Shrinking America to deliver integrated healthcare

Offered as a solution to increase healthcare access, quality and cost containment, integrated healthcare delivery models were prescribed under the Patient Protection and Affordable Care Act enacted in March 2010 including Accountable Care Organizations, Medical Homes and Health Homes.

In rural America, a large number of small and often financially constrained healthcare providers must consolidate, collaborate and clinically align, to meet the requirement for the minimum number (5,000) of Medicare beneficiaries. Together, rural healthcare providers and their public health community stakeholders must be able to connect to a broadband network capable of near real-time transmission of very large and rich media files. To accomplish this goal, approximately 65 million rural Americans must be brought closer to the same access and quality of healthcare as urban Americans. In essence, we must shrink America.

There are significant obstacles to shrinking America. Deregulation of telecommunications has diminished the likelihood of universal service for advanced services, such as internet access and broadband, in favor of letting the market determine which areas obtain service. Today, few rural markets have broadband access through multiple points of presence. Under the FCC's net neutrality ruling, users of high bandwidth applications, like telemedicine, over wireless networks are at the mercy of monopolistic pricing.

While the New National Broadband Plan could provide basic service, we would argue that the demands of rural America healthcare connectivity require the highest bandwidth infrastructure available. Without recognizing this need, integrated healthcare in large sections of the Midwest section of the United States cannot succeed.