Transcript for EP421: Wildly Improving Outcomes When the Patient Is, for Reals, in the Center—For Maternity and Beyond, With Jodilyn Owen

[00:00:02] Stacey Richter: Episode 421, "Wildly Improving Outcomes When The Patient Is, For Reals, In The Center. For Maternity and Beyond."

Today I am speaking with Jodilyn Owen. 

American Healthcare Entrepreneurs and Executives You Want To Know. Talking.  

Relentlessly Seeking Value.  

I want to kick off this show with a clip from episode 415 with Rob Andrews. We're in he's so very eloquently sets the stage here. 

[00:00:44] Rob Andrews: We think that one of the core problems here is that too many intermediaries and providers in the system, their compensation is not in any way dependent on the outcome. So let's think about this NICU baby problem again. Looking at the hospital system, and I'm not at all implying or suggesting any hospital system tries to do this, but I think it is clear that they actually benefit commercially from more babies spending more days in the NICU. 

NICU is usually pretty good margin business. It's expensive, lots of money is paid and margins run pretty well there. So I don't think there's a hospital system in the country that intentionally says,... "Oh, good, let's go out and try to fill up the NICU every day". But when it gets filled up, they benefit. On the other hand, if the hospital invests significantly in early effective intervention, prenatal or even pre-pregnancy, there's no upside to that financially. They don't get rewarded for that. They might win an award from some magazine for best practices, but their margin suffers. And then if you look at the intermediaries, the carriers and PVMs, their outcomes are irrelevant to their performance. If an employee of a self-insured employer has a significant risk prenatal or pre pregnancy, and the carrier does a great job identifying that problem and solving it, they make the same amount of money off that patient or that consumer that they would if they did nothing. So it's a bit harsh to say this, but the carriers make the same amount of money if every child is born healthy and there's not a day spent in the NICU as if they do if every child's born with severe crisis and winds up in the NICU. 

It's not a big mystery in the U.S. economy that people do what you pay them to do. And if you have a system, which we do now, where in the case of maternal health, diabetes management, musculoskeletal management, cholesterol, and cardiac management, when you have a system where many, many players in the system, at best, make the same amount of money for bad outcomes as they do for good ones. 

And at worst, may actually prosper from the bad outcomes. That explains the problem.  

[00:03:09] Stacey Richter: So is this a show about improving maternal health outcomes in the U.S. where it is relatively deadly to have a baby compared to other industrialized nations? Yes, but improving maternal health is also a great case study for what needs to be done to just improve health. 

You could apply it to primary care. You could apply it to chronic care management. It is a fairly broad spectrum solution, as it were. I'm thinking right now about how Dave Chase, cofounder of Health Rosetta, how does he put it? 

He says, every big problem in healthcare already has been solved. The existing challenge is how to massively replicate proven solutions. So yeah, keep that in mind when we talk about what Jodilyn Owen has accomplished with her team in Washington State with their Birth and Health Center. Also, as you consider how you might replicate, keep in mind the struggles she has faced getting contracts from employers, self-insured employers or payers to pay her clinic and a very interesting encounter she had with a VC/PE funded maternal health start-up. It's just interesting where the money is flowing and where it's not flowing.  

But, let's talk about Jodilyn's clinic's outcomes. 

Their zip code is one of the most diverse in the nation. There are 79 languages spoken. There is lots of social determinants of health going on. It is a medically underserved area. It is a federally designated provider shortage area. So this community has every right to have horrible outcomes. 

Meanwhile, nearby, there is a wealthy community. In that zip code, they live 17 years longer than in Jodilyn's clinic's zip code. But if you compare the outcomes that Jodilyn's clinic has compared to the outcomes in the hospital in that fancy neighborhood, Jodilyn's group has far less cesarean rates, far less NICU admissions, far less incidence of gestational diabetes. 

Far quicker access to treatment for hypertension. You might be wondering how much their birth bundle costs, that they are having trouble getting most payers except one to pay for, and getting no VC dollars or funding at all. They're charging $5,000 to $7,000. So let's just say $5,000 to $7,000 compared to what does one NICU admission cost? 

So yeah. This is an exact example of what Rob Andrews was talking about. An exact example. So yeah, enjoy this episode. It's as heartwarming and actionable as it is frustrating. And if you are a payer or a self-insured employer in South Seattle, please give this clinic a contract. Not to drop a major spoiler alert here, but you know what Jodalyn's secret sauce is? 

Nuances for sure, but bottom line, it's about trust. It's about relationships. It's about listening to the patient. It's being part of the local community. If you're shocked right now, raise your hand. There's going to be no one with their hand raised. How many times do we have to figure this out?  

Jodilyn Owen is the clinical director of the Rainier Valley Birth and Health Center. She is a licensed midwife along with a bunch of other credentials.  

My name is Stacey Richter. This podcast is sponsored by Aventria Health Group.  

Jodilyn Owen, welcome to Relentless Health Value.  

[00:06:23] Jodilyn Owen: Thank you.  

[00:06:23] Stacey Richter: So if we're talking about maternal health outcomes in this country, which as Rob Andrews said on an earlier podcast, are scandalous in this country but my impression from what you've talked about earlier, Jodilyn, is that there's a fairly obvious patient journey here. So it's not like this is, you know, anybody's first day at the rodeo. I guess we could choose to do maternal health care. We could choose to do it reactively and just wait for someone to have postpartum depression or wait for these kind of reactive acute preeclampsia or eclampsia, right? Like we could wait for that to happen or we could prevent all these things from happening. And obviously, I mean, there's million dollar babies all the time, right? Like how much preventative care can you afford if you prevent just one preemie from spending three days in the NICU, for example?  

[00:07:15] Jodilyn Owen: You just said a couple of really important things. One is cost savings. And if you look at what this birth bundle costs to deliver and administrate, it's going to be less than or about $5,000. And for somebody who needs a lot of care, maybe seven to ten. And if you look at the cost of one NICU admission, you're looking at hundreds of thousands of dollars. 

That's dramatic. If you look at the cost of somebody who gets coaching support and oversight for lifestyle management changes through the vehicle of all of these providers working together, you're going to save hundreds of thousand dollars downstream, but not just for that patient, but for that patient's family, because we know and all the research shows that if you activate in community, the women in the community to make change, they force other people to change. 

That is the root of this and people are inspired when they are pregnant. So the downstream costs I think are probably immeasurable, but also there's a lot of information about cost benefit analysis of just activating midwifery care. And in this setting, midwives lead this care. We have residents rotating in our clinic. 

We had one with us all day yesterday. She was amazing. We just, we have the best residents. They come in and they want to learn about how to practice like a midwife. They want to learn about slower paced care. All of our visits are one hour long and they are drilled to get their stuff done in 15 to 20 minutes. 

Tops, tops, tops.  

[00:08:39] Stacey Richter: And so just to interject, you're talking right now and you say residents, you mean OBGYN residents?  

[00:08:44] Jodilyn Owen: They are family practice OB residents. And we have a system set up when the resident coming in to learn from midwives, and then if our patients see that resident during a visit that day, they can register to have their baby at the hospital with that resident, providing a continuity of carer for that patient, which is extraordinary in health care today to have that kind of confidence that you're going to show up to the hospital to have your baby and somebody you have met who came to you, who traversed the path to the community and sat with you for an hour to learn about you will be there for you during your birth and the trust that that creates is extraordinary and that's safety, Stacey, that's safety. 

[00:09:29] Stacey Richter: So let's just talk about this from the OB perspective, especially from maybe the hospital's version of the OB perspective or the people that are holding the purse strings relative to the OB GYN services. Because you often hear about there's a shortage and there is limited access to these physicians in a lot of these communities. 

So what strikes me is now they're spending an hour with these individual patients, like that would seem to almost exacerbate the access issue. How would you respond to that?  

[00:10:07] Jodilyn Owen: You just asked me my favorite question. The vast majority of people can start their care with a midwife who then approaches her team to address risk issues and is able to do with support, practice to the full scope of their care. We have doulas, lactation experts, even the social worker. And if a patient needs more, they go into the care of the OB, but they don't lose the rest of that team. And that team is not viewed as an extension of an OB. That's an inappropriate, inefficient use of qualified providers. 

What we need to do is flip the whole thing upside down, start people at the risk that they are appropriate for. I just spoke with a social worker yesterday who had spent a lot of time working in a hospital setting and told me that it was just incredibly sad and frustrating to be called in after the baby is born and hear about a patient and they need access to food, housing, parenting support, all kinds of things, and they're there in that hospital. They have about 23 hours to solve this problem, and then they're just gone. That's not preventative. That's a band aid. It's an important band aid, but it's not preventative. And if you think about prevention, you would start by activating the people who can, who have a deep understanding of this. 

[00:11:28] Stacey Richter: I'm understanding , the answer to my does this actually reduce access and exacerbate the shortage of OBs in this country, I guess it's kind of like, what's the goal here? And I think Dr. Vivek Garg said this quite succinctly on an earlier podcast. He's like, what are you trying to do? 

Actually improve patient outcomes or like crank people through doctor visits that don't actually result in any improvement of outcomes? Because it certainly sounds like it would be better to spend an hour and really think through and help a patient with gestational diabetes now. As opposed to spending however many hours down the road trying to fix something that is life threatening and probably shouldn't have happened in the first place. 

And this is possible because if you have a group of really capable, you call them a table. I like that. If you have a table full of very, rooted in the community professionals supporting the care of that woman who's in the center, not supporting the OBGYN, and I think you made that a really important... because if you put the OBGYN in the center, then you know, it's just like you've got a... you're putting actually a lot of pressure on that particular doctor to coordinate everything. 

And like, it definitely sounds like that's something that it almost should be the other way around, that that table of professionals should be supporting the OBGYN and bringing that individual in when necessary or when the risk amounts to something that's like at the physician level, as opposed to the physician kind of pointing very tactically at people like you go here and do this like, did I get that right? 

[00:13:09] Jodilyn Owen: You did get that right. I think there's also this idea that the OBGYN can somehow fix things and we want them to fix everything. We want to point and say, why didn't their doctor do this and why didn't their doctor do that? But the problem is, and we've had this before, where even the head of a very large OBGYN unit said to me, what are you doing over there? Look at these outcomes and what can we be doing here that would get us there? And I started to talk a little bit about it and share that we have these hour long visits. And she was like, wait, I wonder if we could do hour long visits. And then she just looked at me, she's like, but what do you talk about for an hour? 

I realized to affect change, we have to unwind what has been wound so tightly and so carefully through medical school education, through the practice where you have a preceptor or an attending constantly tapping you when you step out of line. You have to sneak to do something that feels like it's the right thing. 

How do we start to unwind that? It's not a people problem. It's a system problem. And then it's a behavior support issue. We have to support people to do the right thing. And we have to support people to have the courage to do this work. And everybody in that system needs courage to do this work. The patients, the providers, the payers, the administrators, front desk person needs to be highly activated. 

[00:14:42] Stacey Richter: Let me just go back to... You were talking about these hour long visits. And then an administrator at a hospital kind of scratched her head and said, But what would we talk about for an hour? Can you address that really specifically?  

[00:14:57] Jodilyn Owen: Like what do we talk about for an hour? 

[00:14:59] Stacey Richter: You're spiraling around a point, which is that if you don't put the patient in the middle and recognize that there is context around that whole patient, that you actually have nothing to talk about for an hour. Like if the focus is narrowed to let's talk about delivery day.  

[00:15:16] Jodilyn Owen: You know, Stacey, when a person is sitting in front of me for the first time and they're newly pregnant, I always tell them right now you are feeding, nourishing and growing your baby with nobody's permission. You didn't come here to ask me permission to grow your baby. I trust you to do that. What I am here for is to examine and explore, like an adventurous explorer with you, the context of your life that if we have supports for you to achieve your best emotional and mental health, you will meet your baby from a place of health and strength. 

So I view my job as preparing parents to be available to meet their babies from a place of emotional and physical strength. And when you think like that, the question I always start with is what are your goals for this visit? What kinds of questions, observations, or concerns do you have today? And then I'd just be quiet and they'll talk for an hour about those things. 

And the one thing that I learned from one of my great uncles who is just a magnificent physician, he said, just use your best equipment. It's your ears. Just listen, people know what's wrong with them. They'll tell you what they need. And when you're available and accessible to them and you can think creatively about your response that meets them where they are and doesn't drag them to a place they'll never want to go, you can create health change. 

[00:16:47] Stacey Richter: Your uncle is very wise. I just read a story about largely the inequity of maternal outcomes. It was talking about Serena Williams, who was telling everybody, I mean, here you have a top athlete who knows her body like better than any of us could ever hope to, right? Like that's her job. And she is saying over and over again that there's something wrong and no one listened to her. 

[00:17:15] Jodilyn Owen: I had a mom come into care who came in very late in pregnancy and she sat down on the couch and she said, I just have this overwhelming fear that I'm going to need something and nobody will call me back because even when I call the OB just to ask about a symptom, I don't hear back for three or four days and I'm terrified. 

I'm just terrified. We worked a lot of hours together over the course of maybe a couple months, and she called me one day, and she was slurring her words and talking almost nonsensically. And she said, Jodilyn, I'm looking at the place where I prepare food for my children, but I don't remember what it's called, and I'm reading a book to my toddler, and I can't connect these letters. 

I told her to stay on the phone with me. I called 911. I got in my car. I was driving as fast as I could. I followed the ambulance. We got into the hospital. She was in a c-section within moments. She had an acute case of preeclampsia. She knew somewhere deep inside of her that she might need to get ahold of somebody and then her needing to call. If she had called an answering service and said, you know, I'm just having some troubles. Can you have my OB call back? They would not have interpreted. What that meant, and may have just told her to lay down and take a nap. I don't know. That happens a lot. People are told to lay down and take a nap when they don't feel well. 

And instead of probing in, but I knew her and I knew her voice and I knew how smart she was and I knew that she wouldn't have trouble finding the word "kitchen" or reading a story to her children. What does relationship based care mean? We've really lost that in our healthcare system. You might go to the practice where a doctor you hope to see works, but you might see one of six or 12 of their colleagues. 

They may see 10 providers over the course of 10 months going to have their baby and it's an 11th provider, maybe a hospitalist who's there doing the delivery. And that hospitalist has no clue about this person. 

[00:19:14] Stacey Richter: If all women had a center, like, you have, we would not have the maternal mortality that we do in this country, like, period. That has been borne out repeatedly.  

[00:19:26] Jodilyn Owen: Yeah, this is that prevention piece. This is like, we're not rescuing people. We need to think about prevention. The whole system is set up to almost appease the provider's brain into believing that they're saving people. Because, when you do no prevention and somebody comes in very sick. And you have your OR stocked correctly, and you have your protocols you follow, and you have, let's say everything goes right in the hospital and somebody lives through the event that could have killed them. We all look around and we're like, woof, we saved that person. But did the person really need saving or could we have prevented that? 

[00:20:01] Stacey Richter: One thing that you were talking about earlier, which was really striking, was the one example where you recognized that there was a woman who likely was going to have preeclampsia and you made a call to the OBGYN. Do you want to tell that story? Because I think this is very indicative.  

[00:20:21] Jodilyn Owen: So this is what I call the not dead yet syndrome and this is where community health providers and this can be a community health navigator, a midwife or anybody out there in the community and it happens a lot in our world where we see rising blood pressure and maybe we see... we look at lab work and we know that a falling hemoglobin over the course of pregnancy is probably going to lead to preeclampsia and you start to get all these little symptoms building up. 

But they're not clinically there yet, but we know what's coming and it always comes and we do everything we can to try and help prevent it, but let's say we can't. So we start calling around and asking, can we get an appointment for this person? Can we come in and be seen? This is happening. It's going to happen. 

And they'll say, come in, because when you call, they have to let you come in. You go into the ER and they say, you know, you're not like clinically in crisis right now, so you're normal. Go home. And then we have about a three day watch fest where the edema gets worse, the blood pressure keeps climbing, and you wind up with a clinical crisis. 

And then we go in through the ER and we need saving.  

[00:21:29] Stacey Richter: What really struck me, then you have a doctor who is like, well, I'm a hero. I saved this woman when they could have prevented it from the beginning. And I know I'm not talking about all physicians here. And to say this in such stark terms sounds probably harsh, but based on everything that you're saying here, it seems like this is not unusual. 

[00:21:54] Jodilyn Owen: No, because it's a guideline. The guideline of what is considered hypertension in pregnancy, 140 over 90. If you're 138 over 84, ...go home and be watched. You know, so you really have to achieve that threshold, but that doesn't tell the whole story and there is a space for prevention where you are, your body is not normal, but you're also not in life threatening crisis, but you're getting there and we need access for people in that moment then we don't have to save people and we don't have to lose them because we'll be too late. 

[00:22:28] Stacey Richter: Yeah, because from what you were saying before, it's not just that one point in time that's relevant, it's the trend.  

[00:22:33] Jodilyn Owen: It's the trend. Everything in pregnancy at least is a trend. It is rare that you have just a crash emergency. The most common emergency starts with a rising trend. And our systems are not designed to encourage our providers to see those trends and respond to them. 

That's part of the secret sauce of what we do. We're very curious about trends. We're very curious about how we can collaborate with and on behalf of the patient to address those trends in the moment that they're rising. I've worked with providers where we're seeing a patient together who maybe fails their first glucose test. 

I can get them with normal glucose readings almost every time within three days. And the providers are like, you can do what? They're shocked, but we can do it. With most people it works and it just takes time and it takes a lot of education and a lot of teaching and then support.  

[00:23:23] Stacey Richter: Everything that you're describing is a cognitive service. 

And as we all know, poking, prodding and procedures are compensated at a far higher rate. Half the time, as you said, you've got to sneak around to do the things that are right for the patient because they're just not compensated well and you have a whole system. The provider organization is thinking this is a bad use of time. 

The payer doesn't want to pay for it, right? Everybody doing what they're doing creates a system which has resulted in the maternal mortality that we have in this country.  

But talk about one thing for me. There was a VC funded startup venture that moved in down the street from you. Do you want to talk about that story? 

What happened?  

[00:24:11] Jodilyn Owen: This venture healthcare company came in on what felt like the carpet that Aladdin arrives in, in the movie, just like floating down in a sea of shiny sparkle and lands in this, lands in the neighborhood and says, we're here to fix things. We have an idea of what that could look like. 

We want to talk about your ideas and we are so, I don't know, I like to think that we're very open sourced minded, but also that can come across as naive. We sat at a table and answered all of their questions about what we are doing. Somewhere about three quarters of the way in that initial conversation, I realized they're not asking how we're doing it, they're asking what we're doing. 

I tried to poke into that a little bit and was met with a lot of... we know how to do this, we got this. If you talk to the community maternal child health providers, everybody has a story about how this venture capital company came in with their, I don't even know how they do it, billion dollar SEO. 

So if you search, if you search for any search term, instead of finding a midwife in your community, you will find them. They used a lot of the same kinds of phrases and images and things that we use and then made it their own to their, you know, to their credit. It wasn't, there wasn't an attempt to be who they thought that they were going to be. 

They were venture capital funded and hired people without telling them that, that was the source of their funding and because that's a newer kind of model in maternal child healthcare, you know, the providers, we don't know to ask these questions and it didn't work, Stacey, so they they've closed now and their opening caused tremendous disruption to the flow of care for patients in the community to the flow of work for midwives in the community. They advocated at the state level. They advocated for value based payments from payers and never included the rest of the midwives in the state. They played alone. They worked alone and they ended alone. But there was ramifications for that in the community. It's not benign. I think that they all thought that they were going to do something amazing and their idea was amazing. 

And I think it was. When you're driven by this idea that some millionaires want to become more millions of millionaires and we're going to somehow leverage the health of humans to do that, you better be just very careful about how you go about that. I don't think all venture capital is evil. And I think we talk about good money and bad money and all this kind of stuff. 

How do you navigate all of that? But the, the answer could have been that initial conversation could have been them sitting at the table saying, we see you're doing this thing. We see it's working. We have the power to create and collaborate with you in the community on research on data gathering. We can help prove the point that this works. 

We can negotiate on your behalf with payers. We can bring some funding to help level up the ability to hire providers. We can do this and in exchange, we want this. You know, there's a transaction when it's a venture capital, but that's okay. I would assume that there's a way to do this well. Maybe there's not, but could be my naive open mindedness. 

[00:27:40] Stacey Richter: If there was just a little bit less hubris and maybe a little bit less, I'm going to say greed, right? Because this entity could have been thinking, I don't want to share, I don't want to share the money. Right. But it's, it's almost like, so now you got a hundred percent of nothing.  

[00:27:54] Jodilyn Owen: Yeah. That's what you wind up with. 

The thing is, we are always financially, we are always struggling. We are constantly writing grants. We can't just do this for nothing.  

[00:28:04] Stacey Richter: So how are you working with payers? Are payers paying you fairly or what's going on there?  

[00:28:09] Jodilyn Owen: We had an extraordinary event happen at our little clinic where we had the executives and some caseworkers from one of the payers in Washington State that we love to partner with, which is sounds like an oxymoron, but we have one payer here that is a nonprofit payer, they're called Community Health Plan of Washington. 

They're extraordinary. We work really closely with them and are trying, and have been working and supporting them to recognize these spaces that need to be funded, the learning, the collaboration, the learning curve where you learn like, whoops, that's not the right way we have to start over. You need funders who are flexible and who provide you flexible dollars to do that. 

Learning is incredibly important and we don't provide resources to make it happen. They came into our clinic and sat with us and we had executives there and we had a few of their caseworkers who are more on the ground and. And we had some of the value based folks from there on their admin team. We sat and talked for two hours with each other about what we're doing and what they're doing and how we can level each other up. 

And it was probably the most extraordinary conversation of my career. Other than this one, of course. Of having those, having that level of power in our tiny little non-profit asking, what are you doing? Not so we can take it. What are you doing? Can you teach the other providers in our network to do it? 

How can we support that process? How can we support you to continue to do this good work with your patients? We came away with some very solid, I think, future projects. So, that, you know, I have been approached before by some of the big payers, but they come in the office and they say, what are you doing? 

How can we steal it? How can we get this into other places? But they don't ask the right questions. They take copious notes and they're like, I know we can't do this anywhere else. And they walk out. This group of people is very vested and I think we need more like them. And I think they are the remedy because the venture capital healthcare funds are, they're going to keep going. 

But what we need are payers who recognize them when they come in the door and can help guide them to do the right thing and can help guide them to activate on behalf of all.  

[00:30:36] Stacey Richter: It sounds like there's a difference between payers who are actively trying to figure out how to do right by their community, how to actually deliver value based care. 

And then the ones I mean, we can't forget here that a lot of payers have big divisions where they're providing venture capital to some of these startups and trying to make money in that, right? So there's, there's a big difference between, you know, is this conversation financially motivated ? 

Or is this motivated by a need to try to figure out how to level up care in the community and a way to do that?  


[00:31:11] Stacey Richter: Larry Bauer was on the podcast over the summer. And one of the things that he said is you got to trust the providers. You got to trust the people that are in the local community. And help empower what is already working there and the chances of something being able to be picked up and just sort of wholesale dumped someplace else are not great. 

Let's just say especially...  

[00:31:31] Jodilyn Owen: No, it's highly likely not to work. You have to create a structure that can be adapted and I and I want to propose that those two things you just mentioned might not be mutually exclusive. There may be space to explore. Can all these things happen? At the same time, is there a yes and a yes? 

And is there a win win?  

[00:31:49] Stacey Richter: Let's just all recognize that you need to have a trust in the community. You need to have people in these practices or at the table that are part of the community. Otherwise you don't have trust. You don't have relationships. So it's not going to be a, okay, everybody, let's put someone who's not reflective of the community in charge here. Like, it just it fundamentally doesn't work. And from a payer perspective, that's equally important.  

Jodilyn, is there anything I neglected to ask you that you want to mention here? 

[00:32:23] Jodilyn Owen: I don't know if it's the right way to address it, but the root of the solution doesn't actually start with licensed professionals, it starts during the education process. 

And we need to get into pre-health education. We need to get into medical education and healthcare professions education schools, and start talking about this there. And we need to start practicing it and training on it so that when it's time to act on it, they will be comfortable with it. We need to learn with, from, and about each other in the health professions industry so that we can practice with, from, and for each other. 

[00:33:02] Stacey Richter: Yeah, and the one thing that you said that I think that really resonated with me is the idea that everybody at your table, you all go into the hospital. You all are in the room with the OBGYNs, you know, in their halls, but it's kind of a rare thing that they come and visit you. And when they are within the walls of an organization like yours is where there's a lot of learning that happens. Where the context becomes so much more clear and it enables a much less siloed, a much more collaborative, much more productive, much more synergistic relationship when everyone kind of has that same context, which I think is is also what you're saying. 

[00:33:48] Jodilyn Owen: Very much and I will say that in our setting we have the OBs coming to us to learn with us and to teach us and they're being taught by us and that is just done in a lunch & learn and we can go over to their clinic for a lunch & learn and thinking together about how the guidelines that exist in the hospital would be and are expanded by those OBs who are vested in this to include community based care. There's something incredible about asking questions with each other present and showing vulnerability. 

If I thought it was this, but the guideline is that, and I'm not sure how to do it, and there's just an extraordinary thing that happens in that space and you, you develop a regard for each other through that process and the patient feels that. They trust that and they will follow that and that is built over time by learning and failing and growing together. 

[00:34:40] Stacey Richter: Jodilyn, if someone is interested in your work, where would you direct them for more information? 

[00:34:46] Jodilyn Owen: Find me on LinkedIn. And they can always email me. They can call me. I love connecting with people and learning together and finding a better way together.  

[00:34:58] Stacey Richter: Jodilyn Owen, thank you so much for being on Relentless Health Value today. 

[00:35:02] Jodilyn Owen: Thank you for having me, Stacey.  

[00:35:04] Stacey Richter: So let's talk about going over to our website and typing your email address in the box to get the weekly email about the show that has come out. Sometimes people don't do that because they have subscribed on iTunes or Spotify and/or we're friends on LinkedIn. What you get in that email is a full and unredacted, unedited version of the whole introduction of the show transcribed. 

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