Focus on Rural Population: What Your Plan Still Has Time to Do

Here we are at the end of July already! Time flies, especially when we are busy preparing for enacting our bid submission approvals and planning for rollout of plan year 2019 activities and new members. It is not too late to still enhance this year’s activities and positively affect our members within the remaining five months of this plan year, especially in the rural areas of your plan’s service area. CMS released its first “rural health strategy” here: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2018-Press-releases-items/2018-05-08.html

Barriers to care/access and disparities for the rural service areas and their communities are routinely missed as a focus for a care management program objective, a quality improvement process, or independent study within population health management.

Here are a couple of tips to consider and questions to ask yourself as a plan that can truly be implemented within this plan year:

What do you know (or not know) about your rural populations specifically?

Age bands overlaid by claims data/GeoAccess: Oftentimes, populations in rural areas are older than those residing in urban areas. This means access or capability to access care is a potential issue right off the bat. Elderly populations who may be isolated by a rural geographic location due to distance to care can be compounded by other issues: daylight hours available to drive, their own vision, condition of their vehicle, if they have to care for others…you get the picture. Do we as an industry really take into account how to identify those who are isolated by being rural? I believe we can do better!

Plans could take their specific rural counties and break down by age bands the populations who live there; overlay the claims utilization to determine patterns of care AND potential barriers. For example, if you have vision as a supplemental benefit, and you know your elderly population in the rural service area cannot access the vision stores due to the fact they are all urban, how do you expect these members to access care SAFELY simply by having the vision benefit? What can you consider to support these folks? This is where telemedicine could become your new best friend to support the reach your network cannot. I believe plans could use the telemedicine option more than we see today. Many plans are not aware of the details, the codes, and what the benefits are, so please educate your network teams, provider networks, and update your care management program to include this option. If you are not sure what the rules are, look here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf.

Also, consider engaging a home visit vendor to support this population – you will want to make certain that networks can deliver in the rural areas and not face access to members’ issues.

If your plan does have rural hospitals that service your rural counties, please be certain to mine this facility’s utilization, emergency room, observation, and inpatient data. Frequently, rural hospitals serve communities with greater rates of diabetes and known associated hypertension and obesity, all of which speak to the rural community structure and lack of urban services.

Don’t forget the analysis of rural service area prescription drug claims. Drug claims alone often identify issues for and about plan members that may not otherwise be exposed.

Introduce “rural service area access” into your quality program as a quality improvement project. Because rural communities face provider shortages, especially primary care, as well as behavioral health, dental, and vision, consider enacting a rural clinical day, either through a Federally Qualified Health Center (FQHC) or other partner to draw members to a one-stop shop day of service. Sort of like a spa day but for health! If folks cannot get there, offer transportation, too!

Thinking outside the box to enhance our rural populations’ access, engagement, and health outcomes could only benefit everyone. If you need assistance to evaluate your plan’s populations, creative care model changes, please reach out to me at jscott@gormanhealthgroup.com.

 

 

 

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Jane Scott
Jane Scott

Jane Scott is Senior Vice President of Population Health Management and Clinical Innovations at Gorman Health Group (GHG). In this role, she is responsible for leading GHG’s Clinical Innovations practice area. Jane brings GHG clients 37 years of experience in healthcare as one of the industry leaders on the topics of the Centers for Medicare & Medicaid Services (CMS) Special Needs Plans (SNPs), development and implementation of Models of Care (MOCs), as well as the Star Ratings Quality Bonus Payment Program. Her experience expands to the areas of quality improvement (QI), utilization and medical management, claims operations, and provider/associate education.

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