by Dan Derksen, MD, Director, CRH
As millions of uninsured are covered in 2014 through Medicaid and the Marketplace, states face intractable obstacles to health care access, especially in rural areas.
For example, while 19% of the U.S. population lives in rural areas, only 11% of the nation’s physicians practice in rural areas1,2. Rural communities often face protracted health workforce shortages for dental, behavioral, nursing, and medical services.
At a January National Governors Association meeting in Washington D.C., 40 states shared innovative approaches to transforming health care delivery and assuring high quality, accessible and patient centered care. Here are five:
- Retention –Rural Health Professions Tax Credit - retains health professionals in rural areas. Licensed physicians, dentists, psychologists, nurse practitioners, and others are eligible for a tax credit up to $5,000. States: OR, AZ. NM: http://nmhealth.org/PHD/OPRH.shtml; OR: http://www.ohsu.edu/xd/outreach/oregon-rural-health/providers/provider-tax-credits/provider-faq.cfm
- Expansion – Teaching Health Centers – move the primary care training pipeline to rural areas. Graduates have higher rates of practicing in rural and medically underserved areas. States: WA, WV, MA, NY, TX, MT, IL, ME, CA, PA, AZ, NM. Summaries:http://journals.lww.com/academicmedicine/Fulltext/2014/01000/Teaching_Health_Centers___A_Proven_Solution_for.3.aspx;http... http://www.aafp.org/news-now/education-professional-development/20130906thcroundtable.html
- Capacity – Health Workforce Data Collection, Analysis and Policy Act. Practice data is obtained at the time of licensing and renewal, analyzed and used to inform health policy interventions to improve access to care. States: OR, NM NM:http://www.nmlegis.gov/Sessions/11%20Regular/bills/senate/SB0014.html OR: http://www.theoma.org/advocacy/health-reform/workforce/data-collection-time-licensure
- Efficiency – patient centered medical homes, health homes. States: ME, NM ME:http://www.google.com/#q=maine+quality+counts+patient+centered+medical+home+jama&safe=off NM: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1578665/
- Outreach – Reimbursement parity for telemedicine services to expand specialty services to rural areas. State: AZ. http://www.azleg.gov/legtext/51leg/1r/laws/0070.htm
1. U.S. Census 2010: Accessed 1/18/14 at: https://ask.census.gov/faq.php?id=5000&faqId=5971
2. Rosenblatt RA, Chen FM, Lishner DM, Doescher MP. Final report 125: The future of family medicine and implications for rural primary care physician supply. Seattle, WA: WWAMI Rural Health Research Center, University of Washington; 2010. Accessed 1/18/14 at: http://depts.washington.edu/uwrhrc/uploads/RHRC_FR125_Rosenblatt.pdf