Background: Like many rural communities, the five-county Mid-Shore region of Maryland (comprised of Caroline, Dorchester, Kent, Queen Anne’s and Talbot counties) faces unique health challenges, including higher rates of poverty and people living with chronic diseases. To help better meet regional health care needs and provide recommendations that could be applied to other Maryland rural areas, the Maryland Health Care Commission (MHCC) and the Department of Health established a workgroup (via Senate Bill 707 Freestanding Medical Facilities — Certificate of Need, Rates and Definition effective July 1, 2016) on rural health care delivery to oversee a study, hold public hearings and recommend policy options. At MHCC’s request, the UMD SPH and the Walsh Center for Rural Health Analysis at NORC partnered to conduct the study in parallel with the workgroup. The results of the study were published in November of 2017.
Goal: To highlight our mixed methods approach and present a summary of study findings and recommendations for restructuring and enhancing the health care delivery system on the Mid-Shore.
Objectives: To highlight our mixed methods approach and present a summary of study findings and recommendations for restructuring and enhancing the health care delivery system on the Mid-Shore.
Approach: The study consisted of the following: • 5 focus groups with Mid-Shore residents • Stakeholder interviews with community leaders • Analysis of claims and primary care physician workforce data • Review of literature and national rural health delivery models • Input from the Rural Health Care Delivery Workgroup, its advisory groups, and public hearings
Results: Four high-level recommendations to support better health and well-being of Mid-Shore residents and potentially other rural Maryland communities emerged: 1. Establish a Mid-Shore multi-sector Coalition 2. Create a rural community health demonstration program 3. Invest in fundamental programs that expand the health care workforce, elevate community-based health literacy and enable technology 4. Use strategic programs to position Maryland rural communities to benefit from Maryland’s health care reform initiatives.
Importance to public health: Maryland’s health care system is transforming from a volume-based to a value-based reimbursement and delivery system, and is well-positioned to respond to residents’ needs by focusing on improvement of the health and well-being of communities. Our study findings and past experience working with rural communities, indicate that community-driven solutions have the greatest potential for success.