Two new publications from the Rural Policy Research Institute (RUPRI) feature our CEO Charlie Alfero. He serves on the panels that discuss rural health policy and innovative ways to interconnect services for better health outcomes for individuals and communities. Click the link to download the papers.
The U.S. health care system is undergoing significant transformation as a result of Federal, State, and private payer policies designed to improve access to medical care as well as the value and outcomes of health care while attempting to slow cost growth. Some payment innovations drive organizational and delivery changes that have shown evidence of improved quality, reduced care fragmentation, and lowered costs for certain populations. Yet overall, the entire system has not realized substantial cost savings nor has quality improved for everyone. There continue to be gaps between people who live in areas where progress is being made and those who do not, perhaps reflecting symptoms such as rising health insurance premiums, unstable insurance markets with limited plan choice, large variation in uninsured rates and access to care, and continued health professional shortages.
This paper examines the progress of health system transformation and the gaps that remain as they affect rural people, places, and providers. The health system transformation activities examined here are not limited to the Patient Protection and Affordable Care Act of 2010 (PPACA), but also touch upon activities undertaken by states, insurance plans, and private and public payers.
The RUPRI Health Panel released a paper on long-term services and supports delivery in rural areas for policymakers and other interested stakeholders a primer on rural long-term services and supports (LTSS): (1) the fundamentals of the rural LTSS system, (2) rural access to and use of LTSS, and (3) discussion of the opportunities within and limitations of current Federal and State LTSS policy for advancing rural health system transformation toward a high-performing rural health delivery system.1 The paper focuses principally on the population of older (i.e., aged 65+ years) LTSS users.
In an ideal health system, primary care, acute care, post-acute care, and LTSS form a continuum of coordinated services designed to meet individuals’ needs based on their level of clinical, social, behavioral, or other chronic care needs and preferences. In reality, these services tend to be fragmented, with only weak coordinating connections. This fragmentation is the result of multiple funding sources, each with their own legislatively and policy-defined boundaries regarding eligibility, scope of services, and payment rules. The issues that arise as a result of fragmentation are exacerbated in rural areas, where the availability of, and access to, LTSS services is more limited.
For more information on these publications contact RUPRI.