Tom Morris, Associate Administrator for HRSA’s Office of Rural Health Policy (ORHP) at HHS, described the health challenges existing in rural America at the Alliance for Health Care Reform Briefing held July 26th in Washington D.C. He reported that over 50 million people live in rural areas and make up nearly 20 percent of the total population spread across 80 percent of the country. Rural residents tend to be older, sicker, and more dependent on public payers.
As a result, rural communities struggle with issues that relate to access to care, recruitment and retention of healthcare providers, and how to continue to maintain the economic viability of hospitals and other healthcare providers in isolated rural areas.
As Morris explained, ORHP is moving towards a more evidence-based approach in rural programs, working to improve recruitment and retention of the workforce in rural communities, linking HRSA’s telehealth programs to rural communities, and collaborating with other partners across the Federal government on rural issues.
ORHP funds a number of programs focusing on rural communities such as the State Office of Rural Health grants, Rural Hospital Flexibility grants, and Small Hospital Improvement programs. Other grant programs in place include Rural Health Outreach Services, Rural Network Development, Small Health Care Provider Quality Improvement, Delta States Network, and Telehealth Network Grants.
Keith J. Mueller, PhD, Director, RUPRI, Center for Rural Health Policy Analysis and Head of the Department of Health Management and Policy at the University of Iowa described the status of activities happening in Iowa through the Federally Facilitated, State Partnership Exchange.
Presently, the state is developing materials for consumers, seeking partners to assist with enrollment, and so far, two statewide carriers and two regional offerings are being made through the new state marketplace. The state also plans to expand Medicaid, has made workforce development and dispersion of healthcare professionals to areas of greatest need a top priority. Iowa is also moving toward integrating care systems, through providers, insurance carriers, and Medicaid.
According to RUPRI’s Rural Policy Brief just published, “The Medicare Shared Savings Program (MSSP) more commonly referred to as the Medicare ACO Program and associated demonstrations have increased steadily since 2011.”
Today, there are more than 400 Accountable Care Organization in 48 states. Medicare ACOs operate in non-metropolitan counties and 79 Medicare ACOs operated in both metropolitan and non- metropolitan counties.
New Mexico has developed the new concept of Health Extension Rural Offices (HERO) a concept that is very similar to the USDA Agricultural Extension Service, according to Arthur Kaufman MD, Vice Chancellor for Community Health at the University of New Mexico.
The goal of HERO is to place full time agents in rural communities across the state to link community priority health needs with UNM Health Sciences Center (HSC) resources. The program grew out of community input and recommendations as to how the HSC can best help communities improve their health.
He also mentioned that Medicaid Managed Care Organizations have contracted with the University to hire HERO to train Community Health Workers. This program has been very effective in providing patients education, advocacy, and social support for up to six months.
Lisa Miller, Senior Program Officer for the Bingham Program in Augusta Maine reports that Maine the third most rural state in the U.S, has the oldest population of any state. Today, the state has 100 unfilled openings for primary care physicians in Maine.
Maine has several programs in place to help address primary care shortage issues. As many as 60 percent of the University of New England osteopathic medical school’s graduates go into primary care, an allopathic medical school has been established at Tufts Medical School, and Maine Medical Center has a strong rural primary care focus, The state also is moving forward with five advanced practice nurse training programs to help meet workforce shortages.
For more information on the briefing, go to www.allhealth.org.