The Pareto principle—also known as the 80/20 rule or the law of the vital few—states that across most topics and populations, roughly 80% of effects result from 20% of causes. Trends across the healthcare landscape appear to be tracking closer to this principle as disparities in healthcare access between rural and urban populations continue to escalate.
According to the Health Resources & Services Administration (HRSA), while only 20% of the nation’s population resides in rural areas, those residents comprise more than half of the geographic population centers lacking basic medical care, including over 50% of all behavioral health shortage areas.
HRSA identified over 17,000 Health Professional Shortage Areas (HPSAs) nationwide and, of those, 4,224 were designated as “medically underserved.” At FirstCare Health Plans, our members reside throughout 143 counties—mainly in northern and western Texas—which include 538 of these HPSAs. The size of the geographic area in which these individuals live, combined with relatively sparse population densities, amplifies the problem of accessibility. Our challenges have been identifying the vast number of hurdles our members face and implementing relevant operational solutions to improve their access.
New ideas needed
While cliché, healthcare providers and health plans need to collectively think outside the box when it comes to providing access to care. Experience shows what has typically yielded positive results in an urban setting does not always translate to rural populations when it comes to available providers, distance and transportation, specialty care, etc.
One feasible remedy is to increase basic member outreach via phone, web, community events, and in-home visits using licensed third-party providers for basic screenings. Other possibilities include leveraging robust case management—FirstCare’s Expecting the Best Maternity Program uses early identification and intervention for high-risk pregnancies to significantly increase occurrences of healthy babies and mothers, resulting in over $1.7 million in healthcare cost savings during its first year—and using ever-emerging telemedicine capabilities to link rural healthcare centers to larger regional centers typically found within urban areas.
The remarkable shortage of behavioral health providers in rural areas directly contrasts with the rising demand for behavioral health services. We’ve found that case management specific to behavioral health, integrated with our existing medical case management, allows us to help the member holistically. However, even with the expansion of managed care, many behavioral health providers have yet to move to managed care integration for both medical and mental health services. In response, we’re promoting further integration and access to behavioral health providers by encouraging large primary care medical practices to offer behavioral health telemedicine services to our members.
The access problems many rural health plan members face cannot be rectified overnight. Resources, creativity and time can bring these populations up to par with their more urban counterparts. It is the duty of those of us working within the healthcare space—be it providers, health plans, or system administrators—to identify these opportunities and find sustainable solutions to help improve the health of those we serve.