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.
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
“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-
“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.
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Dr. Fredia Wadley, health officer for Talbot County