Addressing health care challenges at the DMAS Southwest Provider Summit in Virginia

As a primarily rural region, southwest Virginia residents face health care challenges including limited mental health services, poor maternity/birth outcomes and an ongoing opioid crisis. These issues underscore the urgency of implementing innovative solutions to improve the overall well-being of Virginian residents. UnitedHealthcare Community Plan of Virginia worked in collaboration with the Appalachian Substance Abuse Coalition at the Department of Medical Assistance Services (DMAS) Southwest Provider Summit to provide Narcan training and to support health education efforts. The Summit included presentations regarding pharmacy, behavioral health and maternity challenges and opportunities for improvement.

Challenges of rural health care

Rural pharmacies face unique challenges of declining rural populations, increased competition from internet and chain store pharmacies, higher prescription drug costs for low-volume pharmacies and difficulties replacing retired pharmacists.¹ Given these challenges, rural pharmacies and hospitals struggle to remain open. From 2010 to 2020, 121 rural hospitals have closed across the U.S., leaving residents with fewer options and longer travel times to receive care.² As rural hospitals close, pharmacy deserts expand, making it even more difficult for residents to access essential services.

Mental health disparities

As of 2019, approximately 90% of counties in southwest Virginia have been designated as Mental Health Professional Shortage Areas, further compounded by limited broadband service.³ This scarcity limits access to both telehealth and walk-in methods to receive care. Counties in Virginia with a shortage of behavioral health professionals have been found to experience poorer health outcomes, with a higher percentage of adults reporting frequent mental distress compared to the state average.

Maternity outcomes

The southwest Virginia population faces concerning maternity outcomes, with new mothers having a Maternal Vulnerability Index (MVI) score of 46.1, surpassing the state average by 10.1 points. The southwest region additionally includes the county with the highest MVI score in Virginia. Lee County was given a score of 83.7 with the most significant indicators of vulnerability being mental health and substance abuse, general health care and socioeconomic drivers.⁴ This region also includes three counties with designated “High” MVI scores ranging 60-79.9. These scores indicate vulnerabilities that need targeted interventions to improve maternal health.

Opioid crisis and doula support

The opioid crisis continues to take a toll on southwest Virginia, with 258 opioid-related deaths reported for the region in 2021⁵ -- up from around 198 opioid-related deaths reported in 2017. Increasing cases of overdose underscore the need for Narcan training and support for individuals with substance abuse disorders. Narcan is an overdose-reversing drug that has demonstrated high efficacy in reducing opioid overdose mortality.

An additional form of support can be found in doulas. Having emerged as valuable assets in maternal care, they are especially beneficial for mothers dealing with substance abuse disorders. Doula engagement has been associated with increased emotional support, improved health literacy and enhanced self-advocacy among women with opioid use disorder (OUD).⁶

DMAS Southwest Provider Summit and Narcan

Dedicated to improving the health outcomes for residents of southwest Virginia, UnitedHealthcare Community Plan of Virginia sponsored a table at the DMAS Southwest Provider Summit in August 2023. This event brought together more than 40 area providers to address pressing issues across behavioral health, maternity and pharmacy focus areas.

In collaboration with the Appalachian Substance Abuse Coalition, UnitedHealthcare Community Plan of Virginia facilitated a Narcan training session during the summit. Attendees had the opportunity to receive certification to administer Narcan through the training led by Linda Austin of ASAC.

Also known as naloxone, Narcan has proven to be a life-saving tool in the fight against opioid overdoses. Take-home naloxone programs have been widely recognized as effective strategies for reducing the rate of opioid overdose-related deaths with studies reporting efficacy of reversal to be as high as 75-100%.⁷

Former U.S. Surgeon General Jerome Adams emphasized the importance of Narcan training, stating, "For patients currently taking high doses of opioids as prescribed for pain, individuals misusing prescription opioids, individuals using illicit opioids such as heroin or fentanyl, health care practitioners, family and friends of people who have an opioid use disorder and community members who come into contact with people at risk for opioid overdose, knowing how to use naloxone and keeping it within reach can save a life."⁸

Southwest Virginia's health care challenges are diverse, spanning rural pharmacy deserts, limited behavioral health care access, poor maternal/birth outcomes and the opioid crisis. UnitedHealthcare Community Plan of Virginia is committed to advancing innovative solutions through collaboration with local organizations such as the Appalachian Substance Abuse Coalition to improve health outcomes of Virginians and addressing the full spectrum of health care challenges facing this population.