Help Rural Consumers and Fuel Growth With Virtual Health

Editor’s Note: Sg2 Director of Virtual Health and Technology Chris Pagano and Sg2 Principal Mark Larson contributed to this post.

People who live in rural markets across the US, about 20% of the population, struggle to access health care. Of rural counties, 77% are designated health provider shortage areas, and the problem is expected to get worse, as 30% of rural physicians are at or near retirement. While this problem may not be hugely surprising, the scale is still shocking, as illustrated by the table below.

This access issue is a call to action to rethink how you deploy the enormous value of your clinical expertise to better serve rural health care consumers, tap into available funding to meet this huge need, and leverage virtual visits to fuel downstream growth.

Segment Opportunities to Serve Rural Markets
Growth markets can be hard to find; however, Sg2 is forecasting 9% growth in outpatient demand in rural markets in the next 10 years, which is higher per capita than non-rural markets. Much of this projected demand is due to a higher percentage of older patients requiring chronic care management in rural areas.

In a previous blog post on improving rural access we explored partnership options for working with rural providers to help them better meet demand, today and tomorrow. Virtual health is one solution that can immediately and dramatically improve access, as well as provide backup to strained providers. However, successful execution requires a tailored approach to make the economics work for all parties, a shared commitment to rural stakeholders’ mission of comprehensive care for their communities, and the development of supportive relationships.

Four approaches (not mutually exclusive) health systems are using to connect virtually to rural consumers and providers are described in more depth below. These tactics will help virtual health planners to connect internal resources to the greatest unmet demand, while focusing on the opportunities that best complement existing strategic priorities.

1. Biggest Opportunity: Connect Specialists to Local Access Points

  • Partner with rural hospitals or providers to build this collaborative offering. Rural hospitals or physician offices are used as the originating site for a teleconsult with a remote specialist not otherwise available in the local market.
  • The value proposition for the rural partner centers on keeping as many services as possible (eg, labs, imaging, rehab) in the rural market. Without strong collaboration, these services are likely being provided outside the market when and where patients seek specialty care.
  • Use the Sg2 Market Demand Forecast to pinpoint procedures with high/growing demand and Sg2 claims data tools Ambulatory Market Strategist and Patient Flow to determine if demand is being met locally. (Please reach out to your account team if you need help accessing or using these tools on the Sg2 Analytics site.)
  • Case Example: Henry Ford Provides Presurgical Teleconsults:
    Henry Ford Health System (HFHS) has a dedicated team working with rural hospitals to explore a variety of partnerships. Through one such partnership, the HFHS urology department offers presurgical teleconsults to patients at a clinic in Escanaba, MI, 6 hours from HFHS’s main campus in Detroit. The urology clinic keeps the $36 originating site fee for the teleconsult and all revenue from imaging and diagnostics. At the same time, surgery referrals to Henry Ford have increased.

2. Treat High-Acuity Patients in Their Local Community

  • Build the internal infrastructure to provide support and higher-acuity care to supplement rural providers.
  • Services often include:
    • eEmergency—Provider-to-provider consults regarding high-acuity patients
    • eHospitalist—Virtual rounding and monitoring to relieve the burden on local hospitalists and primary care providers
    • Telestroke—Remote monitoring of tissue plasminogen activator (tPA) and patient evaluation for transfer
    • Behavioral Health—Virtual visits and virtual assessment tools
    • Pharmacy support
  • Rural (and other) hospitals pay membership/subscription fees to participate.
  • Leading academics (Mayo Clinic, Cleveland Clinic, Johns Hopkins Medicine) and incumbents with great track records working with rural hospitals (Avera Health, Mercy Virtual Care Center) do this on a large scale, but other organizations can carve out sufficient scale to compete locally.

3. Target Chronic Care Management

  • Target specific rural health need(s), which can frequently be supported through grant funding.
  • A broad geographic reach is often needed to create sufficient scale.
  • Initiatives can be either independent or in partnership with rural hospitals/providers.
  • This approach is most effective when it complements other value-based care initiatives.
  • Case Examples:
    • Aurora (WI) Clinical Contact Center—Delivers proactive chronic care management for patients identified as likely to be readmitted. Nurses provide virtual visits, medication refills and care coordination.
    • Telepsychology service for depressed elderly veterans across the rural Southeast—Therapists work virtually with patients to identify value-based activities, obstacles to performing these activities and strategies to overcome these obstacles.
    • Project ADEPT—Georgia Southern University provides diabetes self-management education virtually to clinics within East Georgia Healthcare Center. The goal is to educate patients to encourage behavior change.

4. Open Access to Low-Acuity Visits

  • This low-cost option can expand geographic reach and provide a foothold into new market(s).
  • A recent survey by an Sg2 member showed that rural consumers’ opinions about individual hospitals improve as the size of the hospital increases. Large hospitals and health systems can capitalize on this perception by marketing a virtual visit with their organization directly to rural consumers.
  • Federal legislation may change in the near future, expanding Medicare-approved originating sites for virtual visits to include patients’ homes.
  • This approach avoids the potentially challenging politics involved in collaborating with local hospitals and providers by going directly to consumers.

All of these virtual approaches may generate recurring or additional revenue beyond simply the virtual visit reimbursement. This will be critical in the short-term, as virtual visit reimbursement evolves. For any health systems working virtually with rural hospitals, providers and consumers, keep abreast of the key considerations below.

Key Considerations

  • The program’s goal is to keep appropriate patients in the community while facilitating a well-coordinated transfer as needed. Be prepared to show data that prove you are committed to keeping patients in their local communities.
  • Create a financial model for both the large health system (eg, increased downstream volumes) and the rural hospital (eg, increased imaging and labs).
  • Both parties need to invest in the relationship between providers and between administrative teams, as much as a traditional referral relationship. Relationship development is time-consuming and may limit the number and variety of projects that can be supported/launched concurrently.
  • When collaborating with rural providers any virtual health offering should complement services otherwise available in the market and avoid directly competing.
  • Recognize that broadband access will limit video visit options at rural hospitals and homes. Over 50% of rural Americans lack 25 Mbps bandwidth, which is the FCC benchmark for high-speed internet.

These considerations should help you narrow down the approach that works best for your organization given your market opportunities, existing relationships with rural hospitals, and your physicians’ interest in participating in virtual health.

Sources: National Conference of State Legislatures. Closing the Gaps in the Rural Primary Care Workforce. August 2011; Allen A. A hospital without patients. Politico: The Agenda. November 2017; Avera eCARE website. Accessed January 2018; Rural project examples: telehealth. Rural Health Information HubAccessed January 2018; About rural healthcare. National Rural Health Association. Accessed December 2017; Impact of Change®, 2017; OptumInsight, 2015; The following 2015 CMS Limited Data Sets (LDS): Carrier, Denominator, Home Health Agency, Hospice, Outpatient, Skilled Nursing Facility; Claritas Health Insurance Estimates Derived for Sg2, 2017; Claritas Pop-Facts®, 2017; Sg2 Analysis, 2017.

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