According to the U.S. Census Bureau, about 60 million Americans – one in five – live in rural areas, including 12 million children. But hospitals in these communities face growing challenges: cybersecurity threats, aging infrastructure, staffing shortages and limited funding are all jeopardizing access to care.
Laura Kreofsky, Director of Rural Health, Microsoft Philanthropies, highlights the critical need to bolster rural health care systems. Through efforts like the Rural Health AI Innovation Lab (RHAIL), Microsoft is helping rural hospitals enhance cybersecurity, access affordable AI tools and strengthen collaboration.
Guest:
Laura Kreofsky, MHA, MBA, PMP, CDH-E, Director of Rural Health, Microsoft Philanthropies
Host/Producer: Carol Vassar
Announcer:
Welcome to Well Beyond Medicine, the world’s top-ranked children’s health podcast produced by Nemours Children’s Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.
Carol Vassar, podcast host/producer:
Each week, we’ll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar, and now that you are here, let’s go.
MUSIC:
Let’s go well beyond medicine.
Carol Vassar, podcast host/producer:
According to the US Census, about 60 million Americans, one in five of us, live in rural areas, including about 12 million children. These communities are served by a healthcare infrastructure that is facing unprecedented pressures when it comes to cybersecurity threats, staffing shortages, financial instability, and the challenges of keeping pace with the rapidly evolving digital and AI technology in healthcare. In this episode, we take a closer look at how one tech leader is helping rural hospitals and providers meet some of those challenges head-on and in a financially responsible manner.
Laura Kreofsky is the director of Rural Health at Microsoft Philanthropies. She leads the company’s nationwide initiative to help rural hospitals and providers protect their systems, strengthen their resiliency, and responsibly harness the power of AI through innovative programs and public-private partnerships. In this episode, Laura shares how a Microsoft cybersecurity initiative is helping rural hospitals and providers respond to growing cyber threats, and how a separate initiative is delivering practical, affordable tools that help rural providers streamline operations and improve care.
We started our conversation by addressing the question of whether it’s accurate that rural hospitals are more vulnerable to cyberattacks; if so, why, and what can be done. Here’s Laura Kreofsky.
Laura Kreofsky, Microsoft Philanthropies:
Unfortunately, rural hospitals are more vulnerable in so many ways, one of the pieces that could just dismantle a healthcare organization. Think of what we’ve been through in the last five years, right? COVID, the rise of Medicare Advantage programs impacting the bottom line, Medicaid funding cuts, cybersecurity has just skyrocketed, and I’ll talk a little bit more about that. Other things I think about that just are disproportionately impacting rural healthcare: the rise in violence against healthcare workers, right? It’s a real issue. And then compounding all of those changes, you have emerging and new technology like AI, right? And so we have a lot of change, particularly in rural healthcare organizations.
And when it comes to cyberattacks, unfortunately, rural hospitals are more vulnerable. Studies have shown they are sort of disproportionately at risk, and estimates of about 70% of cyberattacks happen in rural or smaller organizations. There is no shortage of challenges for these organizations.
Carol Vassar, podcast host/producer:
What’s the reason behind…you said 70% of rural hospitals make up of cyberattacks? Why rural hospitals? Are they more vulnerable because they don’t have the protections? What makes them a little bit more vulnerable?
Laura Kreofsky, Microsoft Philanthropies:
Yeah, I think it’s a host of things, and certainly, typically rural provider organizations, smaller organizations, may have older hardware and older infrastructure, which can be more vulnerable. I need to talk to healthcare providers across the country, and it’s not uncommon for them to be running servers and infrastructure to that are 10 or 15 years old. And how do you patch those? And how do you even sort of address that in a larger ecosystem where you have different levels of technology and sophistication around it? Just the legacy software and hardware is a risk.
Also, just resource constraints. So lots of times, rural hospitals have one or two people in their IT shops, and they’re certainly doing the best they can, but they just don’t have enough time, talent, and energy to go around.
Carol Vassar, podcast host/producer:
Now, in terms of Microsoft, what is it that motivated Microsoft to really develop this Micro security program that was aimed at rural hospitals?
Laura Kreofsky, Microsoft Philanthropies:
I’m very grateful for that question, because it’s the reason I’m here in this role. So Microsoft’s cyber threat monitoring team has been tracking threats by industry and geography, and has broader industry and the government, and we came together at the beginning of 2024 with the White House, the American Hospital Association, and the National Rural Health Association, kind of this unprecedented collaboration, to do more together for these rural hospitals, and it’s part of Microsoft’s broader commitment to rural America.
For the last almost 10 years now, Microsoft Philanthropies have been doing a couple of really significant things to support technology adoption in rural America. One of them has been a program we called AirBan that works with local broadband providers to expand broadband access across rural communities and rural hospitals, right? Another one that’s been in flight for about 10 years is a program called Techspert, which really brings jobs and skillings to rural America, is working in close collaboration with rural community colleges.
So this program that we’ve launched is really sort of an extension of that program, and really what’s different, I think, about this is just the level of collaboration and the partnerships we’ve had, particularly with the AHA and the NRHA, but also across the board of so many state hospital association, Offices of Rural Health, and et cetera. We’ve all come together to address this broad reaching problem.
Carol Vassar, podcast host/producer:
And it sounds like private partnerships are really important to that. We’ll talk about that in a little while. You mentioned the program was launched in 2024, in June, I believe. How have you been able to measure improvement, to measure impact in rural hospitals who have brought this to bear, who are implementing it?
Laura Kreofsky, Microsoft Philanthropies:
Great question. And sort of our top line metric around all of this, where we feel how we measure this and say, How are we making an impact, is the number of hospitals that have taken action to make their environment more secure. And that taking action can come in a number of flavors.
And the first one, which is part of the program, is the assessments. We’re providing free cyber risk assessments to all rural hospitals, and even that awareness that comes out and those recommendations, that can spur on a hospital to make some changes in policy or technical configuration, is really important.
The second is around training, and we have curated frontline staff training, a kind of cyber awareness, as well as baseline cyber risk management certification. Over 1000 people have taken those trainings, which is really terrific.
And then finally, for independent critical access hospitals and rural emergency hospitals, as you’re probably aware, they are now eligible for Microsoft non-profit pricing, which lowers the cost of a broad swath of Microsoft products by 60 to 75% ongoing, and what that allows many of those hospitals to do is to really step up their level of security with more robust tools and still achieve some cost savings. I’ve seen a number of organizations be able to take that next level up in their security profile and still have a positive impact to the bottom line, so that’s pretty exciting.
I will say there’s a couple of case studies that are really worth calling out, and one is we go to a hospital in Montana, and like many independent critical access hospitals, they took advantage of the non-profit savings, which, in this case, he asked the CIO for their estimate. It was going to save the organization about $35,000 a year, annually. Personally, I translate that to nurses. That binds another nurse in a rural hospital, or some other care provider.
What was really interesting about this was the CIO was particularly innovative. He used that platform, that investment he’d made in Microsoft, to drive a lot of innovation, both in terms of cost savings in other areas through removing third-party apps, but also cost avoidance. Some of the things, he gives a great example, where they were paying Indeed about $1000 a month for job placements on the posting board. There’s a constant need to attract particularly nursing and physician talent. He was able to use the platform from Microsoft, he was able to find some APIs, and basically bring that in-house and self-create a job board that he was just putting out on their webpage. Ultimately, he did some back-of-the-napkin math and figured that between the value and the cost of takeout and the cost avoidance, he would save that organization about $750,000 over three years.
So there is that top line, Hey, we just saved $35,000 or $70,000, et cetera, on the licensing, which is terrific, but the opportunity is really to be able to take it to the next level and figure out, now what can I do with that?
And then finally, I think just another case study that really I think is foretelling of how CIOs in rural settings are adopting this. One of our sites took the money and invested some time and energy in cloud security. They said, We’re moving to the cloud, which is the right thing to do, but I’ve never configured cloud security, so I’m going to take some time and energy and make sure that I am doing this correctly, because I’m moving to the cloud for security, but if I don’t take responsibility to make sure the security configurations are set appropriately, I could leave my organization even at a greater risk for cyber attack, which is obviously what that CIO doesn’t want.
I mean, those are just a couple of case studies, but it’s really encouraging to see how these rural hospitals are innovating from launching from this program and taking it to the next level.
Carol Vassar, podcast host/producer:
And all of this is encompassed under the Rural Health AI Innovation Lab, RHAIL?
Laura Kreofsky, Microsoft Philanthropies:
I would say the cost savings, and those are coming right out of the cyber program. The RHAIL, actually, that Rural Health AI Lab was sort of the, I call it the other track on the train, right? Cyber is one piece, but helping rural hospital organizations prepare for and think about AI in the context of their organizations is the other part of the program. And I could talk a little bit more about that as we go through this, but that’s been a really sort of exciting piece of this work, as well.
Carol Vassar, podcast host/producer:
Talk about RHAIL. Tell us, it’s an initiative I believe designed to really protect access to healthcare. There are 46 million Americans who live in rural communities, and help the hospitals there improve both cybersecurity and resiliency. Talk about RHAIL. Talk about some of the challenges that motivated the creation of it.
Laura Kreofsky, Microsoft Philanthropies:
Thank you for calling out that word, resiliency, because it’s one I’ve really anchored on as we’ve sort of launched and grown this program, is that cyber is one thing, but it’s reactive, right? It is protecting the fortress, firming the foundation. That’s great, but that’s not going to help rural hospitals prepare for the future.
So deliberately, we’ve been having this second part of the program, which is around AI introduction and adoption. We call it RHAIL, Rural Health AI Lab, and over time, anticipate that a perfect world, we wouldn’t have to spend our days and nights worried about cyber, but we can have that foundation secure and in place and spend more time and energy doing cool things to help rural hospitals.
The RHAIL program, we’ve had two cohorts go through there, and it’s been really rewarding. So different geographies, different technology foundations, different types of rural health leaders coming together and saying, What’s a use case we can solve for all rural hospitals or for most rural hospitals that can be addressed through no-code, affordable AI tools?
The first work group came together last May, had this discussion about how AI was perceived in rural, where their pain points were, and how we wanted to use AI in sort of an introductory and non-threatening way to support and solve a common problem, and the one they came up with was denied insurance claim. And so you think about the rev cycle process in a hospital, and it’s long and winding and it has lots of chutes and ladders in it. Towards the end, you get to this place where billing clerks, who are already overworked, have to go through and address and research why an insurance claim has been denied, and it’s usually, the technical term here is hunt and peck. It’s a lot of just digging through data for institutional knowledge and trying to read those 835 documents that come from Medicare or Medicaid. It’s not an easy task, and it’s not a simple task.
And so what we did is we created a co-pilot tool which we’re calling the Denial Navigator that basically, an organization loads in the 835 documentation that comes back from the payer with the denied claims and the codes, the publicly available Medicare and Medicaid payment guidebooks, and any institutional knowledge they have about how they kind of rework denied claims, so it can be somebody’s notes, it can be policy they have on SharePoint, feed that all into the AI language model, and what the tool does, what Denial Manager does, is surface two or three high probability recommendations of how to resolve that claim.
So it doesn’t take action. It doesn’t reduce the role or the importance of the billing clerk, but it saves them time and energy getting to that short list. Then, the billing clerk can go in, take a quick look at those recommendations, say, Yeah, it makes total sense, or they can do some other research if they feel like the recommendation is inappropriate. And then they can also thumbs up or thumbs down the recommendations, because that informs and makes the model smarter, right? So there’s some ongoing learning with that.
So we have about 10 early adopter hospitals now. We have the next large cohort of about 50 going live on this Denials Navigator tool soon. People are excited about it because, one, it makes them more efficient; two, it can help the organization get more revenue in faster; and a lot of billing staff managers are excited because they see it as a really good training tool for new hires.
So long-term, the plan for this tool is we’re going to put the code out and make it open and free. We’re going to put it on the GitHub platform so that any rural hospital, and it’s actually for any organization, we’ve had some interest from federally qualified healthcare centers, et cetera, so they can pick up this code, take it, and use it in their own environment.
And one last thing around this Denials Navigator tool, it’s EHR agnostic, so it sits next to the EHR, right? That’s important. We’re dealing with a very diffuse technology environment in rural healthcare. It’s also really, really affordable. The only two things it takes is SharePoint, a small allocation of Azure credit, and a couple of Power Amp licenses, so it’s not a significant investment for some of these rural hospitals because, honestly, that would defeat the purpose of what we’re doing.
Carol Vassar, podcast host/producer:
And it sounds like the power to make the decision on that claim still lies with human beings. I’m wondering about the training of people in rural hospitals. How receptive are folks? My understanding is that sometimes people stay in the community hospital, it might be the largest employer in town, and they’ve been there many, many years, lots of institutional knowledge, but used to doing things on paper. How’s the transition been over to something that’s more digital?
Laura Kreofsky, Microsoft Philanthropies:
I think we’re at this sort of pivotal point in how we are addressing healthcare and healthcare delivery. And I think if you look at back through the decade, just the advent of the EHRs was the first one, and that was all about collecting data, and now we’re at this point in our industry evolution where we’re actually using the data and taking the data and letting it be self-informing, so we’re at a really unique transition point.
There’s an organization called Heartland Forward based out of Arkansas, and it’s kind of a think tank around rural communities, rural health, rural life. They did a study last year around receptivity to AI and gen AI in sort of the belt heartland of America, and they surveyed people in Oklahoma and Tennessee and Ohio and just kind of across the board. What I thought was so interesting is that 65% of those surveyed said they wanted AI training, and they wanted it from their employers. And then, similarly, almost 80% said that they thought AI had the potential to have a positive impact on healthcare and healthcare delivery.
Of course, I’ve seen statistics that say almost the opposite, right? That 70% say that AI could have a negative impact on healthcare, and I think both are true. So from an AI standpoint, I think we’re at this cusp of all recognizing this can and likely will be life-changing, and that we’ve got to support everybody in sort of that journey of learning and adoption.
Carol Vassar, podcast host/producer:
So what’s in development, Laura? What are we looking at that’s going to launch in the rural space in partnership with Microsoft and other partners?
Laura Kreofsky, Microsoft Philanthropies:
I think the Denials Navigator – that’s our first really exciting move. We also have a second RHAIL work group underway and hope to have a product out later this year. That use case is really around helping optimize the specialty referrals: not a closed-loop referral tracking system, but thinking about all of those variables that a nurse or a front desk person had to sort of synthesize in their head to find the best place to make a specialty referral in a rural community.
And again, this came out of discussions with RHAIL work group of everything from CMIOs to CEOs. They said, We want to absolutely make sure our patients get the best care and get out to see those specialists. We also wanted to do it in a way that they don’t feel like we’ve thrown them over the fence because they’re somebody else’s problem, but we want to do it in a way that’s a nice handoff to the right person, gets them in, gets them treated, and then that we can bring them back into their community for follow-up care. And they said the first and most important part of that is a successful outbound referral process.
So our second AI tool from RHAIL is focused on that, and of course, we have a lot of other ideas coming at us; we’re sort of cataloging those, and we’ll pick some more to take advantage of.
Carol Vassar, podcast host/producer:
You’ve done a lot in a year.
Laura Kreofsky, Microsoft Philanthropies:
Oh my gosh, yeah. And you know, there’s just tremendous energy around that both within Microsoft and in the industry, and we’ll talk a little bit more about what we’re doing at the industry level here, as well.
Carol Vassar, podcast host/producer:
Before I let you get away, I want to talk about public-private partnerships. We’ve been teasing that throughout the podcast. Why are partnerships key to making certain our rural providers, our rural hospital,s are current, maybe even ahead of the curve when it comes to cybersecurity and the use of AI?
Laura Kreofsky, Microsoft Philanthropies:
Thank you for bringing up that concept ahead of the curve. I have worked a lot in the under-resourced providers, the safety net, and one of the things I really appreciate is how resourceful these organizations can be and how they could do a lot with a little, and I think that’s part of this, right? Let’s give them the foundation to be successful. Let’s give them the foundation to be safe. And that has to come through this private and public partnership.
So, for us, and you mentioned that the program’s been alive for almost a year, a key part of that has been the relationships with the AHA, with the National Rural Health Association, and with state and local partners, because they’re trusted commodities. Here comes Microsoft with an offer to give you things for free, and they’re like, Yeah, right.
I actually had at least one CEO from an organization when I was doing some early outreach and socializing this program. He wrote me. I said, We’re doing this program and love to have Hospital XYZ participate. And the email response was so classic. I saved it, and I may frame it one day, but his response was, I talked to my IT guy. We’re good. The Change Healthcare thing happened to Change, not us. And yes, it did happen to Change, but it affected so many. And it’s part of this, right? We are a very complex ecosystem, and unless we look at it holistically, we’re all vulnerable.
And I think there’s another part of this that I’m really about, and that is the work that Microsoft has done and the partnership piece has spurred more health IT organizations to be interested in asking that same question. It’s like, How can we help? And it has also spurred, for me and for others, this recognition that rural health IT leaders don’t have their own built-in network or ecosystem.
If you think about a lot of professional associations in healthcare, there’s nothing really that has been geared toward rural. NRHA and AHA have conferences, but it doesn’t… An association, but they really have never focused in on IT piece. So last fall, in conjunction with Nordic and with Chime and with other parties, we launched something we’re calling the Rural Health Community or Rural Health IT Community, to be a place for shared advocacy, to be a place for shared networking, and also to be a conduit for these high value offers, and this community has grown organically in six months to over 400 people, and we’ve now stood it up as its own .org so that it is truly meant to be vendor-agnostic. I just say that we all kicked in the seed money, and it’s the community’s opportunity to grow. We have a group of rural hospital CIO advisors sort of steering the ship, and a couple of passionate people behind the scenes making it work.
But here’s what’s really cool is at that first meeting last fall, we surveyed the participants and said, What’s really important to you? What’s important in terms of your technical priorities? One of the top ones was broadband, network redundancy, and all those needs, and got to sitting around talking about it. And I’m like, Wouldn’t it be cool if SpaceX or we could get some Starlink in at that reduced cost for these rural hospitals? And so through connections of connections and time and perseverance, we were able to find the right person at SpaceX, and they are going to do what we’re dubbing as an impact offer for rural hospitals through this rural health community, and offer Starlink units at 85, I think the final number was 88%, but don’t quote me, but 88% off of commercial prices.
Carol Vassar, podcast host/producer:
Huh.
Laura Kreofsky, Microsoft Philanthropies:
Right? And that’s the power of community.
Carol Vassar, podcast host/producer:
And the power of partnership.
Laura Kreofsky, Microsoft Philanthropies:
And the power of partnerships. And now it can be a catalyst for helping surface and address the needs of rural healthcare providers, rural hospitals in unique ways. And sometimes it’s just having a collective voice, right? So we’re excited about that, kind of my passion project, but it is really, at the end of the day, a partnership.
Carol Vassar, podcast host/producer:
You’ve clearly tapped into a need, and others are gathering around you. What do you see as the future? It sounds like this is a movement of sorts. What does the future bring in terms of the community of rural hospitals that you’ve brought together?
Laura Kreofsky, Microsoft Philanthropies:
It does feel like a movement. And what I hope for is more of this, right? More coming together, more coalescence of a voice, more clarity on priorities and us being able to lift up and to solidify the base of rural healthcare, rural health technology, to continue to promote innovation and ultimately keep those rural hospitals, those rural health care providers, keep their doors open, keep their patients healthy, and keep those rural communities thriving.
Carol Vassar, podcast host/producer:
Laura Kreofsky is the Director of Rural Health at Microsoft Philanthropies.
MUSIC:
Well beyond medicine.
Carol Vassar, podcast host/producer:
Thanks to Laura for joining us for this episode, and thanks to you for listening. Our website, nemourswellbeyond.org, provides a plethora of resources related to this podcast, including all of our previous podcast episodes, a place to leave a voicemail if you have an episode idea, and chances to subscribe to both the podcast and our new monthly e-newsletter. That’s nemourswellbeyond.org.
As always, you can find our episodes on your favorite podcast app and on the Nemours YouTube channel. Thank you to our production team for this episode, including Lauren Teta, Steve Savino, Cheryl Munn, Susan Masucci, and Sebastian Riella. Join us next time as we celebrate the 20th anniversary of Reading BrightStart!, an evidence-based reading program that has helped thousands of children get a head start on lifelong literacy. I’m Carol Vassar. Until then, remember, we can change children’s health for good, well beyond medicine.
MUSIC:
Let’s go well beyond medicine.
