1 00:00:00,480 --> 00:00:02,720 This is Laura Dierdahl with the Becker's Healthcare 2 00:00:02,720 --> 00:00:04,879 Podcast. I'm thrilled today to be joined by 3 00:00:04,879 --> 00:00:07,440 doctor Harmander Grewal, who is the chair of 4 00:00:07,440 --> 00:00:09,759 the department of family medicine at Wright State 5 00:00:09,759 --> 00:00:12,880 University, Boonstraff School of Medicine, a physician at 6 00:00:12,880 --> 00:00:15,714 Premier Health, and the Whole Health Clinical Lead 7 00:00:15,714 --> 00:00:18,594 at Dayton VA Medical Center. Doctor. Grewell, it's 8 00:00:18,594 --> 00:00:19,875 a pleasure to have you on the podcast 9 00:00:19,875 --> 00:00:20,375 today. 10 00:00:20,914 --> 00:00:23,074 Thank you so much. Good morning, and, thank 11 00:00:23,074 --> 00:00:25,474 you for this opportunity to share my journey, 12 00:00:25,714 --> 00:00:26,375 in medicine. 13 00:00:27,239 --> 00:00:29,719 Absolutely. Absolutely. Well, let's get right into it. 14 00:00:29,719 --> 00:00:30,760 Could you tell us a little bit more 15 00:00:30,760 --> 00:00:32,920 about yourself and your background, what's really brought 16 00:00:32,920 --> 00:00:34,280 you into the role you have today, and 17 00:00:34,280 --> 00:00:36,859 what inspires you to keep delivering great care? 18 00:00:37,559 --> 00:00:39,719 Absolutely. Absolutely. Yeah. So I currently serve as 19 00:00:39,719 --> 00:00:41,744 academic chair for the department of family medicine 20 00:00:41,744 --> 00:00:43,905 at Wright State University, Moonchild School of Medicine. 21 00:00:43,905 --> 00:00:45,984 And my clinical practice, as you mentioned, is 22 00:00:45,984 --> 00:00:48,325 at Premier Health with Premier Physician Network. 23 00:00:48,784 --> 00:00:50,704 And I'm also the whole health clinical lead 24 00:00:50,704 --> 00:00:52,244 at Dayton VA Medical Center. 25 00:00:52,799 --> 00:00:54,559 I am a servant leader, and I do 26 00:00:54,559 --> 00:00:56,559 wish to bring positive change in the communities 27 00:00:56,559 --> 00:00:57,460 that I serve. 28 00:00:57,920 --> 00:01:01,140 Regarding my background, it's somewhat unusual and unique. 29 00:01:01,199 --> 00:01:03,119 I was born in India, and, 30 00:01:03,759 --> 00:01:06,319 my journey in health care, like, spans between 31 00:01:06,319 --> 00:01:08,579 three countries in three different continents, 32 00:01:09,415 --> 00:01:10,954 to this point in my career, 33 00:01:11,334 --> 00:01:14,234 you know, India, United Kingdom, and US. 34 00:01:14,775 --> 00:01:15,094 And, 35 00:01:15,575 --> 00:01:17,655 my training spans three specialties. So, like, I 36 00:01:17,655 --> 00:01:19,895 started with OB GYN, then I did pediatric 37 00:01:19,895 --> 00:01:21,995 medicine, pediatric surgery, and then 38 00:01:22,469 --> 00:01:25,189 family medicine was my final resting place. And, 39 00:01:25,430 --> 00:01:27,030 so I've worked also in three different types 40 00:01:27,030 --> 00:01:29,109 of health care systems. As you're, you know, 41 00:01:29,109 --> 00:01:31,909 aware, you know, systems in India, UK, and 42 00:01:31,909 --> 00:01:34,549 US are very different. So this international experience 43 00:01:34,549 --> 00:01:35,686 has informed my current thoughts and belief system. 44 00:01:35,686 --> 00:01:36,579 I'm a systems thinker. As a child, 45 00:01:37,715 --> 00:01:38,615 system. I'm a systems thinker. 46 00:01:39,954 --> 00:01:42,194 As a child, I was fascinated by the 47 00:01:42,194 --> 00:01:44,034 logic and beauty of mathematics and physics and 48 00:01:44,034 --> 00:01:46,674 nearly actually decided to train in physics or, 49 00:01:46,674 --> 00:01:49,090 like, specialize in physics, but somehow, you know, 50 00:01:49,090 --> 00:01:50,609 as the universe would have it, it wanted 51 00:01:50,609 --> 00:01:51,590 me to go in medicine. 52 00:01:52,450 --> 00:01:54,450 I wanted to find the same foundational truths 53 00:01:54,450 --> 00:01:56,290 in medicine. So that has been difficult to 54 00:01:56,290 --> 00:01:56,790 find. 55 00:01:57,090 --> 00:01:59,409 It's not just advancement in pure sciences that's 56 00:01:59,409 --> 00:02:01,170 going to change health care for all of 57 00:02:01,170 --> 00:02:02,609 us, but, you know, the collective of the 58 00:02:02,609 --> 00:02:04,775 people that need this health care. So there's 59 00:02:05,314 --> 00:02:07,634 also another layer of extreme complexity of the 60 00:02:07,634 --> 00:02:09,794 health care systems, you know, which operationalize the 61 00:02:09,794 --> 00:02:12,034 delivery of care. So all that is gonna 62 00:02:12,034 --> 00:02:13,175 affect how medicine 63 00:02:13,955 --> 00:02:15,574 advances, but I'm still hoping 64 00:02:15,990 --> 00:02:18,010 to be able to found those foundational truths 65 00:02:18,389 --> 00:02:19,530 finally, you know? 66 00:02:19,990 --> 00:02:22,150 So I completed my medical degree at University 67 00:02:22,150 --> 00:02:22,810 of Delhi, 68 00:02:23,270 --> 00:02:24,969 obgyn training as well. 69 00:02:25,430 --> 00:02:27,030 And then I was in UK where I 70 00:02:27,030 --> 00:02:30,169 did, you know, obgyn, pediatric medicine, pediatric surgery, 71 00:02:30,230 --> 00:02:32,814 moved to US for family reasons, pursued a 72 00:02:32,814 --> 00:02:35,534 residency in family medicine, and completed my residency 73 00:02:35,534 --> 00:02:37,555 at the Ohio State University in Columbus, 74 00:02:38,254 --> 00:02:38,754 Ohio. 75 00:02:39,775 --> 00:02:42,014 So after completing the residency, I was in 76 00:02:42,014 --> 00:02:44,495 different roles, both academic, non academic. I was 77 00:02:44,495 --> 00:02:47,150 in Upstate New York, Portland, Oregon, and now 78 00:02:47,150 --> 00:02:48,050 I'm in Ohio. 79 00:02:48,590 --> 00:02:51,090 I've had exposure to practicing medicine in various 80 00:02:51,469 --> 00:02:53,090 private and public healthcare settings. 81 00:02:53,710 --> 00:02:54,030 And, 82 00:02:55,150 --> 00:02:56,849 I would just talk with some transformational 83 00:02:57,150 --> 00:02:59,310 things that happened during this practice. So my 84 00:02:59,310 --> 00:03:01,604 practice as a women's health medical director at 85 00:03:01,685 --> 00:03:04,344 Syracuse VA Medical Center was transformational as 86 00:03:04,724 --> 00:03:06,405 I learned not only to treat my female 87 00:03:06,405 --> 00:03:08,985 veteran patients as patients, but also to advocate 88 00:03:09,125 --> 00:03:11,604 for the best healthcare for them. And I 89 00:03:11,604 --> 00:03:13,525 realized the limitations of what I had to 90 00:03:13,525 --> 00:03:15,525 offer, you know, with my traditional medical training. 91 00:03:15,525 --> 00:03:17,560 And I pursued to increase my toolbox by 92 00:03:17,560 --> 00:03:19,979 initially getting board certified in integrative medicine. 93 00:03:20,519 --> 00:03:22,439 Started applying for some grant funding to support 94 00:03:22,439 --> 00:03:24,599 development of high value healthcare system for our 95 00:03:24,599 --> 00:03:26,840 patients. And that started my journey towards the 96 00:03:26,840 --> 00:03:28,379 whole health systems of care. 97 00:03:29,239 --> 00:03:31,579 We were successful in getting grant funding from 98 00:03:32,165 --> 00:03:34,004 for CERQ's VA to become a design site 99 00:03:34,004 --> 00:03:35,685 for whole health. And some of our wins 100 00:03:35,685 --> 00:03:37,685 were development of a strong foundation of a 101 00:03:37,685 --> 00:03:39,764 whole health pathway with the recruitment and training 102 00:03:39,764 --> 00:03:41,625 of whole health coaches, whole health partners, 103 00:03:42,004 --> 00:03:43,925 in addition to development of whole health wellness 104 00:03:43,925 --> 00:03:45,865 options and clinical care for our patients. 105 00:03:46,180 --> 00:03:48,280 There were some amazing people who joined me 106 00:03:48,980 --> 00:03:51,000 in this journey and they were my team. 107 00:03:51,379 --> 00:03:52,919 I will always cherish them. 108 00:03:53,780 --> 00:03:55,300 At around the same time, I was also 109 00:03:55,300 --> 00:03:56,980 recruited to be vice chair of medical student 110 00:03:56,980 --> 00:03:59,460 education at SUNY Upstate Medical University, Department of 111 00:03:59,460 --> 00:04:00,280 Family Medicine. 112 00:04:00,745 --> 00:04:01,485 Did the foundational work 113 00:04:01,784 --> 00:04:04,264 which was needed to, you know, develop a 114 00:04:04,264 --> 00:04:06,585 new residency program in family medicine, and we 115 00:04:06,585 --> 00:04:08,985 were successful. It started in 2019. It's been 116 00:04:08,985 --> 00:04:10,605 very successful since then. 117 00:04:11,465 --> 00:04:12,685 Then we were also 118 00:04:13,385 --> 00:04:15,625 interested to develop a rural residency. So we 119 00:04:15,625 --> 00:04:16,139 were successful 120 00:04:20,460 --> 00:04:21,280 for a rural 121 00:04:21,740 --> 00:04:24,860 residency program at Auburn Community Hospital, which also, 122 00:04:24,860 --> 00:04:27,420 you know, our first metrical learning class was 123 00:04:27,420 --> 00:04:28,574 in 2022. 124 00:04:28,975 --> 00:04:30,495 So during my work as a PI of 125 00:04:30,495 --> 00:04:32,095 this grant, I also ended up, you know, 126 00:04:32,095 --> 00:04:34,014 kind of doing a deeper dive in, you 127 00:04:34,014 --> 00:04:35,775 know, the state of rural health, you know, 128 00:04:35,775 --> 00:04:36,595 rural interprofessional, 129 00:04:38,335 --> 00:04:41,055 you know, faculty development, and, you know, also 130 00:04:41,055 --> 00:04:43,215 to look at how to provide equitable care 131 00:04:43,215 --> 00:04:44,355 to our rural communities. 132 00:04:45,339 --> 00:04:47,660 Subsequently had some extra training in, you know, 133 00:04:47,660 --> 00:04:50,060 leadership. I was nominated by SUNY Upstate for 134 00:04:50,060 --> 00:04:52,699 executive leadership in healthcare at Drexel and completed 135 00:04:52,699 --> 00:04:54,720 my fellowship in 2023. 136 00:04:55,259 --> 00:04:57,099 I've had some wonderful mentors, colleagues in my 137 00:04:57,099 --> 00:04:58,699 journey at SUNY as well who helped me 138 00:04:58,699 --> 00:05:00,605 grow and become useful member, you know, of 139 00:05:00,605 --> 00:05:01,264 the community. 140 00:05:02,205 --> 00:05:03,644 So my next big transition in life, I 141 00:05:03,644 --> 00:05:05,404 was recruited to be chair of family medicine 142 00:05:05,404 --> 00:05:07,564 at, you know, Wright State University, BESAM, in 143 00:05:07,564 --> 00:05:10,205 February 2023 and have been very fortunate to 144 00:05:10,205 --> 00:05:11,964 have had some very gifted and accomplished, 145 00:05:13,180 --> 00:05:16,300 faculty members and mentors as well. And, since 146 00:05:16,300 --> 00:05:18,060 the beginning of my tenure as chair here, 147 00:05:18,060 --> 00:05:20,459 we have seen significant growth and development of 148 00:05:20,459 --> 00:05:22,399 a rural residency at Greenville, Ohio, 149 00:05:22,779 --> 00:05:24,079 Addiction Bass and Fellowship. 150 00:05:24,620 --> 00:05:26,540 Our department of family medicine has supported global 151 00:05:26,540 --> 00:05:28,625 health education for our medical students, and now 152 00:05:28,625 --> 00:05:31,025 we are developing lifestyle medicine education for our 153 00:05:31,025 --> 00:05:33,745 medical students. And, so this comes this is 154 00:05:33,745 --> 00:05:35,824 in my wheelhouse. And so we also have 155 00:05:35,824 --> 00:05:38,384 a brand new street medicine program that, we 156 00:05:38,384 --> 00:05:40,305 care a lot about. So that, in a 157 00:05:40,305 --> 00:05:43,045 nutshell, you know, summarizes where I am. 158 00:05:44,000 --> 00:05:45,600 Well, that's amazing to hear. And what a 159 00:05:45,600 --> 00:05:48,000 unique career journey you've had, but that passion 160 00:05:48,000 --> 00:05:50,480 for medicine and helping people and really making 161 00:05:50,480 --> 00:05:52,660 sense of the complexities in health care, 162 00:05:53,040 --> 00:05:55,040 shines through. And so that's amazing to hear, 163 00:05:55,040 --> 00:05:56,400 you know, all the things you've been able 164 00:05:56,400 --> 00:05:58,194 to accomplish so far and then what you're 165 00:05:58,194 --> 00:05:59,955 working on today. And speaking of that, what 166 00:05:59,955 --> 00:06:01,715 are some of the opportunities and headwinds that 167 00:06:01,715 --> 00:06:03,095 you have your eye on right now? 168 00:06:03,715 --> 00:06:05,314 Yeah. So there's been a lot of change 169 00:06:05,314 --> 00:06:07,395 here, so since I joined. Yeah. So the 170 00:06:07,395 --> 00:06:09,475 most exciting change has been that Premier Health 171 00:06:09,475 --> 00:06:12,519 and RightSearch University closely aligned their operations under 172 00:06:12,519 --> 00:06:15,089 a new long term affiliation agreement in April 173 00:06:15,089 --> 00:06:15,819 2024, 174 00:06:16,120 --> 00:06:18,519 which enhances Dayton region's access to state of 175 00:06:18,519 --> 00:06:20,839 art medical care. So this new agreement highlights 176 00:06:20,839 --> 00:06:23,419 the institution's shared commitment to excellence in education, 177 00:06:23,560 --> 00:06:25,180 workforce and economic development, 178 00:06:26,035 --> 00:06:29,074 research, clinical program development, and community health. The 179 00:06:29,074 --> 00:06:32,754 partnership is obviously transformational, and it prioritizes producing 180 00:06:32,754 --> 00:06:35,014 more clinicians, nurses, or the health care providers 181 00:06:35,235 --> 00:06:37,769 that would support our community, spurring new research 182 00:06:38,009 --> 00:06:40,649 opportunities, providing patients better access to vital medical 183 00:06:40,649 --> 00:06:42,089 care, like closer to home so they don't 184 00:06:42,089 --> 00:06:43,610 have to drive, you know, away to other 185 00:06:43,610 --> 00:06:45,069 places to get their care. 186 00:06:45,370 --> 00:06:47,769 And also, you know, formally establishes a primary 187 00:06:47,769 --> 00:06:48,589 academic affiliation, 188 00:06:49,930 --> 00:06:50,430 between, 189 00:06:50,889 --> 00:06:53,289 Wright State and Premier Health, including all Wright 190 00:06:53,289 --> 00:06:53,745 State's colleges 191 00:06:56,785 --> 00:06:57,524 sites of care. 192 00:06:57,904 --> 00:06:59,824 So this provides us new opportunities, you know, 193 00:06:59,824 --> 00:07:02,704 for federal funding to support clinical activities, teaching, 194 00:07:02,704 --> 00:07:04,245 research. And this 195 00:07:04,704 --> 00:07:06,704 will also position Premier Health and Wright State 196 00:07:06,704 --> 00:07:09,330 to develop a comprehensive collaborative approach to meet 197 00:07:09,330 --> 00:07:11,670 the needs of the community for the future. 198 00:07:11,970 --> 00:07:13,810 For the Department of Family Medicine, it will 199 00:07:13,810 --> 00:07:16,370 support our missions of education, clinical care, and 200 00:07:16,370 --> 00:07:19,170 research by supporting innovation, community engagement on a 201 00:07:19,170 --> 00:07:20,310 much larger scale. 202 00:07:20,610 --> 00:07:22,689 We'll also be able to have increased access 203 00:07:22,689 --> 00:07:24,935 to interdisciplinary, inter professional collaboration. 204 00:07:25,555 --> 00:07:27,794 BSM already has strong track record in primary 205 00:07:27,794 --> 00:07:30,115 care medical student education, and this agreement will 206 00:07:30,115 --> 00:07:32,675 likely give access to more educators, you know, 207 00:07:32,675 --> 00:07:34,594 for the medical students at Premier and greater 208 00:07:34,594 --> 00:07:36,594 access to quality and high value care for 209 00:07:36,594 --> 00:07:37,334 our community. 210 00:07:38,220 --> 00:07:40,000 We are also very excited about, 211 00:07:41,420 --> 00:07:44,379 introduction of, AI. So it's introduction of ambient 212 00:07:44,379 --> 00:07:47,420 AI Daxko pilot at Premier Health. It's, starting 213 00:07:47,420 --> 00:07:49,579 this month, and it's gonna allow us to 214 00:07:49,579 --> 00:07:51,100 focus more on what we do best, that 215 00:07:51,100 --> 00:07:52,779 is take care of patients not having to 216 00:07:52,779 --> 00:07:55,264 spend twice as much time on documentation. So 217 00:07:55,264 --> 00:07:56,965 it will help us position wellness. 218 00:07:57,985 --> 00:07:59,504 The next one I would like to, you 219 00:07:59,504 --> 00:08:00,405 know, specifically, 220 00:08:01,425 --> 00:08:03,365 you know, mention is, 221 00:08:04,625 --> 00:08:05,125 Premier's 222 00:08:05,905 --> 00:08:08,085 partnership with Agilon. So this is 223 00:08:08,839 --> 00:08:11,319 a health care tech company which helps to 224 00:08:11,319 --> 00:08:14,120 improve health outcomes for seniors with resources like 225 00:08:14,120 --> 00:08:15,660 new technology and care navigators. 226 00:08:16,199 --> 00:08:18,279 So Premier Health is a nonprofit health care 227 00:08:18,279 --> 00:08:20,199 system which has five hospitals, more than 100 228 00:08:20,199 --> 00:08:21,900 locations across seven counties. 229 00:08:22,435 --> 00:08:24,995 Agilent Healthcare offers resources to physician partners to 230 00:08:24,995 --> 00:08:27,235 practice value based care through its total care 231 00:08:27,235 --> 00:08:29,475 model. So this is a more holistic approach 232 00:08:29,475 --> 00:08:31,634 to Medicare Advantage patients. So it gives them 233 00:08:31,634 --> 00:08:32,535 a high value, 234 00:08:32,914 --> 00:08:34,294 enhanced total system. 235 00:08:35,394 --> 00:08:35,894 And 236 00:08:37,490 --> 00:08:37,990 so, 237 00:08:38,690 --> 00:08:42,209 it kind of, provides technology, people, capital, process 238 00:08:42,209 --> 00:08:44,209 access to a peer network of more than 239 00:08:44,209 --> 00:08:45,089 2,700 240 00:08:45,089 --> 00:08:46,149 primary care physicians. 241 00:08:46,450 --> 00:08:48,129 So one of the benefits of partnership is 242 00:08:48,129 --> 00:08:50,450 additional care managers to help our patients navigate 243 00:08:50,450 --> 00:08:52,264 the health system between appointments. 244 00:08:52,804 --> 00:08:56,245 Agilent's tech platform connects multiple peers, patients, and 245 00:08:56,245 --> 00:08:58,164 physicians into a single platform to create a 246 00:08:58,164 --> 00:09:00,184 single experience for patients and physicians. 247 00:09:00,804 --> 00:09:03,764 Physicians also experience data integration and clinical programs 248 00:09:03,764 --> 00:09:04,860 through Agilent's platform. 249 00:09:11,339 --> 00:09:13,419 Very closely aligned with my concept of whole 250 00:09:13,419 --> 00:09:15,500 health and whole person care. So, you know, 251 00:09:15,500 --> 00:09:17,600 I'm very excited to participate in this. 252 00:09:18,725 --> 00:09:20,804 Other one is our development of street medicine 253 00:09:20,804 --> 00:09:22,424 program that we were very, 254 00:09:23,044 --> 00:09:25,764 you know, fortunate to get grant funding for. 255 00:09:25,924 --> 00:09:27,125 And I will talk a little bit more 256 00:09:27,125 --> 00:09:28,965 about that later. But it's in collaboration with 257 00:09:28,965 --> 00:09:31,120 Premier Health, and it is to meet the 258 00:09:31,120 --> 00:09:33,120 underserved members of a community where they are 259 00:09:33,120 --> 00:09:35,139 and to get them established in regular healthcare. 260 00:09:35,919 --> 00:09:38,240 Regarding education of America students, we are excited 261 00:09:38,240 --> 00:09:40,240 about our new elective, which we started offering 262 00:09:40,240 --> 00:09:42,339 to our students in food as medicine. 263 00:09:42,975 --> 00:09:44,894 And we are planning for another elective next 264 00:09:44,894 --> 00:09:46,735 year, which is going to be exercises medicine. 265 00:09:46,735 --> 00:09:47,235 So 266 00:09:47,615 --> 00:09:49,695 that's our beginnings of our, you know, foundational 267 00:09:49,695 --> 00:09:51,634 work in lifestyle medicine here. 268 00:09:52,254 --> 00:09:53,235 I'm also looking 269 00:09:54,590 --> 00:09:57,710 very closely at rural health transformation program funding. 270 00:09:57,710 --> 00:09:59,549 And it'll be interesting to see, you know, 271 00:09:59,549 --> 00:09:59,950 if, 272 00:10:00,669 --> 00:10:02,910 you know, Ohio gets funded and then, you 273 00:10:02,910 --> 00:10:04,910 know, what innovative solutions are going to be 274 00:10:04,910 --> 00:10:06,210 coming, you know, our way, 275 00:10:07,735 --> 00:10:09,735 to help with the problem of healthcare access 276 00:10:09,735 --> 00:10:11,355 and capacity in rural America. 277 00:10:11,975 --> 00:10:14,534 Now headwinds. So headwinds are same as everyone 278 00:10:14,534 --> 00:10:16,774 in healthcare and education. It's a very complex 279 00:10:16,774 --> 00:10:17,674 healthcare landscape 280 00:10:18,375 --> 00:10:20,294 and same actions do not always translate to 281 00:10:20,294 --> 00:10:22,794 same results in different situations, in different locations. 282 00:10:22,855 --> 00:10:25,789 And you know, so we have to always, 283 00:10:25,789 --> 00:10:28,289 you know, plan, you know, for that. 284 00:10:28,669 --> 00:10:30,830 AI and healthcare is another wild card. I'm 285 00:10:30,830 --> 00:10:33,389 very optimistic, but unethical use of AI can 286 00:10:33,389 --> 00:10:34,129 be disastrous. 287 00:10:34,669 --> 00:10:37,629 So I participate in, DATNV's Vision ten AI 288 00:10:37,629 --> 00:10:39,584 Committee to support the ethical use of AI 289 00:10:39,584 --> 00:10:41,904 in healthcare. And it's very interesting to see 290 00:10:41,904 --> 00:10:43,584 all the different projects that are coming our 291 00:10:43,584 --> 00:10:44,084 way. 292 00:10:44,784 --> 00:10:47,205 Rural health landscape is obviously a bit unpredictable 293 00:10:47,345 --> 00:10:49,365 at this time despite our best efforts. 294 00:10:50,304 --> 00:10:51,044 And then 295 00:10:51,504 --> 00:10:53,345 I'm I'm really looking forward to see what 296 00:10:53,345 --> 00:10:54,245 happens next. 297 00:10:55,800 --> 00:10:57,800 Absolutely. It's just so many factors, as you 298 00:10:57,800 --> 00:10:59,580 said, coming together to really create 299 00:10:59,960 --> 00:11:03,000 a, bunch of opportunities, but also some challenges 300 00:11:03,000 --> 00:11:05,420 and especially thinking about the technology and AI 301 00:11:05,559 --> 00:11:07,720 and really where, you know, that can converge 302 00:11:07,720 --> 00:11:09,240 into a space where you can get to 303 00:11:09,240 --> 00:11:10,644 more of that predictive, 304 00:11:11,125 --> 00:11:13,845 holistic care and value based care too. Now 305 00:11:13,845 --> 00:11:15,764 when you think about value especially, how are 306 00:11:15,764 --> 00:11:18,164 you looking at growth in the future, adding 307 00:11:18,164 --> 00:11:20,325 value to the organizations that you're working with? 308 00:11:20,325 --> 00:11:21,684 What does that really look like for you, 309 00:11:21,684 --> 00:11:23,445 and how are you thinking about that at 310 00:11:23,445 --> 00:11:24,585 a strategic level? 311 00:11:25,389 --> 00:11:27,470 Absolutely. So the big goal of Red State 312 00:11:27,470 --> 00:11:29,470 University, based on the Department of Family Medicine, 313 00:11:29,470 --> 00:11:31,490 is to align with the current healthcare environment, 314 00:11:32,509 --> 00:11:35,470 mission, value, and vision of our organizations, and 315 00:11:35,470 --> 00:11:37,789 also still trade stay true to our own 316 00:11:37,789 --> 00:11:39,470 mission and values. So we have our own 317 00:11:39,470 --> 00:11:42,735 vision, which is preparing tomorrow's family physicians to 318 00:11:42,735 --> 00:11:44,674 enhance the health and well-being of the communities 319 00:11:44,735 --> 00:11:47,375 they serve by defining and providing state of 320 00:11:47,375 --> 00:11:48,115 art healthcare. 321 00:11:48,495 --> 00:11:49,855 Our mission is to lead the way in 322 00:11:49,855 --> 00:11:52,254 educating the next generation of physicians by modeling 323 00:11:52,254 --> 00:11:54,679 the patient centered principles of family medicine, serving 324 00:11:54,679 --> 00:11:56,839 our community's health needs, and contributing to the 325 00:11:56,839 --> 00:11:58,539 scholarly advancement of medicine. 326 00:11:59,000 --> 00:12:00,600 So we have to support rural medicine and 327 00:12:00,600 --> 00:12:02,679 support rural residency. We have to learn how 328 00:12:02,679 --> 00:12:04,839 to leverage, you know, technology and AI to 329 00:12:04,839 --> 00:12:07,500 support, you know, rural health. So we'll continue 330 00:12:07,559 --> 00:12:10,284 to, you know, strive for that. And I 331 00:12:10,284 --> 00:12:12,444 am working with Premier Health, and I am 332 00:12:12,444 --> 00:12:14,304 actively participating in that. 333 00:12:14,764 --> 00:12:16,865 We have to continue to do community outreach, 334 00:12:16,924 --> 00:12:18,845 which we do both from, you know, Bucharest 335 00:12:18,845 --> 00:12:20,845 School of Medicine as well as from Premier 336 00:12:20,845 --> 00:12:21,345 side, 337 00:12:22,309 --> 00:12:24,950 and the VA side. And, we support street 338 00:12:24,950 --> 00:12:27,429 medicine program and addiction medicine program for health 339 00:12:27,429 --> 00:12:29,610 equity to support the community. And, 340 00:12:30,710 --> 00:12:32,629 you know, these are new programs for us, 341 00:12:32,629 --> 00:12:34,629 and we are very excited, you know, to, 342 00:12:34,950 --> 00:12:36,570 you know, support their growth. 343 00:12:37,184 --> 00:12:39,345 We also have an MD in three program 344 00:12:39,345 --> 00:12:41,585 for family medicine, in which our medical students 345 00:12:41,585 --> 00:12:43,424 can graduate in three years if they decide 346 00:12:43,424 --> 00:12:45,665 to go in family medicine or pediatrics, and 347 00:12:45,665 --> 00:12:46,065 then, 348 00:12:46,785 --> 00:12:48,465 you know, go into a residency in family 349 00:12:48,465 --> 00:12:49,889 medicine. And this is, you know, one of 350 00:12:49,889 --> 00:12:52,610 the initiatives at, Montreal School of Medicine to 351 00:12:52,610 --> 00:12:53,909 support primary care. 352 00:12:54,449 --> 00:12:56,610 We also support our family medicine interest groups 353 00:12:56,610 --> 00:12:58,610 and students so that we can continue to 354 00:12:58,610 --> 00:13:00,529 have a robust pipeline of our primary care 355 00:13:00,529 --> 00:13:02,289 providers that stay in the area and that 356 00:13:02,289 --> 00:13:03,190 serve our communities. 357 00:13:04,345 --> 00:13:06,585 And with my specific background in integrated medicine 358 00:13:06,585 --> 00:13:08,664 whole health, you know, developed the UME and 359 00:13:08,664 --> 00:13:11,945 GME in education about lifestyle medicine, especially nutrition 360 00:13:11,945 --> 00:13:13,085 and exercise and, 361 00:13:13,504 --> 00:13:15,465 you know, and and and fine arts, you 362 00:13:15,465 --> 00:13:17,544 know, and how to build health and not 363 00:13:17,544 --> 00:13:18,605 just treat disease. 364 00:13:19,160 --> 00:13:20,920 And how to engage with leadership, you know, 365 00:13:20,920 --> 00:13:23,320 to support ambient AI, Agilent partnership, you know, 366 00:13:23,320 --> 00:13:24,940 implementation in primary care, 367 00:13:25,480 --> 00:13:27,160 how to help with recruitment of strong primary 368 00:13:27,160 --> 00:13:29,240 care workforce, which not only provides excellent care, 369 00:13:29,240 --> 00:13:31,420 but is curious, right, and loves to teach. 370 00:13:31,904 --> 00:13:33,925 How to support our faculty, you know, 371 00:13:34,465 --> 00:13:36,465 how to do robust research and how to, 372 00:13:36,465 --> 00:13:38,865 you know, engage in clinical trials, how to 373 00:13:38,865 --> 00:13:41,665 use lean principles to optimize current processes, build 374 00:13:41,665 --> 00:13:43,605 capacity, higher value care, 375 00:13:44,059 --> 00:13:45,899 and then innovation and sharing of knowledge. Right? 376 00:13:45,899 --> 00:13:48,059 We have to disseminate knowledge as well and 377 00:13:48,059 --> 00:13:50,240 publish, you know, to develop and also, 378 00:13:50,620 --> 00:13:53,440 you know, develop innovative processes in clinical care. 379 00:13:54,620 --> 00:13:57,419 Engage in philanthropic activities, which support the mission 380 00:13:57,419 --> 00:13:59,039 of my department. And, 381 00:13:59,434 --> 00:14:01,195 I think the most important one is that 382 00:14:01,195 --> 00:14:02,174 we have to create 383 00:14:03,355 --> 00:14:06,554 a replicable, patient centered, high value, whole person 384 00:14:06,554 --> 00:14:08,794 care model in outpatient setting, which is powered 385 00:14:08,794 --> 00:14:10,014 by digital tools, 386 00:14:10,394 --> 00:14:12,794 agentic and ambient AI, as well as high 387 00:14:12,794 --> 00:14:13,615 touch and humanistic, 388 00:14:14,529 --> 00:14:16,769 and community based tools, such as health coaching, 389 00:14:16,769 --> 00:14:19,429 health partners, primary care mental health integration, nutrition, 390 00:14:19,730 --> 00:14:22,470 lifestyle medicine, group visits, which are financially sustainable. 391 00:14:23,009 --> 00:14:25,490 So develop whole health and lifestyle medicine all 392 00:14:25,490 --> 00:14:27,615 the way from in vitro trials in the 393 00:14:27,615 --> 00:14:29,534 lab to clinical care and the community with 394 00:14:29,534 --> 00:14:31,455 a lofty goal to create a mini bruzone 395 00:14:31,455 --> 00:14:34,014 and engage local communities and organizations. And I 396 00:14:34,014 --> 00:14:36,014 think I worked very hard to gather some 397 00:14:36,014 --> 00:14:37,214 of the tools, you know, to help with 398 00:14:37,214 --> 00:14:38,735 this goal, and I'm just hoping that I 399 00:14:38,735 --> 00:14:39,634 could be the spark. 400 00:14:41,990 --> 00:14:43,990 I love that. There's so much you said 401 00:14:43,990 --> 00:14:46,070 there that really truly was inspiring to think 402 00:14:46,070 --> 00:14:48,330 about how health care is changing, the possibilities, 403 00:14:48,549 --> 00:14:50,790 and, you know, just having someone like yourself 404 00:14:50,790 --> 00:14:52,870 being that spark, being that person who can 405 00:14:52,870 --> 00:14:54,889 think it and dream it, and then actually 406 00:14:55,294 --> 00:14:57,774 implementing, go start doing it is amazing and 407 00:14:57,774 --> 00:14:59,074 incredible to see, 408 00:14:59,454 --> 00:15:01,454 you know, how you've been able to manage 409 00:15:01,454 --> 00:15:03,694 all these factors coming together to really truly 410 00:15:03,694 --> 00:15:05,634 support the communities that you're serving. 411 00:15:06,334 --> 00:15:08,334 I know resources are tied. We've kinda touched 412 00:15:08,334 --> 00:15:09,464 on it briefly here in our conversation now, 413 00:15:09,464 --> 00:15:09,899 but 414 00:15:11,500 --> 00:15:12,879 hospitals and systems and organizations 415 00:15:13,180 --> 00:15:15,660 are, looking at tight margins now and the 416 00:15:15,660 --> 00:15:17,519 potential for even more tighter, 417 00:15:18,059 --> 00:15:20,139 financial situations in the future. So when you 418 00:15:20,139 --> 00:15:21,660 think about all of these things, what is 419 00:15:21,660 --> 00:15:24,220 one risk or investment that is still worth 420 00:15:24,220 --> 00:15:25,875 making in the next year or so, 421 00:15:26,355 --> 00:15:28,375 even as resources are are tight? 422 00:15:28,914 --> 00:15:30,355 Absolutely. So right now, I think it is 423 00:15:30,355 --> 00:15:32,034 gonna be the street medicine program for us. 424 00:15:32,034 --> 00:15:33,634 You know, we just launched it, you know, 425 00:15:33,634 --> 00:15:36,195 in January '25, and the lead institution is 426 00:15:36,195 --> 00:15:38,355 Wright State University, Bunchal School of Medicine. Our 427 00:15:38,355 --> 00:15:39,975 key partners are Premier Health, 428 00:15:40,309 --> 00:15:41,450 Dayton Dream Center. 429 00:15:41,830 --> 00:15:43,750 You know, we have full funding from the 430 00:15:43,750 --> 00:15:45,990 federal government for this. We also have a 431 00:15:45,990 --> 00:15:48,629 two year one Ohio Recovery Foundation award for 432 00:15:48,629 --> 00:15:50,409 nearly, you know, dollars 300,000. 433 00:15:51,350 --> 00:15:53,350 We have a new HRSA Street Medicine Training 434 00:15:53,350 --> 00:15:55,110 Grant, which is a five year federal award, 435 00:15:55,110 --> 00:15:58,254 you know, supporting expanded training, capacity building, long 436 00:15:58,254 --> 00:15:59,315 term program sustainability. 437 00:16:00,174 --> 00:16:01,934 And so this is gonna be, you know, 438 00:16:01,934 --> 00:16:04,575 it's a mobile community based clinical initiative, and 439 00:16:04,575 --> 00:16:07,375 it is designed to bring low barrier primary 440 00:16:07,375 --> 00:16:07,875 care, 441 00:16:08,350 --> 00:16:11,070 behavioral health support, and substance use services directly 442 00:16:11,070 --> 00:16:13,629 to the individuals that are experiencing homelessness or 443 00:16:13,629 --> 00:16:15,649 housing instability in the Dayton region. 444 00:16:16,110 --> 00:16:18,750 So this program integrates our community service with 445 00:16:18,750 --> 00:16:21,389 robust, federally supported clinical training through the HRSA 446 00:16:21,389 --> 00:16:21,889 award. 447 00:16:22,445 --> 00:16:25,164 We'll be providing primary preventive care delivered at 448 00:16:25,164 --> 00:16:28,125 mobile clinic sites, behavioral health services, including counseling 449 00:16:28,125 --> 00:16:30,924 support, substance use screening, you know, brief intervention 450 00:16:30,924 --> 00:16:31,985 referral to treatment, 451 00:16:32,524 --> 00:16:34,705 care navigation, you know, case management, 452 00:16:35,289 --> 00:16:37,049 and sort of low barrier engagement for patients 453 00:16:37,049 --> 00:16:40,009 without transportation or insurance. Right? Same time, we'll 454 00:16:40,009 --> 00:16:40,910 also be educating, 455 00:16:41,370 --> 00:16:43,929 you know, our residents. So, so there's gonna 456 00:16:43,929 --> 00:16:46,090 be structured training for about 50 right stage 457 00:16:46,090 --> 00:16:47,789 students across medical behavioral 458 00:16:48,250 --> 00:16:49,149 science disciplines, 459 00:16:50,345 --> 00:16:52,524 to enable them to have deeper competency, 460 00:16:52,825 --> 00:16:54,204 you know, in 461 00:16:54,985 --> 00:16:55,804 this work. 462 00:16:56,664 --> 00:16:58,264 So the training elements are going to be 463 00:16:58,264 --> 00:17:00,904 street medicine foundations, which is low barrier care, 464 00:17:00,904 --> 00:17:04,025 trauma informed practice, harm reduction, then clinical skills 465 00:17:04,025 --> 00:17:06,440 in the field, patient assessment, how you wound 466 00:17:06,440 --> 00:17:07,900 care, chronic disease management, 467 00:17:08,440 --> 00:17:10,140 substance use disorder curriculum, 468 00:17:10,759 --> 00:17:13,180 social determinants of health education, interprofessional 469 00:17:13,480 --> 00:17:15,660 collaboration with behavioral health community workers, 470 00:17:16,119 --> 00:17:19,244 documentation, continuity of care in mobile settings, reflective 471 00:17:19,384 --> 00:17:21,164 practice and team debriefing. 472 00:17:22,424 --> 00:17:24,744 And then, you know, also different enhancements like 473 00:17:24,744 --> 00:17:26,924 faculty development, evaluation infrastructure, 474 00:17:27,224 --> 00:17:28,044 you know, sustainability 475 00:17:28,345 --> 00:17:28,845 planning. 476 00:17:29,144 --> 00:17:31,850 So community impact. So this program will increase 477 00:17:31,850 --> 00:17:34,330 access to care for individuals often who are 478 00:17:34,330 --> 00:17:37,230 disconnected from the healthcare system and experiencing homelessness, 479 00:17:37,370 --> 00:17:38,509 substance use disorder, 480 00:17:38,890 --> 00:17:41,529 and behavioral health challenges. Hopefully, it'll reduce ED 481 00:17:41,529 --> 00:17:42,825 reliance and improve, 482 00:17:43,704 --> 00:17:46,904 linkage to ongoing care. So strategically strengthens, you 483 00:17:46,904 --> 00:17:49,464 know, Ryerson University's mission in community engagement and 484 00:17:49,464 --> 00:17:51,164 primary care education and also 485 00:17:51,544 --> 00:17:54,444 expands our workforce training and underserved population medicine, 486 00:17:54,664 --> 00:17:55,964 with, these HRSA, 487 00:17:56,585 --> 00:17:57,565 supported competencies. 488 00:18:00,130 --> 00:18:02,450 Got it. Wow. That's amazing to hear. And, 489 00:18:02,450 --> 00:18:04,529 you know, certainly such a a needed service 490 00:18:04,529 --> 00:18:07,250 for the community and especially thinking about how 491 00:18:07,250 --> 00:18:09,330 you can bring care to people and make 492 00:18:09,330 --> 00:18:11,890 sure that, you're you're hitting all the boxes, 493 00:18:11,890 --> 00:18:14,230 bringing those community workers and everybody, 494 00:18:15,065 --> 00:18:16,825 on board so that you can have such 495 00:18:16,825 --> 00:18:19,785 a a functional and, beneficial program. I think, 496 00:18:19,785 --> 00:18:21,704 you know, looking ahead with our last couple 497 00:18:21,704 --> 00:18:22,904 of minutes here, where do you see some 498 00:18:22,904 --> 00:18:24,825 of the best opportunities for that continued growth 499 00:18:24,825 --> 00:18:26,664 in the future? How are you looking even 500 00:18:26,664 --> 00:18:29,240 further ahead, to really build the the blocks 501 00:18:29,240 --> 00:18:31,639 of foundation for the programs that are so 502 00:18:31,639 --> 00:18:32,599 important to you, 503 00:18:33,000 --> 00:18:34,859 in in in those next few years? 504 00:18:35,559 --> 00:18:36,700 Absolutely. So, 505 00:18:37,079 --> 00:18:39,880 you know, chronic disease management and population health. 506 00:18:39,880 --> 00:18:41,639 Absolutely. You know? So with rising rates of 507 00:18:41,639 --> 00:18:44,845 diabetes, heart disease, CKD, multi, you know, morbidity, 508 00:18:44,845 --> 00:18:47,025 primary care is the center of management. Right? 509 00:18:47,164 --> 00:18:49,164 So future is in value based care pivoting 510 00:18:49,164 --> 00:18:52,204 towards providing best, fastest, most successful primary care 511 00:18:52,204 --> 00:18:54,284 in the most cost effective manner by leveraging 512 00:18:54,284 --> 00:18:54,784 technology, 513 00:18:55,244 --> 00:18:58,365 such as telehealth, remote patient monitoring, Adientiq AI 514 00:18:58,365 --> 00:18:59,539 that supports triage, 515 00:19:00,160 --> 00:19:02,500 documentation in in addition to revenue cycle management, 516 00:19:03,039 --> 00:19:05,600 generative AI, which empowers patient providers at the 517 00:19:05,600 --> 00:19:06,420 same time. 518 00:19:07,360 --> 00:19:08,100 And then, 519 00:19:08,720 --> 00:19:10,500 you know, again, you know, as we see, 520 00:19:12,015 --> 00:19:14,015 you know, AI and health care explosion and 521 00:19:14,015 --> 00:19:16,575 digital health growth is gonna redefine, you know, 522 00:19:16,575 --> 00:19:18,674 interest in value based care for all populations. 523 00:19:18,815 --> 00:19:20,035 So the future is, 524 00:19:20,335 --> 00:19:22,255 you know, where the patient is, not just 525 00:19:22,255 --> 00:19:24,095 caring for the sick where the providers are. 526 00:19:24,095 --> 00:19:26,740 Right? So virtual chronic care clinics, you know, 527 00:19:26,740 --> 00:19:29,619 building hybrid outpatient models inside healthcare systems are 528 00:19:29,619 --> 00:19:31,779 gonna be needed. Care of the elderly, you 529 00:19:31,779 --> 00:19:33,539 know, we're gonna need that, right, as more 530 00:19:33,539 --> 00:19:35,460 of our patients are getting older. So all 531 00:19:35,460 --> 00:19:37,460 these senior care primary care models are very 532 00:19:37,460 --> 00:19:37,960 useful. 533 00:19:38,444 --> 00:19:41,884 Obesity medicine, lifestyle medicine, you know, rural underserved 534 00:19:41,884 --> 00:19:43,345 primary care models. 535 00:19:43,804 --> 00:19:46,125 And then preventable lifestyle medicine. So high patient 536 00:19:46,125 --> 00:19:49,005 demand, low supply, you know, because of demand 537 00:19:49,005 --> 00:19:51,244 reimbursement mismatch at this time, which may get 538 00:19:51,244 --> 00:19:53,309 corrected with new payment models, such as direct 539 00:19:53,309 --> 00:19:55,789 payment to pay to to people to purchase 540 00:19:55,789 --> 00:19:57,230 their own health care and decide where they 541 00:19:57,230 --> 00:19:58,509 wanna put the money. Right? So in the 542 00:19:58,750 --> 00:20:00,349 they can put it in health savings accounts 543 00:20:00,349 --> 00:20:01,710 and use it the way they wanna use 544 00:20:01,710 --> 00:20:04,190 it. So whole person care model, you know, 545 00:20:04,190 --> 00:20:06,109 for all with a clear definition of what 546 00:20:06,109 --> 00:20:08,204 it means, Right? And then a clear implementation 547 00:20:08,424 --> 00:20:10,345 plan with AI support. I think it'll be 548 00:20:10,345 --> 00:20:12,345 an honorable goal for any company that can 549 00:20:12,345 --> 00:20:14,345 develop it and scale it up. Yeah. So 550 00:20:14,345 --> 00:20:16,585 medicine still hasn't found its beautiful, simple, basic 551 00:20:16,585 --> 00:20:18,585 equations, but we can strive for whole person 552 00:20:18,585 --> 00:20:20,460 care that can be scaled up. And we 553 00:20:20,460 --> 00:20:21,980 have to strive for health while taking care 554 00:20:21,980 --> 00:20:23,419 of the sick. And we have to strive 555 00:20:23,419 --> 00:20:25,419 for happiness and good health for everyone while 556 00:20:25,419 --> 00:20:27,200 taking care of those who are less fortunate. 557 00:20:27,579 --> 00:20:29,339 And we have to support patients and provide 558 00:20:29,339 --> 00:20:30,720 autonomy and goal sharing. 559 00:20:31,099 --> 00:20:32,940 And, you know, opportunities for growth are gonna 560 00:20:32,940 --> 00:20:34,964 need policy support and advocacy for the same, 561 00:20:34,964 --> 00:20:37,125 and it takes a village, you know, to 562 00:20:37,125 --> 00:20:38,345 to do this. And, 563 00:20:38,724 --> 00:20:40,724 I mean, that's, that's all I would like 564 00:20:40,724 --> 00:20:41,305 to say. 565 00:20:43,125 --> 00:20:45,445 Fantastic. Well, you know, this is amazing. And, 566 00:20:45,940 --> 00:20:47,700 this vision of health care that you have 567 00:20:47,700 --> 00:20:49,940 is truly incredible. Doctor Grewell, thank you so 568 00:20:49,940 --> 00:20:51,539 much for joining us on the podcast today. 569 00:20:51,539 --> 00:20:53,779 This has been a really fun conversation for 570 00:20:53,779 --> 00:20:55,539 me. I've learned a lot and I'm inspired 571 00:20:55,539 --> 00:20:57,140 by your passion. I look forward to connecting 572 00:20:57,140 --> 00:20:59,220 with you and continuing this conversation in the 573 00:20:59,220 --> 00:20:59,720 future. 574 00:21:00,099 --> 00:21:01,335 Thank Thank you so much. Thank you so 575 00:21:01,335 --> 00:21:03,335 much for this opportunity. And, I would like 576 00:21:03,335 --> 00:21:05,095 to also thank, you know, all of my 577 00:21:05,095 --> 00:21:07,654 colleagues, my faculty, you know, who who who 578 00:21:07,654 --> 00:21:09,575 do this work and who make the make 579 00:21:09,575 --> 00:21:11,434 this happen. You know? Thank you.