Rural Healthcare: World of Change, News, and Innovation: Part I

EDITOR’S NOTE: This is the first in a two-part series on the state of rural healthcare in America. In part two, the author will report on the Pennsylvania Rural Health Model, a new initiative by CMS being developed through the CMS Innovation Center and the State of Pennsylvania.

The first month of 2017 is midway through, and change is happening rapidly. A new presidential administration is soon to take office, its leader having pledged to put forth a plan offering “insurance for everybody,” and the GOP is trying to find consensus on a Patient Protection and Affordable Care Act (PPACA) replacement. 

While these issues and countless others continue to make headlines, other developments are emerging, including the Centers for Disease Control and Prevention’s (CDC’s) recent harsh findings regarding rural health and opportunities to address certain matters specific to the population. In 2017, we will take a look at rural health from a pendulum approach: for every mark of inequity and challenges, we will swing the pendulum to highlight one of many of the little-known and uncelebrated opportunities, initiatives, and collaborations

To that end, while we don’t know much about the future of any healthcare program, including the Centers for Medicare & Medicaid Services (CMS) innovation center, we will closely examine a recent CMS and state partnership to address a multitude of rural health complexities. 


The Rural Stage

To set the stage, we begin with the new CDC study (part of a commentary within a new rural health series in the CDC’s Morbidity and Mortality Weekly Report) that punctuates a disparaging gap of health between rural and urban areas. The report noted that rural Americans are more likely to die from five leading causes than their urban counterparts. The study also cites that in 2014, many deaths of rural Americans were potentially preventable, including:

  1. Heart disease (25,000);
  2. Cancer (19,000);
  3. Unintentional injuries (12,000);
  4. Chronic lower respiratory disease (11,000); and
  5. Stroke (4,000).


Additionally, there are higher rates of cigarette smoking, high blood pressure, obesity, substance abuse, motor vehicle crashes, and opioid overdoses among individuals living in rural areas.


A Call to Action


The realities of rural life require real focus and real funding – not crumbs of afterthoughts. Notice that the CMS study illustrates 2014 numbers – if the study was conducted in 2015 and 2016, the figures might be even higher. No matter; rural patients and providers need to focus even more on population health and care management to develop better individual patient outcomes. Examples of some activities to help stabilize these numbers include:


  1. Increasing cancer prevention and early detection.
  2. Screening patients for high blood pressure and reducing risk for strokes.
  3. Engaging in safer prescribing of opioids for pain and use of non-pharmacologic therapies.
  4. Promoting smoking cessation.
  5. Promoting physical activity and healthy eating to reduce chronic diseases/diabetes, obesity, and inflammation.
  6. Developing habits of motor vehicle safety, including wearing seat belts, watching speeds on gravel and highways, and practicing even more agriculture farm safety.


Stay tuned as we focus next on the unknowns of the PPACA replacement and additional implications of rural sustainability.



Janelle Ali-Dinar, PhD

Janelle Ali-Dinar, PhD is a rural healthcare expert and advocate with more than 15 years of healthcare executive experience in many key areas addressing critical access hospitals (CAHs), rural health clinics (RHCs), physicians, and patients. Dr. Ali-Dinar is a sought-after speaker on Capitol Hill. A former hospital CEO and regional rural strategy executive, Janelle is also a past National Rural Health Association rural fellow, Rural Congress member, and Nebraska Rural Health Association president. She is currently the Nebraska DHHS chair of The Office of Minority Health Statewide Council, addressing needs of rural, public, minority, tribal, and refugee health, and she serves on the Regional Health Equity Region VII council as co-chair of Rural Health and Partnerships. Janelle holds a master’s degree and doctorate in communications and is a recent graduate in public health leadership. Janelle is currently the vice president of rural health for MyGenetx and is a member of the RACmonitor editorial board.

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