Population Health in Rural America in 2020 Proceedings of a Workshop (2021) / Chapter Skim
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6 Rural Health Policy
6 Rural Health Policy
Pages 93-116
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From page 93... ...
of Margaret Mary Health in Indiana, discussed how rural health organizations focus on population health, form collaborative partnerships, and create policy and practices centered on prevention and primary care. He described how a rural hospital can shift from focusing on medical interventions to prioritizing prevention and population health using the example of Margaret Mary Health, a small community hospital in Batesville, Indiana (see Box 6-1)
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From page 94... ...
The mission of Margaret Mary Health -- like many rural hospitals -- is to focus on improving the health of community members, which is aligned with the aims of population health to make populations healthier. Transitioning to Population Health and Value Based Care in a Rural Hospital Putnam explained that Margaret Mary Health began transitioning to a focus on population health approximately 7 years ago in order to better serve its community by keeping people healthier.
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From page 95... ...
He added that unlike the competitive relationships between some urban hospitals, rural hospitals tend to be less competitive and more supportive in wanting other rural hospitals to be effective and successful, and to have good outcomes. Putnam described several lessons learned during Margaret Mary Health's transition to a focus on population health.
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From page 96... ...
Putnam suggested that having a healthy population -- in this case, a result of the shift in focus to population health -- was a major boon to the COVID-19 response at Margaret Mary Health. Toward Value-Based Care Putnam remarked on how rural health systems can lead the way in the shift to value-based care moving forward.
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From page 97... ...
Putnam emphasized that these features of rural health settings are at the core of successful population health efforts. He noted that the same types of shifts in focus toward prevention and primary care efforts that were undertaken at Margaret Mary Health are also occurring in other small communities across the country, which will contribute to the success of broader population health efforts.
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From page 98... ...
leveraging patient engagement incentives to decrease rural bypass and incentivize local care utilization. Long-Term Financial Sustainability The BPC Rural Health Task Force made a separate set of recommendations for improving long-term financial stability, said Mueller.
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For example, it recommended that rules around colocation or shared space arrangements should be clarified to enable rural hospitals to partner more effectively with other health care organizations. It also recommended that advanced practice clinicians should be allowed to work up to their state's scope of practice in rural health clinics.
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From page 100... ...
Global budget models are currently being demonstrated in Pennsylvania, and one is operating in its second generation in Maryland. The task force also recommended decreasing participation thresholds for rural providers for all these alternative payment models, as well as rural health clinics and FQHCs, added Mueller.
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From page 101... ...
Additional Recommendations Related to Population Health Mueller outlined several other recommendations related to population health made by the task force: • Increase the number of rural-specific Center for Medicare & Med icaid Innovation demonstrations and expedite the expansion of promising models to the national level. • Reduce the administrative burden on rural providers by using readily available claims data for quality performance.
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From page 102... ...
He explained that IHS is committed to providing quality health care consistent with statutory authorities and the government-to-government relationship of the United States with American Indians and Alaska Natives. Serving members of 574 federally recognized tribes, IHS is a comprehensive health service delivery system for approximately 2.6 million individuals.
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From page 103... ...
The Department of War was therefore seen as the most effective department for housing the Administration of Indian Affairs and responding to the health care needs of American Indians and Alaska Natives. In 1849, oversight and administration of Indian health was transferred from the Department of War to the civilian Bureau of Indian Affairs located within the Department of the Interior.
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This contracting method continues to be reflected in today's IHS through service delivery mechanisms described in the next section. Indian Health Service Delivery Mechanisms Smith described three types of service delivery mechanisms available for American Indians and Alaska Natives to choose from.
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This is evident in the state of Alaska, which is home to more than 200 federally recognized Alaska Native villages. Alaska has 58 tribal health centers, 160 tribal community health clinics, and 6 tribally operated hospitals.9 Smith noted that since populations can be very small, village clinics are important.
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From page 106... ...
Policy Ramifications of the Indian Health Care Improvement Act Smith said that the IHCIA,13 made permanent with the passage of the Patient Protection and Affordable Care Act of 2010, covers a number of topics and underscores federal policy related to Indian health. It sets the goal of ensuring the highest possible health status for American Indians and Alaska Natives, benchmarked with the objectives of the 11 Life Expectancy American Indians and Alaska Natives Data Years 2007–2009.
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From page 107... ...
Smith said that the IHCIA sets forth objectives for health professionals, uses a government-to-government relationship, and provides the funding necessary for facilities operated both by the Indian Health Service and by tribes. Smith emphasized that as tribes set policies in the future, it is important that the federal government underscore its commitment to providing access to health care to American Indians and Alaska Natives, as established by treaties and within the bounds and scopes of the laws that set forth their authorities.
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From page 108... ...
A large portion of this support was dedicated to maintaining access to nutrition services that are critical for many people in both urban and rural environments, such as the Supplemental Nutrition Assistance Program; the Special Supplemental Nutrition Program for Women, Infants, and Children; and the Emergency Food Assistance Program. It also allocated an additional $1 billion to the Public Health and Social Services Emergency Fund specifically to help health care providers cover the cost of COVID-19 testing for the uninsured.
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From page 109... ...
Since then, the Department of the Treasury, SBA, and Congress have taken steps to address this issue, making it easier for rural providers and others to access PPP loans, added Cassling. CARES Act Funding for Rural Providers Cassling explained that many rural health care providers received some type of financial support via the CARES Act because it included numerous provisions related to health care.
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From page 110... ...
Additional CARES Health Provisions Cassling noted that the CARES Act includes additional provisions regarding extending health care programs, the health care workforce, and telehealth access. "Health extenders" are a group of provisions extending funding for a collective of health care programs such as the Community Health Centers Fund, the National Health Service Corps, and the Teaching Health Centers Graduate Medical Education program.
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From page 111... ...
An additional $75 billion was allocated to hospitals and other health care providers faced with COVID-19 revenue losses and cost challenges. The Disaster Loans Program received $50 billion, and $25 billion was allocated for testing, including $825 million designated for community health centers and rural health clinics.
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From page 112... ...
While rural providers are able to perform surgeries and treat conditions such as pneumonia, they do not have access to the range of services found in urban areas. Rural providers found that some patients were unable to manage their chronic diseases properly because of mental health issues, so they had to create their own programs.
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From page 113... ...
Global Budgeting Model for Financial Stability Murphy asked Mueller to comment further on the Pennsylvania Rural Health Initiative and global budgets. Mueller referenced a recent opinion piece from a group at Harvard University working on the Pennsylvania model (Fried et al., 2020)
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This is occurring in the Navajo Nation, where the Navajo Nation partners with the federal government in a unified command to address the issues. Smith noted that challenges requiring amplified messaging range from access to PPE to broader issues -- related to housing, for example -- that are common in rural communities and perhaps even more frequent in Indian communities.
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From page 115... ...
Role of Electronic Health Records in Rural Care Murphy asked Smith about policies or regulatory provisions that might be helpful in moving forward with EHRs in tribal communities. Smith replied that tribal health programs have explored commercial products in an effort to find their own solutions to sharing information with IHS.
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From page 116... ...
For example, the Navajo Nation covers parts of Arizona, New Mexico, and Utah. Smith said that the current telehealth expansion has presented new opportunities, and IHS is working with other federal agencies (e.g., the Federal Communications Commission)
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