HJAR Mar/Apr 2020

40 MAR / APR 2020 I  HEALTHCARE JOURNAL OF ARKANSAS COMMUNITY HEALTH internet service can also stifle health literacy and prevent patients from utilizing mobile health technologies that support healthy be- haviors. According to a 2018 article published in the Annals Of Internal Medicine, a 2012 survey showed that 21 percent of uninsured persons do not use the Internet. It seems clear that in this technological day and age, the digital divide itself has, in fact, long been a SDOH. With the digital divide in mind, the use of telehealth services has become a staple HIT tool. For some communities acrossArkansas, telehealth is a proven way to connect rural providers and their patients. This allows for patients near their local CHC to receive the whole-person care needed without travel- ing to the specialist, such as a psychiatrist who maybe 50 miles away. CHCs have made it a priority to understand the SDOH needs of their patient population, and work to as- sist with as many of those needs as possible, such as seeing needed specialists through telehealth. Eliminating limitations for reim- bursements for telehealth delivery should be a policy priority for Health Resources Ser- vices Administration (HRSA) and Arkansas Medicaid. Understanding and addressing social fac- tors that affect health outcomes is a pressing issue for physicians and medical profession- als in the communities they serve. In order to reduce negative health outcomes associated with SDOH, a comprehensive approach is needed that includes support for public poli- cies aimed at immediate needs and systemic issues, a better understanding of the issue by physicians, improved interpersonal com- munication, a robust plan that incorporates institutional and community involvement, adequate funding for federal and local initia- tives, considerations of health in community planning, and development and collection of real-world evidence to help best target inter- ventions toward those most in need. An additional component in rural commu- nities are community health workers. These community-based health advocates help build relationships with, and offer support and guidance to the population on taking care of their personal healthcare needs. As health care costs rise, the resource of com- munity health workers can be further tapped to reduce health care spending. Deploying community health care workers within pri- mary care facilities could be a great solution to build upon the holistic care of patients, while also addressing their SDOH. The com- munity health workers could help consult with patients and medical residents to find out their needs, both inside and out of hospi- tals and health centers. Those could include housing, employment, accessing healthcare HIT, or referrals to doctors of social services. Due to there being no degree or certifica- tion for community health workers inArkan- sas, many newcomers to the field gain experi- ence through training programs like the ones in our neighboring state of Missouri. Others may receive on-the-job training or use pre- vious professional or life skills to help resi- dents. Arkansas State Reps. Vivian Flowers and Chris Richey authored legislation, with the input of theArkansas Community Health Workers Association, that proposed certify- ing guidelines for community health work- ers. This could have been a game-changer in creating a network of professionals aimed at assisting our underserved rural population in meeting their healthcare needs in a non- emergent manner. Also, allowing CHCs to bill for Community HealthWorkers services could improve the appropriate utilization of health system resources as well. Primary-care organizations are diamonds in the rough for the health care industry. Some health care providers may be hem- orrhaging money, but struggle to address the SDOH facing the American population. Primary-care groups in rural America such as CHCs, can help bridge this gap. They genu- inely care about reducing unnecessary costs and promoting the quality of prevention strategies and coordination among health fields. Primary care physicians are not only the gatekeepers of the healthcare delivery systems, but they will also be drivers of future innovation. They are the frontline soldiers in a small army striving to ensure continuity of care. We must acknowledge and accept this central fact. It is time for the health care industry to re-focus. n