As a proud product of Montana public schools, most recently finishing a degree in biochemistry at Montana State, I have had a lifelong dream of becoming a rural primary care physician. As a future Montana physician, it is clear we face a rural health reckoning in the coming years, and we must act soon to implement changes and ensure improved health care access.
Currently, the rural care workforce in Montana is poorly situated to meet growing demands. Of our rural counties, 39 lack any behavioral health provider, 38 lack a pediatrician and 13 lack a primary care physician altogether — with similar numbers for nurse practitioners and physician assistants. Insufficient supply of our state’s rural providers leads to 27% of adults lacking a personal health care provider and 38% living in a health professional shortage area.
While these statistics paint a grim picture for rural Montanans’ access to care, Montana has a unique opportunity to reimagine rural medicine and help our providers currently stretched serving rural populations.
One way to alleviate this strain is community health workers, or “CHWs.”
CHWs’ unifying definition is “a frontline public health worker who is a trusted member of and has an unusually close understanding of the community served.” CHWs have received specialized training to check blood pressure, teach individuals to use blood sugar monitors, and provide other forms of basic health care. Importantly, CHWs do not replace other health professionals. Instead, they provide critical resources outside of clinics, helping reduce readmittance at hospitals, improve community health outcome, and free up resources for treating more pressing ailments. More cost effective and patient-centered care by CHWs can relieve strain on physicians, nurses, and other providers already stretched thin in our rural areas.
Excitingly, CHW programs are gaining traction across Montana. In Granite County, a new CHW program works closely with the sheriff’s and emergency departments, addressing behavioral health issues for community members that couldn’t receive resources in the past. Further, Katie Muhly, a CHW in Granite, sees their program as a critical way to enhance wellness in the county and give residents new control over their health. With 32% of the county over the age of 65 (and this number only expected to grow), Muhly helps clients apply for Medicare/Medicaid, performs certain medical screenings, and provides critical patient care in a non-hospital setting. CHWs also focus on community well-being: Muhly has exciting plans to start a cooking class and diabetes management courses soon in Drummond and Phillipsburg.
The program in Granite is just one example, and Montana State University boasts an exemplary 85-hour training course, with full tuition reimbursements available. Speaking with Heidi Blossom, a nurse from Helena who designed the course curriculum, CHWs predominantly don’t have prior medical experience. Instead, they are folks intimate with the community, highlighting retired hairdressers as excellent CHWs she has trained.
Finally, while there are many federal grants for counties to kick start their own programs, Montana must be pragmatic with how we fund CHWs to make them a sustainable entity. Currently, CHWs are not recognized through Montana’s Medicaid program. This must change, as rural states such as Alaska and Texas already have taken this key step to serve their most vulnerable, and we are falling behind. Best of all, studies have shown that CHWs are a cost-effective option for Montana’s budget: one intervention of six CHWs in a community saved a state Medicaid program $1.4 million, with a return of $2.47 per every dollar invested.
If Montana leads investment into CHWs, we can provide cost-saving care for our most vulnerable populations and relieve strain on rural providers moving forward.
Max Yates is a Montana 2020 Truman Scholar and recent Montana State graduate who plans to attend medical school prior to returning to rural Montana to practice as a primary care physician.