The North Country in New York State is a beautiful region but access to healthcare is increasingly difficult and under growing stress. The North Country is the state’s most sparsely populated region and is categorized as a rural area with intense winter weather. The area has a total population of around 600,000 accounting for three percent of the state’s population.
The report “Toward an Integrated Rural Health System: Building Capacity and Promoting Value in the North Country” developed by New York’s North Country Health Systems Redesign Commission, discusses many of the area’s problems with healthcare issues.
According to the report, 14.2 percent of the residents are 65 and older, the median family income is $35,244, and the region is generally challenged by poor health. At the same time, Medicaid enrollment in North Country is significantly higher than the rest of the state and as a result of the higher levels of enrollment, the average annual Medicaid expenditure per enrollee is higher in North Country.
The use of telehealth has proven to be useful but is also faced with problems. Although some providers in the North Country have successfully established telehealth programs and initiatives, the sustainability of many of these telehealth programs present issues.
Even if providers are able to effectively implement telehealth, it is difficult to maintain it without adequate reimbursement from insurers, so the Commission found that without adequate reimbursement, the telehealth program is unsustainable. In addition, providers who have not yet implemented telehealth for various reasons, cite numerous financial, technological, and regulatory barriers that can prevent moving forward with telehealth programs.
However, efforts are being made to expand telehealth capacity throughout the region. A fiber optic telecommunications and telehealth network has been built that currently links many rural North Country healthcare sites to urban centers for consultations, specialty care, and for diagnostic purposes.
In a project to transform the healthcare delivery system in the region, the Adirondack Region Medical Home pilot is moving in the right direction. The results from the pilot show that more diabetic patients receive LDL tests and control over blood sugar levels, teenagers have experienced significant weight loss, reductions in blood pressure have resulted, and hospitals are starting to see lower readmissions rates.
The North Country Health Systems Redesign Commission’s report makes a number of recommendations to improve healthcare. Some of their thoughts are to:
- License and credential telehealth providers and develop policy to encourage and/or require all payers to support telehealth reimbursement
- Allow multiple provider specialties to participate in telehealth
- Develop a rural New York State Telemedicine Resource Center in North Country
- Expand Medicaid reimbursement policy on eligible providers
- Endorse care delivery models to include enhanced care management and care coordination approaches such as the Advanced Primary Care and Health Home model
- Endorse the State Health Innovation Plan that includes workforce priorities
- Suggest the State provide primary care providers access to capital investment funds to address their needs and risks
- Expand the Medical Home Model to apply to Long Term Care as well as primary care settings
- Urge the Department of Financial Services to support expanded participation in Medical Homes by all insurers active in North Country
- Integrate primary care and behavioral health services through regulatory and financial reform and provide financial incentives to primary care and behavioral health services
- Enhance collaboration among primary care providers and behavioral health providers to co-locate screening, assessment, and brief outpatient treatment services
For more information and to view the full report published April 2014, go to www.health.ny.gov/facilities/north_country_health_systems/docs/north_country_report.pdf.