Stories from the Field: Kelly McGrath

Hi, please tell us a little about yourself. 

Hi, I’m Dr. Kelly McGrath, and I’m the chief medical officer at Clearwater Valley Health and St. Mary’s Health (SMHCVH) in North Central Idaho. We’re in the rural and frontier community up here. My role has been to help facilitate some of the system changes that we’ve been working on really for the last five years to deliver more patient centered care around diabetes in our community.

How is SMHCVH’s approach to diabetes care unique from what patients may experience in other healthcare facilities?

Different than what would be seen at other facilities that aren’t doing some of these population-based strategies. It’scertainly different than what traditional medicine has done through the years, and different than what I was trained to do. It’s just having those resources that are more community based, so that we can meet the patient where they are. We’ve worked hard to have a patient-centered medical home here and team-based care. That’s worked really well within the bricks and mortars of our clinics and our hospitals, and we’ve been really pleased with this. But doing more of a population-based strategy helps us to move beyond the bricks and mortar of our clinics and hospitals and meet the patients where they are, whether that’s at a food bank or a community health event. We’re recognizing that we’re reaching patients that we didn’t traditionally reach, which is great.

How has COVID-19 changed your work in diabetes care?

Well, the COVID-19 pandemic has fundamentally restructured my role. The part that hasn’t been as good is that instead of being more strategic and looking forward, I’ve had to take more of a reactive role because things change so quickly. What we were doing a few weeks ago or six months ago fundamentally changed, and we need to react to that. I think the silver lining that we need to look forward is that one thing we have learned as an organization is adaptability. Decisions that might have taken six months before, we will typically make in a couple of hours sometimes, crazy as it is. But then you start to realize that you can do that, and you can do it well if you’re structured in that decision making process. So we’ve learned from that, and that’s been the helpful part of just learning to make decisions and adapt more quickly, so, that’s the good part.

To continue supporting medical and social needs for patients living with diabetes, what are some of your advocacy priorities in the SMHCVH region?

I think that one of the biggest challenges going forward if we’re going to be able to sustain some of the good outcomes that we’ve seen and actually to make them more generalized, is that we need the engagement of other entities in the healthcare system, mainly payers. We’re using new tools to solve the problems that are old but we’re showing that we can improve the outcomes with the use of those tools. But if the tools aren’t supported in payment models either through value-based purchasing or other payment structures, it’s just not sustainable. You can’t run the care of patients in perpetuity off of a grant, you know, there’s not enough grants to go around. If we’re going to do this at large scale for the country and for larger populations, there needs to be engagement of the payers, both public and private payers. Maybe to ask, on their part, what are those elements that we really need to leverage the mutual outcomes that we want, you know, lower cost of care, higher quality, higher value? But then once we identify what those are, let’s set the reimbursement models so that we can sustain that care delivery. That’s one of my greatest anxieties about this going forward is without a payment model, it’s really going to be challenging, no matter how clever we are with the resources we have. At the end of the day, there’s people that need to be paid if we’re going to ask them to go and do this work.