Demonstrating and Improving the Value of Rural Health Services Ty - - PowerPoint PPT Presentation

Demonstrating and Improving the Value of Rural Health Services

Ty Borders, PhD

Professor and Chair, Health Services Management Foundation for a Healthy Kentucky Endowed Chair in Rural Health Policy Editor, The Journal of Rural Health

Value of Health Services

Efficiency Quality Access

Quality

• Challenges to measure and improve
• CAH example

– Questions raised about mean quality 1 – Many relevant quality of care indicators – 75% of CAHs now publicly report 2

• Increasing emphasis on patient-centered care

– HRQL, consumer assessments, patient preferences

1Joynt et al. JAMA (2011) ; 2Casey et al. JRH (2013)

Efficiency

• Small capacity constraints
• CAH example

– Federal govt. has considered eliminating – Some CAHs less efficiently operated 3 – But eliminating special payments would lead to worse financial performance 4

• Increasing pressures for system linkages ?

3Gautam et al. JRH (2013) ; 4Holmes et al. JRH (2013)

Access

• Mixed evidence of R/U disparities in

physician services access 5-6

• Addiction and mental health

– Substance use a major public health issue 7 – Large R/U disparities in mental health – Addiction and mental health Tx lacking 8

• Opportunities for integrating into PCMH ?

5Xu and Borders J H Care Poor Unders (2008); 6Borders Am J Med Qual (2011); 7Gfroerer et al. JRH (2007) ; 8Borders & Booth JRH (2007)

Closing Comments

• Will continue to face tough decisions about how

to allocate resources across R/U areas

• Rural providers will need to find innovative ways

to improve quality, efficiency, & access

• Need good science (HSR) to inform decisions