Grace Advertising & Consulting, Inc.

For decades, rural communities have been all but ignored when it comes to health, workforce and economic development, technology infrastructure, and health professional shortages. This is as rural populations grow older, sicker, poorer, and resource strapped. Finally, these longstanding deficits are getting some attention. The U.S. Department of Health and Human Services (HHS) recently released its Rural Action Plan. Albeit ambitious and long overdue, the Plan's four-point strategy aims to: 1. Build a sustainable health and human services model for rural communities by empowering rural providers to transform service delivery on a broad scale. 2. Leverage technology and innovation to deliver quality care and services to rural communities more efficiently and cost-effectively. 3. Focus on preventing disease and mortality by developing rural-specific efforts to improve health outcomes. 4. Increase rural access to care by eliminating regulatory burdens that limit availability of needed clinical professions. According to HHS Secretary Alex Azar, work on the Plan begin prior to the COVID-19 pandemic in 2018 with the creation of a rural task force that included key leaders and stakeholders across HHS. The goal was "to bring together disparate efforts across HHS and develop the best understanding of where policy and program changes bring about the needed transformation," Azar prefaces in the Plan. He said these four strategies will build upon key initiatives already in motion like increasing access to care in rural communities by opening more community health centers, focusing on value-based health care to improve quality while reducing health care spending, addressing the opioid epidemic in rural communities, and making changes to Medicare to expand access to telehealth services. The move comes at a critical time. As rural hospital closures increase, with at least 10 in Missouri alone, the need for a health care lifeline is crucial. According to the 2010 Census, there are approximately 59.5 million people who live rural across the U.S., making up nearly 20% of America's population. Health disparities and mortality rates are even more dire than those living in urban underserved communities. The rural health landscape as noted in the Rural Action Plan ● Rural residents are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than the urban dwellers. Some researchers estimate the hospital rate for preventable disease is 40% higher for rural people, coupled with a 23% higher mortality rate. ● Rural closures are often linked to a lack of patient volume due to population size and other factors. Most of these hospitals do not provide obstetric (OB) services, leaving pregnant women without accessible maternity care and long commutes to deliver. Rural areas have higher maternal and infant mortality rates. ● Rural areas struggle to attract, recruit, and retain health care providers – with a particularly lean number of behavioral health providers. According to the Plan, 17% of non-metropolitan counties lack behavioral health providers compared with three percent in metropolitan counties. The Plan notes there are fewer physicians, nurse practitioners, and physician assistants (primary care providers or PCPs) practicing in rural areas compared with urban areas. Specifically, there are 5.4 PCPs per 10,000 population in rural areas compared with 7.9 PCPs in urban areas. Rural areas have 3.6 dentists per 10,000 population compared with 5.9 in urban areas. The Plan also notes that rural adults tend to see the dentist less and experience higher rates of permanent tooth loss compared with urban adults. As for mental health services, of the 1,971 rural counties in the U.S., 252 counties have no mental health provider. ● Rural seniors, individuals with disabilities, and other rural residents most likely do not have access to specialty services and must travel to neighboring urban centers for services. Due to flagrant transportation barriers, and limited appointment availability, needed specialty care services are too often forfeited. ● Suicide rates in rural areas tend to be higher than in urban areas. According to the Plan, individuals working in mining, quarrying, oil and gas extraction, and agriculture, are among the top five industries with the highest suicide rates. Broadband access and telemedicine According to the Federal Communications Commission (FCC) one-fourth of rural Americans, or 14.5 million, lack internet access. Although not a direct outcome of the Rural Action Plan, but closely aligned, the FCC, HHS, and U.S. Department of Agriculture announced in early September a memorandum of understanding (MOU) to collaborate and address internet deserts in rural areas. In this joint effort, Team Up for Rural Health Initiative, the aim is to share information to address health disparities, resolve service provider challenges, and promote broadband services and technology in rural areas. The move, which came as more than a million people tested positive for COVID-19 in the U.S., with nearly 200,000 people succumbing to the virus, is slated to prop up the role telehealth will play in rural communities as infection rates increase during this pandemic. "From the beginning of my tenure at the FCC, I've heard and shared the view that telemedicine is a game-changer for rural America," said FCC Chairman Ajit Pai. "The COVID-19 pandemic has made the rural health care PAGE 05 October 2020

• Cover