Collaborating With Rural Providers to Find Growth
There are insufficient options for rural Americans to access health care. Roughly 20% of the US population lives in rural areas, but only 10% of physicians work there. A recent survey asked 1,200 rural stakeholders their top health care priority—access was overwhelmingly the most frequently identified area of need. At the same time, larger health systems are often reluctant to pursue creative partnership options with rural hospitals, citing past experience with entrenched local politics and expectations for long-term goals of acquisition or financial support.
We believe the access challenge in rural communities presents an opportunity for the forward-thinking health system. Collaborating with rural providers to improve access to health care can benefit the mission and the bottom line of large health systems, as well as positively impact the health of rural communities and improve the financial sustainability of rural hospitals.
Creating a Win-Win Situation Is Key to Effective Collaboration
Sure, building multiple shiny new clinics across a rural market with 24/7 open access would no doubt make it easier for rural patients to access care. But that sounds expensive, and good luck finding the needed providers. The key to any collaboration is that it is a win-win for all parties involved. Below are 3 low-cost, high-impact collaboration options that dramatically improved access to care in rural communities and supported health systems’ strategic and mission-oriented goals.
CASE STUDY: PENINSULA REGIONAL MEDICAL CENTER AND LOWER SHORE CLINIC, SALISBURY, MD
- Problem: Peninsula Regional Medical Center, a 292-bed hospital, serves a large rural area. The hospital was struggling to keep rural patients with chronic diseases out of the ED and was being penalized for readmissions.
- Solution: Peninsula used $150K in grant funding from the state to partner with experts from a local, rural integrated primary care and behavioral health clinic, Lower Shore Clinic. Peninsula ED patients were too geographically dispersed to all be treated at Lower Shore on-site, so Lower Shore and Peninsula collaborated to create CareWrap, a high-touch care coordination program with dedicated providers.
- If patients opt in to the CareWrap program, an associate meets them while they are still in the Peninsula ED to start working together immediately.
- CareWrap participants receive frequent follow-up phone calls, home visits, referrals to primary care, transportation, medication education, and assistance with as many social determinants of health as possible.
- Results: 75% of CareWrap patients had no readmissions, 100% have regular primary care visits, and 90% reported they felt more confident managing their health care.
CASE STUDY: MERCY MEDICAL CENTER, DES MOINES, IA
- Problem: Mercy Medical Center receives transfers from its 18 facilities and from 48+ rural hospitals across the state. Other ED physicians call the Mercy ED looking for specialty consults regarding patients they believe need to be transferred. These interruptions were affecting Mercy ED productivity and slowing the process to evaluate and transfer appropriate patients.
- Solution: Mercy Transfer Center, which is staffed 24/7 by a dedicated nurse with 5+ years of experience in ED, was created to answer calls from rural hospitals evaluating patients for transfer.
- For both emergent and nonemergent cases, the transfer center leverages basic software to track physician/specialist and bed availability.
- Once a physician is identified, he or she calls the rural hospital back in 3 minutes to consult and determine if the patient needs to travel to Des Moines.
- A virtual health component is being considered as a next step for the program.
- Results: The Mercy marketing team has worked with rural hospitals to demonstrate ease of use with ONE central phone number to reach the transfer center, and rural hospitals have been receptive. Only patients with appropriate acuity are transferred, which benefits both Mercy Des Moines and the rural facility since more patients are able to be managed locally. In year one, the center created enough new revenue to cover the cost of software and dedicated staff, with more than $1 million in profit.
CASE STUDY: UNIVERSITY OF VIRGINIA (UVA) HEALTH SYSTEM, CHARLOTTESVILLE, VA
- Problem: The University of Virginia Health System believes academic medical centers have an obligation to support rural hospitals as part of its mission. Many of the rural hospitals in its markets are geographically dispersed within the Appalachian region with mountains and a national forest increasing travel times. Providers, especially specialists, needed an option to collaborate while keeping patients in their own communities for as much care as possible.
- Solution: UVA offers a rural virtual health program in partnership with rural providers, offering 60+ clinical subspecialties including: telestroke, diabetes remote monitoring, mental health, high-risk obstetrics care, and first-of-its-kind low-dose CT lung cancer screenings (CT scan at rural facility with a telemedicine encounter and the scan read remotely, with high-risk patients fast-tracked to UVA).
Some basic principles of the program:
- Make the model financially attractive for both parties. The site origination fees are not enough to sustain the program at the rural hospital, rather, focus on the ancillaries that can stay in the rural market (imaging, diagnostics), as well as keeping the patient local for as much care as possible, including hospitalizations.
- Do not compete with a local alternative. Services must be otherwise unavailable and viewed as an addition, not as competition.
- Invest in a deeper relationship between clinical and administrative teams with in-person training and education, as well as ongoing regular interaction.
- Ensure reliable infrastructure, both in the hospital/health system and in the rural provider sites.
- Results: Broad network of partner hospitals and clinic was created across the state. Rural hospitals have seen volume growth for ancillary services (eg, CT scans for low-dose lung screening) and UVA has seen an increase in appropriate, early referrals and feels more connected to the decision-making process when a transfer is needed. Most importantly, network participants are able to keep more patients in the community for programs like telestroke—the UVA rural hospital telestroke partner network has increased participants’ tissue plasminogen activator (tPA) use rate to match the UVA Health System ED. This process also has allowed more stroke patients to stay in the community and avoid stressful and time-consuming transfers.
Ready to Create Your Own Win-Win? Get Started With the Tips Below
- Treat rural partners like valued customers. Tailor programs to make it easy for them to work with you.
- Learn from the experts. Every health system should view working with rural hospitals and clinics as a learning opportunity. Born out of necessity, rural hospitals are innovative and efficient because they care so deeply about the communities they serve.
- Be proactive about assessing opportunities in rural markets. Remember, this is 20% of the US population, you can find growth opportunities by opening new access points.
- Be responsive. Rural hospitals will continue calling asking for help. Be prepared with a rural collaboration strategy.
We are continuing our research in rural health, including building a framework to evaluate and prioritize the ideal future for individual rural hospitals. If you would like to discuss this topic further, or if you have recently undertaken a planning initiative for a rural hospital, please reach out to me at firstname.lastname@example.org—we’d love to hear about your efforts in this important arena.
Sources: Beaton T. UVA cites success with telemedicine, telestroke in rural care. mHealth Intelligence. June 23, 2017; Bolin JN et al. Rural Healthy People 2020: Volume 1. Texas A&M Health Science Center, School of Public Health. 2015; Hostetter M and Klein S. In focus: reimagining rural health care. Transforming Care: Reporting on Health System Improvement. March 30, 2017; American Hospital Association Rural Health Care Leadership Conference. February 4–7, 2017, Phoenix, AZ; Sg2 Interview With Mercy Medical Center Des Moines, 2017; Texas A&M University Rural and Community Health Institute Survey, 2016; Sg2 Analysis, 2017.