At Hopscotch Health, we are on a mission to transform healthcare for rural communities across the country, one at a time, through advanced primary care. As we work to build a solution that solves the many challenges that exist today for rural communities, we have spent countless hours meeting with patients, clinicians, and other stakeholders. We’ve asked questions, we’ve watched our current practices, and we’ve analyzed data to think through underlying drivers of the challenges we need to address and the strengths we can leverage.
So often, we read about the disparity in healthcare between rural and urban settings; the statistics are astonishing and highlight how much opportunity exists to better serve patients and to support providers. What often feels missing from the numbers, however, are some of the incredible things you will see in rural communities, many that will help lay a foundation as we transform rural healthcare.
With that backdrop, I wanted to share a few lessons we’ve learned about the rural communities we serve. In this installment, we’ll highlight three important points to understand for clinical teams operating in these settings; in future posts, we’ll also explore what we’ve heard from patients and caregivers, as well as community partners and others along the healthcare continuum.
1. Trust and connection serve as a foundation for rural communities and will be key to enabling true improvements in health outcomes.
We often hear that healthcare is local. One of the things this means is that what works well in one setting may not work in another. Cultural dynamics and other key factors must be considered as we work to build solutions for patients and providers alike.
For example, we’ve seen how relationships and trust play a critical role in rural communities. 81% of rural residents have a strong sense of attachment to their local community, and two-thirds have had neighbors help in times of need. People help one another and embed themselves in their communities, often at personal cost to themselves. This is a stark difference from urban communities, where we’ve unfortunately seen an erosion in personal connection and a tendency to anchor on transactional relationships.
Many of the physicians and clinicians we work with have spent decades establishing these strong roots in their communities and trust with their patients. They are leaders and trusted sources of care, compassion, support, and information for the people they serve. Patients trust them implicitly, but that is only established over time, with focus and intention.
It is by building on the trust and strength of these clinicians that we can impact outcomes for patients and deliver long-lasting solutions while achieving our mission. To us, that means doing the small things right every time, being there when our patients need us most, even if it’s inconvenient, and following through with what we say we’ll do – all elements that are purposely and operationally built into the care model we’ve deployed. To make true and lasting impact for those we serve, clinical teams must go above and beyond to establish a baseline of trust and connection.
2. Many physicians and clinicians exhibit foundational elements of proven PCP 2.0 models in their practices today, just without the support they deserve, and without a payment model to adequately resource their efforts.
Access to specialty care and hospital facilities has been challenging in rural communities for decades and has been further pressured since the pandemic onset. Rural residents must wait months for appointments and spend hours driving in search of specialists. And even when they can find someone to care for them, the wait time for appointments can be twice as long compared to urban residents.
Due partially to these gaps in access, primary care physicians practicing in rural communities often have a broader scope of practice and manage high-complexity cases themselves that would otherwise be referred to a specialist in an urban or suburban setting. This single point of care, while challenging to maintain, does allow for one clinician to be thinking holistically about a patient’s needs. Rather than referring each organ system to a different specialist and triggering often unnecessary testing or procedures downstream, the PCP has more discretion and ability to guide a patient’s care that appropriately respects their wishes and goals and takes the full picture of their health into account. This true ownership mentality is one of the foundations of great primary care, and a feature that we already see woven into the DNA of our clinical teams.
Independent physicians have also successfully navigated through the pandemic and many other challenges over the last couple decades and have shown leadership, strength, and a resilience that we know to be critical in achieving meaningful outcomes. At Hopscotch, we are seeing the beauty and strength of pairing the best of community-based physicians with proven elements of the best PCP 2.0 models, including more support for providers and innovative payment models to incentivize end-to-end care. When we can tap into this whole-person approach and resource our clinical teams through appropriate risk-based contracting, we can really begin to move the needle on population outcomes.
3. The next generation of physicians and clinicians want the impact and connection that comes with a community-based rural practice, but feel their opportunities are limited without major life tradeoffs.
In rural counties, over two-thirds of physicians are 55+ years old, compared to urban counties where only about half are at a similar career stage, underscoring the need to recruit and retain physicians in rural communities. The current expectation is a nearly 25% decline in the number of physicians living in rural areas by 2030. We have heard directly from graduating residents that they would love to work in a community-based practice serving a rural area, but despite that excitement and interest, we are watching a major supply-demand mismatch – while 20% of Americans live in rural communities, only 10% of clinicians do.
Why is this so? One answer we’ve heard is around the tradeoffs that clinicians must make to practice in these areas. Independent primary care practices serving rural areas may have 1-2 providers serving 2,000+ patients, no other full-time staff, and require the physician to regularly work 60+ hours a week with a few days of vacation to make ends meet in a fee-for-service transactional payment world. This kind of clinical setting is not sustainable, nor does it tap into the many strengths and skillsets of a diverse multi-disciplinary team.
At Hopscotch, we believe our job is to create an environment where the next generation of physicians and clinicians want to practice, one where they can find the impact and the connection they have worked so hard to deserve. By surrounding PCPs with a strong team who can wrap around patients and solve real problems for them, a robust operational and technology stack that drives efficiency and impact, and the administrative and leadership support that is needed, we can start to attract more high-caliber, mission-driven clinicians who want to commit to rural communities for their entire careers.
Building around the needs of clinicians, care teams, patients, and caregivers is a core tenet of Hopscotch Health. So is leveraging the strength of the communities we seek to serve. We are inspired by the camaraderie, resilience, and capability we have seen and will leverage this strong foundation as we work to realize our important and weighty mission.
Thank you for continuing to follow our journey. We’ll keep exploring these themes with a focus on our patients and communities next. Get ready for more exciting updates to come shortly! We are always eager to hear your thoughts, input, and feedback – please drop a comment, check out any of our open job postings, or reach out directly anytime.
 Harvard University T.H. Chan School of Public Health (2018) Life in Rural America
 Harvard T.H. Chan School of Public Health, NPR, Robert Wood Johnson Foundation (2020) The Impact of Coronavirus on Households in Rural America
 Arkansas Gazette (2019) Doctor shortage raises wait times for rural areas
 HRSA Area Health Resources Files (2020 – 2021)
 New England Journal of Medicine (2019) – Implications of an Aging Rural Physician Workforce
 American Hospital Association (2019) Rural Report
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