Building a Regional Healthcare Presence and Partnerships, with Krista Postai and Jason Wesco

Organizations and resources mentioned in this episode:

• Community Health Center of Southeast Kansas
  • Residencies, CHC/SEK
  • Inspire Health Foundation, CHC/SEK
• Health Center Program New Access Point Grants, Bureau of Primary Health Care, Health Resources and Services Administration (HRSA)
• Thrive Allen County
• 'No Mercy': It Is What It Is – Chapter 1, Where it Hurts podcast, Season One
• Wesley House
• Bryant Student Health Center, Pittsburgh State University
• 340B Drug Pricing Program, HRSA

Transcript

Andrew Nelson: Welcome to Exploring Rural Health, a podcast from the Rural Health Information Hub. My name is Andrew Nelson. In this podcast, we'll be talking with a variety of experts about providing rural healthcare, problems they've encountered, and ways in which those problems can be solved. Today I am speaking with Krista Postai, CEO of Community Health Center of Southeast Kansas, and Jason Wesco, who is the President and Chief Strategy Officer of the community health center. Thank you both for joining us today.

Krista Postai: Thank you for having us.

Jason Wesco: Thank you.

Andrew Nelson: Over the last 20 years or so, you've been able to develop a small Federally Qualified Health Center into a larger organization with locations in multiple communities that help to address transportation, housing, and health-related social needs. Can you walk us through that process?

Krista Postai: I'll start. I'll let Jason finish because I wrote the original grant application 22 years ago, and we did so because we were part of a department of a small PPS [Prospective Payment System] hospital who could not afford to keep us going. We were primarily a safety net, a clinic in a double-wide trailer behind a daycare center. And our focus was on children ready to learn, physicals, and immunizations. And at $5 a visit, we weren't making any money. So, the hospital said, "We're going to close." So, I wrote an application to be a Federally Qualified Health Center, and that was the beginning. We started with a trailer, a closet, and an outreach mission doing dental work, and a pediatrician's office in a former dentist's office. So, we started out pretty humbly, and then we almost closed. Our first year was very stressful.

We spent all the money we had from the grant in the first six months, so we learned to diversify, and we had to do a lot of outreach. So we went to schools, we went to nursing homes. We just kind of started going out, which is still our culture today. We then applied for new federal grant money, New Access Points, and the rest is history. Went into Cherokee County, took over a former hospital clinic, and again, we're up to about 60 sites throughout a 7,000 square mile region of southeast Kansas and northeast Oklahoma. And then Jason was here for the rest of the growth. So, Jason, if you want to explain how we went from point A to point Z.

Jason Wesco: Yeah. We live in a part of Kansas that's not necessarily what people think of when they think of Kansas. Clearly, [when] we think Kansas, we think rural, but we're much more like a culture of Appalachia or the Ozarks.

It was coal mining, heavy metal mining, that sort of culture. And so, we live in an area where needs are incredibly high. Where we are here in Pittsburgh, the childhood poverty rate's 35%. So, it's a different kind of environment. And so, as we started to grow services, what we realized is our communities needed everything. For people to be healthy, you can't just do that in an exam room. And so, as Krista mentioned, we partnered with school systems, jails, long-term care facilities, universities, a lot of partnership to get connected, to get where people are; Head Start, great partner of ours. And then as we grew, we're now the 60th largest community health center in the United States, which is pretty incredible, in 21 years. But as we grew, we found other partners, like large health systems that were moving out of rural Kansas, and we were able to work with them and transition.

I think we've transitioned 11 or 12 practices now to us to be able to preserve access. So, in a lot of ways, we're different [from] some health centers because we take care of everyone in our community. It's everyone, people with commercial insurance, people that are uninsured. And so, it's been a very urgent growth for us because we live in small communities, and the people we take care of are our neighbors and our kids' friends and our parents. So, when you look at the growth, a lot of it has been because if we didn't do it, nobody was going to do it. And these small communities — we have clinics in towns as small as 800 people that are very busy, that maybe on paper for large systems don't make sense — but in terms of preserving rural communities and creating good jobs, were very urgent for us. Frankly, we're really good at what we do. We're really committed to patient care, but I think we look around and say, "If we don't do it, nobody's going to do it." So, as we transitioned five or six practices from Mercy a few years ago, we grew by 35% in one year.

Krista Postai: We also go only where we're invited. And the invitations have been almost weekly, especially most recently, schools are really in need of behavioral health services since COVID. We can't grow fast enough. [That] has been our challenge is keeping up with the requests to do more.

Andrew Nelson: Of course, different communities might have different needs. What would you say are some of the greatest previously unmet needs of the people that you're serving?

Krista Postai: I think access to care and affordable care is what we're finding, when we open in a new community. And that's why New Access Point grant funding from the federal government's so valuable. The first 70% of the people that show up have no coverage. Kansas has not expanded Medicaid. So, we have a large percentage of our population that doesn't have access to healthcare. And so, the affordability has been very important, for rural communities especially. Jason will talk about how many clinics we have that are open seven days a week from 7 to 7. So, a lot of folks do commute out to a bigger city or someplace else for a job, and they don't have the access they would otherwise. So being open and being affordable are probably our two greatest strengths, and preserving the healthcare that people established originally as doctors retire, and the average age around here is pretty elderly, and to find a private provider; they're not being replaced. So that is, we are able to recruit young doctors to serve the community and perpetuate the care that they were accustomed to. That's particularly true in Iola. Two physicians who started the practice transitioned it over to us, and now we have four physicians in that practice. So, we were able to double it and able to let the existing physicians retire and enjoy life.

Jason Wesco: And I think we're really appreciating that it's way too hard to be an independent physician in the world; credentialing, billing, all that stuff. So, we serve a really important role in that. We are a regional system. We're locally controlled; patients lead our board of directors, but we're not a great big system that has a headquarters in a major metropolitan area that really doesn't understand the difference between rural and urban or suburban healthcare. It's different. It's a different recruit. It's a different kind of person who wants to work in that environment. And so, we offer some of the benefits of a system, right? We can be efficient, all those things. We can have training and provider trainers and electronic health record trainers. We can cover to stay open, but we're not a massive system that whose goal is to get more expensive care and maybe pull that care out of a rural area and view it as just as a "feeder."

Our goal is to keep people healthy where they are. And we're not a hospital, and not blaming a hospital, I'm just saying we don't have to feed that monster. We don't have to feed diagnostic imaging and specialty care and all of that. Because what we appreciate is, the future of rural America isn't going to be more healthcare. There won't be more healthcare available. So, we have to do more around prevention, health education, getting people to appreciate what they can do to hopefully not need as much healthcare. Since 1920, we've seen consistent population loss in the 11 counties in Kansas that we serve. There are now about 125,000 fewer people in those 11 counties. So, we are all coming to grips with this reality that there's not going to be more in the future. So how can we be smart, preserve access to care, and do it in a cost effective and real high-quality manner. You know, and I think we're the perfect fit for — health centers are the perfect fit for the future of rural healthcare.

Andrew Nelson: Krista, you mentioned your facility in Iola, and how you were able to ensure that people living in that area continued to have access to healthcare. Can you tell me a little bit more about that process?

Krista Postai: We were approached by a private practice, two physicians who had invested in the community and were aging and were concerned that their retirement would leave a huge gap. So, we worked with them originally to help manage their practice. And then with their agreement, transitioned part of the practice over to us; the two founding physicians came with us, and the two other physicians went another direction. It was a private practice, and they were challenged by all the paperwork, the electronic records, all the things that doctors hate to do. We offered them the opportunity just to be the doctor. And they liked that. Dr. Wolf and Dr. Singer — Dr. Singer has since retired, Dr. Wolf is on a retirement track, but they have helped us recruit the next generation, which is what they wanted. They wanted to perpetuate family practice the way they approached it, which was very, they know everyone, everyone knows them. And that's the kind of practice they wanted to preserve. And we were able to do that for them. We were able to build a new building with USDA [U.S. Department of Agriculture] funds, which was much more efficient than the one they had. And so, it was a win-win for everybody.

Andrew Nelson: Over the last 20 years, as you've been expanding and increasing your outreach to these communities, I'm curious about how often you moved into an existing facility or building versus building a brand new one.

Jason Wesco: Yeah. It often starts in a community with existing resources. So, for instance, in Iola, a great story. There's an organization there called Thrive Allen County. That county won the Robert Wood Johnson Culture of Health Prize a few years ago. In 2006 and 2007, they did a community needs assessment, recognized they needed a dental clinic, came and talked to us; we're about an hour and 10 minutes away, and they had a facility, and we raised the money, and we built a dental clinic within their facility. So it was a dental clinic, a medical clinic, and a pharmacy. And over time, as Krista discussed, that practice changed, and internally they were kind of going their own separate ways. So, we assumed some of the medical practice. And then in 2018, acquired land, built a whole separate clinic that brought medical, dental, behavioral health, pharmacy, all of it together in a separate building. So, it's a good question for us. It often happens that we move into something there. Because as you could appreciate in a rural community, it's not often smart to just build something ground-up when you have some existing community resources. But in some cases, it does make sense to either renovate or build ground-up.

Krista Postai: Mound City is another good example. That's in Linn County, which is sparsely populated. They're so close to Kansas City, though, the urban area is oozing down into them. But this was a hospital district and a county that never had a hospital. And they built their own clinic. The community built it. But a larger medical center wanted to divest; they wanted out because it was not economical. And so, we did move into Mound City, and Dr. Allen still works for us. The building's still locally owned, and they're very proud of it; local pharmacy... Every scenario has been different in how we've played it out.

We have built entirely new buildings; Fort Scott, Kansas, which has made national news. When the Mercy Health System closed their hospital, there was actually a podcast called "No Mercy." So, when that hospital closed, we were invited in. We did go into the existing hospital, which was closed; [it was a] huge building. And then we, just a couple years ago, renovated an entire grocery store and have moved in with everything in one stop, one location; very efficient. So that was a completely different scenario. We did that with our own funds. And that community just lost its emergency room. Ascension was running that for a couple years, and supposedly it's going to be reopening soon by another hospital system.

But we're compatible with all of them. We don't owe any one hospital system our allegiance. So, we work with everybody well. So, every scenario has been different. They've all required some cleanup.

Andrew Nelson: I'm sure in those cases, it was very helpful that you didn't have to build a brand-new building.

Krista Postai: It was, and we are very appreciative of the capital funding that HRSA's provided over the years. It's not enough, but it's gotten us this far.

Some of the more rural health clinics when we absorbed them, because of their corporate structure, weren't eligible. So, there was a need to look at what they had. But in all cases, [when] we absorbed other corporations' Rural Health Clinics, we were able to make them more financially viable because of our reimbursement model.

Andrew Nelson: Are there any certain locations that you have that offer unique services to their communities?

Jason Wesco: Yeah. We started with one walk-in care here in Pittsburgh about seven or eight years ago. And it's open 12 hours a day, seven days a week. And that was so popular that we now have 11 different locations with walk-in care, and we found that that's really a great entry point for people, especially young people, into primary care. So that makes us a little bit unique. We also have advanced diagnostic imaging in a couple of communities. We have CT and 3D mammography, DXA [dual-energy X-ray absorptiometry]. That's a little bit different, based on community need.

And then there are just some services that we offer that are a little bit different. For instance, here in Pittsburgh for the last couple of years, we partnered with a local Methodist church to support an outreach mission called Wesley House. And that was really intended to be a way to deliver food to people in the community, and for the last two years has been an overnight shelter for 90 days.

So, every one of our clinics is a little bit different. I mean, there's always the core of medical care; generally speaking, walk-in. But beyond that, some communities, we have transportation, some communities, we have physical therapy. It really depends on resources and community needs. So pretty diverse service offering[s]. But every clinic is kind of its own place.

Krista Postai: Coffeeville is a good example of when we were gifted a clinic, very large clinic. We went from a former DCF [Department of Children and Families] office which needed a lot of love to a very beautiful million-dollar clinic. The local physician was a surgeon. He had developed quite an occupational health business. He actually sewed a thumb on someone who walked into his clinic. You don't get that a lot. And so, that location is continuing to be a focal point for occupational health and a community with a lot of industry, a big oil refinery that does have a lot of a need. So, we've adapted things to what the community wanted and needed. In Pittsburgh, we do inpatient care, which is unusual for Federally Qualified Health Centers because we grew out of a hospital.

Our medical staff pretty much takes care of all the newborns, and we deliver about 230 babies a year there. We also follow our own patients. They have kind of a quasi-hospitalist program. So, we still cover and follow our own patients, which is pretty unusual, but we like that. And it helped us develop a family practice residency here in Pittsburgh in conjunction with KU [University of Kansas Medical Center], in collaboration. So that's unique, to have family practice residents. We've got a pediatric dental residency program. We have a nurse practitioner residency program, which is possible in the community of Pittsburgh, which has about 20,000, big enough to support it.

Andrew Nelson: Yeah. Jason, you just mentioned that partnership with the church, Wesley House. Are there any other noteworthy community partnerships you formed that you'd like to talk about?

Jason Wesco: Yeah, I think we work well with lots of institutions. One, Pittsburgh State University, which is [an] institution of around 5,000, 5,500 students here in Pittsburgh. We partner with them in many ways. Kind of the highlights: We operate their student health center and conduct all their campus wellness activities. So that's been a great partnership in a way that they're able to utilize resources a little bit differently and we're able to more efficiently operate that institution.

We also partner with six counties to provide healthcare in their jails, because what we're seeing, not just here but everywhere, is a lot of folks in jail are dealing with addiction and substance use and mental health, often co-occurring. So, we're able to provide services in our jails.

And I think one of our longest standing and probably most recognized partnerships is with Head Start. And we take care of around 800 or 900 Head Start kids in our region in partnership with our local Community Action Agency. And not only are we providing services to them, but they contract with us to operate their health services program for their kids. So, we've really worked hard to not duplicate, as we always say, we don't want to do things that are being done well and are accessible in other areas, but have really found that working with other health systems and other community institutions has been a great way to kind of spread quickly and get care to people where they are.

Andrew Nelson: You mentioned how the overall population has kind of been dwindling in your area in the last couple of decades. Are there any specific approaches you've taken to addressing workforce shortages?

Krista Postai: We're fortunate though to have a school of nursing in our community. Plus, some of the community colleges around us also train nurses. That's been a lifesaver. But we did have to start to recruit to attract mission-focused providers that understand rural healthcare [, that] has always been a challenge. So that's why we started our own family practice residency program. We're hoping to grow that even bigger. We also have medical students here their last two years of training full-time, hoping that we'll convince them that family practice is the way to go. So, do you want to talk about our new subsidiary, Jason, since you were instrumental in that one?

Jason Wesco: Yeah. We are taking this long view, as Krista mentioned, because for 21 years we've been worried about the future understanding our health infrastructure and frankly, the age of our physicians and dentists and behavioral health providers. We knew that things were only going to get more challenging in terms of access. So, a couple of years ago, we created a foundation called the Inspire Health Foundation. And the foundation's located within our education center, but its goals and purpose are to connect to kids as young as preschool and introduce them to the idea of being a healthcare provider someday. So we have summer camps, we have Inspire Health Kids Camp, and those kids are as young as five, goes all the way up to Inspire Health Academy, which is high school kids. We have Inspiring Women, which is for high school young ladies, and all the topics and faculty are female.

So, we've really focused on that area. And then we go out to schools and have traveling resource trunks that may have topics related to anatomy or biology, that sort of thing. So, our goal is to plant that seed and then support those kids in the idea that they can be, doesn't have to be a healthcare provider, doesn't have to be top of the license, but that they can do that close to home. Because we believe that rural medicine is different, and it's especially different in a high poverty area. And so, we want kids to believe that they can be whatever they want to be when they grow up, and we want to help encourage them to think about healthcare as a pathway. And so, we've been doing that for a couple of years now, and we very much appreciate it's a very long-term goal.

But we have some great examples. Two examples, more than two, but two that I'm thinking of, of an MA [medical assistant] who worked for us several years ago. And she was encouraged by us and encouraged by her physician to go back to med school. And she's now in internal medicine residency and just signed to come back and work for us in two years when she finished school. And another very similar example of a young man who was an MA with us and who is an OB residency, and he's coming back to work for the local hospital to be an OBGYN. So those things kind of happened organically, and our hope is that we can be really intentional and identify those kids and then supporting them. And maybe in 25 years, we'll have a healthcare provider that that comes back or never leaves. Because of that educational opportunity through Inspire Health.

Krista Postai: We've also looked at our benefits. You've got to be competitive anymore, and we have some unique benefits. We offer a sabbatical after five years to our medical providers if they want to go off. A lot of our folks had done mission work before they came to us, in Africa and other countries. So, we still find people who want to go back. In fact, our family physician, who's over our family practice program, just spent a month back in Africa where she was raised, wanted her children to see what life was like as a missionary. So, we have some folks that want to get back into that. Some folks just want to go home and read books. So that's cool. After we absorbed a large corporate group — the Mercy System did transfer all their clinics to us in Kansas — we recognized that physicians were motivated by productivity, not necessarily quality. So, we developed an evaluation process that rewards you for quality. And that's something I think is unique that and we measure physicians get to see how they're doing every day. So, for instance, 83% of a large population that we take care of, and we take care of about 80,000 throughout southeast Kansas and northeast Oklahoma, have their blood pressure in control. And we're still holding it 83%, 84%, which is exceptional in the country. So, even though you're working with a very challenging population, you can help them stay healthy. And we've proven that it doesn't matter where you are or who you're working with, if you apply yourself and motivate others, you can get it done.

Andrew Nelson: You found a cooperative way to help address staffing issues. Are there any other challenges that come to mind that you've had to overcome to get to this point?

Krista Postai: Probably about a million of them.

Jason Wesco: Yeah, and I think that sometimes in rural areas, we fight over territory a little bit. And we do things that aren't necessarily in the best interest of everybody in the community. Sometimes in our communities, certain folks don't really want to talk about poverty and the challenges that we face because it seems like it's negative, or if you're trying to attract businesses, or whatever we're trying to do. And so, we often find ourselves being in the position of educating people about the health and education and overall wellness and economic challenges that we face, just to create kind of a baseline so that we know where we need to go and create some urgency about working together. Sometimes we have encountered folks that believe the community is still the way it was when they were kids, and it's not, and it's much more diverse, and we need to embrace that diversity. So sometimes we're our own worst enemy, I guess, which probably could be said for any community anywhere. That's a little bit frustrating when it seems like we're not working together, but we're working against each other sometimes.

Krista Postai: And when you're under-resourced, as this region has been forever, people get very territorial. So, the idea of bringing everybody together to head in the same direction has been a challenge. When I first suggested that we start a community health center, I got a lot of pushback from Public Health, who said we didn't need it. Those are the people that should have been lined up. The needs assessment clearly indicated that there was a large percentage of the population that wasn't getting care. And again, that's kind of a denial.

And reimbursement's also been a challenge. I think we found inequity sometimes in how different entities are reimbursed, and that's been frustrating. So, we have had to go to the legislature to look at encouraging more people to do more in rural areas.

There're restrictions on licensure that makes it hard. We brought a new physician in from the military, and we had to start him up like he was a resident again. He had years of experience, but he [didn't] have a Kansas license. So, there's been a lot of barriers. We had to cover his costs for a year, basically, because we couldn't bill him, because we couldn't get a full license approved. So, we've been working over the last several years. We've gotten more engaged in advocacy and policy, which is something I think we didn't have time for originally and did slow us down and did hinder our progress.

COVID was interesting. We were heroes during COVID and then post-COVID we have a large percentage of folks that don't believe in masking or vaccination. So, we're having to overcome that. A lot of our children aren't getting vaccinated like they should. So, it's just things that we're all dealing with in healthcare. And I'm not sure there's a magic bullet for it. Just time. And I don't want to have a measles epidemic, but we certainly are bordering on that in some situations where parents are just not getting their kids vaccinated because of COVID, whatever experience they had. We were fortunate though, to be one of the first clinics in Kansas to have the vaccine. And we did, how many phone calls do we have in one day, Jason?

Jason Wesco: 8,500.

Krista Postai: Looking for the vaccine. So, for those people who wanted it, we were heroes.

Andrew Nelson: So yeah, beyond just providing the actual care, an important part of what you're doing is educating people in your community. How do you usually go about doing that?

Krista Postai: One-on-one. A lot of one-on-one.

Jason Wesco: Yeah. I really do think that's how we do it. Now, it doesn't mean we don't do community events and all of that, but we've never really believed that health fairs get a whole lot accomplished. It's been more focused on hiring, getting really good providers, and we have been very good at attracting really high-quality providers and then building trust with patients. And that's where the change happens, right? It's in an exam room where you are working one-on-one with a nurse practitioner, a PA [physician assistant], a doctor, your therapist. That's where I think the change happens. But we also have to be realistic that we're dealing with 125 years of poverty, and 21 years of service isn't going to change it. I don't know if we'll ever catch up. But I think we certainly have become a lot better at viewing ourselves as an important member of the community and leaders in public health in a lot of ways. And sometimes, as Krista mentioned, sometimes that's perceived in a positive light and sometimes that's not perceived in a positive light. But I do think we've certainly seen some measurable improvement in health, but we certainly haven't seen improvement in poverty and a lot of the other underlying reasons why people aren't healthy.

Krista Postai: The introduction of community health workers in the last few years promises to make some progress. I went into it skeptical that you hire laypeople to go talk to other laypeople, but we have trained them. For instance, we got a HRSA grant to improve cancer screenings. And KU came down and trained our community health workers on things to look for, how to motivate people on getting mammograms and getting colorectal tests, which a lot of people don't like to even approach. So, we've had some progress there. We're seeing our numbers move. So, when you have a community health worker go out and tell a peer that's important to show up for a mammogram, it's working. So, I think the beauty of health workers that we're seeing start to multiply across the country, especially in Kansas, we just found that we just got reimbursement for our community health workers, which will make them sustainable. Could be the key to better education. When you have somebody you trust and you know tell you it's good to get an exam, you're more likely to go.

Andrew Nelson: Yeah. Opening up your new locations might be the biggest change that you've been able to make in terms of providing care to patients, and you've mentioned the one-on-one education that can take place in an examination room, and the community health workers. Are there any other things that come to mind that you've done to meet your patients where they are?

Krista Postai: Oh, we have a million different things. We've got some small programs like Baby4Baby, which takes used baby clothes, recycles them and hands them out to families. Because you don't want to underestimate the importance of a well-dressed baby. It means a lot to a mother. We do a lot of baby fairs. We do car seats, because a lot of people don't have car seats, and most car seats are installed incorrectly. So that appeals to any new parent. And then the walk-in care has been good.

Jason Wesco: We have done a lot of outreach with community colleges in our area around sexual health. For whatever reason, in our 11 counties I think [we] have five or six community colleges. We have a lot in our area. And we've tried to stay connected with those students in that way. But mostly the way we reach people is, as Krista mentioned, vaccine events, community partnerships. We take care of somewhere around 1,200 to 1,300 people every day in our clinics spread throughout this region. And so, it's as simple as answering a phone call with a human. Every phone call that comes into this organization is answered by a person. You don't push a button; you don't leave a message.

Now you can, but our calls are answered by a team of people who answer for the entire system, because we believe that that's important. So, the human touch is really important to us. We appreciate we're a relatively big system, but we operate in an area where people want to talk to people. They don't want to talk to computers. They want to come in and see us. And so, I think we've been very responsive. As we often say, we're not providing a thing in a community. We are the community. We have over a thousand employees in this area, and 85,000 patients. So you can't really separate the Community Health Center of Southeast Kansas from the communities that we serve.

Krista Postai: Answering the phone makes a big difference. When we had 3,000 patients, it was a lot easier. So now that we have 80,000, we do staff it seven days a week; I think that matters. You know, if you're stressed and you're sick, the last thing you want to do is get a phone tree that says, "Push one to get a prescription." So, that's been important. Having pharmacies. We have 340B pharmacies, so there is no one that comes to us that can't get the medicines they need. So, if they can't afford them, we'll voucher them. That's made a big difference and that's been a big part of our income as well as our benefit. If you talk to our staff, the best thing that we do for people is the medicines. Get the medicines they need, especially our older patients who may have Medicare [Part] D but find themselves in the donut hole, but doesn't seem to go away, or have a medication that is not covered by their plan. So that's been a huge thing. You walk in our clinics, we don't have glass between you and the registration desk. It's very personal. We say we're patient-owned and patient-operated. And we consider ourselves healthcare the way it should be. And that's defined in multiple ways. Trust is a big piece of it.

Andrew Nelson: Yeah. Patients having that confidence that they're being taken care of by people, and not just talking to a machine, I'm sure, makes a great difference.

Krista Postai: And we do go to people a lot. Televideo is certainly the future in rural healthcare. We get that. We use televideo, especially with some of our interactions with the jails. And we do have an HIV specialist in southeast Kansas, which is probably the only one in a rural area in the state. So, she does use telemedicine to reach out to our other clinic sites. But it's not our primary focus. Our primary focus is face-to-face care. So, we round nursing homes, we do house calls, we're there for people. That's what people want and need in rural America. That's what I want and need.

Andrew Nelson: You mentioned how impactful telehealth can be. Looking forward, are there any new services or new ways of providing services that you want to be able to adopt or expand?

Jason Wesco: Well, a thing we're doing that just started a couple of weeks ago, or a week ago, is a specialty court. Some people call them "drug court." There's lots of iterations of those. But our chief counsel, his father is a judge in a nearby judicial district and has done drug court for years. And success rates are very high. The evidence indicates that it works. In our judicial district that we live in here, three counties, all of them are high-intensity drug trafficking areas. We're at the intersection of two relatively major highways. And so, we have a lot of issues that we need to deal with around addiction. And that specialty court is an incredible tool that I'm guessing most community health centers are not really working in that area.

But we've seen that it works. And I think that's a hallmark of how we do things. That we don't really limit ourselves to what we can and can't do. We find things that work, and we implement them. So, I imagine we're going to see more specialty courts in the future, and they can be for beyond drug diversion. They can be family specialty court. There's lots of iterations of those that I think we could bring that's going to reduce some of the burden on the judicial system and clearly keep people out of jail. Right. That's the goal. Not just provide healthcare when they're in it, but let's try to help them not go there in the first place.

Krista Postai: Yeah. I grew up in a medical system that treated symptoms, and part of our philosophy was that we wanted to address the underlying problems. The symptoms are fine. I mean, people need that care, but if we can eliminate the reason for the problem in the first place, that's what we're focusing on, especially when it comes to addiction and the mental illness, which is we actually have a pretty high rate of disabled in southeast Kansas due to mental health issues and addiction, which we're trying to address. It's like world hunger though. It's huge.

Jason Wesco: Yeah. It really is.

Krista Postai: So, we do start with the kids. Another relationship we have is with the school districts. Back in the day, [in] 2015, we decided we were going to screen 5,000 kids for dental decay. We ended up at our peak more like 35,000, 40,000 kids. And we still are screening about 25,000 kids every year in schools for dental decay by going to the schools and lining kids up and checking their teeth and doing sealants and doing fluoride varnish, again, trying to eliminate the problems that we're seeing in adults who have very decayed teeth and are in pain and will never be able to restore their mouths like they need to be. But if we can prevent their mouths as children from decaying, then we've addressed the future. So that's been our focus when we can, is going in and trying to eliminate the problem in the first place that poverty only makes worse.

Jason Wesco: When you're operating in an environment like this, it's a real challenge for people, for our staff and providers to see that progress is being made. Because we've essentially decided to provide 100% access to care in one of the poorest parts of the country. And that's not a thing that you just open the doors and people are grateful, and they get better. And so, it's a real challenge. It's nice to be able to tell the story and have people hear their story, have our staff hear their story told back. Because we're really grateful for all the hours and all the time that they put in. And the hope that they're creating, because that's really what this organization has founded on: kindness and hope. And boy, it can seem grim sometimes when you're doing this work, and you have to be objective and say you can't fix 125 years in 21 years. But boy, there are a lot of really good things happening. And for me, it means that nobody has an excuse to not do what we're doing. Because if you can do this here, people can do this anywhere. They just have to want to. And rural America needs it. Right. We're losing population and we've got a lot of big challenges, and we can't throw up our hands. We've got to buckle down and get to work.

Andrew Nelson: You've been listening to Exploring Rural Health, a podcast from RHIhub. In this episode, we spoke with Krista Postai, CEO of Community Health Center of Southeast Kansas, and Jason Wesco, who is the President and Chief Strategy officer of the community health center. Look in our show notes for more information about their work and visit ruralhealthinfo.org for all things pertaining to rural health.