The U.S. health care system is undergoing significant transformation as a result of Federal, State, and private payer policies designed to improve access to medical care as well as the value and outcomes of health care while attempting to slow cost growth. Some payment innovations, such as accountable care and other risk-based models, drive organizational and delivery changes that have shown evidence of improved quality, reduced care fragmentation, and lowered costs for certain populations. Yet overall, the entire system has not realized substantial cost savings nor has quality improved for everyone. There continue to be gaps between people who live in areas where progress is being made and those who do not, perhaps reflecting symptoms such as rising health insurance premiums, unstable insurance markets with limited plan choice, large variation in uninsured rates and access to care, and continued health professional shortages. It is clear that more changes are required if real progress is to be made toward lowering total health care system costs, improving access and health care experiences for all individuals, and achieving better population health.
This paper examines the progress of health system transformation and the gaps that remain as they affect rural people, places, and providers. The health system transformation activities examined here are not limited to the Patient Protection and Affordable Care Act of 2010 (PPACA), but also touch upon activities undertaken by states, insurance plans, and private and public payers.
The paper is organized into seven chapters covering topic areas that have key implications for rural people and the rural health care delivery system: Medicare, Medicaid and CHIP, Insurance Coverage and Affordability, Quality, Health Care Finance and System Transformation, Workforce, and Population Health. Each chapter begins with a summary of Policy Opportunities, followed by a background section on Rural Trends and Challenges that summarizes rural-related policy advances and continued gaps. We conclude each chapter with a Looking Ahead section that highlights the most pressing issues in today’s rural health care system environment, and we suggest future policy directions related to each issue. (Author abstract)