Improving healthcare access in Minnesota: workforce, data interoperability, and rural obstacles


Hannah Saunders


As many Minnesotans’ access to healthcare continues to be impacted by workforce shortages, inadequate interoperability of healthcare data, and barriers in rural areas, healthcare leaders met last month at the 2023 Minnesota State of Reform Health Policy Conference to discuss the best solutions and opportunities to increase healthcare access in the state. 

Kelly Asche, senior researcher at the Center for Rural Policy and Development, said this is the first time in Minnesota history that there have been more healthcare jobs available than people, resulting in the lowest unemployment rates seen yet in the field. 

“This is a huge shift from economic development being traditionally about job recruitment,” Asche said. “We need to be in a people deficit mindset.”

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Asche said the state is experiencing an eight to 10 percent job vacancy rate, which cuts across all industries. While the healthcare field has experienced significant labor shortages in rural Minnesota for years, the healthcare industry is now competing against every other industry. Asche noted how Aldi and McDonalds are hiring at $18 per hour while offering $2,500 in tuition waivers. 

“It makes it pretty hard to give an argument as to why somebody should go into some of our healthcare fields where they’re getting $12 to $13 an hour. This is a competition we are all facing, and again, I think a lot of our policies and solutions are shifting from that job recruitment base to a people recruitment base.”

Leota Lind, chief executive officer of the South Country Health Alliance, offered a workforce update from a plan perspective. 

“We’re seeing within our provider network staff shortages in virtually all areas: behavioral health, substance abuse—being one of the most significant homecare services—staffing for our nursing facilities in rural communities, and primary care,” Lind said. “We’ve seen a lot of consolidation over the years, and so our members that we’re serving are also needing to travel longer distances to access care because of the lack of facilities, but also the lack of workers.”

Vacant positions are relatively easy to fill, according to Lind, who said retention is much more challenging. She said individuals are hired directly upon graduating, they spend a couple of years with the Alliance’s provider network to gain experience and education, then move onto a larger county or facility where there are better opportunities for higher wages. 

The COVID-19 pandemic has also reshaped the provider landscape. With the expansion of telehealth services coming out of large companies within the metro area, providers living in rural areas can have a lower cost of living while making higher wages by working remotely in metro areas. This increases the scarcity of rural providers and creates geographical competition for positions and staff members, Lind said.

To address barriers rural communities face when accessing healthcare, like transportation, Savannah Cleveland Queen, manager of customer and community success at findhelp, said they are working on contracting with Uber drivers. Findhelp already contracts with UberHealth, but Cleveland Queen hopes to further close the gap by creating more robust partnerships with drive apps and developing a sustainable model for these kinds of partnerships.

Another issue highlighted during the panel was the interoperability of health data exchanges. Rajesh Sharma, vice president and general manager overseeing systems integration, interoperability, and data analytics product offerings at Gainwell Technologies, said that member engagement is faltering. 

“The reason for that is because our IT systems, they cannot seamlessly exchange data in today’s day and time,” Sharma said.

He explained how in 2021, the Centers for Medicare and Medicaid Services issued the Interoperability and Patient Access final rule. Sharma believes patients should be able to access their basic healthcare data from their mobile phones, including in-network providers, claims, and eligibility. Minnesota is currently implementing this process. Sharma said access to care and services begins at this point.

“Even though this is the first step, interoperability is evolving,” Sharma said, noting that more  health data will get into the hands of members over time. “This is what is going to get us to, someday, the ultimate health outcomes we are talking about.”

Member consent plays a major role in health data interoperability, and even though when members sign-up for the mobile app they provide consent on data that they’re willing to share, it still comes with challenges. 

Cleveland Queen said it’s crucial to educate individuals on where their healthcare data is going, and who has access to it and who does not. She said the responsibility of this form of education falls on individuals doing navigation work in the communities.

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