The COVID-19 pandemic has exposed the need for major investments in digital health services and technology across the country, including telehealth and broadband infrastructure — particularly in rural communities. As a result, the Department of Health and Human Services aims to tackle American rural health care challenges in its latest action plan.
With physician shortages and shrinking numbers of physical health care facilities compared to its urban counterparts, rural areas — which make up 57 million U.S. residents — suffer from higher rates of severe mental health issues and suicide, but lack access to behavioral health providers and services.
Facing mounting and often overlooked health disparities in preventable diseases and illness, such as those associated with higher rates of smoking as well as hypertension and obesity, rural areas are less likely to offer preventive care services that could address these issues.
Rural areas also struggle with racial, ethnic and socioeconomic disparities. For instance, infant mortality and adverse maternal outcomes are higher, but hospital closures continue to disproportionately affect areas with predominantly Black, Hispanic and unemployed residents, who are at an increased risk for these health outcomes.
In addition, the veteran population — a demographic that comprises many individuals over 65 years old — largely reside in rural areas and face high numbers of non-enrollment in the Veterans Health Administration. There are 4.7 million rural veterans, but only 2.7 million enrolled in the VA's health system. While rural veterans are more likely than urban veterans to be enrolled, with more veterans enrolled in rural areas than urban, health care accessibility and health care enrollment challenges have been difficult to address.
“Expanding health care to veterans in rural communities is an ongoing priority for VA,” wrote a VA spokesperson. “We know for many rural veterans, proximity to care can be a challenge, which is why we’re focused on bringing telehealth solutions to reduce barriers to care.”
But at the crux of these longstanding issues is a critical backbone: a robust broadband infrastructure that supports reliable and affordable digital services in health care.
Internet connectivity is necessary for delivering digital care services via telehealth for both rural and urban communities, as well as providing communities with the resources they need. It also influences the effectiveness of larger health IT efforts, including interoperability between health care provider systems, the sharing and exchange of clinical data housed within patient electronic health records, home-based remote patient monitoring and other digital health applications. With gaps in broadband coverage, digital health care service would not be possible.
In pursuit of managing these large-scale challenges that have plagued rural communities for years, as well as responding to COVID-19, HHS launched its Rural Action Plan in September — the first department-wide strategy for addressing American rural health care challenges in 18 years.
Created by the HHS Rural Task Force, the strategic framework outlines a broad, four-point strategy to enhance existing and new agency priorities:
- Build a sustainable Health and Human Services model for rural communities by empowering rural providers to transform service delivery on a broad scale
- Leverage technology and innovation to deliver quality care and services to rural communities more efficiently and cost-effectively
- Focus on preventing disease and mortality by developing rural-specific efforts to improve health outcomes
- Increase rural access to care by eliminating regulatory burdens that limit the availability of needed clinical professionals
Leveraging technology and innovation such as telehealth services for care delivery, in particular, plays a substantial role in supporting people that lack access to physical health care facilities due to physical distance or COVID-19 health safety.
Of the more specific actions, HHS agencies are issuing prize competitions to award innovative telehealth and digital health solutions, funding telehealth-focused research and analysis, focusing efforts to revise policies and regulations for telehealth reimbursement and access through the Centers for Medicare & Medicaid Services, and expanding patient-access to behavioral-telehealth and telehealth-focused centers through the Health and Resource Services Administration.
“Telehealth is a long-term solution to help improve access to health care,” a HRSA representative told GovernmentCIO Media & Research. HRSA provides services to people who are uninsured, isolated or medically vulnerable. “This is important because more than 28 million people — or 1 in 12 people nationwide — rely on a HRSA-supported health center for affordable, accessible primary health care.”
Though broadband access continues to be the largest challenge, HHS plans to expand on its partnerships with other federal agencies, such as the Department of Agriculture, Regional Commissions, FCC and Veterans Affairs, following its goal to prioritize rural community health and support technological advancements in health care.