Thank you for listening to Advancing Health! As we close out 2025, we’re excited to share highlights from two impactful episodes that sparked dialogue around improving health care in America. Advancing Health will return in 2026 with fresh insights and thought-provoking discussions. Until then, we wish you a joyful holiday season and a healthy, happy New Year!

Tom Haederle

Tom Haederle

Chris DeRienzo, M.D.

So for you all, innovation is really grounded in your need to serve your population. So remind our listeners a little bit about Sanford Health and the populations you serve and why innovation has been so core to what you do from the beginning.

David Newman, M.D.

Yeah, so at Sanford Health we're the nation's largest rural health care system. We range all the way from Wyoming to Michigan.

David Newman, M.D.

We have lots of hospitals. We have got big hospitals. We've got small hospitals. We've got critical access hospitals. We've got clinics. We've got a health network. We've got a nursing home. One thing that we don't have though, is a problem that a lot of rural America has is enough providers. We realize that we have to jump to innovative care models to survive because our patients really need.

Chris DeRienzo, M.D.

Well, it's innovative care models and you need providers, but you also have patients who are spread far and wide.

Chris DeRienzo, M.D.

I mean, you all were incredibly generous with your time. We spent some time together in the fall and you showed me what it really is like in parts of rural North Dakota where your patients live. Talk to us about that. And then you will return to given that this is who you all serve, and it really is a sacred mission that you have, the kinds of innovative approaches that you're taking both with virtual care and with AI.

David Newman, M.D.

Yeah. So I say rural, I mean really rural. So in, North Dakota, I live in Fargo, North Dakota. I'm the only andrologist for the state of North Dakota. And Fargo is on the eastern part of the state. And, a lot of my patients come from western North Dakota or even Montana. It is a 400 mile drive

David Newman, M.D.

one way to get to see me.

Chris DeRienzo, M.D.

Whoa.

David Newman, M.D.

And oftentimes it's for a 15 minute appointment.

Chris DeRienzo, M.D.

Oh my goodness.

David Newman, M.D.

And so if they're coming to see me for their hypogonadism or infertility or another thing, I'm the only option in town. You can imagine how frustrating it is if there's a blizzard, or even if there's not a blizzard for them to have to drive that far, take a day off of work, have multiple tanks of gas yet, to miss time away from their loved ones to do something that can be easily done virtually.

Chris DeRienzo, M.D.

And that might even be two days, because I could imagine, you know, if that's an appointment you've been waiting on and you described a little bit about what you do. But remind our listeners what an andrologist is in just a moment.

David Newman, M.D.

Yeah, yeah. You know, I mean I would drive 400 miles and spend the night just so I don't I don't miss that.

David Newman, M.D.

That can be such a key conversation in in a family's life. Right. Absolutely. Yeah. So andrology is sex hormone. So it's a lot of if your testosterone is low or if you're having troubles reproducing. Yeah. From a health perspective, even having one provider like that in that part of North Dakota is great, but you need to reach a massively spread out population.

Chris DeRienzo, M.D.

So, obviously you're the CMO of virtual care. Let's talk a little bit about how Sanford and you think about the kinds of virtual care options that allow a provider with your experience to reach people who are hundreds, if not a thousand miles away.

David Newman, M.D.

Yeah. So we've really been listening to patients and what they want. So one of the big things we heard is that they don't want to be transferred to our flagship hospital.

David Newman, M.D.

So we've got lots and smaller hospitals that feed the larger hospitals. One of the big issues is the lack of some of the pediatric subspecialties in the smaller hospitals. So for example, pediatric infectious disease. If a patient needs a pediatric infectious disease consult, they often had to be transferred to Fargo or Sioux Falls for the higher level of care.

Chris DeRienzo, M.D.

Wow.

David Newman, M.D.

You can think about as a parent, if your child is transferred, you're missing work. You have other children that you can't attend to. It's a big burden. So now leveraging technology and leveraging virtual care, we can beam our own providers, our own pediatric infectious disease doctors into their hospitals. We can keep the patients there. Sometimes you can just see how relieved the patients are knowing that they're not going to be transferred and knowing that they still get the same high quality specialty care in their hometown hospital.

Chris DeRienzo, M.D.

Chris DeRienzo, M.D.

So now maybe it's an hour's drive from the ranch that they live in Dickinson rather than seven hours each way. That doesn't happen accidentally. You've got to be very sensible about designing a system to work like that. How do you do it?

David Newman, M.D.

Yeah. So a lot of it is what the patient wants and from provider buy-in.

David Newman, M.D.

And so we've had some champions that have had driven this. And we have failed fast on a lot of these models that didn't work. For our hub and spoke model a patient, it's the easy button for the patient. So if they're not tech savvy they can go to the clinic. They can have a nurse and room them in a regular exam room, and then the provider beams into the room.

David Newman, M.D.

So it's just like a normal visit. One of the great things about that is they're already there for labs. So if a patient needs an X-ray, they're there. Yeah. If they need blood tests, they're there. And it is their trusted provider. Those labs are going to go straight to their basket and they're going to have follow up there.

David Newman, M.D.

So it's defragmentizing care.

Chris DeRienzo, M.D.

I love this example because medicine is always a spectrum. Neonatologist, endocrinologist. You know I see babies at the super, you know critical hyper acute end of the spectrum. And you know, at the follow up care. And telemedicine is no different, right? There are telemedicine visits you can do in a patient's home with the technology that just exists on their phone.

Chris DeRienzo, M.D.

But these kinds of visits that we're describing here, you need really special setup so that, for example, a pediatric pulmonologist can know what they need to know about, you know, a child who has a chronic condition, to say, no, you're good. You don't have to make the thousand mile round trip drive this month. That's sort of one part of an innovation.

Chris DeRienzo, M.D.

We're both here at this conference and innovation takes lots of forms. I know you all are early users of any number of AI enabled solutions. Where are you seeing an impact today, either for your physicians and APPs or for patients? Yeah.

David Newman, M.D.

So one of the best use cases of AI that I've seen in my career has been artificial intelligence for diabetes.

David Newman, M.D.

In my previous career, I treated a lot of type one diabetes, and patients had an insulin pump, which you can imagine is like a cell phone that they wear in their belt that talks to a sensor, which is a sticker on your skin that continuously checks your blood glucose. There is an artificial intelligence algorithm that tells you when you need more insulin and when you need less insulin, and it will do it for you.

Chris DeRienzo, M.D.

Wow.

David Newman, M.D.

It's the easy button. So that was really cool technology that came out several years ago, but the software was clunky, so they had to come to a major diabetes center to have it downloaded.

Chris DeRienzo, M.D.

Okay.

David Newman, M.D.

With our feedback, a lot of the companies have been able to bring this into the patient's home. So there's an app or a program on their home computer that they can use, and we can do all their work virtually.

David Newman, M.D.

So for a condition like type one diabetes, that is like a part time job.

Chris DeRienzo, M.D.

Yeah.

It is four hours a day. We have completely revolutionized it. So sometimes I see a patient once a year for their type one diabetes.

Chris DeRienzo, M.D.

Once a year?

David Newman, M.D.

Yeah. So it's partnering with the technology.

Tom Haederle

Next, a selection from "Being Okay with Not Being Okay: Destigmatizing Mental Health for Health Care Workers." Your host is Rebecca Chickey, senior director of behavioral health with AHA, talking with Corey Feist, co-founder of the Dr. Lorna Breen Heroes Foundation, and Tiffany Lyttle, director of cultural integration with Centra Health.

Rebecca Chickey

Of course, some of the listeners may not understand when you say removing the barriers to access for mental health care. They may think they're working in hospitals and health systems, so of course they have access to mental health care. Can you go a little deeper on that and describe some of those barriers that you're trying to remove and mitigate?

Corey Feist

Corey Feist

These mostly appear in the form of overly invasive and really inappropriate questions that clinicians are asked about whether they've ever been diagnosed or treated for mental illness, whether they've gone to therapy. And these are the same questions that my sister in law was terrified that she would have to respond to following a singular mental health episode. And so what we have been able to do at the Lorna Breen Foundation, through our All In Coalition and Caring for Caregivers, is to get tools to the front lines, whether it's a licensing board that's asking these questions, or hospitals who ask these questions most commonly in credentialing applications. And have them change those questions and then importantly, communicate

Corey Feist

the changes to the workforce. As I sit here with you today, there are 1.5 million health workers in the United States that are benefiting from the changes that we've made, which we hold out in the All in Well-Being First for Health Care Champions Challenge for licensing and credentialing badge that we give out to hospitals, as well as the licensing boards for doing that important work.

Rebecca Chickey

Thank you. I mean, I don't think many of the listeners may have realized that those questions where: have you ever, as you noted, have you ever been treated?

Corey Feist

And if I could just add one thing, because the American Hospital Association a couple of years ago published their first ever suicide prevention guide at least the first ever that I'm aware of. And in that suicide prevention guide, you identified three key drivers of suicide among health workers. And the first one that you all identified is this concern around the loss of license and credentials associated with the stigma for mental health care.

Corey Feist

So we know that for Laura, this wasn't just an isolated incident. And it's something that we hear from health workers all over the United States that they are fearful for these repercussions. And so we need to do something about it and address it, which is what we've done across the country. And we've made great strides.

Rebecca Chickey

Thanks for mentioning that. There's a variety of, drivers for this concern and this stigma. So thank you. I want to turn now towards another thing that you mentioned earlier, Corey, and that is working with states, working with large health systems in order to advance this in their own organizations and across a particular geography or a regional area.

Dave Newman, M.D.

And I'm going to call out specifically the Caring for Virginia Caregivers work. Can you describe that a little bit? And then we'll bring Tiffany into the conversation.

Corey Feist

Absolutely. Two seconds of background. When the president of the United States signed into law the Dr. Lorna Breen Health Care Provider Protection Act, it created two spheres of programs. And one of those sphere of programs was learning materials for health care leaders to address the root cause of burnout, as well as mental health challenges. That was called the Impact Well-Being guide, which was led by the CDC and our All in Coalition provided guidance on it.

Corey Feist

What we heard from the large health system across the country that was implementing the guide is they like to do this work together in a learning collaborative and they need some help. And so caring for Virginia's caregivers, caring for North Carolina's caregivers, caring for New Jersey's caregivers, and now caring for Wisconsin's caregivers are all efforts for us to take organizations through the phases of work from the Impact Wellbeing guide, and that begins by addressing these mental health barriers.

Corey Feist

It then moves towards education of ten person teams across health systems to address the issues at the root cause and become educated about the solutions. And then finally culminates in a learning collaborative focused on an operational initiative that drives burnout. And that's what we've done with Tiffany and the team in Virginia, now North Carolina, New Jersey and recently expanded into Wisconsin.

Rebecca Chickey

That's fantastic. Tiffany, I bet the question on many listeners minds is, why did Centra decide to join the work of All In, of Caring for Virginia Caregivers?

Tiffany Lyttle, R.N.

Tiffany Lyttle, R.N.

Tiffany Lyttle, R.N.

we went into a global pandemic. So we really need to find avenues that we could help support our health care team members. Not only address their own well-being so that they can carry that forward, but also not place calluses where we should have compassion because we were facing a compassion crisis, right? And when we tell people, you know, you have to be strong, you have to be confident and yes, we are all of those things, but we also have to deal with very messy, beautiful situations of life and humanity, and that can take a toll on us.

Tiffany Lyttle, R.N.

It can leave echoes and it can leave scars, but we are well-practiced in taking care of code situations. I mean, if you think about a code situation, we are practiced, rehearsed, we simulate it, we educate to it. We certify to it every single year. We have avenues and tools to help us be better at coding situations and situations of that nature.

Tiffany Lyttle, R.N.

What do we have in place for taking care of ourselves? Nothing. We don't teach that in school. We don't simulate that. We don't go over it. We don't get certified to it. I mean, now we are starting to see some certifications for health care organizations come through. But that was about the time that we found the Lorna Breen foundation.

Tiffany Lyttle, R.N.

And what perfect timing, you know, that we really needed to find a place for getting those tools, for helping support us in that work and removing the stigma. And I have to say, that's been one of the most important parts of engaging in our health care workforce as well-being is destigmatizing health care.

Tom Haederle

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