Dr. Marc Harrison: Hi, I'm Dr. Marc Harrison, CEO of Intermountain Healthcare. Today I'm with Cyntea Anderson, a nurse with home care and hospice in the Fillmore and Delta area. Cyntea, thank you for making the drive up to Salt Lake to join me. Please tell us a little bit about yourself and then we'd love to hear what's on your mind today.

Cyntea Anderson: I have been doing home health and hospice for 25 plus years. And I started with Intermountain six months after I got married. I worked as a cook at the hospital and the care center, then housekeeping, and I've been in home health since I got my CNA and LPN and all the way up to BSN. I'm too old to retire because I have so much institutional knowledge.

Dr. Marc Harrison: Yeah, we need institutional knowledge. Hey, I love that story of your career path. Did you have a goal in mind or did you sort of take each step one step at a time, Cyntea?

Cyntea Anderson: It was more driven by the birth of my daughter with a lot of medical issues that there's ... It's ongoing.

Dr. Marc Harrison: I see.

Cyntea Anderson: So it was like, oh, I guess I'm not going to scrub toilets for the rest of my life. I was going to go in and finish my biology, but Intermountain owned my soul, so I decided I just had to do something else.

Dr. Marc Harrison: Has it been a good relationship for you?

Cyntea Anderson: It has been a fabulous relationship. And I think that my biggest commitment to Intermountain is the fact that Intermountain and I share the core belief that the quality of your care must never depend on the money you have, where you're from or where you live.

Dr. Marc Harrison: Here, here. Our ethos is everybody without regard for their ability to pay.

Cyntea Anderson: Exactly.

Dr. Marc Harrison: But darn it, we have to be careful with our resources in order to be able to afford that, don't we?

Cyntea Anderson: Yes, we have to because it's wonderful to be able to do that, but we still have to make sure we can get the right payments where we need to and make sure that we're doing our billing and our processing and our supply utilization and all of the visit utilization so that we're not wasting those resources that can be used to help others.

Dr. Marc Harrison: I couldn't agree more. So tell us a little bit about your job right now. So you've done lots of different things. Tell us about your job right now and how you see that fitting into our future of healthcare.

Cyntea Anderson: I love working in the rurals because we are committed to our communities. They're our friends, our neighbors, our family members. I was my father-in-law's hospice nurse because we have limited staffing. This is what we do. But we know these people and anything that we do to help our community be healthier is going to make everybody in the community better. It makes just everybody healthier. I love being in people's homes. I did three years at Utah Valley and I love it, but oh man. Seeing people in their homes, this is where you go to get better. And I work with such wonderful people.

Dr. Marc Harrison: So in addition to keeping people in the least restrictive setting, which is a big part of what you do, keeps them in their social context, probably keeps costs down as well so that we have more affordable healthcare, which is very important to me as you know. I imagine that you also can see evidence of good social function or poor social function when you visit people's homes. Is that, do you think that's an important feature?

Cyntea Anderson: That is an incredibly important feature because when you have a background in a home that has a lot of social problems whether it's emotional, whether it's mental, financial, it could be all of that ties in together for that whole person. And we treat that whole person because we are seeing that whole person. We're seeing their family and how their lack of a caregiver impacts the fact that they can't get to the insulin or can't draw up the right dose. And trying to solve those situations and help them to be able to make these life changes with the new diagnosis. And it's amazing because we see that bigger picture in the home.

Dr. Marc Harrison: That's very interesting. We spend a lot of time these days talking I think very appropriately about social determinants of health. Housing, transportation, food, loneliness, physical security, et cetera. Do you deal with that in your professional life? Are these important features as you work with families?

Cyntea Anderson: Incredibly so because especially that isolation and that loneliness in the rural area because the miles that you have between people sometimes or even their ability to get just to a physician's appointment because they live 30, 40 miles outside of town on a ranch. This is incredibly important, and being able to help them find and utilize and even makeup new ways to utilize resources and so that we can get these people into their doctor appointments and get their meds out to them. And make sure that they can get their shopping done, that they have people who can get the food for them, pick up meds for them…

Dr. Marc Harrison: It makes a huge difference, doesn't it?

Cyntea Anderson: It is. And isolation is so numbing for a person.

Dr. Marc Harrison: Right. So I love your optimism and I like your adventurous spirit. Would you recommend to a young person today, like our daughter's thinking about nursing, do you think that would be a good career in this era?

Cyntea Anderson: Nursing?

Dr. Marc Harrison: Yes.

Cyntea Anderson: Oh yeah. The world is totally lost without nurses. Not that doctors don't do their thing.

Dr. Marc Harrison: No, I know where I fit into the pecking order of nurses rule. Yes.

Cyntea Anderson: Exactly. You guys make a decision and then we interpret, teach, coordinate, help and make it a new lifestyle and so that it works for them.

Dr. Marc Harrison: Beautiful. I know you also have a big passion outside of your work. We've talked a little bit offline about your love for raptors and hawks and falcons. Do you get a chance to see some great birds living out where you do?

Cyntea Anderson: Every day. When I leave my house and head towards Delta I watch for the eagles that sit on the crests of the sand dunes. There's three of them this year and we're so excited to have them back after the wildfires.

Dr. Marc Harrison: And these are golden eagles?

Cyntea Anderson: Golden eagles. Although we are seeing some of the Balds were back this winter, which is really amazing. That's the first time in five or six years.

Dr. Marc Harrison: Nice.

Cyntea Anderson: Oh and hawks. I saw a kettle of migrating Swainson's.

Dr. Marc Harrison: Aren't you lucky?

Cyntea Anderson: I know. I didn't even know what it was. I had to go look it up. And it was amazing. It's breathtaking. I see so many things on my drive around Millard County. It's amazing.

Dr. Marc Harrison: We're lucky to live in the state of Utah, aren't we?

Cyntea Anderson: We are.

Dr. Marc Harrison: Good neighbors, great healthcare. I think Intermountain's making a big difference. And then the natural beauty around us is just kind of off the hook.

One final favor, without breaching HIPAA in any way, is there a patient's story you'd like to tell about something impactful that has happened in maybe the last couple months that can maybe get across to our listeners how important the kind of work you do is to a transformed model or value-based or population-based health?

Cyntea Anderson: The one that immediately comes to my mind is not within the last few months, but it's so powerful.

Dr. Marc Harrison: That's fine.

Cyntea Anderson: To receive a phone call from this big burly rancher who's calling from a hospital up north in tears because they say they won't let his mom come home and she wants to come home because she doesn't want to die in the hospital. And she wants to come home, and they said there is no hospice where you live. And he says, "I know this is what you do. Please tell me how do we do this?" And then the doctors were ... Not because were mean or something. They just wanted to ... They were afraid that she would not make the trip home. That she would die before she reached home and then she would be dying outside of the care of a doctor. So we just made arrangements, and I talked to the nurse at the hospital and we made arrangements with our medical director and he said, "I will cover her the minute she walks out their door." And we got her home, we signed the papers on the hood of the car and they carried her into the house and she was there for five and a half hours. We helped make arrangements to talk to her grandson who was in a foreign country serving a mission. Everybody else was able to be there and she died in her home, in her bed, with her family. I'm so sorry. Happy symptoms controlled. That is why we do this job.

Dr. Marc Harrison: And thank you for doing it. I'm proud to work with you, Cyntea.

Cyntea Anderson: Sorry.

Dr. Marc Harrison: No sorry necessary. This is why we all get up every day.

Cyntea Anderson: Oh yeah.

Dr. Marc Harrison: And I would say mission accomplished on that.

Cyntea Anderson: It's why we do this because it's not an easy job, but it's the best job ever.

Dr. Marc Harrison: Thank you so much, Cyntea. That's beautiful.

Cyntea Anderson: Thank you.