Ru­ral Health looks at treat­ing the per­son, not the symp­toms

In­stead of see­ing a physi­cian for a med­i­cal con­di­tion, the new model would en­cour­age care co­or­di­na­tion for so­cial ser­vices needs, as well.

The Star Democrat - - FRONT PAGE - By DENAE SPIERING dspier­ing@ches­pub.com

EAS­TON — Thurs­day, Nov. 16, is Na­tional Ru­ral Health Day. The na­tion­wide cam­paign to “Cel­e­brate the Power of Ru­ral” fo­cuses on the unique needs of health care in ru­ral ar­eas; some­thing that Dr. Fre­dia Wadley, health of­fi­cer for the Tal­bot County, said is go­ing through some ma­jor changes in or­der to bet­ter serve the ru­ral com­mu­nity.

“Health care is go­ing to have to change and it is go­ing through the pains of that right now be­cause of how rapidly it is chang­ing,” Wadley said. “But what they are look­ing for is how do we do it dif­fer­ently? How do we build some­thing that has qual­ity health care, good out­comes for all the peo­ple re­gard­less of in­come?”

Wadley, to­gether with health of­fi­cers from the five Mid-Shore counties and rep­re­sen­ta­tives from pri­vate med­i­cal prac­tices, hospi­tals, emer­gency man­age­ment and so­cial ser­vices, are all work­ing to not only treat the pa­tient but treat the per­son as a whole to reach those “good out­comes.”

“We are now look­ing at how do we in­te­grate bet­ter not only with

our­selves, but how do we in­te­grate bet­ter with so­cial ser­vices,” Wadley said.

The Ru­ral Health Care De­liv­ery Work­group, cre­ated by leg­is­la­tion with the Mary­land Health Care Com­mis­sion, has made sev­eral rec­om­men­da­tions to ad­dress ru­ral health care needs and goals. Two of the new­est rec­om­men­da­tions that Wadley says play heav­ily in this area in­clude the Ru­ral Health Col­lab­o­ra­tive and the Ru­ral Health Com­plex.

The two rec­om­men­da­tions at­tempt to rev­o­lu­tion­ize a typ­i­cal visit to the doc­tor. In­stead of see­ing a physi­cian for a med­i­cal con­di­tion, the new model would en­cour­age care co­or­di­na­tion for so­cial ser­vices needs, as well.

Whether that is a trans­porta­tion need, men­tal health need, ad­dic­tion need, or di­etary need, the col­lab­o­ra­tion be­tween the or­ga­ni­za­tions and med­i­cal world will be made avail­able in or­der to treat the pa­tient as a whole.

“The drivers of health care trans­for­ma­tion are, how do you serve more peo­ple and have a bet­ter out­come,” Wadley said. “The in­ter­est­ing thing about that is with value-based or out­come­based health fund­ing, most peo­ple don’t re­al­ize what you are try­ing to do is hold health care providers ac­count­able for their pa­tients get­ting the so­cial, eco­nomic, en­vi­ron­men­tal ser­vices, as well. That’s re­ally never been done be­fore.”

The first rec­om­men­da­tion, Ru­ral Health Col­lab­o­ra­tive seeks to bring health of­fi­cials of the five counties to­gether with providers and con­sumers in or­der to take a bet­ter look at what they can do to make a dif­fer­ence in health sta­tus and health cost.

“Could we do it to­gether bet­ter than we could do it as and in­di­vid­ual county?” Wadley said. “That’s the col­lab­o­ra­tive look; it brings peo­ple to­gether to say what we think we would serve peo­ple bet­ter.”

Wadley said some broad ex­am­ples of that would be in meet­ing the needs of an 85-year-old pa­tient, who lives in a ru­ral area, does not have trans­porta­tion but needs to go to the doc­tor, or so­cial ser­vices, or other agen­cies.

She said an­other ex­am­ple may be some­one who is di­a­betic and home­less, they would have no way to re­frig­er­ate their in­sulin or man­age their di­a­betes. But by col­lab­o­ra­tively work­ing to­gether, the agen­cies would be able to bet­ter co­or­di­nate care and en­sure ac­cess to that care for both clients.

The Ru­ral Health Com­plex is the sec­ond rec­om­men­da­tion made by the Ru­ral Health­care De­liv­ery Group. Wadley said it is the next step and it fo­cuses on align­ing the care co­or­di­na­tion in or­der to meet the needs of the clients.

She said the com­plex pro­vides the nec­es­sary com­po­nents in or­der to meet all of the client’s needs, whether un­der one roof or across town.

She said the con­cept al­lows for the di­a­betic pa­tient men­tioned above to then visit the doc­tor and meet with other agen­cies to ad­dress home­less­ness, med­i­ca­tion, trans­porta­tion and any other things they may need or qual­ify for.

Wadley said this has been done in other are­nas such as be­hav­ioral health, where a pa­tient may be at the doc­tor for a pri­mary care visit and able to see a men­tal health provider on the same visit.

“That takes some co­or­di­nat­ing,” Wadley said. “And if all things are not avail­able in one sight, we may be able to say, ‘Okay, you are com­ing in

for your pri­mary care visit at 9 o’clock. Let’s have you go over to so­cial ser­vices at 11 o’clock and we will trans­port you over.’”

She said be­ing able to have a client meet all their needs at one time takes some co­or­di­nat­ing and that is what the col­lab­o­ra­tion piece is all about.

“You wouldn’t do it the same way in every county be­cause they all have dif­fer­ent re­sources,” Wadley said. “But the whole ob­jec­tive of it would be how do we bet­ter in­te­grate clin­i­cal and so­cial ser­vices so that the pa­tient ben­e­fits.”

Th­ese rec­om­men­da­tions go be­yond treat­ing the client for strictly health care is­sues; they delve into the true weak­nesses in ru­ral health care.

Wadley said the big­gest weak­nesses in ru­ral health care is ac­tu­ally not health care. She said health care only ac­counts for 15 to 20 per­cent of the over­all sta­tus of our pop­u­la­tion, as a whole. She said eco­nomic, ed­u­ca­tional, so­cial, be­hav­ioral, en­vi­ron­men­tal and ge­netic fac­tors ac­count for the other 80 per­cent.

“Peo­ple are pretty amazed at that,” Wadley said. “Rec­og­niz­ing that, the health in­dus­try is now look­ing into that and ask­ing how do we do that, how do we get all of those ser­vices for our pa­tients.”

Ac­cord­ing to the Eco­nomic Re­search Ser­vice, the poverty rate in ru­ral Mary­land is 14.2 per­cent, com­pared with 9.5 per­cent in ur­ban ar­eas of the state, and 13.6 per­cent of the ru­ral pop­u­la­tion has not com­pleted high school, while 10.6 per­cent of the ur­ban pop­u­la­tion lacks a high school diploma. The un­em­ploy­ment rate in ru­ral Mary­land is 5 per­cent, while in ur­ban Mary­land, it is 4.3 per­cent.

Wadley said an­other chal­lenge in ru­ral health is the

in­abil­ity to at­tract enough providers, and ad­e­quate ser­vices.

“Most of the time you hear peo­ple say they want more spe­cial­ists,” Wadley said. “But if you re­ally want to im­prove health care sta­tus, you have more pri­mary care physi­cians and nurses and physi­cian’s as­sis­tants.”

She said while hav­ing spe­cial­ists in the area makes it more con­ve­nient and aids in hospi­tals’ vi­a­bil­ity, but for health care and pre­ven­tion, there needs to be a lot more pri­mary care ser­vices.

She said other find­ings show that liv­ing in ru­ral ar­eas also con­trib­utes to eco­nomic is­sues, due to a lack of jobs that are avail­able. An­other is­sue is the ad­dic­tion

rate and the gray­ing of the pop­u­la­tion on the Shore.

She said th­ese fac­tors cre­at­ing a ru­ral health crunch are now re­sult­ing in the same health prob­lems as

ur­ban ar­eas, but with fewer re­sources to ad­dress them.

When asked about the Mid-Shore’s ru­ral health strengths, Wadley said they are few and far be­tween.

“I am look­ing hard for our strengths, be­cause I think our chal­lenges are greater than any strength we have,” Wadley said. “But I think it eas­ier to in­te­grate those ser-

vices in any county on the Mid-Shore than it may be in an ur­ban area.”

She said that is based on the level of net­work­ing and com­mu­ni­ca­tion that is al­ready done in the area.

Wadley said she reg­u­larly meets with school of­fi­cials and rep­re­sen­ta­tives from so­cial ser­vices and that makes the co­or­di­na­tion as­pect

work bet­ter.

“Those re­la­tion­ships are stronger and I think that’s be­cause you can get bet­ter part­ner­ships in ru­ral ar­eas,” Wadley said. “That is one of our strengths we have now, we just need to take it to the next level.”

She said sees the fu­ture of ru­ral health care be­com­ing eas­ier through this col­lab-

ora­tive ef­fort.

“I do see in the fu­ture easy ac­cess to clin­i­cal and so­cial ser­vices when I as a pa­tient dont know about all of those ser­vices, but some­body tak­ing care of me knows about those ser­vices and how to get me there,” Wadley said.

She said Mary­land has been on the fore­front of th­ese types of ini­tia­tives

since the 1970s, re­gard­ing hospi­tal care, but now it is ahead of the game by look­ing at ad­dress­ing those needs through pri­mary care fa­cil­i­ties.

“I think we are one of the lead­ers and it makes it ex­cit­ing liv­ing in Mary­land,” Wadley said.

Fol­low me on Twit­ter @ Dspier­ing617

BY DENAE SPIERING/DSPIER­ING@CHES­PUB.COM

Dr. Fre­dia Wadley, health of­fi­cer for Tal­bot County

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