[00:17:40] [SPEAKER_02]: step two is then embed those connections in protocols, clinical guidelines, right?

[00:17:46] [SPEAKER_02]: And then step three, operationalize it. Right? I think that's where,

[00:17:50] [SPEAKER_02]: in my view, where we have a true disconnect because there's a gap between what the guidelines

[00:17:56] [SPEAKER_02]: for diabetes or cardiovascular are saying, cardiovascular care are saying, and what the

[00:18:02] [SPEAKER_02]: general practitioner, the general dentist or the primary care doctor is doing day in and day out.

[00:18:09] [SPEAKER_02]: And part of it is absolutely a function of we get paid, we do what we get paid to do.

[00:18:14] [SPEAKER_02]: And right now when you talk about closing gaps of care,

[00:18:19] [SPEAKER_02]: did you have a dental visit? It's not in the care gaps.

[00:18:23] [SPEAKER_02]: Did you have a primary care visit? Do you have a primary care doctor?

[00:18:26] [SPEAKER_02]: Do you have an update address? There's all the litany of things that a provider could

[00:18:31] [SPEAKER_02]: pay for to close care gaps. The dental part is not there yet.

[00:18:35] [SPEAKER_02]: And then similarly, as a fee-for-service dentist,

[00:18:39] [SPEAKER_02]: taking up patients' blood pressure is part of the standard care protocols. Right?

[00:18:43] [SPEAKER_02]: How many dentists actually do it other than Dr. Jonathan Levine and the early

[00:18:47] [SPEAKER_02]: adopters, the systemic health oriented dentist? The question is, do we bridge that disconnect

[00:18:56] [SPEAKER_02]: by more education and trying to change the mindset, or is it truly?

[00:19:02] [SPEAKER_02]: Because that's ultimately the right thing to do. Right?

[00:19:05] [SPEAKER_02]: And we've seen the dentists who do that oral systemic health approach to dentistry

[00:19:09] [SPEAKER_02]: tend to have patients who stick with them in their practice for longer periods of time,

[00:19:15] [SPEAKER_02]: higher satisfaction rates, like all of these side effects are there,

[00:19:19] [SPEAKER_02]: benefit side effects are there. So how do you bridge that disconnect

[00:19:23] [SPEAKER_02]: between clinical guidelines and the practice? Is it only payments? Is that what it is?

[00:19:29] [SPEAKER_00]: Is that what it's going to take? Ultimately, you can never really address

[00:19:32] [SPEAKER_00]: the social determinants without addressing the political determinants.

[00:19:35] [SPEAKER_00]: I think you can even in that situation, right? There are providers that are doing that today,

[00:19:40] [SPEAKER_00]: but they're not getting reimbursed for so much of it.

[00:19:42] [SPEAKER_00]: Then they're doing extra work and potentially it could even be contributing to their burnout

[00:19:47] [SPEAKER_00]: and whatever the case, because they have to see more and more patients depending on who's

[00:19:51] [SPEAKER_00]: I think, yeah, we do have to train and prepare because I think is these additional generations

[00:19:58] [SPEAKER_00]: come, they are going to say enough is enough. We've got to move the model,

[00:20:01] [SPEAKER_00]: but at the same time, we've got to continue to work really to bring together a consensus

[00:20:07] [SPEAKER_00]: of all these critical partners to make the change happen.

[00:20:10] [SPEAKER_00]: And I'm just strongly of the belief that when we look at healthcare,

[00:20:14] [SPEAKER_00]: so much of this comes down to lobbying, so much of this comes down to following the money.

[00:20:18] [SPEAKER_00]: And ultimately, we have to have individuals at the highest levels of those associations

[00:20:25] [SPEAKER_00]: that are willing to speak the truth. And I think ultimately we haven't

[00:20:30] [SPEAKER_00]: necessarily had that. I think the most recent leader of the American Medical

[00:20:33] [SPEAKER_00]: Association was someone who believed in systemic health inequities very strongly.

[00:20:38] [SPEAKER_00]: But again, he's now his term has moved on, but he can still be, I think,

[00:20:41] [SPEAKER_00]: without question a leading voice and also in academia and academic medical

[00:20:45] [SPEAKER_00]: systems. And I think we've got to harness some of those folks, and we need to get more champions

[00:20:51] [SPEAKER_00]: of this on both sides of the aisle. And Senate finance has to be engaged because

[00:20:56] [SPEAKER_00]: of the Medicare and all the things go through there in house, ways and means.

[00:21:00] [SPEAKER_00]: And we have to get people that really know how to leverage all those types of things.

[00:21:05] [SPEAKER_03]: Yeah. Here's a simple fact for us and talk about following the money.

[00:21:10] [SPEAKER_03]: So over COVID, people were five times more likely to end up on a ventilator if they had

[00:21:17] [SPEAKER_03]: periodontal disease. So classic comorbidity issues, overcharged immune response system.

[00:21:25] [SPEAKER_03]: So when you think of that and you think about cardiovascular disease and diabetes and all of

[00:21:30] [SPEAKER_03]: these types of systemic health inflammatory diseases, the data sets are there of how to

[00:21:36] [SPEAKER_03]: prevent them. What's not there is I think Jeff's really hitting on it, is the decision makers

[00:21:41] [SPEAKER_03]: and the people who can make the difference. There is not enough voices out there to drive

[00:21:47] [SPEAKER_03]: those early dollars, the prevention, wellness, education dollars. Jeff, we have a foundation

[00:21:52] [SPEAKER_03]: called the Glowgood Foundation. We go to the Bahamas. We have a 14 chair clinic. And when

[00:21:57] [SPEAKER_03]: we went into the schools and when we educated the kids, it was very easy over an eight year

[00:22:02] [SPEAKER_03]: period to see the fact that they didn't end up like their parents with serious oral diseases,

[00:22:09] [SPEAKER_03]: teeth extractions, decay, periodontal disease, abscess. And so as we helped to clean up the

[00:22:15] [SPEAKER_03]: adult population, we saw this great improved trend. And we go down there with nurse

[00:22:20] [SPEAKER_03]: practitioners, dermatologists, doctors and a whole dental specialty team, all under one roof.

[00:22:26] [SPEAKER_03]: Which you start saying to yourself, wow, maybe there's something here. Maybe there's

[00:22:31] [SPEAKER_03]: an integrated healthcare model that gets supported by the payers in the right way that drive

[00:22:36] [SPEAKER_03]: prevention and wellness so that we don't end up where we are today, where we constantly move

[00:22:42] [SPEAKER_03]: to improve our system in every way. Access and really from an economic standpoint also.

[00:22:49] [SPEAKER_00]: To your point, if you look at the federally qualified healthcare center model, right?

[00:22:53] [SPEAKER_00]: Many of them also have dental as part of one approach, right? But look at how they're

[00:22:58] [SPEAKER_00]: reimbursed. They're reimbursed terribly. They're oftentimes not very sustainable

[00:23:02] [SPEAKER_00]: and oftentimes have to have individual philanthropic support to keep them going.

[00:23:07] [SPEAKER_00]: And I think that's a great example. If you look at the community health centers around this

[00:23:11] [SPEAKER_00]: country, some of the best care actually comes out of them yet how their finance is absolutely

[00:23:17] [SPEAKER_00]: abysmal. Truly think about it. And ultimately, I can remember in my hospital system,

[00:23:22] [SPEAKER_00]: we actually tried to help start an FQHC lookalike because we knew some of the challenges,

[00:23:27] [SPEAKER_00]: but the process to do that was so challenging to do it from a healthcare system standpoint.

[00:23:32] [SPEAKER_00]: We were not able to make it work and ultimately our board said cut it.

[00:23:36] [SPEAKER_00]: Which is another point I'll just reference. I think the same thing that I said from a

[00:23:40] [SPEAKER_00]: decision-making thing also applies to the governance of our healthcare systems.

[00:23:44] [SPEAKER_00]: Ultimately, when you look at the governing bodies of healthcare systems, directors,

[00:23:49] [SPEAKER_00]: trustees or shareholders if they're for profit, they generally don't really understand

[00:23:54] [SPEAKER_00]: healthcare. They generally have not served in healthcare. There's very little to no nurses

[00:23:59] [SPEAKER_00]: on them. There's probably no dentists on them. There's probably very little other colleagues

[00:24:04] [SPEAKER_00]: from the healthcare space on them. Ultimately, they're just friends of other board members

[00:24:08] [SPEAKER_00]: that got on there because the other board members put them on. Yet they're making

[00:24:11] [SPEAKER_00]: the most critical decisions for a healthcare system and ultimately all those decisions

[00:24:16] [SPEAKER_00]: impact lives. And so we also have to really focus on that space as well.

[00:24:21] [SPEAKER_04]: Hmm.

[00:24:22] [SPEAKER_03]: Maria, how about the fact, and Jeff, how about the fact that in 25 states now,

[00:24:27] [SPEAKER_03]: nurse practitioners can do the same thing as primary care physicians? Is there some

[00:24:32] [SPEAKER_03]: operating leverage there of these nurse practitioners? Maria and I have some amazing

[00:24:37] [SPEAKER_03]: friends who are leaders in the innovation of nurse practitioners. Isn't this an opportunity

[00:24:43] [SPEAKER_03]: for us to create tremendous leverage with these nurse practitioners? And how would,

[00:24:47] [SPEAKER_03]: in your own mind, how can we integrate this into our healthcare system for the benefit of

[00:24:52] [SPEAKER_00]: our patients? It's a great idea, right? And keep in mind that the process that they had to go

[00:24:58] [SPEAKER_00]: through to make that happen, the battles that they had to fight with the medical societies

[00:25:01] [SPEAKER_00]: within each of the states. I think here's the reality, right? We're going to continue

[00:25:06] [SPEAKER_00]: to see significant growth in nurse practitioners. And I think to your point, if there's a space

[00:25:12] [SPEAKER_00]: where more collaboration can occur, I think it's clearly in that space without question.

[00:25:16] [SPEAKER_00]: As you go, there's also reimbursement challenges still in that case as well. And so at the same

[00:25:22] [SPEAKER_00]: time, we've got to address those things too. We as a whole have to harness the fact that

[00:25:28] [SPEAKER_00]: programs that are growing are nurse practitioner programs. In fact, I'm pretty confident in

[00:25:32] [SPEAKER_00]: this. The data that I've reviewed suggests that nurse practitioner programs are growing far

[00:25:36] [SPEAKER_00]: faster than medical school programs. And I think we're only going to continue to see that,

[00:25:41] [SPEAKER_00]: but what concerns me about that is rural America, frankly, because rural America access

[00:25:49] [SPEAKER_00]: in all aspects of healthcare is truly at what I would consider to be probably some of the worst

[00:25:55] [SPEAKER_00]: levels ever. We're on a cliff and we're about to never get off of it. And yet we don't have a

[00:26:00] [SPEAKER_00]: great intentional focus on everyone to try and fix that. And it doesn't matter how many nurse

[00:26:07] [SPEAKER_00]: practitioners we send in, if we don't have dentists there, if we don't have psychiatrists,

[00:26:10] [SPEAKER_00]: we don't have other care team members, ultimately we're going to be in a significant

[00:26:14] [SPEAKER_00]: challenge. And I think unfortunately we're there in many cases. That brings the kind of

[00:26:19] [SPEAKER_02]: the, when you think of it as a systemic, as a system level, we talk about the integrated

[00:26:24] [SPEAKER_02]: care approach and a care team that is overweight on hygienists, nurse practitioners is the care

[00:26:33] [SPEAKER_02]: could deliver the majority of preventative and wellness services. That's how you go upstream,

[00:26:42] [SPEAKER_02]: that's how you take the next generation to embed healthy hygiene habits, healthy eating habits.

[00:26:48] [SPEAKER_02]: But if you're in a dental desert or medical desert where people who are well in their 40s

[00:26:54] [SPEAKER_02]: who have never seen a dentist but take out their own teeth, that's where you have to be

[00:27:03] [SPEAKER_02]: because technology has very little help in those situations other than maybe some

[00:27:09] [SPEAKER_02]: form of triage. So it's great to talk about interdisciplinary care, integrated care,

[00:27:17] [SPEAKER_02]: augmented care by technology. There's no substitute for the specialist who has gone

[00:27:23] [SPEAKER_02]: to medical school, who has seen multiple cases, who is in there especially for the

[00:27:28] [SPEAKER_02]: cases in those dental and medical deserts. So thinking about that spectrum of needs at

[00:27:36] [SPEAKER_02]: a system level and how do we deploy the best resources to the patients based on what the

[00:27:41] [SPEAKER_02]: need is? So have you, Jeffrey, from your perspective and as you think about the future

[00:27:46] [SPEAKER_02]: of the workforce, are you seeing any pockets in the country that are doing it well?

[00:27:52] [SPEAKER_02]: Any initiatives that are working in that direction that you think us and our listeners

[00:27:57] [SPEAKER_02]: could support and get more involved in? What's on your radar right now?

[00:28:02] [SPEAKER_00]: Yeah, I'm definitely getting super impressed with some of the innovative work that are occurring

[00:28:07] [SPEAKER_00]: at healthcare systems regarding youth apprenticeships. And I think there's great opportunity,

[00:28:13] [SPEAKER_00]: even in this space, to envision when you have a situation where, particularly as an academic

[00:28:18] [SPEAKER_00]: medical center, and they, to your point, whether they have a dental school that's

[00:28:22] [SPEAKER_00]: separate or a dental school that's in a medical school, why not give them that opportunity

[00:28:27] [SPEAKER_00]: to experience that full interdisciplinary approach? And the University of Wisconsin

[00:28:32] [SPEAKER_00]: Health, for example, their director, Bridget, has done an amazing job of developing some amazing

[00:28:38] [SPEAKER_00]: youth apprenticeship programs in many areas of allied health. And I know she's basically

[00:28:43] [SPEAKER_00]: doing it based on needs and then growing it so that these are youth that are getting to

[00:28:47] [SPEAKER_00]: find roles, actual jobs, in the healthcare system. And they're working in these roles with

[00:28:52] [SPEAKER_00]: the intention then to get them further educated and get them retained. And I think

[00:28:56] [SPEAKER_00]: we've got to do those types of things. I look at it from the vantage point of

[00:29:00] [SPEAKER_00]: when people think of medical, they usually think doctor, nurse, even if you think of

[00:29:05] [SPEAKER_00]: dentistry, you always really pretty much go to the dentist, right? You don't think of the dental

[00:29:09] [SPEAKER_00]: assistant or the other care team members. I spend more time with a dental assistant

[00:29:12] [SPEAKER_00]: or other members of the team, dental hygienists, than I actually do with the dentist.

[00:29:16] [SPEAKER_00]: I'm not saying that to be mean, it's just the truth. The dentist comes in and just

[00:29:20] [SPEAKER_00]: checks my teeth at the end. I'm healthy, right? Whereas the dental hygienist, in my

[00:29:24] [SPEAKER_00]: practice, actually they do take my blood pressure. So I'm excited about that.

[00:29:27] [SPEAKER_00]: And I will say they also review other aspects. For example, now some of that is because I've

[00:29:32] [SPEAKER_00]: told them my medical history, right? But they do review it at every appointment,

[00:29:36] [SPEAKER_00]: even though I'm telling them. I think we have got to do more of these types of initiatives

[00:29:42] [SPEAKER_00]: because we have to train our youth that become our future workforce on the full social

[00:29:48] [SPEAKER_00]: determinants of health, on all the aspects of health equity. And we also have to, to your

[00:29:53] [SPEAKER_00]: point, train them and teach them that everything that we do within the mouth also impacts all

[00:29:58] [SPEAKER_00]: aspects of our health. We know it, right? We know it, cancer, heart disease, diabetes,

[00:30:03] [SPEAKER_00]: other aspects. And we've got to change the system. And at the same time, I do believe

[00:30:09] [SPEAKER_00]: we also have to be willing to try new things. And so I'm encouraged, for example,

[00:30:13] [SPEAKER_00]: Maria, I've seen all the great startups that you brought when helped coach into the system.

[00:30:18] [SPEAKER_00]: The challenge I see for so many of the startups though is they're trying to come

[00:30:22] [SPEAKER_00]: fix a broken system. And so sometimes it's also just hard to get into a broken system because

[00:30:27] [SPEAKER_00]: while we know most of us know is broken, some of the people are just defensive about

[00:30:31] [SPEAKER_00]: they don't want to be willing to change it. The industry that's the hardest for a startup

[00:30:35] [SPEAKER_00]: to actually be successful in my opinion is healthcare because we're risk averse.

[00:30:40] [SPEAKER_00]: We're so slow to act. And even though we know the crisis is here, so many people are

[00:30:44] [SPEAKER_00]: just out, we're just humming along. And all of us also have to help to get these startups

[00:30:49] [SPEAKER_00]: into the space to help be successful. And I hope that we'll see more health insurers launching

[00:30:56] [SPEAKER_00]: some of the innovative startup work that they've done. If we can see more of that

[00:31:00] [SPEAKER_00]: supporting these startups, then we can have some systemic change because they're the payer.

[00:31:05] [SPEAKER_00]: And ultimately if you're a hospital and you've got a payer saying,

[00:31:08] [SPEAKER_00]: hey, we want you to try this, then I think it's a little different story.

[00:31:11] [SPEAKER_03]: Yeah. It's such a great point. It's such a great wrap. When dentistry,

[00:31:14] [SPEAKER_03]: one of the areas that we're overlapping in spite of everybody is sleep diagnostics because we own

[00:31:21] [SPEAKER_03]: it now through CAT scans for the jaws that are becoming a standard for many dental offices. We

[00:31:27] [SPEAKER_03]: can see upper airway restriction, which allows us to ask more important questions

[00:31:32] [SPEAKER_03]: concerning sleep. Because if you can't get into deep sleep, you can't prepare your body,

[00:31:36] [SPEAKER_03]: can't repair your body, can't fight cancers, hypertension, cardiovascular disease and all the

[00:31:41] [SPEAKER_03]: So the doctors and dentists really have to collaborate. And that has come out of new

[00:31:46] [SPEAKER_03]: technology, almost some unintended consequences. The fact that CAT scans, cone beam,

[00:31:51] [SPEAKER_03]: computer tomography is now in dental offices from top of the nose, we're looking at sinuses,

[00:31:56] [SPEAKER_03]: we understand airway restriction, make a referral, ear, nose and throat, upper airway problem,

[00:32:02] [SPEAKER_03]: maybe a better answer than what's currently in medicine called CPAP. So what you're saying

[00:32:06] [SPEAKER_03]: is so true and the hope that the payers and the decision makers start opening this conversation

[00:32:14] [SPEAKER_03]: in a much bigger way, but also driven by an undercurrent of this technology and the

[00:32:20] [SPEAKER_03]: impact in the rounds of return that new technology and new research really gives us.

[00:32:24] [SPEAKER_03]: And that will keep us hopeful, right Maria?

[00:32:28] [SPEAKER_02]: It's all about keeping us hopeful because otherwise this is a very complicated,

[00:32:31] [SPEAKER_02]: very lopsided device industry that no one, I do believe that even though there's multiple perverse

[00:32:40] [SPEAKER_02]: incentives in the system and that complexity was man-made, we all created it over the years.

[00:32:47] [SPEAKER_02]: I do believe that everybody in the healthcare ecosystem is operating from best intentions at

[00:32:54] [SPEAKER_02]: the start. They have a different level of tolerance for change or capacity to influence

[00:33:02] [SPEAKER_02]: or drive change. So no one really wakes up one day and thinks, what is the most convoluted,

[00:33:08] [SPEAKER_02]: most expensive and time consuming way I could process claims? Oh, let me just institute

[00:33:14] [SPEAKER_02]: fax machines, right? That's not how somebody wakes up and starts their day. But yet we are

[00:33:21] [SPEAKER_02]: because over the years, all that complexity, legacy systems, we've always done it that way,

[00:33:27] [SPEAKER_02]: that kind of mindset, that kind of legacy, we've just taken on that complexity debt

[00:33:33] [SPEAKER_02]: and kept adding to it rather than saying time out, why are we doing this? Can we take that

[00:33:40] [SPEAKER_02]: 12 step process and turn it into two, right? And that we're not seeing a lot of that

[00:33:47] [SPEAKER_02]: because there's not much of agency, right? A lot of it is like, well, my job is to see the patient

[00:33:53] [SPEAKER_02]: and make sure I see them in 15 minutes and get them out of here with as many factors, diagnoses

[00:33:58] [SPEAKER_02]: that I could get so that would impact my revenue generating units as a primary care doctor. And

[00:34:04] [SPEAKER_02]: so that's the behavior that we all find ourselves into. We don't necessarily intentionally

[00:34:10] [SPEAKER_02]: set out to do that. And sometimes that awareness is all we need. I do want to end

[00:34:16] [SPEAKER_02]: on a positive note. We're trying. This has been because Jonathan started this with how do we fix

[00:34:22] [SPEAKER_02]: this? We had to go into really into the bowels of what's wrong. We had unpacked.

[00:34:28] [SPEAKER_02]: So Jeffrey, what's next for you in terms of your amazing work that you're driving

[00:34:33] [SPEAKER_02]: within Siemens and outside of Siemens? And if our listeners want to follow you, get involved,

[00:34:40] [SPEAKER_02]: stay in touch in all the amazing initiatives that you're driving, what's the best way for

[00:34:44] [SPEAKER_00]: them to do that? The best way to connect is obviously on LinkedIn, always happy to connect.

[00:34:48] [SPEAKER_00]: And to your point, there's definitely a lot that's on the horizon really regarding looking at,

[00:34:53] [SPEAKER_00]: to your point, being that bridge between higher ed and health care to try and really lead some

[00:34:58] [SPEAKER_00]: systemic changes and really more innovation and transformation around topics like apprenticeships.

[00:35:04] [SPEAKER_00]: And I think we have a lot of work to do in our K through 12 system to also just educate them

[00:35:09] [SPEAKER_00]: all these roles and how they can be the future dentists or they could be the future dental

[00:35:13] [SPEAKER_00]: hygienist. They could be a primary care physician that also cares about oral health. We've got to

[00:35:19] [SPEAKER_00]: do a lot of work in that space. And I think particularly that's a space that we haven't done

[00:35:24] [SPEAKER_00]: a lot of great work in. And the other piece to your point is also very involved in supporting

[00:35:29] [SPEAKER_00]: the nursing profession too. I'm a commissioner on the nursing commission because we've got

[00:35:33] [SPEAKER_00]: to change the way that's handled as well. And I think similarly, we've got to bring all

[00:35:37] [SPEAKER_00]: these things together and advance it with a systemic health in line, both for our patients,

[00:35:41] [SPEAKER_02]: but also for the workforce. I love that. And please, my personal invitation to all our

[00:35:47] [SPEAKER_02]: listeners is if you are one of those cross-disciplinary specialists who has a hygiene

[00:35:53] [SPEAKER_02]: degree and a dental degree or a nursing degree and a hygienist degree, if you're one of

[00:35:58] [SPEAKER_02]: those hybrid unicorns out there who are practicing that integrated care, reach out to

[00:36:05] [SPEAKER_02]: any of us, we'd like to know your story. We'd like to capture some of your best practices

[00:36:11] [SPEAKER_02]: and would like to give you a voice about some of the great things that you're doing.

[00:36:16] [SPEAKER_02]: Because these are the types of practitioners, the clinicians, the providers that are out there.

[00:36:20] [SPEAKER_02]: We want to give a voice and spotlight them. It's great. You really define, Maria,

[00:36:24] [SPEAKER_03]: the heroes of the healthcare system because they're the people who are their change agents.

[00:36:29] [SPEAKER_03]: And Jeff, you fall in that category. I want to thank you so much for coming here,

[00:36:32] [SPEAKER_03]: for sharing your thoughts. It was really a great conversation. We know that we're at the beginning

[00:36:38] [SPEAKER_03]: of this fight, really, even though a number of decades working on it. And we'll just keep

[00:36:43] [SPEAKER_03]: this conversation going and keep doing all the great work that you're doing, is my thoughts.

[00:36:47] [SPEAKER_00]: Thank you very much. I appreciate it.

[00:36:49] [SPEAKER_01]: Thank you for joining us. Until next time.

[00:36:59] [SPEAKER_03]: Thanks for listening to the Think Oral Podcast.

[00:37:02] [SPEAKER_01]: For the show notes and resources from today's podcast,

[00:37:05] [SPEAKER_03]: visit us at www.outcomesrocket.health.thinkoral.

[00:37:12] [SPEAKER_01]: Or start a conversation with us on social media.

[00:37:16] [SPEAKER_01]: Until then, keep smiling. And connecting care.