Rural Healthcare Transformation with Scalable Continuous Monitoring

B. 1. Population Health Clinical Infrastructure

Four of the five leading causes of death in rural areas are associated with chronic disease. This situation is exacerbated by gaps in access to primary care and mental health services. Integrated care models may increase access to services in rural communities, as it is an effective strategy to maximize the use of scare rural health resources.

Rural communities can benefit from integrated care models focused on preventative care, long-term care, behavior health, and other social health services through coordination amongst existing community stakeholders.

C. 1. Rural provider strategic partnerships

Rural facilities face several challenges, including low patient volume and high fixed costs that lead to financial strain and workforce shortages that drive up labor costs and limit local resident access to primary and specialty providers. Rural health care facilities may choose to join clinically integrated networks with other rural facilities or partner with larger health care systems to share resources and improve access to services in their communities.

These partnerships can improve the financial viability of rural providers through shared infrastructure and operations resources.

Collaborations with a larger healthcare system may increase access to specialty services and promote sharing of best practices and training resources.

E. 1. Medicaid provider payment incentives

Since its establishment in 2010, the CMS Innovation Center has been testing value-based care via its models. Outside of the Innovation Center, the concept of value-based care has existed since the late 1960’s. The concept rewards increases in quality and reductions in cost.

Compared to urban residents, rural residents have a 44% higher rate of preventable ED visits and a 13% higher rate of preventable hospitalizations. Rural communities can benefit from participating in thoughtfully designed value-based programs focused on value over volume. States can consider leveraging learnings from the Innovation Center in designing these programs.

E. 2. Individuals dually eligible for Medicare and Medicaid

A larger share of Medicare beneficiaries in rural areas are covered by both Medicare and Medicaid than beneficiaries in urban areas. Although studies have found that beneficiaries enrolled in integrated care models have lower rates of hospitalization and readmissions than those who are not enrolled, a minority of dually eligible beneficiaries are now enrolled in integrated care, and there are fewer integrated care options available for dual eligible beneficiaries in rural areas.

Dual-eligible beneficiaries in rural areas can benefit from more intentionally coordinated care for improved health outcomes and reduced total cost of care.

F. 1. Remote care services

Rural areas often lack access to medical care due in part to distance from care and workforce shortages. Remote care services can help expand access to care by allowing clinicians of any type to provide rural residents with care from another location via telehealth, remote patient monitoring, or other modalities. While these services can be useful for rural residents, lack of Medicaid coverage for remote care services, lack of in-State providers, and limited infrastructure can all be limiting factors in providing remote care access for rural residents.

F. 2. Data infrastructure

Rural geography and healthcare facility distribution often necessitate rural residents receiving care from providers and specialists outside of their community at different health systems. High-quality data infrastructure facilitating interoperability is vital for continuity of care. Data infrastructure can also improve rural health outcomes at a larger scale. IT software, for example, can allow hospitals to analyze their patient and outcome data on an aggregate level and make targeted improvements and clinical decisions. Similarly, high-quality T-MSIS data can help State and federal governments make informed decisions about rural healthcare needs. Despite their importance, rural hospitals have upgraded data infrastructure and facilitated patient access to health information at lower rates than other hospitals due to financial and human resources restrictions.

F. 3. Consumer-facing technology

Consumer-facing health technology, such as symptom checkers and AI chatbots, are new developments which can help address critical rural healthcare access barriers like geographic isolation, high costs, and provider shortages. Tools like symptom checkers and virtual consultations enable rural patients to access care without traveling long distances by providing personalized health education and decision support. Providers can also leverage digital health tools to work more efficiently, lowering costs and mitigating provider shortages.