Newman Explains How Sanford Health Is Virtually Rewriting the Rural Health Playbook

Farmers in the Dakotas are logging into endocrinology appointments from the cabs of their combines during harvest season, and the physician on the other end of the screen considers it a point of pride. Dave Newman, MD, Chief Medical Officer of Virtual Care at Sanford Health, oversees a virtual care operation that spans 78 specialties, […]

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Dave Newman, MD, Chief Medical Officer of Virtual Care, Sanford Health

Farmers in the Dakotas are logging into endocrinology appointments from the cabs of their combines during harvest season, and the physician on the other end of the screen considers it a point of pride. Dave Newman, MD, Chief Medical Officer of Virtual Care at Sanford Health, oversees a virtual care operation that spans 78 specialties, reaches 93 locations and serves a patient population spread across 300,000 square miles of the upper Midwest. Two‑thirds of those patients live more than 30 miles from one of the system’s major medical centers. On average, virtual visits save them 176 miles of round‑trip driving.

Sanford Health is the largest rural healthcare system in the country, serving more than 2 million patients across a footprint that stretches from near Wyoming to Michigan, with 99 % of the territory classified as rural. The system runs primarily on Epic, though a recent merger with Marshfield Clinic brought Cerner into the environment as well. Newman, a practicing endocrinologist and informaticist, describes his role as bridging the gap between medicine and technology for an organization where geography makes virtual care an operational imperative.

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The pandemic forced every health system to adopt virtual care, but the post‑COVID pullback that hit many urban and suburban organizations never fully materialized at Sanford. Patients who once drove hundreds of miles to see a specialist had no interest in giving up remote access once it became available. Newman describes the current state of virtual care at Sanford as having reached the “plateau of productivity” on the Gartner hype cycle: patients expect it, providers deliver it, and hybrid models blending in‑person and virtual visits are now standard.

Bridging the Last Mile

One of the biggest surprises has been connectivity. The assumption that rural patients would lack broadband access turned out to be largely wrong. Newman says 99 % of Sanford’s patients have broadband and a device capable of supporting virtual visits. For the 1 % who do not, the organization improvises. One of Newman’s own patients, a rancher outside Dickinson, N.D., has no cell service. The patient does have a 1980s‑era rotary phone with a 20‑foot braided cable. Newman conducts verbal visits over that phone line, refills medications and manages chronic conditions so the rancher does not have to leave his property during calving season.

Mental health has been one of the strongest use cases. Sanford built a direct‑to‑consumer platform that lets patients book a therapist or psychiatrist appointment in a few taps on a mobile app. The goal was to reduce stigma in small towns where patients told the organization they did not want to be spotted in a therapist’s waiting room by neighbors or coworkers. In 2023, the platform brought 12 000 new patients into behavioral health services, people who would not have sought care otherwise.

Start With the Clinician, Not the Tool

One of the industry’s most persistent mistakes, in Newman’s view, is launching technology without involving the people who will use it. Sanford built a homegrown AI model to predict which patients would develop chronic kidney disease, aiming for earlier diagnosis and treatment. The model took years to become operational because the physicians responsible for implementing it were not at the table during development. Once the clinical team was brought in and asked practical questions about how the tool should surface inside Epic—whether as a pop‑up, part of health maintenance, or another workflow—adoption accelerated. The system now catches chronic kidney disease sooner and gets patients into treatment earlier.

The lesson shaped how Sanford approaches every technology rollout. Newman believes healthcare must drive the technology embedded within it, and he wants vendors to bring innovation to the table: built‑in ambient technology, AI tools integrated into care‑delivery platforms, and features that solve clinical problems. He has moved away from point solutions in favor of comprehensive partnerships that offer suites of products.

Change management is central to every deployment. Newman assumes roughly half of any mass email will go unread, so the organization layers communication through town halls, department meetings, leadership briefings and direct phone calls. Governance processes ensure frontline staff—whether nurses, physicians or other clinicians—are represented in decisions before a rollout begins. “If you lead with ‘this is going to help your patients,’ 99 % of doctors are in,” Newman said. “That is what they went into medicine for.”

That approach produced a waitlist for ambient listening technology. Pre‑rollout messaging focused on a straightforward promise: providers would leave work sooner and stop logging into the EMR after hours. The result was demand that outpaced supply.

The AI Bet

Sanford runs every AI project through a governance structure staffed by clinicians and operational leaders. Algorithms must be validated against the organization’s own patient population, and the team re‑evaluates performance every several months.

Workforce shortages in rural America are accelerating AI adoption. Sanford does not have enough patient‑access representatives to handle outbound scheduling calls, so the organization partnered with a vendor to deploy an AI‑powered phone agent named Jane. She calls patients to schedule wellness visits, colonoscopies and lipid panels, and to arrange medication refills. Average call duration is nine minutes, and patients rate the experience 9 out of 10. “It is much more successful than I thought it was going to be, using an agentic agent for non‑clinical use cases,” Newman said.

Looking ahead, Newman predicts that within five years, nearly every clinician will use AI effectively. He draws a comparison to tax preparation: walking into an accountant’s office and seeing an abacus on the desk would raise immediate concerns. Clinicians will adopt AI the same way every profession adopts better tools. “AI in the hands of a skilled clinician makes that clinician better,” he said. “You need a fundamental basis of knowledge to utilize the AI.”

Take it Away

• Virtual care programs in rural health systems should focus on hybrid models that blend in‑person and remote visits within a single, integrated system.

• Engage clinicians at the start of any technology deployment.

• Layer change‑management communications across multiple channels because roughly half of any mass‑email audience will not read it.

• Lead technology‑rollout messaging with direct benefits to patients or providers.

• Validate AI algorithms on your own patient population and re‑evaluate performance regularly; governance structures should include clinicians and operational leaders.

• AI‑powered agents can address workforce shortages in non‑clinical functions like outbound scheduling.

• For the small percentage of patients without broadband, get creative.

When asked for his best advice to leaders building virtual care programs, Newman said, “Always lead with the patient at heart. If you think about the patient, if you think about the providers giving that care, you typically don’t make as many bad decisions.”