Parity & Reform Must Address Rural Behavioral Health Care and Coverage

So much of what we’re hearing, reading and considering when it comes to behavioral health parity and health insurance reform is a function of our urban and suburban perceptions of  health care.  I lived and worked in a rural/frontier state for some time and can recall the difficulties and challenges we faced there and in surrounding states.  I may be in densely populated Southern California today, but I appreciate that even California is riddled with large swaths of rural farmland and Redwood forests where health care and coverage are vastly different enterprises than they are in San Francisco or Los Angeles.

The facts of life in small communities are simple. You’re often isolated from many of the most sophisticated programs and services; you’re challenged to attract a sufficiently qualified behavioral health workforce; you are equally hard-pressed to attract professionals who speak a second language (other than English); and you must deal with disparate economic conditions found in rural and frontier parts of this country.

Telemedicine and telepsychiatry have begun to make in-roads in correcting some of the access problems. Alaskans have wonderful examples to share with the rest of us when it comes to leveraging technology for the sake of access.  But the truth is, if you live in a community of 1,000 people in rural America and lack the resources to travel to and from a qualified professional as far as 100 miles away on a weekly basis (more or less), then you likely will be by-passed by much of what Parity offers.

Call to Act

Employers, health plans, managed care organizations, EAPs and PPOs are called to consider the following dilemmas in the coming months:

1. Expanded coverage doesn’t necessarily equal access for the 60 million Americans who live in medically under-served rural parts of the country. What can plan administrators and networks do to enhance access?
2. Health plans must work to correct workforce shortage issues and abate the looming crisis in behavioral health
3. Our plans must address disparities in reimbursement in rural areas that so often lead to access problems
4. Payers of all kinds need to collaborate and pool resources with providers to fix/build adequate infrastructure
5. Provider networks must meet the needs of vulnerable populations such as children, gender differences, culture and language needs such as those common to the Latino population and Tribal populations

Payers are called to address these and other issues with community leaders, providers, colleges and universities, faith-based programs and government agencies/programs.  Rural health care – unlike its urban and suburban counterparts – cannot afford the kind of fragmentation that characterizes so many of our systems.