Joe Thompson: ‘ZIP code risk’ a mounting concern
Shifts in the scope of delivery and financing models are presenting new challenges for the health care industry, says Joe Thompson, president and CEO of the Arkansas Center for Health Improvement and former state surgeon general.
“There is now a considerable focus on population management and whole health and wellness in addition to treatment of individuals’ physical or mental illnesses,” he says. “This shift has forced the industry to look beyond traditional clinical interventions and into environmental conditions where people live, learn, work and play.”
Thompson calls it “ZIP code risk.”
“What the industry is discovering is that our health risks and outcomes are heavily impacted by where we are,” he says. “In many communities, there is limited access to determinants such as healthy food, safe and affordable housing, transportation options and physical and built environments that provide opportunities for making healthy choices. Too often, our environment makes the healthy choice the most difficult choice. The industry is neither well equipped nor resourced to address these issues.”
Regardless of ZIP code, Arkansans should have appropriate access to care, Thompson stresses. But an outmigration of young people from rural areas is leaving small-town hospitals caring for fewer but older and sicker patients.
“Rural hospitals generally have fewer resources, older facilities, more recruitment difficulties and less technologies than their urban counterparts,” Thompson says. “Medicaid expansion has largely shielded Arkansas from the rural hospital closings seen in neighboring states that have declined to expand.”
More than 50 hospitals in adjacent states have closed since 2010, according to ACHI; in Arkansas, one rural hospital was shut down and another filed for bankruptcy in that same time.
“Still, our rural health care network is struggling. Recognition of ZIP code risk by policymakers and investment by communities, in addition to clinical engagement regarding social needs, will be critical in addressing the overall health of Arkansans and ensuring all of our citizens enjoy long and productive lives,” Thompson says.
Rural health care in Arkansas benefited from the state’s adopted Medicaid expansion under the Affordable Care Act in 2013, he adds. “The program has helped innumerable people receive needed care, slashed Arkansas’ uninsured rate, reduced uncompensated care costs at our hospitals, brought billions of new federal dollars into our economy and helped stabilize our insurance market.”