In my work to help launch the AHA’s Future of Rural Health Care Task Force, I am learning firsthand how innovative, bold and forward-thinking health care organizations are when they have the opportunities to do so. The task force will work to provide strategic thought leadership on the future delivery and financing of rural health care.
Nearly 20% of Americans live in rural areas. Over the years, we have seen rural communities face unique challenges that threaten their ability to maintain access to health care services. The Future of Rural Health Care Task Force will help the AHA identify future trends and emerging strategies, and develop new care delivery and stable finance models to ensure local access to care in rural settings, as well as key operational considerations for the health care field.
Earlier this month, I set out to visit two rural hospitals to learn how health care leaders are striving to improve care for their communities, increase access to care, and engage in strategic partnerships to improve health outcomes.
Along with some of my colleagues in health policy and advocacy, we traveled to Western Wisconsin Health in Baldwin, WI and Winona Health in Winona, MN, both of which exemplified how rural health care organizations are striving to meet the needs of their communities in unique and creative ways. Here’s how they are doing that:
Investing in upstream interventions to address social determinants of health
I received a warm welcome from Alison Page, CEO of Western Wisconsin Health (WWH), who, along with other leaders at the hospital, has big, bold ideas for revolutionizing the health care system. One of the biggest challenges her hospital faces is making services available to people who cannot easily access or afford them. With a disproportionately high number of people struggling with obesity, alcohol abuse, depression and other behavioral health issues, WWH is focusing on upstream interventions to help these patients before they need more intensive services. In addition, WWH leaders are working to incentivize providers for this type of work.
WWH’s new health and wellness center, connected to the medical facility, offers an abundance of programs and classes to help people achieve their best health outcomes. Residents can join the health and wellness center regardless of whether they are WWH patients. In addition, WWH partners with local schools in the area to provide elementary school-aged children with behavioral health care, some of which is funded through grant dollars.
I was impressed by how forward-thinking Page and her colleagues at WWH are; WWH leaders envision a society in which rural critical access hospitals are not only safety nets for the sick but hubs for health and wellness services too. They hope to work with the Centers for Medicare & Medicaid Services to ensure CAH providers are reimbursed based on cost for health and wellness services rendered. “After all, they are geographically dispersed in rural areas where we know people tend to be less healthy than in urban areas,” Page said.
Winona Health leaders have followed in the footsteps of Pennsylvania and Maryland with their Winona Well-being collaborative — a program dedicated to the non-medical needs of its residents, from ensuring patients have access to meals and transportation to linking them with refugee services, county public health services and mentoring for students at risk of not graduating.
Winona’s Pathways to HUB model also uses software to document social determinants of health in the patients’ electronic health records, referring patients to meet with a social worker or community health worker.
Experimenting with new payment models
In an effort to increase access to care, Winona Health is building a clinic in town to offer quick, routine care for basic acute illnesses and prevention and wellness care, in addition to other services. Patients can choose to visit the clinic in person or receive virtual care by taking a “smart exam” to diagnose symptoms. The model charges patients a flat $39 fee once they receive a diagnosis and treatment plan. The cash-only clinic is tailored to Millennials in the two-college town.
WWH also is exploring creative payment models. Page shared with me why she advocates for expanding allowable providers in rural health clinics to include dentists, since most dentists in the state do not accept Medicaid. “We could solve this access problem if a rural health clinic were allowed to employ dentists and bill for them as reimbursable providers,” Page told me. She also advocates for allowing RHCs to serve as host sites for telehealth visits and to be cost-based reimbursed for school-based services in health professional shortage areas. “We already provide behavioral health services in the schools; we could do a lot more if we could bill them as RHC visits.”
Page emphasized the challenges small, rural health organizations face when confronted with increasingly narrow health networks. To increase access to care in rural areas, she advocates for designating all CAHs and RHCs as “essential community providers” and requiring Medicare managed care plans in their primary and secondary service areas to include them in their network.
Partnering with bigger entities to maximize resources
Earlier this year, Winona Health entered into an agreement with nearby Mayo Clinic to ease the referral process for patients. A Mayo representative is now onsite at the clinic to help coordinate care for patients receiving care from both providers.
WWH contracted with Allina Health Twin Cities to share an EHR system, telemedicine services, ED doctors, and tele-hospitalists. They knew the value of partnering with a bigger entity to employ technological solutions for their patient population and for the providers who work at WWH.
Preparing for the future of rural health
The timing of these rural site visits was ideal as the AHA prepares to launch its Future of Rural Health care Task Force on July 18. I was inspired by the opportunity to see first-hand how rural hospitals are innovating across many dimensions to maintain local access to care for the communities they serve.
Joy Lewis is the AHA’s vice president of strategic policy and leads the Association’s long-range policy planning efforts.