It’s time for a “moonshot” to fix rural healthcare in Texas

They grow the food we eat. They farm the materials for the clothes we wear. They provide the energy that drives our cities. These are the rural Texans we love and idealize. But we overlook a serious reality: Rural healthcare delivery systems are either on life support or nonexistent.

This ugly truth leaves rural Texans vulnerable, with limited or no access to care. It also impacts those of us who live in cities but drive through or spend time in the picturesque rural lands for work, or for respite from the frenetic bustle of urban life. In a state as prosperous and resourceful as Texas, this is unacceptable.

It’s time for a moonshot for rural healthcare in Texas. All Texans, from businesses and elected officials to the healthcare industry and academic institutions, should be trying to answer this question: How do we create actionable ideas to improve access, quality and healthcare delivery in this state?

Currently, 170 of the state’s 254 counties are rural. These areas are home to more than three million people. Statistically, rural Texans tend to be older, poorer and less healthy than their urban and suburban counterparts, according to a report, “What’s Next? Practical Suggestions for Rural Communities,” conducted last year by the A&M Rural and Community Health Institute (ARCHI) and the Episcopal Health Foundation (EHF)

The report is instructive, detailing healthcare challenges in rural communities:

  • 35 counties have no physicians
  • 80 counties have five or fewer physicians
  • 58 Texas counties have no general surgeons
  • 147 Texas counties have no obstetrician/gynecologists
  • 185 Texas counties have no psychiatrists

Exacerbating the issue, more than 20 hospitals in Texas’ rural areas have closed in recent years, while 60 percent of the 164 remaining hospitals are at-risk of closing, according to ARCHI. Financial issues, a lack of patients and a lack of leadership are noted in the report as factors leading to the demise of these hospitals.

Sitting idly by will not change the downward trajectory of rural healthcare in Texas. Collectively, we need to create bold, imaginative strategies and solutions to improve access to health care and reduce disparities in health status and outcomes in rural communities.

We must think beyond asking “How do we save the local the hospital?” or “How do we translocate urban healthcare solutions to rural Texas?” Instead, we must reimagine the entire rural healthcare ecosystem to connect telehealth and new types of healthcare workers with potential partnerships and healthcare delivery tools.

For instance, Blue Cross and Blue Shield of Texas (BCBSTX) and Texas A&M University Health Science Center recently launched a new project to incubate answers to the unique health challenges in rural and underserved communities in Texas.

The project will coalesce around the mutual goals of the Texas A&M Health Science Center and BCBSTX. It will be buttressed by BCBSTX’s Affordability Cures endeavor aimed at accelerating efforts to reduce healthcare costs and improve outcomes, including addressing health disparities and social determinants of health.

The initiative will be spearheaded by ARCHI, which since its founding 15 years ago has been on the forefront of identifying the challenges facing small hospitals and creating solutions for how health care can remain in rural communities.

This promising project will unite the expertise of more than 20 cross-disciplinary investigators across eight colleges at Texas A&M University — the Health Science Center’s colleges of dentistry, medicine, nursing, pharmacy and public health, along with the colleges of agriculture, education and engineering.

Focus areas of the project will include:

  • Tackling distance
  • Empowering communities
  • Revitalizing hospitals through new care delivery models
  • And, training rural providers for the 21st century

Initiatives will include using technology in patient and community-centric ways to strengthen ambulatory rural care delivery systems and rural hospital function and issues, including chronic disease management and emergency services.

The research and innovative care delivery strategies that emanate from this collaboration could potentially be a moonshot for rural healthcare — not only in Texas, but across the nation.

It’s a big idea, but both BCBSTX and Texas A&M were founded on visionary change. For BCBSTX, it was health insurance — a notion realized nearly 90 years ago that evolved into a global enterprise. For Texas A&M, it was a land-grant designation that created and funded the state's first public institution of higher education.

Health care and health outcomes in Texas should not depend on one’s zip code. Much work remains to provide access to health care in our rural communities. The healthcare challenges facing rural Texans are many — and cannot be ignored. We are all Texans, and the future of our state is inexorably linked to the health of all of our communities.

Drs. Carrie L. Byington and Dan McCoy

Blue Cross and Blue Shield of Texas