The provider shortage in rural areas is not a new problem, but what could present a challenge are the estimated 5 million net rural residents who may join Medicaid and other insurance plans by 2019, in the wake of healthcare reform coverage expansion. And as efforts increase to expand access to broadband in rural areas, telemedicine should play a key role in the solution.
That forecast is among the findings and projections in the paper “Modernizing Rural Health Care: Coverage, Quality and Innovation,” from the UnitedHealth Center for Health Reform & Modernization.
“I think the big news for rural health executives is the significant mismatch between the coverage expansion and the available capacity,” Lewis Sandy, MD, senior vice president for clinical advancement at UnitedHealth Group, said in an interview. “In many locales across the country, the largest [coverage] expansions are in the very same places where there’s the biggest access shortage in terms of healthcare delivery, particularly in remote parts of the South and the West.”
According to the paper, although the 2014 coverage expansions will place increased pressure on rural healthcare delivery, a higher proportion of rural primary care physicians surveyed said they were currently accepting new Medicaid patients (84% vs. 65% of urban primary care physicians). However, the report also finds that around 11 million rural residents currently live in areas where primary care supply is relatively low but where the increase in the insured population will be particularly high.
“There are serious access issues today, and these are going to be severely impacting rural health residents beginning in 2014, so we better get started on working out what the solutions to that challenge will be,” Sandy said.
The solutions proposed in the paper include ones that are often discussed: improved physician recruitment and retention; better organization of care through medical homes and programs that take advantage of nurse practitioners, physician assistants, and community health workers; and telemedicine and remote monitoring tools. But, Sandy adds, “This is not your grandpa’s telemedicine.”