Rural America is fertile ground for healthcare innovation, experimentation, tech leaders say

Rural health systems and hospitals are poised to be the next hubs of tech innovation, leveraging digital health and virtual care to serve patients across thousands of square miles and over state lines.

Case in point: Sanford Health, which covers roughly 250,000 square miles across several states, broke ground this week on a 60,000-square-foot virtual care center. It's part of a $350 million initiative launched in 2021 to extend telehealth and digital health services across the Upper Midwest. 

With Sanford’s status as the largest rural health system in the country and its location in Sioux Falls, South Dakota, the health system can be the hub of a new wheel of innovation, said Jim Weinstein, M.D., senior vice president of Microsoft Health, speaking in Sioux Falls during an event hosted by the health system about the future of rural healthcare.

With less friction outside of academic and city centers, rural America has fertile soil for experimentation, Weinstein said during the event, which was livestreamed.

Healthcare leaders Sheri Dodd, vice president and general manager of Medtronic Care Management Services, and Geisinger Health System's Michael Suk, M.D., joined Weinstein to discuss the role of tech in healthcare, experimental technology and the future of care. David Shulkin, M.D., ninth Secretary of the U.S. Department of Veterans Affairs, moderated the panel.

“At Microsoft, we see venture groups every week wanting to be in healthcare,” Weinstein said. “Rural healthcare has some very interesting opportunities happening that have received good funding. At Gates Venture Fund, I’ve been pushing for rural health investment, not to compete but to support. I would say at Microsoft, that’s a very clear distinction. Microsoft would never allow us to compete in a healthcare space. Our job is to facilitate the success of healthcare.”

In response to the Amazon acquisition of One Medical physician group, Weinstein said he believes most tech companies do not understand healthcare. He referenced the growing numbers of Americans on Medicaid who were not represented at the summit and represent a population Amazon "would not take care of."

"We have to take the rural communities of America, the critical access hospitals, of which there’s over 3,000 and that’s small for Microsoft, and figure out how to aggregate that data in useful ways to have rural America flip the switch and reverse innovation,” Weinstein said. “Not innovate from the big cities but innovate from rural communities.”

One tool to do so, Weinstein said, was the Microsoft Power BI maps. He used the example of Todd County, South Dakota, where six out of 10 residents are below the poverty line and there is a severe lack of access to broadband internet. Weinstein said that before new reimbursement models and value-based care can be implemented, population idiosyncrasies must be understood.

With aggregate data and mapping tools, experimentation can be well informed and purposeful without risking the patient’s health or wasting their time by avoiding the "throwing darts" approach to innovation and experimentation, he said.

Suk, professor and chair of the Musculoskeletal Institute and the Department of Orthopaedic Surgery at Geisinger, emphasized developing new technologies with a similar understanding of the unique needs of patients. He used the example of digital remote monitoring to increase post-surgery care. If a patient is able to return home faster and receive more frequent care than the standard allotted two- and six-week visits, he believes their positive outcome is guaranteed.

“This idea of a guarantee is not new in the consumer world, but in healthcare, it’s really frightening and really new,” Suk, who also serves on the board of trustees of the American Medical Association, said. “But at the end of the day, I think the world is going to demand this more and more. For systems like Sanford, it can be very doable.”

While Shulkin pointed out that the idea of a guarantee might put “finance people” on edge, Suk referenced Geisinger’s lifetime warranty program for total hip replacements, a first of its kind in the world. The program has been expanded to total knee replacements.

With 50 patients in the guarantee program, he said only one patient triggered the warranty, meaning no out-of-pocket expense. Suk attributed the 98% success rate to streamlining patient care via integrated electronic hospital records and enhancing digital post-acute tools to stave off untoward outcomes.

“It creates system reliability both on the patient side, the hospital side and allows the insurance plan to take some risk on making sure that guarantee would come true,” Suk said. “And I think that most doctors and most healthcare administrators would say that if you’re in control 100% of the means of production, you have a much better chance of guaranteeing that outcome.”

With the use of remote monitoring, only 3% of Geisinger patients are staying at rehabilitation facilities post-musculoskeletal surgery, down from 80%. While standard in-person appointments still took place, digital tools allowed for remote physical therapy, increased contact with medical professionals and an increase in patient feedback, Suk said.

While Dodd lauded rural technology experimentation, she pointed to the challenge of calculating reimbursement in models reliant on patient engagement. For some remote patient monitoring reimbursements to kick in, patients must be compliant 20 days a month. If a patient only engages for 19 days, the compensation doesn’t come through. She is concerned that models like this may sour the healthcare system to technology.

“I am extremely optimistic about value-based healthcare models,” Dodd said. “We were thinking about payment for outcomes a long time ago. I’m really optimistic that can happen, but there needs to be a lot of experimentation … integrated delivery networks are the prime golden opportunity for experimentation.”

The last big push for experimentation in the area, according to Dodd, was mandated by COVID's emergency use authorization. However, without an eye on the sustainability of these digital health programs, she has seen 90% of remote patient monitoring programs fail.

With Medtronic being the primary supplier for remote monitoring at the Department of Veterans Affairs, the longest-running telehealth program of its kind, she said Medtronic worked to design a program made to last.

“They are looking at the veteran more than a single disease state,” Dodd said. “They are looking at the total needs of the veteran. They developed a scalable model that was built for sustainability. As we’re having the [Sanford Health] kickoff and the ribbon cutting, one of the biggest points I can say is design to last, really pilot and figure out use cases, but really design for sustainability and mature your operating mechanisms. You have to be able to have an approach to the patient that is meeting them where they are.”

Meeting people "where they are" means offering every type of technological mode, model and approach, Dodd said. Not only asking whether a patient prefers phone calls or text messages, but do they want to speak with a person or an integrated voice response, or a video call, or something even higher touch? Otherwise, “one-size fits all is going to tank programs because none of us are one-size fits all," she noted.