Blog Post

Healthcare Upside/Down: Rural Healthcare Rocks

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ECG’s radio show and podcast, Healthcare Upside Down, offers unfiltered perspectives on what’s working in US healthcare and what’s not. Hosted by ECG principal Dr. Nick van Terheyden, each episode features guest panelists who explore the upsides and downsides of healthcare in the US—and how to make the system work for everyone.

Rural healthcare is a notoriously tough marketplace. Large proportions of people in rural areas are in poor health and from lower socioeconomic groups. The population is widely dispersed, and low density makes economies of scale difficult to find and sustain. A healthcare facility in a rural setting may be the only one for hundreds of miles; the threat of being acquired by a larger system is constant. Attracting physicians and keeping them is always difficult

Memorial Health System (MHS) in Marietta, Ohio, has encountered all of those challenges. Located at the base of Appalachia, on the Ohio River and bordering West Virginia, MHS is a two-hour drive from most urban facilities. Its patient population is typical of rural areas, and 70% of the patients it serves receive government-subsidized care.

But unlike so many rural healthcare systems, MHS isn’t struggling—it’s thriving.

  • The past 10 years have seen the development of freestanding ERs, primary care clinics, and cancer clinics.
  • MHS hospitals offer 15-minute access to emergency physicians at a time when competing emergency departments have hours-long waits.
  • The system has expanded across a largely rural geography of 360,000 people, a level of scale that enables MHS to provide substantial care in cardiology, neurology, orthopedics, oncology, and other areas.

The architect of that growth is our first guest on Healthcare Upside Down. Scott Cantley, CEO of MHS, has helped put the system on its path to economic and medical success. With rural populations swelling in response to the pandemic, Scott’s vision for MHS is challenging conventional thinking about rural healthcare. “If we could…invest in specialties and access points, [patients would] love to come to the smaller town and get their healthcare,” he says. “They just have to be inspired.“

On the podcast, Scott talks about what it takes to inspire patients—and physicians—to believe in the quality of care in a rural health system. Below are three takeaways from our conversation

Physician alignment is critical.

A shortage of specialists in rural settings means that patients frequently get referred to urban hospitals where capacity is greater. Scott says rural health systems need to focus on keeping patients within their network. “The first place you have to start as a rural provider is your physician alignment strategy. That is the absolute key,” Scott says.

But part of building a strong network is ensuring the physicians have confidence in the quality of care their patients will receive. The primary care team needs to believe in the specialty team, and there must be specialists with the capacity and skill set to perform cutting-edge procedures. “You have to work with your physicians, you have to build their confidence in the quality of care that their patients are going to get. Clearly physicians are going to do what’s in the best interest of their patients,” Scott says. “And so that physician alignment strategy and the belief we’re building something together that’s good for this community, just as it’s good for them, is the first step in creating strategy in a rural system.”

Physicians are more than employees—they’re partners.

One of the greatest difficulties in managing a successful healthcare enterprise in a rural setting is recruiting and retaining physicians. Scott acknowledges the economic realities of operating a healthcare practice in a rural setting; with relatively few commercially insured patients, MHS has had to create financial arrangements to ensure that physicians aren’t penalized for seeing so many government-insured patients

But he punctures the myth that physicians don’t want to work in those areas. “Physicians who want to work hard and want to enjoy the fruits of their labor do really well in rural settings,” he says. “There’s no lack of volume, because these are underserved areas. So if we create the right circumstances, these physicians do very, very well, probably better than their urban counterparts.” And as he notes, “when you have successful physicians, you’ll have a successful health system.”

Money is only one part of the equation. The nature of MHS’s relationship with its physicians is central to the system’s success. Scott emphasizes the importance of relying on physicians’ expertise in clinical matters and ensuring physicians have a voice in leadership. “It’s all about treating physicians as partners, not as employees,” he says. “Physicians need to be the architects of healthcare. They are the clinical decision-makers from the ground up. So, absolutely, keep your physicians at the table—leadership is critical. Having the right infrastructure for physician leadership and the right people in those roles is absolutely essential to having a robust growth strategy.”

People want to get their healthcare locally.

Urban health systems have plenty of advantages—proximity to universities, the latest medical technology, the most renowned physicians, you name it. It’s little wonder they’re destinations for care.

But as Scott points out, asking patients from rural areas to navigate a complex hospital environment in a busy city, hours from home and family, adds anxiety to the already stressful experience of surgery.

“People want to be near their homes,” he says. “When you offer people an opportunity to stay in a market where they’re comfortable, and you haven’t added any stress, they will consistently choose to stay local and rural for their care if they have an option that they believe in. And so that’s our advantage.”

But patients also have to be confident that they’re going to get high-quality care so close to home. Scott says that if physicians believe in the quality of care, they’ll encourage their patients to stay local. “The physicians have to help us create that trust level. Once they’re inspired and know the quality is there, they’ll make the choice to stay. They’re comfortable because this is where they live. They live in small towns.”

Scott expands on these points and touches on many more in the inaugural episode of Healthcare Upside Down.

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