Sustainable solutions to improve rural health

Rural communities face unique challenges. We believe increased funding and a focus on patient activation can help. 
Policy Perspectives

Kristen Ballantine is the Vice President, Public Affairs, at Phreesia.

Last month, we observed National Rural Health Day, a time to recognize the nearly 1 in 5 Americans who live in rural communities and the barriers to healthcare they may face. Rural communities face unique healthcare challenges, including high rates of chronic illnesses and large numbers of under- or uninsured patients, and social determinants of health are often overlooked. At the same time, provider workforce shortages and low, unreliable reimbursement further impact quality of care and often hinder patient access. 

Phreesia is proud to work alongside rural patients and providers to address these barriers through an array of digital and clinical solutions that improve outcomes, ensure sustainability of rural health centers and support patients in being more active in their care. We recently submitted comments to the House Ways and Means Committee Request for Information regarding healthcare access in rural and undeserved areas and applaud Representatives Harshbarger (R-TN) and Tokuda (D-HI) for reconstituting the Bipartisan Congressional Rural Health Caucus. Our letter emphasizes the importance of Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs) in rural communities, as well as patient activation. 

Fund FQHCs and CHCs 

Reliable, enhanced funding can help FQHCs and CHCs invest in and maintain tools to enhance clinical care, including for collecting patient-reported outcomes and administering critical patient health screeners for anxiety, depression, alcohol use disorder and social determinants of health. Phreesia’s collaboration with one of our FQHC clients to better screen and address patients’ unmet social needs was recently recognized by the Health Resources and Services Administration (HRSA) as an innovative solution to allocate community health workers to the patients who need them the most, while using digital solutions to screen people at scale. Models like this developed with rural patients and providers and equitable access in mind help ensure the sustainability of FQHCs and CHCs in rural communities. 

Such models require a sustainable source of funds. We urge Congress to provide enhanced, long-term funding to FQHCs and CHCs. Stable funding ensures these health centers can remain a vital point of access in rural communities and allows FQHCs and CHCs to invest in and maintain, capabilities that help to alleviate otherwise time-consuming administrative tasks like patient registration, insurance eligibility verification and billing in a setting plagued with workforce shortages. Spending less staff time on these tasks allows FQHCs and CHCs to focus on the patient. 

Support patient activation in rural patients 

Patient activation, a patient’s knowledge, skills and confidence to manage their own care, is measured through the Patient Activation Measure® (PAM®). Higher levels of patient activation have repeatedly been shown to be associated with better patient clinical outcomes, mental health outcomes, medication adherence, disease self-management and treatment satisfaction across a number of clinical specialties and their correlating disease populations and chronic disease states. This is particularly important for health conditions that are commonly difficult to manage in rural and underserved communities, such as heart disease, diabetes and pregnancy. More activated patients require less clinical intervention, which is important to alleviate geographical, transportation and access challenges and low provider availability in rural settings. Supporting activation in rural patients would help to improve outcomes, reduce costs, and decrease provider burden. 

The PAM Performance Measure (PAM-PM) is currently being used in the Kidney Care Choices model at the Center for Medicaid and Medicare Innovation, and beginning in 2024, the PAM-PM will be included as a quality measure in the Centers for Medicare and Medicaid Services’ Merit-Based Incentive Payment System (MIPS). 

As we wrote in our response to the Request for Information on improving access to rural healthcare, we recommend that Congress urge CMS to do the following:  

1. Include the Gains in Patient Activation scores at 12 months in the Universal Measure Foundation person-centered care domain. 

2. Study the use of the PAM and SDOH to understand ways to scale social needs screening and address social needs more efficiently without further taxing rural workforce. PAM and SDOH together can help understand the underlying needs for resource allocation and guide interventions. 

3. Include the PAM alongside SDOH screening measures in Medicare quality reporting programs to aid in enhanced quality measurement and improvement efforts related to issues such as care coordination or chronic conditions and health equity. 

4. Include the PAM-PM in new CMS models focused on addressing delivery of care for chronic conditions including the two upcoming models focused on maternal health and behavioral health.