Physician shortages and increasing costs plague healthcare systems across the country. However, rural communities tend to have disproportionately less access to adequate healthcare services.
According to the Journal of the American College of Cardiology, 46.2% of U.S. counties lack a cardiologist. Of these , 86.2% were rural counties where residents have less access to healthcare overall. The Washington Post reported July 29 that rural counties that lacked a cardiologist were also likely to lack a primary care physician.
Sioux Falls, S.D.-based Sanford Health has been trying to close this gap in care by creating an "array of value-based incentives for decades," according to a July 29 AMA post. Sanford is the largest rural health system in the U.S., serving 1.4 million patients across 250,000 square miles of mostly rural areas.
"The trajectory of health care in this country continues toward unsustainability,” said Tommy Ibrahim, MD, president and CEO of Sanford Health Plan, a physician-owned insurance plan within Sanford's health system. The industry has been largely reliant on a fee-for-service structure but it’s not the total solution for the long term."
The system's first step toward value-based care was 26 years ago with its"provider-owned and operated" nonprofit healthcare plan. Sanford utilizes a combination of both fee-for-service and value-based arrangements to create a more broadly accessible system, including pay-for-performance programs, shared savings models and upside-downside risk agreements with collaborating payers.
The Sanford Health Plan also attributes its success to the growth of its Medicare Advantage plan. Dr. Ibrahim told the AMA that this approach has helped Sanford improve patient outcomes, experiences, responses and retention rates. The system reported that emergency department visits fell by 60% and inpatient admissions down57% and increases in preventive care.
“As a provider-led and local nonprofit health plan, we are just different, and a lot of the headlines about Medicare Advantage just don’t apply,” Dr. Ibrahim said. “Our denial rates, prior authorization turnaround times, and member experience scores are considerably better than national averages.”