Approximately 15% of the US population lives in rural America and faces disproportionate health disparities and challenges compared with the urban population. They are more likely to die from common health conditions, they are at greater risk for opioid overdose, and children have increased rates of behavioral health disorders [ Complex socioeconomic, geographic, and demographic factors have historically negatively impacted health access and outcomes in rural America; made worse by rising health care costs, economic uncertainty, and the short- and long-term impacts of the recent pandemic. As mentioned in our April edition of All Access, not only have there been 194 rural hospital closures since 2005, but we are experiencing widespread staffing shortages and an increasing strain on health care budgets. All of these factors have proven to build even greater barriers to care. The entire health care ecosystem needs to play a role in warding off the threats to rural health care and supporting solutions to deliver care to our residents in low-resourced areas.

While there is no panacea for the health care crisis in rural America, finances are undoubtedly a key driver behind many of the challenges. In the absence of a complete overhaul of the US health care system, several smaller initiatives are underway: as part of the Consolidated Appropriations Act of 2021, Medicare established the designation of “rural emergency hospital” (REH). REHs reinforce access to outpatient medical services and reduce health disparities in areas that are not able to sustain a full-service hospital, and allow RHEs to receive Medicare payments for providing emergency services. First introduced in 2021, the Rural Hospital Support Act would modify and extend payment adjustments for rural hospitals and if passed would provide greater financial stability for Medicare dependent rural hospitals ( These Acts provide temporary relief but reform of the Centers for Medicare & Medicaid Services (CMS) and state Medicaid agencies payment methodologies for rural entities is required for long term viability. Additionally, private payers need to recognize the uniqueness of the rural population and create products to address the needs of rural health providers. Sanford Health in South Dakota received a $350 million philanthropic gift to create a virtual care center to serve the Midwest and provide education, research, and advance digital health solutions ( This act of philanthropy has the potential to make a significant impact and hopefully can pave the way for others to follow this example.

Fortunately, the COVID-19 pandemic has normalized telehealth which along with other digital solutions can make a significant impact in bringing health care to underserved areas. Telemedicine can provide a bridge to specialized health care and mobile devices can empower people to monitor their health and get medication reminders. Unfortunately, we have a digital divide in this country and nearly one-third of rural Americans lack access to high-speed broadband services (Perry AF, Federico F, Huebner J. Telemedicine: Ensuring Safe, Equitable, Person-Centered Virtual Care. IHI White Paper. Boston: Institute for Healthcare Improvement; 2021. Accessed June 14, 2023). Beyond virtual options, services need to become more preventative and centered around the home and community. Trust in health care workers is essential in marginalized populations and bringing care to the home or community can provide a level of confidence. Investing in community health workers could facilitate access to care and improve outcomes. In 2022, Optum Health completed more than 395,000 house call visits in rural communities. An Optum supported team made house calls and screened more than 2 million members for social determinants of health needs. The greatest needs were financial support, transportation, food insecurity, and medication affordability ( Enter pharmaceutical manufacturers.

The pharmaceutical industry can support payers and other stakeholders to improve access to care and health literacy resulting in increased medication utilization. There is an opportunity in rural communities to raise awareness about and maximize access to patient assistance programs. Preventative health education and screening can make a significant impact on promoting a healthier lifestyle and achieving positive outcomes. Consider bringing provider education programs along with corresponding patient materials to support health literacy in rural communities. Build strategies to address limited resources, geographic barriers, and socioeconomic inequities specific to target therapeutic areas. It’s often been said, “Your quality of care should not be dictated by your zip code.” All health care stakeholders have a responsibility to support equitable access to quality care in our rural communities.