Building for impact: Digital health innovation for rural Americans

In the United States, the history of virtual care is rooted in rural communities. The first telehealth policies were designed specifically for rural residents. While the COVID-19 pandemic pushed telehealth policy into other settings, Americans living in rural areas have continued to grow as virtual care adopters. According to Rock Health’s 2023 Consumer Adoption Survey, live-video virtual care use grew 16 percentage points among rural respondents between 2020-2023.

Designing digital health for rural communities requires developing a deep understanding of place. Rural residents differ from the rest of the country by average age, income, and a shrinking—but still present—digital divide. The regional and cultural differences that distinguish rural life in the Pacific Northwest from that in Appalachia are just as significant as the commonalities these communities share.

In RockHealth.org’s recent publication, “A Lens on Health Equity in Digital Health: Unlocking the Innovation Opportunity”, we explore three opportunity areas for more equitable digital health impact: facilitating adoption and trust, promoting responsible design, and scaling innovation. We identified four communities that have increasingly adopted digital health, but have often found available options aren’t quite tailored to their needs. We then applied the lens of these opportunity areas to the needs of each individual community—one of which is rural Americans—to develop the action steps below for innovators designing and scaling solutions for these populations. Innovators need to learn the local norms, preferences, and needs of rural communities they hope to serve. Digital products won’t work if they try to substitute rural care models. Instead, it’s about extending the infrastructures that communities have already put in place.

Digital health adoption snapshot

According to Rock Health’s 2023 Digital Health Consumer Adoption Survey, of rural respondents:¹

• 71% have received virtual care at some point
• 34% own or have owned a wearable device
• 70% have searched for healthcare information online
• 49% have searched for a care provider online

Taking action

Respect the community’s existing health culture and infrastructure. In many rural communities, there’s an established pace of life and way of doing things. New healthcare stakeholders need to support existing care frameworks, rather than try and “disrupt” the status quo. Accounting for intersecting identities of rural communities, such as shared religion or tribal affiliation, is a critical first step. Next up: collaborating with and supporting existing community care professionals like community health workers, pharmacists, and doulas can help build trust and tap into community knowledge. Once operating, it’s important to maintain consistent program evaluation standards that prioritize community feedback.

Extend the specialist infrastructure. Even with dedicated local health providers, many rural Americans lack access to specialists, especially for cancer care and rare conditions. Digital can be a lifeline for closing specialist gaps. Tele-consultation platforms can provide rural patients access to academic medical centers, large hospitals, and urban healthcare hubs for expert support. Innovative collaboration platforms like virtual tumor boards are key to helping local clinicians make decisions.

Hippo Technologies combines a voice-activated wearable headset with virtual care consultations, enabling rural clinicians to consult with remote specialists during appointments or procedures, and coordinate care with a patient’s far-away specialist clinician if needed.

Embrace multiple approaches to connectivity. While rural broadband and cell networks have improved in the wake of the COVID-19 pandemic, the reality is that rural internet connectivity in the U.S. is still less reliable than in urban areas, and one in four rural Americans report lack of internet access as a major issue in their community. Digital innovators coming into rural communities can’t have a virtual-only mindset. Care models must combine digital, in-home, and community sites of care. Digital health players need in-person partners and champions to help patients navigate periodic internet challenges.

Homeward provides virtual and in-person value-based care to rural communities. Homeward healthcare providers and team members see patients in their homes, in neighborhood Homeward clinics, and via phone and video appointments.

Consider the relationships between community, industry, and environment. It’s common for rural communities to have one or two dominant industries such as hospitality, manufacturing, or lumber. Many residents may work for the same employer throughout their careers, which makes employer-sponsored healthcare especially important. Some of these industries—like lumber, farming, and manufacturing—also impact the environmental and occupational risks that people are exposed to at work. Digital health startups working with employers in rural areas need to consider how they address environmental, and occupational realities in their offerings.

Sword Health builds digital care programs for musculoskeletal (MSK) physical therapy and pain management. In 2023, Sword Health published results from a single-arm trial demonstrating that their program was effective in improving clinical endpoints such as pain, mental health, and work productivity in both rural and urban program employees. Rural trial enrollees showed higher engagement with educational content and higher rates of program completion than urban enrollees.

Rural Americans are ready for digital health, but solutions need to be ready for them—fitting the unique context of their lives and working within existing systems. Supporting rural virtual care requires collaboration between design, policy, and funding leaders, with community voices represented. Respecting local care models, supporting community healthcare workers, and addressing connectivity issues, are critical steps to success.

Footnotes

1. Analytical cohort selected based on “Rural” response to Survey question, “Which of the following best describes the area you live in?”