Creating Solutions for Rural Health Equity and Sustainability

By: Jennie ML Ossentjuk, commercial market lead for Noridian Healthcare Solutions

Rural American health care facilities operate on razor-thin margins, and their continued existence is often tenuous at best. And the gap in health equity between heavily and sparsely populated areas grows larger year over year.

Solutions to make these care facilities more sustainable for the long-term future start, not necessarily with care they provide, but the ease, access and pace of administrative processes. These business processes are some of the ways in which Noridian Healthcare Solutions is working to help keep rural facilities open so they can continue to provide essential care to their patients. The following analysis from Noridian can serve as a guide to increase health equity to some of society’s most vulnerable populations.

Problems in rural health care affect more Americans than you might think.

The U.S. Census Bureau classifies 60 million Americans as rural. That equates to 1 in 5 Americans—all who rely primarily on rural health care facilities. Movement toward fewer rural facilities for 20% of the population creates an enormous health care gap. Rural Americans are one of the largest medically underserved populations in the country.

Like many industries, the COVID-19 pandemic hit rural health care systems particularly hard. According to an American Hospital Association report, a record 19 such hospitals across the U.S. closed in 2020 alone. Public fear resulted in patients deferring and delaying routine care, leading to even greater financial impacts for these health care facilities that largely rely on government-sponsored payers.

Even before the pandemic, rural health care facilities were affected by low volume and heavy reliance on government payers. The National Rural Health Association reports that since 2010, more than 135 rural hospitals have closed, and that number continues to rise. The association identifies an additional 450 facilities as vulnerable. That number represents nearly one-quarter of rural hospitals in the U.S.

Addressing rural health care inequities takes a nationwide effort. Both government and commercial payers can help close the gap. Noridian contributes by setting rural health care providers up for success in working with existing reimbursement systems—both public and private.

Supporting rural providers translates into a better experience for health care users and payers alike.

Reimbursement is the lifeline for rural providers.

Large health systems, usually urban, have sophisticated infrastructure to connect with payers. Conversely, independent rural providers often do not. Some rural health care facilities are satellite locations associated with larger health systems, and those facilities can tap into the resources of their technology-enabled parent system. But for independent providers and systems, it’s not that easy and comes with unique challenges.

Through nearly six decades of working with a largely rural provider footprint, Noridian has developed a deep understanding of unique business issues affecting rural areas and find the following to be key to reducing burdens for rural health care systems.

  • Provider credentialing and enrollment—Credentialing tasks take precious time away from patient care. In addition, rural locations can mean additional challenges, such as poor internet availability. Noridian streamlines the process to save providers time so they can focus on the patient. The team also works closely with providers on their unique location challenges to ensure applications continue to move forward, despite technology issues.
  • Provider education—The unique challenges of rural providers are addressed through education training, focused on the unique needs of rural practitioners. In 2021, Noridian hosted two webinars for rural providers and created four tutorials focused on rural health care. Topics covered included telehealth services, provision requirements, care management and preventative services. In addition, Noridian has resources specific to rural providers on its Medicare website including a billing guide and resources for how to enroll in Medicare.
  • Claims—Rural providers frequently require enhanced technical assistance, such as review of billing systems and internal controls, to establish the most efficient means of program compliance.
  • Free software for claims submission—Our electronic data interchange (EDI) team supports independent rural providers by offering and supporting user-friendly claims submission software.
  • Advanced payments—Although not a common practice at the time, Noridian issued advanced payments to help keep providers’ doors open during the COVID-19 pandemic. In 2020, Noridian paid millions of dollars in COVID accelerated payments to numerous rural health clinics.

Existing provider relationships can help drive rural access.

Many care models that benefit urban populations leave the rural population without viable access to providers. Medicare Advantage (MA), designed to keep premiums low by limiting the provider network is one such example. However, many MA networks lack rural providers. Many other networks also limit access in rural America.

Alongside other rural health advocates, Noridian is providing input for program development that benefits rural health participants. Of all underserved areas nationwide, 30% of providers therein have existing relationships with Noridian. We envision an environment where it will be easy for rural providers to participate in new or expanded programming and serve their rural constituents

If we don’t act, alarming risks associated with rural health system inequity will increase.

Rural populations have higher risks for health issues. According to the Centers for Disease Control and Prevention, these communities experience higher risks of death. This is largely due to individuals having to travel long distances to receive emergency or specialty care—travel time that can equate to precious, lifesaving minutes.

According to the CDC, rural residents are also more likely to smoke cigarettes, experience obesity or have high blood pressure. Poverty rates tend to be higher, and people are less likely to have sufficient health insurance.

Sustainability should become a priority for all health care-related organizations.

Populations around the world are demanding more responsibility and set standards for a company’s behavior—including environmental, social and governance, otherwise known as ESG. Equity for rural care falls directly into the social and governance categories. Health care and health care-adjacent organizations not only play a big role in this ESG movement; they will one day heavily rely on this when regulations and funding are moving toward societal sustainability as a standard.

Ease of access to rural health care is a key component to health equity. Finding the right solutions to ease the administrative process can be fundamental to providing sustainable health care systems in non-urban areas. The Noridian Healthcare Solutions team helps enable access to care in rural areas, increasing health equity for society’s most vulnerable populations. Read more about Noridian and its commitment to rural health in its 2021 annual report.


About the Author
Jennie ML Ossentjuk is the commercial market lead at Noridian Healthcare Solutions and serves as the central point of contact for health plan administration networks. As market lead, she builds and maintains long-lasting, strong relationships with key customers and influencers, including executive teams, external stakeholders and operating leaders. Leveraging her 30 years of health care experience across diverse sectors, Ossentjuk performs health care market forecasting and develops strategic plans that promote sales growth for both Noridian and its customers. In her previous role as director of business development for Crystal Run Healthcare, Ossentjuk worked with rural providers. She currently serves on the Advisory Board for the Customer Experience Program at Ithaca College.