In this episode we learn about what it is like driving value in rural communities with CHESS Health Solutions senior director of clinical operations and practicing physician Dr. Kimberly Vass-Eudy

Dr Vass-Eudy, as a provider with a rural patient population what are some of the unique challenges about practicing medicine in a rural community? I think the first thing is that the space there's a lot of space in a rural health community. Patients are driving many miles to get to restaurants or grocery stores or to their doctor, so it really does create an issue for some patients especially in a in an economy where there's issues with paying for gas or food. So for a provider in a community like that, they have to be really aware of that distance. It creates community though because a lot of people families will stay in the same area together. So when I was working in a rural health community facility, I would take care of everybody from great grandma all the way down to you know the tiniest infant because they all live nearby they all kind of stayed together and created a community. There's a lot of people in my practice that knew each other which was nice because they would take care of each other and look out for each other and so it was a different concept to me than maybe working in a bigger city where people don't always know each other

And what factors are driving poor health in rural communities? So one of the biggest issues with the rural health community is just learned behaviors. Maybe this is a rural area where there was farming in earlier generations and so eating biscuits and gravy and putting lard in everything is acceptable because you're going to burn off those calories working in the farm from sunup to sundown. But in a more in a in a time when that is not the issue, when they're not working in the in the fields they're working in a factory job and they're coming home and sitting on the couch, those same patterns of eating behaviors not exercising you know veging out on the couch is something that kind of perpetuates bad outcomes or bad health. So I've seen that a lot just - well that's how grandma cooks so that's how I cook and really having a hard time not putting a meat with every meal or you know meat and potatoes with every meal putting gravy on everything. That's something I've had to really try to work with patients on. I think diet and having that education for patients in a rural health community is something that's really lacking and just that learned behavior trying to unlearn it for healthier at lifestyle

And how are these challenges uniquely suited for practicing value-based care? I think what I've learned especially now that I'm part of CHESS is that we really look at the data. We're not making a blanket statement about a group of patients. We're really looking at what those needs of those patients are in their setting. So, what is necessary for rural health practice may not be the same as for an urban practice. I like the idea that we really look at what the needs are and then try to come up with solutions to solve those problems. So, for instance in a rural health community, there's an increased risk of hypertension, diabetes, tobacco use, so we would tailor projects and pilots and processes that would help patients in those settings and for those diseases that may not be the same as in an urban area. And you really can't bludgeon them you know you can't beat them over the head about it it's a process they have to come to the realization that this is something that they want to do for themselves. I just recall a patient of mine. She always this always makes me laugh because she was a diehard smoker, she said you know Dr. Vass-Eudy, when I die my hand is going to be sticking up out of the grave with a cigarette in it. I'm never quitting. And I said OK well lets you know we just talk about it every time - hey are you ready are you thinking about it and finally she quit....