Why States Are Turning To Virtual Care To Transform Rural Health

For those of us who have the privilege of working in healthcare, even incremental progress in the fight to solve our nation’s rural health crisis feels meaningful given the scale of the challenge.

Yet, for all the progress and investment, rural communities still face much higher rates for all five leading causes of death in the U.S.—heart disease, cancer, unintentional injury (including car accidents and opioid overdoses), stroke and respiratory disease. Rural communities also lack dependable access to preventative services and screenings, which would go far in reducing the rates of cancers where early diagnosis and early intervention saves lives. And when it comes to mental health, those living in rural communities are considerably less likely to get the treatment they need.
I was raised in rural West Virginia, and for those of us who grew up in these communities, these sobering statistics reflect an increasingly bleak reality. Our family, friends and neighbors carry a heavy burden, trying to be healthy in a healthcare system that wasn’t built for them.

Following the passage of H.R.1 earlier this year, the Trump Administration has begun implementing a key provision of the bill—the $50B Rural Health Transformation (RHT) Program—an initiative that I believe has the potential to transform rural health and drive unprecedented access to primary care and critical preventative services.

In September, the Centers for Medicare & Medicaid Services (CMS) unveiled details of the RHT program, which will put federal dollars in the hands of state leaders to determine how best to invest in key modernization initiatives to enhance access and clinical outcomes across rural communities.

As state leaders finalize their plans for how they will invest RHT program funds, it’s clear that they are counting on virtual care to be a catalyst for this change. And, from our experience, they are on the right track. Here’s why:

1. Virtual care is a proven solution to meaningfully address geographical barriers   

People living in rural areas must often travel long distances to reach a healthcare provider. That means taking time off from work—not just for the initial appointment, but for follow-ups. This often leads to delays in care, which can make health issues worse.

Virtual care breaks down these barriers. More than 20% of rural Americans already have access to Teladoc Health through their health plan or employer, and our data shows they use telehealth at the same rate as those in urban communities. For example, before enrolling in our primary care program, over half of our virtual primary care patients did not have a regular primary care physician (PCP). As a result, many were overdue for preventative screenings, like mammograms and colonoscopies. Our clinicians provide routine care, schedule those critical screenings for them and close care gaps.

We offer convenient access to Primary Care, 24/7 Care, Chronic Care, and Mental Health services, connecting people who have traditionally been unable to access care with new and convenient ways to see providers virtually. For example, through Catapult Health’s Virtual Checkup program, which is now a part of Teladoc Health, members receive a simple kit in the mail with everything they need to collect a blood sample, check blood pressure and provide other health-screening information.

Similarly, in our chronic care programs, instead of driving hours to a doctor’s office or lab, members receive chronic condition monitoring devices, diabetes test strips and lancets and home testing kits by mail, making it easier to track their health. Additionally, we have seen the power of using cellular-enabled devices to ensure patients don’t have to rely on broadband for access to digital health services. In our model, this level of connectivity allows virtual care coaches to receive immediate notifications of out-of-range glucose readings for people living with diabetes and proactively reach out to support them.

2. States are turning to what works—and measurable outcomes  

States aren’t just looking for ways to expand access—they want proof that these solutions help people get healthier.  

Virtual care makes it easier to catch and treat conditions like diabetes and high blood pressure early. In Teladoc Health’s primary care program, 50% of members diagnosed with diabetes and 35% of members diagnosed with hypertension receive that diagnosis for the first time from our primary care providers. This matters because these conditions disproportionally impact people living in rural areas.

For members starting our program with blood glucose levels that are outside the range of control, our program is delivering a 2.1% average A1c reduction within 90 days, on average. This is a meaningful reduction in risk, given that even a 1% reduction in A1c is associated with a 14% reduction in heart attack.

Our studies have also shown that 58% of program participants achieved an A1c of 6.5% or less after 6 months, which indicates a level of control consistent with diabetes remission. We see sustained improvement over a 5-year period, which demonstrates that we are helping people make lasting health behavior changes that stick.

3. Scale is a superpower  

The challenges facing rural health are sizable—which is why the solutions require scale. 

With the largest nationwide network of virtual care providers, we work with clinicians, therapists and health coaches, and we are delivering primary and preventive care, addressing mental health, managing chronic conditions and orchestrating care in communities nationwide. We serve 60 of the largest 100 health systems in the country, providing them with the technology to launch their own telehealth programs across a range of high- and low-acuity care settings. And we reach millions of rural Americans through established health plan relationships across Medicare, Medicaid and commercial lines of business in all 50 states.

This experience matters—we understand state operational realities and can help them make real and enduring change.  

We also recognize the importance of partnership, which is why we’re proud to be a founding member of Collaborative for Healthy Rural America (CHRA). As part of this initiative, we will work with leading healthcare, technology and consulting innovators to help states participate in the RHT Program.

4. Technology improves access to specialists   

Virtual care technology has also made an enduring impact by helping local hospitals and clinics expand their reach and impact.  One example is the hub-and-spoke network, where specialists use video calls or other technology to help patients or local doctors without having to travel. 

In 2005, South Carolina faced a stroke crisis. Located in the center of the “Stroke Belt,” with one of the highest rates of stroke and cardiovascular disease in the country, the state had only six primary stroke centers and 160 neurologists, giving it an unenviable ratio of 31,000 patients per physician. At the time, stroke was the third-leading cause of death in South Carolina. 

Supported by Teladoc Health technology, every South Carolinian is now virtually within 30 minutes of an expert stroke doctor—which has resulted in better outcomes, with time to life-saving treatment cut in half. Stoke has also dropped from the third leading cause of death in South Carolina to the fifth.

For those of us in healthcare, whether you grew up in a rural area or not, it’s time to support these communities to improve their health and the health of the nation. That requires that we commit to understanding and addressing barriers and constraints and sharing what we learn along the way.

Virtual care is already making a meaningful impact in rural communities, and we’re just getting started. To unlock its full potential, we need to continue to align incentives, focus on outcomes and rebuild care so that it works with the actual realities facing people living in rural areas.

The federal government’s investment is an important step toward realizing this goal, as we endeavor to transform our rural healthcare infrastructure and build sustainable systems that expand access, enhance quality of care and improve outcomes. 

As previously seen on Forbes.com