Kathleen Wessel (Host): Rural hospitals are operating under more pressure than ever thin margins, clinician shortages, and outdated infrastructure. But AI done right can rewire the way care is delivered. Not by replacing people, but by empowering them. That's what we'll explore today. Hello,

and welcome to a HA Associates Bringing Value, a podcast from the American Hospital Association. In these series of podcasts, we speak with a HA associate program, business partners check out on their efforts and learn how they support a HA hospital and health system members. I'm Kathleen Wessel, vice President of Business Management and Operations at the A HA.

Join us as we explore establishing a proactive AI roadmap to support real change for rural hospitals, enabling them to sustain financial performance, ease burnout, and expand access to care. I'm Kathleen Wessel, vice President and business manager and operations at the A HA, and today joined by Amar Kendel, co-founder and president with Homeward Health.

Amar, welcome to the podcast.

Amar Kendale: Kathleen, it's great to be here.

Kathleen Wessel (Host): I wanna dive right in, with a big question for you first. System-wide change can feel daunting, especially when it comes to ai, but it can also open the door to meaningful progress. What should rural hospital leaders look for in ai, especially if they are aiming to reduce administrative burden, expand access, or improve financial margins.

Amar Kendale: So Kathleen, you're right that This is a very unique moment when it comes to AI and specifically generative ai, and it's certainly the case that it can be daunting. The great news is these technologies are very well suited to plugging in to the infrastructure in rural America. And the reason is because it's designed to be compatible.

With things like natural language, with existing systems that are already in place without requiring a very heavy technical lift or financial lift in the way that a lot of previous technologies have required those things. And so our advice as we start to engage with health system executives in rural America has been to start with a strong focus on the core operations in their business.

Making sure that the workflows that are the highest impact are the ones that we begin to consider for deploying generative ai. This is actually quite distinct from how we've approached technology adoption in the past, where really there's been more of a technology push, an idea that there's some kind of product or service available.

Health system executives have had to figure out how to fit that into their operations. I think we're in a unique moment where we can start with the existing operations and bend the technology to our will really accommodate those things that are already in place and are working and use that as a way to drive efficiency and ultimately bottom line impact.

Kathleen Wessel (Host): I love that framing specifically for this segment of membership. and I wanna dig in on that a little deeper, but before we, do that, you have worked at the intersection of technology and healthcare for years. So what gaps in rural care specifically made you realize that This is a moment for a different kind of company with a different kind of solution?

Amar Kendale: So, you know, at its most fundamental, a lot of the challenges faced by rural health systems and rural. Economies more generally are driven by distance. And so if you think about the idea that we have our very precious resources typically concentrated, This is our, doctors and our, nurses, and our really high value staff.

It's our capital equipment. So if you think about, devices and other, important components of delivering care. Because Those are geographically concentrated in rural areas, we have a very unique problem, which is that our patient population is geographically distributed, And so that creates an inherent source of friction and cost.

So the big question for us is how do we overcome that? that's what drives the differences between urban, suburban versus rural, is that proximity to those expensive resources. But the great news is that technology can be used to overcome distance, right? And we've seen a lot of really positive signs of this, during the pandemic with the adoption of telemedicine.

The rapid adoption of broadband, but specifically 5G cellular networks, which are now very well penetrated in rural areas. all of This is really allowing us to overcome this distance barrier, but we have to do it using technology. We can't do it the old way with face-to-face as being the only way to deliver care.

so that becomes a really important part of, what I see as some of the biggest differences between how we can get by in urban and suburban areas, And we simply can't. In rural areas. And so Homeward, was really built around this idea that we have to take a technology heavy approach to overcoming distance, but we also have to retain the things about delivering care that are so critical, to maintain.

So things like building trust, that's something you can't technology your way out of. you have to do that very authentically, and you have to do that ultimately with human relationships. So if that becomes our goal, we wanna preserve trust. We wanna leverage our human staff to build connections with our patient's.

Technology's role becomes to do everything else. It becomes to provide efficiency so that those human interactions can be where the focus is of our staff's time And the things that they might have been doing otherwise. Fetching charts. Trying to pull data together from different places, entering data, getting caught up in, burdensome administrative workflows like billing.

Those are all the really ripe places for us to apply technology so that we can really preserve the things that matter most, which is that human interaction.

Kathleen Wessel (Host): help me think through kind of what does it actually look like when a rural hospital partners with Homeward, and how do you plug into their workflows without requiring big upfront investments or it overhauls.

Amar Kendale: So, a lot of where we begin with any rural health system is in taking stock of where we are. And interestingly, You know, one of the first challenging, problems is exactly this. You know, many rural health systems don't know exactly where they are. as far as, any number of things you might want to see on a scorecard, what is the efficiency of various key workflows?

what are utilization rates looking like? what are the biggest areas of opportunity to point technology? how much budget do I really have to work with in order to produce an ROI? So, we often start there. We often start getting very, intimately connected with senior leadership and understanding their data.

Oftentimes we'll look at that data together and we'll. arrive at a plan together as to where the biggest opportunity areas are for us to, deploy technology. sometimes That is the places where the workflows are the most mature, and sometimes it's where the workflows are missing. I'll give you examples in both categories.

So a couple of places where workflows exist, but there's a lot of opportunity, are on administrative back office. So here's a place where you have revenue cycle management workflows. There tends to be something in place. very often it's a manual process, either insourced or outsourced. but it's a place that's very, amenable to the deployment of generative AI for the purpose of ensuring that there is accuracy.

Quality being maintained, that there's really good record keeping, that there's an ability to interface with the systems that the payers have in order to assure that billing, is happening appropriately and on time. And so, it's an area that really lends itself, very well to automation. And automation in this case means supporting and supplementing the human operators.

So what we find is, unlike a lot of other places where you might have a big team. And the questions on your mind are, are we talking about displacing staff in rural health systems is actually quite different. You're almost always in a position of reduced staff to begin with.

So we're typically starting out in a world where There are open recs, there's hiring. That's been very difficult And we apply the technology in a way that closes the gap, essentially covers that shortfall. There might be one or two existing staff members. We use technology to cover what you might otherwise have needed, four to six additional people to go do.

So that's an example of where there's an existing workflow, it's really well understood. What's missing is the capacity. The other place where we find a lot of opportunity is in areas where the workflows themselves, give us a lot of opportunity to innovate. So one of the most exciting areas in this regard is in the areas of scribing and it's.

related clinical decision support opportunities. So here's another place where, very often, we find that doctors are spending evenings and weekends, their pajama time doing their charting. And This is because, again, due to understaffing, they're often working back to back on patient visits. So very often what falls by the wayside is the documentation.

And so here's an example of a workflow that's far from optimal, but it's a place where scribing is a great example of a technology that simply runs alongside the provider in the course of their visit. Takes really good digital notes. Draws out the most important information and surfaces that for the provider to, assess and confirm.

And so here what we've done is we've essentially created a, new workflow that offsets work that the provider would've had to do on their own. Where things get really interesting though, and This is in a world where to date scribing is not really demonstrated a very strong discreet ROI.

What becomes really interesting is where we can start to point to the future and consider how do we not just. Augment our providers so that they're offloading some amount of their work, but how do we actually give them superpowers? And an example is in the area of clinical decision support, when you have the scribing capabilities to digitize something that's happening in conversation, and you have a base of evidence that you can map all of that content against to give a provider real-time feedback as to what does the evidence say about how to practice.

evidence-based medicine. And so this gets really interesting because now we take every provider and give them this instantaneous access to the entire corpus of the medical literature. Allow them to bring that to bear in every patient interaction. And This is where we get excited about opportunities for return on investment in ways that hospitals in rural America can actually sustain those investments, sustain the, benefit of, placing down a dollar and having confidence that they're gonna see two, three, $4 come back to them.

So, ultimately, you know, what we find is, the combination of these elements is what starts to constitute. A positive ROI And in some cases it's the combination of revenue cycle in the back office And then scribing in the course of a visit, real-time decision support in the course of a visit, that ultimately produce a package that becomes easy to adopt because it produces an instantaneous financial ROI for our, our health system partners.

Kathleen Wessel (Host): I think I am hearing, kind of lots of different, concepts, ideas. all being brought together. can you confirm that number one? I'm hearing references to like modular ai. Can you help break that down for us a little bit? and what does it mean for rural healthcare teams in practice?

Like, how does it help them do more with less? And, I'm kind of piecing together some of your examples, but if you could help me thread that Neil.

Amar Kendale: Well, you know, something you haven't heard me talk a lot about is things like heavy IT investment, and that's very deliberate because it's been one of the biggest barriers to adoption of technologies like these in rural health systems is the availability of technical staff, the availability of it, budget, and I'm deliberately not saying a word about those things because everything I've talked about so far has been about workflows.

That's by design because what we know is in rural health system environments, workflows already exist And this opportunity to piggyback on those existing workflows. Use technology to very seamlessly add capacity and capability is the only way we can really expect technology adoption to happen. and it can't be on the backs of an IT department or an IT budget that's not there.

so with that common theme of we go in, we help executives identify the workflows that are the most amenable, to automation. The way that those workflows get implemented is very much like you might bring on new staff. It's extremely, low lift. And in some cases it's because we homeward bring our own staff to take on that job of interfacing with the technology.

In some cases, the technology is so simple and seamless that it can integrate very easily with, the existing staff's workflow because. it is simply a part of what they already do. Scribing is a great example. It's a part of what they already do, which is talk to a patient, in that normal interaction is where the value comes.

And so, that's been a very deliberate choice that we've made here in the way we've approached what we bring to the market. So, you're right that I did describe a number of different pieces, and I think that's a critical part of how we solve these problems because. To choose just one often means that we're not solving the problem comprehensively from a human perspective.

The reality, how we do our work is we take out a task And we do everything that's needed to finish that task. It's not like we are choosing a particular software tool, And we just use that tool until we're done with whatever that tool can offer us. And so this much more person-centric, human-centric, workflow centric approach is the one that we think really matters.

The backend of that has to result in this concept of how do you get to, net positive return in a short period of time. And that's why I think one of the novel aspects of Home World's approach has been to consider ways to assemble multiple workflows that ultimately produces a net.

ROI. So this idea of how do we create a ladder of adoption, a sequencing of steps, so that every step of the way our rural hospital partners can be viable in making these investments can see that rapid return and use the return on their investment to make the next tranche of investments to continue to accelerate their progress in a, adopting these technologies.

So that's been a very deliberate part of why sequencing matters, comprehensiveness matters, but then biting off just as much as you need to in order to produce that ROI every step of the way.

Kathleen Wessel (Host): Thank you for walking us through that. I love the vision there, the roadmap that you guys create. I think that's a, really achievable, doable, exercise. sorry, we're at our, kind of rounding out our discussion and at our final question, but I really would love to understand how you see AI shaping healthcare.

big question for you, but, what opportunities should a HM members, embrace for real lasting change instead of some of the quick fixes that we're hearing about?

Amar Kendale: there's many layers to this, question you've posed Kathleen and ai, is taking a lot of different forms right now. I think that when we consider rural hospitals And the needs that they have, I think we have to take a step back and ask ourselves, what is the real lay of the land, what's truly available in these environments to work with today?

And how do we make pragmatic steps to figure out what's going to leapfrog, the current status quo and bring, these valuable partners into not just the present but the future. And so, what I really love, to see in the way that technology can be adopted and generative AI in particular, is this concept of co-pilots and co-working.

and I think that rural America is so well suited to this, where we have very talented, committed people in our role communities, And what they're looking for is support. So identifying those places where the technology provides support, not replacement, is a really critical piece of how we make choices.

a second critical piece is this concept of using technology to uplevel capability. And so especially in a world where you have high rates of turnover, you have some recruiting challenges in terms of bringing people, into rural communities from other markets. I think the offer of, upskilling, the offer of the opportunity to be able to work with the latest technology is very attractive for this generation of employees as they're all asking themselves, what does my career look like in an AI world?

And I think it's one of the big draws that rural health systems and hospitals can offer, which is the fact that they're adopting these capabilities not out of. desire to just be on the leading edge, but out of necessity and therefore their level of commitment is very high. And for a person building their career.

In healthcare, the opportunity to do that in rural America is even more valuable than it is in a lot of other places. And so I, really look at that as a unique selling proposition for rural health systems as they adopt these technologies and decide, you know, how both to bolster their own workforce and recruit really talented tech forward people, but also make these commitments to upskilling and upleveling, which is gonna benefit all of us in the long run.

Kathleen Wessel (Host): You know, Amar, I wanna thank you. So much for joining us today on the podcast and sharing your insights with, our a HA members. for listeners, if you'd like to learn more about Homeward Health, please visit homeward health.com. This has been an AHA Associates Bringing Value Podcast brought to you by the American Hospital Association.

Thanks for listening.