When I graduated from residency as a family practice provider, I began my career in a rural health practice. I was not prepared for the depth and kindness of the patients and their families, the multiple generations that I would care for, nor the deep roots I would put into the community. I was also not prepared for the gifts: more zucchini than anyone could eat in a lifetime, fresh caught trout, rutabaga from the garden, handmade arts/crafts, and even a pet beta fish for one of my kids.
My receptionist once had an awful cough and one of our patients brought her some moonshine to soothe her symptoms, but I probably should not mention that one.
Rural communities are a unique environment with a population that is often underserved. The vast expanses of land typically populated with farmers and factory workers have scarce medical resources and an often-defunct hospital systems that could not financially survive serving the smaller population. Patients must travel long distances for services and have come to expect that their primary care provider can take care of most of their ailments.
Access to specialty care or virtual visits, often taken for granted by the modern city dweller, can be a hardship for someone in a rural community. Transportation costs and unreliable internet access can be barriers. Lifestyle factors impact patients’ life expectancy in a rural community. In comparison to their city dwelling counterparts, rural residents do not live as long. Factors contributing to this include increased rates of smoking cigarettes, obesity, and hypertension, which are usually higher in persons that live in a rural area. People in rural communities die at higher rates than city dwellers from stroke, heart disease, and cancer.
A rural community provides unique challenges in the medical care of patients, and it is uniquely suited for a value-based care model. The current fee-for-value care model that most healthcare systems base their provider payment on does not always serve the rural health physician. A fee-for-service model incentivizes a provider to see more patients quickly. In a big city, the patient population is large and growing, providing ample clients in a fee-for-service world. The rural health provider has a smaller, more distant population. The fee-for-service model favors a larger city, and many doctors respond by leaving small towns for urban areas, creating a greater deficit of providers in an already underserved region.
A value-based care model rewards healthcare providers (and systems) for better health outcomes. It incentivizes quality of care over quantity of care. For a rural healthcare provider, this means being able to better care for a smaller population of patients AND being rewarded for a job well done. It puts the patient at the center of the healthcare equation. Is their blood pressure well-controlled? Is their diabetes managed well? Are they getting their cancer screening? Have you counseled them on quitting smoking? If the answer is yes to these questions, then the patient has better outcomes, and the provider has done their job.
Because the value-based care model rewards outcomes, it is well-suited to improve the health and well-being of rural residents who are statistically less healthy than their city dwelling counterparts. It is a solution to a problem that rural health communities have been unable to solve with the current fee-for-service model of healthcare. Value-based care allows the provider time to listen to the concerns of the patient, address their health issues, and discuss the prevention of disease. As a country doctor at heart, I know how important this is to me, but more importantly, I know how important it is to the patient.