About 20 percent of New Englanders live in a rural area by New England Rural Health RoundTable’s definition. And while living in rural New England has many benefits, like natural beauty and tight-knit communities, rural residents tend to face unique challenges in accessing health care. 

Kate Perkins, the deputy director of U.S. program development at MCD Global Health, says rural communities all over encounter these obstacles and “mental health care is especially daunting.” In Maine’s Washington County, which borders the Canadian province of New Brunswick, nearly a third of primary care visits were more than 30 miles from the patient’s home according to the most recent data.

This inconvenience could take hours out of their days or worse still, not allow them to visit a doctor at all if they don’t have access to a car, bus, or train. Because of these logistical obstacles, many residents of rural communities are turning to telehealth.

“Think of telehealth as a form of transportation. We can never make public transportation cost-effective in rural areas, but if we can bring the services to the communities utilizing broadband and telehealth, then we can address a lot of these issues.”

Kate Perkins, deputy director of U.S. program development at MCD Global Health

Telehealth, among other innovative programs, is helping to bridge the gap in New England’s rural communities. 

Health care providers wanted

“We find in most areas outside of big urban centers, there’s a real shortage of all types of physicians, but particularly of primary care physicians,” says Karl Dietrich, MD, program director of the Cheshire Medical Center Family Medicine Residency in Keene, N.H. As predicted by a group of economic researchers from Dartmouth College and other universities in 2019, this shortage has continued to compound over the last four years. The low number of primary care physicians (PCPs) in these areas is expected to plummet even further in the coming years because of increasing care needs among aging rural populations and physicians reaching retirement age.

Cheshire Medical Center, which serves the city of Keene and 32 surrounding towns, aims to establish more rural providers through its new Family Medicine Residency program starting in 2024. “We know that residents are likely to stay in the area that they trained,” Dietrich explains. “If we can train six family doctors in the Keene area every year, I think we have a really good chance of having three or four of them every year stick around… That’s a group that’s having a positive impact and directly infusing some of that talent into this area.”

Through the Family Medicine Residency program, Cheshire will train the kind of physicians rural areas need: those who can handle a wide range of medical needs, are attuned to population health programs and resources, and can provide inclusive care to marginalized and underrepresented communities. 

“A focus of our training program is training folks to provide really outstanding care for LGBTQ populations in rural areas. It can be really difficult to access gender-affirming care, or even some of the sexual and reproductive health care, in more rural places” Dietrich says.

VillageMD, which offers full-service primary care, is also working to address the primary care physician shortage with its commitment to opening more than half of its Village Medical provider locations in medically underserved areas by 2025. Additionally, Point32Health, the parent company of Harvard Pilgrim Health Care and Tufts Health Plan, is expanding access to primary care to its members by partnering with VillageMD. 

“Based on its care model and commitment to expand to medically underserved, rural areas in New England, we see VillageMD as a strong provider partner that shares our commitment to improving health outcomes through a focus on the whole health concept,” says Daniel Hammond, director of Massachusetts and Rhode Island contracting at Point32Health.

Evolving mental health care practices

There is also an urgent need for more psychiatrists and mental health care professionals in rural areas. According to a recent update from the CDC, suicide rates in rural America have consistently surpassed the numbers of those in urban America between 2000-2020. Within this span of time, suicide rates climbed to 46 percent in rural areas as opposed to 27.3 percent in cities. 

“The absolute lack of mental health providers of all kinds is a universal issue in rural areas,” Perkins says. “Then there are issues with distribution of the providers who are practicing, with most located in the areas with the largest population and expecting people to pay upfront rather than being willing to bill insurance.” 

MCD Global Health helps residents surmount these obstacles through a variety of partnerships and programs. They train providers to treat addiction with medically assisted treatment, and they run a career development program for people in substance-use recovery who might be interested in going into the behavioral health field. “We’re trying to create more providers, whether that’s by providing supplemental training to existing medical providers or by getting more people into the behavioral health field in general,” Perkins says.

Behavioral telehealth intervention

When MCD Global Health asked the community of Baileyville, a town in northern Maine with a population of about 1,300, what they needed to improve their town’s health, both the students and adults all asked for more mental health counseling, Perkins says. 

With the support of the Point32Health Foundation and others, MCD Global Health helped implement in-person behavioral and mental telehealth programs in all the schools in the local district in September 2022. During that school year, the program served 77 students. At one school, the number of students participating in therapy rose by more than 450 percent when the program was implemented. 

The in-school nature of the program is key to its success. “Whether it’s in-person or telehealth, you have enhanced that family’s well-being, simply by avoiding the time missed from work and school,” Perkins says. Plus, because older kids tend to be adept at connecting through screens, they were able to focus in-person resources where they are often more needed, on elementary school kids.

“Think of telehealth as a form of transportation. We can never make public transportation cost-effective in rural areas, but if we can bring the services to the communities utilizing broadband and telehealth, then we can address a lot of these issues,” Perkins says.

Though rural New Englanders are up against challenges like physician shortages and distance to care, rural health care providers are committed to developing innovative health care strategies tailored to meet the unique needs of these communities.

Point32Health is a not-for-profit health and well-being organization, guiding and empowering healthier lives for all. Bringing together over 90 years of combined expertise and the collective strengths of Harvard Pilgrim Health Care, Tufts Health Plan, and our family of companies, we help our members and communities navigate the health care ecosystem through a broad range of health plan offerings and tools.