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Spokane, Washington  Est. May 19, 1883

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Jeff Roe: Washington’s rural health care is at a crossroads

By Jeff Roe Premera Blue Cross

For too long, rural health care has remained overlooked and underfunded, in some ways invisible to the rest of the American health care system. Now, the coronavirus is putting Washington’s rural health care at a critical crossroads.

In urban and suburban areas alike, this global pandemic is revealing what’s working well and what’s not working so well about care delivery in America. The difference for rural markets is that the stresses placed on local providers could leave lasting wounds on a system already hurting before any of us heard of COVID-19.

More than a million people – about 14 percent of Washington’s residents – live in rural areas. A 2017 study by the National Rural Health Association, found that people living in rural areas tend to be older, poorer and more likely to experience chronic disease, disability and premature death. These challenges are made worse because rural residents also tend to disproportionately suffer from inadequate access to health care.

Doctors serving our rural communities are getting older – at least half are now more than 50 years old – and we are not replenishing their ranks quickly enough. Younger physicians are moving to urban areas where they command higher compensation, can build specialty practices or access more resources.

Even before the current emergency, we recognized that two things must happen to make health care work better for all Washingtonians: reduce costs and increase access. The virus demonstrates some ways to do that, but also erects some obstacles. These impacts can be especially important in rural areas.

The coronavirus has demonstrated telemedicine’s potential to deliver cost-effective care. Throughout the pandemic, patients precluded from visiting their doctors in person have accessed many types of care remotely.

This is great news for patients in rural areas. Today they too often are expected to travel long distances to consult with specialists or even their primary care doctor. While digital services won’t work for every type of care – you can’t receive dialysis treatment remotely, for instance – they are a viable option for many patients. The more readily available and advanced these services become, the better.

In addition to expanding patient access to care, telemedicine can reduce costs. Telehealth start-ups like 98point6, Doctor on Demand and Boulder Care have demonstrated they can offer an effective and less expensive alternative for patients.

Another trend we see most acutely in rural communities should raise concerns. Health care providers responding to the virus have been forced to suspend many nonemergency services.

This goes beyond “elective” surgeries to include necessary, but not emergency, procedures like joint replacements.

These services provide the financial foundation for many hospitals. When they can’t be performed, a facility’s fiscal health may become compromised. For rural facilities challenged by costs to recruit and retain doctors and obtain new medical technology, these economic consequences can be dire. This makes them attractive targets for acquisition, creating monopoly conditions in some rural communities and driving up patient costs. It’s in the best interest of everyone but Wall Street-backed hospital chains to keep rural health care providers independent.

Premera is investing more than $60 million over five years in programs to address the unique challenges facing rural health care and to improve patient access to care in rural areas of Washington and Alaska. This includes working to alleviate provider shortages, better integrate clinical and behavioral health and improve provider-to-provider consultation opportunities.

Your ZIP code and the size of your community shouldn’t determine the quality of health care you receive. As we continue to fight the virus, we must also work together to protect viable, affordable rural health care.

Jeff Roe is president and CEO of Premera Blue Cross, the state’s only Washington-based provider of health insurance and only insurer operating all 39 counties across the state.