Organization of rural population Organization of rural population medical care and prospect of its medical care and prospect of its

developmentdevelopment

Economic Impact AnalysisJefferson County Hospitals

Direct Effects

Indirect Effects

Induced Effects

Total Effects

Employment Multiplier

15.12 2.84 5.12 23.12

Output Multiplier

1.00 0.21 0.36 1.57

Income

Multiplier

0.67 0.13 0.24 1.03

Rural residents seeking health care are◦ Older than urban residents◦ in poorer health than urban residents◦ more likely to be disabled◦ more likely to be uninsured◦ more likely to face financial barriers in obtaining

healthcare◦ more likely to incur travel burdens while seeking care◦ much less likely to receive services than are their urban

counterparts if they suffer from serious mental illness.

Rural is different

Why not let the market fix it?

• Specific barriers to mental health access– Service fragmentation– Transportation– Lack of cultural and linguistic competency– Medicaid enrollment– Stigma– Immigration status.

Rural is different

Southern Rural is Really Different

Average age rural physicians 45Primary Care

◦ See more patients◦ Are more likely to be in shortage

Only 10% of practicing physicians practice in a rural area Less likely to have evening and weekend hours

◦ Perceived to be of poorer quality◦ Communication challenges due to lack of cell or radio

coverage in some areas make things more difficult◦ Preventive procedures are often sacrificed as patients

and providers attend to more pressing medical issues.

Rural providers

Elevating care

Defining Access

• Conditions where timely early care would prevent hospitalization

• Patients with ambulatory sensitive conditions more likely to be hospitalized in rural America

Ambulatory sensitive conditions

JN Laditka, SB Laditka Health care access in rural areas: evidence that hospitalization for ambulatory care-sensitive conditions in the United States may increase with the level of rurality Health & Place Volume 15, Issue 3, September 2009, Pages 761-770

The phenomena of bypass

So why don’t we just fix it?

• Rural provider autonomy– Strict independence is no longer a success strategy

• Rural practice design– care management, team work, and interoperable

information technology require teams

• Low rural volumes– Need 5000 Medicare lives for an ACO, for example

• Historic rural efficiency– Cheap is not necessarily efficient

Barriers to system improvement

The March to Accountable Care Organizations—How Will Rural Fare? J Rural Health 2011

How does Virginia do?

Locating rural Virginia

Physician distribution

Mental health distribution

Pediatric care

Health care distribution

Elevating care

Defining Access

• Conditions where timely early care would prevent hospitalization

• Patients with ambulatory sensitive conditions more likely to be hospitalized in rural America

Ambulatory sensitive conditions

JN Laditka, SB Laditka Health care access in rural areas: evidence that hospitalization for ambulatory care-sensitive conditions in the United States may increase with the level of rurality Health & Place Volume 15, Issue 3, September 2009, Pages 761-770

The phenomena of bypass

Rural Access

Thank you!