Alex Evans MD & Candice Caesar PMHNP (00:11)
Hello, everyone, and welcome to another amazing episode of Apex Health Podcast. Today, I just want to remind you guys that you are here to experience something that's different than everywhere else. My name is Dr. Alexander Evans. I am a general surgeon, practicing general surgeon, and the host of this great podcast. I have a co host who is Candace Caesar. She's a mental health.

Alex Evans MD & Candice Caesar PMHNP (00:40)
Provider. And today we're going to be talking further about these different things that affect you as healthcare providers and healthcare recipients. You know, in Apex Health, our goal is simple, is to make healthcare easier to understand by bringing today together people that shape healthcare and having honest conversations about issues that affect all of us.

Alex Evans MD & Candice Caesar PMHNP (01:10)
Candace is going to bring us in with our guests.

Candice Caesar (01:13)
Okay, so joining us today is Ronald A. Brizet. He's a respected leader in public policy, government, and business. Ronald is a former Florida state legislator and former chairman of the Florida Public Service Commission. His experience gives him a unique perspective on how policy is created and how those decisions ultimately affect everyday people. Ronald

Candice Caesar (01:42)
Welcome to Apex Health Podcast.

Ronald A Brise (01:46)
Thank you, Candace, and thank

Candice Caesar (01:48)
No way.

Ronald A Brise (01:48)
you, Doctor Evans, for the opportunity to participate in this very important conversation. So look forward to to

Candice Caesar (01:56)
Mm.

Ronald A Brise (01:57)
a fantastic discussion around around healthcare.

Alex Evans MD & Candice Caesar PMHNP (02:03)
Well listen, as we get started, tell me a little bit about tell the audience a little bit about who Ronald Brize really is. Like how did you get to where you are? What are you doing now? Tell us a little bit about you.

Ronald A Brise (02:16)
Sure. thanks for that opportunity. So as as was mentioned in the bio, I had the opportunity to serve as in the in the public sphere. so I served in the Florida legislature for a few terms, representing portions of Miami Dade County. but before then I I I began my public service as a city of North Miami planning commissioner.

Ronald A Brise (02:45)
And so what planning commissioners do as entities think about building within cities, the planning commission reviews plans and makes sure that those plans line up with the city codes and all of that, and then makes recommendations to the city council. Right. so after that, I you know, served in the Florida House, served in the Florida House for two terms, and then I got appointed by the governor to the

Ronald A Brise (03:13)
Florida Public Service Commission. The Flor Florida Public Service Commission is the entity that oversees all of the utilities in the state of Florida. So there's five people who do that. And I had the opportunity to serve on that commission, serve as its chair. And so I also got to do some national work because I was pretty active at NAROC, which is a national association of regulatory utility commissioners.

Ronald A Brise (03:43)
about five hundred people from across the country that do that in the individual states and so I had the opportunity to do that. But most interestingly, I started my career as a science teacher, right? yeah, I started my career as a science teacher and then I continued my education, got MBAs, ran a telecom company while I was

Ronald A Brise (04:13)
in public policy and then eventually we sold the the interest of the telecom company and then so today I help companies navigate government right and so as as companies are thinking about what to do, how to engage, and so we

Candice Caesar (04:34)
Mm-hmm.

Ronald A Brise (04:35)
help them think about policy. So I advise executives, I advise companies help them draft

Ronald A Brise (04:43)
thoughts on on legislation and if they have legislative projects that they are interested in our team helps them navigate that process. So I'm vice president at the Arrow Group, which is a subsidiary of Gunster. Gunster is one of Florida's oldest law firms. We've been around for over a hundred years. And so we provide full service

Ronald A Brise (05:10)
for businesses across the state of Florida and beyond.

Candice Caesar (05:15)
Okay. Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (05:15)
Wow. Wow,

Alex Evans MD & Candice Caesar PMHNP (05:17)
that that's amazing. So you said so much in the in that intro, starting

Candice Caesar (05:23)
Is it

Alex Evans MD & Candice Caesar PMHNP (05:23)
out with with being a science teacher.

Alex Evans MD & Candice Caesar PMHNP (05:26)
You know, part of what you said, I heard this this theme that can continued. It was I served, I served, I served.

Candice Caesar (05:35)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (05:35)
You

Alex Evans MD & Candice Caesar PMHNP (05:35)
kept saying that. That is, you know, that is a phenomenal aspect about your character. You serve, you know, and and the fact is now that you're even serving businesses to to bring them information and and ease and in negotiating the legislature of of of Florida. And and I'm certain you you work in in the national government too, I'm sure. So with all that, with

Alex Evans MD & Candice Caesar PMHNP (06:03)
behind you and all that service that you do, you know, you are have been on both sides of policy, you know, legislature,

Ronald A Brise (06:10)
Sure.

Alex Evans MD & Candice Caesar PMHNP (06:11)
regulator, et cetera. Where do you see the biggest disconnect between healthcare policy and what patients actually experience?

Ronald A Brise (06:21)
Sure, and that's a great question. you know, policymakers often think about things from the perspective of who is bringing the idea,

Alex Evans MD & Candice Caesar PMHNP (06:34)
Mm.

Ronald A Brise (06:35)
whether it's a colleague, whether it's an agency, or whether it's an an interest group, right?

Candice Caesar (06:42)
Mm-hmm.

Ronald A Brise (06:44)
and and so when it's a colleague, the colleague has probably identified a problem.

Ronald A Brise (06:49)
And trying to think about how to solve it. But for healthcare in particular, because healthcare is such a complicated set of policies, right?

Alex Evans MD & Candice Caesar PMHNP (07:01)
Mm-hmm.

Ronald A Brise (07:01)
And and pieces that involve multi-layers of complexity. But when policymakers think about health care and coverage, they think about coverage, programs, and funding. Those are the three things that the policymakers

Ronald A Brise (07:20)
Are thinking about because those are the things that they can quote unquote control, right? So

Candice Caesar (07:25)
Mm-hmm.

Ronald A Brise (07:26)
they can say insurance companies have to cover X, Y, and Z, right? These are the programs that will facilitate that, right? And so with these programs, here are the funding, or here is the funding that will travel along with these programs for X

Candice Caesar (07:44)
Yeah.

Ronald A Brise (07:45)
amount of time. And

Ronald A Brise (07:48)
Patients though don't think about healthcare in that way. They think about it in the terms of access, they think about affordability, and they think

Alex Evans MD & Candice Caesar PMHNP (07:57)
Mm-hmm.

Ronald A Brise (07:57)
in terms of outcomes, right?

Alex Evans MD & Candice Caesar PMHNP (08:00)
Absolutely, hundred percent.

Ronald A Brise (08:02)
And providers are

Candice Caesar (08:04)
Mm-hmm.

Ronald A Brise (08:04)
stuck in the middle

Alex Evans MD & Candice Caesar PMHNP (08:06)
Mm.

Ronald A Brise (08:07)
of all of that, right? And and very often providers are not asked about the programs, they're not asked about the coverage, and they're not asked about okay, how do we provide good access for

Candice Caesar (08:22)
Mm-hmm.

Ronald A Brise (08:22)
people to be able to get the health care that they deserve and need and so forth. So

Ronald A Brise (08:30)
You know, coverage is not the same thing as care. And so

Alex Evans MD & Candice Caesar PMHNP (08:33)
Mm.

Ronald A Brise (08:35)
policymakers often think, and I'm guilty of that, if you say something is covered, in your mind as a policymak policymaker, okay, we took care of that.

Alex Evans MD & Candice Caesar PMHNP (08:46)
Mm.

Ronald A Brise (08:46)
We can walk

Candice Caesar (08:47)
Yeah.

Ronald A Brise (08:47)
away from it and and and they can go from there.

Candice Caesar (08:51)
Yeah. But the reality is different. Mm-hmm. Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (08:52)
Yeah, that yes, absolutely.

Ronald A Brise (08:54)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (08:56)
And you you and you made a point about, you know, coverage and care. I love that because, you know, same thing may be covered, but the the care actually encompasses many other almost untouchables. You

Ronald A Brise (09:10)
Right.

Alex Evans MD & Candice Caesar PMHNP (09:11)
know, does the person have the way to get to the hospital? Do they

Ronald A Brise (09:15)
Right.

Alex Evans MD & Candice Caesar PMHNP (09:15)
have a ride? Do they even though it may be covered, are they gonna be at the place where they need to get that care?

Alex Evans MD & Candice Caesar PMHNP (09:22)
at a certain time or are they gonna you know lan languish at home and and not not be able to get there there's so many other little nuances that that I have the experience unfortunately of a of a woman who lost her coverage she was in the middle of breast breast cancer treatment chemotherapy she lost

Ronald A Brise (09:44)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (09:45)
her coverage and she got so depressed she didn't even come to the physician and and tell him she just disappeared she ended up

Ronald A Brise (09:51)
Wow.

Alex Evans MD & Candice Caesar PMHNP (09:51)
and getting now admitted to the hospital a month later, she actually got her health care back, but now she has this lesion that's fungating and it's it's requires a large is surgery and now the chemo is is even worse and you know sh her outcome's gonna be much worse. So it's like bringing healthcare care to someone is different than just yes, you're checked off. And and I'm so glad

Candice Caesar (10:13)
Mm-hmm. Cover it. Yes.

Ronald A Brise (10:16)
Yeah. Right.

Alex Evans MD & Candice Caesar PMHNP (10:18)
you made that statement. Because

Candice Caesar (10:20)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (10:20)
like

Alex Evans MD & Candice Caesar PMHNP (10:21)
As you're saying, policies outside the hospital really affect the bedside, you know? And so

Candice Caesar (10:26)
Yes. Mm-hmm.

Ronald A Brise (10:27)
Yep.

Alex Evans MD & Candice Caesar PMHNP (10:29)
you mentioned a little bit about how there sometimes physicians are not really involved. What do you think we can do to like move that needle where we can have more physicians involved in the policy making? And I and I and I know that we have the AMA and we have all these other things and

Alex Evans MD & Candice Caesar PMHNP (10:50)
But like it seem still seems like there's there's a lack of listening. I don't know if if

Ronald A Brise (10:57)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (10:58)
and you almost have to you almost have to be a lobbyist yourself and stand there and I don't have the time. I I got patience to see.

Ronald A Brise (11:04)
Right. Right. Right.

Candice Caesar (11:06)
Yeah, yeah, yeah.

Ronald A Brise (11:07)
Right. And that I mean that's that's such a valid point. so I will say this about and and and this is not a diss on associations, right? But associations

Candice Caesar (11:16)
Mm-hmm.

Ronald A Brise (11:19)
are so large and they covered the interest of so many different groups that their

Alex Evans MD & Candice Caesar PMHNP (11:25)
Yes.

Ronald A Brise (11:26)
the their positions are often vanilla on

Alex Evans MD & Candice Caesar PMHNP (11:29)
Mm.

Candice Caesar (11:30)
Yeah.

Ronald A Brise (11:30)
on issues.

Ronald A Brise (11:34)
For different groups within the association, right? So

Alex Evans MD & Candice Caesar PMHNP (11:37)
Yes, yes.

Ronald A Brise (11:37)
if you have a a fight between two sets of providers who are part of the same association, then the association essentially takes a position that they're going to be neutral on that particular issue. And so when

Alex Evans MD & Candice Caesar PMHNP (11:51)
Well.

Candice Caesar (11:51)
Yeah.

Ronald A Brise (11:51)
the legislature hears that they're going to be neutral on that particular issue, what whoever's

Alex Evans MD & Candice Caesar PMHNP (11:57)
Yeah.

Ronald A Brise (11:58)
on the other side of the issue then has carte blanche to move forward

Alex Evans MD & Candice Caesar PMHNP (12:02)
Yes.

Ronald A Brise (12:02)
with their

Alex Evans MD & Candice Caesar PMHNP (12:03)
Whatever they want. Hmm.

Ronald A Brise (12:04)
with their position or

Ronald A Brise (12:06)
the legislature just steps back on the issue altogether. So when you

Alex Evans MD & Candice Caesar PMHNP (12:10)
Mm.

Ronald A Brise (12:11)
think about how how policy is made. So someone says, okay, let's say someone says, okay, we're going to we're going to ensure that everyone has access to X method of treatment, right?

Alex Evans MD & Candice Caesar PMHNP (12:27)
Mm.

Ronald A Brise (12:28)
Whatever it is. Okay. And

Ronald A Brise (12:32)
These are the programs that we think will be affected. And so therefore, legislation will be written so that these programs can be affected. And

Alex Evans MD & Candice Caesar PMHNP (12:42)
Mm-hmm.

Ronald A Brise (12:43)
there'll be funding streams that follow it, right? And that will become the package.

Alex Evans MD & Candice Caesar PMHNP (12:49)
Okay.

Ronald A Brise (12:51)
That gets passed.

Candice Caesar (12:52)
Mm-hmm.

Ronald A Brise (12:53)
And so it's a big framework. Then it goes to the agency, the Department of Health. They go into rulemaking. At that point, after the law has been passed, that's when the real voice of physicians, nurse practitioners, and whoever whatever other provider may be affected has

Alex Evans MD & Candice Caesar PMHNP (13:15)
Mm.

Ronald A Brise (13:15)
an opportunity to engage in a more meaningful way, right?

Candice Caesar (13:19)
Mm-hmm.

Ronald A Brise (13:22)
But by then the law is already written. And within that space, you're just trying to sort of ensure that the rules make sense so that you can operate or implement them.

Candice Caesar (13:35)
Mm-hmm.

Ronald A Brise (13:35)
And so I'm thinking about my wife is a is a mental health nurse practitioner as well. So I I imagine if someone were to ask her, hey, what what do you think?

Ronald A Brise (13:52)
On this legislation, we're going into rulemaking. After she's finished working with patients, right? Does she really have time to

Candice Caesar (14:04)
Mm-hmm.

Ronald A Brise (14:05)
dig into the policy process to provide a fulsome answer to all

Candice Caesar (14:12)
Mm-hmm.

Ronald A Brise (14:13)
of these pieces that she may not be connected with on the regular basis?

Candice Caesar (14:19)
Mm-hmm.

Ronald A Brise (14:19)
to

Ronald A Brise (14:20)
provide a really meaningful to provide real meaningful input in a process that she's foreign to right

Candice Caesar (14:30)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (14:31)
Yeah.

Ronald A Brise (14:32)
so

Ronald A Brise (14:33)
so from my perspective involving polic i mean providers at the beginning

Candice Caesar (14:39)
Mm-hmm. Mm-hmm.

Ronald A Brise (14:41)
to to really help policymakers understand what the real challenges are so

Candice Caesar (14:47)
Mm-hmm.

Ronald A Brise (14:47)
that embedded in the law

Ronald A Brise (14:50)
you have those voices being heard. And at the end, you have real checkpoints to see is it working the way it's supposed to work.

Candice Caesar (15:02)
Mm-hmm.

Candice Caesar (15:04)
Yeah.

Ronald A Brise (15:04)
And then

Ronald A Brise (15:04)
engaging with providers who are providing the care, as well as patients, right, who are receiving the care.

Candice Caesar (15:09)
The care the patient. Mm-hmm.

Ronald A Brise (15:15)
Okay, how is this working? How should we modify policy in order to actually make it work? We thought from a from a theoretical perspective, this would work. We put it in place. It's been, we've had it for a year, a year and a half, two years, okay.

Ronald A Brise (15:32)
What does what is the data telling us now? Yeah.

Candice Caesar (15:35)
Mm.

Alex Evans MD & Candice Caesar PMHNP (15:36)
So you're looking at more of a almost like a pilot pilot your policy. You know, see if it wor

Ronald A Brise (15:42)
Right. Yeah.

Candice Caesar (15:44)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (15:45)
works, see if it works in a in a certain group and then

Candice Caesar (15:49)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (15:49)
push it out.

Ronald A Brise (15:51)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (15:52)
that way it gives the opportunity for, as you mentioned, patients and physicians

Candice Caesar (15:56)
Mm-hmm.

Ronald A Brise (15:56)
Right.

Alex Evans MD & Candice Caesar PMHNP (15:57)
to have input. Yeah. That that makes sense. That makes sense.

Ronald A Brise (16:01)
Yeah.

Candice Caesar (16:01)
Okay.

Candice Caesar (16:02)
So Ronald, I have a question here. So

Ronald A Brise (16:05)
Sure.

Candice Caesar (16:06)
in mental health, and I'm a psychiatric mental health care you know, nurse practitioner similar to your to your wife, but

Ronald A Brise (16:15)
Right.

Candice Caesar (16:16)
we've seen the number of patients, you know, receiving care. It's risen trem you know, remarkably in the last ten years. And what we've found is that having insurance doesn't always mean

Candice Caesar (16:29)
That you can find someone to care for you. Like as a

Alex Evans MD & Candice Caesar PMHNP (16:33)
Yeah.

Candice Caesar (16:33)
provider, getting into, you know, the insurance world, accepting insurances, being credentialed for all of these insurance, you know, on these insurance panels, it can be quite daunting. It could be quite daunting, right, for providers and I'm pretty sure for patients as well. So what needs to change at a policy level?

Candice Caesar (16:57)
To make mental health care easier to access.

Ronald A Brise (17:03)
Well, I think

Ronald A Brise (17:07)
The the thing is

Ronald A Brise (17:11)
Mental health isn't

Candice Caesar (17:13)
Mm-hmm.

Ronald A Brise (17:15)
on from a isn't on parity with with with medical and and it's unfortunate right

Candice Caesar (17:18)
Mm-hmm. Medical. Mm-hmm. Mm-hmm.

Ronald A Brise (17:25)
and so and so the insurance market

Candice Caesar (17:31)
Mm.

Ronald A Brise (17:32)
doesn't treat it that way and

Candice Caesar (17:34)
Mm.

Ronald A Brise (17:35)
and and and the reimbursement rates don't make sense so therefore

Candice Caesar (17:40)
Mm-hmm.

Ronald A Brise (17:41)
there's so many providers who who

Ronald A Brise (17:44)
It's not economical for them to provide the service, right?

Candice Caesar (17:48)
Mm-hmm.

Ronald A Brise (17:48)
associated with the risk and

Candice Caesar (17:52)
Mm-hmm.

Ronald A Brise (17:53)
and and all of that. So part of it is is aligning the the reimbursement rates to the service.

Candice Caesar (18:02)
Mm.

Ronald A Brise (18:03)
And as we mentioned before, in terms of access, making the insurance actually have value, right? Relative to

Ronald A Brise (18:13)
to to mental to healt health. even at e the the medical health care, the traditional medical health care, your insurance card has some value, but

Candice Caesar (18:27)
Mm-hmm.

Ronald A Brise (18:28)
it doesn't have your mental health care card, quote unquote, right? Has even less value than your

Candice Caesar (18:33)
Mm-hmm.

Ronald A Brise (18:36)
your traditional medical care. And

Candice Caesar (18:38)
Yeah.

Ronald A Brise (18:39)
and so I think that that is part of

Ronald A Brise (18:42)
the big

Candice Caesar (18:43)
Mm.

Ronald A Brise (18:43)
issue. You know, there's things such as there's a loan reimbursement pipeline things for for people who who go into the field. Those opportunities are not the same. So so there's the parity issue

Candice Caesar (18:58)
Mm.

Ronald A Brise (18:59)
goes into so many different ways and

Candice Caesar (19:01)
Mm-hmm. Mm-hmm.

Ronald A Brise (19:02)
and to me that that is a huge challenge as to why people don't have access to

Candice Caesar (19:09)
And it's it's

Candice Caesar (19:10)
a yeah, it's unfortunate, Ronald, because mental health is medical health. You know,

Ronald A Brise (19:15)
Yes. Yes.

Alex Evans MD & Candice Caesar PMHNP (19:16)
Okay.

Candice Caesar (19:17)
and and vice versa. I can't tell you the amount of times patients go into the ER for a medical condition only to later find out that it was mental, you know, it was a mental condition. Right. So you know, if you're if you're cognitively not doing well, if you're mentally not doing well.

Candice Caesar (19:35)
then everything else follows, you know, after that follows suit. So, you know, I hear you in terms of the division, it's not on the same parity, same level as medical care. But when we look at even dental, ment

Ronald A Brise (19:49)
Right.

Candice Caesar (19:50)
mental, medical, it's all health care, you know, and I wish that the policy, you know, makers would see that, you know, and not, you know,

Candice Caesar (20:02)
compartmentalize the care that we need to give to patients because we're in twenty twenty six and it's time for care to be holistic.

Ronald A Brise (20:09)
I wholeheartedly agree with that statement. I I

Ronald A Brise (20:11)
you know, it it's a whole person. It's you know, they're not

Candice Caesar (20:14)
Yeah, absolutely.

Ronald A Brise (20:15)
you know, they're not broken up into into different pieces. I mean it's the k right, exactly, exactly. So the care sh

Candice Caesar (20:20)
Yeah. Yeah, we're not we're not put we're not Pinocchio here, okay?

Ronald A Brise (20:29)
so the care should

Alex Evans MD & Candice Caesar PMHNP (20:29)
Yeah, and

Ronald A Brise (20:30)
be comprehensive and the

Candice Caesar (20:31)
Yeah.

Ronald A Brise (20:32)
coverage should be comprehensive.

Candice Caesar (20:34)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (20:34)
And there's another aspect too is opportunity cost. So productivity

Ronald A Brise (20:40)
Right. Right.

Alex Evans MD & Candice Caesar PMHNP (20:43)
greatly diminishes when individuals, groups of individuals have health, mental health issues. You know, how can you focus on your job or whatever it is if you're making widgets, your engineer or your physician? Anything. You know, you can't focus well and do your thing well while you have other

Alex Evans MD & Candice Caesar PMHNP (21:02)
mental issues involved, whether it be just depression to, you know, psychiatric disorders. So I think

Ronald A Brise (21:07)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (21:08)
it's a a very valid point. It it actually is important for American society to

Candice Caesar (21:14)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (21:14)
progress to really focus on this. I think that's very important.

Candice Caesar (21:17)
Absolutely.

Ronald A Brise (21:18)
Yeah, absolutely.

Candice Caesar (21:19)
Yeah. So have another question for you. So we talk about

Ronald A Brise (21:22)
Sure.

Candice Caesar (21:23)
mental health care more openly. So I'm totally grateful for that, but still people kind of struggle to get timely care. What do you think needs to change at the policy level to make again? I know it kind of beating a dead horse here, but I'm pushing. I'm

Ronald A Brise (21:42)
Mm-hmm. Sure.

Candice Caesar (21:44)
advocating, right?

Candice Caesar (21:46)
What do you think needs to happen at a policy level to make mental health care easier to access?

Ronald A Brise (21:53)
Yeah, so I think it boils down to four main things. One is workforce, right? You need to have

Candice Caesar (21:58)
Mm-hmm.

Ronald A Brise (21:59)
an abundant workforce. you need to have a fair reimbursement system, you need to have integration, and you need to invest in technology, right? I I think

Candice Caesar (22:13)
I know.

Ronald A Brise (22:14)
from a from a all of these from a policy perspective, right? So the so the state

Ronald A Brise (22:22)
mean I'm using the word state sort of broadly whether federal or or or local and state need to invest in workforce. So that means investing in college and and and graduate programs and and and so forth, dealing with the reimbursement piece, which will help more providers get in if they can see a clear path for

Alex Evans MD & Candice Caesar PMHNP (22:49)
Mm-hmm.

Ronald A Brise (22:50)
for for the

Ronald A Brise (22:51)
economic value associated with it,

Candice Caesar (22:54)
Mm-hmm.

Ronald A Brise (22:55)
integration into healthcare, right? Writ large. And then

Candice Caesar (22:59)
Mm-hmm.

Ronald A Brise (23:03)
investment in the technology and policy that allows technology to be used responsibly

Candice Caesar (23:10)
Mm-hmm.

Ronald A Brise (23:11)
for the provision of

Candice Caesar (23:13)
Mm-hmm.

Ronald A Brise (23:15)
care. Right? I think those four components together

Candice Caesar (23:15)
Yeah. Mm-hmm.

Candice Caesar (23:19)
Yeah.

Ronald A Brise (23:19)
should be policy objectives and those I think will will create greater access. And

Candice Caesar (23:26)
Mm-hmm.

Ronald A Brise (23:27)
as more people use

Candice Caesar (23:29)
Uh-huh.

Ronald A Brise (23:31)
care, right,

Candice Caesar (23:32)
Mm. Mm.

Ronald A Brise (23:33)
it reduces stigma because

Candice Caesar (23:36)
Absolutely.

Ronald A Brise (23:36)
it becomes more normalized, right? So

Alex Evans MD & Candice Caesar PMHNP (23:37)
Yes. Yes.

Candice Caesar (23:39)
Yeah. Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (23:41)
Very good point.

Candice Caesar (23:41)
Yeah.

Candice Caesar (23:42)
Ronald, when you said, you know, AI, the integration of AI, I think that it's

Ronald A Brise (23:48)
Yeah.

Candice Caesar (23:48)
twenty twenty six and it's come it's come time. It's it's it's time enough for us

Ronald A Brise (23:51)
Ha ha ha.

Candice Caesar (23:52)
to be more transparent, you know,

Ronald A Brise (23:54)
Yeah.

Candice Caesar (23:55)
in terms of patients being able to, you know, access their healthcare and providers being able to seamlessly exchange information without all of these barriers.

Candice Caesar (24:08)
that we sometimes encounter. So I agree with you in terms of investing in, you know, persons that want to go down this track in reimbursements because there is an economic you know, definitely there is economic you know, considerations that need to be made for sure. and the transparency, the AI possibly can help, you know, with that, bridging the gap between medical, mental,

Candice Caesar (24:37)
And just seamless transfer of information from one platform to another and integration. Yeah.

Ronald A Brise (24:44)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (24:46)
Very good point. Very good point. So you s you talked Ronald about some very those four aspects are very poignant and meaningful from for making change. But I guess what I would like to know is who has the most influence over healthcare delivery in America now, like and who who drives policy?

Candice Caesar (25:13)
Yeah.

Ronald A Brise (25:13)
Ha ha.

Candice Caesar (25:14)
Who is it Ronald? Who is it?

Ronald A Brise (25:18)
You know, that's a very complicated question. I mean, I guess the the easiest answer would be the policymakers, right? I mean, I think that that that is probably the easiest answer, but yeah, people who used to sit in my seat, right? people who sit in the seat that I used to sit in, right?

Alex Evans MD & Candice Caesar PMHNP (25:28)
The legislators. So people like you.

Candice Caesar (25:37)
So

Candice Caesar (25:39)
so so so Ronald,

Alex Evans MD & Candice Caesar PMHNP (25:39)
Mm-hmm.

Candice Caesar (25:41)
we have a bone to pick with you, Ronald. You have two

Ronald A Brise (25:43)
yeah, you do.

Alex Evans MD & Candice Caesar PMHNP (25:43)
Ha

Candice Caesar (25:44)
you have two healthcare personnel on this podcast and we have a bone.

Candice Caesar (25:53)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (25:53)
Mm, mm.

Ronald A Brise (25:54)
Yeah, so I would say clearly policymakers have a big role to play in it. But policymakers are informed by and

Candice Caesar (26:05)
Mm.

Ronald A Brise (26:06)
influenced by all the big players. So who are the big players, right?

Candice Caesar (26:10)
Mm-hmm. Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (26:12)
Yeah.

Ronald A Brise (26:14)
You have as we talked about industry groups, you have hospitals, which

Candice Caesar (26:20)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (26:20)
Yes.

Ronald A Brise (26:21)
which are big drivers of policy.

Alex Evans MD & Candice Caesar PMHNP (26:25)
Mm.

Ronald A Brise (26:25)
I mean

Ronald A Brise (26:25)
they have they are well resourced, right? And so they have the ability to engage in advocacy in ways that other groups may not have the capacity to do so.

Alex Evans MD & Candice Caesar PMHNP (26:39)
Gotcha.

Ronald A Brise (26:40)
physicians have huge advocacy organizations, right? the the associations. You have nurses.

Ronald A Brise (26:53)
and nurse practitioners, they all have their associations. The the dentist and you know, everybody has their association. The the the entity that really doesn't have representation at the table as a group is the patient.

Candice Caesar (27:07)
Mm.

Alex Evans MD & Candice Caesar PMHNP (27:08)
Wow, that's deep. Right.

Ronald A Brise (27:10)
Right, when you think about it, the the the group

Ronald A Brise (27:12)
that really doesn't have an organized body that

Candice Caesar (27:16)
Mm.

Ronald A Brise (27:17)
is collecting information from its members, that is synthesizing the input, right?

Candice Caesar (27:25)
Mm-hmm.

Ronald A Brise (27:26)
And then providing white papers, talking points, sponsoring days at the Capitol, sponsoring

Alex Evans MD & Candice Caesar PMHNP (27:34)
Wow.

Ronald A Brise (27:34)
fundraisers for members,

Ronald A Brise (27:38)
And and for for the executive branch, governors and attorney generals and you know all of everybody who's in that

Alex Evans MD & Candice Caesar PMHNP (27:45)
Mm.

Ronald A Brise (27:45)
in that sphere, the only group that does not have an organized group that's at the table is the patient. Right? Everyone

Alex Evans MD & Candice Caesar PMHNP (27:53)
Hmm, is the page. Wow. Wow. And

Ronald A Brise (27:56)
else

Candice Caesar (27:57)
Mm.

Ronald A Brise (27:58)
has all of the the trappings to engage

Candice Caesar (28:01)
Mm, yeah.

Ronald A Brise (28:02)
in organized

Ronald A Brise (28:05)
form of advocacy. And they know how to do it at each level. They know how to get a law passed. They know how to get a law killed or or bill killed. They understand

Alex Evans MD & Candice Caesar PMHNP (28:14)
Mm.

Ronald A Brise (28:15)
how to engage in the rulemaking process. They understand

Candice Caesar (28:18)
Yeah.

Ronald A Brise (28:19)
that if they don't like a rule, they could challenge a rule. They could then take the rule even in the rule making process they can challenge it. And if the rule passes, they can take it to court, right?

Candice Caesar (28:30)
BC

Alex Evans MD & Candice Caesar PMHNP (28:30)
Mm.

Ronald A Brise (28:30)
And

Ronald A Brise (28:31)
and challenge whether it's it's it it's constitutionality or

Ronald A Brise (28:34)
or other pieces of it. But the group that that like like I mentioned before does not have that type of organized body that that is that is paying dues for

Alex Evans MD & Candice Caesar PMHNP (28:48)
Mm.

Ronald A Brise (28:48)
these purposes

Candice Caesar (28:50)
Mm.

Ronald A Brise (28:50)
is is the patient. And that's where the policymaker, that's who the policymaker is technically supposed to represent.

Candice Caesar (28:57)
Mm. Wow.

Alex Evans MD & Candice Caesar PMHNP (28:58)
Yeah,

Alex Evans MD & Candice Caesar PMHNP (28:59)
yeah, that that's difficult. I wonder how we we move the needle on that. How

Candice Caesar (29:04)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (29:05)
do we move the needle on that? I'm just I'm just thinking, you know, if there was a application that had that each individual patient had in their hand or in their phone where they had all their information and then maybe they had some way to to organize through that application

Candice Caesar (29:23)
Right.

Alex Evans MD & Candice Caesar PMHNP (29:24)
to then move as a body.

Candice Caesar (29:26)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (29:27)
And

Alex Evans MD & Candice Caesar PMHNP (29:27)
someone would who would would be a leader to do that, that would that would actually make a little bit of sense because at least you would have certain pockets of groups of patients that have some sort of advocacy. I'm gonna work on that. I'm gonna work on that. I'm gonna work on that app.

Candice Caesar (29:37)
Yeah. Yeah.

Ronald A Brise (29:39)
Right. All right. All right.

Candice Caesar (29:41)
Like I like I like how you're thinking, Professor

Candice Caesar (29:44)
Evans, because you know, the data points is what we need. We need

Alex Evans MD & Candice Caesar PMHNP (29:50)
Right.

Candice Caesar (29:51)
to hear from the patients. And so

Alex Evans MD & Candice Caesar PMHNP (29:53)
Right.

Candice Caesar (29:54)
yeah, why don't you work on that?

Alex Evans MD & Candice Caesar PMHNP (29:56)
I mean

Ronald A Brise (29:57)
Yeah,

Ronald A Brise (29:58)
yeah. I mean not to say that there haven't been pieces. Like the

Candice Caesar (30:02)
Perhaps. Yeah.

Ronald A Brise (30:03)
like during my time during the legislature, like I have seen coverage

Candice Caesar (30:10)
Mm.

Ronald A Brise (30:10)
expanded for specific things. And so

Candice Caesar (30:12)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (30:13)
Mm-hmm.

Ronald A Brise (30:13)
like there was a big push at a certain time for autism care to become

Candice Caesar (30:19)
Mm.

Ronald A Brise (30:19)
like normalized, right? And so now, you know, if if

Ronald A Brise (30:24)
If you if you your child has autism or whatever, you have offer options through your insurance for coverage and so but that took over 20 years of persistent advocacy by parents, right, who who cared about these issues and then came together, organized themselves,

Candice Caesar (30:35)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (30:36)
Advocacy, yes, yes. Mm-hmm. Group together. Mm-hmm. Mm-hmm.

Ronald A Brise (30:46)
they created an entity that you know

Alex Evans MD & Candice Caesar PMHNP (30:48)
Yes.

Ronald A Brise (30:48)
it's autism speaks, and and they they're now across every state. And so

Candice Caesar (30:52)
Exactly.

Ronald A Brise (30:53)
They advocate and and

Candice Caesar (30:55)
Mm-hmm.

Ronald A Brise (30:55)
so they have groups that have, you know, done that. You know, so then you end up with groups like the American Heart Association and you have the

Candice Caesar (31:02)
Yeah.

Ronald A Brise (31:03)
the the you know the the American diabetes, I think it's association.

Candice Caesar (31:07)
So she's

Ronald A Brise (31:08)
so you have all these entities that,

Candice Caesar (31:11)
Yeah.

Ronald A Brise (31:12)
you know, technically represent groups

Candice Caesar (31:14)
Okay.

Ronald A Brise (31:15)
of patients, but it's not

Candice Caesar (31:17)
Mm-hmm.

Ronald A Brise (31:18)
writ large, right? Yeah.

Candice Caesar (31:20)
Okay.

Alex Evans MD & Candice Caesar PMHNP (31:21)
So we're

Candice Caesar (31:21)
Well

Alex Evans MD & Candice Caesar PMHNP (31:22)
we're talking a lot about sort of patients after they've been diagnosed. We're talking about, you know, pathology, I should say. You

Ronald A Brise (31:29)
Right. Right. Yeah. Right.

Candice Caesar (31:29)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (31:34)
know, how do we support as a healthcare as a healthcare organization, as a as a a country in in itself?

Alex Evans MD & Candice Caesar PMHNP (31:49)
How do we move more towards a system of prioritizing prevention? We know, I mean, we've we've done the studies. We all know

Ronald A Brise (31:58)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (31:58)
that prevention, you know, I used to say outside prevention is a pond of the cure. But it's actually true. It's like, you know, when you prevent,

Ronald A Brise (32:03)
Yeah. Yeah. Yeah. Yeah.

Candice Caesar (32:05)
Okay.

Alex Evans MD & Candice Caesar PMHNP (32:08)
you actually save so much cost. And we

Candice Caesar (32:11)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (32:11)
have been chasing the the dollar spending, spending, spending. And, you know, when someone comes to see me and I have

Alex Evans MD & Candice Caesar PMHNP (32:18)
cut out a colon or I have to do something, you know,

Candice Caesar (32:21)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (32:21)
something that has already gone, you know, where was the the colonoscopy that should have happened, you know, when I have to, when my colleagues have to do the cut out prostates, where was the PS PSAs? Yeah,

Ronald A Brise (32:35)
TSA tests, yeah.

Alex Evans MD & Candice Caesar PMHNP (32:37)
where where was the breast, you know, so a lot of these things

Candice Caesar (32:41)
Mm.

Alex Evans MD & Candice Caesar PMHNP (32:42)
are are have been shown. And

Candice Caesar (32:44)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (32:44)
the interesting thing is, you know,

Alex Evans MD & Candice Caesar PMHNP (32:47)
There have now been so many studies, particularly out of Howard University, but so many studies have shown that since the expansion of of healthcare in what was it, 2013, 14 around that time period, across thirteen thirty-three states that accepted the expansion, you

Ronald A Brise (33:08)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (33:09)
know, all those states, every last one of them have shown that they have improved their

Candice Caesar (33:15)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (33:16)
rates.

Alex Evans MD & Candice Caesar PMHNP (33:17)
Of pathology. So the you know, the breast cancer rates are lower, the the the colon cancer rates are lower, the the even the lung cancer rates are lower because

Candice Caesar (33:27)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (33:27)
you're finding these things, their life, they're living longer, they're finding them earlier because they're being screened. So

Candice Caesar (33:32)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (33:35)
we know what's happening. I again, long-winded question, but I'm just wondering, where do you think we are with that? How do we move the needle?

Ronald A Brise (33:43)
Yeah, so

Ronald A Brise (33:45)
yeah, so that's a that's a good question. I you know, prevention

Ronald A Brise (33:51)
Is easier now because more people have access due to some policy decisions that were made in the mid-2000s, right? Post 2008, right?

Alex Evans MD & Candice Caesar PMHNP (34:04)
Yes.

Ronald A Brise (34:05)
so you had some and and as you mentioned, when you had the expansion, so more people had access, so now people on a more regular basis.

Candice Caesar (34:15)
Mm.

Ronald A Brise (34:16)
can make the decision to just go get a regular checkup once a year. Right. I mean, it's just

Alex Evans MD & Candice Caesar PMHNP (34:21)
Right. Right.

Ronald A Brise (34:22)
it's one of these things that if you don't, if you don't have access, you're not going to do. You're not going to take the time off because then you got to go pay for something. And so now it's not costing for most people, it doesn't cost you anything to get your your regular yearly screening. Right. And that helps you

Ronald A Brise (34:45)
keep track of what you need to do. However, you know it's it's a perverse incentive. Right? so

Alex Evans MD & Candice Caesar PMHNP (34:55)
What do you mean by that?

Ronald A Brise (34:57)
meaning that

Ronald A Brise (35:00)
systems are designed to make money, right?

Candice Caesar (35:04)
Mm.

Ronald A Brise (35:05)
And so if if we do prevention as well as we should, the the revenue from healthcare over the curve reduces significantly.

Candice Caesar (35:23)
Mm-hmm.

Ronald A Brise (35:23)
Right? So it is a perverse incentive. So so there are some who aren't

Ronald A Brise (35:30)
as excited

Candice Caesar (35:31)
Mm-hmm.

Ronald A Brise (35:32)
about, you know, funding prevention, right? Because

Candice Caesar (35:36)
Really?

Ronald A Brise (35:37)
there isn't as much money in that. and it doesn't you don't see the payoff right away either.

Candice Caesar (35:44)
It

Alex Evans MD & Candice Caesar PMHNP (35:45)
Yes.

Candice Caesar (35:45)
yeah, but but but Ronald, you know, there isn't

Alex Evans MD & Candice Caesar PMHNP (35:48)
Wow.

Candice Caesar (35:49)
a financial incentive, but there is a financial incentive when we talk about patients, when we talk about, you know, families,

Ronald A Brise (35:55)
Yes.

Candice Caesar (35:56)
when we talk about employers that are paying, you know,

Ronald A Brise (35:58)
Right. Right.

Candice Caesar (36:00)
so much to deal with you know, things that could have been prevented preventative, you know, so it's

Ronald A Brise (36:05)
Right. Right. Yeah.

Candice Caesar (36:08)
just it's just unfortunate. But you know, how do we make sure that

Candice Caesar (36:14)
Kind of asked this question a little bit. We kind of answered, touched on it a little bit, but I want to specifically just kind of come in for like the kill for landing. How do we

Ronald A Brise (36:22)
Sure.

Candice Caesar (36:23)
make sure that patients have a real voice when healthcare policy is being made? What can patients do? Someone that is less people that are listening, how can they have a real voice in healthcare policy?

Ronald A Brise (36:39)
Yeah,

Ronald A Brise (36:40)
that's that's a very good question.

Candice Caesar (36:42)
Mm-hmm.

Ronald A Brise (36:44)
and it does take an act of sis citizenry, right?

Candice Caesar (36:49)
Mm.

Ronald A Brise (36:50)
Meaning

Alex Evans MD & Candice Caesar PMHNP (36:50)
I like that word.

Ronald A Brise (36:51)
as as a citizen, if there are things that I care about, it is incumbent on me

Candice Caesar (36:58)
Mm-hmm.

Ronald A Brise (36:59)
to try to understand what's going on, right? And and and I'll be the first to say that it's not easy. And

Candice Caesar (37:08)
Mm-hmm.

Ronald A Brise (37:08)
right.

Ronald A Brise (37:09)
But there are ways to track things. Like in the Florida, you so if you were someone lives in Florida, they can go on the Florida, my Florida house, and they can track bills or they they put in healthcare. And it they will see all of the bills that are up for the session dealing with healthcare. They can set up to get notifications about those bills, what's happening when they're in committee.

Candice Caesar (37:38)
Mm-hmm.

Ronald A Brise (37:39)
What's their next committee? They can

Ronald A Brise (37:41)
actually see who's testifying about what, what the positions of the different groups are relative to to that issue. So if it's an issue that I have an interest in, I have

Candice Caesar (37:56)
huh.

Ronald A Brise (37:57)
as a citizen the capacity to pick

Candice Caesar (37:59)
Mm-hmm.

Ronald A Brise (37:59)
up the phone and call my legislator and say, Hey, call their office.

Candice Caesar (38:06)
Mm-hmm.

Candice Caesar (38:07)
Mm-hmm.

Ronald A Brise (38:07)
You

Ronald A Brise (38:07)
may not get them, but you may get their aid or whatever. Hey, bill numbers such and such. Help

Candice Caesar (38:14)
Mm-hmm.

Ronald A Brise (38:14)
me understand what it does.

Candice Caesar (38:16)
wow.

Alex Evans MD & Candice Caesar PMHNP (38:17)
Mm.

Ronald A Brise (38:17)
Right? I care about this topic, so help me understand what it does. And if you formulated a position on it, then you

Candice Caesar (38:27)
Mm-hmm.

Ronald A Brise (38:27)
could tell them, here is my position. And you could ask them, hey, how can I formally put

Candice Caesar (38:34)
Mm-hmm.

Ronald A Brise (38:34)
in my position?

Ronald A Brise (38:36)
about this bill, right? So they

Candice Caesar (38:37)
Wow. Okay.

Ronald A Brise (38:39)
could, you know, send an email with the information and they could ask so that their their comments could be added

Candice Caesar (38:49)
Mm-hmm.

Ronald A Brise (38:49)
to the record of the committee. And they

Candice Caesar (38:52)
Mm-hmm.

Ronald A Brise (38:52)
could do that all the way to every committee stop. The only place that they can't do that is when the bill hits the floor of each chamber, right? Because that's they f that's

Candice Caesar (39:00)
Mm-hmm.

Ronald A Brise (39:03)
where it's ultimately voted on.

Candice Caesar (39:05)
Mm.

Ronald A Brise (39:05)
And

Ronald A Brise (39:06)
but in between there, you have changes and tweaks that are made along the way. And so

Candice Caesar (39:09)
Mm-hmm. Mm-hmm.

Ronald A Brise (39:12)
after a while, as a citizen, that you're doing that,

Candice Caesar (39:16)
Mm-hmm.

Ronald A Brise (39:17)
your legislator will get to know the people in his or her office or themselves, they will get to know you because you have expressed interest in a particular thing.

Candice Caesar (39:27)
Mm. Mm-hmm.

Ronald A Brise (39:31)
If you are in the vicinity when the

Candice Caesar (39:33)
Yeah.

Ronald A Brise (39:33)
bill is up,

Ronald A Brise (39:35)
Show up at committee. Sign up so that you can testify as a person.

Candice Caesar (39:37)
Wow.

Ronald A Brise (39:39)
Say, hey, look, this is how this bill is going to affect me. Right. And so I care about this. This is

Candice Caesar (39:42)
Yeah. Wow. Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (39:44)
Yeah.

Ronald A Brise (39:47)
how it's going to affect me, my family, my livelihood. I don't think

Candice Caesar (39:51)
And

Ronald A Brise (39:51)
that you all are thinking about the full

Candice Caesar (39:53)
Mm-hmm.

Ronald A Brise (39:54)
ramifications. Or I support what you're doing.

Candice Caesar (39:58)
Mm-hmm.

Ronald A Brise (39:58)
I think what

Alex Evans MD & Candice Caesar PMHNP (39:58)
Yeah.

Ronald A Brise (39:59)
you're doing is great. This is how it's going to enhance

Candice Caesar (40:02)
Yeah.

Ronald A Brise (40:03)
my life.

Candice Caesar (40:03)
Mm-hmm.

Ronald A Brise (40:03)
And so forth and so on. And so those

Ronald A Brise (40:06)
are ways that people can can engage in a very constructive manner in the process.

Candice Caesar (40:13)
You know, Ronald, a lot of people don't know that they have the ability or the option to do that. So I want to thank you for just breaking that down. And this is something that can happen statewide. You can

Ronald A Brise (40:26)
Yeah.

Candice Caesar (40:27)
get involved, you can call your legislator, you can, you know, send emails, you can again be

Alex Evans MD & Candice Caesar PMHNP (40:32)
Right. Mm-hmm.

Candice Caesar (40:33)
a part of, you know, and and it's just good to know what is going on, you know. and so

Candice Caesar (40:39)
I just love the fact that you broke it down and we you know, you know, the in such a way where everyday citizens can get involved in in the process. And even if, like you say, not only just to show like, okay, well, I'm against something, but also to show up in terms of, you know, your support for for a particular bill that might be you know, getting passed or whatever. So thank you so much for for

Candice Caesar (41:06)
you know, just giving us that information. That was information for me at least. Wasn't it for you, Dr. Evans? Yeah.

Alex Evans MD & Candice Caesar PMHNP (41:12)
Absolutely. Absolutely.

Candice Caesar (41:14)
Yeah. Yeah. So I'm gonna switch here a little bit and talk

Ronald A Brise (41:17)
Sure.

Candice Caesar (41:18)
about technology. It's the it's a hot topic. It's a hot

Ronald A Brise (41:21)
Yeah.

Candice Caesar (41:21)
it's it's a red button in the room. So technology, as you know, is changing healthcare rather quickly from telehealth, remote monitoring to AI. and in my practice, I'm a

Candice Caesar (41:36)
Again, psychiatric, mental health nurse practitioner, I have the ability to work telehealth. So I'm really grateful for AI and what it's doing in terms of making my work more efficient. But how do we make sure, right, it closes the healthcare gaps? We've spoken about several gaps in healthcare, integration, you know, making you know the transfer of documents a little bit seamless, you know, insurance, all of that stuff. How do we make sure that AI

Candice Caesar (42:04)
closes the healthcare gaps instead of creating new ones, not making more work for us. When the computer first came out, it it made more work for us in healthcare. I didn't like

Ronald A Brise (42:13)
Right.

Candice Caesar (42:14)
it as a nurse, right? Because, you know,

Ronald A Brise (42:16)
Yeah.

Candice Caesar (42:17)
like, you know, we did a lot of charting. It we had to you we had to tend to the the computer and there was less tending to the patients, right? So how do we make sure that AI again is closing these gaps instead of creating new ones?

Ronald A Brise (42:34)
Yeah, and that's a great question. So I I think it it boils down to a few questions, right? I think whenever

Candice Caesar (42:39)
Right.

Ronald A Brise (42:41)
one is thinking about introducing new technology or adapt or or or using new technology, integrating new technology, and this could be across any field, but in terms of healthcare in particular, this is the question I would ask. Does it reduce friction between the patient and care? Right?

Ronald A Brise (43:04)
That's question number one, right? What

Alex Evans MD & Candice Caesar PMHNP (43:04)
Big topic, yes.

Ronald A Brise (43:07)
and then what else does it do? Does it reduce distance? Right?

Candice Caesar (43:10)
Yeah.

Ronald A Brise (43:11)
Does it reduce waiting time? Does it lower cost? Does it help clinicians make better decisions? Does

Alex Evans MD & Candice Caesar PMHNP (43:19)
Mm.

Ronald A Brise (43:19)
it help manage chronic con chronic conditions before they become crises? So all of those things when when integrating technology or new technology, those are things that I would I would ask.

Ronald A Brise (43:34)
Right? Before

Alex Evans MD & Candice Caesar PMHNP (43:35)
Mm.

Ronald A Brise (43:35)
I make an investment in this, you know,

Candice Caesar (43:38)
Mm-hmm.

Ronald A Brise (43:39)
does it democratize healthcare more? Right?

Candice Caesar (43:41)
Mm-hmm.

Ronald A Brise (43:42)
Or does it is it technology for technology's sake? Is it

Candice Caesar (43:47)
Mm.

Ronald A Brise (43:48)
data collection for data collection sake? Right?

Candice Caesar (43:51)
Mm-hmm.

Ronald A Brise (43:51)
or is it doing something that makes the provider's life better

Candice Caesar (43:58)
Mm-hmm.

Ronald A Brise (43:59)
at the same time as making the patient's experience better?

Ronald A Brise (44:04)
More efficient and effective.

Candice Caesar (44:05)
Mm-hmm. Mm-hmm.

Ronald A Brise (44:08)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (44:10)
That's an excellent, excellent answer. What

Candice Caesar (44:12)
Yeah. Yeah.

Alex Evans MD & Candice Caesar PMHNP (44:13)
do you think about that, Candace?

Candice Caesar (44:15)
Well, I think that, you know, like you said, you know, it's about asking whether or not it's closing the gap, right? And in terms of, you know, access, making the provider's, you know, life easier, more efficient, but also making the patient's experience, you know, better. And I can tell you that for me, Dr. Evans, that one of the things that I love about AI.

Candice Caesar (44:41)
It allows me to be present with my patients. Prior to AI, I was documenting and you know, my

Ronald A Brise (44:46)
Yeah.

Candice Caesar (44:47)
head was down and I was listening to the patient and document because I didn't want to lose track. Lise,

Alex Evans MD & Candice Caesar PMHNP (44:50)
Yes.

Candice Caesar (44:52)
your wife could say the same thing too. Like we're

Ronald A Brise (44:52)
Yeah. Yeah.

Candice Caesar (44:55)
documenting because we wanna, you know, we're formulating our diagnosis, right? So we can treat and we

Ronald A Brise (44:59)
Yeah.

Candice Caesar (44:59)
have to have that accurate documentation as much as possible.

Candice Caesar (45:04)
But with AI, you know, and all of these notices that's coming out that kind of listens

Ronald A Brise (45:08)
Mm-hmm.

Candice Caesar (45:09)
to the conversation and obviously we ask the patient for for consent to do so,

Ronald A Brise (45:13)
Sure.

Candice Caesar (45:14)
I am able to be present with my patient. And I can't

Alex Evans MD & Candice Caesar PMHNP (45:17)
Mm.

Candice Caesar (45:17)
tell you what a gift that has been for me in my practice, being able to be there because, you know, Dr. Evans, you know, you know, we talk about it. I love to know what's going on. I love to know the scoop. So I don't want to miss a thing, you know?

Alex Evans MD & Candice Caesar PMHNP (45:30)
Right.

Ronald A Brise (45:30)
Yeah.

Candice Caesar (45:32)
So I'm like, okay, so what what happened? And and and this happened.

Alex Evans MD & Candice Caesar PMHNP (45:35)
Half and we in.

Candice Caesar (45:36)
So what happened then? And yes,

Ronald A Brise (45:37)
Mm-hmm.

Candice Caesar (45:39)
yes, yes. So I wanna be there with you. I'm like, do we need to beat him? Do we need what do who do I need to fight? You know? So, you know, the patient can

Ronald A Brise (45:45)
Right. Right. Right. Right.

Alex Evans MD & Candice Caesar PMHNP (45:46)
Yeah.

Candice Caesar (45:48)
see my engagement, right? That's not for all patients, but like the patient can see my engagement, my ability to listen attentively. And

Ronald A Brise (45:58)
Right.

Candice Caesar (45:58)
I think that that really helps their experience.

Ronald A Brise (46:02)
Right.

Candice Caesar (46:02)
Right.

Alex Evans MD & Candice Caesar PMHNP (46:02)
Yes, absolutely.

Candice Caesar (46:03)
So

Candice Caesar (46:04)
yeah, so I think that you've made some really good points about the patient experience. And I think that, you know, in mental health it is getting better because of AI and I cannot

Ronald A Brise (46:14)
Mm-hmm.

Candice Caesar (46:14)
wait to see. For me, it's the integration, right? Is it's like okay,

Ronald A Brise (46:17)
Right. Right.

Alex Evans MD & Candice Caesar PMHNP (46:18)
Right.

Candice Caesar (46:19)
I want to be able to have the information that I need to be able to treat this patient, to be able to pick up where the other provider left off to continue the care and not just, you know, start, stop, start, stop, start, stop. You know, so

Candice Caesar (46:32)
That's what I'd love to see. So thank you for asking.

Ronald A Brise (46:35)
Yeah. The only other thing I would say is AI shouldn't create I mean not AI, not AI, just AI, but technology should

Alex Evans MD & Candice Caesar PMHNP (46:45)
Technology. Mm-hmm.

Ronald A Brise (46:47)
not create additional barriers, right?

Candice Caesar (46:51)
Mm-hmm.

Ronald A Brise (46:52)
So that if you are if

Candice Caesar (46:55)
Yeah.

Ronald A Brise (46:55)
you live in a rural area and your internet is not stable.

Candice Caesar (47:00)
Mm.

Ronald A Brise (47:01)
And you know, all of those things. So then it could become a potential barrier.

Candice Caesar (47:05)
Yes.

Ronald A Brise (47:06)
even though we have shortened technically shortened the distance,

Candice Caesar (47:10)
Mm.

Ronald A Brise (47:10)
but then we have

Alex Evans MD & Candice Caesar PMHNP (47:11)
Mm-hmm.

Ronald A Brise (47:11)
potentially created an additional barrier. So there's a there's a little bit of a balance there,

Candice Caesar (47:16)
Mm-hmm.

Ronald A Brise (47:17)
which goes back to the initial part of the conversation, which is access, right? Access

Candice Caesar (47:21)
Isn't it?

Alex Evans MD & Candice Caesar PMHNP (47:21)
Mm-hmm.

Ronald A Brise (47:21)
has to

Ronald A Brise (47:22)
do with proximity and the number of of people who are providers who are available to provide care and etc.

Ronald A Brise (47:30)
but all of those things I think are are are part of the the comprehensive conversation

Candice Caesar (47:36)
Mm-hmm.

Ronald A Brise (47:37)
around the use of technology.

Candice Caesar (47:38)
Yeah. Mm-hmm. Yeah. Excellent, excellent

Alex Evans MD & Candice Caesar PMHNP (47:40)
Yeah.

Candice Caesar (47:41)
point.

Alex Evans MD & Candice Caesar PMHNP (47:41)
excellent points. Excellent points. And I and I I echo your p your comments, Candace, because of the fact that I have had the same experiences where you walk into a room you've got multiple patients on the floor to see and you're you're half listening to them because you're thinking about okay, what what you gotta jot down. Whereas

Candice Caesar (48:00)
Yeah. Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (48:03)
if there is an ambient

Candice Caesar (48:05)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (48:05)
AI or a ambient listening device in the room.

Ronald A Brise (48:08)
Right.

Alex Evans MD & Candice Caesar PMHNP (48:09)
that can record it and then you just go back and read and read and make sure that what you was said and comments were made were accurate and then they can it can actually help you pull out the diagnosis codes and so forth that you need. I mean it makes the physician's life more easy, but it allows the physician to spend more time focusing on that individual patient. So again,

Candice Caesar (48:31)
Exactly.

Alex Evans MD & Candice Caesar PMHNP (48:32)
it it really goes back to the patients. So so I

Ronald A Brise (48:35)
Yeah, I will

Alex Evans MD & Candice Caesar PMHNP (48:36)
I I applaud that.

Ronald A Brise (48:37)
I will

Candice Caesar (48:38)
Yeah.

Ronald A Brise (48:38)
ditto that. I had a doctor's appointment today and

Candice Caesar (48:41)
Mm-hmm.

Ronald A Brise (48:42)
and my doctor was like, Hey, do you mind if I use something to record our conversation and

Alex Evans MD & Candice Caesar PMHNP (48:49)
Mm.

Ronald A Brise (48:50)
you know, which so that my notes are done and I said, Yeah, I don't have a problem with that. And

Alex Evans MD & Candice Caesar PMHNP (48:53)
Right. Right.

Ronald A Brise (48:55)
tell you what.

Ronald A Brise (48:56)
She was much more relaxed,

Candice Caesar (48:58)
Yeah.

Ronald A Brise (48:59)
you know, and

Alex Evans MD & Candice Caesar PMHNP (48:59)
Of course.

Ronald A Brise (49:00)
engaged. I mean, so our our conversation was much more natural because she had time

Candice Caesar (49:04)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (49:05)
Right.

Ronald A Brise (49:05)
to actually turn around. We were chatting and

Candice Caesar (49:08)
Yeah.

Ronald A Brise (49:08)
chatting about different things associated with what we were talking

Alex Evans MD & Candice Caesar PMHNP (49:11)
Exactly.

Ronald A Brise (49:12)
about, but there was time to to open up a little bit more. And and

Alex Evans MD & Candice Caesar PMHNP (49:16)
Mm. Right.

Candice Caesar (49:17)
Mm-hmm.

Ronald A Brise (49:17)
I think I got a lot more out of the today's visit. She got a lot more in terms of information and

Alex Evans MD & Candice Caesar PMHNP (49:23)
Right. Yes.

Ronald A Brise (49:25)
And she doesn't have to be up tonight at two o'clock, three o'clock in the morning, you know,

Candice Caesar (49:27)
Fighting and helped. Yeah.

Alex Evans MD & Candice Caesar PMHNP (49:28)
Exactly.

Ronald A Brise (49:30)
trying to remember what she scribbled down or what she typed in the computer and then to to then clean it up and and go back and clean it up again and and and all of that. So so yeah.

Alex Evans MD & Candice Caesar PMHNP (49:38)
Get ready for Billy. Yeah. Hundred

Candice Caesar (49:41)
Mm. Yeah.

Candice Caesar (49:43)
Yeah. Yeah. I'm glad you had

Alex Evans MD & Candice Caesar PMHNP (49:43)
percent, hundred percent. You know

Candice Caesar (49:46)
that patient experience.

Ronald A Brise (49:48)
Yes.

Alex Evans MD & Candice Caesar PMHNP (49:50)
You know, you know, I I just wanna sometimes I I wonder if if our audience knows kind of what we do at Apex Health. And our real goal at Apex Health is to do what you're saying is to really allow access of care. You know, we started out as a company that focused on reducing healthcare costs, mostly in companies and so forth, but we are generally really about

Alex Evans MD & Candice Caesar PMHNP (50:17)
giving our application to as many people across the country so they can have open access to their physicians. And that's what we're all about. So, you know, at the end of the day, when we have these conversations, we're really trying to learn how to do better as a company, how to do better as providers in general across the board and use technology to really do what you guys just said is to make it easier.

Alex Evans MD & Candice Caesar PMHNP (50:46)
on the patient, make the patient feel more comfortable about their care and want to engage with physicians to to do that thing that we all talked about, which is preventative care. Not not

Candice Caesar (50:57)
Yeah.

Ronald A Brise (50:57)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (50:57)
caring about what the what the industry makes. Yeah.

Ronald A Brise (51:00)
Right.

Candice Caesar (51:00)
Yeah, exactly. And you know, and and Ronald,

Candice Caesar (51:03)
I think that there's room for us to grow as well. You've also, you know, identify the fact that, you know, hey, there might be, you know, connection issues, you know, patient may not have

Alex Evans MD & Candice Caesar PMHNP (51:10)
Mm-hmm.

Candice Caesar (51:11)
access to, you know, a a device. And so that has us, you know, also thinking creatively about, you

Alex Evans MD & Candice Caesar PMHNP (51:19)
Mm-hmm.

Candice Caesar (51:19)
know, how to access those patients, you know. So, yeah. Mm-hmm. Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (51:25)
Excellent. So Ronald, one last question I want to ask

Ronald A Brise (51:28)
Sure.

Alex Evans MD & Candice Caesar PMHNP (51:28)
you. So

Alex Evans MD & Candice Caesar PMHNP (51:31)
If you could change one thing about the way

Candice Caesar (51:34)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (51:35)
healthcare policy is made in America, what would

Candice Caesar (51:38)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (51:39)
that be?

Candice Caesar (51:40)
What would that be, Ronald?

Ronald A Brise (51:41)
I

Ronald A Brise (51:42)
think I'd want to revisit the incentives.

Candice Caesar (51:44)
Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (51:45)
Mm.

Ronald A Brise (51:46)
Right? In other words, how do we ins we talked about prevent prevention and access. How could we prioritize prevention and incentives and make those incentives as high as the incentives of curing? Right? So

Candice Caesar (52:04)
Mm-hmm. Mm-hmm.

Ronald A Brise (52:07)
if we could, you know

Ronald A Brise (52:09)
figure that out. And that's a hard nut to crack, right?

Candice Caesar (52:12)
Mm-hmm.

Ronald A Brise (52:13)
but it is one that I I

Alex Evans MD & Candice Caesar PMHNP (52:17)
basically compensate

Alex Evans MD & Candice Caesar PMHNP (52:19)
are you saying compensate those who are giving care or profiting from care to allow them

Candice Caesar (52:25)
insurance company.

Alex Evans MD & Candice Caesar PMHNP (52:27)
to sub to support prevention? Yes.

Ronald A Brise (52:28)
support yeah support prevention like and support

Candice Caesar (52:29)
Mm-hmm.

Ronald A Brise (52:33)
programs or systems that help

Alex Evans MD & Candice Caesar PMHNP (52:38)
Wow.

Ronald A Brise (52:38)
in all of prevention in other words if you I mean we're we see we're seeing some of it like you know you

Candice Caesar (52:46)
Yeah. Mm-hmm.

Alex Evans MD & Candice Caesar PMHNP (52:46)
Mm.

Ronald A Brise (52:47)
get points from your insurance if you if you exercise if you know all

Candice Caesar (52:49)
Yes.

Alex Evans MD & Candice Caesar PMHNP (52:51)
Mm-hmm.

Ronald A Brise (52:51)
of these things and so if if if we can boost that up right

Alex Evans MD & Candice Caesar PMHNP (52:58)
Wow.

Ronald A Brise (52:58)
And then also, you know, support real access, right? I mean,

Alex Evans MD & Candice Caesar PMHNP (53:04)
Yes, yes.

Ronald A Brise (53:05)
so that so that my insurance card really means I can get care. Right. It's it does what it says it does, right?

Candice Caesar (53:10)
What it says.

Alex Evans MD & Candice Caesar PMHNP (53:12)
Yes, yes.

Ronald A Brise (53:15)
so I think that those are the two things I think if I had if I had a Chris if I had all the power in the world

Candice Caesar (53:22)
Mm.

Ronald A Brise (53:23)
to make changes in in in the healthcare arena, I think I would

Ronald A Brise (53:27)
I would do that. And then I would I would also put money

Candice Caesar (53:32)
Mm.

Ronald A Brise (53:33)
in prevention. In other words, what could we do that would help people in prevention? Like we invest

Alex Evans MD & Candice Caesar PMHNP (53:40)
Mm.

Ronald A Brise (53:41)
in in in research for a whole bunch of other things. How do we,

Alex Evans MD & Candice Caesar PMHNP (53:43)
Right. Right.

Candice Caesar (53:44)
Mm.

Ronald A Brise (53:45)
you know, what what can we do to invest to to make prevention sexy and easier for people? Yeah.

Candice Caesar (53:52)
I like that. I like that.

Alex Evans MD & Candice Caesar PMHNP (53:53)
Wow. you know,

Alex Evans MD & Candice Caesar PMHNP (53:54)
I want to live in in your kingdom. King Brize.

Ronald A Brise (53:56)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (53:58)
Yes, King Brize. I honor you.

Candice Caesar (54:01)
You know,

Candice Caesar (54:03)
I I wanna leave this podcast by saying that, you know, I wanna champion mental health is medical health. Okay.

Ronald A Brise (54:09)
Absolutely. Absolutely.

Alex Evans MD & Candice Caesar PMHNP (54:11)
Yes, yes.

Candice Caesar (54:14)
You know, that is

Ronald A Brise (54:15)
Yeah.

Candice Caesar (54:16)
my thing. So Ronald, thank you. Thank you for joining us and helping us better understand how decisions made in policy ultimately reach people receiving care.

Candice Caesar (54:28)
And to everyone listening, remember healthcare policy isn't just about laws, regulations, or institutions. It's about people. If you found this conversation valuable, please like, subscribe, and share this episode with someone who could benefit. Thank you again for joining the Apex Health Podcast, where we are making healthcare easier to understand one conversation at a time.