Braving the wilderness: Tackling remote care in rural areas

Rural healthcare in the US

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Rural health is the health of people living in rural areas, who are generally located farther from healthcare facilities and other services than people living in urban areas. Rural Americans are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease and stroke than their urban counterparts. And rural Americans often are at greater risk for poor health outcomes for a wide variety of reasons, but access to care in rural communities - or more remote areas -  is one of the greatest barriers to better health.1 Rural areas face more healthcare issues - primarily healthcare access related, but also because of cultural and health behavior differences, access to food, poverty and significant physician shortages. More doctors are needed in rural areas because rural residents tend to be older, poorer and sicker. Older patients in general have at least two to three more comorbidities, so they already need more doctors and more care.2 The complexities of access to rural health care are even worse for older patients - patients that often have more co-morbidities and even greater barriers to accessing difficult to reach care. And with more and more baby boomers aging into their 60’s and above, this population is growing and their healthcare needs are increasing. Add the rural physician and provider shortages, and access to care is even more complex. The physician shortages and the aging rural population is a very concerning combination. Patients in rural communities would benefit from remote care programs to supplement and support their in-person care. 

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Rural Americans are facing several unique challenges

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Medicare patients in rural areas

Rural America is continuing to get older, which impacts the number of seniors needing to access medical care in these areas. A report from the US Department of Agriculture shows that over 20% or rural residents are over 65, compared to 16% in urban areas. 1 in 5 rural residents is over 65. As expected, the fall in the working age population in rural areas is happening too.3,4  The aging baby boomer population is driving the increasing numbers of Medicare beneficiaries and fewer workers, impacting access to care and also provider shortages as the demand grows and more providers retire in rural areas which already had a provider deficit,  as well as everywhere else. Read more on the impact of aging baby boomers on the demand for senior care. It’s a struggle to find providers and to find caregivers in rural areas. CMS cites more than 61 million Americans live in rural areas.5 In 2023, more than 1.8 million Medicare beneficiaries were enrolled in a Medicare Advantage plan, more than four times the number enrolled in 2010 (400,000).6 More aging folks over 65 in rural areas, and the growth in Medicare enrollment translates into an average enrollment growth increase of 12% in rural areas compared to 8% in metropolitan areas between 2010 and 2023. 6 

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RHCs in the US

According to the Center for Medicare and Medicaid Services (CMS), rural health clinics (RHCs) were established in 1977 to get healthcare access to Medicare patients in rural areas across the U.S. - including access to physicians, nurse practitioners, physician assistants, clinical psychologists and more.  

RHC facilities focus on providing both primary care and preventive care to Medicare patients across the rural US.7

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To qualify as a rural health clinic, facilities must:

• Be located in non-urbanized area as defined by the US Census Bureau
• Employ at least one nurse practitioner or physician’s assistant
• Have a nurse practitioner, physician’s assistant or nurse midwife working at least half the time the clinic is open
• Offer routine diagnostic services and more 7

These requirements reflect the absolute bare minimum in providers and access. And even for these minimal provider hours, provider availability and access remain a huge problem for RHCs. 

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There are over 5,200 active RHCs across the US (hundreds more that are inactive).7  A 2023 National Association of Rural Health Clinics (NARHC) survey found that 60% of rural Americans are served by RHCs. (The survey was conducted to better understand the impact of clinics on patients served.) While the survey response rate was limited, overall they were able to determine that the RHC program serves 37.7 million patients per year which is over 60% of the 61 million Americans living in rural areas. 8

Rural Americans face several unique challenges. Rural residents tend to be older and poorer than their urban peers, and rural communities often face extra challenges with access to care, financial viability and the important link between healthcare and economic development, which continues the cycle. 9

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Biggest issues and barriers to rural care: ACCESS 

Access is the core issue for providing or getting care in rural areas in the United States. It’s harder for people to get any healthcare in rural areas. The main healthcare problem in rural areas is access to care, which causes many problems for patients and caregivers living in rural or remote settings.10

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Access in rural care:

Provider shortages

Distance and travel burdens

Rural communities’ health status and health disparities 

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Provider shortages

The shortage of doctors/providers in rural areas (shortage of clinics in these areas too) is profound. Shortages are even worse for specialists and sub-specialty care in these settings.  Many Medicare patients require complex, specialty care in addition to well managed primary care for chronic conditions. There are hundreds of inactive RHCs and not enough providers to serve the number of people in need of care. Right now, it looks like the shortages will continue to worsen. As provider shortages and fewer facilities increase, the distances to operating clinics may become even greater if clinics have to continue to close or consolidate resources due to not enough providers for each clinic. 

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Distance & the resulting Travel burdens  

Greater Distances

Patients must travel long distances to access care. As clinics close and don’t have enough providers, this distance can grow exponentially and sometimes patients are dealing with vast geographic areas. This can be even worse for older patients as they often can not drive those distances themselves, and need someone to take them. 9,11

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Travel time and costs 

With great distances, patients have the added costs of travel and possible lodging, as well as time away from home and responsibilities. This often results in more costs and income loss. Problems with access to reliable transportation or patients unable to transport themselves face increased barriers and costs too.11 

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Rural health disparities and the impact on health status 10

Less access contributes to poor management of health conditions, and more uncontrolled, often chronic health conditions - e.g. high blood pressure, obesity, heart disease, diabetes, etc. which require care and management, and typically is already increased in this population. Even for Patients with better access and (better) chronic disease management. Also, rural areas show statistically higher rates of smoking, substance use and substance mis-use making health care access, support and management are even more important. 9,10 

All of this  - provider shortages, distances, costs and rural health disparities - all lead to poor outcomes and few options.  

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Hope on the horizon

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Rural medical programs are increasing

There is some hope on the horizon. New programs are springing up to incentivize medical students to go into primary care in rural areas, and rural health programs are available in some medical schools. Rural areas comprise about two-thirds of the primary care health professional shortage areas nationwide, even though only 20% of Americans live in rural areas. The problem is only going to worsen, which will increase the costs of care and decrease health outcomes. Projections indicate that the United States likely will suffer a shortage between 17,000 and 48,000 PCPs by 2034.12 PCPs in rural areas struggle to find and retain staff, negotiate with insurance companies and prevent burnout. 

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Medical Schools are increasing rural primary care residency matches and are adding rural health tracks - The Swedish Cherry Hill rural program in Washington State, for example, and 32 newly accredited programs received support last year -  and training patients in more rural areas from the onset  - some examples include the Tufts School of Medicine (usually Boston based) MaineTrack MD program which has graduated 10 classes of students trained in Maine, and The University of Washington Medical School now has a campus in Eastern Washington as well as the Seattle campus. As a result, an increasing number of students are now entering medical school programs that focus on rural medicine.12  Also, remote care programs can have a profound impact on so many of the issues causing problems for the growing number of older patients in rural areas needing more care. And can be effective almost immediately. - but the provider shortages are already dire and the existing providers are already burnt out.

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Remote care programs can help patients in remote and rural communities

Better access to care 

Improved continuous and holistic care

Better outcomes

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Remote care management helps alleviate many of the problems and concerns about access to care, the amount of care, the specificity of care and poor outcomes for older patients living in remote or rural communities throughout the US.   With remote care management, patients from rural and remote communities can benefit from more care, better and more comprehensive care, and a consistent and trusted point person delivering that care. Comprehensive, holistic care yields improvements in trust, patient satisfaction, provider satisfaction, the effectiveness and quality of the care delivered, compliance and better health outcomes. More care, better care, holistic and consistent care make the experience more efficient and effective for patients, caregivers and providers alike. 

Being able to access the range of remote care solutions can improve access, satisfaction, quality of care, efficiency of the experience and care, the effectiveness of care, the quality of care and health outcomes. The ability to connect and have an ongoing relationship with a provider, creates deeper connections and trust. When you remove the barriers of access, time and the need to travel - patients living in rural communities can have better healthcare and health outcomes while they get more consistent, comprehensive, thoughtful care with remote care programs and solutions.

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Care and connection lead to better health outcomes

Remote care can fill the access gap with more frequent care, and a provider who can consistently provide that care and build a trusting relationship with the patient and their caregiver. With a dedicated care partner who will regularly check in with patients and monitor their health markers, patients then have someone to answer questions, have a more consistent picture of their health, and more chance of help in an emergency - or at least someone to call to assess and triage a situation immediately, even if they can’t get to a clinic or hospital right away. With remote care, rural patients can get better care without all the barriers, challenges, inconvenience and difficulties associated with getting to the clinics. Reducing barriers and increasing care - with a trusted provider with whom the patient feels the benefits of being known and having a relationship -  often improves patient compliance and buy-in, which in turn improves health outcomes.  

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Reimagine the delivery of rural health care for patients in remote locations 

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Superior Technology

Staffing Solutions

Collaborative Partnership

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Medsien can be a partner for practices and health care organizations in rural communities. Working together using our superior technology and staffing solutions, Medsien’s remote care solutions can help rural clinics and providers deliver remarkable remote care management - while relieving many of the burdens of rural clinics, providers and patients living in rural communities. 

Our technology connects providers and keeps everyone up to date and on the same page while relieving the care burden on clinic providers - while ensuring high quality, efficient, and effective care, and increasing patient health outcomes.

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Our staffing solutions offer a personal connection, a trusted advisor and an ongoing care manager to alleviate the care burden on overworked staff. We deliver personalized, high-quality care to patients without any of the burdens of travel to and from clinics and related costs. With Medsien remote care’s staffing solutions, patients can be known and seen quickly, easily and quite regularly. 

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We work together as operational and clinical partners making sure that seniors in remote, rural communities are receiving superior care.  We are not a third-party vendor simply offering EHR integration software.  We are a partner to RHCs and other practices - working seamlessly together to build and scale remote care programs quickly and effectively.  

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Medsien remote care management solutions increase the efficiency, effectiveness, quality and satisfaction with patient care.  All while offering support, connection and improving the health status and health outcomes of aging seniors in rural communities. Learn more about Medsien

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Citations & Sources:

1. https://www.cdc.gov/ruralhealth/about.html#:~:text=Rural%20Americans%20are%20more%20likely,stroke%20than%20their%20urban%20counterparts.
2. https://dailyyonder.com/rural-news/health/
3. https://kffhealthnews.org/morning-breakout/us-rural-populations-are-skewing-older-1-in-5-is-over-65/#:~:text=A%20report%20from%20the%20U.S.,age%20population%20is%20also%20happening.
4. The US Department of Agriculture’s annual Rural America at a Glance Report
5. www.cms.gov/priorities/health-equitey/rural-health
6. https://www.kff.org/medicare/issue-brief/medicare-advantage-enrollment-plan-availability-and-premiums-in-rural-areas/#:~:text=In%202023%2C%20more%20than%201.8,enrolled%20in%202010%20(400%2C000).
7. https://www.definitivehc.com/resources/healthcare-insights/top-25-rural-health-clinics-total-visits#:~:text=Definitive%20Healthcare%20tracks%20over%206%2C000,of%20which%20are%20currently%20active.
8. https://www.narhc.org/News/29910/Sixty-Percent-of-Rural-Americans-Served-by-Rural-Health-Clinics#:~:text=%E2%80%9CWe%2520know%2520that%2520there%2520are,Baugh%252C%2520Executive%2520Director%2520of%2520NARHC (NARHC 2023 Survey)
9. www.cms.gov/priorities/health-equitey/rural-health
10. https://medlineplus.gov/ruralhealthconcerns.html#:~:text=Less%20access%20to%20health%20care,high%20blood%20pressure%20and%20obesity.
11. healthinfo.org/topics/rural-health-clinics/organizations
12. https://abcnews.go.com/Health/staff-longer-delays-fewer-options-rural-america-confronts/story?id=97911613#:~:text=Rural%20areas%20comprise%20about%20two,likely%20to%20worsen%20over%20time.  [ABC news & embedded sources]

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