1. Organization of rural population medical care and prospect of its development

4. Economic Impact Analysis Jefferson County Hospitals Direct Effects Indirect Effects Induced Effects Total Effects Employment Multiplier 15.122.845.1223.12 Output Multiplier 1.000.210.361.57 Income Multiplier 0.670.130.241.03

7.  Rural residents seeking health care are ◦ Older than urban residents ◦ in poorer health than urban residents ◦ more likely to be disabled ◦ more likely to be uninsured ◦ more likely to face financial barriers in obtaining healthcare ◦ more likely to incur travel burdens while seeking care ◦ much less likely to receive services than are their urban counterparts if they suffer from serious mental illness. Rural is different

9. Why not let the market fix it?

10. Specific barriers to mental health access –Service fragmentation –Transportation –Lack of cultural and linguistic competency –Medicaid enrollment –Stigma –Immigration status. Rural is different

11. Southern Rural is Really Different

12.  Average age rural physicians 45  Primary Care ◦ See more patients ◦ Are more likely to be in shortage  Only 10% of practicing physicians practice in a rural area  Less likely to have evening and weekend hours ◦ Perceived to be of poorer quality ◦ Communication challenges due to lack of cell or radio coverage in some areas make things more difficult ◦ Preventive procedures are often sacrificed as patients and providers attend to more pressing medical issues. Rural providers

13. Elevating care

14. Defining Access

15. Conditions where timely early care would prevent hospitalization Patients with ambulatory sensitive conditions more likely to be hospitalized in rural America Ambulatory sensitive conditions JN Laditka, SB Laditka Health care access in rural areas: evidence that hospitalization for ambulatory care- sensitive conditions in the United States may increase with the level of rurality Health & Place Volume 15, Issue 3, September 2009, Pages 761-770

16. The phenomena of bypass

17. So why don’t we just fix it?

18. Rural provider autonomy –Strict independence is no longer a success strategy Rural practice design –care management, team work, and interoperable information technology require teams Low rural volumes –Need 5000 Medicare lives for an ACO, for example Historic rural efficiency –Cheap is not necessarily efficient Barriers to system improvement The March to Accountable Care Organizations—How Will Rural Fare? J Rural Health 2011

19. How does Virginia do?

20. Locating rural Virginia

21. Physician distribution

22. Mental health distribution

23. Pediatric care

24. Health care distribution

25. Elevating care

26. Defining Access

27. Conditions where timely early care would prevent hospitalization Patients with ambulatory sensitive conditions more likely to be hospitalized in rural America Ambulatory sensitive conditions JN Laditka, SB Laditka Health care access in rural areas: evidence that hospitalization for ambulatory care- sensitive conditions in the United States may increase with the level of rurality Health & Place Volume 15, Issue 3, September 2009, Pages 761-770

28. The phenomena of bypass

29. Rural Access

30. Thank you!