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We proudly support the many of our provider partners across the country who are providing essential care to those serving rural and underserved communities. McKenzie Health System is one such partner whose innovation in preventive health and wellness is making a meaningful impact in the lives of those they serve in Sanilac County, Michigan.  Here, McKenzie’s President and CEO, Steve Barnett, offers insights from his team's experience as an Accountable Care Organization -- and shares some strategies for success in rural communities.

The vast mileage between rural populations, towns and facilities means that people may have to travel farther to access healthcare, and the resources may not be as comprehensive as in denser populations. Most concerning, there are significant care disparities in rural areas, often due to insurance issues, socioeconomic status, health behaviors, job opportunities and basic access. This affects 46.1 million Americans living on 72% of the land in the U.S.

Having experienced large multi-hospital academic settings, I now have a deeper appreciation for working in a rural health system. I’ve been president and CEO of McKenzie Health System (MHS) in Sanilac County, Michigan for 16 years, and held the same roles at a critical access hospital prior. However, I’ve also been a hospital-based respiratory therapist and a certified registered nurse anesthetist at a larger, academic medical system, so I’ve seen the differences that the setting and hospital type make. 

Though working in a rural health system can be challenging – including the financial difficulties – I’ve found it satisfying to ensure that people in rural communities can access the high quality healthcare they need. National Rural Health Day shines a light on rural communities, allowing others to become aware of the wonderful care provided by rural hospitals. And it’s an opportunity for rural hospitals across the nation to make our voices heard. 

Rural health: A model for innovation

When I worked at large academic centers, and even at urban community hospitals, I spent a lot of time trying to accomplish meaningful changes. The layers of bureaucracy in larger health systems wore me out. I can get more done at a rural hospital in a week than I could in a year elsewhere. That’s because rural hospitals are forced to innovate, since we often have fewer resources – financial and human – to give our patients the best care. I believe larger hospitals can adapt what they’re doing and learn from their rural counterparts, if they take the time to see how we’re handling things and rethink their own processes.

We’ve had to innovate how we access specialists. As a rural hospital, we sometimes need to find larger facilities interested in extending their specialists to us. Telemedicine is a natural fit, but it does not work well for every specialty or situation. We sometimes need in-person access, which is difficult when specialists have a full schedule. Innovative thinking is working with larger facilities to create unique clinic models that allow the specialist to be more efficient in the time they spend with the patient

Since the Affordable Care Act passed in 2010, the entire health industry had to evolve how we deliver care, focusing on wellness and value. Innovation has been key, and we helped establish the National Rural ACO in 2013. ACOs were not initially designed for rural hospitals, so I needed to seek out others who shared our vision to create a rural ACO.  

What began 10 years ago as one rural ACO with 12,000 lives, has exploded to the multiple collaborative rural ACOs we have today. Once again, rural hospitals have been able to demonstrate how to shift care delivery so it works to improve the lives of local populations.

Rural health win: The annual wellness visit

A primary tool we focus on through the ACO is the annual wellness visit (AWV). MHS has achieved and maintained the highest AWV rate of any of Signify Health’s rural communities, with more than an 80% completion rate. That didn’t happen overnight. Like anything new, we tried a few different approaches before landing on our current internal model, driven by nurses who are skilled at encouraging people to become involved in their healthcare. 

Our nurses understand the value of AWVs and how they can lead to so many other health opportunities that ultimately improve our population’s quality of life. MHS nurses, and the rest of the care team and staff, are very competitive. When we set the bar high, as we did with AWV completion rates, they do not stop until that goal is met. 

We use an innovative and team-based approach to care delivery and population health workflows. We mastered this approach as we participated in the ACO Investment Model (AIM), which helped MHS’s providers and staff learn to introduce workflows focusing on population health that included prevention efforts like AWVs. We have also improved our chronic care management program using these workflows and models.

Not all rural health organizations have reached the same levels of success, and we were proud to be honored as the winner of the 2023 Award for Rural Innovation and Wellness at the Signify Symposium in July.

National Rural Health Day comes once a year, but our work in rural health goes on every minute of every day of every year. Take a little time to think about the type of healthcare your community offers and the problems and challenges you face. Think about your resources and how you spend your time. Are there any lessons you can learn from your rural health colleagues? When someone reaches out to partner on an initiative or to help their patient, can you take a minute to see how you can assist, solving problems in a different way? We all need healthcare, and our rural populations may not fit into the same box or have the same access to care that our sister institutions have. Recognizing that – and doing something to improve it – is what this day is all about.

Written by Steve Barnett, President and CEO, McKenzie Health System