Luis A. Rojas, MD, FACOG, Clinical Vice President of Oncology Service Line at Avera, joins the show to discuss the system's efforts at serving cancer patients in their most rural communities. Dr. Rojas highlights both Avera's procedures and investment in innovative technology, and their belief in the mission of Catholic health care as a way to serve everyone, no matter where they live.
As the national conversation around HR1, Medicaid and health care access continues, Catholic health care continues to affirm its belief that everyone deserves access to high-quality, affordable care. As this episode's guest highlights, that includes those in rural communities.
Luis A. Rojas, MD, FACOG, Clinical Vice President of Oncology Service Line at Avera, joins the show to discuss the system's efforts at serving cancer patients in their most rural communities. Dr. Rojas highlights both Avera's procedures and investment in innovative technology, and their belief in the mission of Catholic health care as a way to serve everyone, no matter where they live.
Brian Reardon (00:07):
Welcome to Health Calls, the podcast of the Catholic Health Association of the United States. I'm your host, Brian Reardon, and with me is Josh Matejka. Hey, Josh.
Josh Matejka (00:15):
Hey, Brian.
Brian Reardon (00:16):
Good to have you here as we are starting to wrap up this season on humanity and technology. And for this episode, I think it's kind of worth bringing up the conversation that's currently happening as we're recording this, that there's a lot of discussion about what's going on in Congress and specifically for Catholic healthcare for the CHA and our members, the potential for Medicaid cuts. So as we look at the ongoing conversations around the potential Medicaid cuts, and I think a lot of the frustration that people have with the lack of access to affordable care, how does this conversation that we're going to have here in a moment, we're going to talk to Dr. Luis Rojas, he's Clinical Vice President of Oncology Services at Avera. How does this conversation with Dr. Rojas fit into the theme of the season and what's going on in the world around us today?
Josh Matejka (01:08):
Yeah, Brian, I don't think anybody that is paying attention to CHA and is a part of our kind of network is really surprised by this. But our colleagues in Washington DC are very much a part of the conversation about the legislation that's going through Congress right now that might drastically change the access that millions of people in the United States would have to high quality healthcare. And in Catholic healthcare, we really believe in access as a core principle of what we believe and what we want to practice. And I think the program we're going to talk about today is a great example of that. It's taking this high quality, this really innovative technology, and it's offering it to people who might not be seen as the people who would normally have access to that. We don't want just that access to be extended to people in high populous areas, to urban areas.
(01:53):
People in rural areas need that care as well, and sometimes urgently need that care. And that's what we're seeing from this program, is they're offering that high quality care to people that might not otherwise have. They're investing in technology, they're investing in innovation, and we want to put forward that program and these types of programs as an example of this is what our members are doing. They believe in this and they're not just saying it. They're practicing what they preach. And so that's why we wanted to elevate this program. And I hope that a lot of people see the beauty of that in this conversation, especially as we continue to have this national conversation about legislation and healthcare access.
Brian Reardon (02:27):
Yeah, completely. And throughout the season, we've really talked about how technology is applied through the perspective of Catholic healthcare and making sure that it never loses its humanity. And I think what Avera and a lot of our members do is making sure that the care that's delivered is done consistent with our mission and our values. And you're right, this is another example, and I got to hear from Dr. Rojas when I was up at Avera with some colleagues earlier this year and came away from that meeting, really impressed and thought that would make for a good conversation. So let's go ahead and bring in Dr. Luis Rojas. He's Clinical Vice President of Oncology Service Line at Avera. Dr. Rojas, thanks for joining us.
Luis A. Rojas, MD, FACOG (03:09):
Brian, Josh. Thank you for having me today.
Brian Reardon (03:12):
So yeah, we were talking about access to healthcare and how important that is. And I think the examples like the program that you co-lead are some of the examples that we like to present is really setting that high standard of quality. So I guess to start off with, our listeners are probably like, what are they talking about? Oncology services. Can you give our listeners an overview of the program that you lead there at Vera?
Luis A. Rojas, MD, FACOG (03:32):
Yes, thank you. It's my pleasure, to be honest, to give you an overview of our oncology service line program, I have to start by giving a little bit of background to Avera. Avera is a health ministry rural in the gospel that was founded by the presentation of tine sisters. We serve a vast rural area, 72,000 square miles in the Midwest covering the majority of South Dakota, southwest Minnesota, northwest Iowa, northeast Nebraska. And we understand as we serve rural communities that there are disparities in rural areas. The mission of Avera is making a positive impact in the peoples and communities that we serve. So years ago to try to do this in rural America where there are disparities in healthcare outcomes, the concept of line came about. So I co-lead the oncology service line for Avera Health with Katie Van Beek. And the service lines in our service line is basically based on delivering on that mission that I stated before, having a brand promise that our patients will get the same high quality cancer care everywhere, their access and Avera clinic, whether it is in our main hub in Sioux Falls, South Dakota, where we have a tertiary hospital or it is in one of our other five hubs that are in more rural communities.
(05:00):
We strive to provide the same high quality cancer care. And we do that by identifying in our main hub what are our needs, what's the newest technology, what is lacking in our other six hubs and delivering that care. We want to do rural oncologic care differently. Others that do rural care, they do it and say they're doing it by bringing the care to where all the specialists are. We want to bring the specialist and the specialty care and the technology and innovation to the patients in their community because it is very hard to go through cancer care, the journey of cancer treatments. It's even worse when you have to travel 300, 400, 500 miles to get that care. So we understand that, and that's what the oncology service line at Avera is about.
Brian Reardon (05:53):
And when I think of specialty care, and maybe this is a bit of a generalization, but it seems the hub and spoke model. So you have high quality pick your specialty, and in this case we're talking about oncology services. You have a concentration obviously at a tertiary or ary facility. And then the sort of expectation is that the satellite hospitals clinics in that market or in that service area, patients flow to the hub and your model's a little bit different.
Luis A. Rojas, MD, FACOG (06:21):
Yes, that is correct. In oncology in general, there are very well established specialties that we have. We are redesigning ourselves where we have specialties within medical oncology itself. But the question is how do we deliver that specialty care locally? So we have a subspecialization process with a rural flare where we make our specialists available through technology and innovation locally in those most rural communities, utilizing that technology and innovation.
Brian Reardon (06:56):
And how do you work to prioritize the communities when you're implementing the new technology? I can imagine the amount of capital investment, the human resources, just all of the time technology that goes into making sure that that care is delivered locally. So can you talk through a little bit about prioritization of resources?
Luis A. Rojas, MD, FACOG (07:17):
Yeah. When we started in this journey, we basically went around our system and after visiting with our president and CEO and our senior leaders in each of the regional presidents, we decided we're going to go through each of our six main hubs or cancer institutes and do a SWOT analysis and determine what are the needs. Each of our regions had different needs. We actually engaged the local teams to give us outline, what are your strengths, your weaknesses, and what are the opportunities that we can leverage based on that? So we came up with some strategies that we're delivering on, but it's having a prioritization means that you need to have a presence and you need to go through those areas. So we travel to our six cancer institute six times a year and identify what are their needs and try to deliver upon that, having obviously a model that is outlined by the whole group. When I say by the whole group, we bring all our oncologists and all our teams together in meetings, not only locally, but centrally, where we had very frank and open discussions about what are the needs and how we can deliver. So it's a total team effort.
Brian Reardon (08:38):
And when I heard your presentation earlier this year, I was really amazed at all of the different cutting edge cancer services and cancer treatments that you're providing again at these six locations across your rural footprint in the states you described earlier. So our listeners, because I think this is important, can you give us an overview of what sort of new technologies and treatments that you've been able to integrate into this program?
Luis A. Rojas, MD, FACOG (09:03):
Yes. While our main cancer institute in Sioux Falls, South Dakota has pretty much everything that other big academic institutions have. We are the only factor accredited bone marrow and cellular therapy program. We have robotic technologies, we use genomic sequencing, personalized medicine, you name it. With the use of telehealth, we are able to deliver the intellectual expertise that our specialists have in our rural communities. We actually had to get very creative as one of the problems in rural settings is it is difficult to hire the appropriate or the ideal expertise. So for example, in the area of radiation oncology, so deliver radiation, each of our hubs have a linear accelerator, but sometimes we're lacking the manpower to implement that because when you have a small rural community, it's difficult to hire radiation oncologists to deliver that care. So we in 2019 piloted an irradiation program for which we had to go to Washington and CMS and get approved to work on this.
(10:20):
So what we have is some very high tech cameras and appropriate technicians in each of our hubs. And we have a central radiation hub where a radiation oncologist can literally be in one physical location, but treating a patient 300 miles away with the right team there. And we use that by having that technology available. One of the other things that talking about new technologies using telehealth, it really broke my heart when we had patients in rural communities that we were offering new therapies, the therapies of the future based on clinical trials, that they wouldn't go and enroll in that clinical trial because they couldn't leave the ranch to go and get 'em. Well, we have figured out how do we deliver those clinical trials locally in our most rural communities using telehealth and a group of team members that travel to do the coordination of the clinical trial with the local team and the local providers.
(11:25):
Some of our communities don't have a physician In one of our most rural communities, we have two advanced practice providers, nurse practitioners, that have rotated through with our specialist to learn the ways and the techniques and the clinical aspects of it. And we collaborate as a team where the specialist or the oncologist is in the main hub and the nurse practitioner is the patient in the distant rural community so that we can deliver that care and so on. We have been able to, for example, develop nine different multidisciplinary tumor conferences that happen via Zoom and where the oncologist that is in one of our rural communities, which we have two communities that have physical medical oncologists, can dial in and present their oncology cases so that our specialist pathologist, radiologist, subspecialists within the area of oncologists can give their expert opinion so that that care can be delivered to the highest level of quality.
Brian Reardon (12:35):
And I love the application of telehealth, and I know Avera has been in the telehealth game, if you will, for even pre COVID. You guys have been on the cutting edge of that, and this is some great examples of the impact that that's had in delivering care to patients. The other thing that struck me in your presentation that I heard was the sort of, again, the human part of this, that if you mentioned a linear accelerator, it's a very complicated machine to run, and if a technician is out sick, you have the ability to deploy folks so that machine, if somebody has an appointment, you don't have to cancel the appointment for patients. Can you talk a little bit about the human element of delivering this care and how you staff accordingly?
Luis A. Rojas, MD, FACOG (13:16):
Yes. We have, specifically in radiation, we have been able to kind of do a more centralized models where we have a team, for example, for you to deliver radiation you need, besides the physician and advanced practice provider, you need a team from physics, a physicist, a team from calculates those, the symmetrists, and then you need the therapist. The therapist had to be at the bedside, obviously. But we have been able to, for example, the physicist and the symmetries, we have a centralized team of those experts that are the ones that are able to support six different regional linear accelerators or radiation machines. If there would be one of the team members that's sick, all of a sudden we are actually, in the physician standpoint, we have the same model. We have a physician that can cover when others go out, somebody goes out unexpectedly or goes out on vacation. This physician can cover from a distant, that's how they work as a team, as partners to deliver the care and make a positive impact in our communities.
Brian Reardon (14:22):
And so let's talk a little bit about the impact all of this has, again, we are talking about care. For those who living in rural communities, what would you share with folks that don't live in a more rural area or maybe used to having a hospital down the street? What kind of impact is this having on those patients that you're serving?
Luis A. Rojas, MD, FACOG (14:39):
It makes care more accessible. I mean, I trained in a very urban area in Philadelphia as an obstetrician and gynecologist, and then went to do my oncology training in Cleveland Clinic. And you have everything there. And it's a very highly populated area where those patients can move themselves rather quickly because you're just heading to short distances here. That's not the same. This partnerships that we have within the Avera Oncology service line and leveraging all that technology allows us to live every day and deliver that mission of making a positive impact in our patients of our most rural communities. We can bridge those disparities that are in outcomes or that are a consequence of lack of access to specialists, lack of access to technology by just using the team and the system that has been developed to deliver that care. So in urban communities, there are it's disparities because when in a place like New York City where you may have the problem of getting to your doctor, even though it's a short distance because of traffic and all that, here's distance in broad geographic area that we have to bridge that we need to bypass.
Brian Reardon (16:02):
So before I bring Josh back into the conversation, what's next? What's the long-term strategy for the program?
Luis A. Rojas, MD, FACOG (16:08):
Yeah, I think our long-term strategy is continue to, we know we have achieved some success, but we know we have much more work to do to continue decreasing those disparities in care and to continue to bring the very best to our persons in need in our rural communities. While we have been able to bridge and bring clinical trials and the newest medications to some areas, we know that we just bring cooperative group trials or kind of just the bare tip for us to bring the newest of the newest technologies and innovations in healthcare. We need to continue working together. Our goal is to bring all that to those patients and to decrease the gaps in cares and outcomes. We are focused on doing more targeting interventions like the irradiation piece in other areas that will hopefully deploy in the future here.
Brian Reardon (17:11):
That's great. Josh, let me bring you back into the conversation maybe and where we begin with the topic of access.
Josh Matejka (17:17):
Yeah. Dr. Rojas, like I said earlier, access is something that we see as so important to people kind of across ideological lines at this point, and the access to high quality care, no matter where you are, no matter how much money you have, what kind of infrastructure you have around you, that is so important to so many people. And I think ultimately it gets back to the mission of Catholic healthcare, and ultimately that we are a ministry of the church. How do you see Vera's mission playing into your day-to-day in this program, and how do you think it fits into the long-term strategy of the program?
Luis A. Rojas, MD, FACOG (17:53):
I think Avera's success is that the culture of the organization, it's really lived day by day, that mission. It's lived day by day and the teams, we don't have teams. We are one team, one green team is how I want to say it, because everybody knows that if we work together, we deliver on that mission, which is of making a positive impact in the life of our patients. An example of that, we recently implemented a software for breast cancer, early identification of high risk population. We had that in our main hospital. We have been able to partner with our local primary care providers and the oncology service line to bring that high, high-risk clinic model using this piece of technology, but also using our human or individuals that are willing to collaborate. And we are delivering success in our most rural communities by bringing that out. It takes a village, it takes a team, and everybody understand the mission of Avera wants to live that mission and do that properly because at the end, we are treating our communities, our patients, and that is our family members, our loved ones, our friends.
Brian Reardon (19:18):
Oh, nice summary. Again, that was Dr. Luis Rojas. He's the Clinical Vice President, oncology service line for Avera. Dr. Rojas, thanks for being with us.
Luis A. Rojas, MD, FACOG (19:26):
Thank you for having me today. It's been a pleasure.
Brian Reardon (19:29):
And this has been another episode of Health Calls, the podcast of the Catholic Health Association. I'm your host, Brian Rudin. Health Calls executive producer, of course, is Josh Matejka. And I do want to give a shout, I think Josh, we both want to recognize the work of Yvonne Stroder. Yvonne just retired, so we appreciate her help, particularly this last season in providing support, in getting things organized. So Yvonne, if you're listening, thank you. And this episode, we also want to thank Brian Hartmann here at Clayton Studios in St. Louis. You can find Health Calls on all of your favorite podcast apps and services, as well as on our website, chausa.org/podcast. And if you enjoy the show, please give us that five-star rating, maybe share some feedback. We'd love to hear from you. And as always, thanks for listening.