Dear Medicaid Directors, State Leaders, and other invested collaborators who were awarded Rural Health Transformation (RHT) Grant funding,
Your job is exhausting and tireless — you are seen and heard. From aging patient populations with chronic illnesses, co-morbidities, and rising homelessness to the math not always adding up in your favor on Medicare and Medicaid reimbursements, to struggles to recruit and retain health professionals when the nearest Target or movie theater is a two hour drive away, you regularly face hard questions with no easy answers. As someone who has been on the board of an Federally Qualified Health Center (FQHC), worked in health IT for decades, and served our U.S. government, I get how easy it would be for you to throw up your hands, pack your car, and head to greener pastures in the suburbs or metro areas. But, you don’t. You dig in and show up for your communities with compassion, ingenuity, and a problem solver’s mindset — often with very few resources at your disposal.
The new $50 billion in rural health transformation federal grant funding is a welcome jumpstart that will improve rural health equity gaps. This funding is a welcome opportunity to support the approximately 85 million Americans living in rural areas, who frequently need to travel 20-30 miles for primary care, but sometimes up to 100 miles or more for specialty care. Barriers like distance and access to specialty care often result in people skipping care, with fatal consequences — as noted in a Boston University Public Health article.
Below are five things that would be at the top of my wishlist if I were in your shoes, wondering how best to invest these funds in my community. While technology is a key area of investment, it doesn’t solve the problem — it enables the healthcare system to work significantly better. Health data exchange and interoperability allow for remote patient monitoring, hospital at home, and community-based organization collaborations, and should absolutely be a part of your strategy.
- Your state should work with healthcare providers to upgrade their Electronic Health Record— or the equivalent— and then pay to connect them to the state or local HIE. Data sharing is essential to keeping patients healthy and safe, facilitating their care wherever they go. Shoring up data exchange and making sure that broadband and cellular services are there to support this is equally important. States or grant recipients should be convening all important stakeholders around a state-wide interoperability roadmap using existing Health Information Exchanges (HIEs) and interoperability pathways. Many of these organizations already exist- there is no need to reinvent the wheel. Now is the time to connect into the broader network of providers, payers, labs, and other vital resources in your state.
- Workforce recruitment is a challenge, but advancements in telehealth can fill in those gaps. We often think of telehealth as a connection between clinician and patient, but telehealth can also be clinician to clinician, across great distances. With the right infrastructure, specialists can be present for procedures or consultations remotely. This additionally helps with cross-training and expanding the skillsets of rural health care providers. We also need to make sure clinicians can work at the top of their license and that state laws support that.
- AI is a topic all unto itself, but to keep things simple- one cannot have an AI strategy without first having a data strategy, and interoperability is the foundation of that data strategy. Rather than shop for AI solutions, determine your greatest business, operations, or patient compliance needs, and then see what kinds of success AI might have in solving those problems. The greatest AI successes we’re seeing in healthcare are related to document processing and assisting clinicians with drafted responses in their client portals for their review.
- Use funds to improve,upgrade and renovate clinical space to make it more efficient and conducive to different levels of care. Create clinically integrated networks that allow sharing of resources — especially medical equipment, technology and staff. These infrastructure improvements will allow for better and more efficient care of patients and reduce burden for providers.
- Look to expanded, community-based models of care. Food insecurity, transportation and housing vulnerability, mental health- these are all things that are often treated as the periphery of healthcare, but in reality are at its core. Establishing community-based referrals for food banks or programs with rideshare providers have made the world of difference in places like New York state, and can in yours too. Faith-based organizations, local schools, libraries, or other communal gathering spaces which are closer to people’s homes can become part of the connected fabric of care. It requires a technical infrastructure to support it, but is very much a worthy investment.
For too long, you have had to get by on little more than luck, pluck, and ingenuity. The rural health transformation program is not going to change the stark realities of the rural healthcare crisis overnight. But, it is a welcome start. And, with thoughtful and innovative uses of the funds, this beginning may turn out to be truly transformative. Looking back to outcomes of some prior government funded programs, in many cases, the intent was good, but the execution did not allow for a future path.
Let’s learn from those mistakes, and ensure this funding is invested to its fullest and greatest good. These are some things to think about as you and your state partners collaborate to improve the care and outcomes of your patients/citizens. I also anticipate the funding will help to alleviate your heaviest burdens. We all work in healthcare because we care about patients, and because we want to support health, happiness, and longevity for all.
My best and sincerest wishes to you in this pursuit — I am with you, here for you, and always cheering you on.
Author bio:
Lynda Rowe is a health IT consultant with more than two decades of senior-level experience spanning payers, health systems, vendors, start-ups, and the federal government, including roles at the CDC, InterSystems, Booz Allen Hamilton, and J2 Interactive where her work has centered on interoperability, value-based care, and data systems that support national public health infrastructure. A long-time advocate for underserved communities, Lynda has served on the board of a Federally Qualified Health Center for 20 years and brings that commitment to equity into her consulting practice and industry thought leadership.
Photo: Niyazz, Getty Images
