News & Views

Rural Hospital Closings, the Impact on Obstetric Care and How Mobile Can Help

Rural Hospital Closings, the Impact on Obstetric Care and How Mobile Can Help

Digital Health, Health Navigation, Medicaid

Since 2010, over 100 hospitals have closed and according to the Health Resources and Services Administration (HRSA), the numbers are likely to increase. As of December 2018, there were over 6,000 areas in the U.S. with health professional shortages, nearly 60 percent of which are in rural areas.

In a new poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, one out of every four people living in rural areas said they couldn't get the health care they needed. It’s a function of access to care; and transportation is a big part. About a quarter of those cited noted the distance of their health care location or its difficulty to get to as the biggest barrier.

Closures are due in part to reduced Medicaid reimbursements, but lack of provider networks in these areas also make it hard for plans to keep up. And it’s a workforce issue across all specialties; new physicians prefer to work in urban areas. According to NPR, only 1% of doctors in their final year of medical school say they want to live in communities under 10,000; only 2% in towns of 25,000 or fewer.

Moms Are Hit Especially Hard

These trends are having a big impact on expectant mothers. A study published last year in Health Affairs found that over half of rural counties now lack obstetric services, increasing the distance pregnant women must travel for care and delivery. And seeing an OB-GYN regularly is especially crucial for pregnant women with additional risk factors, like hypertension or gestational diabetes.

The burden is being shifted to family practitioners and ER doctors. Babies are being delivered in the ER by physicians who don’t have advanced training in obstetrics (for instance, they might not recognize the signs of preeclampsia). Higher-risk, preterm births are more likely in counties without obstetric units. And when new moms come in postpartum, these physicians may not be trained to observe the signs of depression and other issues.

When Wildflower began working with the Wyoming Department of Health, we learned firsthand about these “maternal care deserts”. In Wyoming, about one in four women receive less than adequate prenatal care, according to Wyoming Department of Health Vital Statistics. In fact, we learned, there was no Level III or IV NICU in the entire state. And Wyoming is not alone! This calls for a new model of care.

Digital Health Has Tremendous Potential

Telehealth and mHealth technologies can help overcome geographic challenges and extend the reach of OB specialty care to patients living in remote areas. In addition to providing huge savings, telehealth allows providers and health plan case managers to communicate with patients and better coordinate care.

And while telehealth is making strides, women especially prefer mobile technology. Smartphones can help extend the geographic reach of maternity and pediatric care programs and provide 24/7 access to information. Intelligent mobile tools offer convenience and peace of mind, providing a touchpoint to a woman’s health plan and hospital/health system.

In addition, mobile can provide social and emotional support and reduce isolation. As they learn about local, community-based resources – including support groups – new parents are connected to others who can help them navigate this critical life transition. And mobile trackers, educational content, and other resources can help to ensure healthier parents and babies.

Smart mobile applications personalize support based on access to care and social determinants of health. They also are built to specifically serve those living in rural and frontier areas, such as working offline to combat inconsisent access to high-quality broadband Internet.

If you would like to learn more about how mobile can help address the rural health crisis, reach out today.