Reviews the opportunities and challenges reform
initiatives under the Affordable Care Act present for
rural communities. Assesses four types of organizational
models for delivering integrated care management. Each
model has different strengths and drawbacks, weighing for
and against implementation in rural areas.
- Introducing an integrated care model in a rural
community requires an investment in building
relationships with local providers and adapting to local
culture and services.
- Integrated care models that cannot adapt to the local
delivery system are more likely to face resistance from
local providers and those they serve and potentially
duplicate or displace existing rural capacity.
- Most models of integrated care management have an
inherent bias toward larger organizations and
infrastructure. Most are built on an investment in health
information technology and other systems and capacities.
- The potential success of any integrated care model is
limited by gaps in the continuum of health care services
and long term services and supports available in a rural
- "Wraparound" integrated care models can fill gaps in
existing care coordination capacity, offering a flexible
approach that can adapt to a local rural delivery system.
- An investment of public resources in shared supports
can lower the cost of integrating care in rural delivery