Life in rural Virginia is full of peaks and valleys.
On the one hand, there’s the boundless nature, personal privacy and slower pace of life that only the countryside can afford. But on the other: dropped calls, unreliable internet connections and resources that can be miles away from where a person lives.
It’s a hindrance for those looking to idly scroll Instagram or navigate to their next destination on Google Maps. And for those seeking medical attention, it can be downright harmful.
“Growing up country consistently consigns you to lower health outcomes and higher mortality rates — a fate we cannot accept as a community,” Mike Pruitt, who represents a swath of rural southern Albemarle County on its board of supervisors, told The Daily Progress.
For many of Pruitt’s rural constituents, clinics and hospitals can be a half-hour, or more, journey; neither the University of Virginia Health System nor Sentara Health, the two primary providers of health care in the area, has physical facilities in the county south of the city of Charlottesville.
Patients can travel to Charlottesville, if they have the time and transportation. Or they can opt for a virtual appointment via telehealth, if it’s offered by their provider and if they have access to a reliable connection.
“Internet and cell phone service is the number one issue in rural areas,” Nancy Gill, a former mayor of the town of Scottsville just south of Pruitt’s district, told The Daily Progress. “The whole thing is internet, that to me is the juggernaut.”
That struggle has caught the attention of state and national organizations.
Late last year, the Association of American Medical Colleges named UVa Health one of 13 recipients of the 2023 Telehealth Equity Catalyst Awards. The recognition came with $15,000, money UVa Health said it plans to use to expand access to care for rural residents, specifically in southern Albemarle.
The question is how.
The billion-dollar health system of the state’s flagship university has promised to expand telehealth in a corner of Albemarle County that notoriously lacks cell service and broadband connections. But it has emphasized that it has no plans to provide that necessary infrastructure, not with its new grant money and not in the future.
UVa Health CEO Craig Kent told The Daily Progress plainly, “We are a health system and providing connection and internet access is not something that we do.”
How will the money benefit patients in southern Albemarle? Officials wouldn’t say.
What they would say: UVa Health will not be constructing any physical telehealth hub in the county, UVa Health will not support expansions to the county’s internet infrastructure and UVa Health will not specify how it will spend its thousands of dollars to expand telehealth access in southern Albemarle.
‘They feel unseen’
There was a meeting. And more are planned.
In November, UVa Health officials, including Director of Telemedicine Nikki Facteau, met with a coalition of local government and nonprofit representatives from the town of Scottsville, Yancey School Community Center, Blue Ridge Health District, Region Ten Community Services Board and Health Equity and Access in Rural Regions, or HEARR.
Those community representatives described to UVa Health officials the multiple barriers that stand between residents in southern Albemarle and quality health care: internet, transportation and, more importantly, trust.
“When they go to UVa, they feel unseen,” Peggy Scott, vice president of HEARR, told The Daily Progress. “We’ve heard that over and over. People don’t trust that the information is good information for them, and they don’t know who their providers are.”
Scott’s group is a nonprofit organization focused on improving the health and well-being of residents in Albemarle, Fluvanna, Buckingham and Nelson counties. It puts on health and wellness fairs, coordinates water testing, hosts exercise programs and serves as a liaison between local and state health care organizations.
Scott is a longtime resident of Albemarle County and recently retired from a career working as a registered nurse and cancer care coordinator at UVa Health, where she started working in 1983.
She explained that most of the low-income residents of rural Central Virginia that she engages with at HEARR, and as a member of Yancey School Community Center’s advisory panel, only seek medical care in emergencies.
“One of the biggest issues for patients getting to a facility is transportation,” said Scott. “And feeling as though, if it’s not urgent, then they don’t need to go because a family member has to take off work or they have to find child care.”
When asked how she would like to see the $15,000 spent, Scott immediately responded with “transportation” to a physical facility and stressed the need to ensure patients can routinely receive quality treatment.
“They feel like they’re just another number when it comes to large entities, when it comes to our medical center,” said Scott. “What people look for is continuity and consistency so that you’re there when the needs arise. That trust piece comes about with longevity and long engagement, they [UVa Health] seemed to hear that.”
But, she added, “It’s been told to them multiple times.”
Scott and the rest of the coalition will find out if UVa Health listened to them this time when they reconvene at a planned meeting in March to hear the health system’s proposed solutions.
The Daily Progress reached out to Facteau at UVa Health for comment. She never responded.
But based on a statement UVa Health released in December announcing its award, the medical institution is aware of the issues.
“In-depth research revealed residents in these rural communities access healthcare less often and are less aware of the health services available to them,” reads the statement. “This is due to several factors, including limited transportation options along with varying levels of access to the internet and cellphone service.”
The statement goes on to say UVa Health aims to raise awareness and access by “reducing barriers to access care on-site and leveraging communication channels.”
The Daily Progress asked UVa Health spokesman Eric Swensen if he could specify how the funding will be used to achieve those goals and expand telehealth care in southern Albemarle. If using the money to expand broadband or improve cell reception is off the table, would UVa Health consider establishing a telehealth hub, a space where patients could access the connections they need to contact their health care providers?
“We’re thankful to have grants from groups like the AAMC that enable us to explore potential solutions, with the goal of finding a sustainable solution that works for a broad cross section of the community,” Swensen responded. “UVa Health is not planning to build a physical hub. We’re exploring potential existing locations in the community that could be used as telehealth hubs. But we’re also exploring other models with the same goals.”
Without any further clarification, residents in southern Albemarle still have no clear idea as to how the money UVa Health has promised to spend on them will be used.
It doesn’t inspire confidence for many of those people who already feel disconnected, said Scott.
“People are expecting them to leave short term,” she said. “You have to be able to create trust and show up in an emergency if you really want to make an impactful, meaningful and long-lasting experience.”
Jason Inofuentes, program manager for Albemarle County’s Broadband Accessibility and Affordability Office, said there should be some grace allowed for UVa Health as it determines how best to use its money.
“They want to explore what models are available,” he told The Daily Progress. “It’s important to make clear that this is all in early stages of exploring the right approach, so I don’t believe they’re wedded to any one approach yet.”
But residents in southern Albemarle have been vocal that whatever approach is used to expand telehealth will have to overcome the reality that there is not enough infrastructure to support telehealth in much of the area.
And while many are hopeful UVa or its health system could assist in bridging that gap, UVa Health’s chief executive said it is not even within their purview, much less their future plans for telehealth in the area.
“We don’t have an initiative to solve that,” Kent said.
Internet access as public health
Kent and his colleagues in southern Albemarle have different ideas about the relationship between public health and internet access.
Pruitt pointed out that the county’s broadband office falls under its department of human services.
“This is a fundamental health and human need,” said Pruitt. “Internet and cell access, they are public health issues. If you don’t have cell service or when you don’t have internet access and you need to contact your mental health provider, that’s a public health service.”
A study released by the National Bureau of Economic Research in August found that expansions in broadband in rural areas were responsible for a 16% improvement in patient outcomes.
“Broadband access primarily helped patients choose higher-quality providers,” reads the report authored by two faculty research fellows at the University of Michigan and Hunter College. “We also found some evidence that broadband improved provider quality.”
For those in Albemarle, broadband, and by extension quality medical care, is hard to come by.
“We feel a responsibility for all the communities in Charlottesville and in the region,” said Kent. “What we’re trying to do is ensure the level of healthcare in each of those communities is equivalent to the highest level.”
But data collected by the Virginia Department of Housing and Community Development and Virginia Tech in 2023 clearly shows that the majority of Albemarle County south of Charlottesville does not have reliable broadband coverage, defined as download speeds of at least 100 megabits per second and upload speeds of 20 megabits per second.
In layman’s terms, at those speeds the average high-definition movie would take about four minutes to download to a device.
But even a household that has the bare minimum to qualify for reliable broadband service, can still face problems if a router isn’t close by or if several devices are simultaneously online on the same network.
Inofuentes said that Albemarle’s Broadband Accessibility and Affordability Office has spent the past three years attempting to address the lack of connectivity in southern Albemarle.
With monetary assistance from the American Rescue Plan and Virginia Telecommunications Initiative, the department, in partnership with Palmyra-based internet provider Firefly Fiber, is aiming to achieve universal broadband countywide by 2025.
Until that’s established, telehealth options in southern Albemarle will be limited, whatever they are. And physical health care facilities will remain practically nonexistent.
The town of Scottsville may act as a hub for the rural communities in southern Albemarle and neighboring counties, but with a population of less of 550 people, it’s never going to be a viable option for health care providers to establish physical clinics and hospitals.
Health care is a business, and in order to maximize profit and improve the quality of the product for the highest number of consumers, rural clinics and hospitals have been consolidated over the past century into massive health care systems.
Today, you are not just a patient, you are a client.
And, as Pruitt said, “The town of Scottsville does not have the client base sufficient to satisfy a small urgent care.”
The only medical care center even near Scottsville is 5 miles west of town, a nonprofit community health center called Central Virginia Health Services Southern Albemarle.
It’s available, but it’s not ideal.
CVHS Southern Albemarle lacks emergency care and a primary care physician. And Scott said its difficult hours also make it hard for patients to make appointments; the clinic is closed on weekends and is only open from 8:30 a.m. until 5 p.m. on weekdays.
Between a clinic with odd hours and the hospitals in Charlottesville half an hour away, and no health care provider willing to invest in facilities in a rural corner of the county, telehealth may be the only way to meet the medical needs of southern Albemarle’s residents.
“I totally recognize that internet access has to be a key piece of this problem,” said Pruitt. “I don’t think it’s optimal, but telehealth has to be a central part of that.”
Kent put it more bluntly.
“In rural Virginia, if we don’t show up via telehealth, then no one’s going to show up and the care is not going to be provided,” he said. “Even with mental health care, it’s better to provide mental health care via telehealth in rural Virginia than nothing.”
But what good is telehealth in a community without reliable internet service? Also nothing.