An architect’s POV on transforming rural health

‘Wellness districts’ and restructuring beyond walls and payments

click to enlargeHealthcare building architect Doug Elting cannot be accused of thinking small. The Transformation of Rural Health starts with reimagining healthcare facilities serving rural areas into facilitators of population health: “…the  local healthcare center as the source of health and vitality….focus(ing) on the provision of services that will maintain health, enhance public participation and redefine the scope of care.” (Not difficult imagining when you see an attractive wellness/rehab center like Butler County Health Care Center in Nebraska, left.) Like Clayton Christensen, Mr Elting envisions decentralized care that incorporates telehealth, care coordination, PHRs, fitness and social support. He then moves to an organizing principle called Wellness Districts:

Rural community, county and critical access hospitals will become components of Wellness Districts composed of Life Enhancement Centers coupled with physicians and physicians groups. These Life Enhancement Centers (LEC) are flexible and agile facilities containing a variety of services meeting the needs of the population. The LECs could contain: patient-centered medical home physicians’ offices, wellness and rehabilitation centers, specialty clinics, diagnostic centers, wound care centers, nutrition and cooking classes, outpatient treatment centers and urgent care facilities. LECs may include related services including dental offices, eye care specialists and retail functions including: durable medical equipment, opticians, retail pharmacies, food services etc.

Wellness Districts will receive payments for maintaining the health of the people in the service area.The Wellness District would receive a prepayment from the state for Medicaid participants, the Centers for Medicaid and Medicare Services (CMS) for Medicare participants. They would also receive prepayments from local employers and from private citizens to provide for the individuals unique health needs. This value-based compensation would include funds for catastrophic wrap-around insurance coverage for major life threatening events such as heart failure, cancer, trauma or other services not provided by the Wellness District. The Wellness District would have the incentive to keep the people in its service area healthy to reduce its costs and increase its margin.

While his context is rural America, this is also applicable to organizing healthcare in any area where population is scattered and services are distant, whether or not private or national payers. This could also apply to underserved urban areas or even suburbs where large medical centers increasingly dominate but in an unorganized way. But there’s a staticness to this model which this Editor invites Mr Elting to address: what about payment for care outside the district, if you are temporarily relocated or traveling? Visions in Architecture (VIA) via LinkedIn

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Comments

  1. Donna,
    Thank you for your question. This article is the first of a series of articles. Future articles will outline care for the chronically ill and value-based compensation models. I believe that several innovative payment models will evolve based on area demographics and geography. The most promising that is occurring across the country is the use of self-insurance plans for the employers and participants within a wellness district. The district can use the self-insurance plan to mitigate risk, provide plan portability and to insure against catastrophic or traumatic events.

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