Becker's Hospital Review

19 THOUGHT LEADERSHIP to be considered critical access but remain just as remote and important as those with that designation. Nate Shinagawa. COO of UCI Health (Orange County, Calif.): One of America's strengths, compared to anywhere in the world, is our recognition that immigrants add value to the culture and success of our country. Nowhere is this more evident than in healthcare, where 25 percent of all physicians are international medical graduates. Many of these physicians came to America through the H1-B visa program, a critical pathway that's provided talented physicians to underserved areas, including much of rural America. For example, in places like North Dakota, H1-B applicants represent almost 5 percent of all physicians. We can turn around the healthcare access problem in rural America with progressive immigration policies. Expand H1-B visas, fast-track the green card process for physicians and nurses, expand the J-1 visa waiver program and make it easier to attain state licensures. In a year, we'd see the impact of these changes to the great benefit of rural America. Cristen Page, MD. Executive Dean of the UNC School of Medicine (Chapel Hill, N.C.): We should address this issue with humility. Our neighbors living in rural areas need to be listened to and supported as they know best what is needed in their communities. I have dedicated much of my career to rural workforce development and creating sustainable programs that introduce future providers to the impacts that they can make and the joys that they can find in rural service. We need more providers in rural service – not just physicians, but nurses, APPs, and others. We need to support the expansion of rural residency and other training programs and to continue building strong networks so that success stories and knowledge can be shared. And we need to leverage technology to support our rural providers as well as new models of care to better serve our rural patients. Arianne Dowdell, JD. Vice President and Chief Diversity, Equity, and Inclusion Officer of Houston Methodist (Texas): Equitable access to healthcare may not just mean a brick-and-mortar location but also working closely with community partners to support people with chronic health conditions through prevention, education and access. Looking at data to learn more about the communities we serve or those we have the potential to serve and knowing more about incidence rates of certain diseases is helpful when meeting the healthcare needs of patients, particularly those in rural communities. At Houston Methodist, we oen talk about meeting people where they are and that includes supporting people with varying education levels, limited knowledge about their own healthcare, or those who have little to no access to technology. We learned a lot during the pandemic about how we can support people who may fall into these areas of their healthcare journey, and we're continuing to use those lessons learned to create quality healthcare experiences for people despite where they live. Nick Stefanizzi. CEO of Northwell Direct (New Hyde Park, N.Y.): 'Saving' rural healthcare will be predicated on solving for the unique challenges experienced by these populations – primarily, addressing access and social determinants of health, which in the context of rural health, are synergistic strategies. To start, given that the National Rural Health Association has described that of the more than 7,200 federally designated health professional shortage areas, 3 out of 5 are in rural regions, access is a clear structural barrier. e fix here can't just be brick and mortar facilities and providers. Rather, solving for this will require a combination of in-person and virtual treatment modalities to expand the pool of providers available for critical services. It will also require an investment in digital tools and resources that enable individuals to better engage and manage their own health. All must be highly integrated and easy to navigate if we expect widespread adoption and utilization. Further, a population health approach to addressing the social determinants of health and the underlying factors that can adversely influence the health of populations living in rural communities will similarly help to address root causes. An individual's zip code oen has more impact on health than any other factor, and in order to raise the health of rural populations, the focus needs to expand beyond traditional medical care. rough innovative and proactive interventions, we can enable health professionals and individuals to better engage and manage chronic and other conditions that exacerbate the challenges associated with the lack of access to local care providers. Taken together, addressing access and social determinants will go a long way in solving the rural healthcare crisis. Kerry Mackey. Vice President of Hospital Operations, Women and Children's Services at NYU Langone Health (New York City): Telemedicine/telehealth services can be utilized to expand access to care in rural areas. We learned this from COVID-19 when we had to extend healthcare outside the hospital's doors/walls. Also, implementing a home hospital service can complement telehealth/telemedicine by bringing that day-to-day nursing care to the applicable patient's home. In addition, utilizing data and outcomes to negotiate reimbursement rates for Medicare services is how we can overcome the challenge around service or provider restrictions. Scott Polenz, CPA, MBA, FACHE. Vice President of Physician and Advanced Practice Clinician Relations of Marshfield Clinic Health System (Wis.): Saving rural healthcare is about as ambitious an undertaking as you can aspire to because of the complex, interwoven challenges that must be addressed. Fixing rural health care requires fixing our national health care system and a societal-level shi with regard to how we view health and health care. On a national level, we have to commit to the systemic changes required to truly move to a value-based system. On a more rural- specific level, we need massive investments to upgrade our overall public health infrastructure. Rural communities lag behind metropolitan counterparts in areas like access to transportation, availability of internet, distance from sites of care, access to healthy food and many other community- based resources. is basic infrastructure is fundamental to accessing quality health care, and it is going to take systemic, sustained investment to equip rural health care with the tools we need. Chad Dilley. COO of IU Health Saxony (Fishers, Ind.): IU Health is proud to serve many rural Indiana communities in places like Tipton, Bedford and Frankfort. ere are really two inherent challenges: the geography of small populations spread over large areas, and provider recruitment to live and work away from urban centers and the specialty and subspecialty support that affords. We are continuing to lean into virtual care, virtual consults and telehealth to make care more accessible for patients close to home (or at home), and support our teams with the expertise and collaboration they need to provide excellent care in rural settings. Kira Carter-Robertson. Senior Vice President of Regional Hospitals at Sparrow Health System (Lansing, Mich.): I would love to say there is a magic bullet to save rural healthcare, but I don't think the answer is one-size-fits-all. While rural hospitals may face similar pressures, rural communities are not all the same. In the short-term, rural healthcare providers will have to

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