Values-based care offers the freedom to fix rural health problems
The tools we need to achieve long-term stability for community providers and ensure better outcomes for rural America are available, and CMS can help us leverage them.
Almost 14% of Americans live in rural communities. For those of us in healthcare who work with numbers all day, it’s important to constantly remind ourselves what those numbers represent. Each person who makes up that 14% is a unique individual with a name, a face, a family, and a quality of life that should be better served by the healthcare system.
It’s no secret that some of the biggest health care disparities today exist for those living in rural America, where geography, lack of infrastructure, and other social factors contribute to drastically worse health outcomes. It’s an unjust reality, underscored by a mortality rate that is 23% higher among people living in rural communities than among those living in urban communities. Individuals in rural communities earn so much more.
Recently, CMS’s Rural Health Council released its Improving Health in Rural Communities 2021 report, which highlights initiatives by multiple agencies over the past year. I applaud CMS for its increased focus on the needs of rural communities and its continued commitment to improving the health and well-being of those living in rural, frontier, tribal and geographically isolated areas.
The CMS report outlined a number of key federal programs that have provided rural Americans with greater access to care in recent years, including:
- New payments for telemedicine and diagnostic services, tools that will continue to be an essential part of preventative care in the future
- Policies to address the provider shortage by allowing more non-physician practitioners to practice within the cap of their licenses
- New payment models that further exempt rural providers from fee schedules, giving them the flexibility and freedom they need to improve outcomes and achieve financial independence in their communities
These initiatives show incredible advances in rural care delivery and payment, but more needs to be done. Namely, we also need to expand access to remote cellular patient monitoring (RPM) to empower individuals to take action to manage their chronic conditions. Cellular-based RPM can play a critical role in reducing spending and improving outcomes for people in rural communities struggling with cardiovascular disease, diabetes and other chronic conditions; For example, devices can detect arrhythmias and alert providers and plans in real time, giving physicians ample time to initiate life-saving interventions.
For many patients, this technology can mean the difference between life and death. This makes RPM absolutely essential for people living in rural communities where the nearest hospital can be tens of miles away. But despite its tremendous potential to revolutionize the way we approach care, its minimal use boils down to reimbursement. Change payment models and we will inspire providers to realize the potential of RPM with millions of patients in these communities.
We also need to do more to meet people where they are. It’s a popular idiom in healthcare and beyond, but I mean it quite literally: we need to extend the experience of health and care delivery into the daily routines of individuals. We must bring service to homes and communities where it is most convenient and accessible. Where do people shop? Where do you make contacts? That’s where health care has to be.
The chain hospital model has had success in urban and suburban communities, but we cannot rely on this approach to work in rural America, where the population is geographically dispersed and the nearest neighbor — let alone the nearest hospital — is dozens of miles away can way. If we are to reach people in rural communities within their weekly routines and begin to address critical care gaps, we must adopt hybrid care models that include partnerships with trusted community providers, mobile clinicians, virtual care and remote patient monitoring devices.
What I am describing is nothing short of a rural health redesign, but it is necessary to bring quality care to the 14% of Americans who simply do not currently have access to it. The tools we need to achieve long-term stability for community providers and ensure better outcomes for rural Americans are at our disposal. I encourage CMS to help us use it.