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Welcome and Introduction:

Challenges and Innovations in Rural Health Policy

June 21, 2017

Tom Morris

Associate Administrator, Rural Health Policy

Health Resources and Services Administration

• Opportunity for Charting a New Path for Rural Health

• Value of the Team Approach

• Examples

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Policy Collaboration at the State Level

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At this meeting we’re here to discuss:

• Where can state policymakers have the most influence?

• How can state leaders most effectively impact (and improve) rural health?

• NCSL has identified four policy areas for your consideration:• Emergent issues & health system changes – addressing current

uncertainty • State strategies to address the health workforce in rural areas• Innovations for sustainable rural health facilities• Using data to drive change

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Key Policy Areas for Consideration

Introduction to Rural Health Policy Priorities at

HHS/HRSA

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Defining “Rural”

• 65% of counties are rural

• 445 “frontier” counties

• About 17% of the population lives ina rural area

• Supporting Access via … • Workforce Training

• Clinician Placement (National Health Service Corps)

• Infrastructure Support

• Targeting Resources by Designating Shortage Areas

• Enhanced Payments through Medicare and Medicaid

• Pilots and Demonstrations

• Provision of Public Coverage

• Support of Private Coverage

• Investments in Technology

• Telehealth

• Broadband

• Electronic Health Records

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The Federal Investment in Rural Health

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Agency for Health Research and Quality

Administration for Children and Families

Centers for Medicare and Medicaid Services

National Institutes of Health

Substance Abuse and Mental Health Services Administration

Rural Health andthe Department of Health and Human Services

Centers for Disease Control

Health Resources and Services Administration

Indian Health Service

Administration for Community Living

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Rural Health andthe Department of Health and Human Services

https://taggs.hhs.gov/ReportsLocation/GrantsByLocation_MetroNonmetro

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HHS Secretarial Priorities

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Opioids

Child Obesity

Mental/Behavioral Health

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The Federal Office of Rural Health Policy

Build Healthy Rural

Communities

Policy & Research

Community Based

Programs

Telehealth

State & Hospital

Programs

ValuesAccountable Knowledgeable Collaborative RespectfulInnovative Responsive

MissionFORHP collaborates with rural communities and partners to support programs and shape policy that will improve health in rural America.

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Rural-Specific Programs

• Pilot Programs for Rural Communities• Expanding the Community Health Gateway

• Public Health Programs• Screening

• AEDs and Opioid Reversal Programs

• Grants Focusing on Performance and Quality Improvement for Small Rural Hospitals

• State Offices of Rural Health

Community-Based Division Hospital-State Division

Office for the Advancement of Telehealth

• Telehealth Network Grants

• Telehealth Resource Centers

• Licensure and Portability

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Health Resources & Services AdministrationAnd Rural Health

Health Centers

Serve 1 in 3 people living in poverty and 1 in 6 rural residents

Maternal and Child Health

Home Visiting: In FY 2016, 160,000 parents and children nationwide received HRSA-supported home visiting services, in 35% of all urban counties, and 23% of all rural counties

Bureau of Health Workforce

In FY 2016, 160,000 parents and children nationwide received HRSA-supported home visiting services, in 35% of all urban counties, and 23% of all rural counties

28 of 59 Teaching Health Centers include a rural rotation

Training grants support 187,764 students from rural areas; HRSA-supported training spots include 8,409 rural locations

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Rural America is Not …

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Myth Busting/Preaching to the Choir

A Smaller Version

of Urban America

What Are the Differences?

• Significant Regional Variation

• Infrastructure

• Mix of Clinicians, but overall

shortages

• Higher Poverty

• Geographic Isolation

• Weather as a Risk Factor

• Higher Percentage of Elderly

• Financial Viability/Payer Mix

• Employment and Economics

• Patient Volume

• Health Disparities

• Declining Population

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Key Rural-Urban Public Health Differences

Source: Analysis by Dr. Kate Beatty, ETSU

Emergent Issues in Health System Change

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• Environmental: • Transition from Volume to Value

• Pressure on State and Federal Budgets

• Future Structures of Publicly Funded Coverage

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Current Uncertainty about Changes to the Health System

Regulatory Burden

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Major Medicare Payment Updates

• A Specific Ask for Input from Providers …

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• Little Data Available

• 911 Coverage Not Universal

• High Fixed Costs, Low Patient Volume, Long Trips

• Heavily Reliant on Volunteers

• Financially challenged

• Amidst Challenges … Opportunities• Community Paramedicine

• First-Responder Wireless Spectrum

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Rural Emergency Medical Services Considerations

• Telehealth

• Electronic Health Records

• Mobile Health

• Broadband

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Rural Health and the Elusive Technology Solution

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Health Workforce

Recruitment, Retention and Distribution

HRSA’s Workforce Programs

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https://www.hrsa.gov/about/organization/bureaus/bhw/index.html

http://scopeofpracticepolicy.org/

• Health Profession Training Grants• Primary Care

• Nursing

• National Center for Health Workforce Analysis

• Area Health Education Centers

• New Scope of Practice Resource

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HRSA’s Workforce Programs

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https://taggs.hhs.gov/SearchAward

• The National Rural Recruitment and Retention Network• State-Level Resources

• New Training Module Series

• Tools for Enhancing Retention

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Rural Recruitment and Retention

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Expanding Rural Hospital Residency Training

HRSA GME Eligibility Tool

How it works:

• Tool located on HRSA Data warehouse:

• Filter by State, County, Hospital Name

to select hospital

• 1 Report per hospital that indicates

whether DGME, IME, or other training

costs have been incurred since 1997

• Not applicable to CAHs

• Hospitals must still touch base with

MAC to confirm

Direct Link: https://datawarehouse.hrsa.gov/tools/hdwreports/Filters.aspx?id=462

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The Workforce Investment and Opportunity Act

• FY 2016 - $10.14 billion to administers federal government job training and worker dislocation programs, federal grants to states for public employment service programs, and unemployment insurance benefits.

• $9.18 billion in discretionary funding

• $96 million mandatory

• Primarily provided through state and local workforce development systems

• Opportunities/Challenges for Healthcare

• Getting Health Employers on State and Local Workforce Boards

WIOA

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• Thousands of Wage and Salary Jobs Projected, 2014-2024

• Source: Bureau of Labor Statistics

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Why This Matters …

3,795

1,889

941

790

765

756

507

339

325

268

137

80

-27

-48

-383

-814

Health care and social assistance

Professional and business services

Leisure and hospitality

Construction

Retail trade

State and local government

Financial activities

Educational services; private

Wholesale trade

Other services

Transportation and warehousing

Mining

Information

Utilities

Federal government

Manufacturing

Sustainable Rural Health Facilities

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Rural Safety-Net Providers

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Rural Safety-Net Providers

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Rural Safety-Net Providers

Rural Hospital Viability

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Rural Hospital Viability

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Using Data to Drive Change

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The Overlooked Rural Disparity

Rural Realities Disparities

Findings from the 2016 RWJ County Health Rankings

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Source: Singh GK, Siahpush M. American Journal of Preventive Medicine. 2014;46(2):e19-e29 (updated data)

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70

75

80

85

1969-1971 1975-1977 1981-1983 1987-1989 1993-1995 1999-2001 2005-2009

Metro, Both Sexes Non-Metro, Both Sexes

Metro Males Non-Metro, Males

Metro, Females Non-Metro, Females

Rural Health Disparities

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New CDC State Rural-Urban Data Tools …

https://blogs.cdc.gov/nchs-data-visualization/category/chart-type/

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• Online data query tool created by FMT

• Provides graphs and data to compare CAH

performance for various measures across user-defined

groups

New Tool for CAHs

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• Getting the Rural Voice in to the Policy Process

• Putting Research Findings into the Hands of Rural Leaders

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Rural Health Policy and Research

https://www.ruralhealthresearch.org

https://www.ruralhealthinfo.org/

• Finance

• Health Care Team Assumptions

• Evidence-Base

• Population Thresholds

• The Evaluation Trap

• Block Grants vs. Direct Community Funding

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Rural Health Policy Pitfalls

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• NCSL, ASTHO and NGA available to help support your data needs

• Partners will connect you with HRSA resources and help you access the information you need to craft rural health policy in your states

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Support for your Team-Work

• Wishing you the best of luck in crafting your state team action plans

• We look forward to having the opportunity to discuss your concerns and ideas

• Questions?

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Thank you