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05/2014

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.

Key Findings:

• 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 community.
• "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 systems.

Maine Rural Health Research Center

Eileen Griffin, Andrew Coburn

Aging, Care management, Health information technology, Health services