Access to healthcare in rural settings is a true challenge. Americans living in rural areas are more likely to die from five leading causes than their urban counterparts. How should we be thinking about and addressing this issue?

Nannette Sloan,  former Vice President, Compliance, Medecision

When Nannette Sloan moved from an urban area to a rural community, access to care suddenly became a very real and troubling challenge that affected her personally, not just a professional concern.

“As a new patient, I couldn’t even find a doctor. They offered me an appointment several months out in the hopes that the clinic would get a new doctor. But I needed a doctor right away,” said Sloan, who served as Vice President, Compliance at Medecision.

The challenges surrounding access to care became even more glaring as Sloan heard of the daily struggles that family, friends and community members were dealing with. “I know people in this community who are heart patients and diabetics, and their doctors are ‘revolving’ doctors. How can they receive quality care when they are starting over with a new doctor all the time?” Sloan said.

Access to specialists is even more troubling. “There are very few specialists in this town. If you fall and break your shoulder, the hip doctor is likely to work on it. We also have a large number of diabetic patients and there are no kidney doctors in the area,” Sloan said.

And emergency situations can be disconcerting as well. “When patients have a stroke, they are transferred to the nearest large city, which is over an hour away. If their family doesn’t have transportation, they might wind up being in the hospital alone without any support,” Sloan said.

Seeing these challenges up-close has made access to care in rural communities a hot button issue for Sloan. The fact that Centers for Disease Control and Prevention (CDC) research shows that Americans living in rural areas are more likely to die from five leading causes than their urban counterparts should make the issue resonate with other leaders as well. The study shows that many deaths among rural Americans were potentially preventable, including 25,000 from heart disease, 19,000 from cancer, 12,000 from unintentional injuries, 11,000 from chronic lower respiratory disease, and 4,000 from stroke.1

“I’m shocked that people haven’t thought about rural access challenges more — and, I admit, I was one of those individuals who never thought about it until it affected me personally. Healthcare leaders always say they want access for everyone, but that has to include access for everyone in rural areas, not just access to care for people who live in big cities,” Sloan said, as she pointed out the need for large organizations such as pharmaceutical companies and medical schools to create partnerships with rural communities in an effort to bring more clinicians to remote areas.

Health plans also can help by enhancing access through the innovative use of technology as well as improved care management. For example, health plans could use telecommunications applications such as Skype to enable members to conduct online conferences with care managers and providers. Real-time monitoring devices also could help.

“Blood pressure cuffs, for example, could be used to monitor the blood pressure remotely and all that data could then can be downloaded and shared with physicians or nurses,” Sloan said. Mobile clinics equipped with MRI technologies and other FDA compliant devices could also be leveraged to collect and share data with clinicians, who could then manage care remotely.

Overcoming technical difficulties

Health plans, however, need to ensure that members are comfortable using technology. A health plan might want to “sponsor a community event to show rural community members how to use their phone with a Skype app and how that could help them communicate with doctors who are located in urban areas. I see a lot of flip phones around here and I know a lot of people that still don’t have mobile devices, so education is a huge factor,” Sloan said.

Health plans also need to help members overcome the connectivity challenges that commonly plague rural communities. “It might be possible to set up a strong, secure network connection in a community center where members could come weekly to conduct online sessions with their care providers. It could be set up in a private room where they could have their privacy and be in alignment with HIPAA too,” Sloan suggested.

While it is important to empower members to optimally leverage technologies, health insurers also need to integrate the data that these technologies produce with existing records. By doing so, plans can create the 360-degree view of member health needed for improved care management. A system such as Medecision’s Aerial™ can integrate this information to provide all care team members with a shareable 360-degree, dynamic, longitudinal patient health record, which provides quick insight into key quality metrics, medications, ED and hospital visits, and more. In addition, Aerial InCircle™, a social-mobile platform from Medecision, can connect everyone in a member’s trusted health circle – physicians, caregivers and trusted family and friends – and enable them to access real-time information about a member’s health and participate in meaningful, context-specific conversations.

“Care coordination is crucial,” Sloan concluded. “If a care manager could access all of the data collected from remote devices as well as information contained in the medical record, then they can have better insight into a member’s health situation and could help the member better manage conditions.”

1 Centers for Disease Control and Prevention. Rural Americans at Risk of Death from Five Leading Causes.

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