Last Thursday, the Nashville Health Care Council, Leadership Health Care and Bipartisan Policy Center hosted the panel discussion “Solving the Rural Health Care Puzzle: National, State and Provider Perspectives” for more than 250 Council members at the Hilton Nashville Downtown. The sold-out event addressed rural health challenges including health disparities and the move to value-based over volume-based care.
Moderated by Bill Frist, M.D., former U.S. Senate Majority Leader and member of BPC’s Rural Health Task Force, the conversation included Alan Levine, executive chairman, president and CEO, Ballad Health; Sarah Chouinard, M.D., chief medical officer, Community Care of West Virginia; and Stuart C. McWhorter, commissioner, Tennessee Department of Finance & Administration.
View event photos on Flickr.
Photo credit: (c) 2020, Donn Jones.
Frist began the discussion by informing the audience that 60 million Americans live in rural areas – in fact, 93% of Tennessee is rural – and are at greater risk of dying from conditions like respiratory diseases, heart disease and cancer than those who live in urban and suburban communities. Rural communities also face an alarming rate of hospital closures, employee shortages and other geographic barriers to providing timely care.
“When you look at rural America, you see patients who are a lot sicker and older than those in urban areas. As a result, we have chronic illnesses that are less controlled and more severe. Layered on top of that now is the opioid epidemic,” said Chouinard. “I don’t think the solutions are hard. We don’t need expensive technology to solve this problem. We need boots on the ground people who are addressing issues like behavioral health and addiction.”
“There is the obvious problem of people who can’t afford their medications, don’t have transportation or food security,” said Levine. “The data shows the best solution for health care costs is to reduce poverty, which will close the racial and income disparity gaps and reduce the cost of health care long-term. Whatever we’re going to do to solve these issues will require patience, commitment and time.”
All panelists agreed that early intervention and pioneering initiatives are key to maintaining the health and well-being of rural communities. Levine cited plans Ballad Health is developing to focus on residential support for pregnant women who suffer from homelessness or addiction – providing treatment, prenatal care, parenting skills and other supports to help improve the likelihood for a healthy mom and baby. Chouinard referenced Community Care of West Virginia’s partnership to educate teachers about how to support students who have encountered adverse childhood experiences. McWhorter added Tennessee Gov. Bill Lee’s proposed K-12 Mental Health Trust Fund will place behavioral health support services in schools.
In addition to early intervention projects, the panel discussed how they are combating workforce shortages and economic development challenges.
“The opportunity we’re seeing is we have to bring new jobs and support existing industries in the rural parts of our state, and to do that we have to create more incentive,” said McWhorter. “You can’t draw people to these areas of the state unless there are benefits, and we have to make the investments in areas like health care, education and more. These foundational investments will change the trajectory for economic development.”
Panelists agreed that broader industry efforts to reform payment models are valid, but they’re often targeting urban health care cost centers and end up squeezing already challenged rural health care providers. They argued the unique challenges of rural health care call for solutions that are tailored to those communities.
To conclude, Frist asked panelists to share an optimistic outlook on the future of rural health. Chouinard reiterated the importance of motivated providers and grassroots efforts to go out in the field and solve problems. Levine and McWhorter expressed gratitude for state government officials and policies that carefully consider the individuals who need services and those who are paying for them.
The event was produced in partnership with the Bipartisan Policy Center (BPC). The BPC’s Rural Health Task Force will release recommendations aimed at improving the health and health care of the 60 million Americans living in rural communities this spring. The report will build on BPC’s 2018 report, Reinventing Rural Health Care: A Case Study of Seven Upper Midwest States, focusing on five key areas: 1) critical access hospitals, 2) workforce issues 3) payment reform, 4) telehealth, and 5) maternal health.