Strategies for Overcoming Access Barriers

How do you redesign specialty care delivery when geography, workforce limitations, and infrastructure stand in the way?    In this episode, I sit down with Paul Rosen, MD, MPH, MMM, Professor of Pediatrics at West Virginia University, a former official at the Centers for Medicare & Medicaid Services (CMS), and the first pediatric rheumatologist to serve both West Virginia and the Northern Navajo Medical Center in Shiprock, New Mexico.    Together, we explore the structural and clinical realities of rural healthcare and the unconventional strategies that may hold the key to expanding access.     Strategic Takeaways  • Redesign specialist workflows to expand reach.  Hybrid models that combine telehealth with select in-person visits can help specialists serve more patients, especially in underserved regions, without adding full-time capacity.  • Translate national initiatives into local solutions.  Insights from CMS value-based care programs, like pre-op optimization and proactive care coordination, can be adapted to meet the unique demands of rural care delivery.  • Build sustainable models that protect your workforce.  Flexible scheduling, part-time roles, and better triage processes help prevent burnout while making the most of limited specialist availability.  • Use telehealth to strengthen care (not just simplify it).  Virtual care offers more than convenience. It creates new visibility into the patient’s home life and can drive smarter follow-up, better referrals, and reduced travel burden.  • Create systems for sharing what works.  Peer learning communities and cross-institutional collaboration can accelerate innovation in rural care without waiting for national policy shifts.  What creative strategies have you seen work to improve rural healthcare access? 🎧 Listen to the podcast—https://lnkd.in/gg9Yph3T

The healthcare landscape is filled with brilliant insights and promising pilots that never scale. As human-centered designers, we excel at uncovering needs and creating compelling solutions—yet implementation remains our greatest challenge. Transforming promising pilots into widespread practices represents a profound opportunity to shape healthcare's future. When innovative approaches successfully scale, they create ripple effects—enhancing patient experiences, improving outcomes, and often reducing burden on care teams. Our opportunity lies in developing implementation approaches as thoughtful as our initial designs. Institutional inertia often presents the first major hurdle. Overcome this by starting with targeted 8-week interventions that demonstrate immediate value. Identify informal leaders who shape culture—the veteran nurse or respected physician whose opinions influence others. Create visual artifacts that make pain points undeniable and build emotional connection to the need for change. Regulatory concerns require thoughtful navigation. Invite compliance partners into design sessions from day one, giving them ownership in finding solutions. Distinguish between actual requirements and accumulated practices—you'll often find more flexibility than assumed. Consider modular implementation where less-regulated components can advance first. Address the human element of implementation. Design changes that reduce workload in visible ways—for every new step added, eliminate two. Create a "change budget" that acknowledges the cognitive costs and limits concurrent initiatives. Develop frontline champions who receive dedicated time for implementation support. For measurement challenges, create simple dashboards that include both traditional and experience measures. Develop visual data stories showing impact through multiple perspectives to build a compelling case. Establish 30-day feedback cycles where users shape refinements. When moving from pilot to scale, build solutions with a stable core and flexible edges that adapt to different contexts. Document "implementation recipes" with specific steps and resource requirements. Connect implementation teams across sites to share adaptations and solutions. By addressing these barriers with practical strategies, we can accelerate human-centered innovation in healthcare—moving from isolated bright spots to transformative change at scale.

The average patient is a myth. And when we design for a myth, we leave real people behind. We map out healthcare journeys that seem straightforward: 👉 Step 1: Visit your doctor 👉 Step 2: Change your diet 👉 Step 3: Get moving 🎯 Outcome: Managed diabetes From a system perspective, it looks like a staircase. But for many people—especially those facing structural or social barriers—the same journey feels like scaling a mountain range. With dragons. Behavioral science reminds us: what matters isn’t just the steps, but how they feel to the person taking them. And friction isn’t evenly distributed. Some patients face extra weight on every step: 🚧 Transportation gaps 🚧 Unpredictable work schedules 🚧 Low trust in the system 🚧 Limited support 🚧 Overwhelm and decision fatigue Here are a few examples we’ve seen in the field: 🧠 Scarcity mindset changes decision-making. Members juggling unpredictable work hours, caregiving, or housing insecurity aren’t just “busy”—they’re navigating survival. That affects memory, motivation, and how decisions get made. 💬 Reading level is a barrier, not a knowledge gap. Even well-intentioned outreach fails when it’s written for a policy team instead of a patient. Simplicity is a form of respect. 🎯 One-size nudges don’t fit all. A text reminder might work for one person—but another may need a pre-scheduled visit, a trusted phone call, or help from a community health worker. If we want equitable outcomes, we can’t just remind people harder. We have to design differently. ✅ Design for those facing the greatest barriers—not just the mythical “average” ✅ Simplify decisions and reduce friction at every step ✅ Build trust before we expect action Equity isn’t just about offering the same care to everyone. It’s about designing care that works for everyone. 👋 If you want to design health journeys that work for everyone, not just the "average", let's talk.

Recent discussions have highlighted significant gaps in telehealth access, particularly affecting non-English speakers and older adults experiencing homelessness. These groups often face barriers such as limited digital literacy, language obstacles, and inadequate access to necessary technology, which hinder their ability to benefit from telehealth services. Addressing these disparities requires a multifaceted approach. Implementing culturally sensitive telehealth platforms, providing language interpretation services, and offering community-based digital literacy programs are essential steps toward equitable healthcare access. Moreover, policymakers must prioritize infrastructure improvements to ensure reliable internet connectivity in underserved areas. As healthcare professionals, we have a responsibility to advocate for and implement solutions that bridge these gaps. By fostering inclusive telehealth practices, we can move closer to a healthcare system that serves all individuals, regardless of their socioeconomic status or linguistic background. https://lnkd.in/gjtZCqJ7

Now is Not the Time to Mourn (Even Though It's Tempting to Do So) With the U.S. stepping back from its long-standing leadership in global public health, we all feel a sense of tremendous loss. But if the pandemic taught us anything, it's that resilience and innovation thrive in the face of disruption. When COVID-19 upended traditional ways of working, we adapted—fast. And in doing so, we discovered tools and methods that didn’t just fill gaps—they transformed how we collaborate, communicate, and deliver care: Digital Platforms broke down geographic barriers, allowing us to reach communities in real-time while slashing travel and overhead costs. Telehealth and Mobile Health Tools became lifelines in regions with limited healthcare infrastructure, bringing services directly to people’s phones. Behavioral Science unlocked powerful ways to influence health behaviors, from boosting vaccine uptake to reducing mental health stigma. The question now is: How do we keep this momentum going? 1. Leverage Digital Tools for Cost-Efficient Collaboration The shift to virtual trainings and workshops proved we can deliver high-impact learning without the expense of travel. This opens the door to more frequent, inclusive, and scalable partnerships across Sub-Saharan Africa. 2. Expand Telehealth and Mobile Health Solutions In SSA, simple tools like SMS reminders, WhatsApp health updates, and mobile data collection became critical for delivering public health messages, tracking disease outbreaks, and ensuring continuity of care. These low-cost, scalable solutions have the potential to permanently bridge healthcare gaps. 3. Empower Community-Led Interventions The pandemic highlighted the power of local leadership. When global supply chains and international aid were disrupted, community health workers and local organizations became the backbone of response efforts. Their deep understanding of local norms and behaviors allowed for culturally sensitive interventions that resonated with communities. 4. Maximize Cost-Efficiency Through Virtual Collaboration The move to virtual meetings and events didn’t just help us survive—it made us more agile and connected. By cutting down on overhead costs, we can reinvest those resources into strengthening public health systems where they’re needed most. The global health landscape has suffered a major setback. It should drive us to embrace what we've gained. The tools and strategies we developed during the pandemic aren’t just temporary fixes—they’re the foundation of a more resilient, sustainable public health future. What innovative strategies have you seen emerge from the pandemic that we should continue to build on? #GlobalHealth #BehavioralScience #DigitalInnovation #TelehealthAfrica #SouthSouthCollaboration #PublicHealthAfrica #ResilientHealthSystems #PostPandemicInnovation

"Rural populations experience higher cardiovascular death rates than their urban counterparts caused by a higher burden of traditional risk factors and significant social, economic, and health system challenges." With February being Heart Month, I selected an article that highlights a stark reality: rural-urban disparities in cardiovascular mortality have widened significantly, especially during the pandemic. Rural areas saw an increase in age-adjusted cardiovascular mortality rates from 431.6 to 435.0 per 100,000 between 2010 and 2022, while urban areas experienced a decline from 369.3 to 345.5 per 100,000. This disparity is driven by several factors: - Higher prevalence of traditional risk factors such as diabetes, hypertension, and obesity in rural areas. - Socioeconomic challenges including higher poverty rates, lower educational attainment, and lack of insurance coverage. - Healthcare access issues, exacerbated by the pandemic, which disrupted care and deepened financial hardships. To address these inequities, we need a multifaceted approach: 1. Enhance healthcare access in rural areas by investing in telemedicine and mobile health clinics. 2. Improve socioeconomic conditions through policies that address poverty, education, and employment. 3. Strengthen public health initiatives focused on preventive care and management of chronic diseases. 4. Implement bedside clinical activities such as regular screenings, personalized patient education, and community health programs to ensure early detection and management of cardiovascular risk factors. 5. Develop integrated healthcare delivery systems that coordinate care across different providers and settings, ensuring continuity and comprehensive care for patients. In the realm of policy, I also believe that Medicaid expansion, financial incentives for physicians and practitioners to work in rural communities and additional support for community health workers must be considered. By tackling these root causes and implementing these solutions, we can work towards reducing the cardiovascular mortality gap and ensuring better health outcomes for all communities. A shout out to my colleague Courtney Greene for identifying this article for me. #HealthEquity #PublicHealth #RuralHealth #CardiovascularHealth #HealthcarePolicy #IntegratedCare #DEI #diversityequityinclusion

Addressing Access to MSK Care: PTJ Review ➡️ Addressing Health Care Access Disparities Through a Public Health Approach to Physical Therapist Practice ➡️ Global Rehabilitation Needs: 1 in 3 patients worldwide require rehabilitation services, with musculoskeletal disorders (MSDs) being the leading cause of disability. ➡️ Disparities in Rehabilitation Access: Rehabilitation professionals are disproportionately concentrated in high-income areas, leaving low-income populations with unmet needs. ➡️ Public Health Frameworks: Physical therapists should adopt population-level strategies to expand access, lower costs, and improve care quality for underserved groups. ➡️ Health Impact Pyramid: Physical therapy traditionally focuses on tertiary prevention, but shifting towards primary and secondary prevention can enhance population health outcomes. ➡️ Digital & Telehealth Innovation: Telehealth and digital solutions offer opportunities to increase rehabilitation access and reduce costs for marginalized populations. ➡️ Employer-Based & Direct Contracting Models: Integrating physical therapy into employer-sponsored health plans improves employee health, reduces costs, and enhances satisfaction. ➡️ Task-Shifting & Community-Based Solutions: Training health workers and integrating physical therapy into primary healthcare can address workforce shortages and improve access. ➡️ Women's Health & Pelvic Floor Disorders: Population health approaches can improve access to pelvic floor muscle training (PFMT), digital therapeutics, and culturally relevant interventions. ➡️ Conclusion: Expanding physical therapy beyond traditional clinic settings and leveraging public health strategies can create a more equitable and sustainable rehabilitation system. Access and accessibility to MSK care. Transitioning from tertiary to primary prevention strategies.

💡 Been thinking a lot lately about how value-based care (VBC) and health equity tie together… and it’s clear there’s a long road ahead to make them work seamlessly. VBC has its heart in the right place—it’s supposed to bridge gaps in healthcare access and quality. But let's be for real: if we don’t address some stubborn barriers, we risk widening those gaps instead. Here’s what keeps coming up in conversations: 1️⃣ Disparities Aren’t New: Patients with public insurance (Medicaid/Medicare) or no insurance often see lower-quality care and worse outcomes. VBC is designed to change this, but without real structural shifts, we’re going to keep bumping into the same issues. 2️⃣ Unintended Setbacks for Safety-Net Providers: Some VBC programs inadvertently penalize the very hospitals and clinics committed to serving high-need communities. These places need more support, not added pressure, to serve patients effectively. 3️⃣ Risk Adjustment Matters: Not all patients start at the same place. VBC needs robust adjustments for social determinants of health. Otherwise, providers might find themselves navigating impossible choices with patients who need extra care. 4️⃣ A Health Equity Lens is Essential: We can’t just assume VBC will “naturally” reduce disparities—it has to be built to. We need metrics that specifically measure health equity progress and reward real reductions in care disparities. (I know I said physicians don't need more metrics in a previous post, but this is to measure work already being done, not add on more work!) 5️⃣ Insurance Barriers Are Still Real: Coverage type too often dictates care quality and access, even under VBC. Publicly insured and uninsured patients shouldn’t face added administrative and financial hoops. What am I missing? How are you making VBC work toward actual equity? Let’s keep this conversation real and solutions-focused! 👇 #ValueBasedCare #HealthEquity

India's healthcare ranks 145th globally, and these strategies could be our last chance to stop it from getting worse! During his recent trip to California, I had the opportunity to have a conversation with the CEO of Apollo 24|7, Madhivanan Balakrishnan to discuss the pressing need for improved healthcare delivery in India. We explored several ideas on how to make healthcare more accessible, even at the grassroots level. Here are 4 takeaways from our discussion that could revolutionize healthcare delivery at the grassroots level in India: 📌 Mobile-first approach is showing promising results. In Karnataka, basic health apps helped rural healthcare workers reduce diagnostic errors by 43% in just 6 months. 📌 Telemedicine solutions are needed in remote areas and are no longer optional. When implemented in Maharashtra's rural districts, it cut down emergency room visits by 35% by enabling quick specialist consultations. 📌Low-cost diagnostics that can detect diseases early are critical. Doctors with portable ECG devices in Tamil Nadu villages helped detect heart conditions 2x faster, at 1/5th the usual cost. 📌Smart health records could be revolutionary in rural areas. One district's implementation helped reduce treatment time by 40% by giving doctors instant access to patient history. This reminds me of what I always say in my talks: the best innovations happen when we blend technology with deep human understanding. I'm curious: what healthcare challenge around you needs a design-thinking makeover? Share your thoughts! #Innovation #DesignThinking #DigitalTransformation #Healthcare

"Isn't a 6 month wait to see our specialist a sign of true patient loyalty?" — anonymous healthcare executive This mindset is still shockingly common inside many health systems... and it really troubles me. Loyalty doesn’t survive endless phone trees or months-long referral gaps. Access is where modern competition begins — and for many health systems, it's their biggest weakness. Six weeks to see a PCP? Six months for a cardiologist? The patient's already gone — and next time, they won't even bother to calling to check. Your system standards should be simple, obvious, and hard lines: 1. 🩻 Urgent Care — Same day, <10 miles or 10 min (or virtual) 2. 🧑⚕️ Primary Care — Within 2 weeks, <20 miles or 20 min (or virtual) 3. 🩺 Specialty Care — Within 4 weeks, <40 miles or 40 min (or virtual) Not theoretical targets. Minimum competitive expectations that are table stakes for a good patient experience. Want to fix access — without adding headcount? Check out the carousel below for 7 care delivery channels to expand access in a fraction of the time of building it yourself. 💡 REMEMBER: There will always be someone internally saying “we can build that.” And maybe you can. But even if you had the money, you don’t have the time. And you definitely don’t have 18 months to argue about which way to go. That’s why partners exist — to help you move faster. And the right ones let you white-label the solution to your brand. That means you get the loyalty, you earn the revenue, and you stay in the center of the relationship. #Access #PatientExperience #HealthSystems #DigitalHealth Fabric & Aniq Rahman AristaMD & Brooke LeVasseur RubiconMD Health Catalyst & Dave Ross TytoCare & Joe Brennan Amenities Health GoHealth Urgent Care Carbon Health Baylor Scott & White Health System executives: If you could fix just one access bottleneck right now, which would it be? 🔥