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Practical Roadmap toward 21st century rural health care for more than 50 million Americans.

Projects an increase of around 5 million newly insured rural residents by 2019 -- even as the number of physicians in rural America lags

--Quality of care is rated lower in rural areas in 7 out of every 10 health care markets; both physicians and consumers in rural areas more likely to rate quality of care lower than those in urban and suburban markets

--Innovations in care delivery -- particularly telemedicine and telehealth -- can absorb future strain on rural health care systems

Rural Americans experience more chronic health conditions such as diabetes and heart disease than urban and suburban residents, have greater difficulties accessing high-quality care, and from 2014 millions more of them will likely participate in Medicaid and government-subsidized insurance, according to a new paper released today by the UnitedHealth Center for Health Reform & Modernization.

At the same time, more use of technology, such as broadband access that would increase telehealth solutions, can help ease strain on the system and further promote healthier outcomes in rural communities.

The paper, titled "Modernizing Rural Health Care: Coverage, Quality and Innovation," explores how health reform implementation, particularly health insurance expansion, will increase the need for innovative care models and points to technology and a stronger role for rural primary care as promising solutions. It also reports the results of a new Harris Interactive survey of 2,000 patients and more than 1,000 primary physicians in rural and urban areas.

"The next few years will be times of considerable stress on rural health care, but also times of great opportunity, since across the country there are already impressive examples of high-quality care, tailored to the distinctive needs of the local community," said Simon Stevens, UnitedHealth Group executive vice president and chairman of the UnitedHealth Center for Health Reform & Modernization. "The challenge for all involved in rural America now is to build on that track record of innovation and self-reliance, so as to ensure that all Americans -- wherever they live -- can live their lives to the healthiest and fullest extent possible."

The new report includes new findings on coverage, access and quality, as well as detailed suggestions for improvement:

Rural coverage: The report contains new projections showing that around 5 million rural residents may join Medicaid and other insurance plans as a result of the planned 2014 coverage expansions -- which would represent a higher percentage increase than in urban areas. Already almost one-third of people in rural areas depend on Medicare and Medicaid, compared with one-quarter in urban areas.

Rural access: Coverage is not the same as access to high-quality care. More than half of rural primary care doctors report that patients they refer to specialty care have to travel an average of about 60 miles. Furthermore, the 2014 coverage expansions will place increased pressure on rural care delivery. The good news for rural areas is that a higher proportion of rural primary care physicians surveyed said they were currently accepting new Medicaid patients (84 percent vs. 65 percent of urban primary care physicians). And looking forward to 2014, 59 percent of rural primary care doctor respondents plan on accepting new Medicaid patients, compared with only 44 percent of their urban counterparts. However, the report also finds that around 11 million rural residents currently live in areas where primary care supply is relatively low but where the increase in the insured population will be high relative to other counties. Partly as a result, almost half of rural primary care physician respondents expect a primary care shortage over the next few years (compared with 37 percent of urban primary care doctors).

Rural care quality: The report finds that both rural consumers and rural primary care physicians rate the quality of local care lower than do their urban and suburban counterparts. While nearly two-thirds (63 percent) of urban and suburban residents assess the quality of their local health care as 'excellent' or 'very good,' only half of rural residents do so (49 percent). Nearly a quarter (24 percent) of rural residents say their local care is only 'fair' or 'poor,' compared to 12 percent of urban and suburban residents who believe that. New data in the report also pinpoint the need to improve health screening and preventive care in rural areas.

Practical Solutions: Given these challenges, there is an urgent need to deploy at scale innovative new rural care models. The working paper identifies a range of options, drawing on successful private and public examples in particular parts of the country. The report goes on to call 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 paper offers several concrete steps to promote greater use of rural telemedicine and telehealth:

-- expanding rural 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 use of telemedicine technologies and health professionals.

Source: UnitedHealth Group