BPC Report: Rightsizing Rural Healthcare in America Demands National Attention

Washington, DC—While there are renewed efforts to revive rural America, its residents continue to face greater disparities and barriers to quality healthcare than their urban counterparts and should not be disenfranchised from national policy discussions. Today, the Bipartisan Policy Center releases a new report which highlights the challenges of healthcare delivery in rural areas of the Upper Midwest and identifies key areas for reform that could apply nationally to all rural communities.

The report, Reinventing Rural Healthcare: A Case Study of Seven Upper Midwest States, was created over a six-month period in collaboration with the Center for Outcomes Research and Education (CORE). It includes insight from nearly 100 national thought leaders and healthcare providers in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, and Wyoming on the current state of rural healthcare, and the strategies and tools needed to deliver high-quality, high-value care to rural and frontier areas of these states.

Centers for Disease Control and Prevention data show that 46 million Americans living in rural areas are at a greater risk of dying from heart disease, cancer, chronic lower respiratory disease, and stroke than their urban counterparts. Rural residents also have higher rates of obesity, tobacco and opioid use, and suicide than those living in urban areas.

“In order to address healthcare in rural America, federal laws should better align to meet the unique needs of rural areas of our country,” said G. William Hoagland, BPC senior vice president. “The 115th Congress has introduced numerous bills that address rural healthcare, but acted upon individually, they are piecemeal and take a siloed approach to improving access and delivery and that will not solve this problem.”

BPC’s survey of the seven Upper Midwest states identified four specific policy areas for developing recommendations:

1) Rightsizing Healthcare Services to Fit Community Needs. Recognizing not every community needs a Critical Access Hospital (CAH), communities should adjust services to better suit the needs of the local area. In an effort to prevent closures, CAHs should be allowed to provide more primary care and prevention-focused services.

2) Creating Rural Funding Mechanisms. Given small population sizes, growing healthcare needs, and demographic trends, rural areas need alternative Medicare and Medicaid reimbursement metrics and payment mechanisms that allow for value-based alternative payment models and innovation. Appropriate reimbursement mechanisms for telemedicine should also be examined to accommodate the virtual provider and the on-site provider or host hospital.

3) Building and Supporting the Primary Care Physician Workforce. New workforce models should be examined in collaboration with universities and residency programs to expose providers to rural environments and telemedicine, and reserve placements in medical programs for rural residents. Alternative providers such as nurse practitioners and physician assistants can fill vital primary care roles in rural communities.

4) Expanding Telemedicine Services. Telemedicine is a promising way to connect patients with providers and create a peer network for rural providers that will improve recruitment and retention. However, it must be supported by adequate broadband services and reimbursement. Rural health systems need to provide health professionals with the necessary tools and technology to offer this type of quality care to their patients.

“This report serves as a critical snapshot of the healthcare challenges and opportunities for reform in rural communities across America, said Walter Panzirer, a trustee at the Helmsley Charitable Trust. “Strengthening the financial viability of the rural healthcare system and providing an injection of innovation and technology to these underserved communities is imperative.”

“Rightsizing America’s rural healthcare system will require bipartisan action from Congress,” said Anand Parekh, BPC chief medical advisor. “Tackling the barriers to delivering quality and efficient healthcare to rural America is long overdue.”

This work was funded through a grant from The Leona M. and Harry B. Helmsley Charitable Trust. 



Joann Donnellan, Bipartisan Policy Center, jdonnellan@bipartisanpolicy.org, 703-966-1990.

Laura Fahey, Helmsley Charitable Trust, lfahey@helmsleytrust.org, 212-953-2814.

T1D Program Defines Clinically Meaningful Outcomes

In partnership with other members of the T1D Outcomes Program Steering Committee, Helmsley has jointly come to a consensus in defining and standardizing meaningful type 1 diabetes (T1D) outcomes other than hemoglobin HbA1c (A1c), which is an average of blood glucose levels over a three-month period. Although A1c remains an important measure, its limitation as an average means it does not capture the entire picture of glycemic control, particularly around day-to-day variability in blood-glucose levels. The statement, published in Diabetes Care, a journal of the American Diabetes Association, defines additional clinically meaningful T1D outcomes beyond A1c such as hypoglycemia, time in range, hyperglycemia, and diabetic ketoacidosis (DKA).

The intended impact of these outcome definitions and standardizations is to encourage regulatory agencies and payors to consider the bigger picture of glycemic control when evaluating new diabetes treatments and technology. The consensus statement was developed over the course of two years and incorporates diverse perspectives from persons living with T1D and their caregivers, clinical experts, industry, Advisory Committees representing researchers, and clinical evidence.

Led by grantee JDRF International, the fellow T1D stakeholders represented in the Steering Committee also include: the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, the Pediatric Endocrine Society, and the T1D Exchange.

Read the joint announcement at jdrf.com and the Diabetes Care article at care.diabetesjournals.org.

Conservation Brochure

State Policy Framework Outlines Path to STEM Opportunities for Underserved Students

Achieving the Dream and Jobs for the Future released the Middle-Skill STEM State Policy Framework this week, outlining five key recommendations for how states can improve academic and career pathways for historically underserved students.

Recent research has shown a large number of STEM jobs require less than a Bachelor’s degree. This critical fact of today’s workforce underscores the role that community colleges can play in launching many more individuals to high-paying, quality careers in STEM fields. Such “middle-skill” STEM jobs represent an unprecedented opportunity for the historically underserved students who disproportionately enroll at community colleges.

The framework’s recommendations are based on the STEM Regional Collaboratives, a yearlong multi-state initiative funded by the Trust to identify effective, concrete ways in which state policy can help community colleges build middle-skill STEM career opportunities for students and meet the high demand of local labor markets.

Read the Middle-Skill STEM State Policy Framework at achievingthedream.org.

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