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Rural health care studied in report

A new white paper titled "Modernizing Rural Health Care: Coverage, Quality and Innovation" offers data detailing the challenges rural Americans face and proposes solutions for improving quality, access and affordability to health care in rural areas.

The paper suggests that telemedicine might help to take up the slack in the system created by an expected shortage of rural physicians and rising demand.

The report features a new analysis by The Lewin Group, which projects an increase of around 8 million insured rural residents by 2019 due to Medicaid expansion and a state insurance exchange.

The paper, released by the UnitedHealth Center for Health Reform & Modernization, reported that South Dakota's 430,000 rural residents comprise 53 percent of the state's total population.

Among the findings:

• South Dakotans have less access to health care. There are only 73 primary care physicians per 100,000 rural South Dakota residents compared with 110 primary care physicians per 100,000 urban and suburban South Dakota residents.

• Rural Americans are more likely to receive lowerquality health care through a highly fragmented local care delivery system, to be obese and to participate in public, taxpayer-funded health plans, such as Medicare or Medicaid.

• Nearly half of rural doctors nationwide expect to see a shortage of physicians and mid-level health professionals in the coming years.

• Nationwide, rural patients reported an average distance of about 60 miles between their local primary care physician's office and a specialist's office.

• There will be a potential increase of around 5 million insured rural residents nationwide by 2019 -- even as the number of physicians in rural America lags.

• Physicians living in rural areas were more likely than their urban and suburban counterparts to say diabetes, hypertension, heart problems and cancer are major health problems affecting their communities.

The report suggests several ideas to meet the growing number of patients and a reduced number of providers in rural settings.

The report calls for: new incentives and reimbursement models for rural primary care physicians; a bigger role for the 24,000 rural nurse practitioners and physicians assistants; greater provider collaboration across rural areas and with urban health-care systems; innovative models using mobile health clinics; faster rural uptake of electronic health records; well-designed market incentives for rural areas; and greater engagement by rural consumers in improving their health.

The report shows that telemedicine technologies -- which use information technology to facilitate communication between patients and health-care providers -- are particularly well-suited to rural areas like South Dakota where vast distances, low patient density and low provider density create challenges in accessing and providing care.

A greater employment of telemedicine can expand capacity, drive coordinated care, improve the quality and efficiency of the delivery system and support more patient self-management.

The paper offers several concrete steps to promote greater use of telemedicine and telehealth, including:

• Expanding broadband connectivity to enable growth of telemedicine adoption;

• Improving and aligning reimbursement approaches across payers to encourage greater use of telemedicine across rural settings;

• Improving availability of telemedicine technologies to consumers;

• And reducing regulatory barriers to the use of telemedicine technologies and health professionals.