A law recently signed in Maryland established the “Rural Healthcare Delivery Workgroup” (Workgroup) to study how rural healthcare delivery in the Mid-Eastern Shore region in the State is progressing. The workgroup was charged to make recommendations to meet the healthcare needs in the five county Mid-Shore region, which could then be applied to other rural areas in Maryland.
The Mid-Eastern Shore area is not as vast and not as sparsely populated as rural areas in some other states. However the Maryland Shore region covers a large geographic area with an older population with more chronic health conditions and fewer financial resources than other urban and suburban areas in the State.
The workgroup’s discussions center on Caroline, Dorchester, Kent, Queen Anne’s and Talbot counties. The challenges to this region include long travel distances to healthcare facilities in a region with few public transportation options, limited workforce, a limited number of healthcare facilities, plus there is a shortage of primary care physicians, specialists, nurses, and allied healthcare workers.
To move the study forward, The University of Maryland School of Public Health in partnership with the Walsh Center for Rural Health Analysis at the University of Chicago was selected by the Maryland Health Care Commission to conduct the study which has been working in close collaboration with the members of the workgroup.
After holding a series of meetings and public hearings, the Workgroup recommended that the State should establish and support the “Rural Community Health Complex Program” to serve as the focal point for redesigning healthcare delivery in rural regions.
The workgroup recommended that a Rural Health Collaborative (RHC) organization be established to launch the Rural Community Health Complex Program. Plans were initiated to make this rural community health program a reality by mobilizing and educating local groups and then develop specific plans to establish and direct the program.
The focus for the Rural Community Health Complex Program is primary care. The Essential Care Complex (ECC) program to be established will consist of a primary care office to be directed by a physician or other healthcare practitioner.
The primary care office is to be in a stand-alone physical location, and may be co-located in a nursing home, EMS facility, school, or in a health mobile for smaller communities. The ECC should provide routine primary care including walk-ins, and some non-standard visits such as group visits for managing some chronic conditions.
The EEC could also act as the anchor for other initiatives including mobile integrated healthcare that pairs EMS and community health workers. Specialists, dentists, and behavioral health providers along with hospice and palliative care providers should be encouraged to partner or co-locate at the complex’s site when feasible.
Sites established as part of the Rural Community Health Complex Program will need to expand the scope of services offered to include providing primary care based on the Patient-Centered Medical Home model, an advanced ambulatory care site with free standing EDs, and a Special Rural Community Hospital (SRCH).
The SRCH will be a small rural hospital consisting of an emergency department, an observation unit with the capacity to provide inpatient and outpatient surgeries, and needs to provide inpatient care. The SRCH would provide telehealth capabilities and would support telehealth assessments and consults with patients outside of the hospital with clinicians at regional and academic medical centers.
The use of technology will need to support coordination among healthcare providers and social services plus provide a vehicle for educating patients on health literacy and self-management for chronic conditions.
Use of technology to provides services will be made available through a “Patient Centered Support Hub” which is already available via the use of interoperable EHRs. Today, EHR patient portals and services are currently available through the “Chesapeake Regional Information System for our Patients” (CRISP), or are currently planned to be available via the CRISP Integrated Care Network (ICN).
Go to http://mhcc.maryland.gov/mhcc/pages/home/workgroups/workgroups_rural_health.aspx to view the report of the Workgroup on Rural Health Delivery to the Maryland Health Care Commission titled “Transforming Maryland’s Rural Healthcare System: A Regional Approach to Rural Healthcare Delivery”.