According to the last Census, almost 19 percent of the American population lives in a nonmetropolitan area, representing approximately 59 million people. Rural and highly rural people tend to be older and sicker than their metropolitan counterparts. Rates of smoking, obesity, ischemic heart disease, chronic obstructive pulmonary diseases, and other chronic diseases are also highest in rural counties. Individuals living in nonmetropolitan areas are more likely to be uninsured and living in poverty.
Another barrier to care in rural communities is access. Transportation and long distances to healthcare facilities affect the ability to get timely, needed care for those living in rural areas. Coupled with physician shortages and hospital closures in rural areas, there are many challenges to providing accessible high-quality care in rural areas.
To address these rural health challenges, the annual Rural Health Policy Institute convened in Washington, DC, on February 2–6. Discussions centered on accountable care organizations (ACOs), closures of critical access hospitals, Medicare and Medicaid regulations, and reimbursement policies played front and center. During the conference, representatives from several federal agencies described how planned initiatives could bolster health in rural communities.
Mary Wakefield, from the Health Resources and Services Administration (HRSA), highlighted ongoing efforts to increase enrollment in healthcare coverage under the Patient Protection and Affordable Care Act. She noted that future funding opportunities to rural communities will include a focus on home health, telehealth, and prevention of opioid abuse. Gina Capra, of the Department of Veteran’s Affairs Office of Rural Health, spoke of the recent Veterans Access, Choice, and Accountability Act of 2014 (Choice Act), which will allow Veterans who do not have access to timely care to see local physicians where possible.
Dr. Patrick Conway, deputy administrator for innovation and quality at the Centers for Medicare & Medicaid Services, shared the ongoing focus on delivery system reform initiatives, including recently announced ACO successes. The White House Rural Council, represented by the U.S. Department of Agriculture’s former undersecretary for rural development, Doug O’Brien, spoke of the Obama administration’s focus on children living in rural communities. Attendees also heard from a variety of House and Senate members from rural areas about their ongoing support of rural health issues.
The conference closed with a review of the current health status of those living in rural areas. The Rural Health Policy Institute allowed those on the front line of rural healthcare to advocate for rural communities and prepare for future federal initiatives and funding opportunities.
At Altarum Institute, we support rural health projects that explore the access and quality of care challenges faced by rural communities. We recently completed an evaluation of their Access Received Closer to Home (ARCH) pilot project for the Veterans Health Administration (VHA). This 4-year evaluation for the HRSA Office of Rural Health Policy (ORHP) examined an approach to improving access for Veterans located at five pilot locations (Farmville, Virginia; Caribou, Maine; Billings, Montana; Flagstaff, Arizona; and Pratt, Kansas).
VHA contracted with local providers to enhance healthcare access in these areas. Through site visits, claims analysis, and review of quality metrics, the evaluation team provided needed information on both program implementation success and opportunities for improvement. The evaluation provided evidence that the program provided high-quality healthcare closer to Veterans’ homes at a similar cost to that of Veterans not participating in the program and was highly valued among participating Veterans.
We saw great value demonstrated in this pilot and were pleased to learn that the Veterans Access, Choice, and Accountability Act of 2014 extended Project ARCH for 2 more years.
For ORHP, Altarum is evaluating the impact of the Frontier Community Health Care Network Coordination Grant. In Montana, the grant supports community health workers at 11 rural pilot sites to improve care transitions for those individuals who may be frequent users of hospitals and emergency rooms. We are conducting site visits, patient satisfaction surveys, and claims analysis so that we can inform ORHP about the grant’s impact.
Rural areas are distinguished by their demographics, risk factors, mortality, insurance coverage, and accessibility. Many initiatives to study rural areas’ access issues are ongoing, and more efforts to continue to support rural health are underway. Continued evaluation programs that foster deeper understanding will be key to understanding these initiatives’ impact.
Dora Hunter is an analyst for the Health Quality Research Practice Area at the Altarum Institute. This blog published with permission of the Altarum Institute.