Part Two: Reshaping patient care in rural America

Rural America is often described as a ‘healthcare desert,’ where severe issues of adequate access exist, especially when compared to urban communities. The stark differences between rural and urban healthcare systems are undeniable, but we’ve also come to deeply appreciate the many differences in the fabric of patients’ communities and lives themselves.

October 28, 2022
Insight
By
Dr. Sandeep Palakodeti
Sandeep and his father

We can’t always model rural care after urban care. Urban healthcare has its own set of flaws, challenges and complexities; that aside, what rural patients want and need is completely unique to their own environmental and societal context.

If we’re going to improve our healthcare system, we have to be listening carefully and endlessly to the patients and communities we serve. Patients are at the center of everything we do. Every person in the U.S. deserves simple, accessible and inclusive healthcare, no matter where they live. We’ve spent years listening to patients, spending valuable time with them, and developing important relationships. 

In Part 2 of this blog series, we’re focusing on what we’ve heard from rural residents, the lessons we’ve learned and how we’re answering back.

The lessons we’ve learned from rural American patients

1. Most rural patients prefer in-person visits with their providers, but are willing to tap into other modalities (e.g., virtual care) in specific circumstances.   

It turns out that for rural Americans, while virtual care certainly has an important role to play, most prefer working with their doctor in person. In a 2021 survey of rural households throughout the U.S., 62% of those who reported using telehealth services responded that they would have preferred an in-person visit over a virtual visit.[1] What’s more, a separate survey showed that a greater percentage of rural residents trust health information from a doctor (88%) than from an online source (52%).[2]

For rural residents, there’s something to be said about getting face-to-face time with their healthcare providers. Like in any relationship, it’s an important part of establishing trust. If the majority want to see physicians in person and are more likely to trust the information they’re getting from their doctor, then we need to ensure we’re meeting patients where they are, as they are.

Time spent in the clinic is a cornerstone of good care. There’s a healing element to a physical space that brings together patients, caregivers, and care teams, embedded within their community. Our team at Hopscotch recognizes the immediate opportunity in rural markets, where many live within reasonable driving distance to a local hub, to ensure we can effectively deliver the power and preference of in-person connections. We do this by removing the barriers preventing patients from getting the care they deserve and ensure the care we deliver is comprehensive, yet simple and accessible. 

How Hopscotch provides patients with simplified care:  
  • We see and act on opportunities to place clinics in locations that need them
  • We earn the trust of our patients and build on the relationships we establish
  • We provide flexible care delivery options for certain populations
  • We make it easy to schedule appointments and access our teams

Simplifying care is key and helps us build trust. Patients who trust their doctors are more likely to adhere to suggested prevention and treatment plans, resulting in healthier populations overall. We believe intentionally forming trusting and lasting relationships through the power of in-person connection allows our model to thrive.

2. We must ensure rural patients have proper access to the healthcare resources they need and deserve. 

While the majority of rural patients' preference is in-person care, they’re still required to travel 2.5 times further than urban patients to access basic care.[3] The long distances between residents and care providers become real barriers for patients to receive the critical or preventative care they need. On the bright side however, barriers like these have actually helped to establish real strength in communities, where caring neighbors count on each other for support, security and comfort. To illustrate, 81% of rural residents report having a strong sense of attachment to their local community and 2/3 have had neighbors help in times of need.[4] This inspires the Hopscotch model and motivates our teams to become the same helpful neighbors.

Even for patients that may depend on virtual care to avoid lengthy travel, they may be faced with issues of connectivity. While slowly improving, there are still challenges with cellular and broadband access in some rural communities. In 2019, only 72% of rural residents had moderate- or high-speed broadband available in their census blocks, and rural households were less likely to have internet subscriptions than urban households (75.2% versus 84.4%). Internet service providers also cited a smaller customer base, decreased adoption rates, difficult terrain, and issues of digital literacy and affordability.[5]

We’ve learned through the establishment of our clinics that many of the residents we support live within 30 minutes of the biggest town in the county, where they travel regularly for day-to-day necessities like groceries and banking. So, while distance certainly limits access, the real issue is that healthcare organizations aren’t actually willing to invest in rural communities. We’re proud to say that we’re different, and we’re actually trying to address and fill those gaps.

How Hopscotch is improving accessibility of care for rural patients: 
  • We seek out locations with lesser density and open clinics in those areas, which are often ignored by larger systems but still vital access points for residents.
  • We educate community members on how to engage with digital tools that support their care.
  • We organize transportation for patients to accommodate in-person visits, in some cases.
  • We provide patients with a larger network of care including behavioral health support and social services. 
  • We’re available when patients need us and spend meaningful time with them, always listening closely.

Our team-based care model empowers our teams to provide great care to all patients and generate experiences we’re proud to share. Just recently, a Hopscotch care team member spent a week following up with a patient and noticed they began to sound much worse on the phone as the days passed. The care team member arranged for a same-day urgent appointment in a Hopscotch clinic. The patient, already identified as high risk, was found to have an infection and was promptly prescribed antibiotics before they would have decompensated and ended up in the hospital. The care team then did a follow-up home visit, where several SDOH and home safety issues were identified and resolved. As a result, the patient’s symptoms improved and they were kept out of the hospital, through a combination of modalities that met their needs. 

Our model allows us to create dynamic scheduling, engage with patients as they need us to, and prioritizes access in our clinics so patients can receive same-day care and flexible follow-up care to ensure our plans are well-executed. This improves quality, outcomes, cost and satisfaction for both the patients and care teams.

3. We must focus on improving diversity, equity and inclusion of healthcare within rural communities. 

We already know that racial disparities in healthcare have long been recognized and evaluated. Back in 2005, a report from the National Academy of Medicine found that racial and ethnic minorities were receiving lower quality healthcare than white people, even when insurance status, income, age and severity of conditions were comparable.[6] Unfortunately, very little has improved since then. A report in 2021 from the Agency for Healthcare Research and Quality found that since 2000, disparities have narrowed for only about 8% of measures for American Indian and Alaska Native populations, 2% of measures for Asian populations, 3% of measures for Black populations, 4% of measures for Hispanic populations, and 10% of measures of Native Hawaiian/Pacific Islander populations.[7] 

These disparities are only exacerbated in rural communities, where our attention must be turned to groups who are underrepresented. It’s critically important to shine a light on racial, gender, and orientation inequities within rural communities in order to cultivate diversity and drive health equity. 

At Hopscotch we’re building teams that protect and support those that are often overlooked or forgotten, or even intentionally left behind by a system with the wrong incentives. Understanding rural patients means understanding all rural patients. We believe strongly in identifying, codifying, and creating interventions for the many inequities we see across the populations we serve. Our team-based model drives a holistic approach to providing better healthcare for all, and it requires us to understand the nuances and needs of every individual population and beyond that, every individual patient. That means taking into account and customizing care based on all factors related to genealogy, environment, culture, lifestyle, socioeconomic status, care accessibility and beyond.

These lessons we’ve highlighted help us better understand and address the challenges and complexities of the state of healthcare in rural communities, so that we can provide a better patient experience, better clinical outcomes, lower cost of care and a better provider experience. We can provide a model of healthcare that’s simple, accessible and inclusive. And not just for rural patients, but for all patients. 

Join our mission to make rural healthcare more simple, accessible and inclusive for all

What’s clear in healthcare is that the status quo is failing patients. We urgently need world-class clinicians and teams to come together to bring world-class care to these strong rural communities. As more people discover the beauty and flexibility offered in rural communities and take advantage of remote work, we will only have more access issues to solve. Models like Hopscotch can help address the needs of a diverse population and provide much higher satisfaction and longevity for the teams serving in these areas.

Check out the first of this three-part series to discover the lessons we’ve learned from rural physicians. If you’d like to learn more about the Hopscotch team-based care model or are interested in joining our mission, we’d love to hear from you – just complete our short contact form.

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