National Rural Health Day: Reflections on the Past 30 Years in Rural Health and the Road Ahead

Terry Hill, Senior Advisor for Leadership and Policy

After being asked to compose a blog on the evolution of health care over the thirty plus years of my career, I procrastinated until the last minute. Looking backward has always been a challenge for me, whether it's logging in technical assistance, filling out travel vouchers for payment or just expounding on the good old days of yesteryear. I always like to think about what lies ahead. Perhaps the future roads are growing shorter, but I'm just as excited as ever to explore what's around the next curve or what's beyond the next great obstacle.

Using my road metaphor, there have been a lot of curvy roads and a lot of formidable obstacles for rural health care in the past thirty years. Difficulty recruiting and retaining physicians and other primary care providers has been constant. Complexity has increased during this period as thousands of new drugs have been launched, thousands of new medical procedures have been used and thousands of new medical devices have been approved. Technology expansion has been another constant, as medical technology, telehealth technology and health information technology have become commonplace in even our smallest most remote facilities. The accelerating rate of change in health care has been challenging for rural health providers, and at times it has seemed that the next curve in the road would lead to a steep drop-off or at least an impassible road ahead. But somehow, we've always made it past the obstacles, thanks largely to the determination, resiliency and innovation of our rural health providers and their advocates. We do this work, either directly or indirectly, because people living in small towns across America depend on health care being available when it's needed. We do the work because it's an opportunity to contribute and provide meaning to our professional lives.

The road ahead in 2013 and beyond is sure to be especially bumpy, and maybe even hazardous for all health care providers. Dramatic transitions to a new payment system based on value, with new requirements for better quality, better population health and lower costs is already taking place. Rural health can not only survive in the ensuing era of health reform, it can lead the way. I am optimistic that new health care delivery models will be employed as effectively in rural as in urban, and that new partnerships will be formed between rural and urban health care organizations based on mutual value, rather than on strict referral of patients. In short, rural will find a meaningful place in the new health system.

The time for beginning the new road trip is now. Rural providers must start to plan their future destination, and begin to equip themselves with the necessary technology, quality processes and efficiencies to be successful down the road. They should not pull off at the next rest stop to wait for further instructions. The road to value does not come with a GPS nor even a detailed roadmap. As has been done so many times in the past, we'll have to forge our way past or through the obstacles, with limited resources and expertise, and arrive at a future system that is worth celebrating. Better health, better care, lower cost; I plan to be around to contribute at least in some small way to that final destination.