Earlier this year, Wipfli, a NOSORH investing partner, convened a virtual panel discussion on business issues facing rural healthcare executives. Wipfli’s healthcare group provides consulting and strategic advisory to rural hospitals. Panel members were comprised of state and national association leaders. Here is a recap of top themes rural healthcare leaders are focused on for 2021, including telehealth and retail competition.


Telehealth: Primary Care and Behavioral Health

The pandemic triggered enormous growth in telehealth. Panelist Terry Hill of the National Rural Health Resource Center encouraged organizations to focus on the opportunities (and outside threats) enabled through telehealth.

“Virtual primary care is now a possibility, and there are national competitors intent on establishing a relationship with your patients,” Hill told attendees. Rural healthcare providers are urged to form partnerships or build the infrastructure required to adopt virtual healthcare delivery options.

Beyond virtual primary care, telemonitoring is a way to care for older patients and those with long-term conditions – allowing people to stay in their own homes. Telemonitoring has made incredible advances and is going to play a pivotal role in accountable care organizations and value-based models.

Panelists addressed the primacy of mental health issues in rural communities and the acceleration of demand during the COVID-19 pandemic. Discussion included the link between mental illness and increased chronic health care costs, demonstrating a need for greater integration of mental and behavioral health services with primary care.

Returning to the theme of telehealth, the demand for tele-psych services rises to the top. It is and will continue to be a major method of reaching patients with behavioral and mental health issues. Opportunities for advancement here include greater integration with primary care, improved data and outcomes reporting and greater integration with emergency departments (and, optimally, diversion from EDs).

Improving community health

Panelists saw a need for rural healthcare providers to play a more assertive role in a network of care coordination. This includes an imperative for wellness visits, even for those providers who are not accountable care organizations.

Community paramedicine was also discussed as an opportunity to provide in-home care and preventive services to improve patient health. Developing these services would address chronic health issues and social indicators of health while building the capacity of rural ambulance systems.

Preparing for value-based payments

There’s a growing demand for rural hospitals to document the value they’re providing. To achieve the necessary level of insight and reporting, hospitals will need to develop their information systems. In turn, better data will help organizations target interventions to high-cost patients and deliver on value models.

New retail competitors

Rural healthcare providers can expect growing competition – and opportunity for partnership – from retail outlets such as Walmart, Amazon, CVS and Walgreens. Walmart is rolling out primary care clinics nationwide. Meanwhile, Amazon has acquired PillPack and has made other advances that signal the company is intent on providing in-home patient healthcare in the future.

Likewise, tech leaders Apple and Google will play a growing role in patient health in the future as health trackers and other wearable devices become more mainstream.

Peer groups and collaboration

Panelists placed emphasis on an ongoing need for networking, connection and information sharing among hospital peer groups, local health departments and local government. Panelists shared anecdotal information from healthcare leaders who’d established consistent weekly or semi-weekly meetings with municipal leaders, prison officials, etc. as a COVID-19 response tool and urged rural healthcare leaders to follow suit.

One panelist cautioned against a “return to normal,” after the pandemic has passed, suggesting that ongoing collaboration will be the key to maintaining preparedness and an effective response to future pandemics and health crises.

Staffing issues and resource disparities

While some rural healthcare organizations have been able to provide hazard bonuses to their care providers, others do not have the resources to do so. This has exacerbated already difficult staffing issues in many rural communities.  Panelists also warned that retirements may accelerate after the pandemic. There is a sense among providers that they are “taking one for the team” right now, but once the emergency is over they will leave the profession for good.

Community education and Strategic Planning

Panelists called for a special focus on community education and engagement around vaccine adoption as well as greater healthcare and wellness issues. Panelist Tim Size from the Rural Wisconsin Health Cooperative directed attendees to PSAs available at wha.org/stopthecovidspread.  Panelists urged healthcare leaders to move beyond emergency response mode and begin a refresh of their strategic plans, considering new demands and developments ushered in by COVID-19.

Visit Wipfli.com/healthcare for insights and solutions to the unique challenges facing rural health providers.