Overcoming Challenges in Rural Healthcare Systems

Collaboration is key to the survival of rural healthcare.

Rural health systems are at a crossroad in the rapidly changing world of health care policy and reimbursement methods. To stay relevant and a resource for the community; governance and leadership must be willing to explore new care delivery models and collaborative partnerships. You cannot do it alone.


As a rural health system CEO, I had the fortune of being part of two Texas collaboratives, representing 13 rural communities, that have as a common core mission to help each other find ways to keep our respective organizations strong for the community. The challenge is daunting and real. According to Becker’s Hospital Review, 87 rural hospitals have closed since January 2010. Fourteen hospitals have closed in Texas, the most of any state.


“Population health management” and “pay for value” are two concepts driving change. The simple translation of these concepts is payers are increasingly moving dollars from acute episodic care to a bundled system for a defined population of patients, particularly patients with chronic diseases. Again, the challenge is daunting and real.


The 2018 Robert Wood Johnson Foundation annual review of population health reported our county ranked 186 for “health outcomes” and 205 for “health factors” out of 242 measured Texas counties. Other members of the collaboratives faced similar challenges. Solutions are often cost and resource prohibitive at the individual community level.

Our work together defined three major strategic imperatives that would focus resources at the collaborative and community level:
  1. Invest in patient health information technology and analytics. In order to impact the chronic disease management and health of our communities, we must have data on how, when, and where care is being provided at the individual patient level – data payers have had for a long time. We joined with six Texas rural health systems to form a rural accountable care organization under the umbrella of a national management company that managed 33 rural ACOs across the country. This scale of collaboration made the technology and analytics affordable.

  2. Invest in care coordination. Once you have the information, care coordination plays a major role in making the transition from fragmented, siloed care to a seamless system of care built on the Institute for Healthcare Improvement’s triple aim of Improving the patient experience of care (including quality and satisfaction); Improving the health of populations; and Reducing the per capita cost of health care. The support of the ACO infrastructure helped our community create a network of 25 local providers committed to implementing best practice care coordination protocol.

  3. Invest in wellness. Reducing the lifetime impact of chronic disease, defined by both quality of life and health related expenses, requires more than just better coordination of care. It requires an increased focus on both prevention and recovery. A regional collaborative of nine health systems shared best practices, licensure, and training to support diabetic education programs at the community level. Our organization was fortunate to partner with the County and construct a 20,000 ft² Wellness and Rehabilitation Center using grant and philanthropic dollars to pay for a majority of the building. In partnership with a national wellness center management company, medical wellness is now a major service line for the medical center.

The transformation of rural healthcare delivery systems is still in its infancy but early results are promising. Caravan Health, a leading ACO management company recently released data showing a 43% reduction in uncontrolled diabetes. The Texas ACO collaborative had a 98% quality score from CMS in 2016 across 31 care domains.


Finding opportunities to create collaborative partnerships is key to having the resources to stay relevant and remain a strong resource for your community.

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