Implementing A New USDA Rural Development Program Targeting Small Rural Hospitals and Their Communities (original) (raw)
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Trends in Rural Health Clinics and needs during U.S. health care reform
Primary Health Care Research & Development, 2013
Aim: Rural Health Clinics (RHCs) are primary care clinics certified through Medicare and Medicaid to provide health care to the medically underserved in rural areas of the United States. The purpose of this paper is to describe how the characteristics of RHCs have either changed or remained stable over a 10-year period in the past: from the late 1990s to 2007. In addition, it is also to describe some of the outstanding needs of RHCs as they navigate the transitions of U.S. health care reform. Methods: Using a panel of RHCs continuously in existence from 2006 through 2007, we calculated and compared statistics with corresponding statistics from the literature. We described the geographic distribution of RHCs, demographics of their counties of location, and characteristics of RHC structure and staffing. We also explored the implications of the recently enacted health reform law (the Patient Protection and Affordable Care Act or ACA) for RHCs, and the improvements that RHCs need as it is implemented. Findings: By the end of the study period, the highest percentages of RHCs were in the South and Midwest, the percentage of RHCs in the West had grown, and that in the South had declined. RHCs served counties with increasing proportions of individuals below poverty and Hispanics/ Latinos. The percentage of independent clinics had grown, as had the percentage of forprofit clinics. Finally, the percentage of nurse practitioner full-time equivalents had grown as a proportion of the total for three providers. Conclusions: In investigating the performance of RHCs, many managerial and operational factors are not well understood. It is imperative that RHCs gather the information that could help them maximize the elements of their performance that would keep them financially stable. In addition, a broader awareness of the unique challenges that RHCs face in this era of health care reform is needed.
Advancing the Transition to a High Performance Rural Health System
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Advancing the Transition to a High Performance Rural Health System Charles Alfero MA Andrew F. Coburn PhD University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center Jennifer P. Lundblad PhD, MBA Stratis Health A. Clinton MacKinney MD, MS University of Iowa, College of Public Health Timothy D. McBride PhD Washington University in St. Louis, Brown School of Social Work
Evaluation and Program Planning, 2019
This rubric can be used by providers, decision makers, policymakers, agencies, communities themselves, and other key stakeholders in rural areas to standardize and prioritize strategies to improve access to care in their communities. Use of the rubric can inform decision making processes by providing evidence-based, comparable results pertaining to the impact and feasibility of pertinent access to care improvement strategies. The rubric can be further modified to meet the specific population and/or health needs of each community. In the long-term, this rubric could facilitate discussions of strategy implementation successes and opportunities for improvement between rural communities.
The Journal of Rural Health, 2003
This paper describes the Arkansas River Valley Rural Health Cooperative (ARVRHC), one of the Arkansas networks jump-started with support from the Southern Rural Access Program (SRAP). The initial goal of the network was to develop a subsidized health insurance program to provide affordable medical services for the uninsured population (23%) in the 3-county service area. When planning efforts called for the network to address broader needs, the ARVRHC crafted a more comprehensive 3-pronged program model consisting of 3 interrelated programs: (1) the Health Care Access Program (HCAP), (2) the Health Education and Disease Management Program (HEMIMP), and 3) the Information and Assistance Program (l&AP). The HCAP is designed to address the financial barriers to access through a community-based health plan. The HEGDMP focuses on improving the health of individuals through education, counseling, and preventive care. The IGAP links lowincome families to existing public assistance programs (eg, Medicaid) and social support services. The Prescription Drug Assistance Program is one of the l&AP programs that helps individuals without prescription coverage obtain drugs at no cost. A key lesson learned is the importance of combining technical assistance with funding. The ARVRHC has been successful in leveraging funding, having received over $1.7 million in grant funds since 1999. A critical challenge facing the network today is the need for ongoing subsidy funding. Proposed legislation for a federal demonstration of the HCAP and similar programs would enable full implementation and evaluation of this model. he underlying intent of the Southern Rural Access Program (SUP) is to improve access to basic health care in the most underserved, poor, rural states in the nation. Development
Advancing Population Health in Rural Places: Key Lessons and Policy Opportunities
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This paper aims to advance the policy discussion of population (defined as either a patient panel that is based on conditions such as diabetes, all enrolled patients, or the general community) health in rural places, with a focus on the role of rural health care organizations. Although efforts to address population health can originate in a variety of settings, the rural health care organization can be a natural place to start. Facilitative Considerations-Previous Demonstrations and Examples: After a review of previous demonstration projects, public health and health care organization partnerships, urban system investments, and community health needs assessments; common facilitative considerations for successful population health interventions emerged. Communities and health care organizations interested in improving population health can benefit from creating community buy-in and participation, fostering collaboration within and across entities, engaging a diverse workforce, utilizing a variety of funding streams, planning for sustaining of funding after the original investment, and leveraging existing infrastructure. Key Findings-Medicare and Medicaid: Though the demonstration projects discussed in this report have their roots in the Medicare and Medicaid programs, there are other ways that Medicare and Medicaid are addressing population health through policy. Within Medicare, care management programs, value-based payment arrangements, supplemental benefits, and telehealth expansion all help achieve population health goals. In Medicaid, the provision of preventive services, connection to social supports, State administrative flexibility, and telehealth do the same. Based on progress thus far, future efforts to address population health in Medicare and Medicaid programs must prioritize staff and infrastructure development, flexibility in covered benefits, and further expansion of telehealth. Policy Opportunities: To determine the optimal structure of a strategy to incorporate population health in rural areas, more rural demonstration projects are needed (publicly or privately supported). These demonstrations must then be evaluated using rural-relevant metrics consistently across projects. Unique strengths of rural communities can be identified that help others replicate successful demonstrations. A population-health strategy will take advantage of favorable rural community characteristics: smaller scale in terms of population served, existing collaboration between organizations that are already known to one another, and a strong sense of community strengths and needs. In addition, rural communities can benefit from effective collaboration within and across entities because community leaders and organizations can know each other personally and can clearly define the distinct assets each community organization can provide. A rural area's strong sense of community can be advantageous to gaining broad-based community support for population health activities, but to maximize this support, initiatives must have stable long-term funding, and the preventive services offered must be affordable. The community will also become more invested in population health efforts if the local workforce is embedded in the projects. Offering alternative pathways to rural provider inclusion in value-based payments, decentralizing training programs into rural environments, and updating payment policies can all facilitate local workforce engagement. Finally, the population health changes that take place can be sustained beyond a defined demonstration project period by offering transitional supports to providers, providing comprehensive technical assistance to the community, and using Medicaid authority to create policy changes that would provide long-term funding support. Future Considerations: Efforts at both the State and Federal levels aim to address the health challenges that face rural communities. These efforts, including rural-centered task forces, ongoing activities to implement population-health-centered legislation such as the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, and emerging rural health proposals and bills from Congressional members and presidential candidates alike must move forward grounded in population health strategies. 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State health policy and rural hospitals
The Journal of rural health, 1992
Many rural hospitals are experiencing dificulties. This article explores the views of various government and hospital officials on state health policy for rural hospitals. The authors discuss how these officials define the rural hospital issues and suggest appropriate state interventions to assure hospital viability and local access to care. The authors recommend that states, hospitals, and communities decide through a formal process what level of health and medical care should be available in rural areas, and states assist in low-cost ways those rural hospitals that are ready to change or that, with kelp, will be ready to make suck operational changes as service reconfiguration, afiliations, and working agreements with other health care organizations to continue and improve local access to health care.
Economic analysis of rural health in the USA- suggested solutions for the market
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The present article endeavors to conduct an in-depth analysis of the healthcare economy in rural communities and compare it to the urban communities within the United States. Our examination will encompass an evaluation of available resources, incentives, and market powers. In light of our findings, we will propose recommendations aimed at enhancing the efficiency and sustainability of the existing healthcare model within rural communities.