The 4 lessons I learned while striving to preserve and increase access to care in rural communities

As a former executive leader at several health care organizations throughout my career, I understand the unique challenges facing rural hospitals and health systems. Since the 1980s, I have made it my mission to preserve and increase access to care for those in rural communities in eastern Maine and Montana – among the most remote and rural areas in the continental U.S. With nearly 60 million Americans living in rural areas, we experienced first-hand how access to high-quality, affordable care is crucial to positive health outcomes.

At an especially challenging time for hospitals nationwide – with dozens of rural, hospitals, closing their doors – I understand how hard health care leaders are working to keep care local and close to home.

On this National Rural Health Day, I want to thank rural hospitals and health systems with caregivers working round the clock who not only care for COVID-19 patients on limited resources, but also work tirelessly year-round to pilot alternative payment models, embrace telehealth and experiment with bold, innovative ideas to transform health care to fit the needs of their communities.

I’ve learned a great deal in my role overseeing health care systems and gladly share some of those lessons that helped my organizations succeed in the hope that they can help others

Lesson #1: Meet patients where they are

As president and CEO of Eastern Maine Healthcare Systems – where I worked over three years to re-brand and re-launch as Northern Light Health – I discovered that we were most successful when we met patients where they are. For instance, telemedicine retail services and home care were all tools we deployed. With a unique large, rural geographical area comprised of wide open spaces, the northern part of Maine benefited from the home care we distributed throughout the region. I’ve also worked with physician-led groups to design a care delivery model that is Affordable Care Act-compliant and fits within an accountable care organization. Ensuring that you can deliver care as seamlessly as possible for patients is key.

And to further enhance the patience experience, I took on the task of re-branding the health system to create a more integrated delivery system to make health care work for patients. We created a single electronic record system across all sites of care to make delivery and access to care for patients as seamless as possible.

Lesson #2: Encourage professional development

I’ve found firsthand that recruiting and retaining high-quality medical professionals in rural areas is an ongoing challenge. In Maine, we knew that if we hired a Mainer, they were likely to stay in the area, with the only caveat being that they may want to move around within the system. We not only allowed that, we encouraged it; we would leave back doors, side doors, and front doors wide open to allow them to have a career path that might take them through several of our organizations.

At Northern Light Health, we saw a nursing shortage – of 1,100 nurse openings within the 12,000-employee system; almost 10% of the workforce. To address this, we partnered with academic programs and successfully increased the number of nursing students within the system. And one of our most successful initiatives was recruiting foreign nurses through a company that provided a two-year contract for them to stay within our organization. We were successful at keeping a lot of foreign nurses even once their time was up. The trick was to provide them and their families with a social network to help them feel part of the community.

Lesson #3: Take initiative and uncover partnerships

I believe that competition is a waste of resources. At Northern Light Health, we were part of an accountable care organization and operated on the edge of innovation. We joined an accountable care organization early on, and embraced what I call “co-opetition” – collaborations with our competitors. We successfully co-designed our community health needs assessment with other providers within and outside the state. By doing this, we were letting other organizations know that we were all in this together. We all shared the same end goals – to help patients and keep them healthy.

There’s often a lot of opportunity around redesigning processes, work streams and maximizing use of technology. The goal is to optimize all of your resources.

In addition, there’s tremendous financial stability, resources and peace of mind to be gained from partnering health systems with small, rural critical access hospitals. I’ve seen firsthand how powerful and beneficial these types of partnerships can be for communities who rely on local care close to home.

Lesson #4: Innovation requires building community trust

In Maine, we faced challenges in care delivery transformation that were unique to rural environments. These included a lack of commercial payers, since it was hard to get them to engage in discussions about various payment models. I knew this was vital to our growth as a system serving a specific population, so we made the decision to proactively reach out to employers, patients and even potential patients.

By working with the community to proactively engage these stakeholders before they needed hospital services, people came to appreciate all that you do before they were in crisis; they were better able to understand the educational aspect of preventive care.

I think that now more than ever, health care leaders have an opportunity to come together and reimagine health care of the future. We all want to maintain high-quality, affordable health care, but that might not look the same way it did even five years ago. Figure out whose role it may be to best communicate that to your community while convincing them that the changes you implement are to help make things seamless. Building trust with the community and partners will serve you well.

Michelle Hood is AHA executive vice president and chief operating officer, and president for the AHA’s Health Forum