The March to Accountable Care Organizations-How Will Rural Fare?

MacKinney, A. Clinton; Mueller, Keith J.; McBride, Timothy D.

doi:10.1111/j.1748-0361.2010.00350.x

Cited by 30 publications

(37 citation statements)

References 6 publications

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“…These may include facilitating partnerships between rural providers and larger healthcare systems to create ACOs, in an effort to improve coordination of care and access to specialty care providers. 44 Other solutions include establishing mobile specialty provider programs, where rural healthcare sites that cannot support a full-time specialty provider collaborate with a visiting physician to provide space for specialty-care practice on a regular basis, 46 , and implementing care through telehealth, where various technologies (e.g., phone, video, electronic transmission of diagnostic images) are used to provide health care, health information, or health education from a distance. 47 …”

Section: Discussionmentioning

confidence: 99%

Health care eligibility and availability and health care reform: Are we addressing rural women’s barriers to accessing care?

Zimmermann¹,

Carnahan²,

Paulsey³

et al. 2016

Journal of Health Care for the Poor and Underserved

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Background Rural populations in the US face numerous barriers to healthcare access. The Patient Protection and Affordable Care Act (PPACA) was developed in part to reduce healthcare access barriers. We report rural women’s access barriers and the PPACA elements that address these barriers as well as potential gaps. Methods For this qualitative study, we analyzed two datasets using a common framework. We used content analysis to understand rural, focus group participants’ access barriers prior to PPACA implementation. Subsequently, we analyzed the PPACA text. Results Participants described healthcare access barriers in two domains: availability and eligibility. The PPACA proposes solutions within each domain, including healthcare workforce training, Medicaid expansion, and employer-based health care provisions. However, in rural settings, access barriers likely persist. Discussion While elements of the PPACA address some healthcare access barriers, additional research and policy development are needed to comprehensively and equitably address persistent access barriers for rural women.

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Section: Discussionmentioning

confidence: 99%

Health care eligibility and availability and health care reform: Are we addressing rural women’s barriers to accessing care?

Zimmermann¹,

Carnahan²,

Paulsey³

et al. 2016

Journal of Health Care for the Poor and Underserved

View full text Add to dashboard Cite

show abstract

“…20 As ACOs are established, particular attention should be focused on the specific needs of rural communities. 20–22 …”

Section: Discussionmentioning

confidence: 99%

How 3 Rural Safety Net Clinics Integrate Care for Patients

et al. 2014

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Background Integrated care focuses on care coordination and patient centeredness. Integrated care supports continuity of care over time, with care that is coordinated within and between settings and is responsive to patients’ needs. Currently, little is known about care integration for rural patients. Objective To examine challenges to care integration in rural safety net clinics and strategies to address these challenges. Research Design Qualitative case study. Participants Thirty-six providers and staff from 3 rural clinics in the Safety Net Medical Home Initiative. Methods Interviews were analyzed using the framework method with themes organized within 3 constructs: Team Coordination and Empanelment, External Coordination and Partnerships, and Patient-centered and Community-centered Care. Results Participants described challenges common to safety net clinics, including limited access to specialists for Medicaid and uninsured patients, difficulty communicating with external providers, and payment models with limited support for care integration activities. Rurality compounded these challenges. Respondents reported benefits of empanelment and team-based care, and leveraged local resources to support care for patients. Rural clinics diversified roles within teams, shared responsibility for patient care, and colocated providers, as strategies to support care integration. Conclusions Care integration was supported by 2 fundamental changes to organize and deliver care to patients—(1) empanelment with a designated group of patients being cared for by a provider; and (2) a multidisciplinary team able to address rural issues. New funding and organizational initiatives of the Affordable Care Act may help to further improve care integration, although additional solutions may be necessary to address particular needs of rural communities.

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“…25 While joining an existing ACO or forming an out-of-region ACO may provide or increase needed resources, it also could threaten local control and result in out-of-area patient referrals, further draining local hospital and specialty service volumes. 23,26 Case Study: WWAMI in an Era of the ACA and ACOs…”

Section: Impact Of Wwami On the Rural Workforcementioning

confidence: 99%

“…Few rural locations can achieve this volume without partnering with out-of-region health systems. 23 New patients brought in by the ACA to critical access hospitals will most likely be Medicaid participants, with lower reimbursement rates. 24 Other challenges are the need for sophisticated financial and information management systems, care coordination, and data analytics that require sophisticated staffing and investment.…”

Section: Impact Of Wwami On the Rural Workforcementioning

confidence: 99%

Challenges and Opportunities in Building a Sustainable Rural Primary Care Workforce in Alignment With the Affordable Care Act

et al. 2013

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The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.

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The March to Accountable Care Organizations-How Will Rural Fare?

Cited by 30 publications

References 6 publications

Health care eligibility and availability and health care reform: Are we addressing rural women’s barriers to accessing care?

Health care eligibility and availability and health care reform: Are we addressing rural women’s barriers to accessing care?

How 3 Rural Safety Net Clinics Integrate Care for Patients

Challenges and Opportunities in Building a Sustainable Rural Primary Care Workforce in Alignment With the Affordable Care Act

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