This is Laura Dierdahl with the Becker's Healthcare
Podcast. I'm thrilled today to be joined by
doctor Harmander Grewal, who is the chair of
the department of family medicine at Wright State
University, Boonstraff School of Medicine, a physician at
Premier Health, and the Whole Health Clinical Lead
at Dayton VA Medical Center. Doctor. Grewell, it's
a pleasure to have you on the podcast
today.
Thank you so much. Good morning, and, thank
you for this opportunity to share my journey,
in medicine.
Absolutely. Absolutely. Well, let's get right into it.
Could you tell us a little bit more
about yourself and your background, what's really brought
you into the role you have today, and
what inspires you to keep delivering great care?
Absolutely. Absolutely. Yeah. So I currently serve as
academic chair for the department of family medicine
at Wright State University, Moonchild School of Medicine.
And my clinical practice, as you mentioned, is
at Premier Health with Premier Physician Network.
And I'm also the whole health clinical lead
at Dayton VA Medical Center.
I am a servant leader, and I do
wish to bring positive change in the communities
that I serve.
Regarding my background, it's somewhat unusual and unique.
I was born in India, and,
my journey in health care, like, spans between
three countries in three different continents,
to this point in my career,
you know, India, United Kingdom, and US.
And,
my training spans three specialties. So, like, I
started with OB GYN, then I did pediatric
medicine, pediatric surgery, and then
family medicine was my final resting place. And,
so I've worked also in three different types
of health care systems. As you're, you know,
aware, you know, systems in India, UK, and
US are very different. So this international experience
has informed my current thoughts and belief system.
I'm a systems thinker. As a child,
system. I'm a systems thinker.
As a child, I was fascinated by the
logic and beauty of mathematics and physics and
nearly actually decided to train in physics or,
like, specialize in physics, but somehow, you know,
as the universe would have it, it wanted
me to go in medicine.
I wanted to find the same foundational truths
in medicine. So that has been difficult to
find.
It's not just advancement in pure sciences that's
going to change health care for all of
us, but, you know, the collective of the
people that need this health care. So there's
also another layer of extreme complexity of the
health care systems, you know, which operationalize the
delivery of care. So all that is gonna
affect how medicine
advances, but I'm still hoping
to be able to found those foundational truths
finally, you know?
So I completed my medical degree at University
of Delhi,
obgyn training as well.
And then I was in UK where I
did, you know, obgyn, pediatric medicine, pediatric surgery,
moved to US for family reasons, pursued a
residency in family medicine, and completed my residency
at the Ohio State University in Columbus,
Ohio.
So after completing the residency, I was in
different roles, both academic, non academic. I was
in Upstate New York, Portland, Oregon, and now
I'm in Ohio.
I've had exposure to practicing medicine in various
private and public healthcare settings.
And,
I would just talk with some transformational
things that happened during this practice. So my
practice as a women's health medical director at
Syracuse VA Medical Center was transformational as
I learned not only to treat my female
veteran patients as patients, but also to advocate
for the best healthcare for them. And I
realized the limitations of what I had to
offer, you know, with my traditional medical training.
And I pursued to increase my toolbox by
initially getting board certified in integrative medicine.
Started applying for some grant funding to support
development of high value healthcare system for our
patients. And that started my journey towards the
whole health systems of care.
We were successful in getting grant funding from
for CERQ's VA to become a design site
for whole health. And some of our wins
were development of a strong foundation of a
whole health pathway with the recruitment and training
of whole health coaches, whole health partners,
in addition to development of whole health wellness
options and clinical care for our patients.
There were some amazing people who joined me
in this journey and they were my team.
I will always cherish them.
At around the same time, I was also
recruited to be vice chair of medical student
education at SUNY Upstate Medical University, Department of
Family Medicine.
Did the foundational work
which was needed to, you know, develop a
new residency program in family medicine, and we
were successful. It started in 2019. It's been
very successful since then.
Then we were also
interested to develop a rural residency. So we
were successful
for a rural
residency program at Auburn Community Hospital, which also,
you know, our first metrical learning class was
in 2022.
So during my work as a PI of
this grant, I also ended up, you know,
kind of doing a deeper dive in, you
know, the state of rural health, you know,
rural interprofessional,
you know, faculty development, and, you know, also
to look at how to provide equitable care
to our rural communities.
Subsequently had some extra training in, you know,
leadership. I was nominated by SUNY Upstate for
executive leadership in healthcare at Drexel and completed
my fellowship in 2023.
I've had some wonderful mentors, colleagues in my
journey at SUNY as well who helped me
grow and become useful member, you know, of
the community.
So my next big transition in life, I
was recruited to be chair of family medicine
at, you know, Wright State University, BESAM, in
February 2023 and have been very fortunate to
have had some very gifted and accomplished,
faculty members and mentors as well. And, since
the beginning of my tenure as chair here,
we have seen significant growth and development of
a rural residency at Greenville, Ohio,
Addiction Bass and Fellowship.
Our department of family medicine has supported global
health education for our medical students, and now
we are developing lifestyle medicine education for our
medical students. And, so this comes this is
in my wheelhouse. And so we also have
a brand new street medicine program that, we
care a lot about. So that, in a
nutshell, you know, summarizes where I am.
Well, that's amazing to hear. And what a
unique career journey you've had, but that passion
for medicine and helping people and really making
sense of the complexities in health care,
shines through. And so that's amazing to hear,
you know, all the things you've been able
to accomplish so far and then what you're
working on today. And speaking of that, what
are some of the opportunities and headwinds that
you have your eye on right now?
Yeah. So there's been a lot of change
here, so since I joined. Yeah. So the
most exciting change has been that Premier Health
and RightSearch University closely aligned their operations under
a new long term affiliation agreement in April
2024,
which enhances Dayton region's access to state of
art medical care. So this new agreement highlights
the institution's shared commitment to excellence in education,
workforce and economic development,
research, clinical program development, and community health. The
partnership is obviously transformational, and it prioritizes producing
more clinicians, nurses, or the health care providers
that would support our community, spurring new research
opportunities, providing patients better access to vital medical
care, like closer to home so they don't
have to drive, you know, away to other
places to get their care.
And also, you know, formally establishes a primary
academic affiliation,
between,
Wright State and Premier Health, including all Wright
State's colleges
sites of care.
So this provides us new opportunities, you know,
for federal funding to support clinical activities, teaching,
research. And this
will also position Premier Health and Wright State
to develop a comprehensive collaborative approach to meet
the needs of the community for the future.
For the Department of Family Medicine, it will
support our missions of education, clinical care, and
research by supporting innovation, community engagement on a
much larger scale.
We'll also be able to have increased access
to interdisciplinary, inter professional collaboration.
BSM already has strong track record in primary
care medical student education, and this agreement will
likely give access to more educators, you know,
for the medical students at Premier and greater
access to quality and high value care for
our community.
We are also very excited about,
introduction of, AI. So it's introduction of ambient
AI Daxko pilot at Premier Health. It's, starting
this month, and it's gonna allow us to
focus more on what we do best, that
is take care of patients not having to
spend twice as much time on documentation. So
it will help us position wellness.
The next one I would like to, you
know, specifically,
you know, mention is,
Premier's
partnership with Agilon. So this is
a health care tech company which helps to
improve health outcomes for seniors with resources like
new technology and care navigators.
So Premier Health is a nonprofit health care
system which has five hospitals, more than 100
locations across seven counties.
Agilent Healthcare offers resources to physician partners to
practice value based care through its total care
model. So this is a more holistic approach
to Medicare Advantage patients. So it gives them
a high value,
enhanced total system.
And
so,
it kind of, provides technology, people, capital, process
access to a peer network of more than
2,700
primary care physicians.
So one of the benefits of partnership is
additional care managers to help our patients navigate
the health system between appointments.
Agilent's tech platform connects multiple peers, patients, and
physicians into a single platform to create a
single experience for patients and physicians.
Physicians also experience data integration and clinical programs
through Agilent's platform.
Very closely aligned with my concept of whole
health and whole person care. So, you know,
I'm very excited to participate in this.
Other one is our development of street medicine
program that we were very,
you know, fortunate to get grant funding for.
And I will talk a little bit more
about that later. But it's in collaboration with
Premier Health, and it is to meet the
underserved members of a community where they are
and to get them established in regular healthcare.
Regarding education of America students, we are excited
about our new elective, which we started offering
to our students in food as medicine.
And we are planning for another elective next
year, which is going to be exercises medicine.
So
that's our beginnings of our, you know, foundational
work in lifestyle medicine here.
I'm also looking
very closely at rural health transformation program funding.
And it'll be interesting to see, you know,
if,
you know, Ohio gets funded and then, you
know, what innovative solutions are going to be
coming, you know, our way,
to help with the problem of healthcare access
and capacity in rural America.
Now headwinds. So headwinds are same as everyone
in healthcare and education. It's a very complex
healthcare landscape
and same actions do not always translate to
same results in different situations, in different locations.
And you know, so we have to always,
you know, plan, you know, for that.
AI and healthcare is another wild card. I'm
very optimistic, but unethical use of AI can
be disastrous.
So I participate in, DATNV's Vision ten AI
Committee to support the ethical use of AI
in healthcare. And it's very interesting to see
all the different projects that are coming our
way.
Rural health landscape is obviously a bit unpredictable
at this time despite our best efforts.
And then
I'm I'm really looking forward to see what
happens next.
Absolutely. It's just so many factors, as you
said, coming together to really create
a, bunch of opportunities, but also some challenges
and especially thinking about the technology and AI
and really where, you know, that can converge
into a space where you can get to
more of that predictive,
holistic care and value based care too. Now
when you think about value especially, how are
you looking at growth in the future, adding
value to the organizations that you're working with?
What does that really look like for you,
and how are you thinking about that at
a strategic level?
Absolutely. So the big goal of Red State
University, based on the Department of Family Medicine,
is to align with the current healthcare environment,
mission, value, and vision of our organizations, and
also still trade stay true to our own
mission and values. So we have our own
vision, which is preparing tomorrow's family physicians to
enhance the health and well-being of the communities
they serve by defining and providing state of
art healthcare.
Our mission is to lead the way in
educating the next generation of physicians by modeling
the patient centered principles of family medicine, serving
our community's health needs, and contributing to the
scholarly advancement of medicine.
So we have to support rural medicine and
support rural residency. We have to learn how
to leverage, you know, technology and AI to
support, you know, rural health. So we'll continue
to, you know, strive for that. And I
am working with Premier Health, and I am
actively participating in that.
We have to continue to do community outreach,
which we do both from, you know, Bucharest
School of Medicine as well as from Premier
side,
and the VA side. And, we support street
medicine program and addiction medicine program for health
equity to support the community. And,
you know, these are new programs for us,
and we are very excited, you know, to,
you know, support their growth.
We also have an MD in three program
for family medicine, in which our medical students
can graduate in three years if they decide
to go in family medicine or pediatrics, and
then,
you know, go into a residency in family
medicine. And this is, you know, one of
the initiatives at, Montreal School of Medicine to
support primary care.
We also support our family medicine interest groups
and students so that we can continue to
have a robust pipeline of our primary care
providers that stay in the area and that
serve our communities.
And with my specific background in integrated medicine
whole health, you know, developed the UME and
GME in education about lifestyle medicine, especially nutrition
and exercise and,
you know, and and and fine arts, you
know, and how to build health and not
just treat disease.
And how to engage with leadership, you know,
to support ambient AI, Agilent partnership, you know,
implementation in primary care,
how to help with recruitment of strong primary
care workforce, which not only provides excellent care,
but is curious, right, and loves to teach.
How to support our faculty, you know,
how to do robust research and how to,
you know, engage in clinical trials, how to
use lean principles to optimize current processes, build
capacity, higher value care,
and then innovation and sharing of knowledge. Right?
We have to disseminate knowledge as well and
publish, you know, to develop and also,
you know, develop innovative processes in clinical care.
Engage in philanthropic activities, which support the mission
of my department. And,
I think the most important one is that
we have to create
a replicable, patient centered, high value, whole person
care model in outpatient setting, which is powered
by digital tools,
agentic and ambient AI, as well as high
touch and humanistic,
and community based tools, such as health coaching,
health partners, primary care mental health integration, nutrition,
lifestyle medicine, group visits, which are financially sustainable.
So develop whole health and lifestyle medicine all
the way from in vitro trials in the
lab to clinical care and the community with
a lofty goal to create a mini bruzone
and engage local communities and organizations. And I
think I worked very hard to gather some
of the tools, you know, to help with
this goal, and I'm just hoping that I
could be the spark.
I love that. There's so much you said
there that really truly was inspiring to think
about how health care is changing, the possibilities,
and, you know, just having someone like yourself
being that spark, being that person who can
think it and dream it, and then actually
implementing, go start doing it is amazing and
incredible to see,
you know, how you've been able to manage
all these factors coming together to really truly
support the communities that you're serving.
I know resources are tied. We've kinda touched
on it briefly here in our conversation now,
but
hospitals and systems and organizations
are, looking at tight margins now and the
potential for even more tighter,
financial situations in the future. So when you
think about all of these things, what is
one risk or investment that is still worth
making in the next year or so,
even as resources are are tight?
Absolutely. So right now, I think it is
gonna be the street medicine program for us.
You know, we just launched it, you know,
in January '25, and the lead institution is
Wright State University, Bunchal School of Medicine. Our
key partners are Premier Health,
Dayton Dream Center.
You know, we have full funding from the
federal government for this. We also have a
two year one Ohio Recovery Foundation award for
nearly, you know, dollars 300,000.
We have a new HRSA Street Medicine Training
Grant, which is a five year federal award,
you know, supporting expanded training, capacity building, long
term program sustainability.
And so this is gonna be, you know,
it's a mobile community based clinical initiative, and
it is designed to bring low barrier primary
care,
behavioral health support, and substance use services directly
to the individuals that are experiencing homelessness or
housing instability in the Dayton region.
So this program integrates our community service with
robust, federally supported clinical training through the HRSA
award.
We'll be providing primary preventive care delivered at
mobile clinic sites, behavioral health services, including counseling
support, substance use screening, you know, brief intervention
referral to treatment,
care navigation, you know, case management,
and sort of low barrier engagement for patients
without transportation or insurance. Right? Same time, we'll
also be educating,
you know, our residents. So, so there's gonna
be structured training for about 50 right stage
students across medical behavioral
science disciplines,
to enable them to have deeper competency,
you know, in
this work.
So the training elements are going to be
street medicine foundations, which is low barrier care,
trauma informed practice, harm reduction, then clinical skills
in the field, patient assessment, how you wound
care, chronic disease management,
substance use disorder curriculum,
social determinants of health education, interprofessional
collaboration with behavioral health community workers,
documentation, continuity of care in mobile settings, reflective
practice and team debriefing.
And then, you know, also different enhancements like
faculty development, evaluation infrastructure,
you know, sustainability
planning.
So community impact. So this program will increase
access to care for individuals often who are
disconnected from the healthcare system and experiencing homelessness,
substance use disorder,
and behavioral health challenges. Hopefully, it'll reduce ED
reliance and improve,
linkage to ongoing care. So strategically strengthens, you
know, Ryerson University's mission in community engagement and
primary care education and also
expands our workforce training and underserved population medicine,
with, these HRSA,
supported competencies.
Got it. Wow. That's amazing to hear. And,
you know, certainly such a a needed service
for the community and especially thinking about how
you can bring care to people and make
sure that, you're you're hitting all the boxes,
bringing those community workers and everybody,
on board so that you can have such
a a functional and, beneficial program. I think,
you know, looking ahead with our last couple
of minutes here, where do you see some
of the best opportunities for that continued growth
in the future? How are you looking even
further ahead, to really build the the blocks
of foundation for the programs that are so
important to you,
in in in those next few years?
Absolutely. So,
you know, chronic disease management and population health.
Absolutely. You know? So with rising rates of
diabetes, heart disease, CKD, multi, you know, morbidity,
primary care is the center of management. Right?
So future is in value based care pivoting
towards providing best, fastest, most successful primary care
in the most cost effective manner by leveraging
technology,
such as telehealth, remote patient monitoring, Adientiq AI
that supports triage,
documentation in in addition to revenue cycle management,
generative AI, which empowers patient providers at the
same time.
And then,
you know, again, you know, as we see,
you know, AI and health care explosion and
digital health growth is gonna redefine, you know,
interest in value based care for all populations.
So the future is,
you know, where the patient is, not just
caring for the sick where the providers are.
Right? So virtual chronic care clinics, you know,
building hybrid outpatient models inside healthcare systems are
gonna be needed. Care of the elderly, you
know, we're gonna need that, right, as more
of our patients are getting older. So all
these senior care primary care models are very
useful.
Obesity medicine, lifestyle medicine, you know, rural underserved
primary care models.
And then preventable lifestyle medicine. So high patient
demand, low supply, you know, because of demand
reimbursement mismatch at this time, which may get
corrected with new payment models, such as direct
payment to pay to to people to purchase
their own health care and decide where they
wanna put the money. Right? So in the
they can put it in health savings accounts
and use it the way they wanna use
it. So whole person care model, you know,
for all with a clear definition of what
it means, Right? And then a clear implementation
plan with AI support. I think it'll be
an honorable goal for any company that can
develop it and scale it up. Yeah. So
medicine still hasn't found its beautiful, simple, basic
equations, but we can strive for whole person
care that can be scaled up. And we
have to strive for health while taking care
of the sick. And we have to strive
for happiness and good health for everyone while
taking care of those who are less fortunate.
And we have to support patients and provide
autonomy and goal sharing.
And, you know, opportunities for growth are gonna
need policy support and advocacy for the same,
and it takes a village, you know, to
to do this. And,
I mean, that's, that's all I would like
to say.
Fantastic. Well, you know, this is amazing. And,
this vision of health care that you have
is truly incredible. Doctor Grewell, thank you so
much for joining us on the podcast today.
This has been a really fun conversation for
me. I've learned a lot and I'm inspired
by your passion. I look forward to connecting
with you and continuing this conversation in the
future.
Thank Thank you so much. Thank you so
much for this opportunity. And, I would like
to also thank, you know, all of my
colleagues, my faculty, you know, who who who
do this work and who make the make
this happen. You know? Thank you.