Kathleen Wessel (Host): As hospitals continue to face mounting pressures that threaten both patient outcomes and financial sustainability, they have the opportunity to transform care delivery while achieving measurable ROI through specialty telemedicine. Welcome

to a HA Associates Bringing Value. A podcast from the American Hospital Association. In this series of podcasts, we speak with a HA business partners, check in 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, and today I'm joined by Heather Barrett, chief Executive Officer at stem.

And Carrie Hollis, chief Operating Officer, also with stem. In this episode, we'll explore why telemedicine is a strategic imperative for modern hospitals, and uncover how services like Telepsychiatry, telestroke, and Tele ICU, can transform care delivery, reduce costs, and improve continuity of care for sustainable change. Heather and Carrie, welcome to the podcast.

Heather, I'm gonna start with you for our first question. and AJ members are dealing with a host of challenges. You know, it could be overcrowded, emergency departments, rising transfer rates, or high readmission rates, you know, all of these strained resources and impact financial performance. How does telemedicine help address these operational pain points and help improve continuity of care?

Heather Barrett: I think, telemedicine does exactly, what it's supposed to do, which is to prove that it's it's value. When hospitals can access board-certified specialists on a on demand basis, they're able to move patient's through a system that's more efficient. Telemedicine is helping to reduce ed boarding times by accelerating consult response times, which.

We all know improves throughput and decision-making at critical moments. at stem, we support hospitals across more than 24 specialties, which allows our care teams to stabilize, diagnose, and treat patient's locally instead of defaulting to transfers. Not only do we help hospitals to preserve capacity and revenue and reduce physician burnout, but we also help to keep patient's closer to home, which is a better outcome and experience for patient's.

Continuity of care is a huge part of this. Telemedicine doesn't just work on episodic consults. It's structured, it's longitudinal coverage. A clear clinical governance with specialty medical directors and standardized protocols and telemedicine has really become an extension of all hospitals care teams rather than an outside service that it used to be known for.

Kathleen Wessel (Host): Yeah, I think the transformation of telemedicine, especially, due to the impacts of COVID, really it has been a. Really welcome addition, to service lines and, and really how we deliver care overall. So thank you for really diving into that. I wanna maybe take a step back and, take the opportunity to learn a little bit more about you both, how you arrived, where you arrived.

And Heather, why don't we start with you. what key experiences shaped your journey as a CEO and how have they influenced your decision for expanding access to specialty care?

Heather Barrett: Well, my background has always been at the intersection of operations, finance, and process management execution. for the last six years, I have worked very closely with hospital leadership teams to solve really recurring problems, which was always, coverage gaps, transfer leakage, and inconsistent specialty access. And specialty access for all is very near and dear to my heart.

And so because of that, my experience And in my personal life and professionally have really helped to shape my vision for stem, which brings telemedicine. In a more rigorous, clinically operationally aligned and scalable solution to hospitals. It's not about technology alone, and I think a lot of people, when they think about telemedicine, that first initial thought is always the technology, but for us, it's really about building an infrastructure that improves patient outcomes.

While supporting financial stability for the hospitals. So my role in partnership with Carrie and our team has really been focused on helping hospitals to translate telemedicine into more of that day-to-day operational success. And so for us, that means really working closely with the leadership teams to align their workflows.

Performance metrics, really ensure an overall solution that integrates seamlessly with their existing team.

Kathleen Wessel (Host): thank you for that. I love that perspective. Carrie, shifting to you, could you tell us a little bit more about yourself And what strategies you prioritize when supporting hospitals in developing telemedicine initiatives?

Cari Hollis: Sure. so I am the Chief Operating Officer here for Specialist Telemed. I started my career back in, I don't know, something. Right. but with doing so, I, started in nursing and I feel like starting in nursing has really shaped how I see. Healthcare in general. it definitely helps to keep me grounded in what patient's And the frontline team actually need.

And we're not just looking at, Hey, what is on paper? We can actually relate to what is happening there in the hospitals And what is needed from that perspective. Over the years I've moved into healthcare operations and telehealth leadership, and I've found a real passion here for building programs that expand access to care in meaningful ways.

I've been in telehealth now for over 15 years. On a personal level, I'll say that I'm a mom of five and a proud CC of one. so access, flexibility, and reliability in healthcare really do matter to me. I'm also a strong advocate for organ donations. my family's story definitely helps to lead that journey there for us.

My father was a heart recipient and my. Son was an organ donor for five. so that experience alone has really enforced how powerful access to care and strong systems truly are. the impact that reaches far beyond one patient to another is just important and it really is life-changing. So I think that definitely helps to keep my work grounded and purpose And in people, and not just process in general.

When you want to look at, you know, what are several strategies that I would prioritize or what I prioritize when supporting our clients across a variety of care settings. We cover more than just hospitals, so we cover outpatient and other clinics as well too. I'm a huge believer in telehealth that it isn't just a temporary solution.

It needs to be permanent. I advocate, for a permanency of telehealth through the work that I do with the American Telehealth Association Council. And there we really focus on advocating, you know, policies, that support long-term access and sustainability for virtual care delivery. We really do believe that patient's should have the ability to receive high quality care just from, anywhere, not just one particular location that falls within a certain geographical, zip code.

So with that, we definitely continue to advocate to make permanent what telehealth has expanded and, waivers have been in place through. COVID. in addition to that, I am a certified telehealth coordinator and certified recruiter, which really does help to shape, how we approach the work that we do here with Specialist Telemed, also known as STEM So, It allows us to bridge the clinical operations And the workforce strategy, and definitely makes sure that programs aren't just well designed on paper, but again, making sure that they're fully staffed, compliant, and operationally sustainable.

When you look at stem, I definitely think that we continue to focus on helping hospitals build telemedicine programs, that are designed to scale. And last, that's important. We don't wanna develop something that's just temporary. we want something that will be adopted and made permanent, to help with those patient gap coverage needs that may be in place.

we also, help to build organizations that enhance data driven quality systems, so we oversee quality and compliance too. Here under operations, we definitely wanna make sure that we measure outcomes, improve performance, and maintain those clinical excellence. needs across all programs. And I would say finally, as we, look at our partnerships again with our different clients, we partner with hospitals to develop technology enabled workflows that definitely improve clinical efficiency and patient outcomes, and ensuring virtual care integrates seamlessly at the bedside with those hospital systems.

So care delivery feels more natural, reliable, and efficient.

Kathleen Wessel (Host): I want to just add, thank you so much for sharing kind of your personal stories. I firmly believe these personal experiences really inform and help us understand kind of how you think about care and how you think about, the way your organizations are contributing to, health and healthcare. So, thank you so much for sharing kind of your background with us.

and Carrie, I wanna dive in a little more, to some of the comments that you had made. How does access to board-certified specialists through telemedicine help to reduce emergency department boarding times, prevent transfers, and keep patient's in-house, especially in rural communities?

Cari Hollis: so I think that's a really important question, especially when you're talking about royal locations and community hospitals that are consistently trying Toban. Violence, access. They have problems. Staffing. We all know that, in those locations it's hard to have someone physically present, for different specialties there, And then the financial pressures that they currently face.

One of the biggest challenges that we see hospitals face in the emergency department is definitely throughput boarding, right? So you're looking at patient waiting. Times. And what are they waiting for? Well, they're waiting for specialty consults because you don't technically have a cardiologist or a neurologist present to be able to do that consult at that time.

You're looking at transfer acceptance. you're also looking at, you know, certain clinical decisions that delay that throughput there for that patient when hospitals don't actually have the immediate access to board-certified specialists on site. Those delays quickly create operational bottlenecks, backlogs in the ed, longer wait times, and again, what do we all see or hear?

especially being a nurse, sometimes at the bedside we hear the frustration from the patient's and additional staff. What telemedicine and specifically what we do here at STEM can help with telemedicine? Definitely changes the speed to specialty care. I think through the services like tele neurology and other telemedicine specialties, hospitals can gain immediate act.

Access to the board-certified physicians and definitely help to, evaluate patient's in real-time, guide treatment decisions quickly and help to determine whether a patient truly needs a transfer or can they safely stay and receive that care locally. Do you have the, option to be able to provide TPA or TNK at the bedside And the staff available?

If so, then why can't we? Help to keep that patient local rather than having to transfer them out. when those decisions happen faster, it definitely reduces those ed board. In times it improves that throughput. It frees up beds and staff resources. Too many cases you'll see that patient's can be treated in emitted locally instead of being transferred out, and sometimes when they're transferred out it's hours away.

With that, you can keep that patient, local and their families Can be at their bedside too without having to worry about that burden of how far away they may be to be at the bedside with that patient. from an operational standpoint, I think that, this definitely helps to remove major friction points.

You have fewer unnecessary transfers, fewer delays in the care, and better utilization of existing resources. From a financial standpoint, which if any CFOs are listening to this podcast right now, You know that their EARS are burning. Just trying to figure out exactly, what you're looking at from that financial standpoint, meaning that hospitals can now retain more cases.

It improves that reimbursement capture and avoids the high cost associated with that transfer out. Even that agency staffing in order to do so for that patient, the stability there matters for a lot of the royal hospitals operating on thin margins. Um. Another huge impact, on patient experience and continuity of care is that patient's receive faster answers.

They get faster treatment and consistent specialty care. Without leaving their community, their primary teams can still remain involved, so you can continue care, from inpatient to outpatient. And then also that care there definitely helps the patient feel more, included. And at the end of the day, I definitely would say that this telemedicine isn't just a clinical solution, it's an operational solution, a financial sustainability strategy, and one way to deliver equitable access to care.

So it's very important, to be able to have that access to care for any type of specialty anywhere the patient is located. So.

Kathleen Wessel (Host): You know, excellent points. Thank you. Heather, switching to you, kind of from your perspective, how does telemedicine become not just a clinical solution, but a strategic lever for financial performance? And what steps should hospitals take to realize these gains?

Heather Barrett: I think a lot of times, especially now, you know the landscape between. When telemedicine really exploded at the time of COVID, as we all remember and all probably have had some personal, interaction with it At that level, it's really changed, meaning there are a lot more providers that are interested in providing telemedicine.

There's a lot more hospitals and facilities that are now aware of the benefits of telemedicine and are still shocking to us. Sometimes there are still people that are very hesitant or. Really haven't had the experience in a hospital level. and we're talking about clinicians and, hospital staff members that just still haven't quite found the understanding of, how this really does impact their communities and their hospitals.

So I think understanding it as a whole, but to begin with, for us, And STEM is a huge. Proponent of implementing things and processes and service lines in a real thoughtful manner. And we do that in a way that aligns that clinical excellence that, Carrie kind of spoke about with the operational and financial goals that the hospital has.

So we've seen hospitals reduce transfer costs. They've shortened their length of stay and they've improved their case mix by adding. In telehealth by adding in additional specialties that they were unable to staff or recruit for at their facility. So all of that combined really does focus on improving patient outcomes, as Carrie had mentioned.

But I think what hospitals are really looking for now, And in facilities are looking for now is an affordable way to get these folks in the door. And so STEM has really created several types of models. There is a model that. Bridges the gap from a access perspective. So we've got hospitals that are small and rural and have very low census in some of these specialties, but they really could use it.

and they really could. Benefit in their communities could benefit by having these specialties. So STEM has created what we call the STEM Alliance program, which allows small rural hospitals with lower typical volume to provide access to specialty care by partnering with other local, small rural hospitals or sister hospitals within their state and community to be able to combine and utilize that service across multiple facilities at a lower rate than what they would normally.

be able to access that through. And again, the key here is alignment. So telemedicine has to be integrated across the clinical, financial, and operational team with those same shared goals and transparent performance metrics. And going back to that thoughtful implementation. STEM always is asking during the implementation process for that telehealth champion.

So really designating a person or a team of individuals at the facility That is going to help, be part of that process and implement that service line And this program into their facility is key because you've got a mix of, um. Nonclinical team members at the hospital, nurses, physicians, a, a slew of people that are going to be introduced to this new program, but may not always utilize the program.

And so making sure that you have full involvement and buy-in from the whole clinical team And the hospital staff is really important, And that really helps focus the, I think, financial performance and, metrics overall. So successful programs start with clarity. They start with thoughtful and aligned integration. And I think understanding what problem are we really trying to solve here is very important for the hospital to understand.

So STEM is coming in as the partner to help solve the problem, but for the hospital to really understand what is the big picture here that we're trying to do? Is it, we are trying to reduce, lengths of stays and reduce transfer costs. Absolutely. That's typically key. Is it that we want better patient outcomes?

Absolutely. But making sure that we can align with those hospitals to clearly define what those goals and KPIs around throughput and transfer avoidance, readmissions, providers, all of That is extremely important. And really, I think understanding where that financial performance really lies. It's easy to say that bringing in a group of tele neurologists or telepsychiatrist.

Is less expensive sometimes than staffing an entire team of physically present psychiatrists or neurologists at a hospital. It reduces the cost for the hospital from a benefits perspective and, all of those things. But really what we're, looking here to expand. Is really understanding the financial impact it has for the patient's And for those, telemedicine measured metrics and management of the strategic service line.

So if you understand what your clear goal is, what we're really trying to do by bringing STEM in from a telehealth perspective, that I think is the, clearest way for us to understand that financial impact.

Kathleen Wessel (Host): thank you very much for kind of walking us through all of those aspects. I think I, had in mind a few of them, which seemed kind of clear at the beginning of this conversation, but that really helps kind of elucidate all of the different, benefits for considering this kind of program And what you need to think about.

Heather Barrett: Yeah, and I think one other thing that we didn't talk about is reducing physician burnout. I think that's a really big. Focus, especially for 2026. We heard a lot about this during COVID, but we've got physicians sometimes that are staffed at hospitals and they're the only provider of their specialty.

And so knowing that they're supported by an entire team of board-certified specialists behind them gives them the peace of mind to take time off and to, spend time with their family and to get rest and sleep. I think that's really important and it's also a great way for the hospital to show their physicians that they're supporting them, in, I think all aspects by introducing telehealth also.

Kathleen Wessel (Host): Absolutely. Thanks for highlighting that. I do wanna ask one final question, and Carrie, maybe you can help understand kind of what guidance and practical advice you have for a HA members as they look to implement telemedicine as a scalable solution.

Cari Hollis: So I think that's a great question, to close on because telemedicine itself really has moved beyond a pilot program and temporary solution. Um. And it needs to be built intentionally in sustainability. so my first piece of advice is to design from scale, from day one. Don't build telemedicine as a side project.

Make sure that your infrastructure, the staffing models, licensing your credentialing processes. We know how burdensome that can be and how long it can take. governance structures. Make sure that they can all grow with demand. You don't want to be. Able to provide a service That is well utilized, but yet you can't make it sustainable because of the administrative burdens that are facing you behind doors too.

So if the foundation isn't necessarily solid, then programs struggle when volumes increase. Um, in addition to that, what I would say is just think strategically, invest in workflow integration from a frontline adoption approach. So telemedicine definitely succeeds when you look at it and it fits naturally into how the clinicians already work.

How is the current workflow happening? Look at those workflows within the staff. how do they currently consult? And we try to mimic. As much as possible, and integrate that workflow So, it seems naturally at the bedside or wherever it may be, that we're providing that care focus on technology enabled workflows that definitely help integrate with your EMR, the nursing teams, transfer centers, and operational teams.

So virtual care feels seamless rather than. Disruptive. I think a lot of times, especially being a nurse, we are shorthanded too, not just by the physicians themselves getting burnout, such as what Heather mentioned, but nurses too, we're short staffed. Right? So what is a workflow that works to be able to bring a, wow.

A computer or a tablet or something to the patient bedside and, and really, yeah. Knowledge, that technology piece there to make that consult happen for that patient, but yet still have the time to focus on what you need to with the additional patient's outside of that. So definitely kind of look at workflows and finally what I would say is just I would strongly encourage leaders to advocate for telehealth permanency.

Engage with your organization such as the American Hospital Association here And also the American Telemedicine Association. Make sure that your voice is represented. The future of access definitely depends on it.

Kathleen Wessel (Host): I think that was a great note to end on. Heather, Carrie, I wanna thank you so much for joining me on the podcast today and sharing, your feedback, sharing your research, And the framework That is helping healthcare leaders drive meaningful and lasting change, And what that means for a HA members.

Thank you so much, for our listeners. If you'd like to learn more about stem, And the a, a programs that you've heard on this call today, please visit us@sponsor.aj.org. This has been an AHA Associates Bringing Value Podcast brought to you by the American Hospital Association. Thanks for listening.