On the surface, the conventional rural health story is one marked by rising financial pressures, dwindling care access and closure risks. But those constraints don’t define rural healthcare, and the idea that rural systems are always playing “catch up” to their urban counterparts isn’t always true.

Dr. Prathibha Varkey, president of Mayo Clinic Health System, Mayo Clinic’s community arm, argued that rural healthcare can be a valuable testing ground for new innovations to solve some of healthcare’s largest challenges during an April 13 fireside chat at Becker’s 16th Annual Meeting.

“If you can solve it in a rural community, you can absolutely solve it in a destination practice,” she said. “You can absolutely solve it in an academic health system.”

The need to rethink care delivery for the 1 in 5 Americans living in rural areas has never been greater, Dr. Varkey said, citing a stack of pressures that rural healthcare leaders know all too well. More than 200 hospitals have closed or converted to facilities that exclude inpatient care since 2010, according to Chartis.

Meanwhile, an aging population is driving demand for more complex care just as physician shortages — particularly in specialty care — are widening. Many communities still lack reliable 5G coverage., while maternity deserts and transport gaps cut access further. And in many of those communities, the local hospital is the area’s largest employer, meaning financial pressure on the institution flows downstream onto the entire local economy.

For Dr. Varkey, that stack of constraints is exactly why rural systems are positioned to lead, not follow.

“It’s the perfect space to innovate because you’ve got all these constraints, and the way you’re going to solve it cannot be incremental. It has to be completely disruptive,” she said.

Dr. Varkey leads more than 17,000 employees across 16 community hospitals and more than 50 multi-specialty clinics in Minnesota, Wisconsin and Iowa. Five years ago, the system launched an integration journey to transform from a network of community hospitals into a single integrated system. Colloquially, staff members think of the concept as “one hospital with 16 doors” — or 17 if you count the system’s Advanced Care at Home program.

This foundation has enabled a steady stream of innovations that often touch Rochester, Minn.-based Mayo Clinic Health System first.

Mayo’s hospital-at-home program launched in 2020 with twin pilots at Mayo Clinic Health System in Eau Claire, Wis., and Mayo Jacksonville, Fla. At Mayo Clinic Health System alone, the program has saved more than 7,700 hospital days with patient satisfaction above 90%, Dr. Varkey said.

Several years later, the health system implemented AI-driven dynamic capacity management into its hospital-at-home program. The technology now decides in real time where a patient is admitted across the network, based on staffing, surgical schedules and acuity. Once AI was integrated into this process, the system identified four times more appropriate hospital-at-home patients than the manual process had.

In another example, a Mayo Clinic Health System gastroenterologist and an AI medical director built an evidence-based anesthesia protocol backed by AI to identify which patients could safely receive conscious sedation instead of complex anesthesia during colonoscopy procedures. The change significantly expanded screening capacity, allowing for 150 additional colonoscopies per month in that rural community within 30 days. The protocol has since spread across the Mayo Clinic enterprise and is one of more than 300 projects related to AI algorithms in various stages of implementation across the system, according to Dr. Varkey.

In Albert Lea, Minn., where Mayo Clinic Health System is essentially the sole primary care provider, leaders realized traditional capacity expansion wasn’t going to meet community care demands. About two years ago, the system instead launched a vendor-partnered digital primary care on-demand model and has conducted more than 22,000 virtual visits. About 33% occur in the evenings, at night or on weekends, suggesting the virtual care is displacing what would have likely been emergency department visits for many patients.

Mayo Clinic Health System is also using AI for risk stratification. An algorithm runs overnight against the system’s elderly chronic disease population and produces, by 7 a.m., a list of the 20 patients most likely to require an emergency room visit or be admitted to the hospital. The list goes to a care coordinator or nurse for proactive outreach. Dr. Varkey said the program has reduced readmissions and cut total cost of care for the cohort by more than 50%.

In April, Mayo Clinic Health System launched an “AI agent-thon” initiative to teach staff how to design and deploy their own AI agents. It is a clean illustration of a theme Dr. Varkey returned to throughout the conversation: The most durable innovation in healthcare is bottom-up, not top-down.

Dr. Varkey said the cultural shift in a transformation effort typically takes about two years to manifest. The clearest sign that it’s working, she said, is when front-line staff start bringing new ideas to leadership and asking why the system isn’t moving faster.

“I think that is the biggest reward any leader can hope for,” Dr. Varkey said. “Because then the people are taking the helm of the transformation.”

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