Rural hospitals nationwide are struggling for survival. Since 2010, 135 rural hospitals have closed – but that doesn’t tell the whole story. In rural communities, the loss of access to care results in increased mortality rates, the eradication of many good jobs, and accelerated economic decline. As Pennsylvania’s secretary of health, Dr. Rachel Levine set out to reverse this trend and help rural hospitals not only survive but thrive. For this reason, I am excited President Biden has nominated Dr. Levine to become assistant secretary of health at the federal Department of Health and Human Services. Her knowledge and expertise from implementing the Pennsylvania Rural Health Model will help her transform care in rural communities nationwide.
The Pennsylvania Rural Health Model launched in 2019 with the goal of testing global budgets as a health care delivery solution for hospitals. These global budgets pay rural hospitals a predictable amount per month, which stabilizes operations and maintains health care access for the community. This type of stability allows providers to focus on delivering care and improving health rather than treating sickness, ultimately bolstering the economic viability of the community.
The global budget model implemented under Dr. Levine’s leadership also provides a foundation for rural hospitals to focus on their community’s specific needs, such as addiction treatment, performing routine cancer screenings, and managing patients with chronic disease to reduce the need for more intensive acute services. The model strives to improve quality of care while lowering overall cost and increasing patient satisfaction.
In this model, the “secret sauce” is the all-payer nature of the system. Rather than getting paid based on units of services billed, a hospital receives a steady payment each month based on historic data. Medicare, Medicaid, and several commercial insurance companies participate, and the alignment of incentives provides the hospital with better, more predictable reimbursement. Dr. Levine’s leadership in coordinating multiple commercial insurance companies, along with the state’s Medicaid agency, was pivotal to the success of the program. The model does not depend on chasing additional revenue but delivering care centered on social determinants of health that extend beyond clinical care, such as behavioral health, economic development, and the environment.
I listened to Dr. Levine outline the program’s goals at the kickoff press conference in 2019. Under Dr. Levine, this first-in-the-nation program was made a priority of the state’s administration for rural Pennsylvania. The Pennsylvania Rural Health Model is now in its third year and achieving its innovative goals. This has not been easy, but through the hard work of Dr. Levine and her team, the Pennsylvania Rural Health Model is steadily increasing the number of rural hospitals participating in the program. Eighteen hospitals are currently enrolled, and 12 more may join in the coming year.
As I have traveled the United States for the National Rural Health Association and its advocacy efforts, I have seen rural America yearning for transformational, evidence-based leadership with the potential to change the narrative for rural health. Dr. Levine recognizes that rural hospitals are integral to local health care access and economic stability. She understands that it is difficult – if not impossible – for new businesses to locate in a rural area without high-quality health care infrastructure. And she understands that focusing on the needs of underserved populations, like those in rural communities, can rise a tide that lifts all boats. Through the Pennsylvania Rural Health Model, she led an impressive effort to stabilize health care in one of the most rural states in the country. For these reasons, I support Dr. Rachel Levine to become the next Assistant Secretary for Health at HHS.
Brock Slabach, MPH, FACHE is the senior vice president of the National Rural Health Association and is a member of the Pennsylvania Rural Health Redesign Authority. He lives in Leawood, Kansas.