ndrew Savitz  0:01  
That would be the vision, is that spiritual care is broadly accessible, that it is considered an important aspect of one's well being, and that it is part of more innovative holistic care models.

Ben Wagner  0:18  
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Unknown Speaker  1:00  
care. You Hello everyone, and welcome to this week's episode of the Medical Alley Podcast. I'm Ben Wagner. I hope you're having a great start to your week. Today a conversation about spiritual care with an emerging Medical Alley organization called spiritual well, the company offers online chaplaincy services and support across diverse faiths and denominations in real time. Founder and CEO, Andrew Savitz is with us today. Andrew, welcome.

Andrew Savitz  1:35  
Good afternoon. Thanks for having me. 

Ben Wagner  1:36  
So I really appreciate you being here for this conversation, and before we get into your company, I'd love to hear a little bit more about you and really your path to leadership. And the question I like to ask is, what keeps you inspired to do the work that you keep doing every day? 

Andrew Savitz  1:51  
Yeah, thank you. It goes back to when I was a kid. I always got involved in organizing friends to go out and do something, whether that was something that, in hindsight, was entrepreneurial related, such as putting together art and then trying to sell it to our parents, or volunteering and taking on leadership roles in student groups And with my synagogue growing up, ever since middle school, I was, you know, a vice president of of this or, you know, in college, a president of that organization. And so I think you know, what's always motivated me is groups of people that are united by some mission, no matter how big or small, can make a difference and and get to have fun and get to know each other and build connections while doing it. And you know, I've always enjoyed opportunities related in or unrelated to healthcare and business to be part of those groups, and have been lucky enough to lead folks throughout my life. 

Ben Wagner  2:59  
And now you're leading this company, spiritual for a little bit more than a year now. And I'd love to hear a little bit more about about the organization, really, kind of the motivation behind starting a company like this, and we can get into a little bit more about kind of what that journey has been like too. But what was the, what's the main problem that spiritual is really trying to solve for?

Andrew Savitz  3:20  
 Yeah, we'll start with our formal mission and then get into some of the problems within the healthcare landscape and in communities that we're looking to solve. Spirituals. Mission is to expand access to professional spiritual care that promotes healing, comfort and improved quality of life, and we do that for patients, for family caregivers, for employees, and because we're a telehealth model, we seek to do that wherever and whenever. Spiritual needs need to be met. The problems that we're trying to solve fundamentally relate to access today, professional spiritual counselors or healthcare chaplains, which I'm sure we'll get into a little bit more later on, are primarily available in hospitals and in hospice programs, and within those points of care, their access is very disparate. So it's most likely that if a hospital has a chaplain, or has many chaplains on their staff, it's likely an urban, well funded hospital. There are very few critical access or rural hospitals that are able to maintain a strong professional Chaplain department in in hospice. Right? Hospice is delivered in a very fragmented way, and so when spiritual counselors are available, it's it's very episodic. It's often provided through a regulatory framework lens, rather than truly being there for the patient and family as often as they'd like, right? Because, because chaplains are spread thin within a setting like a hospice, and so even if they. Would like to meet with a patient or a family more often they're not often able to the other dimension of access, and part of our mission and part of the problem we're trying to solve is that spirituality, though it, is separate from religious identity. For many people, there is a religious component to it, and Chaplain staff, chaplains in hospitals and in hospice disproportionately are of a Christian denomination, and often minority populations lack access to professional spiritual counselors or chaplains that represent them from a cultural or religious denomination perspective. And so at the root of spiritual vision and the birth of the company was to expand access in more places to professional spiritual care for all, for as many faiths and denominations as possible. And, you know, health equity is core to that mission as well. Now it gets into a component of we talk a lot about in the mental health space, which is culturally competent care. Absolutely, it sounds like that's a real problem, or a real, I wouldn't say a problem, maybe, but that's more of a an issue that this company is solving for yes in many ways, and part of it gets also down to, you know, what do we mean by by chaplain, right? And that healthcare Chaplain is different than community clergy. Community clergy are often folks that are leading a congregational setting, right, and their their day to day is to lead a community or congregation within an institutional framework, right? Whether it's a church, synagogue, a mosque, that is different than the context with which healthcare chaplains are operating healthcare. Chaplains are interdisciplinary care team members trained and skilled at being part of a broader healthcare system and team, and there are many places, particularly in the community based setting, where that health equity and and disparity of access exists. Because some organizations are, are, I like to say, mixing apples and oranges, right? They they might believe they have a chaplain on staff, but it turns out it's often a volunteer pastor, for example, from a nearby church. And so, you know, true access to professional spiritual care throughout the care continuum, there's quite a bit of disparity in terms of access that we're trying to solve for. And that gets into a question I had too of you know, what is the what are the services really that these chaplains provide. So a professional healthcare Chaplain is trained and experienced in doing formal spiritual screenings, formal spiritual assessments, and then once they've done that initial assessment, are able to do interventions related to spiritual counseling. They're trained to really meet the patient or or individual where they're at right? So it could be that somebody wants a prayer right that is unique to their particular faith, denomination. For some people, prayer is not a meaningful intervention, but they want to just talk about their feelings. They want to talk about the change in their life that is giving them stress and really work out, from the perspective of spirituality, how to overcome something that's causing them suffering or discomfort. And it's related for some folks, for as grief counseling is another related intervention for a particular need that individuals might have, for why they might want to meet with a chaplain. The other, I would say, skill set and aspect of what makes a chaplain, a chaplain in a healthcare context, one just like other care team members, they're equipped to chart and document their encounters, right? So again, their interventions are intended to be part of a broader care team that is multidisciplinary. And lastly, they're equipped and trained to triage when maybe what's going on with an individual should be referred to another mental or behavioral health care provider. And in many organizations or care models, sometimes the chaplain is the first that a patient is willing to open up to about something deeper going on that then and they're able to, they're able to be that first point of contact and make an effective referral, maybe to a licensed mental health counselor for more acute or severe mental health distress that maybe went unnoticed by their care team members. 

Ben Wagner  9:49  
Oh, I see, okay. Well, that, and that brings me to a point that I want to touch on here in a moment, which is that that relationship between spiritual health. Health and Mental Health before we get to that too, I do want to ask just about spiritual itself. How does this company really differentiate itself from traditional chaplaincy services? 

Andrew Savitz  10:11  
Yeah, great question. So traditionally, right, as I alluded to earlier, spiritual care delivered through by chaplains are primarily provided in the hospital and in the hospice setting. In hospice, it's a requirement that hospices provide spiritual counseling as a core service alongside other core services required by Medicare in a hospital setting, the Joint Commission often includes in their accreditation requirements that hospitals are meeting the spiritual and emotional needs of patients, and there are quality measures that Medicare measures in the hospital and in hospice and other settings related to meeting spiritual and emotional needs.

Unknown Speaker  10:57  
What makes us different is that we're not only seeking to provide care in those traditional settings of the hospital and hospice, where the interactions also tend to be fairly episodic, right? As you can imagine, in a hospital, particularly where there's a short length of stay, an interaction with a chaplain might be a one off, right? It might be when an individual is going into a procedure, and maybe they would like some comfort prior to going into that high stress, maybe high risk surgery, and then maybe they see that chaplain or a chaplain after. But that's it. Right, we believe that what telehealth as a modality enables us to do is to put spiritual care further into community and into population health models and into points along the care continuum where it isn't traditionally accessible.

Unknown Speaker  11:55  
And when we do that, we're able to provide the care not just for an episodic need, but longitudinally. So let me give you a couple of examples. We are in the process of

Unknown Speaker  12:08  
designing an opportunity or a pilot with a kidney care provider, and they are one of the largest providers of chronic kidney disease and dialysis treatment across the United States, and currently they don't provide spiritual care. Formally, they don't have chaplains on their teams, but they see the value that either in a dialysis treatment setting or when the patient then goes home or goes you know, along with their life, it's not when they're in the four walls of a hospital that they're experiencing, you know, the risk of existential distress that they're experiencing, the symptoms related to existential distress. And so telehealth and what makes spiritual different is we would be able to give that organization the power and the ability to connect their patients with our chaplains in a

Unknown Speaker  13:03  
in a novel way, well, and you mentioned that that that point there of existential distress, which is

Unknown Speaker  13:14  
a common patient experience, I would Imagine, for patients facing chronic disease, major issues related to their health. What role do you see chaplains having in addressing really the mental health of the patient? Sure, so upstream of a particular mental health symptom or condition, whether that be

Unknown Speaker  13:40  
low severity stress or maybe moderate anxiety or depression. Right upstream of those experiences, individuals may be at risk of existential distress. So I've used that term a while, but would love to define it a little bit better. It's the experience of feeling, you know, why? Why me? Why is this happening now? And you know, more formally, it's an experience of feeling a lack of hope, meaning or purpose in one's life.

Unknown Speaker  14:13  
So what? What can cause existential distress,

Unknown Speaker  14:17  
chronic or serious conditions, loneliness and social isolation, loss and grief,

Unknown Speaker  14:25  
burnout at work, there are a variety trauma is another example.

Unknown Speaker  14:32  
There are a variety of sources of existential distress that people experience related to a health event or healthcare condition or a non health related event that if left unmanaged, can then have downstream impacts on mental health, and if further left unaddressed, can have further impacts on physical health. Right, we know that individuals with

Unknown Speaker  14:57  
unmanaged depression and anxiety.

Unknown Speaker  15:00  
Often are at higher risk of experiencing hospitalizations. We know that among older adults, those that are socially isolated, feel like they're not connected to other people in their lives. They're at higher risk of of dementia and all cause mortality. And so existential distress is not the one thing that contributes to those downstream impacts, but it is an important and well studied phenomenon that is part of a broader psychosocial approach to health. And chaplains are uniquely qualified to help people identify that they might be experiencing existential distress, and then put forward the interventions to help people wrestle with that and and and hopefully overcome it. Today's episode is brought to you by CSA group, a global leader in product testing and certification, accredited as a nationally recognized testing laboratory by the international accreditation service, CSA group understands the importance of obtaining product certification for medical equipment, helping you access markets worldwide and establish credibility on a global scale. Having direct access to their industry experts, CSA group can guide you through the certification process and help you prepare for product certification with over 100 years of expertise, CSA group is your trusted partner in health care testing and certification. Visit CSA group.org/health,

Unknown Speaker  16:32  
care to learn more. You know, when we look at the health care landscape right now, mental health is discussed far more than it was even 1015, years ago.

Unknown Speaker  16:46  
You may call it may it may be mainstream now, whereas spirituality, I don't think, is necessarily part of that conversation right now. Why do you think that is? Yeah, it's a great question. I've thought about it a lot. I think there are three big reasons. One, and when you're talking about healthcare, there's no way around this topic eventually coming up. But reimbursement,

Unknown Speaker  17:10  
mental health counseling is often reimbursed. There's a long way to go to increasing that access and increasing that reimbursement in certain situations, and there's been, as you put it, for many, many years, if you know, decades now, advocacy and and change with regard to the reimbursement framework for mental health.

Unknown Speaker  17:34  
That has not happened for spiritual care. There are no billable CPT codes for spiritual care right when hospitals

Unknown Speaker  17:44  
are experiencing operating losses and they have to cut staff, unfortunately, often it's chaplains, among others, who are cut which which further feeds into the lack of access and disparate disparity of access. So I think one reimbursement has a lot to do with it, and my hope is that as we move away from a fee for service medical system towards a more value based care system, that that'll change, but but number two is, I think there's been a conflating of religion and spirituality,

Unknown Speaker  18:19  
and that within healthcare, in particular which, which often for very good reason, is rooted in in in secular

Unknown Speaker  18:29  
paradigms, right of peer reviewed research And of objective fact,

Unknown Speaker  18:38  
I think that medicine has historically

Unknown Speaker  18:44  
wanted to avoid bringing religion, or organized religion into treatment and and what's in a way of throwing the baby out with the bathwater. Medicine historically has lost sight of the impact of spirituality,

Unknown Speaker  19:00  
even when it is independent of organized religion. The third and final reason, I would say, is that an individual's experience of spirituality is fairly subjective, right? And when something is subjective, it's hard to measure, it's hard to build treatment around, and healthcare as a whole, I think is adopting a psychosocial approach in many other interventions, and is more open to embracing treatments interventions and research related to more subjective interventions. And I think you're starting to see the pendulum swing actually, as as healthcare as a whole, moves towards more holistic care, spirituality we see and spiritual health is is becoming more more mainstream. It's not where mental health is yet, but I think it's on that path. I'll give you just two.

Unknown Speaker  20:00  
Examples, the VA is Whole Health Program, and the VA is a national leader in providing high quality professional spiritual care. They've got as part of their whole health program different domains of health and wellness, and spirit and soul is one of them, another kind of local example here in Medical Alley is life Spark, right there. They're an innovator in population health for for seniors, and their seven pillars of health include purpose being, belonging. That's three of the seven. And so you're right that spirituality and spiritual health are not yet where spirit where

Unknown Speaker  20:44  
mental health, is in the conversation, but I think we're heading in that direction and and hopefully spiritual is on the forefront of helping to force that conversation and then build the capacity to deliver on that care. So Andrew, what feedback have you received from patients or healthcare professionals who have been interested in using spiritual yeah, thanks for the question. I spend most of my days talking to hospital leaders, with senior care leaders, and

Unknown Speaker  21:17  
you know, a lot of the initial feedback is, I wish this already existed, or how is no one else doing this?

Unknown Speaker  21:24  
This would be so valuable for our patients or for our residents.

Unknown Speaker  21:32  
So the reception has been very positive. I think with that said, there are barriers, right? And some of the reaction too is you know, depending on the situation, a concern of cost, in part, because of the the lack of reimbursement, right? And I believe that spirituals model is one that that makes this service very cost effective, particularly scaling over, you know, different facilities, different geographies, but a second barrier or reaction, right is sometimes

Unknown Speaker  22:06  
skepticism around whether telehealth will be

Unknown Speaker  22:13  
convenient or easy to use, particularly for older adults. So I don't find that always, but I do come across that fairly often,

Unknown Speaker  22:22  
and I try to provide a little bit of context of other telehealth use cases that have been around now for years, right? And AARP data showing growing embrace of telehealth among older adults, and not just telehealth specifically, but but other related technologies, right? You know, video chatting,

Unknown Speaker  22:47  
text messaging for non healthcare reasons, has been highly adopted across age groups, including among older adults. And you know counterintuitively, that the highest users of telehealth utilization. When you look at the data by insurance type, is Medicare beneficiaries even more than by privately insured individuals, and that's according to CDC study of telehealth utilization over the last post covid years. Andrew, we We talk often about the role of a chaplain, not just providing support for patients,

Unknown Speaker  23:28  
but also offering support to healthcare providers. And we know we're seeing burnout rates among health systems increasing. I think it's interesting that chaplains have a role in caring for the health of the healthcare providers as well? Yes, absolutely. So we know from recent studies that 75% of healthcare workers identify that they're experiencing work related burnout. The cause of that often relates to compassion fatigue, moral injury, exhaustion and burnout has been around for a long time. It's been exacerbated by covid and workforce shortages that are only looking to get worse when you look at the gap between the healthcare workforce supply and the growing number of potential patients out there, right? And so yes, spiritual care and chaplains have have often played a role in helping to meet the needs of healthcare workers. Some of that is, is very informal, right? Depending on the organization, it may just be that a chaplain is taking it upon themselves to check in with with colleagues and co workers. You know, how you doing? Do you know that that was a pretty rough case we just had, or a rough code, you know? Do you want to talk about it? Right? Some organizations have formalized it a little bit more. Where I've heard of organizations referring to code lavender, where maybe after a.

Unknown Speaker  25:00  
A patient death or an otherwise traumatic experience between the healthcare team and and the care that they've delivered, the the team as a whole will take a pause, a very intentional, you know, pause of their work, to check in with each other. And in some organizations, chaplains are called upon to facilitate that time and others, they're not, and it's very case by case specific. Do you see an opportunity there to keep providers in the workforce, especially you mentioned in rural areas, where the provider shortage is increasing at an even faster rate than it is in more urban areas? Yes, absolutely. I think there, on a couple of fronts, there's an opportunity. One is,

Unknown Speaker  25:48  
as as we've discussed, right, spirituality is one lever to pull in helping people feel more connected to what's going on in their lives, to finding meaning in their life and purpose. And we know that people get into healthcare in particular compared to other industries, because they are inherently mission oriented, because they are service oriented, and when people suddenly start to feel a lack of connection to their work in healthcare, there's significant cognitive dissonance, right between the reasons I got into this profession versus how I am experiencing it day to day, which leave people feeling unsatisfied and

Unknown Speaker  26:31  
and may push them out of the workforce. Right? We've seen record

Unknown Speaker  26:37  
vacancies and and turnover within healthcare over the last few years. Secondly, we know that even in Minnesota

Unknown Speaker  26:48  
and even in rural communities, where maybe the patient population is not quite as diverse

Unknown Speaker  26:55  
as maybe here in the in the metro in particular, because you mentioned rural communities, the healthcare staff are quite diverse, and so what our telehealth model enables, right is individuals, no matter where they are, even if they're working in a rural setting, it's possible that they're the only person in the building

Unknown Speaker  27:18  
of a minority, racial or ethnic background or of a religious background. And so what our service enables is for them not just to receive needed spiritual care, but to access a chaplain who has competency in their particular culture and their particular spiritual or religious beliefs. And that in many communities can only be done virtually, and it wouldn't be feasible to do that.

Unknown Speaker  27:46  
You know, solely in person. That's such a valuable, valuable service.

Unknown Speaker  27:52  
I Andrew, I wonder. You know, as we look kind of to the to the future here, you know, what does the future to you look like in the spiritual health space in the next five to 10 years? Yeah, thank you for the question.

Unknown Speaker  28:07  
One, what it looks like to me is spiritual health is recognized and acknowledged as being as important to people's overall health and outcomes and quality of life as as mental health and behavioral health are today, that that would be, I think, one vision to aspire to.

Unknown Speaker  28:30  
And I think that the data do do suggest that that that is the case, but, but our our mentality and our care models have not caught up to that yet

Unknown Speaker  28:41  
second and I think it's, it's, you know, part of our vision as well, is that spiritual care is broadly accessible

Unknown Speaker  28:49  
throughout the care continuum, right? That it is available through through home health and home care models, that it's available in outpatient and ambulatory treatment settings, that it's available as part of a broader care management or chronic condition management approach, alongside other interdisciplinary care team members, and that individuals for whom spirituality is important to them and their health and their well being, They have access to a professional chaplain, not as a secondary or as an afterthought sort of thing, right? Or that they're not only,

Unknown Speaker  29:32  
you know, on a one off meeting with a chaplain who happens to be available when they're admitted for something in the hospital, but there is more of a holistic access to spiritual care because of that more holistic impact it has on quality of life. The last thing I would say, too, that I believe is part of our broader vision, is that as the healthcare system moves towards more value based care arrangements.