In the eighth episode of Telehealth Heroes, we interview Kathy Schwarting, the CEO of Palmetto Care Connections. She talks about improving technological literacy, her upcoming telehealth summit, and PCC’s goal to bring Google Fiber and improved broadband to rural communities in South Carolina.
Episode transcript
Brandon:
On today’s episode, we get to talk to Kathy Schwarting, who is a CEO of plum meadow care connections from my home state, South Carolina. Well, my adopted home state, South Carolina, and she’s doing some amazing stuff about getting tele-health out into the rural parts of the state. Kathy, welcome to the show today.
Kathy:
Thank you very much for having me. I appreciate the opportunity to tell our story about rural health care in South Carolina
Brandon:
And, and rural health care is near and dear to your heart. Tell us where you live and where, where PCC is located actually.
Kathy:
So we’re located in very rural Bamber county, which is about 15,000 people and 3000.
Brandon:
Yes.
Kathy:
So the town of Bamburg is about 2,500 people, but I grew up in the PD area of the state in Dillon county and a very small community called Lakeview, which is about 700 people. So I have lived in rural except going to college and graduate school my entire life.
Brandon:
That’s fantastic. And tell us a little bit about what Palmetto care connections does for the state of South Carolina.
Kathy:
So to tell you how we got to pound Medicare connections, I worked for two small rural hospitals here in the area, one in Bamberg county, one environmental county, and a few years ago, they both closed. When I worked for those two hospitals, one of my jobs was to recruit physicians and their families to the community, to work for the hospital. When those hospitals closed, I knew that it would be very much more difficult to recruit physicians and mid-level providers to these rural communities when we didn’t have a hospital, cause there wasn’t a support system. It was hard enough when you had a full-blown no 24 hour service hospital, but without a hospital, it was very difficult. And at the time tele-help was sort of the up and coming thing that was going to be the future. And I really looked into it and thought this would be a really good way to bring services to these rural communities. If we were not able to bring the actual physician or provider to the community. So in 2010, we started paying Medicare connections, which is a nonprofit tele-health network. And our mission in life is to bring services and increase access to care in rural and underserved areas across the state
Brandon:
10 years. So you’ve been doing this for over 10 years now. What were the challenges that you faced 10 years ago? Tell telehealth today is completely different than it must’ve been 10 years ago. What was it like when you were starting telehealth back then?
Kathy:
So 11 years ago, when you would tell people that you worked until a health, nobody knew what that meant. And I didn’t have to explain, you know, it’s like if you’re looking into a TV screen and people would go, oh yeah, yeah, I get that. But they didn’t know the term telehealth, telemedicine. They didn’t understand what video conferencing or a virtual visit man at the time. And now since the pandemic, everybody knows what telehealth is and everybody wants to do telehealth. We spent the first part of our journey, really educating healthcare providers about the importance and the significance of offering services through telehealth. And we sort of focused on that part of it up until the pandemic hit. And now we do a lot of education from the patient or consumer perspective. We have a lot of folks that call us and they called us during the pandemic.
Kathy:
When most things were shut down, how do I do tele-health? How do, what if my, how do I know if my doctor provides telehealth? If I have a tele-health visit, I haven’t had several people call me, had the, I have a doctor’s appointment is through tele-health. I don’t know what I’m supposed to do. What am I supposed to do? How do I connect to them? So now we don’t necessarily have to explain to people what telehealth is. We just have to help make it accessible and make sure that they have enough broadband to be able to do telehealth from their home, their office or wherever they’re located.
Brandon:
So that’s really interesting. It’s interesting to see how telehealth in a rural state has evolved over the last decade, really. And it’s actually exciting to know that people understand it now that your job in that regard is done, but it opens up a whole new challenge of how do I do this and all these other things. So there’s always going to be a need and just those needs change over time, which is a very interesting. So you, you mentioned about the broadband and I can imagine broadband and internet access is an issue in a state such as South Carolina, which is largely rural. Can you talk a little bit more about that and what are the challenges that you experience when trying to get telehealth out into rural parts of a state?
Kathy:
When we were working primarily with the healthcare providers in the early part of PCC, we had issues of broadband and enough connectivity at the actual healthcare facility, right? So we worked diligently for years to make sure that the healthcare providers had access. And that was a challenge in itself. So that kind of brought us into the broadband arena. And then when actually prior to COVID, when more consumers started being interested in telehealth, and we knew that there was a barrier, we started looking into what it would take to expand broadband from the patient perspective, and then boom, you had COVID and everybody wanted to do telehealth. And every provider that, that I can think of implemented telehealth because a lot of their patients were too scared to come into a waiting room because they were fearful that there were other contagious folks through the room.
Kathy:
So we surveyed a lot of the rural providers. And I would say one provider in particular here in Bamberg about 25% of her patients could not do a telehealth visit either because they did the patient, did not understand how to download or how to connect, or they had no connectivity at all. Now up in the PD area, we worked with an FQHC, which is a federally qualified health center and probably 50% of their visits had to be done via the phone because their patients either could not get access or had no connectivity whatsoever, which I know this is not about doxy me, but which may doxy me so relevant during the pandemic because the patient doesn’t have to download anything. Right. Right. We have to make it as easy for the patient as we can possibly make it so that they can use the little bit of technology or the small amount of resources that they have to be able to have a connection.
Brandon:
Absolutely. And have, how have you seen internet access increase over the last couple of years? Do you see it becoming ubiquitous throughout the state or are you, will you always see connectivity issues persistent
Kathy:
Now? So I would say that during COVID our legislature really stepped up and put a lot of funding into broadband, build out or infrastructure development. And they also developed a South Carolina broadband office, which I don’t know if most folks know that, but it is located within the office of regulatory staff. It now has a director and a staff of its own. And the legislature is in the process of putting several the, I don’t think they’ve defined it yet, but the rumors that I’ve heard are about $500 million into broadband build out. And what they’re doing with that money is through ORs. The broadband office is providing grants that have to be matched to the internet service providers, giving them an incentive to build out into more of the rural and remote areas. So I think our internet service providers have stepped up. Our south gun legislature stepped up and the federal government stepped up because there’s now lots and lots of funding for broadband support, even at the patient level.
Kathy:
So they came out with a program called for example, the emergency broadband benefit program. And if you are eligible for that, a household can get up to $50 a month. There’s a subsidy to pay for their internet calls. And it also provides a subsidy to help them buy a device. So I think everybody has sort of stepped up their game a little bit to try to make broadband more accessible. I mean, in our rural community here in Bamberg, when COVID hit and the students had to actually go home for virtual learning, they estimated that 70% of the kids in our school district had no internet service at all. Now you can’t do virtual learning. You can’t get healthcare, you can’t be connected to the outside world if you’re in that 70% and in a country as, as you know, forward moving as we are. And as a fluent and as rich as we are to have people in our rural areas with absolutely no internet whatsoever is completely unacceptable.
Brandon:
Yeah. That you make a great point because a broadband and internet access, isn’t just for telehealth. It benefits education. When kids can’t go to school and they need to connect with their teachers, well, you gotta have internet to do that. Now, this internet connection, is it you say broadband, is that over the air or is this also through cable as well?
Kathy:
Well, I think what the state is trying to do is to actually build out fiber and fiber optic cable is actually your best, most consistent form of internet. However, we’re not going to be able to do that quickly because it’s going to take a lot of money and a lot of time. So there are things that you can do from the air. There are point to point connections. You can put small antennas on the outside of a person’s home and connect it to a transmitter. So there’s all kinds of different ways to do it. And I think that we need to be creative and to start with, we need to get internet out as fast and as quickly as we can. And then we can worry about, is it the most efficient and best service that we can provide? And that gives us more time.
Kathy:
That’s my opinion. That gives us more time to build the fiber out, which is absolutely the best option altogether. But we have been embarking the last six months or so on the digital literacy campaign, because what we found is a lot of folks, particularly low income households, and a lot of your senior citizens, they don’t really understand the benefit and the value of having the internet. And if $75 a month, they know that they can’t afford that. So they just, you know, disregard the fact of having internet. And so we have embarked upon with some funding from the department on aging and a group, a nonprofit called rural LISC. We have been providing digital literacy training to senior citizens. And what I mean by that is we’ve been teaching them how to use a device. We’ve been showing them how to do a telehealth visit, connecting them with their own provider.
Kathy:
We have been showing them how to get online and Google diabetes or Google what the diet for a diabetic, or if they’re having issues with one of their medications. And maybe it doesn’t sit well with their stomach or they’re, they’re unable to take it, get online, to find out what they can do so that there is not that adverse reaction. So in the process of doing this pilot, we have also given these senior citizens a tablet that they keep that is theirs. And we have given them a year’s worth of free cellular service and for the hundred or so seniors that we have put through the program so far, luckily we’ve only had one senior whereby the cellular service did not work in their home. And I think it is pretty good. So our service is another option. It’s not your greatest option, but if you’re out in a rural area and that is the best that you can get, it will connect you at least four, it will help visit or, you know, some other issues that you need to have.
Kathy:
But I think digital literacy is very important because a lot of folks that are older and N E not even senior citizens, but folks that are in their forties and fifties, that didn’t go through that type of training. A lot of them don’t know how to use technology. They don’t know much about cyber security. So that’s another thing that we taught the seniors. What do you do to avoid getting scammed on the internet, right? What do you do to get to avoid being scammed on your phone? And so we’ve tried to teach them a little things that they need to do and think about if they get an email or if they get a text or if they get a call on, you know, somebody calls them at their house and asked for money, right? So we’ve been trying to teach all of those things.
Kathy:
And they had responded amazingly. I mean, they have loved it. We actually ended up providing eight hours of hands-on training to each senior, which was a lot more than what we had originally planned, but it’s because they asked for more training. They wanted to know how to use Pinterest, how to use Facebook. You know, we taught them how to use zoom because as a physician, you know, during the pandemic, a lot of folks were socially isolated. And that just only added to the mental health issues that our state fences. So when you can’t talk, when you can’t see or visit with your children or your grandchildren, or your neighbor or your, your cousins for over a year, that really does a lot to our mental and emotional stability. So teaching them how to use them, to connect with their family and friends and their children. They absolutely love that. And I hope that, you know, we hope that COVID is going to go away one day. However, if we continue to have issues like we’ve had over the last two years, they will now have the technology and the ability to be able to connect to family, friends, their healthcare provider, go out, find a recipe if they’re stuck at home for a week and they want to do some baking. So those kinds of things are important to folks, especially when they’re isolated at home and can’t get out in the community,
Brandon:
Right? Health is more than just the acute visit. It’s the holistic, the, the, the health of the whole individual. And a lot of that is emotional mental health that is key and often overlooked, but very, very important. How, how have the providers and patients you’ve worked with in the rural areas, how have they come to adopt and accept tele-health or over the years that you’ve worked with them?
Kathy:
I think that the physicians in particular, in the earlier years were quite resistant. Most of them, if they were older, because they were not used to using technology that way, a lot of your younger providers were a little bit more open to it. A lot of patients were skeptical of it. I think I read a, I did a presentation one time and looking up statistics about 75 to 80% of people prior to the pandemic were very weary of virtual visit. However, once they did a virtual visit and understood that confidentiality is still important in a virtual visit about 75% of those were very open to doing future tele-health visits. So I think a lot of it is you have to introduce them to the technology. And we had lots of seniors to tell us during our training, you know, we’re scared of the technology, but taking the time to show us how to use it and to show us that if we touch the wrong place or we drop it, we’re not going to break it.
Kathy:
We’re not gonna, you know, lose a $200 device or that, you know, that, that we’re okay, touching it, dropping it, putting it in our pocket, putting it, putting it in our pocket. But those kinds of things are just really simple things that make folks more open to it. And I would say, now, if you are a provider, a clinic, a federally qualified health care center or a hospital, and you’re not using telehealth nowadays, you are behind the times because everybody else is stepping up to the plate to use it. And when we talked to a lot of the patients and they say, well, what do I do? I said, call your provider, ask your provider, do you provide tele-health services? And if they do not ask them, if they have the ability, would they be interested in doing that? Because it would certainly make your life easier.
Kathy:
Then if they choose not to do that, you as a patient has an option, you continue to work with that provider, or you can go find another provider that will do. So I think we’re at the point where the patient is going to start asking the provider. We were hoping that would happen 10 years ago. That’s the pandemic. I think it pushed us one of the good things to come out of the pandemic was it probably pushed tele-health 10 years forward in a way that we could have never gotten there as quickly, the way that we were doing it two years ago. So patients are going to start demanding it now. And as a physician or provider or a hospital, you better step up your game or they’re going to go somewhere else for services. That’s what I think is going to come down to in our future.
Brandon:
Absolutely. Now, speaking of future, so mission accomplished getting telehealth across the state, checked on that. W w what is PCC going to do 10 years from now?
Kathy:
Well, you know, we have really gotten into the broadband arena, and I think there’s a lot of work that needs to be done. We really have embraced digital literacy. We would like to, we would like to we’re in the process of trying to work with health and human services, to do a lot of digital literacy across the state, to low income families. We have talked with a lot of the health systems, M U S C Prisma McCloud, trying to teach their employees and their staff, how to be digital navigators, right? I mean, we all, all of the healthcare systems, and even the rural health clinics, they put a portal in place, right? And they want their patients to go online and view their reports, view their labs, but nobody teaches patients how to do that. Nobody sits down with them and explains to them about the whole username and password.
Kathy:
And we think that simple because we do it every day, but to people who have never been online before, that’s not really a simple thing. So I think really trying to we’re at a point now where I really want to do a lot of good for my communities. We’re in the process of working with some public housing subdivisions to bring internet into those units and to teach them the value. And you think about it. If we could really teach people to better manage their own health care, we could reduce a lot of unnecessary cost that our state and campuses, especially with some of the Medicaid population, I was in one of the public housing units earlier this week, actually, and this lady was saying, my daughter doesn’t have any insurance. And so she hasn’t been to the doctor’s office in several years. She did not even know that there was a federally qualified health center here in the county that sees patients regardless of their ability to pay.
Kathy:
So I guess what we want to do is a lot of education. There’s a, I think you can open up a person’s world and you can take them out of just their rural community. If you teach them how to be digitally literate, how to, how to go online, how to, how to travel outside of their community. And that may not be physically traveling, but that may be traveling on the wide world web, right. And teaching them how to better manage their health care and really helping the people in our state that need the help. The most, I would teach him the senior citizens. I think I did a video and we taught them an awful lot that they taught us more in return than we ever thought we would get out of it, just their appreciation, their patience with us, because this was new to us. And we might mess up and they’re like, oh, take your time. And they were just a very thirsty, eager to learn, learn group of folks. And I really liked to help those like that in the future.
Brandon:
And there’s a lot of wonderful people out there that are often overlooked because they don’t live in a, in a big city. They’re, they’re out there, but they’re still important, just as important as everybody else. And so I think it’s fantastic that we have people like you in the world, focusing on these people who are largely underserved, just because of where they live. Not because they’re any less important.
Kathy:
We’re in the waist that a long time ago. And I, we, we actually live by this at PCC, but your zip code should not define the quality of life that you live. It should not just because you live in Allendale, South Carolina, if you have a stroke that doesn’t, that it should not define you, that you’re going to be disabled and possibly die from that stroke because you were not near a stroke center, you should have as good of access to care in Allendale, South Carolina, as you do in Greenville or Charleston, South Carolina, and you should have the amenities, you should be able to do virtual learning. I mean, our kids in the rural areas are so much more disadvantaged than kids in the larger cities, simply because they don’t have internet access. And we should not accept that as a measure, a way to measure the quality of life. So I really think that all zip codes in South Carolina should have equal access to education, to employment, to health care, to knowledge, to travel to all of those things that you can do if you have internet access.
Brandon:
And it really that the internet access really ultimately lowers that digital divide, or I’m sorry, it lowers the divide of access to services because the services are becoming more digital, which, which democratizes or levels of playing field in many ways. But it key. The key to that is getting that the internet access in order to access those services.
Kathy:
How many people do you think now can actually get a, by going into a facility and filling out a paper application, they don’t do that anymore. We get the whole thing with the vaccines, right? We want it, we rolled it out, but we, if you wanted to register to get the vaccine, you had to go online. I mean, town, what kind of a di divided we have there? I mean, not just with the folks that the lower income folks, but none of our, most of our senior citizens don’t know how to use the internet. And they don’t know how to go online and register. A lot of them don’t have email addresses, right? So how are they supposed to truly get the vaccine? And, you know, everybody wants to say, well, the rural areas there, vaccination rates, aren’t nearly as high as the urban areas.
Kathy:
Well, I wonder why I think we’ve gotten to make it. And even if they hack or somebody did a vaccination clinic, what did they do? They wanted to email it out or they wanted to put it on Facebook. Well, what about those people who aren’t on Facebook? You know that most of these small towns, unfortunately don’t have newspapers anymore. I mean, right. Hamburg has a very small newspaper that runs once a week. So does barn also does Allendale sun and most of the small towns. So the people that are used to reading it in the newspaper, if the paper comes out on Wednesday, you decide on Thursday that you’re going to do a vaccination clinic on Tuesday. They don’t even get the paper to know about that vaccination clinic. Right. And we wonder why the vaccination rates are lower, but we’ve got to be able to communicate people all across the state, regardless of where they live, so that everybody has the same access to services that they should have. And whether that’s healthcare, whether that’s employment, whether that’s education, I think it all goes together. If you can increase a person’s ability to do tele-health, then they have that capability. Then they also have the capability to do virtual learning online. Absolutely. Then our farms nowadays, their equipment runs off of wifi. And so we, we’ve got to close that gap sooner than later, I think,
Brandon:
Right. It’s healthcare, it’s education, but it’s also jobs, a lot of jobs or work at home. Well convene, absolutely. Right. It’s increasing access to high paying jobs and you don’t have to put factories out there. You can just, you know, bring the job to the people through a digital means. So in fact, with docs to me, most of our, all of our employees on the team work remotely. So there’s a reason somebody from Bamberg couldn’t work for docs to me, just because that’s just the way companies are, are moving towards. So pulmonary care connections also hosts the South Carolina telehealth summit. And you’ve been doing that for several years now. Can you talk a little bit about what that’s all about?
Kathy:
Yeah. So this we’re actually having our ninth annual tele-health summit, November 9th, 10th, we’ve actually planned for 11 summits, but due to an ice freeze or due to a hurricane, we’ve had to cancel a couple. So this will be the ninth one. And we had gone from a half a day to basically two and a half days. Last year was the first year that we actually had to go to virtual and we had over 500 folks attend. And what we like to do in that summit is to showcase a lot of our statewide efforts, showcase programs, showcase platforms, such as doxy me, and really tell the story, let people to understand that we have a lot until a health growth in South Carolina, bring in experts at, or from on a national level or maybe on a regional level to show what they’re doing in their areas to show that we’re actually hanging in there.
Kathy:
And in some cases I think South Carolina is ahead of the curve and ahead of other states with our progression and growth of telehealth. And we like to have program spotlights. For example, there is a homeless shelter or homeless resource center down in Charleston called the navigation center. And they actually have brought in tele-health as a resource for the homeless in Charleston. And that’s a very innovative program and a rare, very creative way to help that population of folks who may not be comfortable going into a hospital or a doctor’s office. And so the tele-health, but once again is bringing the provider to the patient. And so showcasing programs like that showcasing, we actually in the state did a really great job of implementing a grand rounds program, showcasing programs like that, where you can get on there and hear experts talk about the vaccination efficiencies and effectiveness.
Kathy:
They can talk about a lot of the tele-health programs, such as the opioid echo program, where you can actually do education through the use of tele-health and train primary care providers in rural areas, how to better treat opioid patients. You can do that with any kind of a program. You can do that with maternal fetal medicine. You can do that with HIV and hepatitis C. So really trying to showcase programs like that across the state. And then we have a special award ceremony where we recognize who our champions for that year had been. We always have a national tele-health champion that they have implemented or sponsored several congressional bills that have had an impact on our state. We do a state total health champion, I think last year, Dr. Jimmy McElligott who co-chairs the south mental health Alliance with me was actually our tele-health champion for the state. We do
Brandon:
That every year. I’m just curious.
Kathy:
We knew this every
Brandon:
Year. Yes. Every year. No, he does not.
Kathy:
He should.
Brandon:
I was going to say it like, I mean, hotels is Jimmy one, this, I mean he’s
Kathy:
Last year was his first year. And I was like, I can’t believe we waited this long to recognize Jimmy, but Jimmy is very humble and it was a big honor for me to actually be able to give him that award. But we look at programs of excellence. We look at innovative awards and who the pioneers in our state are. So we really want to recognize those leaders and those, the ones that are pioneering for us and rushing down the road to, to find out what the problems are before we get there. So that’s really the goal of the tele-health summit. And we have all of our health systems to participate. We have our payers, we have blue cross blue shield. We have our broadband providers like spectrum and Segra. So we have lots of different supporters and sponsors for that big event,
Brandon:
Who is the intended audience and that, and also who would benefit from this and who could attend this.
Kathy:
Our target audience is really anybody interested in telehealth
Brandon:
In South Carolina or just
Kathy:
last year, we had a lot of out of state folks participate. We send our announcements to all of the different resource centers in the various states that do telehealth resource work, but our target audience and our goal in South Carolina is to teach and train anybody in South Carolina. That’s interested. So your hospital administrators, their staff members, providers, whether they’re physicians, nurse practitioners, we always have something around school-based telehealth for your school-based nurses. Also folks in the federally qualified health centers or the rural health clinics are free clinics. We actually touch on as many topics as we can. And for example, this year, we’re going to showcase a little bit about how skilled nursing homes are using tele-health. So we really tried to do a lot across the board to touch on all the different professions that might be interested in learning how to do tele-health or who they might can call or network with to learn more. So it’s a really big networking opportunity as well. And our sponsors and our exhibitors showcase their platforms, their products. You can, if you’re looking for a type of a platform, or if you’re looking to work with a broadband provider, you can find those exhibitors at this event and do a one-on-one with them. So you can learn more about their product and see if their product meets the need that you have in your own organization.
Brandon:
So this year is virtual. Is it, is this going to be permanently virtual or do you intend to get back to in-person
Kathy:
Events? Because we had planned to do an in-person and most of our folks want to go back to an in-person. I think in the future, we will have some sort of hybrid model where we do have an in-person, because you can’t take away from the networking opportunities and meeting with a Jimmy Miguel to get one-on-one, to get him to explain to you what his philosophy on the future of telehealth is. Right. I think we’re always going to have to have a virtual model for those that can’t physically get there, or for whatever reason, maybe they’re a little weary of being in a large crowd. I think the days of how we used to do things are gone and we’re going to have to do hybrid models of almost everything going forward. This may not be the, the one and only pandemic that we ever experienced. And so we need to get comfortable doing things virtually just like we’re doing here today. But, but I think at some point there is a lot of value in face-to-face just like some doctor’s appointments tele-health is great, but it is a compliment to healthcare, right? And there are some instances where you need to go in and physically meet with your provider one-on-one for whatever reason that may be. So it’s not to replace that. And I don’t think virtual is to replace in person, but it’s to compliment each other.
Brandon:
Yeah. We often say that tell docs, MES, we’re not, we’re not trying to replace in-person visit. We’re just trying to augment that in person visit and to provide additional option for Dr. Smoot patients, whether they want it in person, or you want to virtually, it doesn’t matter, you meet with a patient that’s the most important thing. And you just have an additional tool in your quiver to another way to meet with your patients. So that’s
Kathy:
Very much in line with you on that completely.
Brandon:
Awesome. Well, Kathy Schwarting thank you so much for your time. Had a really great pleasure and thank you for everything you’re doing in South Carolina. And hopefully this, this message and the work that you’re doing South Carolina can propagate throughout the rest of a rural America.
Kathy:
Well, thank you so much for having me and listening to our story. And I would like to say one other note, I think for those folks listening out there, we need to have a rebranding campaign for rural, because I think rural gets a bad rap sometimes. And there are lots of really good reasons to visit travel through or live in a rural area. And people should really do that. There’s a lot of peacefulness here that a lot of people in larger cities may have. So don’t just throw rural out, you know, out the window. Think about it, learn a little bit more about it because I think, I think it’s a really great place to live.
Brandon:
Absolutely. Having grown up in rural north, north, rural New York, I can definitely test that. There’s a lot of good, good people that live there and, and it’s, it’s a beautiful part of the country, any place it’s rural. And one of my favorite things to do is when I’m driving through South Carolina are to take back roads through rural South Carolina. Cause there’s just a lot of beauty there. So I, I echo that sense
Kathy:
And you can get a lot of good hung cooking going on. Some of
Brandon:
That’s right, the Southern cooking, Southern hospitality. So Cathy, thank you so much for your time. I appreciate it.
Kathy:
Thank you. I appreciate you so much. You have a great day. You too.
