Bringing Integrative Medicine to Rural Communities

Yoon Hang (John) Kim, MD, MPH, joins Integrative Practitioner content specialist, Avery St. Onge, to discuss the benefits and challenges involved in adding integrative health services to a rural critical access hospital.

Find us at integrativepractitioner.com or e-mail us at [email protected].

Theme music: “Upbeat Party” by Scott Holmes via freemusicarchive.org and “Carefree” by Kevin Mcleod via incompetech.com.

Transcript

Avery St. Onge: Hello everyone and welcome to the integrative practitioner podcast. You're on the go resource where we bring you closer to top industry experts through exclusive interviews with leaders in integrative medicine. I'm Avery St. Onge, content specialist of integrative practitioner, and today we're talking about the benefits and challenges involved in bringing accessible integrative health care to rural, underserved communities. We're so happy to have you as part of this community of integrative health care professionals. If you're interested in learning more about our membership offerings and you can get access to exclusive content and networking opportunities, please visit integrative practitioner.com/join. For today's episode, I'm joined by Dr. Yoon Hang Kim. For over two decades Dr. Kim has been a pioneer in integrative medicine creating sustainable and impactful integrative medicine programs in various settings, including healthcare systems, academic medicine and private practice. Today, Dr. Kim serves as Chief Medical Officer at Memorial Hospital, a rural critical access hospital in Carthage, Illinois, where he also practices integrative medicine and acupuncture. Welcome, Dr. Kim, thank you so much for joining me on the podcast today.

John Kim: Well, thank you. I'm very grateful to be here. 

Avery St. Onge: We're thankful to have you. So to begin, can you tell me a little bit more about Memorial hospital, the hospital where you work and what you mean when you call it a rural critical access hospital.

John Kim: So the it's a federal funding program, and they they function a very vital role for the rural, rural setting. And one of the rules is that you can't have more than 25 beds in the average duration of hospital stay has to be under 96 hours. And then they must be also more than 35 miles from another hospital. And then there are some other rules. And that allows for us to also create a what is known as rural health clinic, which the integrative medicine clinic is taking advantage of. And what that allows is higher reimbursement, given the difficulty of our mission and the relative poor access to care.

Avery St. Onge: So, the clinic is kind of under the hospital, umbrella, but it's not the hospital itself. This is where people are coming for kind of outpatient here. Okay. And they're all they have to live 36 miles away,

John Kim: Oh, no. Oh, that's the requirements of Memorial Hospital to get to another hospital. The Federal guideline says it must be 35 miles from another hospital. But there are exceptions, if there are poor roads or difficult terrain. And I think we qualified quite a long time ago before we had the benefit of more interstate like roads, I think have come recently. So when they received that status, I think that even they didn't meet the 35 miles de us all by small roads.

Avery St. Onge: And then what are the benefits associated with bringing integrative medicine to a hospital like Memorial? Why would you do that? 

John Kim: So, actually, this was the brainchild of our visionary CEO, Ada Baer, who wanted this service because she believes in it. And she correctly feels that this will also benefit the providers and employees just by having this program and we know in the VA experience, places with strong integrative medicine or Whole Health Program, the even the non participant employees are happier, and they stay longer. And Ms. Barra somehow knew that was the case. And she really believes in all furthering the health of our community. I know that everyone says it. But for example in on her off time, she volunteers for probably several boards, nonprofit that furthers the health and wellness of the whole county. So she really believes it I think through and through. And before I arrived, she has been looking for someone like me for about seven years and she's been preparing step by step I call hiring a holistic rd team and we even have a teaching kitchen that's bigger or same as any of the big systems that I've ever seen. And we have a small hospital and I think If you look at the square footage of what is dedicated to integrative medicine, functional medicine, lifestyle medicine, divided by total area, I don't think there'll be a health system that will have the higher percentage than us. Because it just there's so much in here. So the other part is that we are in a food desert. What that means is that our county has a grand total of one supermarket. That's it, they sometimes have fresh vegetables for maybe half of the time that they're open. Because it's a supply chain issue. In our hospital, under the guidance of Ms. Bear, we have stepped away from big big companies and in favor of locally available companies that that provide us fresh foods several times a week. And again, Ms. Bear wants us to operate at cost, which allows us to buy probably 50%, or a lower market value of salads, for example, the salads that if you want to purchase would be $12. Outside in here, it's $6. And we even have salads that are like $3 $2. And that's because I believe that Ms. Bear wants us to be the center of a center of health and wellness, because we don't have a lot of resources. She's leveraging the resources, the hospital to create this.

Avery St. Onge: Okay, can you just tell me a little bit more about how the integrative medicine services at Memorial function and what the services look like and kind of how its positioned if it's a separate clinic, or if it's kind of integrated throughout the care at the hospital.

John Kim: So, what we've decided to do is to create an institute of health and healing, and it's called a Memorial Institute of Health and Healing. And we have currently one physician to our n nurse navigators. One is integrative oncology nurse navigator, the other is general ticket to medicine navigator. So what we offer first is integrative oncology program. And second is we also have integrative pain management program. And then the third is reversing diabetes, mitigating obesity epidemic. And then the fourth is integrative and functional medicine consultation services. And the fifth is where we are in the process of developing integrative primary care services.

Avery St. Onge: That's great integrative medicine, a lot of the time, it's just inaccessible to a lot of different people. And so how do you provide these people with integrative medicine while still keeping it affordable and accessible.

John Kim: So for us, the magic sauce is the rural health clinic, the rural health clinic, we are given all inclusive rate. And the rate is quite favorable for us to continue our business because federal government wants us to continue our mission in serving these people. So that all inclusive rate I think allows us, basically for me to provide in the integrate the consultation services are a covered benefit for us. So we have 90 minutes initial 60 minutes, initial follow up, and 30 to six minutes, 60 minutes. And that's all all time billing. But as far as the federal government is concerned that it doesn't really matter how long I spent with the patient, it gets covered by all inclusive rate and what I've, with the support of the CEO, ADA, the business plan is that we are going to do well over the time, initially, we're going to lose money, but at follow ups are don't have to be always an hour, or they can be 30 minutes and as we go into telemedicine may be even shorter. So that's how we do it. Number two is that the lifestyle medicine requires a lot of time, not just one time two times. So what I'm leveraging is currently, I'm looking at several models, number one is free. I'm told that we have high percentage of poverty in this area, and we have weekly sessions in group sessions that is completely free. Or if they have diabetes, and they're my patient there. They have obesity, they're my patient that can come. And the other part is that we also have one on one free navigating that's done by one of our RN navigators who in this case would be functioning as a coach as well.

Avery St. Onge: Is this free with insurance or even to patients without insurance?

John Kim: It’s free. All they have to they just have to see me one time and then if they say listen, I can't afford you guys anymore. I just want to come to the support group and like welcome.

Avery St. Onge: Yeah, I would imagine that it's kind of a hard sell at first, because there's money to be put into it. But in the long run, if you're preventing disease and in this community, then I would assume that there would be a lot of money saved,

John Kim: The numbers look extremely favorable. We've been operating more than four months in clinic six months total time. And I think by next year, we should be breaking even the first mark is my salary and looks like probably within a year, we should get there. And we do have the cash services occupying shirt, not because we wanted that to be cash. But insurance companies have determined that largely, it's not a covered benefit. Medicare has some limited coverage for back pain, but very limited. And Blue Cross Blue Shield of federal employee will cover acupuncture, but we don't have a lot of those people where we are. And we're looking how we can become a provider for VA services. So we're looking into all that.

Avery St. Onge: And then what are the limitations or barriers that you've come across, or just in general involved in incorporating integrative medicine into a hospital like Memorial?

John Kim: So, in Memorial Hospital, I've not really come across with that, because I've worked for big systems, such as optim, I've worked for huge companies, academic centers, private hospitals, not for profit, profit. And what I've learned is very simple. If you can't get your CEO, CMO, CFO, CFO, and CMO, the marketing officer in one room, and they're not willing to back you, and they all want to roll into different directions, don't walk away, run away, because you can't succeed. So here, as part of my interview, I had a chance to run the numbers. And I met with a CFO, and I address my concerns, and they felt that my proposal has a high likelihood of success. So I came here, I would say that working with health system is very difficult. It's like Beauty and the Beast outside. They love you. But really, you're operating with a beast? Because not because they want to be but they have to be. Right.

Avery St. Onge: So, what are the components of an integrative medicine program that you think are standard and essential when beginning a program?

John Kim: So, I think that integrative medicine consultation services is essential, because it's it can be covered by insurance. And I think that more and more I think functional medicine, functional medicine, testing, or addressing root causes, whether or philosophically one agrees or not, I think that market has ruled on that. And the social validity is that people want functional medicine. And my job is to provide what people are willing to do. So for example, in our population, plant based medicine is not that popular. But they are more willing to be okay with keto based medicine, keto medicine, or medicine that puts people into ketosis, utilizing low carb diet, and a lot of that is eggs and animal protein. And all they were quite okay with that.

Avery St. Onge: Yeah, that's interesting to think about how you would structure a program based on where you are, and then the needs of that population and the beliefs of that population. So do you think that this kind of program has the potential to be widespread in hospitals throughout the U.S.?

John Kim: I think that question is already Yes, because if you go to academic Consortium for Integrative Medicine, and or integrative health, you can see a lot of them. The disparity is that you don't see smaller hospitals in a rural area. I don't think they have been one member, I could be wrong, but I don't I don't think so. Probably next year 2024, we will apply to become a member or an associate member according to their new guidelines. So I would say that, that it, it can be done. I'm a believer that it can be done. But like I said, the first thing is that the older C suite has to buy into it. And they can't just believe it. There has to be a credible pathway to all making profit. And I think we have it here. Well, we do sell supplements. We do do functional medicine testing. And, and but more than that, in our vision or a mission to become a regional health center for this area. We're beginning to have people driving more than 60 minutes to come and see us. So we're drawing people from 75 Miles us all and beyond. And that is something that doesn't happen to this health system with other services that's happening with us. And for our top leaders, they value that. And we've as matter of fact, this week, we had a out of state patient fly in, because we take insurance, and I'd spend 90 minutes and I will do functional medicine, I will do integrative medicine, I will do a lifestyle medicine based on what they want. So integrative medicine, I call it the wisdom is powered by the wisdom of healing, east and west of new and old. Whereas functional medicine is the wisdom from the power from science, advances in science. So they're very, you know, I may end up doing st similar approach, but it's powered by different so functional medicine, I have to test I have to test it to figure out I'm driven by data. Whereas the integrative medicine, I think it's more driven by my experience, our professional, combined knowledge and detail, patient questioning, that's why my visits are like up to 90 minutes.

Avery St. Onge: I've kind of asked this question, and you've kind of addressed it. But I know that getting medicine to rural communities is just so difficult in the first place. How do you think that integrative medicine could improve overall medicine?

John Kim: And that's an excellent question. And that's why the project of the fifth project is going to be integrated primary care. There are ways that that have been proven through case studies, that a membership based integrative medicine membership based primary care, in my case, whatever I do, it'll be integrative medicine is embedded, that can save up to 50% of the cost of health costs in a hospital setting. So that's how much we can benefit. And then the other part is that we do have businesses here. So imagine some of those businesses would also get 50% savings in health care cost. Once we can demonstrate it and we're one of the largest employers in the county, we can we have so many other businesses that may be interested in saving money. And when they can save money from health care, they can hire all the people in our community. And because really, I think Gandhi all said it best when he said that poverty is the worst form of violence. It's endemic, it's prevalent. And the solution to that is better jobs. And by doing this, I do believe that we can enhance the health of the companies, which is the lifeblood of the health of the county that we serve. And beyond great ripple effect. 

Avery St. Onge: That makes sense. Well, those were really all the questions that I had for you, Dr. Kim, do you have anything else that you'd like to add?

John Kim: Yeah, so I'm just very grateful, because our CEO, Ada bear is a visionary. And she is what I considered the best leader I have ever worked, who is authentic, who's compassionate, and who's, who has a very strong vision. And I think that having not like in the past, my failures that I have experienced in other systems is not having that. I would say that, you know, hopefully a leader is watching this, it is crucial that the leadership sign on, and if there's anyone who's in the health system, and it's a very lonely position often. So I would say that they can reach out to me, I have a personal slash professional website, it's just my name, yunhong kim.com. And then they can just reach out to me, and they can just talk to me, I'm happy to talk to them and support them. It's a very, very lonely position, running an integrative medicine until you create a community, which is kind of what I've done here is that I have to my two nurses, I've just put out a advertisement to attract all NPS. And I'm creating a wellness workplace as well. So then, for me, I didn't have any difficulty attracting RN, to RNs, we recruited relatively easily where other departments I'm not experiencing that, even with MP position, I've talked to several people already, and one person has already applied. So and this is like I just posted a job last week. So so we're not experiencing other things that other rural systems are saying it's hard to recruit people. It's all because we're different. We attract people and people are mission driven. And so I would encourage other leaders to do this. The people who are in my position, contact me.

Avery St. Onge: Well, that's great. Thank you so much. I'm I'm always happy to talk to people and to share stories of people who are bringing integrative medicine to underserved communities community because I feel like so often integrative medicine is given to the most privileged people in this country. So it's always really nice to hear people who are bringing it to people that really need it.

John Kim: So one last thing is that our proposal has been accepted to present at integrative medicine for underserved 2023 Conference, which is upcoming in November in Austin, Texas, and our CEO, and the Director of Food and Nutrition Services and myself will be presenting in a panel. And they have given us extra time, 40 minutes for us to share our experience, which I am very grateful for. 

Avery St. Onge: That's great. All right. Well, I hope I'm able to tune into that presentation. Thank you again, Dr. Kim, and have a great rest of your day.

John Kim: Thank you. I appreciate you.

Avery St. Onge: Thanks for listening. We'd like to thank Scott Holmes and Kevin MacLeod for providing us with our theme song. Be sure to visit our website integrative practitioner.com or send us an email at IPE [email protected]. Remember to like and subscribe to our show. We'll see you next time.

Editor's note: Transcripts are autogenerated.