Tackling Rural Health Challenges During Rural Health Month and Beyond

During Rural Health Month, it’s a good opportunity to examine the current state of American rural health and new approaches that seek to reduce the long-standing health inequalities between rural and urban healthcare.

To begin with, our nation’s rural communities are beginning to change. Since 2010, rural populations have experienced a steady decline. However, data confirms that this trend is beginning to reverse and, in 2016, rural counties began to add population.

Despite slight gains in population, the make-up of the population remains fairly consistent. Rural America tends to be less racially and ethnically diverse than urban areas; experiences a higher rate of poverty than urban communities; and is older. In fact, rural counties are particularly attractive to seniors, so much so that 10 million people ages 65 and older live in rural America.

Consequently, there are very specific healthcare needs associated with rural residents, but, historically, the healthcare system has struggled to meet these needs.

According to the American Communities Project, healthcare in rural America is simply less accessible, with an additional 393 people per primary care physician than the national average.

Some examples:

• Fewer than half of rural women live within a 30-minute drive to a hospital with perinatal services, and over 10% have a drive of 100 miles or more
• Access to substance abuse treatment is limited, as 92% of substance abuse treatment facilities are located in an urban setting
• A disproportionate number of rural communities face issues related to social determinants of health, such as 33% of rural residents who indicated that homelessness is an issue in their community, oftentimes a bellwether of lack of access to—or follow-up for—healthcare.

This lack of access puts an undue strain on the rural emergency department (ED) to serve as a point of care, driving up unnecessary utilization. According to a recent JAMA article, rural ED visit rates increased by more than 50%, while urban rates barely increased. With an average emergency room visit costing $1389, this can add up.

The overall lack of proper access to healthcare, combined with social determinant of health factors, results in a less healthy rural population. Residents in rural communities exhibit a greater risk of death from the 5 leading causes of death: heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke. They also experience higher suicide rates and have higher rates of fatal drug overdoses than urban communities.

Now is the time for organizations to step up and improve rural health by offering new, innovative ways to improve access to the care they so desperately need.

One way to alleviate healthcare access issues in rural communities is through community paramedicine, a quickly evolving field where emergency medical services (EMS) providers seek to reduce the use of EMS services for 911 calls, overcrowding emergency departments, and, subsequently, reduce healthcare costs.

Community paramedicine is an advanced level of nationally certified professional care enabling registered community paramedics to work in expanded roles to provide primary healthcare, preventative services, monitoring and other out-of-hospital services. In rural areas, they help fill the gaps in the local care delivery systems due to shortages of physicians and long travel times to the nearest hospital or clinic.

Community paramedicine is used widely throughout California, Minnesota, and Nevada, and is being tested in South Carolina and New York. In April 2019, Kentucky and Hawaii passed community paramedicine legislation that was subsequently signed into law by the governors of both states

WellCare Health Plans, which provides government-sponsored managed care services including Medicaid and Medicare, is among the first managed care organizations to create a care management model around community paramedicine that serves Medicaid members in need and establishes an effective financial model for municipalities and states to make it sustainable, pragmatic, and workable. The model deploys an integrated care team with the community paramedic into rural areas to provide physical and behavioral health, lab draws and to assess the home for environmental health risks.

WellCare has implemented 2 models for community paramedicine. The first relies on 911 calls to dispatch an EMS to a member’s home, and the second schedules appointments for the paramedic to visit a member. The latter is especially beneficial for serving members who are at high risk for hospital readmission or have multiple chronic conditions, allowing for regular follow ups to ensure the member is staying compliant and adherent to treatment plans.

Testament to this approach, an internal case study from the Manatee County community paramedicine program in Florida, showed a significant reduction in the number of ER visits and hospitalizations related to proper diabetes and congestive heart failure management. This innovative approach allows WellCare to increase healthcare quality and close care gaps in rural communities and improve member and provider satisfaction at the same time.

To recruit workers to the community paramedicine field, WellCare is turning to those who are intimately familiar with providing healthcare in challenging environments: medically trained military veterans or other transitioning military personnel. WellCare is recruiting and covering training and certification costs for these individuals, a win-win for filling staff needs, as well as addressing veteran employment challenges. Additionally, there is a financial benefit to the community, both from a cost-savings perspective from a recruiting standpoint, and because it can help stimulate the local economy as far as workforce development.

Community paramedicine is starting to make strides, characterized by compassion, community engagement, patient-centric care and sustainable value for rural communities and states. By continuing to foster better care for rural Americans, we can make inroads in leveling the healthcare playing field not only during Rural Health Month, but all year long.