How to Address Access to Care in Rural America

Between 47-60M people in the U.S. live in rural areas. They are also, on average, 10.5 miles from the nearest hospital compared to 5.6 miles for those in suburban areas and 4.4 miles for those in urban areas.

Rural residents lack access to quality, primary and specialized care, have higher rates of chronic illness, and mortality, and higher healthcare costs. They’re also more likely to be uninsured and they face multiple barriers such as low income, lack of health literacy, and other SDoH factors such as lack of transportation.

“We see that members in rural areas based on geography, social capabilities, and financial needs don’t always have the same access to affordable, quality healthcare as those living in major cities and other areas but getting care to them is just as important,” according to André Loubier, SVP, Provider Experience and Network, CareCentrix.

With CMS’ push toward health equity and value-based care, payors are continually exploring ways to improve access to rural communities, close care gaps, prevent unnecessary post-acute care and hospital readmissions, and curb costs. Solutions in the home and at community retail pharmacies are increasingly filling a void, but more collaboration across the industry is needed.

Rural Healthcare Challenges

Physician and nursing shortages are widespread, but compared to urban areas, rural communities have fewer primary and specialty care physicians. In fact, only 10% of physicians practice in rural areas, and over 65% of primary care Health Professional Shortage Areas (HPSAs) are located in rural or partially rural areas, according to the American Hospital Association. 

Without enough providers, patients lack access to preventative care, vital screenings, and treatments.

Plus, many receive inappropriate care by heading to the emergency department, even for routine care. Between 2005 and 2016, visits to rural EDs increased 50%. “Unnecessary, over-utilization of the ED diverts care away from those who need it and taxes already over-burdened staff,” Loubier said.

While the home can address access issues, providers may find themselves driving up to an hour away to provide services. “Travel takes up a lot of time and providers have less opportunity to touch as many patients as they would like to,” he said.

Of course, the COVID-19 pandemic worsened existing home health staffing shortages and long-standing health inequities in rural communities. For example, delayed care and preventative health screenings have led to a rise in advanced cancer diagnoses. Plus, findings from a recent study in JAMA Health Forum suggest that wellness visits and preventive health screenings have not returned to pre-pandemic levels. 

Provider Network Strategy Designed for Rural Access

As payors look to improve access, close care gaps, and drive better outcomes in rural areas, home health and community resources must be a vital part of their network strategies. Ensuring that provider networks can be accessed by their member populations, regardless of location, and members can receive services and have an optimal experience comes down to three key areas:

1.    Evaluate the network

Building a provider network should consider the performance metrics and attributes that are most important to the payor, which can change over time. Reviewing claims data and provider performance on a regular basis can help evaluate and build a network from the bottom up, ensuring that they can provide the services members need.

“Payors can’t afford to let their provider networks get stagnant or stale,” according to Loubier. “They must constantly consider if the network is meeting the needs of their members and look at opportunities to grow the network or streamline it for higher utilization, more efficiency, and better partnerships. If there is growth or need in rural communities, updates to the network can’t wait.”

Offering virtual care options is also critical to ensure equitable access in rural communities. “Many times, members who come out of an acute care setting go to a caregiver’s home instead of their own, so ensuring they’re cared for wherever they are is important,” Loubier said.

2.    Prioritize whole-person care

For members living in rural areas, receiving preventative or follow-up care can be challenging. Therefore, when there is an opportunity to engage with these members, providers should be proactive and go above and beyond the standard of care and take a whole-person approach. Taking the time not only to address members’ clinical needs but also to understand their non-clinical needs including finances, transportation, and caregiver support, and barriers to care such as language, health literacy, and cultural factors is important. “The focus on health equity has changed the way payors view providers in their network,” Loubier said. “Providers who are servicing members in these rural areas have a better understanding of the community and can provide culturally competent care. This can help build trust and address SDoH in a sensitive way that maintains the member’s dignity.”

3.    Ensure timely, effective care

Since rural populations lack access to quality care, payors should include providers in their network that provide evidence-based, appropriate care and have proven outcomes. Payors must also ensure care is delivered at the right time to ensure continuity of care and prevent unnecessary readmissions. Therefore, they must have providers that can quickly start services after a hospital or SNF stay and have a process in place to validate that care has started. "Payors are always looking for ways to close care gaps, and working with a partner that has an extensive network of providers that deliver quality and timely care in the home is important,” says Loubier.

Collaboration Beyond the Home

CareCentrix and Walgreens are working together to address health disparities that exist in rural communities. CareCentrix works with payors to understand their populations’ needs, and contracts with home health agencies and providers to build a network that can reach rural markets, and provide quality, appropriate, timely care. We have 99%+ on-time starts of care and monitor and track our providers to validate that care has started.

Additionally, providers take a whole-person approach to care by identifying behavioral health and SDoH gaps, providing those insights to our health plan partners, and working together to address them.

Through Walgreens Virtual Healthcare, members meet with doctors or nurse practitioners via chat or video from the comfort of their homes. The solution offers treatment for general medicine, urgent care, women's and men’s health, skin health, and other common health needs. Members can also get their prescriptions filled at a pharmacy of their choice, including Walgreens or Walgreens Same-Day Prescription Delivery. Available in 9 states that encompass nearly 50% of the U.S. population, the service is quickly expanding.

With 78% of the U.S. population who live within 5 miles of a Walgreens location, hard-to-reach markets can be reached and members can get the care they need and deserve

Want to learn more about how CareCentrix and Walgreens are connecting members to care? Read some of our previous Connected to Care articles.