Lawmakers Incentivize and Facilitate Health Care Delivery to Rural Missouri

Published May 25, 2016

Missouri legislators and medical school professionals are pursuing ways to incentivize and facilitate delivery of health care services to underserved areas of the state.

Lawmakers appropriated $2.2 million for the Offices of Primary Care and Rural Care and Women’s Health and $2.9 million for the Primary Care Resource Initiative for Missouri (PRIMO) under House Bill 2010, an appropriations bill Gov. Jay Nixon (D) signed into law on May 5.

PRIMO is a student loan debt forgiveness program for medical and dental students, including dental hygienists, who agree to practice in underserved communities.

To accomplish a similar objective of delivering health care services to rural patients, the University of Missouri School of Medicine has launched the Show-Me Extension for Community Healthcare Outcomes (ECHO), a telehealth project in which specialists train clinical practitioners located in areas with low availability of specialists.

Reducing Rural Barriers

With approximately 1.5 million Missourians lacking sufficient access to primary care, the state would need 643 additional practitioners to achieve a standard target population-to-practitioner ratio of 2,000 to one, according to a 2013 report by the Missouri Foundation for Health. Although almost 30 percent of Missourians live in rural areas, only 18 percent of the state’s primary care physicians practice in rural areas, the report states.

Patrick Ishmael, director of government accountability at the Show Me Institute in St. Louis, says removing barriers that deter people from entering the health care industry will help patients gain access to physicians.

“One of the keys to improving American health care is reducing barriers to patient access,” Ishmael said. “Increasing the supply of available health care professionals is an important component to achieving that end.”

Telehealth Medical Training

A University of Missouri School of Medicine project is improving the quality of health care providers by using modern video conferencing technology to provide specialized “training, education, and engagement opportunities” to health care professionals in rural areas, according to the project’s website.

Lawmakers established the Show-Me ECHO in 2014 and fully funded the project in 2015. According to its website, “[ECHO] trains primary care clinicians to provide specialty care services … [because] there aren’t enough specialists to treat everyone who needs care, especially in rural and underserved communities.”

Rachel Mutrux, director of ECHO and senior program director at Missouri Telehealth Network, says imparting knowledge and specialized training to health care providers improves their experiences as caregivers.

“ECHO is a training and education program focused on primary care providers,” Mutrux said. “Allowing primary care providers to learn enhances their professional life.”

ECHO’s six programs provide specialized training for treating autism, chronic pain management, dermatology, endocrinology, hepatitis C, and childhood asthma.

Mutrux says the ECHO model has been highly praised and is being used in other countries at an increasing rate.

“It has been shown that patient-provider satisfaction has increased,” Mutrux said.

Michael McGrady ([email protected]writes from Colorado Springs, Colorado.

Internet Info:

“Extension for Community Health Care Outcomes,” Missouri Telehealth Network, University of Missouri Health, 2016:

Issues in Missouri Health Care, Missouri Foundation for Health, 2013: