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Strengthening the Rural Health Infrastructure

Assuring Quality of Care

For Rural Populations


Charles J. Fazio, M.D., Medical Director, Central Minnesota Group Health, Waite Park, MN.

This session explored the special challenges health plans serving rural enrollees face in developing quality assurance programs and meeting national health maintenance organizations (HMOs) accreditation standards.

Dr. Fazio discussed the problems inherent in collecting, analyzing, and interpreting utilization data for a rural patient base, where there are relatively few enrollees and few encounters compared with urban populations. Though some of the information challenges are similar to those found in urban organizations (e.g., time, cost, staffing needs), the challenges are more burdensome for small rural practices that have fewer resources. Rural practices are often still using manual record keeping, making record review and computer-assisted analysis for quality improvement difficult at best. For example, there is no way to easily scan the system for all two year olds who have not yet completed their immunization series. Information systems or their lack are a significant barrier to being active participants in certain quality initiatives.

Dr. Fazio looked at measures and criteria developed by the National Committee for Quality Assurance (NCQA) for comparing and assessing health plans and reviewed NCQA's mission and values, which aim at providing information on quality to the marketplace and promoting improvements in the quality of managed care. He reviewed the specific NCQA accreditation standards exploring special challenges for rural practices and health plans with rural constituencies.

Dr. Fazio made the following summary points regarding rural areas:

  • Managed care organization (MCO) networks will extend throughout States to include rural areas; regulators may want to keep in mind the special needs of rural areas before setting universal standards.
  • Rural practitioners are affected differently by MCO initiatives than urban practitioners. There is an opportunity for State regulators and purchasers to influence what MCOs do regarding quality standards. For example, some States require accreditation of MCOs.
  • There are opportunities for MCOs to assist rural practitioners with infrastructure improvements, education, and/or practice initiatives. States can provide incentives to encourage cooperation and can offer financial support to help build infrastructure. There are also opportunities for MCOs and State policymakers to cooperate on what they request of (rural) practices.


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