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Prioritizing health equity means keeping telehealth for mental health and addiction care

Posted on Nov 16, 2020 in Mental Health & Addiction Care, Scroll Images

John Boyd, PsyD, CEO for Mental Health & Addiction Care at Sutter Health

At Sutter Health, we see tremendous value in viewing mental health and addiction care through a “human health” lens for many reasons, including the fact that they are so intertwined with our experiences as human beings. Never has this been truer than now, as COVID-19 has caused massive disruption to our daily lives, leading to heightened anxiety, loneliness and uncertainty. Building meaningful relationships with the people who seek our care can provide a consistent, strong foundation for recovery. In 2020, safely achieving this much-needed sense of continuity and stability meant rapidly scaling up our telehealth service offerings across our network.

John Boyd, PsyD, CEO for Mental
Health & Addiction Care at Sutter Health

For many years, my healthcare colleagues and I have viewed telehealth as a potentially revolutionary way to remove barriers to access for more of the population, particularly in rural areas that face geographic isolation and provider shortages. Telehealth offers a range of benefits for these traditionally underserved communities, and at the outset of the COVID-19 pandemic, it became clear that it would be a critical component of our response.

Thanks to the decisive action of federal and state regulators, telehealth guidelines were eased, the state of California required reimbursement, and insurance providers revised reimbursement procedures to cover these vital video visits.

All of these changes enabled our integrated network to rapidly scale our telehealth services to meet our communities’ medical and behavioral healthcare needs. The numbers are powerful—a clear signal that we should make permanent the regulatory changes and flexibility granted during this unprecedented time.

We’ve seen this significant expansion of services in the past seven months (March through October, 2020):

● 90% of outpatient behavioral health visits shifted to virtual care

● More than 30,000 patients referred to Quartet, our partner for in-person, telepsychiatry and digital-care services

● Achieved a decrease in no-show rates for both established and new patients, thanks to new patient referrals via video: at 5%, which is down from 15-25%

● 4,440 telepsychiatry consults completed across 16 Sutter emergency departments and hospitals (In fact, 10,900 patients have benefited from telepsychiatry in 16 hospital emergency departments since the launch of this service in 2017.)

Regulatory changes made at the beginning of the pandemic are directly allowing us to better serve patients, and it’s worth noting which specific populations are benefitting. Even before stay-at-home orders began, people living in rural communities faced challenges in being able to consistently make in-person appointments due to factors like limited transportation, finding childcare and taking time off work. Prior to the pandemic, Medicare also required that a patient’s very first visit with a mental health provider be in-person to qualify for reimbursement. Thanks to the flexibility granted this year, new patients can conduct their first visits through telehealth. This small change made a huge difference for rural patients, elderly or disabled individuals, and anyone else whose schedule makes in-person visits difficult.

Providing high-quality care to people with mental health or addiction issues requires early intervention, long-term care and acute response in emergencies. And until we can eliminate the unfortunate stigma long associated with mental health and addiction care, in-home telehealth visits can also take the fear out of seeking care. By virtually meeting individuals in their own homes, we’re ensuring that they have consistent support no matter what’s going on in the outside world. We can reach those in need before they find themselves in a moment of crisis.

As we look to the future, we should be encouraged by this year’s successes with telehealth and inspired to build on these advancements to further reimagine mental health and addiction care. Virtual visits must remain a necessary and vital aspect of care. The evidence is overwhelming, and we know the demand for this care is becoming greater than ever as well. We have an opportunity to permanently alter the role of telehealth in our healthcare system, and we support the regulators, policymakers and legislators working to make that a reality.

COVID-19 may have been the impetus for the rapid acceleration of our telehealth services, but our commitment to human health and providing the care that our communities need should drive us to keep the momentum going.

Learn more about our telehealth offerings at Sutter Health, or make an appointment, here.

Diabetes Language Matters

Posted on Nov 13, 2020 in Quality Care, Scroll Images, Uncategorized

Diabetes care teams across Sutter Health are talking differently these days. That’s because the effect language has on patient care and patient outcomes can be profound. Endocrinologist Melissa Weinberg, M.D., affiliated with Sutter Pacific Medical Foundation and lead physician of Sutter’s Diabetes Clinical Improvement Community (DCIC), explains that as our U.S. healthcare system moves toward a more patient-centered approach, it’s necessary for providers to reexamine their words.

“When we started looking at diabetes care through a linguistic lens, we found unintended judgmental language across chart notes, patient education handouts, and even in our conversations. Beginning this November, to recognize American Diabetes Month, our teams are working on using person-first language whenever possible,” Weinberg says.

Talking the Talk

Person-first language puts a person before their diagnosis, describing what a person “has” rather than asserting what a person “is.”

“Despite even the best intentions, words can result in patients feeling like they are their diagnosis,” says Michelle Bradley, an exercise physiologist with Palo Alto Medical Foundation, who also serves on Sutter’s DCIC and is working to promote World Diabetes Day on November 14.

Referring to a patient as ‘diabetic’ can reinforce that as their identity, i.e. “I am diabetic.” Rather, Bradley says, it would be better to say “a person with diabetes” which puts the patient first and shows compassionate and encouraging language that may help enhance their outcomes and experience.

Stigma around certain language can impact care. According to two different studies (here and here), possibly because of perceived judgment from healthcare professionals, people with diabetes sometimes altered or underreported blood glucose levels or omitted information during provider visits.

Neutral Language Helps Remove Stigma

While a language movement in healthcare isn’t a new concept, there is greater emphasis to use language that empowers and supports. Here are four examples of phrases that Sutter diabetes care teams are working to incorporate in patient communications:

  • Monitoring blood sugar/glucose” instead of “Testing blood sugar/glucose”
  • A person who…” (takes medication 3/7 days, unable to access supplies, continues to eat ice cream before bed) instead of “Non-compliant, non-adherent, unwilling”
  • Managing, Working towards…” instead of “controlled, uncontrolled, sub-optimal”
  • Use “Guidelines or Recommendations are…” instead of “You should, have to, need to, must”

“The way we speak affects the way we think and ultimately how patients feel,” says Weinberg.

More Than Their Diagnosis

Sutter Health is committed to improving healthcare outcomes for all, which includes communication with and about patients.

“When we change our language, we change the perception. Simple wording changes can go a long way in helping to build and strengthen patient relationships,” says Bradley.

Championing Mental Wellness for Those Who Champion Our Freedom

Posted on Nov 11, 2020 in Mental Health & Addiction Care, Scroll Images

A blog by James Conforti, COO Sutter Health, and John Boyd, PsyD, CEO Sutter Health Mental Health & Addiction Care

On Veterans Day, we honor all of the incredible people, those living and those who are not, for their service to our country. While we should honor these men and women every day, today we pay tribute to their commitments and thank their families, too. We also acknowledge their sacrifices—many that came at a great price.

For veterans and their families, their sacrifices can often result in increased mental health challenges, addiction and suicide. The National Council for Behavioral Health notes that less than half of returning veterans in need of mental health treatment receive needed support and care. In addition, the Council reports 30% of active duty and reserve military personnel deployed in Iraq and Afghanistan—about 730,000 men and women—have a mental health condition such as post-traumatic stress disorder (PTSD) or major depression that requires treatment. The Veterans Administration reports that 22 veterans die by suicide every day. And the impact extends beyond veterans to their families, with longer deployment lengths associated with more emotional challenges among military children and more mental health challenges among partners.

We know this first-hand.

James served in the U.S. Army for several years as did his father and his brother. Combined, they have almost 50 years of service. He remains connected to his comrades to this day in a forever cemented bond and is connected to many more through his healthcare role. Whether assisting those who support our homeless veterans or helping address the mental health challenges they face, he sees firsthand the lasting impact of their service to our great country. Many veterans transition into civilian life smoothly. Unfortunately, there are many more who struggle not only with the transition out of military service but the lasting effects of their service.

John has worked with veterans in clinical settings. He also has the firsthand experience of losing his cousin, Wes, who served three tours of duty in the Marines in Iran and Afghanistan. The loss did not happen while on duty, but after Wes’ attempts to return back to civilian life.

Prior to serving, Wes was an ambitious young man who was already a homeowner. On tour, he saw many heart-wrenching scenes, including witnessing the death of a fellow Marine. Following his time in the military, he was met with little formal support to transition back into civilian life. With limited access to mental health care and addiction prevention, he became addicted to opioids. Eventually, the addiction progressed to heroin. Wes lived with John and his partner for a significant period of time. He was in and out of treatment centers, all private, due to his challenges accessing veterans’ services. Despite much love, energy and expense, Wes and his family paid the ultimate price when his addiction led to his death at age 32.

While some steps are improving support to veterans, there is so much more that must be done. We must continue to advocate for increased mental health support, including addiction care, intervention and suicide-prevention services. We must be mindful when we thank our veterans for their service that many carry a lasting moral injury from the actions they had to take while on tour or in war. We must all come together—healthcare experts, business leaders, faith communities, veterans’ advocates, families—to be fully present for veterans as they return to civilian life. That means genuinely and warmly welcoming veterans back, giving them the care and support they deserve, and opening doors to social connection and employment.

There is no shame in the pursuit of mental wellness for these champions of our freedom—or for any one of us. Mental health is human health, after all, and we are all human.

Please join us in pausing today to honor our veterans—whether they are known or unknown to you. We hope that, when you do, you think about the spirit of their sacrifices and remember their shared commitment to peace. We hope you will also consider giving back to those who served us all.

Resources for Veterans
US Department of Veterans Affairs has a hotline at 1-855-948-2311.
National Suicide Prevention Lifeline at 1-800-273-8255. Or, you can connect with a trained crisis counselor through the Crisis Text Line by texting 741741.
Cohen Veterans Network, a Veterans Crisis Line is available at 1-800-273-8255, Press 1.
PsychArmor, online training to support military service members, veterans and their families.

Noble Mission: Air Force Veteran Makes Landing into Healthcare Just in Time for COVID

Posted on Nov 11, 2020 in Integrated Network, Scroll Images

Bristol Falls, a swimming hole in Ayers’ hometown

As a kid growing up in Bristol, Vermont, Lee Ayers already had a strong love for his country building in his tiny chest. The American Dream evoked feelings of opportunity and pride. Over time, those feelings evolved into a desire to do something bigger beyond his small hometown. While others were more focused on college, he wanted to broaden his horizons in other ways. Traveling the world, experiencing other cultures and serving his country would be his education.

Ayers met with recruiters from a few branches of the military, but ultimately felt that the Air Force was the best fit for him. It has a structure and culture that spoke to him most. He ventured off to basic training a month after his 18th birthday.

Life Lessons

In his 24 years of military service, Ayers spent all of his time in supply chain operations—a field he knew would benefit him well when he transitioned to civilian life. He had a hand in sending nuclear supplies, fuel, aircraft and vehicle parts across the globe. He was stationed in Alaska, Florida, Georgia, Illinois, Texas and Washington. His international destinations included England, Germany, Iraq, Kuwait and South Korea. The places, the cultures, the missions all combined into unbelievable teachings. And one of the most profound lessons he learned was one in trust.

As part of a combat logistics unit, Ayers and his team could get the call day or night to fly anywhere in the world. On one occasion, he and his team were summoned to Saudi Arabia to tear down and clean up a special operations camp. His group of seven were dropped in the middle of the desert—one small airstrip in a sea of sand. The unit was there 45 days, disassembling the camp with the goal of leaving the desert as it was before special operations’ arrival. As their own supplies dwindled and the last of the gear was packed, Ayers realized that the last remaining item left with the team was faith. Faith that their work paid off. Faith that the pilot had their coordinates and would return for them. And as the lights from the plane slowly descended from the night sky and chirped its tires on that little runway, Ayers trust was affirmed.

Trust, communication, commitment, camaraderie—all traits and features of the military life that Ayers loved. When the time came for him to make the move to civilian life, he scoured and studied for opportunities that mirrored what he had experienced during his service.

“The military attracts a certain type a person who wants to serve and give back, which is not unlike healthcare,” said Ayers. “I hadn’t thought about healthcare originally, but the experience completely translated. You are saving lives in the military. I can do that again now in a different way.”

Enemy #1: COVID-19

Little did Ayers know how much of that was true. He joined Sutter about three months prior of COVID-19 arriving stateside. His original and current role is overseeing the supply chain operations for all affiliates across the network. His responsibility evolved into playing a key role within Sutter Health’s Emergency Management System, or SHEMS, which helps provide a coordinated response across the network in times of disaster. Ayers remarked how familiar SHEMS felt to military command centers he had been in the past, including one where he served as an Air Force Supply Chain subject matter expert aiding the global distribution of materials and supplies during the Ebola crisis.

Thanks to the research, relationships and creativity of Ayers and his supply chain teams, Sutter secured the necessary PPE to help protect patient and employees. While undoubtedly there were challenges along the way, the team remained focused on solutions.

“These are no fail missions,” he said, drawing parallels again from the military to healthcare. “PPE is one of the enemy’s weaknesses.”

Much remains to be seen with the pandemic and now through the flu season, but Ayers remains at the ready. Part of that comes from the security he feels in his experience and his choice to make the transition into healthcare.

Lee Ayers

“I’m super proud of my 24 years of service to our country,” he said. “And I feel fortunate every day to work at Sutter. I know it was meant to be that I’m here. I am so impressed with Sutter’s integrated network and the heroes I work with every day. Sutter is an organization that’s connected, strong, competent and completely aligned with its mission to care for people and save lives.”

Sutter Salutes Military Support Efforts

Sutter Health’s appreciation for military service members goes beyond the more than 1,300 veterans and reservists who work within the not-for-profit network. Sutter Health supports a number of community organizations that help veterans, today and throughout the year. A couple of examples include the Fisher House Foundation, which provides lodging for families of military members undergoing hospital treatment for a combat injury, illness or disease, and the American Red Cross’s Reconnection Workshops, which are no-cost, confidential workshops to help returning service members and veterans readjust to life within their family, community and workplace.

“We’re proud and grateful for the service and sacrifice of our military members, and for the veterans and reservists who are helping care for our communities through our not-for-profit mission,” said Sarah Krevans, president and CEO of Sutter Health. “We meet our mission through teamwork, and our efforts have made an even greater impact during this unprecedented time.”

New East Bay Clinic Places Breast Cancer Patients at the Center of Care

Posted on Nov 10, 2020 in Cancer Care, Scroll Images

Telehealth Increases Convenience, Allows Time to Get Questions Answered

Michelle and Joe Goldsmith

Like many women who receive a diagnosis of breast cancer, Michelle Goldsmith, was overwhelmed when her biopsy showed breast cancer. She had so many questions about her diagnosis and knew that difficult decisions lay ahead. She knew she needed to make a battery of appointments and ultimately visit oncologists and other specialists located in different locations.

As Goldsmith was beginning to make plans, a friend told her about the Multidisciplinary Breast Cancer Clinic that had just been launched by breast cancer specialists at Sutter East Bay Medical Foundation (SEBMF). Goldsmith made one phone call to a nurse navigator, and that set off a process that she now calls “life changing.”

The nurse navigator helped her plan the various tests and scans. The novel part of the process is that, once Goldsmith had the appropriate scans, all the oncologists and specialists met together in one pre-clinic conference call to go over her history and records to determine her best treatment for a cure.

Immediately after the call, Goldsmith was able to schedule a comprehensive team consultation with her breast surgeon in-person as well as virtual consultations with her medical oncologist and radiation oncologist.

After the two-and-a-half-hour appointment, Goldsmith left the office having met with her entire treatment team and with a one-page summary detailing her diagnosis, stage, and course of treatment. And because of the convenience of telemedicine video visits, Goldsmith could meet with all the specialists in one office, rather than seeing each one at a different time in a different location.

 “It made all the difference in the world,” Goldsmith said of the multidisciplinary approach. “As a patient you feel so supported. It made me feel good that they had all agreed on a course of action, it wasn’t just one person’s opinion. And then you could see the oncologists face to face, and ask them as many questions as you wanted.”

Eileen Consorti, M.D. and
Rita Kwan-Feinberg, M.D.

Rita Kwan-Feinberg, M.D., and Eileen Consorti, M.D., breast cancer surgeons with SEBMF, started the program that is a similar design to multidisciplinary programs at other cancer centers around the country and well-documented in medical literature. The clinic began in mid-August and since then about 25 women – all with new breast cancer diagnosis – have been seen in the clinic based in Oakland.

“Part of it is looking at a way to have a much more streamlined approach for the patient,” explains Dr. Kwan-Feinberg. “With breast cancer, the treatment is always multidisciplinary so it makes sense for the patient to have one visit that is multidisciplinary and involves a team approach. From the patient’s perspective, I wanted each patient to have the best experience that would reduce the anxiety and fear that comes with a breast cancer diagnosis by answering all questions and having a treatment plan in one day.”

Dr. Consorti says a benefit is that the clinic helps coordinate the communication between different oncologists and specialists, and it is a convenient way for the patient to be able to speak to members of the team in one place, at the same time.

“Everyone is communicating in one fell swoop and is on the same page,” Dr. Consorti said, referring to the pre-clinic conference. “For the patient, it lays out their plan so they know what their care will entail.”

The two surgeons say it was a perfect time to start a patient-friendly, multidisciplinary program in part because of Sutter Health’s increasing capabilities in telehealth. After the patient meets with a breast cancer surgeon in person, an iPad is rolled into the office, and the patient meets via video visit with a medical oncologist and a radiation oncologist who are in other locations. And the program can be managed at a time when the number of in-person, office visits have been spread out to reduce possible exposure to COVID-19.

“The patient doesn’t go from office to office on different days so it minimizes exposure for patients and staff, and we have implemented deep cleaning procedures in the clinic,” Dr. Kwan-Feinberg said.

The pre-clinic virtual meetings are usually about 45 minutes long and include the breast surgeon, the medical oncologist, the radiation oncologist, the nurse navigator, the medical assistants and the surgery scheduler. Depending on the case, other clinicians are involved such as the pathologist, a geneticist and a lymphedema prevention specialist.

In addition to coming up with the best medical treatment, the plan that is given to the patient can be personalized, taking into account any relevant social issues or personal preferences. For instance, if a woman has children, there may be a list of child care resources. And, Dr. Kwan-Feinberg recalls that in one case the team learned that a patient was interested in herbal medicine so they included a referral in her plan to a physician who specializes in integrative or holistic treatments.

“My patients have been saying, ‘this is so great, I have a team taking care of me,’ ” said Dr. Kwan-Feinberg.

CAL FIRE Fundraiser Benefits SPMF Cancer Support Services

Posted on Nov 9, 2020 in Cancer Care, Scroll Images

Current and former employees of the California Department of Forestry and Fire Protection’s Sonoma-Lake-Napa Unit, known as CAL FIRE, recently donated $20,000 to Sutter Pacific Medical Foundation’s (SPMF) Cancer Support Services program.

Their donation was made possible thanks to monies raised from the Unit’s Forestry Crab Feed. This annual event invites CAL FIRE employees and their family and friends to eat in the name of fundraising.

“Our tradition with this dinner is to help raise money for those in our community in need,” said Ben Nicholls, CAL FIRE Division Chief. “We have retired members battling cancer, so we’ve heard firsthand the impact these counseling groups and other services have on these individuals. We wanted to give this year’s donation in their names. This $20,000 also represents the largest one-time contribution given in our 60-year history of hosting the Forestry Crab Feed.”

Sutter Health’s approach to cancer care combines conventional medical treatments with evidence-based supportive services and integrative practices to strengthen and enhance a patient’s overall well-being.

“Donations like this mean everything,” said Cindi Cantril, RN, MPH, OCN, CBCN, regional director of cancer support services and patient navigation for Sutter Bay Medical Foundation. “We are proud that all the money that’s given, 100 percent of it, impacts patients directly.”

Sutter affiliates provide care for nearly a third of all cancers in Sonoma County.

Cancer care for the mind, body & soul

Cancer Support Services offers a wide range of supportive services to help patients and their families address the many physical, psychological and emotional challenges that come with a cancer diagnosis through navigation, support groups, peer support, and patient education.

SPMF’s Cancer Support Services program helps improve the long-term health of patients by offering services that:

  • improve patients’ knowledge of their diagnosis and their ability to practice self-care
  • reduce the stress, fear, and anxiety of both patients and their caregivers
  • improve adherence to individualized treatment plans and continuing survivorship care
  • educate them about local and national resources on a wide range of topics (e.g., finances, nutrition, stress reduction, exercise, and recovery)

Despite the challenges of the COVID-19 pandemic, early cancer detection is still the key to recovery.

Medical experts agree that if you had an appointment postponed or canceled due to COVID-19, such as an annual mammogram, now is the time to reschedule it.

For more information about cancer care at Sutter Health, visit here.