The most important health care decisions don't happen
in isolation.
They happen when leaders come together.
Becker's sixteenth annual meeting brings together more than
3,500
hospital and health system executives this April in
Chicago.
With 800 speakers from Ascension,
Cleveland Clinic, CommonSpirit and more, the conversations get
real. Leaders will share how their scenario planning
for policy shifts, breaking through value based care
barriers, and building clinical teams that translate new
ideas into real world care.
Join top decision makers in the room April
13 through the sixteenth.
For the agenda and event details, visit beckers
hospital review dot com and click on the
events tab in the upper right.
This is Laura Dierda with the Becker's Healthcare
podcast.
I'm thrilled today to be joined by doctor
Douglas Ross, chief medical officer at AdventHealth Carolwood.
Doctor Ross, it's a pleasure to have you
on the podcast today. Thanks so much,
Laura. Great to be here. Honored to be
here. Absolutely fantastic. Well, I'm excited for our
conversation because we're gonna be talking a lot
about,
age related neurological and cognitive conditions, some of
the challenges related to that, as well as,
you know, how clinicians and organizations can really
support those who are going through those challenges.
But before we dive in, can you tell
us a little bit more about yourself and
AdventHealth Carol Wood?
Yeah. Sure. I'm an ENT by background, and
I'm the
hospital leader here focused on operationalizing
care models
so that,
clinicians can do the highest
value work while the system lowers barriers for
patients and families.
I've been in,
administration now. I started,
in administration around 2008.
And so I've been in, health care administration
for a long time and particularly
in guiding and leading
and helping doctors,
as,
the evolution, and that's a kind word to
say, of medicine
has been occurring. But,
so,
I've had a lot of battle scars, but,
really enjoyed the role.
AdventHealth began as a mission driven health system,
so just talking about us. And we've grown
into a larger integrated network that emphasizes whole
person care.
Clinical excellence wrapped with spiritual and social supports.
That philosophy shapes how we approach aging. It's
not only about medical diagnosis,
but it's about independence,
dignity, and quality of life.
So Atherton Health Carrowood is our Tampa area
acute care campus that functions as a community
hub for neurology and aging services.
We provide inpatient acute care, stroke services, outpatient
neurology, and memory care access for families who
want expert care close to home.
And importantly for us, and for the community,
Carrollwood is connected
into the AdventHealth's
broader neuroscience
institute
and the systems memory and aging programs, and
we have a few.
The so that connection lets us offer sophisticated
diagnostic and specialty input,
when patients need it.
And that keeps, that and we also
keep the care as local and, patient centered
as possible.
On a practical level, that means we focus
on three things at Carrollwood, timely access,
interdisciplinary
coordination,
and care navigation.
Timely access, we want seniors to be seen
quickly. We really, like, really want our entire
population who comes, spends time with us, not
to waste their time. So we wanted them
seen quickly,
when their concerns arise or you know, and
provide
interdisciplinary
core coordination,
which is
really for the senior,
long term cognitive conditions are complex and rarely
managed by a single specialist. So
we combine primary care, neurology,
geriatrics,
pharmacy, rehab, and social work into team based
pathways.
In care navigation,
we help families understand next steps, whether that's
home services, therapy,
or clinical trial.
That blend of, community access plus system
expertise is how we make the care both
capable and compassionate.
So we're really, you know, we really are
focusing
systematically
and using both our local and
system resources in dealing with these challenges of
this aging population.
That's helpful to understand and, you know, really
critical, especially when you think about the aging
population. I know there's a growing number of
people that are are entering into that space
and a huge demand for, those types of
services. So,
with that steady growth of age related neurological
and cognitive conditions, where are some of the
health systems like yours feeling the greatest pressures,
and how is that changing care delivery models?
It's a good question.
Let me start with the, pressures. Three big
forces really we see are converging. The first
is, demographics. The population 65 and older is
growing rapidly.
More older adults means higher prevalence of dementia,
Parkinson's disease,
stroke
survivors, living with cog cognitive deficits, and,
multimorbidity.
That increases volume
across clinics, EDs, and, post acute services. So
that really puts a strain.
Second is the workforce and diagnostic bottlenecks.
There simply aren't enough neurologists and geriatric specialists
in many communities,
really pretty much in most communities factually.
And that creates long wait times and pushes
a lot of responsibility back onto our primary
care docs,
which is the right clinical quarterback, but needs
better tools and team support
in order to do the right
by the patient.
Third, the social side, there's caregiver stress, fragmented
transitions from hospital home and constraints and skilled
nursing and home care capacity. And these upstream
social gaps translate into preventable readmissions,
crises, and poor quality of life, not just
for the patient, but for the caregiver as
well.
So how are systems responding, you ask? Well,
the pattern I'm seeing and what we're building
at AdventHealth is a movement
from episodic specialist,
centric care
to longitudinal
team based and community anchored models.
What does that mean, really? So
number one, we're we're creating interdisciplinary
memory clinics and 65 plus primary care pathways
that embed social work, pharmacists, and care navigators.
That's a one stop approach, reduces fragmentation,
and speeds decision making for families. Really
a great model. I've I've I've witnessed it
myself. It's it's phenomenal.
We're also scaling telehealth and home based care
to reach patients who can't easily travel.
Teleneurology
visits, virtual caregiver coaching,
and remote monitoring reduces unnecessary ED visits and
keeps patients safer at home.
And, in terms of that, we're also in
trying to increase our,
the number of neurologists. So for example, at
our sister hospital in Tampa,
we're starting a neurology residency hopefully by 2027
because we recognize the need for further neurologists,
in our community.
We're investing, in data driven triage too. EHR
flags,
we use, EPIC, but, you know, a lot
of the EHRs have these flags.
Brief digital cognitive screens in primary care,
and where helpful blood
biomarkers or a functional texting, which we'll talk
about in a little bit, I think, to
prioritize
who needs specialty input.
And we're strengthening caregiver support because caregiver well-being,
like I said before, is a clinical outcome
in itself.
So we do coaching, respite resources,
and navigators
to, lower the caregiver strain and reduce crises.
The goal really isn't to replace specialists,
but it's to use specialists more effectively by
reserving their time for patients
who truly need advanced diagnostics
or interventions
while ensuring everyone else is, receiving the right
support and follow-up. And,
you know, much like our behavioral health crisis
in in the country, a lot of the
burden has fallen on the primary care doctors
as we all know. And
and that's really
becoming
more true with our seniors and dementia
and other,
cognitive abnormalities.
That makes a lot of sense and, you
know, it's such a helpful overview in how
everything, the landscape is changing and has been
evolving. I think it's, fascinating to hear about
all of those different factors that, you know,
are are really,
converging together in order to, bring about change
in the care delivery models, not only, you
know, just the population shifts in caregiver, but
also thinking about the technology that's available and
how you can use that. So I know
that many organizations still rely heavily on cognitive
testing and structural imaging.
What are some of the limitations that are
becoming more apparent there, and how does the
functional brain assessment add value to some of
the clinical decision making that you're doing as
well?
Yeah. Well, I think, all the tests are
are are useful in some regard. You know,
traditional tools,
short cognitive screens and, structural MRIs, they're indispensable,
but they have their limits. And
cognitive schemes like, MMSE
or MOCAs
are practical.
They're fast,
but they're just snapshots.
And they can be influenced by education,
language, mood, or culture, and they often capture
change only after the disease has progressed. And
structural imaging, standard MRI or CT scan,
is terrific,
for ruling out tumors, large strokes, or hydrocephalus,
or gross atrophy of the brain. But,
yet in early neurodegenerative
diseases, the MRI can look deceptively normal.
So,
by the time a problem shows on these
measures,
biological disease has often been present for years.
So that's where functional and, molecular assessments add
real clinical value. And there are three practical
areas of advantage and things we can use
today.
So in, for earlier pathophysiologic
insight, the PET imaging and,
emerging plasma biomarkers can detect, Alzheimer related pathology
before substantial cognitive decline,
which is phenomenal
because that's usually when we catch it, when
you see the cognitive decline.
But that means that you can identify biological
targets
when an intervention still has a chance to
alter trajectory.
And really for families, that timing is everything.
Then there's a mechanistic clarity,
functional tools like FDG PET scan or tau
amyloid PET scans or advanced MRI analytics,
and even EEG based network measures
help distinguish
ideologies
like Alzheimer's versus vascular cognitive impairment versus frontal
temporal syndromes
where treatment and prognosis
differ.
That clarity avoids guesswork
and speeds the right plan of care.
And third, practical triage and monitoring. So blood
based biomarkers are becoming a scalable screening,
step.
Quantitative EEG and advanced functional
MRIs can support monitoring over time without repeated
invasive tests.
For health systems, those are tools to triage
who needs expensive scans
and who can be managed conservatively with risk
reduction and supportive care.
So clinically, adding functional assessment changes
lets us, counsel families more accurately about prognosis
and
decides whether disease modifying therapies are appropriate.
Or enroll patients
in trials selectively.
Or personalized non drug interventions,
everything from targeted cognitive rehabilitation
to fall prevention programs.
That's fascinating to hear, and I think so
helpful to understand some of the different technologies
and,
opportunities available for for testing because I think,
you know, having the most sophisticated,
you know, technologies and processes out there, really
makes a big difference in the treatment and
trying to get early and those kinds of
things.
How do you see the field evolving in
the next year or two?
Well, it's an exciting field, right now. I'm,
I'm very optimistic. And as I said before,
the earlier you can
make a diagnosis with this,
the better. So, I mean, as this biomarkers
become
cheaper to do and more accessible to that
could be used as a primary,
care.
You know, that'll be so so biomarkers will
move into routine workflows,
Blood tests for amyloid and, phosphorylated
tau
are already increasingly reliable and much easier to
deploy than the PET or the or CSF
testing.
And that really does mean primary care can
play a larger screening role and refer the
right patients faster.
Second, the disease modifying therapies are changing expectations.
With therapies that target underlying pathology now available,
health systems, must create processes to confirm pathology
and deliver therapy safely.
Infusion pathways, monitoring protocols, and shared decision frameworks.
And I know when we are building our
new, medical office buildings across the state and
across our multistate,
we are building infusion centers into those,
clinics or into those, office buildings
with the I idea not just for cancer,
but for infusion of, these kind of,
therapies for,
Alzheimer's, much bigger population.
Thirdly,
digital and AI tools will support early detection.
Voice and speech analyses,
passive monitoring, and machine learning models that integrate
EHR data will help flag at risk patients
who need evaluation.
For example,
Parkinson disease now can be diagnosed using AI
and voice and speech analysis,
which is fascinating.
And that expands detection beyond the small subset
that comes to special attention.
Fourthly,
care delivery will shift upstream to prevention and
function. You know, life style interventions, vascular risk
control, and cognitive training are being adopted in
community programs,
and they offer the potential to delay progression.
We haven't really found a cure yet, but
we have found things that can delay progression,
which is
the best we have so far.
And health systems that integrate prevention with diagnostics
and specialty care will have the highest impact
really.
And finally, equity will be the implementation
challenge. You know? We must ensure the new
tests and therapies don't become available only to
patients who live near tertiary centers. That's why
hub and spoke models,
telehealth and targeted outreach
are essential. And,
at AdventHealth, we practice this a significant amount
of hub and spoke,
opportunities for patients so that they can take
advantage of tertiary care
even entering
into one of our
primary care offices.
Got it. That makes a lot of sense,
and it's really fascinating to think about how
you're able to go upstream there more and
really rework, the way you're connecting with the
community and the programs that are available,
so they're more convenient to the patients, especially
with the technology we have evolved evolved to
include digital and more.
I I'm curious.
Where do you see some of the biggest
opportunities for AdventHealth to continue growing in the
age related medicine field?
Well, for AdventHealth, the opportunity is clear. You
know? Scale integrated community anchored programs that connect
primary care, memory clinics, home services, and specialty
hubs.
And at
Carrollwood, specifically,
our role is to be a local access
point, a place where families get time
you
you know, the embedding of biomarker screenings and
streamlined triage in primary care,
expanding the home,
and teleneurology
so frail seniors aren't forced to travel, and
investing in care navigators and care giver programs
really at the local level because that's really
where you're gonna touch the patients and their
families.
And then, of course, we're running, through our
larger
research arm, pragmatic trials and registries, so they
have patients have access to these therapies even
just coming to Carrollwood.
And then for population health outreach, we use
our EHR,
data to target once it becomes more
defined, you know, how we can do prevention
and close gaps.
So, really, these the all these moves really
align with our mission
at AdventHealth for better health outcomes, you know,
supported caregivers
and
care that treats the whole person, which is
what we believe in.
I love that. Doctor Ross, thank you so
much for joining us on the podcast today.
This has been such a fascinating conversation, and
I look forward to connecting with you again
soon.
I appreciate it, Laura. Thanks for having me
on. I I'm, you know, it's a it's
an interesting topic, a mix of science and
social, I think, really. You know? We have
to we're dealing with, Alzheimer's. I think most
of us have all been touched by patients
with Alzheimer's, whether they're relatives or close friends,
and family.
So we understand the import of really being
able to diagnose early,
start interventions,
support the caregivers. It's all very critical, and,
I appreciate the opportunity to talk about it.
Thank you.