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  The Health Record Review
by Frank Irving


Report Says Telemedicine and Telehealth Can Relieve Future Strain on Rural Healthcare

Posted on Wed, Jul 27, 2011 - 11:14 am

A report released July 27 by the UnitedHealth Center for Health Reform & Modernization states that rural Americans experience more chronic health conditions such as diabetes and heart disease than urban and suburban residents. The report also notes that consumers in rural areas have greater difficulties accessing high-quality care, and – in the near future – will be more likely to participate in Medicaid and government-subsidized insurance.

At the same time, according to the report, more use of technology -- such as broadband access that would increase telehealth solutions -- can help ease strain on the system and further promote healthier outcomes in rural communities.
The paper, titled “Modernizing Rural Health Care: Coverage, Quality and Innovation,” explores how health reform implementation, particularly health insurance expansion, will increase the need for innovative care models. It points to technology and a stronger role for rural primary care as promising solutions. It also reports the results of a new Harris Interactive survey of 2,000 patients and more than 1,000 primary physicians in rural and urban areas.
“The next few years will be times of considerable stress on rural health care, but also times of great opportunity, since across the country there are already impressive examples of high-quality care, tailored to the distinctive needs of the local community,” said Simon Stevens, UnitedHealth Group executive vice president and chairman of the UnitedHealth Center for Health Reform & Modernization. “The challenge for all involved in rural America now is to build on that track record of innovation and self-reliance, so as to ensure that all Americans…can live their lives to the healthiest and fullest extent possible.”
The report contains new projections showing that around 5 million rural residents may join Medicaid and other insurance plans as a result of the planned 2014 coverage expansions. That would represent a higher percentage increase than in urban areas. Already almost one-third of people in rural areas depend on Medicare and Medicaid, compared with one-quarter in urban areas.
Also, according to the report, more than half of rural primary care doctors said that patients they refer to specialty care have to travel an average of about 60 miles. And the 2014 coverage expansions will place increased pressure on rural care delivery. The good news for rural areas is that a higher proportion of rural primary care physicians surveyed said they were currently accepting new Medicaid patients (84 percent vs. 65 percent of urban primary care physicians). Looking forward to 2014, 59 percent of rural primary care doctor respondents plan on accepting new Medicaid patients, compared with only 44 percent of their urban counterparts.
However, the report also finds that around 11 million rural residents currently live in areas where primary care supply is relatively low but where the increase in the insured population will be high relative to other counties. Partly as a result, almost half of rural primary care physician respondents expect a primary care shortage over the next few years (compared with 37 percent of urban primary care doctors).
The report finds that both rural consumers and rural primary care physicians rate the quality of local care lower than do their urban and suburban counterparts. While nearly two-thirds (63 percent) of urban and suburban residents assess the quality of their local health care as “excellent” or “very good,” only half of rural residents do so (49 percent). Nearly a quarter (24 percent) of rural residents say their local care is only “fair” or “poor,” compared to 12 percent of urban and suburban residents who believe that. New data in the report also emphasize the need to improve health screening and preventive care in rural areas.
Given these challenges, the report conclude, there is an urgent need to deploy innovative new rural care models. Among the options called for in the report:
  • new incentives and reimbursement models for rural primary care physicians;
  • a bigger role for the currently active 24,000 rural nurse practitioners and physicians assistants;
  • greater provider collaboration across rural areas and with urban health care systems;
  • innovative models using mobile health clinics;
  • faster rural uptake of EHRs; well-designed market incentives for rural areas;
  • and greater engagement by rural consumers in improving their health.
The report recommends greater use of rural telemedicine and telehealth in the following areas:
  • expanding rural broadband connectivity to enable growth of telemedicine adoption;
  • improving and aligning reimbursement approaches across payers to encourage greater use of telemedicine across rural settings;
  • improving availability of telemedicine technologies to consumers; and
  • reducing regulatory barriers to use of telemedicine technologies and health professionals.
Photo by Nicholas_T courtesy of Creative Commons license.