Tackling Rural Health Disparities with Data, Evidence, and Partnerships

To better understand challenges and opportunities for improvement in rural health care, program administrators and policymakers need better access to health care pricing and usage data. Mathematica developed the Rural Health Potentially Avoidable Utilization (PAU) Dashboard, which provides more than 2,000 rural hospitals in the United States with data on the percentage of Medicare revenue from PAU in emergency department or inpatient care settings.

We have also worked with partners to develop hospital cost and quality dashboards, such as the Hospital Cost Tool and the Health Systems Dashboard, to give policymakers and researchers tools to better understand hospital pricing and quality. We aim to increase transparency on costs and acute admissions, to improve quality and affordability.

To address rural hospital closures, policymakers and CMS created the Rural Emergency Hospital (REH) designation, the first new type of rural hospital created in more than 20 years. REHs will provide emergency and outpatient services. Medicare will pay REHs at a rate 5 percent greater than the Outpatient Prospective Payment System reimbursement, including a monthly facility payment totaling $3.2 million per year. REHs are designed to maintain access to critical outpatient hospital services in communities that might be unable to support or sustain a small rural hospital. They are also required to provide 24-hour emergency and observation services.

Mathematica assists the Rural Emergency Hospital Technical Assistance Center by providing direct technical assistance to small rural hospitals, critical access hospitals, and rural community stakeholders interested in exploring the benefits and feasibility of converting to an REH. Our technical assistance activities include custom financial modeling, virtual learning events, and developing and sharing educational resources.

CMS and other health care payers are supporting efforts to change financing for rural hospitals to improve health while maintaining access to care in rural areas. In the past few years, a multidisciplinary team of researchers, data scientists, and analysts has been working with federal and state partners to explore the potential of alternative payment models to achieve those goals. Alternative payment models can incentivize better care coordination, primary care follow-up, and community health partnerships.

The global budget payment model can provide a powerful incentive for hospitals to reduce PAU by implementing strategies that improve health. Under global budgets, hospitals can maintain financial wellness while working to improve community health, because hospital payments no longer depend on the volume of admissions or services provided.

Mathematica is working with state health organizations in Vermont, Pennsylvania, and Washington to help design and implement alternative payment models in rural settings with multi-payer participation. In Pennsylvania, our experts are helping to implement a multi-payer global budget payment model. We are working with the Pennsylvania Rural Health Redesign Center and the CMS Innovation Center to support recruitment efforts, develop requirements for data submission, design new payment models and adjustments, produce financial analysis, calculate global budgets, and aggregate and analyze data for payers and providers.

Social, environmental, economic, and physical factors in rural communities affect residents’ health. That’s why improving health in rural communities requires whole-person care that addresses physical, behavioral, and social needs. Mathematica has worked with governments and health care and social service providers to understand and address these factors. We support CMS and the Accountable Health Communities Model awardees that serve rural Medicare and Medicaid beneficiaries. We are providing them with peer-to-peer learning activities and technical assistance to identify shared challenges and brainstorm solutions to address patients’ health-related social needs in rural communities.

Rural communities’ behavioral health challenges include being hit particularly hard by substance use disorders. However, rural residents face a shortage of providers and often must travel long distances to receive care. They are also less likely to have insurance coverage for such care. Efforts are underway across the country to better meet behavioral health needs, including in primary care settings. By analyzing a large health system located in the Dakotas and rural Minnesota, we were able to shed light on a concrete example of how to incorporate behavioral health services into primary care in underserved areas. This approach achieved positive results on quality-of-care processes and emergency department use. We have also studied programs that address the challenges rural communities face in serving parents with substance use issues and whose families are involved in the child welfare system, and described strategies to help parents with recovery and to help families reunify.