Recommendations

Medical transportation and emergency medical services are vital to people accessing and receiving care. Currently, emergency medical transportation services, publicly funded non-emergency medical transportation, and transportation programs funded through the state transportation budget are limited in their ability to fully meet local needs. There are many privately or grant-funded transportation programs that attempt to fill these holes, however major gaps still remain. Policy changes need to be explored and new regulations established to expand existing services and support continued diversion of unnecessary hospital admittance.

The Federal Plain Writing Act of 2010 was passed requiring all federal agencies to “…improve the effectiveness and accountability of Federal agencies to the public by promoting clear Government communication that the public can understand and use.” The Centers for Disease Control and Prevention subsequently adopted the policy and created the Clear Communication Index to assist agencies in adapting to the new policy. Based on the secondary data and focus group findings, a clear communication or plain language policy would be beneficial in helping Marylanders understand health information. Clear communication or plain language policy also includes large print, audio formats, video formats, or other accessible/alternative language formats based on county need.

Behavioral health, its impact on individuals and families, and the difficulty with treatment dominated many conversations. One barrier to effective treatment is the limited number of providers and services in the area. Further, care coordination between behavioral health providers and other health practitioners was seen by many as limited in rural Maryland. A policy or study needs to occur to better understand the impact on behavioral health treatment.

Telehealth programs are used throughout rural Maryland to increase access to health providers. However, there remains a gap between the number of health specialists and the need statewide. Telehealth could serve to fill part of this gap while new recruitment and retention efforts are developed to attract more rural health providers. To make this happen, medical reimbursement policies and stable funding streams need to be established, as well as stable infrastructure (broadband, etc.) in rural locations to support it.

One of the largest barriers to rural health is the recruitment and retention of providers. Virtually all data sources emphasized the difficulty of both finding qualified providers to work in rural areas and then retaining them once hired. This problem exists across disciplines, affecting primary care providers, specialists, behavioral health physicians, and oral health providers. To correct the problem, policy makers, administrators, rural health professionals, and others need to study barriers to recruitment and retention and identify best practices. After completion, an action plan to make changes should be developed and enacted to improve Maryland’s rural health.

Care coordination or case management was identified throughout rural Maryland as a needed service for health system navigation. Research shows that care coordination can both improve health outcomes and reduce or control health care costs for the individual and system (Substance Abuse and Mental Health Services Administration). Currently, most people are only able to access reimbursable care coordination through Medicare with limited insurance companies offering it to other audiences. Mechanisms for expansion and reimbursement need to be explored to help control costs and achieve better health for rural Marylanders.

Numerous counties and focus groups discussed the difficulty of people adequately accessing and using the health care system, understanding their benefits, tracking costs associated with care and general use of their health insurance plan. While the onus to navigate the system cannot be put solely on the individual, people do need to be educated on how to use the system. Health insurance education programs have been found to increase consumer confidence and capability in navigating the system. Community Health Workers and Insurance Enrollment professionals, and partnerships between these professionals and rural health organizations, should be expanded to meet this need.

Patient advocacy was discussed in multiple focus groups. This pertained largely to patients being able to ask and communicate with physicians, ensuring that their needs as patients are recognized and met and that their voices are heard in health care decisions. There are a couple ways to accomplish this recommendation. First, formal advocates, either volunteers or employees, are used by many systems to help ensure medical care is patient-centered. These advocates can and do consist of Peer Recovery Specialists, Community Health Workers, and case managers situated in different agencies and organizations. Second, patient or family members can be educated on ways to ensure their voice and needs are part of the decision-making process. This will increase the likelihood of medical adherence and behavior change in the consumer’s everyday life.

The need for more consumer education about healthy lifestyles, disease prevention and management was discussed. This included nutrition and cooking classes, parenting skills, gardening, tobacco cessation classes, chronic disease management and prevention, physical activity and other related topics. Many community organizations employ Community Health Workers and educators to offer these services with perceived success from community members. Ways to increase access to these services should be explored.

As previously discussed, there are two unintended consequences that emerged from the focus groups. First, both consumers and providers perceive that people are being discharged from the hospital sicker or do not understand why some patients are observed before being admitted or released. Second, consumers who have pain management issues have seen an increase in stigma and being mislabeled as addicts. To begin mitigation of these issues, the following recommendations have been made.

Patient Discharge and Hospital Admission
Increased patient education is necessary regarding the reasons for patient placement on observation versus admission, and the importance of treatment in the community versus in the hospital. The state also needs to conduct a comprehensive review of patients who are discharged and how well they recover in the community. While the perception is that people are sicker when leaving, it needs to be assessed by a rigorous research process. Pain Management and Unintended Stigmatization The state, pharmacies and other appropriate personnel need to update the CRISP database and ensure its continued use. This will help all pharmacies and appropriate medical personnel see the medical and medication history of patients and help identify those who may be drug-seeking and those with pain management issues. In many rural counties, people have personal relationships with long-standing independent pharmacies that understand their health history and needs, which may be an informal protective factor from stigma. An increase in the number of in- network pharmacies for Medical Assistance, Medicaid and Medicare to include local independent pharmacies would benefit rural residents. Finally, education and stigma reduction efforts need to be developed for health care providers.

Medical transportation and emergency medical services are vital to people accessing and receiving care. Currently, emergency medical transportation services, publicly funded non-emergency medical transportation, and transportation programs funded through the state transportation budget are limited in their ability to fully meet local needs. There are many privately or grant-funded transportation programs that attempt to fill these holes, however major gaps still remain. Policy changes need to be explored and new regulations established to expand existing services and support continued diversion of unnecessary hospital admittance.

The Federal Plain Writing Act of 2010 was passed requiring all federal agencies to “…improve the effectiveness and accountability of Federal agencies to the public by promoting clear Government communication that the public can understand and use.” The Centers for Disease Control and Prevention subsequently adopted the policy and created the Clear Communication Index to assist agencies in adapting to the new policy. Based on the secondary data and focus group findings, a clear communication or plain language policy would be beneficial in helping Marylanders understand health information. Clear communication or plain language policy also includes large print, audio formats, video formats, or other accessible/alternative language formats based on county need.

Behavioral health, its impact on individuals and families, and the difficulty with treatment dominated many conversations. One barrier to effective treatment is the limited number of providers and services in the area. Further, care coordination between behavioral health providers and other health practitioners was seen by many as limited in rural Maryland. A policy or study needs to occur to better understand the impact on behavioral health treatment.

Telehealth programs are used throughout rural Maryland to increase access to health providers. However, there remains a gap between the number of health specialists and the need statewide. Telehealth could serve to fill part of this gap while new recruitment and retention efforts are developed to attract more rural health providers. To make this happen, medical reimbursement policies and stable funding streams need to be established, as well as stable infrastructure (broadband, etc.) in rural locations to support it.

One of the largest barriers to rural health is the recruitment and retention of providers. Virtually all data sources emphasized the difficulty of both finding qualified providers to work in rural areas and then retaining them once hired. This problem exists across disciplines, affecting primary care providers, specialists, behavioral health physicians, and oral health providers. To correct the problem, policy makers, administrators, rural health professionals, and others need to study barriers to recruitment and retention and identify best practices. After completion, an action plan to make changes should be developed and enacted to improve Maryland’s rural health.

Care coordination or case management was identified throughout rural Maryland as a needed service for health system navigation. Research shows that care coordination can both improve health outcomes and reduce or control health care costs for the individual and system (Substance Abuse and Mental Health Services Administration). Currently, most people are only able to access reimbursable care coordination through Medicare with limited insurance companies offering it to other audiences. Mechanisms for expansion and reimbursement need to be explored to help control costs and achieve better health for rural Marylanders.