1 00:00:02,240 --> 00:00:05,120 The most important health care decisions don't happen 2 00:00:05,120 --> 00:00:05,779 in isolation. 3 00:00:06,160 --> 00:00:08,179 They happen when leaders come together. 4 00:00:08,800 --> 00:00:11,519 Becker's sixteenth annual meeting brings together more than 5 00:00:11,519 --> 00:00:12,559 3,500 6 00:00:12,559 --> 00:00:15,519 hospital and health system executives this April in 7 00:00:15,519 --> 00:00:15,974 Chicago. 8 00:00:16,535 --> 00:00:18,635 With 800 speakers from Ascension, 9 00:00:18,935 --> 00:00:22,135 Cleveland Clinic, CommonSpirit and more, the conversations get 10 00:00:22,135 --> 00:00:24,935 real. Leaders will share how their scenario planning 11 00:00:24,935 --> 00:00:27,574 for policy shifts, breaking through value based care 12 00:00:27,574 --> 00:00:30,510 barriers, and building clinical teams that translate new 13 00:00:30,510 --> 00:00:32,370 ideas into real world care. 14 00:00:32,909 --> 00:00:35,480 Join top decision makers in the room April 15 00:00:35,480 --> 00:00:37,010 13 through the sixteenth. 16 00:00:37,469 --> 00:00:40,109 For the agenda and event details, visit beckers 17 00:00:40,109 --> 00:00:42,429 hospital review dot com and click on the 18 00:00:42,429 --> 00:00:43,965 events tab in the upper right. 19 00:00:45,484 --> 00:00:47,725 This is Laura Dierda with the Becker's Healthcare 20 00:00:47,725 --> 00:00:48,225 podcast. 21 00:00:48,524 --> 00:00:50,204 I'm thrilled today to be joined by doctor 22 00:00:50,204 --> 00:00:53,185 Douglas Ross, chief medical officer at AdventHealth Carolwood. 23 00:00:53,405 --> 00:00:54,684 Doctor Ross, it's a pleasure to have you 24 00:00:54,684 --> 00:00:56,924 on the podcast today. Thanks so much, 25 00:00:57,469 --> 00:00:59,869 Laura. Great to be here. Honored to be 26 00:00:59,869 --> 00:01:03,229 here. Absolutely fantastic. Well, I'm excited for our 27 00:01:03,229 --> 00:01:05,229 conversation because we're gonna be talking a lot 28 00:01:05,229 --> 00:01:05,729 about, 29 00:01:06,349 --> 00:01:09,069 age related neurological and cognitive conditions, some of 30 00:01:09,069 --> 00:01:10,875 the challenges related to that, as well as, 31 00:01:11,034 --> 00:01:13,995 you know, how clinicians and organizations can really 32 00:01:13,995 --> 00:01:16,234 support those who are going through those challenges. 33 00:01:16,234 --> 00:01:17,995 But before we dive in, can you tell 34 00:01:17,995 --> 00:01:19,515 us a little bit more about yourself and 35 00:01:19,515 --> 00:01:20,894 AdventHealth Carol Wood? 36 00:01:21,354 --> 00:01:24,555 Yeah. Sure. I'm an ENT by background, and 37 00:01:24,555 --> 00:01:25,295 I'm the 38 00:01:26,340 --> 00:01:28,519 hospital leader here focused on operationalizing 39 00:01:28,899 --> 00:01:29,640 care models 40 00:01:30,099 --> 00:01:30,659 so that, 41 00:01:31,060 --> 00:01:32,840 clinicians can do the highest 42 00:01:33,219 --> 00:01:35,939 value work while the system lowers barriers for 43 00:01:35,939 --> 00:01:37,079 patients and families. 44 00:01:37,795 --> 00:01:38,834 I've been in, 45 00:01:39,635 --> 00:01:41,474 administration now. I started, 46 00:01:41,875 --> 00:01:44,454 in administration around 2008. 47 00:01:44,995 --> 00:01:47,334 And so I've been in, health care administration 48 00:01:47,555 --> 00:01:49,174 for a long time and particularly 49 00:01:49,555 --> 00:01:50,935 in guiding and leading 50 00:01:51,590 --> 00:01:53,049 and helping doctors, 51 00:01:53,909 --> 00:01:54,390 as, 52 00:01:54,869 --> 00:01:57,269 the evolution, and that's a kind word to 53 00:01:57,269 --> 00:01:58,569 say, of medicine 54 00:01:59,030 --> 00:02:00,489 has been occurring. But, 55 00:02:01,269 --> 00:02:01,750 so, 56 00:02:02,069 --> 00:02:04,469 I've had a lot of battle scars, but, 57 00:02:04,709 --> 00:02:06,105 really enjoyed the role. 58 00:02:07,064 --> 00:02:09,944 AdventHealth began as a mission driven health system, 59 00:02:09,944 --> 00:02:12,344 so just talking about us. And we've grown 60 00:02:12,344 --> 00:02:15,224 into a larger integrated network that emphasizes whole 61 00:02:15,224 --> 00:02:16,125 person care. 62 00:02:16,585 --> 00:02:19,965 Clinical excellence wrapped with spiritual and social supports. 63 00:02:21,259 --> 00:02:24,219 That philosophy shapes how we approach aging. It's 64 00:02:24,219 --> 00:02:26,080 not only about medical diagnosis, 65 00:02:26,459 --> 00:02:28,000 but it's about independence, 66 00:02:28,379 --> 00:02:30,479 dignity, and quality of life. 67 00:02:31,099 --> 00:02:33,659 So Atherton Health Carrowood is our Tampa area 68 00:02:33,659 --> 00:02:36,594 acute care campus that functions as a community 69 00:02:36,655 --> 00:02:38,835 hub for neurology and aging services. 70 00:02:39,534 --> 00:02:43,215 We provide inpatient acute care, stroke services, outpatient 71 00:02:43,215 --> 00:02:45,935 neurology, and memory care access for families who 72 00:02:45,935 --> 00:02:47,955 want expert care close to home. 73 00:02:48,569 --> 00:02:51,550 And importantly for us, and for the community, 74 00:02:51,610 --> 00:02:52,830 Carrollwood is connected 75 00:02:53,209 --> 00:02:54,110 into the AdventHealth's 76 00:02:54,409 --> 00:02:55,389 broader neuroscience 77 00:02:55,689 --> 00:02:56,189 institute 78 00:02:56,969 --> 00:02:59,849 and the systems memory and aging programs, and 79 00:02:59,849 --> 00:03:00,794 we have a few. 80 00:03:01,914 --> 00:03:04,254 The so that connection lets us offer sophisticated 81 00:03:04,555 --> 00:03:06,495 diagnostic and specialty input, 82 00:03:07,034 --> 00:03:08,495 when patients need it. 83 00:03:09,194 --> 00:03:11,775 And that keeps, that and we also 84 00:03:12,074 --> 00:03:15,114 keep the care as local and, patient centered 85 00:03:15,114 --> 00:03:15,854 as possible. 86 00:03:16,290 --> 00:03:18,050 On a practical level, that means we focus 87 00:03:18,050 --> 00:03:20,389 on three things at Carrollwood, timely access, 88 00:03:21,090 --> 00:03:21,590 interdisciplinary 89 00:03:22,370 --> 00:03:22,870 coordination, 90 00:03:23,250 --> 00:03:24,389 and care navigation. 91 00:03:25,569 --> 00:03:27,810 Timely access, we want seniors to be seen 92 00:03:27,810 --> 00:03:29,969 quickly. We really, like, really want our entire 93 00:03:29,969 --> 00:03:32,935 population who comes, spends time with us, not 94 00:03:32,935 --> 00:03:34,694 to waste their time. So we wanted them 95 00:03:34,694 --> 00:03:35,514 seen quickly, 96 00:03:36,375 --> 00:03:39,175 when their concerns arise or you know, and 97 00:03:39,175 --> 00:03:39,675 provide 98 00:03:39,974 --> 00:03:40,474 interdisciplinary 99 00:03:41,175 --> 00:03:42,074 core coordination, 100 00:03:42,375 --> 00:03:43,115 which is 101 00:03:43,415 --> 00:03:44,955 really for the senior, 102 00:03:45,450 --> 00:03:49,210 long term cognitive conditions are complex and rarely 103 00:03:49,210 --> 00:03:51,469 managed by a single specialist. So 104 00:03:51,930 --> 00:03:54,189 we combine primary care, neurology, 105 00:03:54,569 --> 00:03:55,069 geriatrics, 106 00:03:55,530 --> 00:03:58,409 pharmacy, rehab, and social work into team based 107 00:03:58,409 --> 00:03:58,909 pathways. 108 00:03:59,745 --> 00:04:00,805 In care navigation, 109 00:04:01,264 --> 00:04:04,625 we help families understand next steps, whether that's 110 00:04:04,625 --> 00:04:06,164 home services, therapy, 111 00:04:06,705 --> 00:04:07,925 or clinical trial. 112 00:04:08,465 --> 00:04:11,764 That blend of, community access plus system 113 00:04:12,064 --> 00:04:14,699 expertise is how we make the care both 114 00:04:15,180 --> 00:04:16,879 capable and compassionate. 115 00:04:18,220 --> 00:04:20,699 So we're really, you know, we really are 116 00:04:20,699 --> 00:04:21,199 focusing 117 00:04:22,300 --> 00:04:22,800 systematically 118 00:04:23,180 --> 00:04:25,120 and using both our local and 119 00:04:25,500 --> 00:04:29,120 system resources in dealing with these challenges of 120 00:04:29,180 --> 00:04:30,399 this aging population. 121 00:04:31,875 --> 00:04:34,115 That's helpful to understand and, you know, really 122 00:04:34,115 --> 00:04:36,435 critical, especially when you think about the aging 123 00:04:36,435 --> 00:04:38,514 population. I know there's a growing number of 124 00:04:38,514 --> 00:04:40,595 people that are are entering into that space 125 00:04:40,595 --> 00:04:43,394 and a huge demand for, those types of 126 00:04:43,394 --> 00:04:44,430 services. So, 127 00:04:44,910 --> 00:04:47,089 with that steady growth of age related neurological 128 00:04:47,229 --> 00:04:49,550 and cognitive conditions, where are some of the 129 00:04:49,550 --> 00:04:51,789 health systems like yours feeling the greatest pressures, 130 00:04:51,789 --> 00:04:54,850 and how is that changing care delivery models? 131 00:04:55,789 --> 00:04:56,850 It's a good question. 132 00:04:57,789 --> 00:05:00,175 Let me start with the, pressures. Three big 133 00:05:00,175 --> 00:05:02,735 forces really we see are converging. The first 134 00:05:02,735 --> 00:05:06,175 is, demographics. The population 65 and older is 135 00:05:06,175 --> 00:05:07,074 growing rapidly. 136 00:05:07,694 --> 00:05:10,675 More older adults means higher prevalence of dementia, 137 00:05:10,735 --> 00:05:11,955 Parkinson's disease, 138 00:05:12,269 --> 00:05:12,769 stroke 139 00:05:13,389 --> 00:05:16,509 survivors, living with cog cognitive deficits, and, 140 00:05:16,910 --> 00:05:17,410 multimorbidity. 141 00:05:18,910 --> 00:05:20,290 That increases volume 142 00:05:20,669 --> 00:05:24,269 across clinics, EDs, and, post acute services. So 143 00:05:24,269 --> 00:05:26,235 that really puts a strain. 144 00:05:26,775 --> 00:05:29,754 Second is the workforce and diagnostic bottlenecks. 145 00:05:30,375 --> 00:05:34,074 There simply aren't enough neurologists and geriatric specialists 146 00:05:34,855 --> 00:05:35,835 in many communities, 147 00:05:36,295 --> 00:05:38,715 really pretty much in most communities factually. 148 00:05:39,189 --> 00:05:41,509 And that creates long wait times and pushes 149 00:05:41,509 --> 00:05:44,149 a lot of responsibility back onto our primary 150 00:05:44,149 --> 00:05:44,970 care docs, 151 00:05:45,509 --> 00:05:48,790 which is the right clinical quarterback, but needs 152 00:05:48,790 --> 00:05:50,810 better tools and team support 153 00:05:51,189 --> 00:05:52,569 in order to do the right 154 00:05:53,064 --> 00:05:53,884 by the patient. 155 00:05:55,144 --> 00:05:59,165 Third, the social side, there's caregiver stress, fragmented 156 00:05:59,384 --> 00:06:02,665 transitions from hospital home and constraints and skilled 157 00:06:02,665 --> 00:06:05,805 nursing and home care capacity. And these upstream 158 00:06:05,865 --> 00:06:08,605 social gaps translate into preventable readmissions, 159 00:06:09,520 --> 00:06:12,399 crises, and poor quality of life, not just 160 00:06:12,399 --> 00:06:14,639 for the patient, but for the caregiver as 161 00:06:14,639 --> 00:06:15,139 well. 162 00:06:15,839 --> 00:06:19,060 So how are systems responding, you ask? Well, 163 00:06:19,279 --> 00:06:21,520 the pattern I'm seeing and what we're building 164 00:06:21,520 --> 00:06:23,115 at AdventHealth is a movement 165 00:06:23,514 --> 00:06:24,894 from episodic specialist, 166 00:06:25,754 --> 00:06:26,894 centric care 167 00:06:27,354 --> 00:06:28,095 to longitudinal 168 00:06:29,035 --> 00:06:31,454 team based and community anchored models. 169 00:06:32,235 --> 00:06:34,014 What does that mean, really? So 170 00:06:34,634 --> 00:06:36,735 number one, we're we're creating interdisciplinary 171 00:06:37,274 --> 00:06:41,129 memory clinics and 65 plus primary care pathways 172 00:06:41,750 --> 00:06:44,970 that embed social work, pharmacists, and care navigators. 173 00:06:45,589 --> 00:06:48,730 That's a one stop approach, reduces fragmentation, 174 00:06:49,270 --> 00:06:52,410 and speeds decision making for families. Really 175 00:06:52,710 --> 00:06:55,564 a great model. I've I've I've witnessed it 176 00:06:55,564 --> 00:06:57,185 myself. It's it's phenomenal. 177 00:06:57,725 --> 00:07:00,305 We're also scaling telehealth and home based care 178 00:07:00,444 --> 00:07:02,625 to reach patients who can't easily travel. 179 00:07:03,324 --> 00:07:03,824 Teleneurology 180 00:07:04,764 --> 00:07:07,345 visits, virtual caregiver coaching, 181 00:07:07,839 --> 00:07:11,199 and remote monitoring reduces unnecessary ED visits and 182 00:07:11,199 --> 00:07:13,459 keeps patients safer at home. 183 00:07:15,279 --> 00:07:17,919 And, in terms of that, we're also in 184 00:07:18,079 --> 00:07:19,694 trying to increase our, 185 00:07:20,574 --> 00:07:23,134 the number of neurologists. So for example, at 186 00:07:23,134 --> 00:07:25,154 our sister hospital in Tampa, 187 00:07:25,455 --> 00:07:29,134 we're starting a neurology residency hopefully by 2027 188 00:07:29,134 --> 00:07:32,355 because we recognize the need for further neurologists, 189 00:07:32,975 --> 00:07:33,875 in our community. 190 00:07:34,569 --> 00:07:38,189 We're investing, in data driven triage too. EHR 191 00:07:38,330 --> 00:07:38,830 flags, 192 00:07:39,449 --> 00:07:42,009 we use, EPIC, but, you know, a lot 193 00:07:42,009 --> 00:07:43,870 of the EHRs have these flags. 194 00:07:44,410 --> 00:07:47,629 Brief digital cognitive screens in primary care, 195 00:07:48,095 --> 00:07:49,394 and where helpful blood 196 00:07:49,694 --> 00:07:52,334 biomarkers or a functional texting, which we'll talk 197 00:07:52,334 --> 00:07:53,615 about in a little bit, I think, to 198 00:07:53,615 --> 00:07:54,115 prioritize 199 00:07:54,574 --> 00:07:56,194 who needs specialty input. 200 00:07:56,654 --> 00:08:00,354 And we're strengthening caregiver support because caregiver well-being, 201 00:08:00,414 --> 00:08:02,894 like I said before, is a clinical outcome 202 00:08:02,894 --> 00:08:03,555 in itself. 203 00:08:04,189 --> 00:08:06,689 So we do coaching, respite resources, 204 00:08:07,870 --> 00:08:08,610 and navigators 205 00:08:09,310 --> 00:08:12,209 to, lower the caregiver strain and reduce crises. 206 00:08:12,990 --> 00:08:15,410 The goal really isn't to replace specialists, 207 00:08:15,724 --> 00:08:18,764 but it's to use specialists more effectively by 208 00:08:18,764 --> 00:08:20,865 reserving their time for patients 209 00:08:21,404 --> 00:08:23,425 who truly need advanced diagnostics 210 00:08:23,805 --> 00:08:24,704 or interventions 211 00:08:25,644 --> 00:08:28,845 while ensuring everyone else is, receiving the right 212 00:08:28,845 --> 00:08:30,464 support and follow-up. And, 213 00:08:30,870 --> 00:08:33,509 you know, much like our behavioral health crisis 214 00:08:33,509 --> 00:08:35,350 in in the country, a lot of the 215 00:08:35,350 --> 00:08:37,509 burden has fallen on the primary care doctors 216 00:08:37,509 --> 00:08:38,730 as we all know. And 217 00:08:39,190 --> 00:08:40,169 and that's really 218 00:08:40,629 --> 00:08:41,129 becoming 219 00:08:41,910 --> 00:08:44,490 more true with our seniors and dementia 220 00:08:45,134 --> 00:08:45,855 and other, 221 00:08:46,735 --> 00:08:47,955 cognitive abnormalities. 222 00:08:49,535 --> 00:08:50,894 That makes a lot of sense and, you 223 00:08:50,894 --> 00:08:53,535 know, it's such a helpful overview in how 224 00:08:53,535 --> 00:08:55,934 everything, the landscape is changing and has been 225 00:08:55,934 --> 00:08:58,654 evolving. I think it's, fascinating to hear about 226 00:08:58,654 --> 00:09:00,929 all of those different factors that, you know, 227 00:09:00,929 --> 00:09:01,690 are are really, 228 00:09:02,250 --> 00:09:05,049 converging together in order to, bring about change 229 00:09:05,049 --> 00:09:06,970 in the care delivery models, not only, you 230 00:09:06,970 --> 00:09:09,850 know, just the population shifts in caregiver, but 231 00:09:09,850 --> 00:09:12,570 also thinking about the technology that's available and 232 00:09:12,570 --> 00:09:14,774 how you can use that. So I know 233 00:09:14,774 --> 00:09:17,575 that many organizations still rely heavily on cognitive 234 00:09:17,575 --> 00:09:19,195 testing and structural imaging. 235 00:09:19,654 --> 00:09:21,334 What are some of the limitations that are 236 00:09:21,334 --> 00:09:23,414 becoming more apparent there, and how does the 237 00:09:23,414 --> 00:09:25,575 functional brain assessment add value to some of 238 00:09:25,575 --> 00:09:27,495 the clinical decision making that you're doing as 239 00:09:27,495 --> 00:09:27,995 well? 240 00:09:28,589 --> 00:09:31,149 Yeah. Well, I think, all the tests are 241 00:09:31,149 --> 00:09:33,709 are are useful in some regard. You know, 242 00:09:33,709 --> 00:09:34,769 traditional tools, 243 00:09:35,230 --> 00:09:39,169 short cognitive screens and, structural MRIs, they're indispensable, 244 00:09:39,470 --> 00:09:41,409 but they have their limits. And 245 00:09:42,095 --> 00:09:43,875 cognitive schemes like, MMSE 246 00:09:44,574 --> 00:09:45,475 or MOCAs 247 00:09:46,095 --> 00:09:46,754 are practical. 248 00:09:47,294 --> 00:09:48,115 They're fast, 249 00:09:48,495 --> 00:09:49,714 but they're just snapshots. 250 00:09:50,495 --> 00:09:52,355 And they can be influenced by education, 251 00:09:52,735 --> 00:09:55,569 language, mood, or culture, and they often capture 252 00:09:55,569 --> 00:09:58,389 change only after the disease has progressed. And 253 00:09:58,769 --> 00:10:02,230 structural imaging, standard MRI or CT scan, 254 00:10:02,689 --> 00:10:03,429 is terrific, 255 00:10:03,889 --> 00:10:07,350 for ruling out tumors, large strokes, or hydrocephalus, 256 00:10:08,774 --> 00:10:11,355 or gross atrophy of the brain. But, 257 00:10:11,894 --> 00:10:13,754 yet in early neurodegenerative 258 00:10:14,134 --> 00:10:16,955 diseases, the MRI can look deceptively normal. 259 00:10:17,335 --> 00:10:17,835 So, 260 00:10:18,615 --> 00:10:20,615 by the time a problem shows on these 261 00:10:20,615 --> 00:10:21,115 measures, 262 00:10:21,450 --> 00:10:24,269 biological disease has often been present for years. 263 00:10:25,370 --> 00:10:28,410 So that's where functional and, molecular assessments add 264 00:10:28,410 --> 00:10:31,230 real clinical value. And there are three practical 265 00:10:31,370 --> 00:10:34,750 areas of advantage and things we can use 266 00:10:35,050 --> 00:10:35,550 today. 267 00:10:35,915 --> 00:10:38,014 So in, for earlier pathophysiologic 268 00:10:38,795 --> 00:10:40,795 insight, the PET imaging and, 269 00:10:41,355 --> 00:10:46,095 emerging plasma biomarkers can detect, Alzheimer related pathology 270 00:10:46,795 --> 00:10:49,295 before substantial cognitive decline, 271 00:10:50,579 --> 00:10:51,559 which is phenomenal 272 00:10:52,019 --> 00:10:54,419 because that's usually when we catch it, when 273 00:10:54,419 --> 00:10:56,360 you see the cognitive decline. 274 00:10:57,059 --> 00:10:59,240 But that means that you can identify biological 275 00:10:59,379 --> 00:10:59,879 targets 276 00:11:00,339 --> 00:11:02,820 when an intervention still has a chance to 277 00:11:02,820 --> 00:11:03,799 alter trajectory. 278 00:11:04,865 --> 00:11:07,684 And really for families, that timing is everything. 279 00:11:08,705 --> 00:11:10,804 Then there's a mechanistic clarity, 280 00:11:11,825 --> 00:11:14,865 functional tools like FDG PET scan or tau 281 00:11:14,865 --> 00:11:17,764 amyloid PET scans or advanced MRI analytics, 282 00:11:18,710 --> 00:11:21,210 and even EEG based network measures 283 00:11:21,750 --> 00:11:22,730 help distinguish 284 00:11:23,110 --> 00:11:23,610 ideologies 285 00:11:23,910 --> 00:11:28,309 like Alzheimer's versus vascular cognitive impairment versus frontal 286 00:11:28,309 --> 00:11:29,210 temporal syndromes 287 00:11:29,750 --> 00:11:31,210 where treatment and prognosis 288 00:11:31,590 --> 00:11:32,090 differ. 289 00:11:32,754 --> 00:11:34,294 That clarity avoids guesswork 290 00:11:34,674 --> 00:11:37,014 and speeds the right plan of care. 291 00:11:37,394 --> 00:11:40,355 And third, practical triage and monitoring. So blood 292 00:11:40,355 --> 00:11:43,254 based biomarkers are becoming a scalable screening, 293 00:11:43,794 --> 00:11:44,294 step. 294 00:11:44,620 --> 00:11:46,800 Quantitative EEG and advanced functional 295 00:11:47,179 --> 00:11:50,960 MRIs can support monitoring over time without repeated 296 00:11:51,019 --> 00:11:52,080 invasive tests. 297 00:11:52,860 --> 00:11:55,600 For health systems, those are tools to triage 298 00:11:55,660 --> 00:11:57,279 who needs expensive scans 299 00:11:57,684 --> 00:12:00,165 and who can be managed conservatively with risk 300 00:12:00,165 --> 00:12:02,105 reduction and supportive care. 301 00:12:02,644 --> 00:12:05,625 So clinically, adding functional assessment changes 302 00:12:06,165 --> 00:12:09,865 lets us, counsel families more accurately about prognosis 303 00:12:10,085 --> 00:12:10,585 and 304 00:12:11,179 --> 00:12:14,079 decides whether disease modifying therapies are appropriate. 305 00:12:14,860 --> 00:12:16,079 Or enroll patients 306 00:12:16,700 --> 00:12:18,079 in trials selectively. 307 00:12:18,940 --> 00:12:21,279 Or personalized non drug interventions, 308 00:12:21,899 --> 00:12:24,480 everything from targeted cognitive rehabilitation 309 00:12:25,695 --> 00:12:27,394 to fall prevention programs. 310 00:12:28,894 --> 00:12:30,975 That's fascinating to hear, and I think so 311 00:12:30,975 --> 00:12:33,715 helpful to understand some of the different technologies 312 00:12:34,175 --> 00:12:34,575 and, 313 00:12:35,055 --> 00:12:37,919 opportunities available for for testing because I think, 314 00:12:38,000 --> 00:12:39,539 you know, having the most sophisticated, 315 00:12:40,720 --> 00:12:43,519 you know, technologies and processes out there, really 316 00:12:43,519 --> 00:12:45,039 makes a big difference in the treatment and 317 00:12:45,039 --> 00:12:46,480 trying to get early and those kinds of 318 00:12:46,480 --> 00:12:46,980 things. 319 00:12:48,159 --> 00:12:49,839 How do you see the field evolving in 320 00:12:49,839 --> 00:12:51,230 the next year or two? 321 00:12:51,534 --> 00:12:54,195 Well, it's an exciting field, right now. I'm, 322 00:12:55,014 --> 00:12:57,715 I'm very optimistic. And as I said before, 323 00:12:57,774 --> 00:12:58,995 the earlier you can 324 00:12:59,375 --> 00:13:01,154 make a diagnosis with this, 325 00:13:01,534 --> 00:13:04,434 the better. So, I mean, as this biomarkers 326 00:13:04,815 --> 00:13:05,315 become 327 00:13:06,629 --> 00:13:09,669 cheaper to do and more accessible to that 328 00:13:09,669 --> 00:13:11,049 could be used as a primary, 329 00:13:11,509 --> 00:13:12,009 care. 330 00:13:13,589 --> 00:13:16,149 You know, that'll be so so biomarkers will 331 00:13:16,149 --> 00:13:17,769 move into routine workflows, 332 00:13:18,125 --> 00:13:20,544 Blood tests for amyloid and, phosphorylated 333 00:13:21,004 --> 00:13:21,504 tau 334 00:13:22,284 --> 00:13:25,084 are already increasingly reliable and much easier to 335 00:13:25,084 --> 00:13:27,424 deploy than the PET or the or CSF 336 00:13:27,485 --> 00:13:27,985 testing. 337 00:13:28,845 --> 00:13:31,164 And that really does mean primary care can 338 00:13:31,164 --> 00:13:33,500 play a larger screening role and refer the 339 00:13:33,500 --> 00:13:34,960 right patients faster. 340 00:13:35,899 --> 00:13:39,039 Second, the disease modifying therapies are changing expectations. 341 00:13:39,580 --> 00:13:42,960 With therapies that target underlying pathology now available, 342 00:13:43,500 --> 00:13:47,120 health systems, must create processes to confirm pathology 343 00:13:47,179 --> 00:13:48,879 and deliver therapy safely. 344 00:13:49,784 --> 00:13:53,965 Infusion pathways, monitoring protocols, and shared decision frameworks. 345 00:13:54,424 --> 00:13:56,664 And I know when we are building our 346 00:13:56,664 --> 00:13:59,625 new, medical office buildings across the state and 347 00:13:59,625 --> 00:14:00,684 across our multistate, 348 00:14:01,269 --> 00:14:04,329 we are building infusion centers into those, 349 00:14:05,269 --> 00:14:07,769 clinics or into those, office buildings 350 00:14:09,029 --> 00:14:11,610 with the I idea not just for cancer, 351 00:14:11,669 --> 00:14:14,264 but for infusion of, these kind of, 352 00:14:14,904 --> 00:14:15,945 therapies for, 353 00:14:16,345 --> 00:14:18,125 Alzheimer's, much bigger population. 354 00:14:19,225 --> 00:14:19,725 Thirdly, 355 00:14:20,264 --> 00:14:23,004 digital and AI tools will support early detection. 356 00:14:23,465 --> 00:14:25,004 Voice and speech analyses, 357 00:14:25,545 --> 00:14:29,149 passive monitoring, and machine learning models that integrate 358 00:14:29,289 --> 00:14:32,009 EHR data will help flag at risk patients 359 00:14:32,009 --> 00:14:32,990 who need evaluation. 360 00:14:34,329 --> 00:14:35,069 For example, 361 00:14:36,329 --> 00:14:39,529 Parkinson disease now can be diagnosed using AI 362 00:14:39,529 --> 00:14:41,069 and voice and speech analysis, 363 00:14:41,894 --> 00:14:42,875 which is fascinating. 364 00:14:44,214 --> 00:14:47,014 And that expands detection beyond the small subset 365 00:14:47,014 --> 00:14:48,554 that comes to special attention. 366 00:14:49,334 --> 00:14:49,834 Fourthly, 367 00:14:50,375 --> 00:14:53,495 care delivery will shift upstream to prevention and 368 00:14:53,495 --> 00:14:56,819 function. You know, life style interventions, vascular risk 369 00:14:56,819 --> 00:15:00,259 control, and cognitive training are being adopted in 370 00:15:00,259 --> 00:15:01,319 community programs, 371 00:15:01,860 --> 00:15:04,440 and they offer the potential to delay progression. 372 00:15:05,459 --> 00:15:07,220 We haven't really found a cure yet, but 373 00:15:07,220 --> 00:15:09,799 we have found things that can delay progression, 374 00:15:09,860 --> 00:15:10,365 which is 375 00:15:11,245 --> 00:15:12,784 the best we have so far. 376 00:15:13,164 --> 00:15:16,304 And health systems that integrate prevention with diagnostics 377 00:15:16,524 --> 00:15:19,565 and specialty care will have the highest impact 378 00:15:19,565 --> 00:15:20,065 really. 379 00:15:20,524 --> 00:15:22,945 And finally, equity will be the implementation 380 00:15:23,485 --> 00:15:25,870 challenge. You know? We must ensure the new 381 00:15:25,870 --> 00:15:28,509 tests and therapies don't become available only to 382 00:15:28,509 --> 00:15:32,050 patients who live near tertiary centers. That's why 383 00:15:32,190 --> 00:15:33,410 hub and spoke models, 384 00:15:33,790 --> 00:15:35,570 telehealth and targeted outreach 385 00:15:36,029 --> 00:15:37,570 are essential. And, 386 00:15:38,004 --> 00:15:40,804 at AdventHealth, we practice this a significant amount 387 00:15:40,804 --> 00:15:41,865 of hub and spoke, 388 00:15:42,725 --> 00:15:44,964 opportunities for patients so that they can take 389 00:15:44,964 --> 00:15:46,664 advantage of tertiary care 390 00:15:47,044 --> 00:15:47,944 even entering 391 00:15:48,245 --> 00:15:49,625 into one of our 392 00:15:50,404 --> 00:15:51,784 primary care offices. 393 00:15:53,309 --> 00:15:54,589 Got it. That makes a lot of sense, 394 00:15:54,589 --> 00:15:56,509 and it's really fascinating to think about how 395 00:15:56,509 --> 00:15:58,909 you're able to go upstream there more and 396 00:15:58,909 --> 00:16:01,549 really rework, the way you're connecting with the 397 00:16:01,549 --> 00:16:03,569 community and the programs that are available, 398 00:16:03,949 --> 00:16:05,949 so they're more convenient to the patients, especially 399 00:16:05,949 --> 00:16:08,644 with the technology we have evolved evolved to 400 00:16:08,644 --> 00:16:10,345 include digital and more. 401 00:16:10,804 --> 00:16:11,704 I I'm curious. 402 00:16:12,485 --> 00:16:13,845 Where do you see some of the biggest 403 00:16:13,845 --> 00:16:16,404 opportunities for AdventHealth to continue growing in the 404 00:16:16,404 --> 00:16:17,865 age related medicine field? 405 00:16:18,884 --> 00:16:21,605 Well, for AdventHealth, the opportunity is clear. You 406 00:16:21,605 --> 00:16:25,389 know? Scale integrated community anchored programs that connect 407 00:16:25,389 --> 00:16:28,589 primary care, memory clinics, home services, and specialty 408 00:16:28,589 --> 00:16:29,089 hubs. 409 00:16:29,709 --> 00:16:30,529 And at 410 00:16:31,070 --> 00:16:32,129 Carrollwood, specifically, 411 00:16:32,589 --> 00:16:34,589 our role is to be a local access 412 00:16:34,589 --> 00:16:36,705 point, a place where families get time 413 00:16:46,785 --> 00:16:47,285 you 414 00:16:49,120 --> 00:16:51,839 you know, the embedding of biomarker screenings and 415 00:16:51,839 --> 00:16:54,019 streamlined triage in primary care, 416 00:16:54,639 --> 00:16:56,019 expanding the home, 417 00:16:56,559 --> 00:16:57,459 and teleneurology 418 00:16:58,480 --> 00:17:01,120 so frail seniors aren't forced to travel, and 419 00:17:01,120 --> 00:17:04,654 investing in care navigators and care giver programs 420 00:17:04,714 --> 00:17:07,115 really at the local level because that's really 421 00:17:07,115 --> 00:17:09,355 where you're gonna touch the patients and their 422 00:17:09,355 --> 00:17:09,855 families. 423 00:17:10,954 --> 00:17:13,434 And then, of course, we're running, through our 424 00:17:13,434 --> 00:17:13,934 larger 425 00:17:14,315 --> 00:17:18,234 research arm, pragmatic trials and registries, so they 426 00:17:18,234 --> 00:17:21,159 have patients have access to these therapies even 427 00:17:21,159 --> 00:17:22,299 just coming to Carrollwood. 428 00:17:23,159 --> 00:17:26,279 And then for population health outreach, we use 429 00:17:26,279 --> 00:17:27,099 our EHR, 430 00:17:28,039 --> 00:17:31,019 data to target once it becomes more 431 00:17:31,505 --> 00:17:34,325 defined, you know, how we can do prevention 432 00:17:34,545 --> 00:17:35,684 and close gaps. 433 00:17:36,465 --> 00:17:39,025 So, really, these the all these moves really 434 00:17:39,025 --> 00:17:40,485 align with our mission 435 00:17:40,865 --> 00:17:43,184 at AdventHealth for better health outcomes, you know, 436 00:17:43,184 --> 00:17:44,164 supported caregivers 437 00:17:44,545 --> 00:17:45,045 and 438 00:17:45,619 --> 00:17:48,039 care that treats the whole person, which is 439 00:17:48,100 --> 00:17:49,320 what we believe in. 440 00:17:50,420 --> 00:17:52,180 I love that. Doctor Ross, thank you so 441 00:17:52,180 --> 00:17:53,700 much for joining us on the podcast today. 442 00:17:53,700 --> 00:17:56,019 This has been such a fascinating conversation, and 443 00:17:56,019 --> 00:17:57,619 I look forward to connecting with you again 444 00:17:57,619 --> 00:17:58,119 soon. 445 00:17:58,985 --> 00:18:00,745 I appreciate it, Laura. Thanks for having me 446 00:18:00,745 --> 00:18:02,664 on. I I'm, you know, it's a it's 447 00:18:02,664 --> 00:18:05,384 an interesting topic, a mix of science and 448 00:18:05,384 --> 00:18:07,465 social, I think, really. You know? We have 449 00:18:07,465 --> 00:18:11,305 to we're dealing with, Alzheimer's. I think most 450 00:18:11,305 --> 00:18:14,039 of us have all been touched by patients 451 00:18:14,180 --> 00:18:17,640 with Alzheimer's, whether they're relatives or close friends, 452 00:18:18,259 --> 00:18:19,000 and family. 453 00:18:19,700 --> 00:18:22,820 So we understand the import of really being 454 00:18:22,820 --> 00:18:24,840 able to diagnose early, 455 00:18:25,694 --> 00:18:26,595 start interventions, 456 00:18:27,694 --> 00:18:30,575 support the caregivers. It's all very critical, and, 457 00:18:30,815 --> 00:18:32,974 I appreciate the opportunity to talk about it. 458 00:18:32,974 --> 00:18:33,634 Thank you.