Rural Lifelines, Part 3: Transforming the Health Care System
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Across the country, short-term clinical solutions like workforce surge support are needed to meet immediate patient needs, but they also leave community health centers vulnerable to long-term challenges in providing sustainable care and support based on emerging conditions and changes in the policy landscape. States now have a vital opportunity to invest in true system transformation that modernizes and redesigns systems to deliver lasting results for rural communities.
At this intersection of health research and practice, JSI has evaluated countless rural programs to understand what made them work or what held them back. States trust us to lead high-level health delivery systems, and health centers turn to us for the training and support needed to implement long-term solutions. In Part 1 of Rural Lifelines, we honed in on provider support, and Part 2 focused on improving patient access to care. This third and final installment addresses the system as a whole, digging into innovations particularly relevant in rural settings to catalyze change.
Strengthening Population Health Management
In Anderson Valley, a rural agricultural area in northern California, a person recently diagnosed with type 2 diabetes was being coached on best practices for managing his condition. He listened, but then asked if his health provider could come to the vineyard where he picked grapes and explain this information to his colleagues and supervisor. The clinic agreed, and they had an information session at the vineyard to raise awareness of diabetes, supporting others to manage their chronic conditions effectively.
“Although this man began as a patient, he became a champion for diabetes care, and the clinic worked with him to help connect others to care,” says Elena Thomas Faulkner, JSI senior policy consultant and director of JSI’s Population Health Management Initiative (PHMI) technical assistance. “This approach of turning focus beyond just one patient and towards the community as a whole is central to the transformation needed for more proactive and effective rural health care.”
Through PHMI, JSI supports Anderson Valley Community Health Center (CHC) and 26 other CHCs across California to apply strategies to advance population health management best practices. Drawing on the core principles needed for building community capacity, JSI and partner organizations coach health centers on empanelment, data quality and reporting, care team implementation, clinical interventions, behavioral health integration, and financial sustainability strategies essential for successful population health management to improve patient health outcomes.
Incentivizing Team-Based Care
Flexible care models that incentivize innovation in care, collaboration, and integration across specialties enable providers to adapt service delivery to patients’ unique needs and account for the operating realities of rural care. In rural settings where staffing is more limited, prioritizing health care functions, encouraging providers and their team members to leverage their skills (often referred to as “working at the top of their license”), and integrating service areas can ensure that patients receive the care they need.
“Team-based care is especially valuable in rural settings,” says Lauren Dahlman, a JSI senior technical associate. “It promotes more efficient and effective primary care delivery, specifically by addressing the needs of an expanding patient population while there is a simultaneous shortage of primary care physicians.”
In Colorado, JSI has been supporting team-based care for over ten years. Starting in 2015, we have worked with dozens of primary care organizations as they established the infrastructure required to implement a comprehensive team-based care model. We have continued to support these organizations to build and sustain the foundational skills to enhance team-based care. Participating clinics reported that JSI’s support successfully renewed commitment to team-based care; highlighted areas for improvement in communication, processes, and workflows; and helped to set actionable goals.
Investing in Value-Based Care
Traditional financing models have left rural clinics struggling to survive. These models reward volume over quality, incentivize an emphasis on specialty care, and leave clinics caring for fewer patients scraping for the funding needed to provide high-quality primary care.
Value-based structures can change this. When payment is tied to health outcomes, health facilities can prioritize services that will deliver the best health outcomes rather than those that will help cover costs. Value-based care provides compensation to cover population health efforts such as chronic care management, enhanced care teams, data and health IT investments, and coordination with other sectors to address non-medical drivers of health, which are essential but often underfunded activities in traditional care payment mechanisms. JSI recently implemented a developmental evaluation of 11 health centers’ engagement in value-based care opportunities in Texas. The findings demonstrate that robust health IT, data quality and reporting, and staff soft-skills development, like project management, are critical to improve quality and cost and advance staff and patient interests.
Sustaining Health System Transformation
To achieve true transformation, we must fundamentally rewire the system. As explored in Part 1 and Part 2 of this Rural Lifelines series, strengthening provider support and expanding patient access are critical first steps. But without the systemic transformation detailed here in Part 3, these efforts remain vulnerable to shifting grant cycles and temporary policy decisions.
Rural communities are not just smaller versions of urban centers; they possess unique strengths, deep community networks, and distinct operational realities. By aligning financial incentives with community-wide health outcomes and equipping rural clinics with the right technological and strategic support, states have the opportunity to transform vital rural lifelines into enduring, self-sustaining pillars of community health.