Addressing Appalachia’s Healthcare Gap

Amanda Winstead is a writer from the Portland area with a background in communications and a passion for telling stories. Growing up, she spent summers in Maryland with her grandparents, walking sections of the Appalachian Trail or visiting historical sites in the area. More recently, she hiked the trail in full for the first time and fell absolutely in love, especially with its rich history. She was especially taken by the trail’s natural history and the way it links together the American story, from the site of George Washington’s inoculation of troops against smallpox to the last battlegrounds of Shay’s Rebellion. If you want to follow her writing journey, or even just say hi you can find her on Twitter.

Rural Appalachia struggles with healthcare issues significantly more than other areas across the country. Healthcare Disparities in Appalachia, a report by the Appalachian Regional Commission, highlights the various gaps in healthcare access and success throughout the region. Most notably, seven of the leading causes of death in the nation have markedly higher mortality rates in Appalachia.

This means that more Appalachian people are dying from heart disease, cancer, COPD, injury, stroke, suicide, and diabetes than people in any other region across the United States. Drug overdoses and other “diseases of despair” are highest in Appalachia, with substance use problems having systemic roots. There are numerous reasons for this, but healthcare gaps are at least partially to blame.

The State of Appalachian Healthcare

Especially in rural areas, Appalachian residents are subject to restricted access to healthcare professionals. The number of primary care physicians per 100,000 people is 12% lower here than the national average — increasing to 21% and 33% lower in Southern and Central Appalachia, respectively. Dentists and other specialists are harder to come by, as well. This lack of accessibility has resulted in notable changes to the healthcare landscape in Appalachia.

Rise in Urgent Care Centers

Urgent care centers, like MedExpress or Concentra, are cropping up all over the place — including in rural Appalachia. In fact, the U.S. has seen 11,150 new facilities and is projected to increase that by 7% each year.

Urgent care centers are helpful to Appalachian communities due to their lower cost and ability to take in more patients. Typically, people visit these facilities for less-severe illnesses and procedures, such as a common cold or vaccination. The physician assistants and nurse practitioners that work there free up valuable time at other facilities with primary care physicians and specialists. This is vital in situations where there are high numbers of patients. For instance,  many healthcare facilities 60% uptick in patient volume due to the pandemic. 

Compared to other areas of the United States, Appalachian regions experienced a markedly slower spread of COVID-19. Being disconnected can have unique perks, such as slowing the spread of infectious diseases. However, with less connectivity comes less healthcare access and advancements when patients need it most.

Healthcare Connectivity

While the rate of transmission of infectious diseases may be slowed in rural Appalachia, there are still plenty of illnesses requiring patients to seek treatment. Obesity, drug use, mental issues, and smoking all lead to health complications that need to be addressed. These factors combined likely contribute to high mortality rates in the region. Unfortunately, the lack of connectedness to healthcare advancements and the low supply of healthcare professionals means that those needing care can’t always receive it.

A lack of connectivity manifests itself in lifestyle differences but also in a lack of information or even misinformation. While internet access in Appalachia isn’t necessarily hard to come by, there is a stark urban-rural divide. The only Appalachian counties to match the national average in device access were metropolitan counties. Otherwise, rural Appalachia fell behind. 

This lack of access to technology can stall information spread and, further, extend to healthcare facilities. A digital disadvantage can also mean a scarcity of IT professionals to build robust IT infrastructure in healthcare systems. 

In addition to the newest treatment systems and technology, healthcare relies on an interconnected web of communication to best meet patients’ needs. Doctors and facilities need to be able to quickly and securely transfer patient files and information between care providers. If this isn’t possible, patients aren’t receiving the efficient, informed treatment they deserve.

Closing the Appalachian Healthcare Gap

Luckily, there are steps being taken toward improving the state of healthcare in rural areas. Especially in the wake of the COVID-19 pandemic, professionals are thinking harder and smarter about how to expand healthcare access to everyone across the country — not just those in metropolitan areas. With time and hard work, there will hopefully be more available beds in hospitals, better-paid staff, and lower mortality rates in rural Appalachia.

Technology

As mentioned above, healthcare facilities need IT infrastructure solid enough to support their robust technological needs. Healthcare information technology includes a variety of electronic methods, such as: 

• Patient healthcare portals and apps;
• Electronic medical record systems (EMRs, EHRs, and PHRs); 
• Online prescribing systems; 
• Online provider order entry; 
• Electronic disease registries; 
• Clinical decision support (CDS);
• Telehealth.

Reimbursement is apparently on the mend in rural healthcare, allowing rural facilities to recover financially. Hopefully, financial means will be allocated to the most advantageous parts of healthcare technology

Public Investment

In the past, the lack of public investment in the region has been a major source of health disparities in Appalachia. Rural health facilities have ended up behind when trying to educate staff and implement new tech, much less keep up with new tech in the first place. Now, financial issues are leading to staff retention problems — but technology may be able to help in this area, simultaneously.

Public investments could be key in closing the gap. Luckily, major organizations are already taking action. UnitedHealth Group has invested $10 million in Appalachian healthcare as of 2023, with plans to upgrade the inherently flawed system. These include planned investments in clean energy, creative placemaking, community health, and food and agriculture. 

This is a nice first step for Appalachia to start financially recovering from being behind in the healthcare sector. Financial resources could mean more budget to pay previously underpaid staff and increase retention rates.

Staffing

Retention issues and layoffs have plagued the rural Appalachian healthcare system. Especially with COVID-19 complications, there have been staffing issues, particularly in more remote areas. For example, Appalachian Regional Healthcare furloughed 500 employees in 2020 amidst a loss of revenue due to COVID-19 postponing non-life-threatening procedures. Although beds and staff were scarce, this eastern Kentucky and southern West Virginia chain of healthcare facilities was forced to shut down part of its operations and run without 8% of its employees. This is just one example of how rural healthcare is failing the public, especially in times of need. It also leaves remaining employees underpaid and overworked, prone to burnout and more mistakes.

Fortunately, the introduction of financial reimbursements and smarter technology into rural healthcare should offset these staffing issues. Traveling nursing jobs are more popular due to higher pay, and rural healthcare facilities just haven’t been able to keep up. However, technology is opening more opportunities for healthcare professionals with entrepreneurial aspirations. 

While staffing is down, the demand for healthcare is high. With the help of healthcare tech, medical professionals can turn to telehealth to help more patients regardless of area. This means that rural healthcare professionals can get more work and patients in rural areas can see a professional virtually without having to travel or wait for subpar care in their location.

Analytics and Community

Technology and community are intertwined in many ways — from telehealth access to the spread of vital health information. If rural Appalachian healthcare facilities are to improve their contribution to communities, they will need to embrace analytics in a deeper way. 

One such way is to track patient movement. Rural facilities don’t have the resources to waste on misplaced patients. Analysts should keep a keen eye on how many patients have been transported to the wrong treatment centers, misdiagnosed, or otherwise treated poorly. This can not only improve efficiency in rural healthcare, but it can also enhance healthcare courtesy in Appalachia.

Many patients report poor bedside manners contributing to their negative healthcare experiences in rural Appalachian facilities. Optimizing healthcare processes and retaining healthy employees will lead to less burnout and better courtesy to the Appalachian community of patients. After all, this is what rural healthcare is all about — community wellness regardless of hardship. Taking steps to improve this is the only way.