Rural Missouri needs better infrastructure to connect the places, people and ideas that can power strong rural communities.

Expansion of broadband technology will create new opportunities in rural Missouri, including in health care delivery. High-speed internet services will allow increased access to telehealth services, and enable new health technologies — such as remote home monitoring and direct to provider services — helping patients and health care providers more efficiently access services. At the same time, rural businesses of all kinds — from agriculture to warehousing — increasingly rely on high-speed internet services. Both the Missouri Farm Bureau and the Missouri Chamber of Commerce and Industry have included expansion of broadband services in their strategic initiatives.

Public transportation in rural areas can be sparse, and for rural residents with special needs, it can be nonexistent. Access to transportation is essential to maintaining the health of rural Missourians. Support for innovative models like HealthTran should be part of Missouri’s policy. Access to care and transportation can allow rural residents to age in place — strengthening individual health, and supporting connected families and communities.

Missouri’s poor roads, and the greater distances to care for rural residents, complicate access to care. Rural hospital closures, which can lead to other health care providers leaving the community, exacerbate travel to care.

Improved infrastructure will help attract and retain talent and spur business development. As a result, a stronger rural economy will help support Missouri’s rural health care infrastructure — access to hospitals, physician services, and pharmacy and dental health. The improved ability to move goods and information will help attract and retain businesses and health care workers, strengthening the economy and improving the health of rural Missourians.

Suggested policies:

• Increase funding to improve access to rural broadband capable of supporting hospital applications.
• Use a newly announced federal initiative to improve the safety of rural roads, dubbed “Rural Opportunities to Use Transportation for Economic Success (ROUTES)”.

Gov. Parson has made job creation a pillar of his administration’s agenda. Building the health care workforce in rural Missouri is a natural extension of the governor’s jobs program. Moreover, there are added benefits of strengthening the rural health care workforce, including maintaining high-skill and well-paying jobs in rural communities, and ensuring rural Missourians can receive health services locally.

Parson has made several new investments that support the health care workforce. These investments — to increase capacity for training and incent entry into health professions — are an important start toward addressing workforce shortages.

Primary care is essential to improving health and the rural health care system. Targeted investments and policy changes could improve access to primary care and reduce the primary care workforce shortage in rural Missouri.

Suggested policies:

• • Authorize participation in the interstate licensure compact for physicians.

• • Expand the capacity of advanced practice registered nurses to address the health care needs of rural Missourians.

• • Increase appropriations for health workforce development initiatives of the Area Health Education Centers.

• • Expand and increase funding of the “Fast Track” workforce development initiative for nontraditional students.

• • Clarify how physicians and certified registered nurse anesthetists will manage the use of controlled substances in surgical anesthesia.
  • Ensure health insurance companies promptly decide whether to add new physicians or other practitioners to their provider networks. Concern about undue delays is strongest in rural communities where practitioners already are in short supply. A rural community fortunate enough to recruit a practitioner is ill-served by long delays in getting them credentialed and compensated for treating rural residents.

A primary health care system with the capacity to ensure that individuals receive the care they need, manage chronic conditions and live healthy lives is essential. The Parson administration is committed to building a better Medicaid program and a more efficient health care system. The foundation of that effort must be improved primary care access and performance. Six rural Missouri counties lack a primary care provider and 71 lack obstetrics coverage. And, there’s a large disparity in the number of PCPs between urban and rural communities. These disparities are evident in access to oral health services, and pharmaceuticals and pharmacist consulting, as well.

Nearly all of rural Missouri is a Health Professional Shortage Area for Mental Health. Missouri needs additional resources and clinicians to address the behavioral health crisis. Clinicians who agree to practice in these areas can participate in loan repayment assistance programs through the National Health Service Corps. In addition, Missouri should examine behavioral health programs to identify and eliminate any barriers for those who wish to practice in rural areas.

Missouri could expand access to rural behavioral health services through better integrated primary care services. The Substance Abuse and Mental Health Services Administration partnered with the Health Resources and Services Administration to produce resources for rural providers, in addition to federal funding for innovative training programs.

The state could access federal Medicaid funding to support behavioral health through state waivers authorized by the Trump administration. Pursuing waivers in these areas would increase the state’s capacity to deliver high-quality behavioral health services in areas of greatest need.

Stronger partnerships between Community Mental Health Centers, rural primary and acute care providers, and Federally Qualified Health Centers would improve the capacity of health care providers to treat behavioral health problems locally. Better integration of community-based outpatient care could expand opportunities for rural Missourians to receive behavioral health care close to home.

The opioid and substance abuse crisis is one of the greatest public health threats facing Missouri. Overdose deaths now exceed traffic-related fatalities in Missouri. Changes in state policy, and targeted investment in intervention and recovery, could help curb the high toll on rural communities, which tend to be disproportionately impacted by this epidemic.

Suggested policies:

• • Through state and federal funding, add Certified Community Behavioral Health Organizations in rural areas which, among other benefits, would furnish more caseworkers to manage the post-discharge service and support needs of behavioral health patients in hospital emergency departments.

• • Develop and promote innovative health literacy and patient education initiatives in rural areas.

• • Conduct or commission an analysis of the role of social determinants of health in impeding access to behavioral and primary care in rural Missouri through an appropriations initiative for the Missouri Department of Mental Health and Missouri Department of Health and Senior Services.

• • Increase funding to reduce waiting lists for coverage of services for the developmentally disabled.
  • Clarify state government’s intent to allow the use of telemedicine to comply with state and federal standards governing access to clinicians and types of services.