With their focus on places and people, rural medical institutions could lead the way in improving America's healthcare system.
A lot of people write about the future of rural health care. Typically there is no shortage of anxiety on the topic. But there is more to the story. We need to understand that rural can be health care’s future.
I know better than most the list of challenges for rural communities. I don’t deny them, but it pays also to look at what we do well and how rural health care can help lead American health care.
Rural health care is part of the change sweeping across the country. The mandate has rightly become to drive quality of care up and costs down while improving the health of the whole community. Rural is and will be part of that “Triple Aim” movement.
The best of rural health has long focused on places and patients. “Place-based” care means that health organizations consider the values, tradition and economic well being of the community when they make decisions. “Patient-centered” care means that we organize the health-care experience around the needs of the patient as opposed to just the convenience of the provider.
One great example of place-based, patient-centered care is the work of Ministry Door County Medical Center based in Sturgeon Bay, Wisconsin. They subsidize a clinic in partnership with the 718 year-round residents of Washington Island in Lake Michigan. That wouldn’t happen if the medical center didn’t value places and patients.
These values are deeply embedded in rural health and will be a key driver of success for health care in both rural and urban communities. We do not need to turn rural into a small version or outpost of urban. We do need to build on our natural strengths as we continue to evolve our services to meet the Triple Aim.
Rural health has a strong base upon which to build. In collaboration with the National Rural Health Association, iVantage Health Analytics has shown that the cost per rural Medicare beneficiary is 3.7% lower than the average cost per urban beneficiary and that neither rural nor urban dominate on quality measures.
Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute have developed a national report of county health rankings that is updated annually. In general, rural counties are expected to not do as well as urban counties due to lower levels of employment, income and education, among other factors that drive health status.
This year, given these factors, you would expect only 13 of Wisconsin’s rural counties to be in the top half of counties with the best health. In fact 20 are in the top half of the counties with the best health. Quite a few rural communities are doing something right to out-perform expectations.
The reality and potential of neighbors caring for neighbors has long been a strength of many rural communities. They more readily bring together diverse leaders from throughout the community and region to address multiple determinants of health, such as access to local health care, education and jobs.
Rural hospitals in Wisconsin are respected around the country for the quality of the care we provide. The Medicare program (our major payer) should think of us as a demonstration site for how payment policies can evolve to best fit the needs of rural beneficiaries and communities. We remain hopeful that they will come out of Washington D.C. to Wisconsin to learn more about how rural communities and Medicare can become more closely aligned.
The National Rural Health Association has identified four priorities for moving toward the future of rural health: 1) adapt the current systems to allow payment for preventive health measures and care coordination, 2) support local hospitals and physicians and clinics as a physical and virtual hub of service delivery, 3) maintain flexibility – the ability to adapt to ever changing events, and 4) most importantly, “preserve what we have until we have clarity of where we are going.”
Underlying these priorities is a critical foundation: Don’t throw the good out with the bad. We must protect local access to rural health-care providers and physicians. We have already seen “health” insurers refusing to contract to provide local rural health care. We must support and defend the right of residents to seek care locally. Access standards must continue to “reflect the usual medical travel times within the community.”
John McKnight, a long time community organizer and founder of the Asset-Based Community Development Institute at Northwestern University had it right.
“The place to look for care is in the dense relationships of neighbors and community groups,” McKnight said. “We have a competent community if we care about each other, and about the neighborhood. Together, our care manifests a vision, culture and commitment that can uniquely assure our sense of well-being and happiness.”
Tim Size is executive director of the Rural Wisconsin Health Cooperative in Sauk City.