Q&A: Virginia Rural Health Association executive director Beth O’Connor

Beth O’Connor is the executive director of the Virginia Rural Health Association (VRHA), serving 2.5 million Virginians living in rural communities. VRHA provides services such as group PPE purchases, assistance in telehealth service implementation, and Mental Health First Aid training for rural health clinics across the Commonwealth.

In this Q&A, O’Connor discusses health disparities, the need for more robust rural infrastructure to support telehealth expansion, making the insurance market more competitive and the effect of COVID on rural Virginia’s health care workforce.

 

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Nicole Pasia: You recently spoke at the VCU Virtual Colloquium Addressing Health Equity in Virginia and called attention to health disparities rural Virginia communities face. What disparities are top-of-mind for VRHA right now?

 

Beth O’Connor: “We have a number of concerns about the health disparities that we see in our rural communities, on many levels. Lack of access to facilities of providers, especially specialists and maternal health. Lack of basic infrastructures, such as public transportation and broadband, and accessibility. On average, people in our rural communities don’t have access to affordable health insurance. So there’s a variety of disparities that we’re looking at and looking to address.

In terms of COVID, a big concern for us is there’s already a shortage of primary care providers, health care staff in our rural communities. And as COVID infection numbers ries, it is absolutely overwhelming our facilities and the capacity of the staff.” 

 

NP: Can you speak on how VHRA is working with rural health clinics and supporting them throughout the pandemic? Has there been additional funding allocated to VHRA to address their needs?

 

BO: “Most of the funds that we’re communicating about with our facilities are federal dollars. [VHRA is] providing resources for facilities to make sure they understand, ‘Where is the money coming from, how are they allowed to use it? What’s the deadline for using it?’

There’s been some deadlines that have been very interesting. ‘How are you supposed to spend this money in this amount of time, when you don’t have it yet?’ All the red tape that happens with those types of funds, [VHRA is] helping people understand how the process works.

For rural communities with lower levels of infrastructure, that gets tricky. There’s been some funds earmarked specifically for telehealth. Do you have the broadband capacity for [telehealth expansion] and if you don’t, is there a way to get broadband capacity? If so, is there a way to do it fast enough to be able to use the funds? Consistently, the answer is ‘I don’t know.’ It depends from one community to the next of what resources are available to put all the pieces together.” 

NP: There’s been a lot of discussion on making insurance more affordable for Virginias, especially with the influx of new enrollees after the Special Enrollment Period that ended last month. How would you frame this conversation around rural health?

 

BO: “When you think about traditional insurance, it is supported by your employer, you buy into your company’s plan. So some complications of that in rural areas. One is, on average, you have more people who either work for a small business or are self-employed, such as farmers … two, there’s a higher percentage of people in our rural communities who are unemployed, and don’t have that traditional avenue for insurance. Three, a higher percentage of people who are on Medicaid, Medicare.

But then the other concern is … many of our rural communities, because they aren’t seen as competitive markets, there may only be one, maybe two insurance providers that even cover the area. There are many places in rural Virginia where there is only one option. There’s no way to say, ‘Plan A works better for me for this company, as opposed to Plan B for that company’, because they’re only Plan A. There’s no incentive for the insurance provider to lower the cost.”

 

NP: What are VRHA’s concerns regarding the long term effects of the pandemic on health care in rural communities?

 

BO: “We know that our healthcare providers or doctors or nurses, other folks, are absolutely burned out. And there’s a very valid concern that some of them will simply leave the profession and in our rural communities where we already have shortages, that’s a frightening thing to ponder. 

With that, what experience are our nursing students and medical students currently having in the middle of the pandemic, when we’re enforcing social distancing protocols? Are they truly getting in the clinical experience that they would have otherwise? I’m not sure about that. So there’s a concern that they’re not going to feel as confident as they maybe should have been”…

For many years, our rural hospitals nationwide have been really under fire. We’ve lost well over 100 hospitals in the last 10 years and continue to lose hospitals during COVID. It is highly unusual for a rural hospital to be able to reopen once it is closed. You can imagine if you only had one hospital in a county … How much further do people have to travel in an emergency situation … and what does that do to the impact of health outcomes? It’s very frightening and we’re hoping that Congress takes action to make sure that we can address those barriers in our communities.”

NP: On the flip side, what projects is VRHA working on that give you hope in the midst of the pandemic?

 

BO: “There are some grant opportunities that have come up because of COVID, currently the USDA and their emergency health care funds. There’s funds for immediate response of dealing with,  the direct impact of COVID right now — what you need to expand your services to be able to deal with COVID, which is fabulous in the immediate term, but they also have a long term track, which is five to $10 million, to do some serious look at addressing healthcare needs in rural communities …

On a more general scope VRHA has a number of projects we’re excited about. In particular, we recently launched our Pride of Rural Virginia Initiative, which is looking at addressing health inequities for the LGBTQ+ population. We’ve had some community conversations, bringing together health care providers, and members of the community to talk about what can be done to address the issues in the home communities, and we see some great things coming out of that project in the future.”

 

This interview was edited for clarity and length.