Rural is Not …

Tom Morris

Office of Rural Health Policy, Health Resources & Services Administration

U.S. Department of Health & Human Services

A Smaller Version of Urban

Virginia Rural Health AssociationDecember 11th, 2014

Today’s Presentation

Rural Differences & Demographics

Rural … The Policy Conundrum

Successful Approaches

2015 Opportunities

What Are the Differences?

• Infrastructure

• Mix of Clinicians

• Higher Poverty

• Geographic Isolation

• Weather as a Risk Factor

• Higher Percentage of Elderly

• Financial Viability/Payer Mix

• Shortage Areas

• Employment and Economics

• Patient Volume

• Health Disparities

• Population Trends

• Other?

Where Does Rural Fit In?

This Week in Poverty:

Congress Turns Its Back on Rural America“ ‘Rural America often gets overlooked. We know Kansas is referred to as a

‘Flyover State’,’ said Gray [head of a local Community Action Agency]. ‘But there

are a lot of people here, and a lot of people in poverty. Sequestration is just one

cut. It’s the impact of that steady erosion of financial resources that is much

greater in rural communities—because there are far fewer resources.’ ”

The Nation, June 14th 2013

As more move to the city,

does rural America still matter?“ During the 1990s, people flocked to

rural areas to take advantage of the

growth in jobs. But with fewer positions

now available, a major incentive to move

out of the big city has vanished. ”

USA Today, January 13th 2013

Farm Bill Defeat Shows

Agriculture’s Waning Power “ The startling failure of the farm bill last

month reflects the declining clout of the

farm lobby and the once-powerful

committees that have jurisdiction over

agriculture policy, economists and

political scientists said this week.”

New York Times, July 2nd 2013

So, why does this matter?

• Research and Data

• Funding Formulas• Public Health

• Community

Development

• Perception and

Public Policy

• Unintended

Consequences

The Checkered History

of Top-Down Solutions

for Rural Health

• Prospective Payment Systems

• Risk-Based Managed Care

• Volume-Focused Quality

Measurement

• Health Care Provider Education and

Training

• Provider-Centric Evidence-Based

Programs

Working Toward a Solution …Ensuring a Rural Voice Within HHS

http://www.hrsa.gov/ruralhealth/index.html

Section 711

Of the

Social

Security

Act

Sec. 711. [42 U.S.C.

912] (a) There shall be

established in the

Department of Health

and Human Services (in

this section referred to

as the “Department”) an

Office of Rural Health

Policy (in this section

referred to as the

“Office”).

• Rural Specific Resources

• Grants

• State Offices of Rural

Health

• Population Neutral

Approaches in National

Programs

• Rural Reimbursement

Models

• CAHs, Swing Beds, RHCs

What works …

Benefits of a Level Playing Field

• The Community and Migrant

Health Center Program

• The National Health Service

Corps

• Medicare Incentive Payments

• Head Start

You’re Welcome …

• Rural innovations

discovered by urban

folks

http://www.whitehouse.gov/administration/eop/rural-council

The White House Rural Council

• Key Steps So Far …

• Rural Provider Burden

Reduction

• http://www.hrsa.gov/ruralhealth/policy/p

olicyupdate03142013.pdf

• CAHs NHSC Expansion

• Access to Capital for Health

IT

• Health IT Pilots for Rural

Veterans

• Rural Health Philanthropy

Partnership

Looking

Ahead

to

2015

The 2015 Open

Enrollment

Period Runs

through

February 15

The Health Insurance Marketplace

The Rural Uninsured: What We Know

• More likely to be eligible for coverage under the

Marketplace

• More likely to eligible for coverage under the

Medicaid Expansion

http://www.public-health.uiowa.edu/rupri/publications/policybriefs/2014/The%20Uninsured.pdf

Rating Areas & Rural

• Year One Quite Variable

• Link to Population Density

http://www.public-

health.uiowa.edu/rupri/publications/policybriefs/2014/Geographic%20Variation%20in%20Premiums%20in%20Health%20Insurance

%20Marketplaces.pdf

ORHP Bi-Weekly

Outreach & Enrollment• Highlight Innovative

Approaches

• Share Strategy

• Question and Answer with

Follow-Up

• Contact: Helen Newton

• hnewton@hrsa.gov

Promoting the Rural Coverage Expansion

From Crisis to Creativity• Assessing Rural

Hospital Risk

• Re-Thinking Mix of

Models for Rural

• Learning from Current

Pilots and Demonstrations

ORHP Community Health

Funding and ResourcesFY 2015/16 Competitive

Programs

• Small Health Care Provider

Quality Improvement Program

(FY 16) *

• Rural Health Network

Development Planning Program

(FY 15 and FY 16) *

• Care Coordination

• Allied Health

http://www.raconline.org/communityhealth

Workforce

• President’s 2015 Budget

• Re-Thinking Residency Training

• Expansion of the NHSC

• ORHP Investments

• Rural Training Tracks

• Health IT Training

• Allied Health

Contact Information

301-443-40835

tmorris@hrsa.gov

www.ruralhealth.hrsa.gov