Can Health Care Reform Expand Patient-Centered Care in Rural Communities?

The patient-centered model of care is well-regarded as a means to address the needs of older adults with chronic diseases. The patient-centered model is not only good for patients: many experts argue that it is a way to reduce avoidable emergency care use and hospitalizations, and a resource-effective way to manage chronic disease and provide coordinated care among the wider population. While patient-centered services are rarer in rural areas in the US, a recent article points to some provisions in the Patient Protection and Affordable Care Act that may encourage the development of patient-centered care in rural and isolated communities (Bolin et al 2011).

The authors argue that the act will better enable providers to deliver services in a “culturally sensitive, family-centric way” (italics theirs), as it includes provisions that expand reimbursement for preventive care and the management of chronic diseases, provides pilot programs that provide mobile health clinics, and includes workforce training and incentives (such as loan forgiveness) for professionals to work with rural and other underserved populations.

The article also points to some remaining barriers to providing person-centered care to rural populations. While the act does establish incentives for professionals to work with underserved communities, recruiting and retaining staff will continue to be an issue for rural communities. State budgets and other fiscal situations may make some states less able or less willing to support the necessary workforce and education programs. There are also state-by-state differences on Medicaid reimbursement that may make it difficult to provide a sufficient range of services. The authors argue, however, that the patient-centered care model may be sufficiently cost-effective and valuable to patients to succeed. The expansion of patient-centered care into currently underserved communities would be particularly valuable to older adults in these communities.

Article cited:

Bolin JN, Gamm L, Vest JR, Edwardson N, Miller TR, (2011). “Patient-Centered Medical Homes: Will Health Care Reform Provide New Options for Rural Communities and Providers?” Family and Community Health 34(2):93-101

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