Practical Roadmap toward 21st century rural health care for more than 50 million Americans

• Projects an increase of around 5 million newly insured rural residents by 2019 – even as the number of physicians in rural America lags
• Quality of care is rated lower in rural areas in 7 out of every 10 health care markets; both physicians and consumers in rural areas more likely to rate quality of care lower than those in urban and suburban markets
• Innovations in care delivery – particularly telemedicine and telehealth – can absorb future strain on rural health care systems

Rural Americans experience more chronic health conditions such as diabetes and heart disease than urban and suburban residents, have greater difficulties accessing high-quality care, and from 2014 millions more of them will likely participate in Medicaid and government-subsidized insurance, according to a new paper released today by the UnitedHealth Center for Health Reform & Modernization. 

At the same time, more use of technology, such as broadband access that would increase telehealth solutions, can help ease strain on the system and further promote healthier outcomes in rural communities.

The paper, titled “Modernizing Rural Health Care: Coverage, Quality and Innovation,” explores how health reform implementation, particularly health insurance expansion, will increase the need for innovative care models and points to technology and a stronger role for rural primary care as promising solutions. It also reports the results of a new Harris Interactive survey of 2,000 patients and more than 1,000 primary physicians in rural and urban areas.

“The next few years will be times of considerable stress on rural health care, but also times of great opportunity, since across the country there are already impressive examples of high-quality care, tailored to the distinctive needs of the local community,” said Simon Stevens, UnitedHealth Group executive vice president and chairman of the UnitedHealth Center for Health Reform & Modernization. “The challenge for all involved in rural America now is to build on that track record of innovation and self-reliance, so as to ensure that all Americans – wherever they live – can live their lives to the healthiest and fullest extent possible.”

The new report includes new findings on coverage, access and quality, as well as detailed suggestions for improvement:

Rural coverage: The report contains new projections showing that around 5 million rural residents may join Medicaid and other insurance plans as a result of the planned 2014 coverage expansions – which would represent a higher percentage increase than in urban areas. Already almost one-third of people in rural areas depend on Medicare and Medicaid, compared with one-quarter in urban areas.

Rural access: Coverage is not the same as access to high-quality care. More than half of rural primary care doctors report that patients they refer to specialty care have to travel an average of about 60 miles. Furthermore, the 2014 coverage expansions will place increased pressure on rural care delivery. The good news for rural areas is that a higher proportion of rural primary care physicians surveyed said they were currently accepting new Medicaid patients (84 percent vs. 65 percent of urban primary care physicians). And looking forward to 2014, 59 percent of rural primary care doctor respondents plan on accepting new Medicaid patients, compared with only 44 percent of their urban counterparts. 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 high relative to other counties. Partly as a result, almost half of rural primary care physician respondents expect a primary care shortage over the next few years (compared with 37 percent of urban primary care doctors). 

Rural care quality: The report finds that both rural consumers and rural primary care physicians rate the quality of local care lower than do their urban and suburban counterparts. While nearly two-thirds (63 percent) of urban and suburban residents assess the quality of their local health care as ‘excellent’ or ‘very good,’ only half of rural residents do so (49 percent). Nearly a quarter (24 percent) of rural residents say their local care is only ‘fair’ or ‘poor,’ compared to 12 percent of urban and suburban residents who believe that. New data in the report also pinpoint the need to improve health screening and preventive care in rural areas.

Practical Solutions: Given these challenges, there is an urgent need to deploy at scale innovative new rural care models. The working paper identifies a range of options, drawing on successful private and public examples in particular parts of the country. The report goes on to call for: new incentives and reimbursement models for rural primary care physicians; a bigger role for the 24,000 rural nurse practitioners and physicians assistants; greater provider collaboration across rural areas and with urban health care systems; innovative models using mobile health clinics; faster rural uptake of electronic health records; well-designed market incentives for rural areas; and greater engagement by rural consumers in improving their health. The paper offers several concrete steps to promote greater use of rural telemedicine and telehealth: 

• expanding rural broadband connectivity to enable growth of telemedicine adoption;
• improving and aligning reimbursement approaches across payers to encourage greater use of telemedicine across rural settings;
• Improving availability of telemedicine technologies to consumers; and
• Reducing regulatory barriers to use of telemedicine technologies and health professionals.

via http://www.unitedhealthgroup.com

Urges infusion of Health IT to support health care delivery and consumer purchasing

“We appreciate the Administration's outreach to the business community to help drive a national discussion on innovation and economic growth. We share the view that health IT innovations are critical to successfully reforming the nation’s health care system by improving care quality and lowering costs for patients and employers”

Lonny Reisman, M.D., Aetna’s chief medical officer, spoke at the roundtable and encouraged further, rapid innovation in the development of health technology.

“We appreciate the Administration's outreach to the business community to help drive a national discussion on innovation and economic growth. We share the view that health IT innovations are critical to successfully reforming the nation’s health care system by improving care quality and lowering costs for patients and employers,” Reisman said.

“The delivery and coordination of health care services in America must change. Aetna is helping by investing in innovative health care tools and technologies that can seamlessly and securely exchange information among care providers and give them valuable, actionable, patient-specific health care information right in the physician's office, in the emergency room, or wherever they see a patient. Improved information flow will drive higher quality, more convenient health care at a lower cost for all.

“While this evolution on the inside of the health care system is occurring, the way the system opens to patients must also change in response to the sea-change in American consumer behavior. The health care system must provide convenient, mobile support of health care purchases to meet consumers on their terms as we build the new health and wellness marketplace. The system must respect that, for many, convenience is the key measure of quality, and must make cost, performance and access to information readily, easily available. We are building these necessary mobile health solutions and joining with other businesses to meet the demand for complete health information mobility in today’s fast-paced, ever-changing technology environment.”

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 33.8 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.

On behalf of Farzad Mostashari, the National Coordinator for Health IT, Rebecca Daniels Kush has been invited to serve on the HIT Standards Committee, a federal advisory committee that makes recommendations to the National Coordinator on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information for purposes of adoption, consistent with the implementation of the Federal Health IT Strategic Plan, and in accordance with policies developed by the HIT Policy Committee.

Dr. Kush was selected to fulfill a requirement of the Department of Health and Human Services (HHS) to appoint a member from the research community to the HIT Standards Committee. The term of this appointment is May 2011 to June 2013.

"The implementation of informatics standards across the continuum of care delivery to clinical research to data archiving and analysis is essential for cost effective and precise progress in health diagnostics, prevention and therapeutics," states Steven Hirschfeld, MD, PhD, Captain U.S. Public Health Officer, Operations Chief and Chief Medical Officer, USPHS Rapid Deployment Force-1 and Associate Director for Clinical Research and Acting Director, National Children's Study, Eunice Kennedy Shriver National Institute of Child Health and Human Development. "Dr. Rebecca Kush is ideally qualified for advancing these goals and providing high quality and objective perspective based on her international experience, her leadership, track record and vision."

Rebecca Kush is currently president and CEO of the Clinical Data Interchange Standards Consortium (CDISC), an open, global standards developing organization that has concentrated on developing standards to support medical research and related areas of healthcare for the past 14 years. Dr. Kush has over 30 years of experience in the area of clinical research, including positions with the U.S. National Institutes of Health, academia, a global clinical research organization and biopharmaceutical companies in the U.S. and Japan. She earned her doctorate in Physiology and Pharmacology from the University of California San Diego (UCSD) School of Medicine. She has served on the Board of Directors for the U.S. Health Information Technology Standards Panel (HITSP), Drug Information Association (DIA) and currently Health Level Seven (HL7) and was a member of the advisory committee for the WHO International Clinical Trials Registry Platform. Dr. Kush has served on appointed committees for the Institute of Medicine, provided expert input to the President's Council of Advisors on Science and Technology (PCAST) and has authored numerous publications for books and journals, including New England Journal of Medicine and Science Translational Medicine.

Dr. Kush was also recently invited by Dr. Harold Varmus to present at the NCI Director's Industry Liaison Group and to serve as a domain expert on the caBIG Oversight Ad hoc Subcommittee of the National Cancer Institute, Board of Scientific Advisors. The purpose of the Ad hoc subcommittee is to evaluate the scientific merit of the caBIG Program's ongoing and planned initiatives and to advise the NCI Board of Scientific Advisors (BSA) and the NCI Director about steps that should be taken to improve the caBIG program and to enhance its utility for current and future users of the program.

"On behalf of the CDISC Board of Directors, I would like to thank Becky for her continued commitment to standards in medical research," said Paula Brown Stafford, Chair-elect of the CDISC Board of Directors and President of Clinical Development, Quintiles. "As the CEO of CDISC she represents over 300 member organizations and will be able to work on their behalf through this new appointment."

About CDISC

CDISC is a global, open, multidisciplinary, neutral non-profit organization that has established standards to support the acquisition, exchange, submission and archive of clinical research data and metadata. The CDISC Healthcare Link Initiative collaborates to link research and healthcare through standards-inspired innovation to further the CDISC mission and vision. The CDISC mission is to develop and support global, platform-independent data standards that enable information system interoperability to improve medical research and related areas of healthcare. The CDISC Vision: Informing patient care and safety through higher quality medical research. CDISC standards are global, vendor-neutral, platform-independent and freely available via the CDISC website. Additional information on CDISC can be found on the CDISC website at www.cdisc.org.

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For the original version on PRWeb visit: www.prweb.com/releases/prweb2011/7/prweb8649678.htm

Investigators with the Mayo Clinic-led SHARP project are close to finishing a suite of computing tools that can identify and sort digital health information from any electronic medical record, regardless of file format and data organization. Seeking to safely and securely convert stores of electronic health records into a bottomless pool of real-world clinical knowledge, dozens of experts in informatics, computer science and medicine attended a two-day conference at the University of Minnesota Rochester to highlight milestones of the SHARP initiative and identify future projects.

"The nation is hoping the SHARP community will deliver a product that will transform the way health information technology is used and thought about," said Christopher Chute, M.D., Dr. P.H., a Mayo Clinic epidemiologist and the principal investigator for Mayo's SHARP grant.

Mayo plays a leading role in the $60 million Strategic Health IT Advanced Research Projects (SHARP) program, which is funded by the U.S. Department of Health and Human Services. SHARP supports three major goals of electronic health information: better care for patients, better health for specific populations and lower health care costs.

"There is a huge ocean of information that has the potential to significantly improve delivery of care," said Wil Yu, the federal agency's SHARP program coordinator.

The information exists in the millions of electronic medical records kept in hospitals and clinics across the United States, but it is inaccessible as a single body of knowledge because there is no standard format for medical records.

Different hospitals and health information technology vendors tag and store health information in different formats — many of them proprietary. Mayo Clinic and the three research institutions also funded by SHARP are working on software to mine the data for best practices and statistical trends.

"This gets to the heart of meaningful use," said Lacey Hart, Mayo's SHARP administrator. "It's one thing to meet the government requirement that you should have an electronic record & but it's another thing, once you have that record, to make meaning out of it."

The project is ambitious: Eighty-nine experts from dozens of research institutions and the federal government attended a conference in late June at the University of Minnesota's Rochester campus. Areas covered ranged from informatics and computer science to medicine and administration.

To date, investigators have used natural language processing tools to isolate health information from about 30 medical records from patients with diabetes. When run through computing systems developed in partnership with IBM's Watson Research Center, those 30 patient records explode into 134 billion individual pieces of information to be organized and stored.

When working with sensitive records like patient information, researchers say they recognize that data privacy and security is paramount to a successful end product.

"The privacy of patient data is something we must hold in sacred trust," Dr. Chute said. "We want to do this as we partner with the communities, rather than exploit them."

The three other research Areas funded by the ONC's SHARP grants are:

• University of Illinois at Urbana-Champaign, Area 1, security of health information technology
• University of Texas Health Science Center at Houston, Area 2, patient-centered cognitive support
• Harvard University, Area 3, health care application and network platform architectures

The 16th annual University of Nebraska-Lincoln poll, taken last March and April, found that 91 percent of rural Nebraskans own a cell phone, though how they use that technology varies significantly among demographic groups. Three-quarters of respondents use the Internet or email from home; 18 percent said they had no access at home.

The digital divide refers to the gap between individuals, households, businesses and geographic areas in their access to communications technologies such as cell phones and Internet. Federal and state agencies have made it a priority in the last decade to shrink that gap, in large part though technological advances.

While technology gains and public programs have helped close the gap, other factors now may be more important, said Bradley Lubben, UNL public policy specialist who's part of the Rural Poll team.

"The digital divide is more about demographics and socio-economics than it is about technology," Lubben said. That's important for policy-makers to know, he added, because it means additional efforts to bridge the divide that are based solely on technology are unlikely to close the gap further.

Of those demographic and socio-economic factors, the Rural Poll showed that generally speaking, women are more plugged into Internet and cell phone technology. Randy Cantrell, rural sociologist with the Nebraska Rural Initiative, said women in rural Nebraska tend to be better educated, more socially engaged and more frequent shoppers than men. Also, not surprisingly, younger people, more educated people and people with higher household incomes were most likely to use the Internet and use their cell phones for activities other than voice calls, according to the poll.

Rural Poll surveys were mailed to about 6,400 randomly selected households in Nebraska's 84 non-metropolitan counties. Results are based on 2,490 responses.

Rural Nebraskans have fully embraced modern communications technology as a must-have, not a luxury, Lubben said. Of the 91 percent of poll respondents who own cell phones, 30 percent use them for voice calls only, 39 percent use messaging services in addition to voice calls and 31 percent also use them to access the Internet.

As for the Internet, 80 percent of rural Nebraskans use it to research products or services; 78 percent for information related to hobbies and projects; 74 percent for health or medical information; 72 percent to purchase products; 60 percent to watch video on a video-sharing site; and 55 percent for social networking.

According to the poll, 62 percent of rural Nebraskans have positive attitudes about the Internet's usefulness in taking formal courses to further their education or careers, and 77 percent say researching health information online can help people better manage their health. However, they retain a healthy skepticism, too, with 39 percent agreeing the quality of information found online is questionable. Twenty-one percent disagreed with that statement, and 40 percent had no opinion.

Most rural Nebraskans also have positive opinions about shopping online. Sixty-five percent said the Internet is the best place to buy hard-to-find items, and 72 percent said it's convenient. As with education and health information, though, the poll found rural Nebraskans had some concerns. But Cantrell pointed out that even among frequent online shoppers, there are concerns. Sixty-four percent said they were reluctant to provide their credit card number or other information, and 65 percent said they preferred to see items before buying them.

"People are not convinced it's a good deal, there's some things they don't like about it, but they do it anyway" as the simplicity and convenience of online shopping seems to trump concerns about it, Cantrell said.

As for conducting government business online, rural Nebraskans indicated some initial reservations, but those who tried it were overwhelmingly positive. Ninety percent of those who renewed driver's licenses or auto registrations online agreed it was convenient, while 79 percent who paid taxes, fees and fines online felt similarly.

And rural Nebraskans view social networking as a good way to keep up with friends and family, to provide support to people isolated by geography or disability and to obtain information or advice. But 56 percent of respondents said they don't trust that people on social network sites are accurately representing themselves and 67 percent think online social networks have replaced face-to-face communication.

Although 18 percent indicated they don't have Internet service at home, many of those people find other ways to get online, including at work and public libraries.

The Rural Poll is the largest annual poll of rural Nebraskans' perceptions on quality of life and policy issues. This year's response rate was about 39 percent. The margin of error is plus or minus 2 percent. Complete results are available online at Nebraska Rural Poll.

The university's Center for Applied Rural Innovation conducts the poll in cooperation with the Nebraska Rural Initiative with funding from UNL Extension and the Agricultural Research Division in the Institute of Agriculture and Natural Resources.