Strengthening Partnerships Makes for Better, More Holistic Rural Healthcare

This article was written by Wendy Welch, MD, MBA, chief medical officer at Cardinal Innovations Healthcare (full bio at the end).

Rural Americans face numerous healthcare challenges. To start, they are more likely than urban dwellers to be “living in poverty, unhealthy, older, uninsured or underinsured, and medically underserved.”¹ Patients also may lack transportation or face other difficulties getting to appointments, which can delay care and lead to adverse consequences. Some studies, for example, show cancers are diagnosed later and mortality rates are higher in rural populations.²

In addition, the relative inaccessibility to primary and specialty care providers in rural settings certainly doesn’t help. There are just 13.1 physicians and 30 specialists per 100,00 residents in our rural communities, compared with 31.2 physicians and 263 specialists in urban settings.³ That is one reason why roughly one quarter of rural Americans struggle to get needed healthcare, according to a May 2019 study by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health.⁴

Getting Americans in rural areas the right care at the right time is an issue that must be tackled at all levels—from federal, state, and health plan policies down to the community organizations and providers who live in these communities. However, by working together there are many opportunities to overcome the unique challenges of managing care in rural settings.

Strategic Solutions

From a member perspective, an integrated and holistic approach to care means we are capable of meeting all the health needs of each individual. That includes managing their physical health, their behavioral health, their pharmacy needs, and their social determinants of health (SDOH) as well.

What such truly person-centered care requires is coordination. Health plans must have visibility into physical health, behavioral health, medication, and SDOH needs. Care plans must be inclusive of all of those elements and should be directed by professionals who are intimately familiar with available resources in the communities they serve.

There are numerous ways to strengthen this strategy.

For example, a few forward-thinking companies are working to ensure individuals have access to technology—such as smartphones or other mobile devices—so they can receive virtual support for certain healthcare services. Another innovative solution is to train an individual’s family member to provide direct care in the home, and to reimburse them for their services.

Yet another method that has the potential to be particularly effective involves deepening the partnerships between local rural primary care providers and the academic medical centers and specialists to which they refer patients. With this model, specialty care providers deliver virtual consultations to patients with their primary care physician present. The local physician then has the insight needed to offer the services, medications, and follow-up care based on the consultation.

There are numerous upsides to this approach. First, the member receives care in the comfort of their community, eliminating the need to travel lengthy distances. In addition, it offers the benefit of experiential learning for rural clinicians. By participating in virtual consultations, clinicians gain exposure to the recommended care protocols and medication guidelines associated with managing members’ specialty care. Thus, this approach helps elevate the skill set of local providers to the benefit of the entire community. Stronger clinical partnerships can also help rural providers feel more empowered and less isolated, lessening frustrations that often result from having to send members elsewhere for care.

However, the biggest benefit might be that members can develop deeper care relationships with an all-inclusive provider team. Increased communication and coordination among local physicians, specialists, behavioral health providers, and community advocates can provide a practical solution to increasing and simplifying access to care in rural settings and keeping members at the center of the care continuum.

To that end, we must not overlook the power of community support networks within rural communities. The tight-knit relationships within rural centers can provide tremendous benefit for members.

One example involves the care coordinators who Cardinal Innovations Healthcare embeds in the North Carolina communities it serves. These care coordinators become familiar with the resources available to support their populations. With discretion, the small social network within a rural community can be called upon to recommend and engage members and others who may not know what services are available or how to access them.

It is especially important for care coordinators to engage members, their families, and other stakeholders, because the organization manages members with complex substance use disorders, intellectual and developmental disabilities, and behavioral health conditions. In addition to helping coordinate clinical and behavioral health care, care coordinators work with other service organizations including public health departments, schools, housing organizations, transportation services, and more. The objective is to provide a holistic solution that wraps the right community resources around each member in support of their treatment goals.

Community in Action

Healthcare is never one dimensional. It takes an entire community of people all sitting at the table together to overcome the challenges of managing care, especially for rural populations.

Ongoing efforts to coordinate care management and resources can prove beneficial for the rural communities that need it most. Building community partnerships at all levels can help improve access to care and address all the needs of member populations—and in so doing, emphasize the whole health of each unique individual.

Bio

Wendy Welch, MD, MBA, is chief medical officer at Cardinal Innovations Healthcare, where she provides clinical and medical executive leadership for the organization. She is board certified in psychiatry, child and adolescent psychiatry, and addiction psychiatry, and recently received an MBA in business administration, management and operations from the University of Massachusetts, Amherst. With 24 years of experience, Welch joined Cardinal Innovations from Virginia Commonwealth University (VCU) where she developed Virginia Treatment Center for Children’s THRIVE, a specialty service for adolescents with addiction. In her role as associate professor at VCU, she taught managed care literacy and worked with health system leaders on value-based care initiatives.

References:

1. CMS Rural Health Strategy. CMS website. cms.gov/About-CMS/Agency-Information/OMH/Downloads/Rural-Strategy-2018.pdf. Accessed September 10, 2019.
2. Rosenberg J. Implementing solutions to close the rural cancer care gap. The American Journal of Managed Care® website. ajmc.com/journals/evidence-based-oncology/2019/june-2019/medical-world-news-managed-care-updates. Published April 11, 2019. Accessed September 18, 2019.
3. About rural health care. National Rural Health Association. ruralhealthweb.org/about-nrha/about-rural-health-care. Accessed September 10, 2019.
4. NPR, Robert Wood Johnson Foundation, Harvard T.H. Chan School of Public Health. Life in Rural America—Part II. media.npr.org/documents/2019/may/NPR-RWJF-HARVARD_Rural_Poll_Part_2.pdf. Published May 2019. Accessed September 10, 2019.