As the health-care industry continues to struggle to provide providing adequate services to patrons in rural settings, two solutions have already been successfully deployed in some areas: independent providers and health-care homes.

Each rural place has unique needs and assets, but these health-care alternatives could be a good choice for some communities.

First, independent providers: In rural Idaho, where populations in some counties can be so small that a hospital isn’t viable, both independent and provider-based clinics, are the bread-and-butter of rural healthcare.

Graphic courtesy of Maryville University.
Graphic courtesy of Maryville University. Click the image to see the full graphic.

In these clinics, especially the independently led ones, primary care is given by physician assistants (PA) and even family nurse practitioners (FNP). PAs work under the supervision of a physician, but depending on the state issuing the license, an FNP may be free to run a practice fully independently.

Saving money shouldn’t be the only factor in healthcare decision, but when rural hospital closure rate is increasing, it’s difficult to say that there aren’t any money-related healthcare decisions. Some might argue that independent providers are replacing physicians with nurses and PAs and patients are the worse for it. But an increasing reliance on independent providers could actually improve care, and not because clinics can afford to hire more of them than doctors.

Independent providers like PAs, FNPs, and LPNs more than likely have as much education as their medical doctor counterparts. They are licensed to prescribe medicine and conduct certain clinical procedures. Of course, this model does not preclude medical doctors. In Idaho, many of the rural clinics are staffed by an M.D. and a physician’s assistant or nurse practitioner, with the physician’s assistant or nurse taking the primary role.

It is a combination of these providers that will best serve a rural community. A permanent clinic need not even be in place. Like itinerant judges and preachers of old, some providers can establish weekly visits at community centers, schools, or clinics that were once shuttered but now open whenever care is needed.

Is Minnesota’s Model Viable?

Another way of addressing rural medicine is the “health-care home” model. The Minnesota Department of Health wrote a report in 2009 that attempted to provide a model for reforming rural healthcare. The report defines rural as fluid. What is rural in one state, like Minnesota, may not be rural in another. The working definition of rural might even vary from county to county within a single state.

What these communities have in common is that they lack access to healthcare. Their isolation breeds a number of issues: the need to travel long distances for primary care, a lack of specialty care, and populations with increasing chronic illnesses. The Minnesota report advocates a health-care home model, which is essentially a co-op of health-care providers.

The health-care home isn’t a home in a traditional sense of the word. It’s a network of providers, from primary to specialty, on whom a community can call at any time to provide the necessary care. They are a great model for communities where patients with special needs, such as youngsters with a specific condition, live.

Some health-care homes are simply networks. Others operate out of clinics, like the Del Norte Community Health Center in Crescent City, California. Del Norte serves an economically hard-hit northern California region where death and disease rates are among the highest in the state. Yet by some measures residents of Del Norte County receive a superior level of care compared to the rest of the state, reports the Eureka Times-Standard. The county averages 48 preventable hospital stays per 1,000 patients, compared to the state rate of 59. “As the major primary care health provider in the county, the clinic is most responsible for that track record,” the Eureka Times-Standard reports.

The medical home in Crescent City is a template for what health care homes can do for rural communities. Because it is primarily patient centered, the team of home health-care providers works together and with the patient to create a care plan. This is true health-care, not just sickcare.

What Will Work?

It’s difficult to determine what will work for rural health-care reform. Reform is, by definition, an ongoing process. What works for one community may not work for another. Communities full of wealthy retirees may want concierge care rather than paying for a community clinic, yet the health-care home model, using providers like PAs, FNPs, and LPNs, could be a great combination for many rural communities. Rural America can be a testing ground for innovative approaches, improving care for everyone in the long run.

H.E. “Hattie” James is a writer and researcher living in Boise, Idaho.  She holds an MBA and has worked in education and sports journalism and previously served as electronic content manager for a government agency. hejames1008 or Linkedin at

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