By Kelly Munson
National Rural Health Day (NRHD) is Nov. 21, and it’s a good opportunity to examine the current state of rural healthcare and new approaches to reduce the long-standing health inequalities between rural and urban America.
Rural Communities at Risk
In 2010, the National Organization of State Offices of Rural Health (NOSORH) created NRHD as a way to recognize the ongoing efforts, contributions and collaborations occurring in our country’s rural communities to address the unique challenges in accessing and delivering healthcare services.
Today, our country’s rural areas tend to be less racially and ethnically diverse than urban areas; experience a higher rate of poverty than urban communities; and tend to have older populations. In fact, rural counties are particularly attractive to seniors, so much so that 10 million people age 65 and older live in rural America.
Consequently, there are very specific healthcare needs associated with rural residents. According to the American Communities Project, healthcare in rural America is simply less accessible, with an additional 393 people per primary care physician than the national average.
Further, research shows:
- Fewer than half of rural women live within a 30-minute drive to a hospital with perinatal services, and over 10% have a drive of 100 miles or more;
- Access to substance abuse treatment in rural America is limited, as 92% of substance abuse treatment facilities are located in an urban setting;
- Residents in rural communities exhibit a greater risk of death from the five leading causes of death: heart disease, cancer, unintentional injury, chronic lower respiratory disease and stroke. They also experience higher suicide rates and have higher rates of fatal drug overdoses than urban communities.
Now is the time for organizations to step up and improve rural health by offering new, innovative ways to improve access to the care they so desperately need.
Alleviating Rural Health Issues with Community Paramedicine
One way to alleviate healthcare access issues in rural communities is through community paramedicine, a quickly evolving field where Emergency Medical Services (EMS) providers seek to reduce the use of EMS services for 911 calls, overcrowding emergency departments, and, subsequently, reduce healthcare costs.
Through the program, registered community paramedics work in expanded roles to provide primary healthcare, preventative services, monitoring and other out-of-hospital services. In rural areas, they help fill the gaps in the local care delivery systems due to shortages of physicians and long travel times to the nearest hospital or clinic.
WellCare is among the first managed care organizations to create a care management model around community paramedicine that serves Medicaid members in need. Through the model, WellCare deploys an integrated care team, including a community paramedic who visits rural areas to provide physical and behavioral health, lab draws and to assess the home for environmental health risks. The model is fully customizable and can be tailored to the needs of local communities.
WellCare has implemented two models for community paramedicine. The first relies on 9-1-1 calls to dispatch an EMS to a member’s home, and the second schedules appointments for the paramedic to visit a member. The latter is especially beneficial for serving members who are at high risk for hospital readmission or have multiple chronic conditions, allowing for regular follow ups to ensure the member is staying compliant and adherent to treatment plans.
Testament to this approach, an internal case study from the Manatee County community paramedicine program in Florida, showed a significant reduction in the number of ER visits and hospitalizations related to proper diabetes and congestive heart failure management. This innovative approach allows WellCare to increase healthcare quality and close care gaps in rural communities and improve member and provider satisfaction at the same time.
WellCare is Helping to Attract Healthcare Workers to Community Paramedicine
To recruit workers to the community paramedicine field, WellCare is turning to those who are intimately familiar with providing healthcare in challenging environments: medically trained military veterans or other transitioning military personnel. WellCare is recruiting and covering training and certification costs for these individuals, a win-win for filling staff needs, as well as addressing veteran employment challenges.
While we have made great strides toward improving rural healthcare with community paramedicine, there is still much work to be done. By continuing to foster innovative approaches and better care for rural Americans, we can make inroads in leveling the healthcare playing field not only on Rural Health Day, but every day.
Kelly Munson is WellCare’s Executive Vice President and Chief Medicaid Officer.