Rural health models in the age of COVID-19

While the Affordable Care Act and Medicaid expansion ensured health insurance for many U.S. citizens, rural areas still suffer from a unique set of healthcare challenges such as economic burdens, high rates of chronic illness, and insufficient access to providers. These issues have only intensified with COVID-19 depleting rural health resources at an alarming rate. 

With over 120 rural hospitals closing over the past decade and more than 40% operating at a negative margin, health leaders are tasked with implementing new strategies to address rural health deficiencies.

A model for change

The availability of rural hospitals is more vital now than ever before as organizations navigate the coronavirus pandemic. Rural facilities can alleviate major hospital patient overflow, and be utilized for initial triage and recovery care. 

One state on the cutting edge of making rural health improvements is Pennsylvania. Created in 2019 with five participating hospitals, the Pennsylvania Rural Health Model aims to help rural hospitals stay open and offer access to healthcare and jobs for the surrounding communities. 

The PA Rural Health Model is the third state specific model being tested by the CMS Innovation Center. Under the program, major healthcare payers, including Medicare and Medicaid, pay participating hospitals a fixed amount annually instead of when the service is rendered. This covers all inpatient and hospital-based outpatient items and services. By implementing an alternative payment model, transitioning hospitals from a fee-for-service model to a predictable global budget payment is strengthening the financial viability of hospitals to improve health outcomes and maintain continued access to care.

In addition to providing hospitals financial security, Wayne Memorial Hospital CEO David Hoff said savings should be generated to invest in more preventive care and education. 

“The intent is also to help hospitals transform over a six-year period of time to invest more in preventive care with the ‘extra money’ or savings that should be generated,” said Hoff in a statement on the Wayne Memorial website. “Hospitals could use a portion of that stable income to fund health initiatives, such as vaccinations, or work in collaboration with others to address issues like lack of transportation or create programs for patients with chronic obstructive pulmonary disease.” 

Participants in the model can trial innovative methods of care since they operate at a smaller scale. Endless Mountains Health Systems is deploying its personnel in new ways as shared by CEO Loren Stone with Pew. Some of these efforts include monitoring patients in their homes, helping them with transportation to medical appointments, and providing health education to cardiopulmonary patients, with plans to expand this to diabetes and heart disease patients. 

As part of their Rural Hospital Transformation Plans, Endless Mountains and other hospitals can invest in quality and coordinated care, obtaining support and continuous feedback from stakeholders in the community and tailoring the services they provide to their needs. 

Nationwide results and looking ahead

While The CARES Act is providing financial aid and flexibility for rural hospitals, The National Rural Health Association is requesting more government resources, such as cash assistance and no-interest loans, to help rural hospitals survive while combating the impact of COVID-19. Initiatives like the Pennsylvania Rural Health Model can ensure a future for rural health, and innovation in key areas such as telehealth is essential as virtual care becomes a necessity. 

The Federal Centers for Medicare and Medicaid Services support the PA Model and investing in other states can empower healthcare systems across the country to make similar improvements during these critical times. CMS has provided $96 million in loans to help establish rural health networks called accountable care organizations (ACOs), which have the purpose of concentrating the delivery and financing of healthcare. 

The investment also focuses on creating data and analytics to help providers achieve better health outcomes at lower costs. The results have been positive thus far, saving Medicare $262 million and decreasing hospitalizations, readmissions, and emergency room visits.

With Pennsylvania anticipating up to 30 more participating hospitals in the near future, the state serves as an exemplary model of transforming rural healthcare. Communities need their rural hospitals now more than ever, and initiatives such as the Pennsylvania Rural Health Model show the importance of having a strong infrastructure in place.