The promising future of rural healthcare, even amid the COVID-19 pandemic

Across the U.S., 174 rural hospitals have closed since 2005, and 47% of all rural hospitals have a 
negative operating margin. Yet, there is a promising future for rural healthcare. Reason for optimism has emerged, and ironically, the COVID-19 pandemic has enhanced it. 

In 2019, I helped host a landmark Rural Health Convening of the Mountain West states. The summit revealed great potential for strengthening rural healthcare nationwide and set in motion a public-private partnership with CMS that is pursuing that promise. 

Since then, three primary reasons to be optimistic have emerged, dramatically changing the prospects for rural healthcare. 

First, in August 2020, CMS announced a piloted model in 15 rural communities providing each up to $5 million to engage local stakeholders and state Medicaid programs in redesigning healthcare. This model includes improvements to care coordination and payments more aligned with patient outcomes rather than fee-for-service. CMS’ model is a vital initiative providing much-needed financial incentives to participating communities and crucial learnings for the nation. 

Second, healthcare systems can take some steps independent of the CMS model. At Intermountain Healthcare, we have initiated our approach to strengthening rural hospitals and are piloting it in central Utah. 

We reimagined primary care, with physicians paid on salary rather than fee-for-service and surrounded by a team of other providers who focus care on those who need it most. The team screens patients’ social needs and health conditions to determine if nonmedical factors, such as lack of adequate housing and food, are compromising their health. The team then connects patients to community resources and coordinates with other providers to ensure a unified approach. 

This type of coordination is vital because research shows that up to 60% of a person’s health outcomes is determined by nonmedical factors such as living and working conditions, social environment, economic situation and healthy behaviors. The remaining 40% is determined by genetics and the healthcare system. 

Maximizing population health requires the participation of those traditionally involved in providing healthcare and others who should be engaged further, such as schools, employers, grocery stores and social service providers. 

Third, and this is where COVID-19 enters the picture, telemedicine has transformed healthcare in America, especially in rural areas. COVID-19 made telemedicine essential, allowing patients to receive care without risking exposure to infection when traveling to a clinic or hospital, and healthcare providers to offer that care without risking exposure themselves. 

To enable telemedicine to fulfill this new role, the federal government expanded the list of covered telehealth services, eligible providers and care sites while relaxing privacy regulations. The impacts on rural healthcare are hard to overstate because they dramatically improve job opportunities and financial performance of hospitals in rural areas. 

The explosion of telehealth usage has spotlighted that internet connectivity is vital, akin to other utilities like water and electricity. It supports healthcare, educational and employment opportunities and an entry point to access community resources. The urgency of connecting communities during the pandemic has led to essential collaborations between health providers, local governments and businesses with federal support. 

For more than five years, Intermountain has been using telemedicine to keep patients in their communities and provide them access to medical specialists. One example is our tele-oncology program, where oncologists in metropolitan areas lead patient care at rural hospitals. The collaboration of tele-oncologists and rural caregivers allows patients to be screened, receive their care plan, treatments, and recovery at the local hospital where before they could not. The benefits are clear: a review of 150 patients found an average of $1,013 in savings per patient by avoiding travel-related expenses and $833 in savings per patient family in potential lost wages because they weren’t required to travel for care. 

Despite COVID-19—and in part because of it—the future of rural healthcare is brighter than it has been in a long time. The optimism that is now justified provides new momentum. It offers hope that can energize all stakeholders, especially those who call rural communities “home.” 


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