The equality deficit in rural health care: how to enhance America’s primary care backbone

People who live in rural America, who number 50 million, have less disposable income, are more reliant on Medicare and Medicaid, and suffer a higher incidence of chronic health conditions. These people also have less access to primary care doctors — fewer than half the number of doctors per 100,000 population than the rest of the United States’ health citizens.

UnitedHealth Group’s report, Modernizing Rural Health Care: Coverage, quality and innovation, presents the profile of rural U.S. health and recommends practical solutions for raising health standards and outcomes in rural America based on innovation delivery and financing models already in place throughout the U.S.

The report also incorporates new survey data of consumers and primary care physicians on health challenges, perceived quality of care, and access to services.

The chart illustrates how primary care physicians split on their perceptions of patients’ chronic care conditions based on whether they practice in rural or urban settings. The greatest chronic care challenges across all physicians are seen to be diabetes, hypertension, cardiac problems, cancer, drug abuse, alcohol abuse, teen pregnancy, and domestic violence — all seen more acutely by rural physicians. Only violent crime is seen as a less acute problem by rural physicians compared to their urban colleagues.

Several of these health challenges (especially hypertension, diabetes and teen pregnancy) are also seen as most acute in the rural South compared to other rural regions in the U.S. “The rural South bears a disproportionate burden of chronic conditions,” the report observes, as the ‘stroke belt’ of the south is marked by higher levels of obesity, smoking and diabetes.

As health reform expands newly insured populations, the rural primary care infrastructure will be especially challenged to provide grassroots care to these health citizens. 1 in 2 doctors in rural areas expect there will be a shortage of physicians and mid-level professionals in the next few years in their local communities.

UnitedHealth Group offers several recommendations to address the rural health delivery gap, present and worsening in the future including:

• Primary care medical homes as a reimbursement model, including gainsharing from improved preventive care and care coordination
• Multidisciplinary teamwork in rural primary care, expanding the roles of nurse practitioners, PAs and others to practice what they learned in school
• Provider collaboration across rural areas with urban health systems, especially through the use of telemedicine
• Mobile health clinics
• Expanded use of electronic health records (EHRs)
• Rural consumers’ engagement in managing their own health.

These approaches will require changed payment models to re-align incentives and motivate adoption of new workflow, collaboration with complementary providers, and patient-engagement. In addition, updating regulations on technologies and professional credentialing would be required to re-align provider networks and incentivize use of telemedicine technologies.

Health Populi’s Hot Points: There’s an “equality deficit” in health care in the U.S., with rural Americans bearing more of the chronic disease burden, worse health outcomes, and connecting-the-dots — less access to primary care.

Around the world, it is nations with the strongest primary care backbones who tend to spend less money overall on their health care and enjoy better health outcomes than in the U.S. — with a primary care maldistribution and, in rural America, a professional shortage.

The expansion of telemedicine, along with the deployment of primary care work teams with a full complement of clinical types and training, will help the U.S. address that deficit. This will hold true not only in rural American, but in many metropolitan and urban areas with lack of access to primary care. UnitedHealth Group’s report is as relevant to urban poor areas as it is to the rural hinterlands.

UnitedHealth Group’s report is well-timed in the context of the mind-numbing debt discussions in the U.S. The debt deal announced by Congress and President Obama on 1st August 2011 includes several key threads of health care impacts in the legislative language, which include but aren’t limited to Medicare and how providers will be paid. The deal as written as of 8/1 will also impact State governors, who are already hamstrung on how to cover expanding Medicaid rolls and growing demand for services.