Taking Healthcare by Storm: Industry Insights with Dr. Angie Settle

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Angie Settle, DNP, APRN, BC, FNP, CEO of West Virginia Health Right.

Dr. Settle shares her journey into healthcare, shaped by her Appalachian roots, and discusses WV Health Right's mission to provide free, quality care to underserved populations in the mountain state. She highlights challenges like vaccine hesitancy, the nonprofit's COVID-19 response, and reliance on volunteers, grants, and innovative community programs to deliver comprehensive healthcare.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

Publication number QI-031425-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

 Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the Medical Director of Quality Insights. And today we have a very special guest, Dr. Angie Settle, DNP, APRN, BC, FNP. All those letters, A, L, M, N, O, P. She's been the CEO of West Virginia Health Rights since 2014.

Dr. Settle received her Master of Science in Nursing from Marshall University in 1997 and her Doctorate in Nursing from the University of Alabama. And she has an Executive Certificate in Nonprofit Leadership from Harvard University. Yes, West Virginia Health Right is the state's oldest and largest non profit free and charitable clinic.

Dr. Settle has dedicated her career to improving health care access for underserved communities and her leadership has been instrumental in expanding services to thousands of West Virginians. From navigating the challenges of the COVID pandemic to overseeing the expansion of the East End Clinic, Dr.

Sebel's vision and commitment to the health of her community are truly remarkable. So today we're going to be talking about her journey, the vital work of West Virginia Health, right, and how she and her team are addressing the healthcare needs of the most vulnerable in West Virginia. Andy, thank you so much for being with us today.

Absolutely. I, it's a pleasure. I appreciate you inviting me on. Great. So you have a fascinating journey to becoming the CEO of West Virginia Health, right? Can you share what motivated you to pursue a career in healthcare and how your personal experiences shaped your leadership style today? Sure. Well, I mean, I remember, uh, dressing up as a nurse when I was like four or five years old for Halloween.

And it's just always, I've just kind of had a pairing in nurturing. It's all I remember actually, but, um, you know, once I became a nurse, I wanted to do more, I knew I wanted to, you know, advance my education and get a terminal degree, but what brought me, um, to, uh, to HealthRight was my internship as a, uh, nurse practitioner student.

It was one of my rotations back in 1995. And I just. I just fell in love with the, the patients and the, the mission, and it was just such a pure thing, um, you know, to see so many volunteers come in and, and just focus on patients and, and that pretty much was it for me. I was sold. Yeah, it's a wonderful place.

I gotta say, uh, we were talking before we started recording that I spent some time, um, volunteering at health, right. And it just was a. It is a magical place. I also have fond memories and I mean, part of it, I mean, I started first as a nurse, then a nurse practitioner. And when the prior CEO, um, Pat White, he just recently passed, she was a dear, dear friend of mine, um, the founding CEO of Health Road, just.

You know, when she retired, it wasn't like I wasn't, I wasn't dying to be a CEO. I really enjoyed, you know, direct patient care as a nurse practitioner. And at the time I was the clinical, um, coordinator. So I helped oversee, you know, volunteers and all the clinical aspects, but I was so, um, worried about the mission being lost with new leadership.

If somebody came in from the outside, you know, that hadn't been there all those years, because at this time I'd been there, gosh, 17 years and, um. It was pretty much just, you know, the passion of, of what we do. And then, of course, there was some excitement in the fact that I had been here for so many years and had a lot of, you know, insight into what patients needed and, and some of the things at Gadsden Cares that I thought we might, you know, could address.

under my leaderships and even things you know just staff related there were little things you know if you work somewhere anybody as you take note you're like man if you know if I was ever in charge I'd like to do this or I'd like to change that and um I've gotten to do that over the last It's 10 and a half years and we've had pretty, pretty rapid growth actually, so I'm pretty proud of that.

Yeah, you should be. You were born and raised in West Virginia. Yep. How did, how did that experience influence your approach to health care leadership and community service? Well, I come from a long line of proud Appalachian women, um, you know, my, my grandmother, she had a farm and, and, you know, Big strawberries and, and little side story.

When she was 87, she, she fell off an apple tree. She's printed an apple tree. So that's the, the proud backbone that I come from here in Appalachia. But I think, um, my love for West Virginia and for the people, um, is just an extension of what I, what I do here, it pushes me forward. And I think it's, it's made people receptive, you know, as well.

Um, having that little bit of, uh, West Virginia twang in your voice when you're talking to patients, they, they know they can relate, um, and they know that, you know, that I'm one of them. So it's always, uh, you know, work to my advantage and I feel like, um, my experience just growing up here and my love for the state, uh, it's just, you know, kind of propelled me forward.

And, you know, when you get exhausted and you're tired and you think, how am I going to do this one more day? That, that. You know, that desire to help your home state and the people, your community, it just kind of pushes you forward. Yeah. So West Virginia Health Right has been a lifeline for so many in the community.

You talked a little bit about the mission of the organization. Can you walk us through that mission and what sets it apart from other health care providers? So the founding, uh, The mission of West Virginia Health Right is basically just to provide access to quality health care to all individuals, regardless of income or insurance status.

And that's what it was founded on, you know, back in 1985. So, that's how it started. And upon that, we just built over the years to include other things like, you know, behavioral health care, pharmacy, dental. Uh, substance use disorder care, you know, health education, we have some pretty innovative programs like, uh, the Prep to Serve Appalachia program with Chef Paul, where we're having patients that are in recovery and trying to get back on their feet or going through, uh, you know, an intense training program for front of the house, back of the house, working at, uh, fine restaurants to try to get people a living wage, so, you know, Um, we've done that over the years, but the big foundation of that is, of course, our volunteers, where we don't, we don't, don't hire dentists or, or physicians.

They're all volunteer and without, you know, those 600 volunteers, we couldn't do what we do. But what really makes us different is, is money's never part of the equation here. There's never an exchange of money. There are no co pays, you know, there are no sliding scales. Um, we never ask patients to pay us anything.

So, um, you know, we do bill Medicaid. We do bill Medicare. We, we got into that arena once the Affordable Care Act came to be and we realized so many people would have insurance and not really access. But, um, billing is an afterthought. We do what we always did all these years and then we submit a bill and if it's paid for, fine.

If it's not, that's also fine. We don't let, um, insurance or reimbursement navigate care. So, at the heart of West Virginia Health, or it truly is, um, Just a desire to help people and patient care and patient centered care is at the forefront of everything that we do here. Yeah. And I will say, you mentioned Chef Paul and he is another one of my heroes.

Maybe he can get on the talk about that exciting program. He started there. Yeah, it's wonderful. Yes. So the expansion of the East End Clinic is such an exciting development. Can you tell us about the process and challenges of expanding the clinic to meet the needs of more patients? Sure. So, when I took over as CEO in 2000, July 1, 2014, we had 15, 000 patients.

You know, about that time was everybody's like, oh, you know, the Affordable Care Act is going to be the end all be all. We won't need free clinics anymore. And I was like, not so fast. Um, because there's always. Gaps in care. There are gaps in care for Medicare patients. You know, they don't have dental care.

There's gaps for Medicaid patients. Some of them don't have vision coverage. So, uh, you know, there's so many gaps in behavioral health care. So one of the things that we've always done is look for those gaps in care. We don't ever want to duplicate services. You know, we want to, to fill those gaps in care.

So over the years by doing that, you know, we've grown to 45, 000 patients. So it became increasingly hard. To, uh, fit the staff and patients into a building that, you know, it was originally, you know, we built that in gosh, in 1999, moved in here in 2000 and thought, you know, wow, it's two stories. We'll never fill this building.

And, um, we actually had built out every corner of that, that small space. So, well, I'll say small space. It was huge to us then, but now it's small, but, um, so we started looking at the expansion back in 2019. And then, of course, COVID hit, and we gained another 10, 000 patients during COVID, um, and we became the number one, um, testing site in the state of West Virginia.

We had, like, a five line drive through and ended up doing over 100, 000 free COVID tests. So, we had that going on, but, um, We started designing and redesigning and everything, but the main effort was a 12 million project to double the space at the clinic. So it was like originally 15, 000 square feet, now it's 30, 000 square feet, but we had to raise that, you know, 10 million, and then with inflation and everything, it became 12 million.

But, um, We, um, finally, after, you know, a lot of fundraising efforts and grant writing efforts, we were able to get the money together and, um, we got it, uh, completed and had our grand opening this past, uh, June. So we're in this new space and, you know, it's all paid for, which is wonderful is when you're a free clinic and you have to, you know, write grants for ongoing.

Uh, programmatic things. It's so hard to have, you know, another side, you know, effort going on when we're trying to raise money. So we're really blessed. The beautiful space. Um, but it was definitely, definitely needed. It was five years, uh, in the making. Wow. And during that time, the last five years, you know, not much has happened.

Right. Right. Right. So the health break provided, yeah, crucial services during the pandemic. Uh, that the clinic provided. So how did your organization respond to that health care crisis and what impact did your COVID 19 testing and vaccination efforts have on the community? Well, you know, a lot of people now they look at that and they think, wow, you know, how did health right, and you were literally, well, you, you know, from being in healthcare during that time, it was unprecedented, um, and we were just basically reacting to need.

We, we never had any intention. I've been the number one testing site in the state of West Virginia. We didn't intend on having a drive thru. We, you know, at first we had a walk up, and then we turned it into a drive thru, and it's basically just responding to need. There was so much need, just even, uh, you know, 911 operators, uh, with police force, even like physicians, et cetera, and ERs and whatever, just to have to Um, access to testing and we had a rapid PCR testing machine, one of the few in our area.

So, we even, you know, hired additional nursing staff to run that late into the evening to try to do as many tests as we could in a day. And, of course, when the vaccine came out, we were elated. And, um, and then we turned our efforts to also, you know, assisting, um, Dr. Sherry Young, who was the, um, health officer at Connaughton Charleston Health Department, and we became the Uh, extension for the health department when they did their weekend outreach for vaccinations, we became the, uh, drive thru effort.

So a lot of times we would go down to the Civic Center Coliseum and we would be on the, uh, one arm of that and we would be the outside, uh, drive thru realm. And then people could go inside as well. So we did that, gosh, multiple, multiple weekends. Um, you know, if you're like me, when you look back at the pandemic, you think, how in the world did we survive that?

Uh, cause it was, you know. All day, every day, you know, doing our regular efforts and then, you know, the COVID efforts on top of that. So, but again, it's just, you know, being here in the community and responding to needs, we don't always have this big plan in place. It's just kind of day to day. Pivoting and responding to need, and that's kind of what we did then.

Yeah, yeah, it was, it was, uh, yes, I agree. It was one day at a time. Yes, it was. So, one of the most impressive aspects of West Virginia Health Right is its comprehensive care, including vision, dental, behavioral health services. So, how do you ensure that these services meet the diverse needs of your patients, especially, I mean, you mentioned underinsured or uninsured.

Well, it's you have to be again pretty reactive and listening to patient needs. Um, one of the main efforts that we have to do, of course, is our volunteers, because, um, while, you know, you arrive, we have private insurance, you have a need, you call up, you make an appointment. If somebody is uninsured, a lot of times there's a roadblock with, you know, they have to pay 200 up front or They can't even get in the door sometimes, um, without that, that planned.

Or if they have certain Medicaid or Medicare, there's certain things that aren't covered. So, um, when we do any kind of program here, we want to make sure that we include, um, the whole gamut. We want to make sure that it's something that uninsured can access, that Medicaid can access, Medicare can access.

The, the three that we, that we treat here, which I don't think I mentioned earlier, we only see uninsured. underinsured, which we consider Medicaid and Medicare. We see veterans for services not covered, like dental. And then everybody has to be under 250 percent federal poverty level. Um, so anything that we do, we won't offer it to one population and not the other.

And a lot of that is, you know, our volunteers that come in these volunteers that are people in the community, urofology, orthopedics, whatever. And they They may have their own, you know, rules in their own private office, but they'll come to HealthRight and they'll see, you know, anybody that we need them to see that qualify here.

So that helps us a lot to make sure. Um, but one of the huge things, you know, it's fundraising and grant writing. Um, it's not easy to provide, you know, medications, um, to our thousands and thousands of patients. You know, that's, that's money that we have to pay. We, we don't fit into like a federally qualified health center.

Puzzle, we don't fit into different areas. So we a lot of times have to pay retail for. Um, medications and things like that. So it's a little bit harder for us, you know, to make sure that we meet all these needs, but the, probably the biggest thing that we do is it's just a lot of grant writing. Um, we, we don't get reimbursement for a lot of what we do, especially, you know, if patients are uninsured, there is no reimbursement, or if you're filling gaps in care for those with Medicaid or Medicare, those are going to be things that aren't covered.

So naturally, you know, about. 83 to 85 percent of what we do here is not reimbursable. So when you look at that, um, it's really hard to sustain that model. So it's, it's a lot dependent on donations, fundraising, and grant writing efforts. Um, and that's, Don Cornwood, we've been successful with that and that's something we have to continue.

Yeah, you've definitely been successful. So the Health Rights Immunization Program plays a key role in improving public health in the region. Can you share about how the program works and why it's so important for the community? Well, we want to make sure, again, that everybody has access. So, you know, we try to carry, we're not like a health department, so we can't always have embryo immunization.

Sometimes if it's something that we have to pay for, we try to get it through drug programs. So we try to offer. As many immunizations as we can. A lot of times, uh, students that are going to, say, nursing school, there's certain required vaccinations that they have to have, and sometimes that can be a barrier, or, you know, people going in the food service industry, like, like, what, you know, hepatitis B vaccinations or whatever, so.

We try as much as we can to either provide those or partner with orgs like the health department so that we can access those because we don't want those to be any kind of barrier for people. Of course, influenza vaccine, you know, the COVID vaccine, anything like that, we're always worried about access to care.

We don't ever want income to be a barrier. We don't ever want to see, you know, people with money have access to something that our patients don't have access to. So we do a lot of innovative. Programs with partners and, and, and drug companies and with the National Associate, National Association of Free and Charitable Clinics, Um, where they provide different vaccinations and we're always looking for opportunities to bring those on board and offer those to our patients because, you know, what a travesty.

It would be to have something preventable, like an influenza death or something, and somebody not, you know, have to go through that when they could have accessed an immunization. So we want to make sure, again, that we're having equality and, uh, there with our patients as well. Yeah, and on that same topic, Vaccine hesitancy, it's been a significant challenge.

It's probably, you know, after the COVID pandemic. So what strategies has HealthRight used to address concerns and encourage vaccination in the communities? Well, you know, a lot of times it's, uh, debunking, uh, myths and, and we earlier, you and I were talking about social media. Um, it's one of the things that I think is so frustrating with social media, which I told you, uh, uh, have been 15 months.

Colleen of Facebook. Hallelujah. I quit Facebook, but it's so frustrating to see something on there and then it just takes hold like wildfire. And before you know it, everybody's believing it. Um, it's so hard, you know, when you look at like how I grew up, you know, I'm a 1971 birth baby. So, you know, your physician would tell you, pediatrician say you need it.

Your mom would say, okay, where do I sign? And that was the end of that. And now it's so much up for debate. Um, I try to tell people one on one, you know, what I do with my You know, I have kids natural and then two bios. I mean, two adopted. So I have eight kids total and I say all my kids are vaccinated to the hilt with everything that that that can get because I want to prevent disease and illness.

A lot of times we're doing one on one things. I have leadership, um, at Health Right, Shayla Leftridge, uh, who helps us a lot with our Westside, uh, community outreach. Uh, it's so important if you're going to do outreach to African Americans that you have that lived in experience. So, there's a lot of vaccine hesitancy there and, and Shayla's able, you know, to help me there, but I think just putting, you know, actually people trust us.

They, you know, they see what we do. They see the work that we do. They see our hearts in the right place. And, um, a lot of times that'll go a very long way if we Suggest things or say, you know, this is offered. Um, we try just to dispel as many myths as we can and, and get the word out there. And, um, I think we're pretty successful with that.

Of course, everybody, you know, has access to all YouTube and that, this, that, and the other, so we do our best, but, um, I try to just practice what I preach and, you know, show people with my own life and my own children, what I do. Yeah, that's all you can do. And I think trust is so important. Yes. So, as you mentioned, there's been significant increase in patient volume over the years.

So, what do you see as the biggest healthcare challenges facing West Virginians today and how is HealthRight positioned itself to help overcome them? Well, a couple of questions. For HealthRight, our biggest challenge is always going to be funding to sustain what a lot of people don't understand is. That health right, um, the thing that stands in the gap for so many lower income employed West Virginians, traditionally people look at a free and charitable clinic and they think, you know, I'll just be honest.

People think, oh, and that's for people who can't work or don't want to work. And it's not, I mean, 83 percent of our patients are, are employed. It's just lower income jobs where they work two or three part time jobs. Uh, there are people that wait on you every day when you go to a restaurant or. You know, when you go to the gas station or wait on you through the drive through or take care of your kids at daycare, these are people that are working every day.

Um, but medications are so expensive and when, and so is insurance. And a lot of times things that they can get through the marketplace. Maybe affordable, but then they have huge deductibles, copays, that kind of thing. So it actually is like carrying around a card, but, but there's no, uh, real service there.

Only if they have like a catastrophic illness, like an open heart surgery. So a lot of what people don't get as where the thing that stands in the gap there for those people by us, you know, giving medications and care to somebody who makes too much for Medicaid, we can let them continue to work. A lot of people don't understand what the Medicaid system, a lot of times it's, uh, it, you know, de incentivizes people to advance.

So if they get a raise, a dollar raise, and I just got a call the other day from a girl. She'd gotten, she'd worked overtime and it had kicked her off qualifying for Medicaid. So suddenly she was faced with no insurance and she was calling to say, well, can I come to HealthRight? Because her other alternative was she was going to have to quit her job in order to have health care.

And you don't want to get in that situation. So, a lot of times that's what we do here is we stand in that gap and say, okay, go ahead and get that dollar an hour raise. That's fine. You can still come to HealthRight. We'll give you those medications, you know, that we get through the BRIC programs. You can continue.

Um, to advance yourself in life, um, so for us, it's funding overall, big things in West Virginia going forward. I have some concerns. I, I worry, um, where, you know, with diabetes and heart disease and all that and the overall, you know, where we're headed, uh, but I do think we've made big strides, um, and I hope we, we continue to do so.

Yeah. So finally, as the CEO. How do you maintain your passion and drive for the mission of West Virginia Health, right, especially your, your responsibility is large and it's growing. So what inspires you to go, keep going every day? Well, I've been here since 1997, this March, so it'll be what, 28 years? Gosh.

Uh, and. You know, there are some days we do get tired. It's, it does get, I'll be honest, it's tiring to tell the story and try to, you know, encourage people to give, try to get state funding, try to see, you know, people to see the value in what we do and to tell that story over and over and over. But, um, you know, I'll run into a patient at Kroger.

And they go, Hey, you know, Hey, Angie, you remember me on a, you know, and then they'll tell me a story or we'll run into somebody through our, you know, mobile dental clinic and they'll send me a picture of somebody's before and after their teeth before and after in the change. You know, they have this huge smile on their face or, you know, you see somebody that, that you help, uh, and go through recovery efforts and now they're, you know, employed and they've got their kids back.

So, it's those little day to day stories that push me forward whenever you feel like you're just so exhausted and how are you going to keep doing this? And, you know, it is, it's a lot to, you know, because I carry the weight of all these patients around with me. This is not anything that I take lightly.

You know, they depend on us for healthcare and Our medications and, and they're big decisions to make in terms of, you know, where to spend funding and where, where not to put funding and how far we can take the mission, but, um, running into those people, there's one, you know, the story just when I feel like, you know, I'm just exhausted, I run into somebody in the lobby or, you know, somewhere out at Groves, like I said, and they tell me a story and it's like, yep, that's, that's the reason, that's why we keep doing this and, um, and that's, that's what's, Kept me here every day, uh, my entire professional career.

It's, it's, there's nothing like it. It's those little stories that change and making a difference that, that propel you forward every day. Yes, definitely. The success stories are just fantastic. Absolutely. It's a little, little. If people want to learn more, um, how would they do that? So I would encourage you to go to our website.

It's, um, course, www. wvhealthright. org. Um, and it'll take you through the different sites. We have three locations now. We have the one on the East end, one on the West side and one at Covenant House. We also have mobile dental clinic that travels to five rural counties of our state. We have mobile medical.

Um, so we have done a lot of different programs and things like prep to serve, health education. I have two teaching kitchens. We've expanded so much over the last decade. Um, we've been really blessed. To have, you know, some funding come along and these really great ideas that we've collected over the years and just seeing patient need and able to just, you know, put those into action.

So anybody that's interested, if you go on that website, it's going to, you know, tell you a lot. I don't care if anybody calls me. My direct number is 304 445 931. I'm happy to talk to you about HealthRight and we love to have people visit. We'd love to get medical students and students, college students, anybody interested in the health care field.

A lot of people say, Hey, I think I want to be a dentist. Can I come, can I come, you know, shout at somebody? And that's something that we're happy to do. We get paid, you know, students from Georgetown, um, Notre Dame. We get people from all over that come here. Um, and I'm pretty amazed by what we do. A lot of people were here, we're used to it, but for people that come in, it's like, wow, this is really, this is really unique and innovative what you do here.

So we're proud to show it off and we love to have people tour and just see what we do here. Yeah, I would encourage everyone to do that if you want to see it. It's a wonderful place. Dr. Angie Settle. Thank you so much for being with us. You're an inspiration and I am, it makes me happy that there are people like you in the world.

So thank you. Thank you, Dr. Storm. See, you're one of me. Volunteer there too. So it's her from the same clong. again for joining us. Thank you.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.