January 26, 2022 by Tammy Howell
North Country HealthCare’s CEO was recently featured on the Arizona Physician Podcast.
In the episode, Dr. Anne Newland discussed telehealth, rural communities, and the impact of COVID-19 in northern Arizona.
Read on below for the full transcript of the interview!
North Country HealthCare CEO, Dr. Anne Newland was featured on the Arizona Physician Podcast published earlier this month. In the episode she talked about how COVID has affected communities in northern Arizona, as well as the benefits and drawbacks of telemedicine. She also provided insights on how primary care doctors can be an important pillar in the communities where they live and work.
Read on below for a complete transcript of the interview with Dr. Newland, hosted by Taylor Pomeranz, Masters of Public Health 2022 Candidate. The podcast comes from the Maricopa County Medical Society.
Pomeranz: Welcome to the podcast, Dr. Newland.
Newland: Thanks so much Taylor!
Pomeranz: We’ll jump right in. The organization provides multiple services: family medicine, behavioral health services, dental care and more. I see that North Country serves 12 communities in northern Arizona. Being from rural Arizona myself, I have seen the challenges rural communities face with healthcare. As a corporation do you face any challenges with any of your communities that you serve?
Newland: Well the biggest challenge we always have is recruiting and retaining highly qualified staff. I’m always so impressed with the level of commitment that our team members have to rural medicine and to the mission of North Country HealthCare to provide primary healthcare services to populations that need it the most. But really it comes down to recruitment and retaining good professionals.
Pomeranz: And does that impact the services that are provided at all in these rural communities?
Newland: I feel fortunate that we’re able to provide a broad range of services in our clinics. But some clinics are able to offer more than others. For example, we were able to open a dental clinic in the Show Low area just at the end of August, and it took a number of different things coming together to be able to do that. So first we had a capital grant from the federal government that gave us some of the money that we needed to put in a dental clinic in the clinic we have there. And the community is of a large enough size that it’s not so hard to recruit a highly-qualified dentist.
Some of our outreach programs – we hold grants for things like the Well Woman HealthCheck program, which is a pass-through grant from CDC that helps us provide screenings for cervical and breast cancer for low-income women – and one of our challenges in providing that service is actually hiring care coordinators and people to administer parts of the grant throughout northern Arizona. It’s easy to focus sometimes on hiring medical and dental professionals – people like dentists, physicians, nurse practitioners – but it’s also people who can be care coordinators and run various grant programs. Everything from breast and cervical cancer screening to our HIV/AIDS programs, other early childhood intervention programs, all sorts of things.
Pomeranz: Very well rounded. I know we’re in this COVID pandemic. Has the COVID-19 pandemic affected rural communities for you?
Newland: Absolutely. Here in Arizona most of us are familiar with how devastating COVID-19 has been in Native communities, particularly on the Navajo Reservation. That’s had strong effects on our community partners and on our staff, because they’ve personally felt the effects of disease. And in the counties we serve there’s just a wide range of impact from COVID-19. Our corporate offices are based in Flagstaff in Coconino Country, but we have three clinics in Mohave County. We also have clinics in Navajo and Apache Counties. Each of these sites has a little different niche, and the politics in the area are different.
In some of our communities there’s been more vaccine hesitancy, and that’s been challenging to help encourage people to follow precautions, get the vaccine. When I think of the disease impacts of COVID-19, one of the things that happens in small communities, if somebody has been severely affected, there may not be those support services. Things like occupational therapy, physical therapy, or speech therapy available to help them recover. We had a very sad outcome of COVID-19 with one of our staff members and she’s going to have to relocate to a much larger community to help her recover from the disease. That’s just a small example. In smaller communities when people die or are impacted by the disease, the ripple effects of that are really profound. Some of our communities have been really shaken by prominent community members who have died – by the morbidity and the mortality of COVID-19. It’s really shaken a lot of folks.
Pomeranz: I bet. With your more rural areas, compared to being in Flagstaff, can you see a lot of them coming into Flagstaff to get that care?
Newland: Some come into Flagstaff, but depending on the community, it may be more convenient to go down to Phoenix or even to Las Vegas, depending on what their insurance is. For people living in Mohave County, if they’re on Medicare, it makes more sense a lot of times if you’re in Kingman or Bullhead to go to Las Vegas for some specialty services. If you’re in Lake Havasu it’s actually easier to go down to Phoenix than to come to Flagstaff. Same for Payson; it’s easier to go down to Phoenix than to come to Flagstaff. Although certainly we do see a number of people who come to Flagstaff for services.
Pomeranz: What are some ways that health disparities for rural and underserved communities can be reduced?
Newland: That’s a really big, complicated questions. I’d say the very first part of helping reduce disparities is access to care. You’ve got to have a way for folks to get in to see their primary care provider, to get age-appropriate health screenings. They also need to be able to get specialty care when that’s what is indicated, dental services, things like that. First and foremost, it’s access to care.
One of the things that I think sets North Country apart, and it’s really because we’re a community health center, is that, not only do we have mechanisms to keep the doors open and make sure that people have access to care, but we also have a higher level of reporting requirements than most other practices. As a community health center we have to file a uniform data system report each year. It looks on the demographics of the people we serve, our financials, but most importantly it looks at standards of care, a lot of them that are covered in Healthy People 2030. Things like cervical cancer screenings, breast cancer screenings, childhood immunizations, adult immunizations, the birth weight of infants. It’s actually kind of overwhelming, all the data we look at, but we try to have programs that target improving those outcomes. Areas that we’re focusing on right now are trying to improve our colorectal cancer screening rates. Especially during the pandemic, that’s something that slid off as people deferred care. Things like breast and cervical cancer screenings and childhood immunizations, those are all important parts of the picture.
Pomeranz: Do you think telemedicine works effectively in improving rural health services?
Newland: The short answer is yes. The long answer is yes and we need to be clear about the ways that telehealth improves services in rural America. We leverage telehealth in a number of different ways. There’s obviously patient encounters, direct patient services that telehealth can facilitate. But in many of the communities we serve, my patients tell us that they get their best Wi-Fi access in our parking lot because they don’t have good broadband access at home. In rural communities that broadband is an essential part of that.
Even though this can help have that person-to-person care, one of the ways that we leverage different types of expertise within North Country is through telehealth services, and this is even before the pandemic. For example, for HIV and AIDS-related services, we have a handful of providers who have expertise in this area and they would hold telehealth encounters. You might have somebody based in Flagstaff, but then they’re able to have encounters with people in Winslow, in Show Low, in Lake Havasu City, all in the same afternoon, without having to drive. And I think the way that services like that work best is when you can combine those telehealth visits with in-person visits. Because oftentimes there’s really no substitute for being able to sit down with a patient, talk to them face to face, do a physical exam. Those are all really important parts of care but telehealth is a great augmenter to those in-person clinical services.
The other way we’ve utilized telehealth is to provide cohorts of care. For example in treatment for hepatitis C, back before some of the newer treatments were available, we collaborated with Banner to have cohorts of patients going through ribavirin treatment, and that way local primary care providers could oversee the care but do it in conjunction with experts, hepatologists and nurse practitioners who specialize in hepatology so that we could better manage complications in the field, and the patients didn’t have to travel such a long distance to start their care.
We’ve also leveraged telehealth to increase education and familiarity for our providers with different specialty topics. One good example here is in pain management. We’ve worked with Project ECHO out of the University of New Mexico and have been able to have multidisciplinary case reviews. So it’s professionals talking to professionals, but then that directly impacts the care of our patients because we increase the knowledge base of our providers and can actually review individual cases and get expert opinion that we’re able to provide in rural Arizona.
Pomeranz: That’s amazing! So there’s a lot of pros. Do you see any disadvantages when it comes to telemedicine in rural areas besides getting that broadband, that they have to go to a central area? Anything else?
Newland: I think sometimes people think, Oh if we just get the broadband in place, that will provide access. And it does provide a type of access. But there’s really no substitute for being able to be in person and on the ground. For people who are providing care in small communities, part of providing care is also understanding the larger community that the patient resides in and knowing the resources that are available. And knowing how you can leverage other relationships, whether it’s at the city level, the county level, just a regional level, to address things like good water, safe schools, making sure there’s a rec center where people can gather. Those are all parts of health. I think if we only focus on telehealth, we miss that important glue that a clinician in a community provides.
Pomeranz: I love that answer, thank you. Lastly what services or resources could medical associations or governments provide in order to help boost patient care in northern Arizona?
Newland: One of the most important things is just making sure that community members and clinicians who provide services in northern Arizona are at the table when policy decisions are being discussed. Arizona is an interesting state in that so much of the population is concentrated in the lower third of the state and in the northern two-thirds of the state there’s huge distances between larger economic centers, sites where care is delivered, and sometimes its easy to forget that we’re here. I think it’s super, super important to make sure there’s a multitude of voices at the table so that we can craft wiser policies.
Pomeranz: I want to thank Dr. Newland and North Country HealthCare for their work in northern Arizona and their commitment of excellence in rural communities. If you’re interested in learning more about North Country HealthCare and the services they provide, please visit their website, northcountryhealthcare.org or contact 928-522-9400.
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