Mid-Shore News: Rural Health WorkGroup Focuses on Health Delivery Transformation


Tasked with studying the healthcare needs for the five counties of the Mid-Shore and offering policy templates to the State, Rural Health Care Delivery Group held their third of seven workshops at Washington College on Monday.

The 32-member committee co-chaired by Deborah Mizeur and Dr. Joseph Ciotola, and attended by health care officials, county and state elected officials and business owners, the workshop sought to clarify the goals and possible implementation of an across-the-board transformation of health care delivery of the mid-Eastern Shore as national health care trends change from total dependence on hospitals a sole provider for health needs.

The work group’s focus is “to examine challenges to health care delivery, including limited availability of health care providers and services; special needs of vulnerable populations; transportation barriers, and the economic impact of closing, partly closing or converting health care facilities and also to identify how the benefits of telehealth and the Maryland all-payer model contract might help in restructuring the delivery of rural health care services. Finally, the study is to develop policy options that address the health care needs of residents and improve the health care delivery system in the five counties.”

Rural Health Care Delivery Workgroup. Co-chairs Joseph Ciotola and Deborah Mizeur at center.

Rural Health Care Delivery Workgroup. Co-chairs Joseph Ciotola and Deborah Mizeur at center.

Addressing the complexity of designing a transformative rural healthcare model for the mid-shore, Deborah Mizeur said that much of the first two meetings were used to orient all committee members to the healthcare landscape. “We have a wide spectrum of membership, from physicians to businessmen and we all need to be on the same page to move forward. I’m energized and encouraged by the progress we’ve made.”

The session began with an overview of Maryland’s progression plan for an All-Payer Model given by Katie Wunderlich, Gov. Hogan’s deputy legislative officer for health care issues. Using slides, Wunderlich walked the group through key strategies, components, and a timeline to frame further work group discussions on how best to create policy platforms to be submitted to the State next October.

One slide, “Rural Health Nationally” stood out as a profound indicator of the need for a systemic change in rural health care delivery. It showed that in urban settings:

  • morbidity rates in females decreased by 10% and in rural areas morbidity rates increased by 40% along with a fivefold increase in opioid and heroin overdoses, doubling of suicides and tripling of deaths due to cirrhosis of the liver, linked to alcohol abuse.
  • At the same time, nationally, “rural hospitals have faced declining margins of 5% annually since 2011, due to shrinking inpatient demand.
  • Nationally, 68 rural hospitals have closed over the last 5 years, and an additional 670 are vulnerable to closure in 2016, up from 280 in 2015.
  • Many Americans living in rural communities rely on their hospital as one of their few sources of health care.

With a declining use of hospitals nationwide due to migration from inpatient care to outpatient care—from hospital-centric to population-centric— the focus is on a continuum of care keeping patients healthy through preventive and primary care services, and out of acute care facilities whenever possible. Refined medical procedures have shortened inpatient stays while outpatient procedure have kept patients out of the hospital altogether.

Wunderlich offered key points to sustaining rural health care with an emphasis on building on the success of the current rate-setting Total Patient Revenue (TPR)—the mechanism replacing Fee-For-Service incentives—and creating a geographic value-based model incentive “to address local accountability for population health and Medicare total cost of care.”

“This is basically putting in rewards for providers, for hospitals, for when they are able to improve their methods,” Wunderlich said.

Wunderlich added that a critical component to addressing rural health care is the transformation of primary care to support care management, care coordination, connections to behavioral health, social services and other resources.

In its fourth year of a five-year plan transforming the state’s health care system, 2017 will include continuing infrastructure development and increased support of high need patients with a 2018 focus on primary care home models, incentive harmonization and developing and organizing geographic and regional efforts.

Deputy secretary for public health at the Department of Health and Mental Hygiene Howard Haft discussed community-based “patient centers” working in tandem with the primary care model as part of the overall transformation needed to meet the needs of the rural population.

“We’re really going to have to transform what we do in primary care, Haft said. “There are insufficient numbers of doctors in the state and certainly a disproportionate number of doctors in rural communities who have to provide more and more care in small intervals. So we must shift from how many people we can see to delivering the best care for every person you can see.”

Patient Centers offer interdisciplinary teams of doctors and specialists who coordinate diagnostics and treatment while taking the stress off overloaded primary physicians. Patient centers would alleviate some of the problems in recruiting new physicians, according to Haft. Many primary physicians are seeing between 35 and 40 patients day. Along with the fact that attracting a physician to a rural area and a lower income model is difficult, Haft sees patient centers as the strengthening of relationships between patient and physician by using coordinated care efforts rather than episodic care visits. This model encourages teamwork between a patient —and his or her willingness to work toward person health goals—physician and other support staff.

The video starts with some of Health Services Cost Review Principal Deputy Director Katie Wunderlich’s overview of the progression plan and is followed by. Dr. Howard Haft, Deputy Secretary for Public Health, DHMH.

The next meeting will be held in March in Annapolis.The Rural Health Care Delivery Plane will be submitted to the State General Assembly in October.

This video is approximately 13 minutes in length  To see slides of each of the presentations, go here. Scroll to the January 9 meeting section.


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