Transcript
Andrew Nelson: Welcome to Exploring
Rural Health, a podcast from the Rural Health Information
Hub. My name is Andrew Nelson. In this podcast, we’ll be
talking with a variety of experts about providing rural
healthcare, problems they’ve encountered, and ways in
which those problems can be solved. Today I’m talking
with Amanda Kennedy, manager of the Mercy Virtual
Substance Use Recovery Program, or vSURP. The program is
operated out of the Mercy Virtual Care Center and serves
patients in the five states that Mercy encompasses.
Amanda, can you tell us about vSURP, and how it differs
from traditional approaches to treating substance use?
Amanda Kennedy: So, Mercy vSURP was set
up about five years ago in some of the Mercy Hospital
systems. We’re different than your traditional recovery
programs, where we are embedded inside a hospital system.
Historically, hospital systems treat substance use
primarily as a medical crisis to stabilize, and then what
happens from there is, a patient is typically handed a
list of resources of those specialty recovery places at
discharge and told, “Good luck. Go ahead and call,
yourself.” So, what we did is we challenged that, and we
said that this is actually a long-term chronic disease.
So instead of a medical crisis, we need to treat it for
the full disease in a hospital system, not refer them out
to specialty practices. So, we’ve embedded an outpatient
program inside the hospital system.
Andrew Nelson: What ongoing needs did
you see in your community that made you realize this
model could be helpful?
Amanda Kennedy: You know, we identified
these barriers inside the communities of getting the
treatment. So that gap between stabilization and
emergency department or going to your primary care and
asking for help. So, a lot of things these patients are
missing…
One big key thing is transportation, especially when
you’re talking about rural communities. In order to get
to a clinic, you have to have a working car. It might be
45 minutes to an hour away. So, transportation was a big
thing. We’re all-virtual, so you don’t have to go
anywhere. We come to your smartphone.
The second is that immediate need. So, here’s the biggest
example we give. If you walked into your primary care
office and you were recently diagnosed with cancer,
that’s scary, it’s deadly. You want that immediate care.
So similarly, a patient that’s walking in and asking for
help with their substance use disorder, particularly
opiates, that’s deadly. Tomorrow, they can go out and use
and die. They need care today, as opposed to getting
screened and waiting for weeks for an appointment with a
physician. So, we have made a guarantee that patients are
seen within 24 to 72 hours, not just with an intake
worker, but with the physician, to start treatment
immediately.
And then I think the final piece that we always talk
about is those traditional recovery pathways. When you
call for help, you’re immediately asked, “What kind of
insurance do you have?” And you shouldn’t have to answer
that right away, right? Your healthcare should not be
dictated with how you can pay. So, we don’t ask that
question because at Mercy we take any payer source, even
self-pay, and we work with the patient after they’re
stabilized to figure out how they’re going to pay for
their bills.
Andrew Nelson: Given that you’re
providing care virtually, have you found that broadband
accessibility has been an obstacle to providing care to
patients?
Amanda Kennedy: In those rural
communities, at times, yes. So, when we first stood up a
few years ago, we were in the city areas, right? Where
there was no issue. So, as we are expanding and growing
into rural, sometimes we do. So, there’s two different
ways, right? So, we do have to see a patient on video, at
least for their first visit, to establish that care. It
can be choppy. Our doctors get it. While we do say
transportation is a barrier, we are working on getting
telehealth carts inside of Mercy primary care clinics, so
that the patient can actually go to their primary care
office and use their broadband. I’ve had patients that
have gone out to their neighbor’s houses and sat on their
porch and used their Wi-Fi or go to a local McDonald’s
and sit in their car and use the Wi-Fi. So, there’s a
will, there’s a way, but it’s kind of finding that way
around it.
Part of this particular grant we have is we are getting
hardware, making sure there’s hardware embedded in some
of our primary care clinics for our patients to use.
Mercy is already pretty forward with most of that since
COVID. We have many virtual service lines in the
hospital, but since we’re an outpatient program, we’re
looking more at those clinics to where a patient can just
go in and use one of their rooms. When a patient calls
and they say, “I don’t have a phone,” my team trained to
say, “Well, what about your parents? Do they have a phone
you can borrow? Or do you have a laptop?” Some patients
have kids that have tablets, right? “Can you do that?”
So, we also partner with Lincoln County EMS [featured in
the
June 2026 episode], who is doing a lot of forward
work. And we had them go to their local EMS dispatch, and
they let them use one of their cell phones. Whatever we
can do to make it work, we do.
Andrew Nelson: Do you want to talk a
little bit about that 72-hour post-discharge window and
how that ongoing support for patients compares to
traditional models where you’re referring folks to
community providers?
Amanda Kennedy: Now, specifically in
these five rural hospitals where we’re piloting at
through this grant that we have, patients that go to the
emergency room, all of the physicians and providers have
now been trained through my team on how to do an
induction of the medication in the ER. If the patient
isn’t quite ready for that process yet, they’re trained
how to educate the patient, how to even do it on their
own at home. So, we talk about that 72-hour gap.
Worst case scenario, let’s say a patient is seen on
Friday in the ER, and my team gets in the office on
Monday to call them, what they would be doing is leaving
the ER with medication in hand; free medication, at that,
with this grant. So, they’re leaving with three days of
buprenorphine or Suboxone, along with an entire packet, a
written-out packet of step-by-step instructions of, “This
is how you can tell if you’re in withdrawal to start the
medicine, this is how your first dose should look. This
is how your next dose should look. These are some
frequently prescribed medicines that you might’ve also
been sent home with, and how to take them. This is the
vSURP number who will be calling you on Monday.” So, the
patient is literally leaving the ER with their treatment
with them for us to connect the following day. There are
zero gaps.
Andrew Nelson: Yeah, it’s really cool to
hear that you can provide them with that kind of
structure after they physically leave the facility. In
rural communities, especially, stigma can remain a
massive barrier to seeking help. Have you seen that the
virtual nature of the follow-up care you’re providing
helps to protect patient privacy, and has that been a
factor in patient engagement?
Amanda Kennedy: Absolutely. I think you
hit it on the nail, right? In rural communities,
everybody knows everybody. They know what car you drive,
right? So, if you’re going up to the local methadone
clinic, they’re going to know your car’s there, right?
So, they’re going to know you’re getting treatment.
Whereas with us, you can do it in the comfort of your own
home. You can do it in your office. We’ve treated
patients on work sites, in their car, wherever they can,
to have that anonymity. Also, they’re not even having to
call, they’re going to Mercy. So Mercy, in most
communities, is known as a healthcare system. So again,
you’re protected by HIPAA. People are not going to know
if you’re going into your primary care’s office to ask
for help about diabetes versus substance use. Where other
places, when you’re walking into those recovery centers,
you’re announcing that that’s what you’re asking for help
with. We recently had a patient who even asked us to send
a prescription to a pharmacy about 45 minutes from his
house because he was so stigmatized and afraid and
ashamed of what people would think in that area that knew
him, that had treated him for years medically, if he was
filling this kind of medicine. So, we are very much able
to provide that support and trust.
Andrew Nelson: I’m sure that’s very
helpful for a lot of people, to be able to maintain that
distance from some forms of support that they might feel
are more embarrassing or more stigmatized. On the other
hand, having a personal face-to-face relationship with
providers can often be something that’s very important to
people. How do you go about ensuring that the virtual
aspect doesn’t create a disconnect between provider and
patient?
Amanda Kennedy: When you ask that, I
think of two different things. So first, the way our
program is designed is to have a very small care team so
you’re not bouncing from provider to provider. So, we not
only are treating the patient with medicine, we’re
treating their social needs as well with a collaborative
care model. Each patient has one physician and one social
worker. So that’s it. So, over a spectrum of time, they
are really developing that relationship. And let me tell
you, we actually recently had a physician that’s moving,
and we have patients that are now breaking down in tears,
right? Due to the rapport that they’ve built, knowing
that they have to transition care to somebody else.
Because that’s just the connection that we make with
them. It’s funny, sometimes you’ll answer the phone for
somebody and they’ll say, “No, I only want to talk to my
social worker,” because of that connection. So, it’s
truly that one-on-one care that we’re not giving them an
entire team, we’re giving them that one person.
I think the other thing is trust in the Mercy system. So,
myself and our medical director, Dr. Smith, have really
been intentional about going out to these communities and
taking road trips to go out and shake hands with all the
Mercy providers and physicians so they know who we are.
So, if you go to your primary care, and Dr. Jones says,
“You know what? I actually know Dr. Smith. He came here
and talked to me. You can trust him with your care.” I
think that goes a long way, right? If you’ve been with
Dr. Jones your whole life, they’ve delivered your babies
and you trust them. And so, knowing that they trust us
and we’re in the same healthcare system, I think really
goes a long way as well.
Andrew Nelson: You said when you’re
discharging patients from the ED, you’re providing them
with a medication discharge pack that gets them through
the next 72 hours, right? And then the next step is,
they’re going to be talking to a licensed clinical social
worker?
Amanda Kennedy: I can run you through
how that looks. We have patient navigators. Typically,
when a patient is discharged with a referral, they’re
given a phone number and said, “Call this place and
schedule an appointment.” So, our patients don’t call us,
we call them. So, the patients are referred to us, and we
are taking that initiative and calling them and saying,
“Hey, it looks like you were really struggling and you
were in the ER last night. We’re here to help you.” So, I
have two navigators that do those phone calls every day.
And not only do they do it once, if the patient doesn’t
answer, we call at least three times to engage with them.
And so, talking about that rapid access, myself and Dr.
Smith originally came from the emergency department. So,
we faced this model on that need for emergent care. So,
the navigators only take about 10, 15 minutes to go
through a consent piece, making sure that they have a
video phone that works, asking a few follow-up questions,
and then that’s when they’re scheduled with a physician.
That navigator is really trained to be empathetic and to
explain to the patient next steps and what to expect. The
navigator also answers the phones for all of our other
things. So, we were talking about that connection to the
physician and the social worker, patients oftentimes will
call and just ask for that navigator, because they were
the first voice of the program. They have that skillset
getting that patient buy-in for their recovery.
So then truly, a lot of times it’s same day or next day,
that appointment for the physician is scheduled. The
physician sees the patient, and after the physician sees
the patient, they of course schedule them for the week
follow-up. And the day that the physician sees the
patient, the social worker is then calling and saying,
“Hey, it looks like you established with our physician.
They’ve prescribed you some medicine. Let’s review that
medicine one more time,” so that the patient feels very
comfortable with the medicine. And then the social worker
follows pretty closely with phone calls that first week
or so while that patient is stabilizing on the medicine.
And then scheduling a full psychiatric assessment
afterwards. So that’s another key portion, is our
licensed social workers are doing that behavioral health
assessment. And then we also collaborate with a
psychiatrist for any psychiatric support or needs. Taking
away that wait list, again, for psychiatry. The
psychiatrist is able to give recommendations to our
addiction docs for any psychiatric needs that need help.
So truly, within the first two weeks that patient is
being brought in, full circle for addiction care,
psychosocial needs, and that extra recovery support.
Andrew Nelson: Substance use can
certainly lead to a lot of feelings of isolation and so
forth. So, it sounds like you have a really good
framework there to help take care of them and get them on
that path to recovery, not just addressing an immediate
issue, but providing ongoing support.
Amanda Kennedy: And we have an
open-ended commitment. So, a lot of places will do a
30-day treatment or even intensive outpatient, they’ll do
60 days. I have patients today that I’ve been seeing for
five years. They stabilize, a lot of patients stabilize,
just like [with] a lot of chronic diseases. Addiction
does cycle. So, I’ll have stable patients for years, and
then all of a sudden they’ll call us, and say, “Oh, I had
a blip, right? I had a mess-up.” And we’ll just start
back from the beginning and get them back on track again.
So, there’s no end of when they need to be discharged.
Andrew Nelson: Have any challenges
arisen in sharing patient data between the ED, the
virtual platform, and whatever provider or community
resources? And were there standards that you had to
develop in order to facilitate that?
Amanda Kennedy: We are all one Mercy,
right? So that is the beauty, is that we all have one
embedded electronic medical record that we all put stuff
in. Now, when we created the program, we had to work to
make our own internal workflows. Before we existed, there
was no referral for us. So, I would say that’s maybe our
biggest barrier is, we have a referral now, but now it’s
educating 40-plus hospital systems that this program
exists and there’s a referral to place and how to do it.
So, I think that that’s the biggest workflow that we’ve
had to work through, of how to get that referral going.
But other than that, no, everybody can see things back
and forth, and that’s truly the beauty of it.
So, a lot of times my physicians that are seeing the
patient, even after the first visit, they might send a
secure message to the referring physician and say, “Hey,
thanks for that referral. I know you saw him in bad
crisis in the ER, but I just talked to them two weeks
later. And guess what? They’re going out there and
getting a job.” Because that positive feedback to that ER
physician who’s just kind of, boom, boom, boom, trying to
treat people’s traumas and get them moved on, that’s
going to remind them the next time they see a patient,
“Hey, that program really does work, let me refer.”
Andrew Nelson: Is Mercy ubiquitous in
your area, or have there been any situations where you’re
after providing initial care, you were coordinating with
a different health system to continue that care for a
patient?
Amanda Kennedy: Oh, yeah, absolutely.
So, one of our favorite lines is, “We’re not here to keep
patients.” Recovery is best for wherever they can go,
wherever a patient can go. So sometimes we’ll see
patients in the interim where if they do have a bed set
up at a 30-day treatment program, but that’s not for
another two weeks, but they were seen in the ER, great.
“Come to the ER, start at vSURP, start with us for two
weeks. Go to your recovery place. Good luck. We’ll get
you some medicine if you do. If you like it there, if
they discharge you with other outpatient services, we’re
happy that you came to us, that we were a step in the
road, otherwise you can come back to us.” So we very much
work with those community agencies and partner.
Andrew Nelson: It can definitely be a
challenge in rural areas to provide that kind of
patchwork or that coherent care when people can be spread
out so much. How would you go about defining success for
a rural population where recovery might look different in
terms of maintaining employment, family reunification and
so forth? Are there nonclinical social determinants of
health that you’re looking at in terms of outcomes?
Amanda Kennedy: That’s a great question.
You know, leadership or people that are giving you
funding, they always want numbers, right? And sometimes
it’s really hard to put a number on success of this,
right? The best example I can give is, what’s that number
on a child that’s not in foster care anymore, or that
child that wasn’t taken into foster care because mom
established with us while she was pregnant, and had a
healthy delivery? So those numbers are really hard to
quantify. A lot of it is just those individual stories.
We do keep track manually of some of those things. So
those social determinants of health, of who gained
employment, who established with a medical home, right?
So, I will tell you, we’ve served a little over a
thousand patients in our whole area over five years, and
we have established like 150 of those patients with a
medical home. So those are patients that had no medical
home, didn’t have any medical care, and now they’re
embedded in our system for all of their medical needs.
Same thing with employment, right? We’re in the hundreds
now of patients that were unemployed and they’re now
employed. And so, think about those small things. They’re
able to pay the rent so they’re not being evicted. And so
those trickle effects in those rural communities really
do make a difference.
Andrew Nelson: If there was another
healthcare system that wanted to try to replicate this
model, what do you think might be the biggest hurdle, or
some of the biggest hurdles, that they would face?
Amanda Kennedy: I think the biggest
hurdle that we have found, because it affected us as
well, is truly that internal stigma and buy-in, right?
So, this is a new wave of medicine. Suboxone has been
around for years, but there used to be some restrictions
on it, with an X waiver where you had to be specifically
licensed to prescribe it. So, it was very much a, “I
don’t want to do this in my practice. We shouldn’t do it
in this healthcare system.” Since COVID has gone away and
some laws have changed, we truly are that change in a
large healthcare system of educating the physicians and
the providers that this is a safe medication, that this
is best practice for patients with this. So that first
hurdle of stigma, but how we’ve gotten over that is
finding those champions in those local community
hospitals. I will tell you firsthand, we have rolled out
to some Mercy [location]s where we maybe don’t have a
local champion, and it hasn’t really gotten off the
ground compared to the ones where we have a local
champion that’s willing to let us come and do rounds with
us and introduce us to the physicians and say, “This is a
great program, listen to their stories.” That is what has
truly made the difference of success and not, internally
in our system as well.
Andrew Nelson: So, it has a lot to do
with forming connections with communities, right? And
finding individuals that can help support and advocate
for your program in certain areas? Because we often see
that people trust people that they know. It seems like
that’s an important part in terms of getting buy-in.
Amanda Kennedy: Yeah. Two things you
said there. Absolutely. They only trust who they know,
right? Especially when we talk about, “We’re big city
medicine,” right? We’re doing telehealth, and sometimes
we’re in a different state than them. Why would they
trust me? Right? So, it is making that connection. You
ask anybody in recovery, there’s a statement, a quote
that says, “The opposite of addiction is connection.” And
when you said that, I thought, you’re right. We’re not
only connecting with the patients, right? We are
deliberately making sure that those patients have that
one-on-one connection with our team, but we have to do
that same thing internally in our systems across five
different states, making that personal connection so that
they can trust us to care for their patients as well.
Andrew Nelson: How important was the
funding that you received from FORHP [the Federal Office
of Rural Health Policy] in making this program a reality?
Would you have been able to do it at all, or would you
have had to operate on a much- smaller scale?
Amanda Kennedy: We’ve been around for
five years, but [vSURP was] not fully integrated into all
of Mercy. So, what we have deliberately done over those
five years is we’ve had to have funding through different
organizations, either internally or externally, to allow
us to continue to go across the Mercy footprint. So, this
funding made it 100%. That was the only way we were going
to get to Southwest Missouri, was with this funding
source. Word of mouth, we had 10 referrals in Southwest
Missouri for a year. Within a year prior to the grant, we
had 10 referrals come in. After the grant, in the first
month, we had 10 referrals because we were able to
educate. And obviously it’s exponentially moved on. So, I
think that has allowed us to grow in those communities.
Not only that, but we talk about that 72-hour bridge of
medicine, that’s only through this grant. I am not able
to offer that in every Mercy community. So, this is a
true pilot of, “Does this work, is this a need?” so that
we can take it to Mercy leadership in the future or other
grant sources and say, “Listen, it worked here, we want
to do it in other places.”
Andrew Nelson: Yeah. It seems like
medication covering that gap is a really important part
of facilitating moving from emergency care to an ongoing
kind of support being provided for them. Your grant
period ends in August of 2026. What’s your roadmap for
sustaining the vSURP program, once that RCORP funding
expires?
Amanda Kennedy: We have some other
funding available to continue at least through the next
three fiscal years. And then, we’re also actively
applying for other grants. HRSA [the Health Resources and
Services Administration] has released some other grants.
We have not expanded to Oklahoma at all, and we have a
pretty big footprint in some of the Oklahoma area that
we’re going to hopefully actively apply for another grant
to do something very similar, if not even on a larger
scale, with community partners in Oklahoma. So, every day
we’re talking about grants and other funding sources. We
are not just grant-funded, I should also add, we are
embedded with a lot of insurance-based patients, so we do
have some revenue that offsets some of the costs. We’re
not fully revenue-based and fully functioning in the
black, per se, but so this is why we actively work with
our grants team as well to make sure that we kind of have
a mix of both. Mercy senior leaders have said that this
program is here to stay, so we will find a way. We can’t
take this away from our communities now.
Andrew Nelson: You’ve been listening to
Exploring Rural Health, a podcast from RHIhub. In this
episode, we spoke with Amanda Kennedy, manager of the
Mercy Virtual Substance Use Recovery Program, or vSURP.
Look in our show notes for more information about their
work and visit ruralhealthinfo.org for all things
pertaining to rural health.
