Why Rural Communities Benefit Most from Value-Based Care

Rural Communities Benefit Most from Value-Based Care

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The 2020 census shows that 46 million people, about 14 percent of the USA’s population, live in rural America. With the increasing shortage of primary care physicians, rural Americans are underserved in healthcare.

To meet these concerns, the National Association of Rural Health Clinics Program (NARHC) was developed by the federal government. The main focus was to address more effectively the Medicare and Medicaid recipients residing in rural areas by encouraging physician assistants and nurse practitioners to work in better collaboration. Around 4,413 federally certified Rural Health Clinics (RHCs) are providing primary care services in 47 states—furthermore, the association advocates for the needs of Rural Health Clinics in policy making.

Understanding Rural Dynamics

There is a vast contrast between urban and rural lifestyles that reflects on their problems and advantages. The healthcare system in rural areas has its unique elements.

These unique elements speak of the need for Value-Based care, much more than in urban settings. 

Demographics and Traditions

Rural populations, despite being sparsely located, tend to have strong cultures of community. These close-knit relationships foster strong beliefs and convictions, even towards their healthcare, that are often challenged by the logistics of the environment.

  • The health facilities are usually situated at a considerable distance and are not easily accessible
  • These facilities most likely do not have specialists and they usually make do with a general practitioner.
  • In rural communities, there tend to be common health challenges due to lifestyles that include physically taxing occupations and less healthy diets.
  • Household net incomes in rural areas are roughly 4% lower than those in urban areas, and approximately 13.3% of families live below the official poverty threshold.
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How Value-Based Care Works For The Rural Population

Value-based care (VBC) is a proactive and preventive care model that fulfills the unique and challenging needs of the rural population.

  • VBC manages chronic disease patients and prevents ER visits and hospitalization.
  • The VBC approach administers and focuses on more targeted and efficient healthcare interventions to address a rural community’s most pressing healthcare problems.
  • Routine check-ups and screening can identify a foreseeable disease that can be treated right away by the provider at the RHC.
  • This early intervention spares the patient the expanse of commuting to cities and consulting the specialists, not to mention, the deterioration of health and suffering.
  • Value-Based care is an integrated process of care collaborators. In rural settings, nurses play a vital role in engaging patients and their families for health education and awareness.

How Value-Based Care Works For The Rural Provider

  • The traditional Fee-For-Service model can be beneficial monetarily for the provider working in densely populated areas like big cities but may not be financially viable in rural settings where the physical area is wide but the population is less.
  • A  rural provider working with a physician assistant and a nurse, who is doing the preliminary and routine examination of a patient, saves a lot of time for the provider to see more patients in less time.
  • In rural communities, the resources are limited, and Value-based care encourages providers to deliver cost-effective care while maintaining quality. By focusing on outcomes and efficiency, Value-Based care helps ensure that limited resources are used optimally to benefit the community.
  • Technology is one of the tools that VBS uses. Telemedicine or virtual visits serve greatly in rural communities, considering their geographic challenges, making it easier for patients and providers.
  • In a value-based care model, healthcare providers have the opportunity to listen to patients’ concerns, and address and engage in discussions about disease prevention. This aspect enhances the human touch element.
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Value-Based Care In Rural Communities; Progressive Figures

At the NAACO’s Fall Conference 2023, challenges shared for healthcare in a rural structure included staff/provider shortages, lack of specialists, transportation, maintaining the care team, lack of post-acute care options, and fragmented and insufficient resources. Best practices for serving this population reflect leveraging both technology and leading-edge care approaches.

Dr Richard Cole of Patrick County Family Practice (a private healthcare practice) presented some facts and figures on the efficacy of enrolling in an ACO program.

The situation before joining the ACO program their all-inclusive billing rate [AIR] was $87, which gave them no incentive to do the annual wellness visit [AWV] at $87 per visit.

They were the only facility in the whole county. So they had to increase their service hours and later on, had to open an ‘urgent care clinic’ to meet the needs of the community.

Due to the workload, they didn’t and could not pay attention to the quality measures.

Things gradually changed for them for the better after they joined the ACO program.

To effectively launch the Patrick County ACO effort, they focused on the following:

  •    Instruction
  •    Education
  •     Accurate codes and analytics

They were able to

  •  Increase their annual wellness visits
  •  Add three nurses for chronic care management
  •  Become well-trained for Transitional Care Management
  •  Improve their end-of-life program

They adapted so well to the ACO program that they have shared savings yearly and were the second highest in the county.

Dr. Cole also shared his future concerns as well including

  • Hiring physicians for longer periods as living in rural settings is not everyone’s preference
  • Achieving better and increased broadband, as telemedicine can’t work if there is not a good internet connection
  • Controlling costs into the future as wage expectations and inflationary pressures continue
  • Engaging with specialists
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Patrick County is one of the many examples where we can see that Value-Based care has great potential to bring about positive changes in rural healthcare, but for that, it’s essential to consider the unique characteristics and challenges of each community when implementing such models. Successful adoption requires collaboration among healthcare providers, payers, and community stakeholders to create a system that is responsive to the specific needs of the rural population.

https://www.ers.usda.gov/webdocs/publications/102576/eib-230.pdf

https://www.narhc.org/narhc/ESX_About_Us_2.asp

https://www.ruralhealth.us/blogs/ruralhealthvoices/october-2018/why-rural-health-care-providers-should-invest-in-v

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