Industry Voices—Is healthcare leaving a fifth of us behind? How joint ventures can prioritize rural America

A sunset over a barn structure
Consolidation and a shift toward digital services will reshape healthcare, but rural communities could be left behind. (Getty/ehrlif)

Investment activity in healthcare was at an all-time high in 2017 with consolidation and venture capital funding reconstructing the industry, inadvertently leaving behind a fifth of our communities.

Bigger is better was the theme as hospitals, payers, and health services companies consolidated. Diversification, vertical integration, and sheer size seem to be the target formula for navigating legislative uncertainty. CVS agreed to buy Aetna, asserting the combination could benefit consumers through improved coordination of care. Optum purchased Davita Medical Group, further expanding United Healthcare’s vertical integration into care delivery. Many hospital systems consolidated, including Dignity Health and Catholic Health Initiatives, which created the country’s largest not-for-profit hospital system.

On the funding side, digital health and consumerism continued to attract billions of dollars from venture capital. The first three quarters of 2017 exceeded the combined total for 2016 digital health investments with over $5.3 billion invested, according to PwC’s Q3 2017 MoneyTree Report. Many of these companies focus on personalized medicine, wearable devices, virtual care, and other strategies and innovations catering to more affluent consumers. One of the largest deals of 2017 was with 23andMe, a gene diagnostic company producing personalized reports on ancestry and health for people interested enough to spend $100 and spit in a cup.

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These bigger, more digitally connected organizations represent progress, but they also leave behind a significant portion of our population and providers: those living and serving in rural communities. According to the National Rural Health Association, people living in rural areas represent almost 20% of the population in the United States. They tend to be older, have lower incomes, and are more likely to be covered by Medicaid. Access to both primary care and specialists is more challenging due to greater distances and less capacity. Rural Americans are also less likely to own a cell phone or smartphone and more likely to have limited internet: 53% lack access to adequate broadband.

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Rural healthcare providers, including critical access hospitals and federally qualified health centers, face a daunting future. Often overlooked as acquisition targets, unable to afford data and IT infrastructure, and serving underconnected patients, they struggle to stay solvent. Rural hospitals in states without Medicaid expansion are more likely to close, their futures even more at risk as the Affordable Care Act continues to unravel.

Healthcare for rural residents must become a priority. Benevera Health’s work in New Hampshire, where half of the hospitals are Critical Access Hospitals, can serve as a model for helping protect and improve healthcare in rural areas. Our payer/provider joint venture enables smaller hospitals to engage in value-based care, utilize data and technology, and implement new care delivery models. Smaller hospitals can leverage data and IT infrastructure and gain access to population health analytics and resources they could never afford on their own. This model enables risk sharing and participation in insurance partnerships typically reserved for large hospital systems.

RELATED: FCC looks to expand funding for the Rural Health Care Program to support telemedicine and virtual care

Further, Benevera’s approach focused on whole person, in-person care thrives in rural communities where nonmedical factors significantly impact or represent barriers to care. We serve as a single point of contact for patients, educating them on insurance, providing transportation, scheduling appointments, helping access community resources, and supporting management of clinical conditions. By providing a concierge model typically associated with higher income patients and living in the communities we serve, Benevera is embraced and quickly establishes trust with rural residents.

Rural hospitals are increasingly challenged to find opportunities to survive in the data-driven, digitally connected, bigger-is-better world of healthcare. Joint venture and partnership models such as Benevera Health offer important synergies that can enable rural hospitals to serve their communities and remain independent.

As mission-driven organizations, rural hospitals are often pillars and major employers in their communities. Their closure has even more downstream impact than critical losses in the delivery of healthcare. The healthcare industry and society at large must be committed to finding solutions.

Corbin Petro is president and CEO of Benevera Health, a technology-enabled health services organization created out of a partnership between Harvard Pilgrim Health Care and four hospital systems, including Dartmouth-Hitchcock.