Federal Role in Rural Health Tom Morris Associate Administrator, HRSA - PowerPoint PPT Presentation

Federal Role in Rural Health Tom Morris Associate Administrator, HRSA Federal Office of Rural Health Policy

Infrastructure & Workforce Investment Infrastructure & Workforce Investment • Supporting Access via … – Enhanced Payments through Medicare and Medicaid • Special designations – CAH, RHC, Swing Beds, etc. • Pilots and Demonstrations – Workforce Training, Clinician Placement • (National Health Service Corps) – Access to Capital, Investments in Technology • Telehealth • Broadband • Electronic Health Records – Targeting Resources by Designating Shortage Areas (HPSA) 2

Key Federally Supported Parts of the Key Federally Supported Parts of the Rural Health Safety Net Rural Health Safety Net

Disparities in Rural America Disparities in Rural America • Rural populations are more likely than urban populations to be: – Living in poverty – Unhealthy, Older – Uninsured or underinsured, Medically underserved • Add to that social determinants: – Transportation issues – Housing – Income – Distance to facilities – Disparities w/in rural communities (tribal, racial etc)

Disparities in Rural America Disparities in Rural America Moy E, Garcia MC, Bastian B, et al. Leading Causes of Death in Nonmetropolitan and Metropolitan Areas — United States, 1999–2014. MMWR Surveill Summ 2017;66(No. SS ‐ 1):1–8. DOI: http://dx.doi.org/10.15585/mmwr.ss6601a1

Federal Office of Rural Health Policy Federal Office of Rural Health Policy State and Hospital Community Based Telehealth Programs Policy and Research Programs Programs State Offices of Rural Rural Health Research Telehealth Resource Black Lung, Delta, Opioids, Health, Flex and Small Centers, Rural Health Centers, Network Grants, Care Coordination, Rural Hospital Value, Rural Policy Licensure Portability, Rural Network Development and Improvement Programs, Analysis, RHC Policy and Child Poverty, Rural Planning, Quality Rural QI TA, Small Rural Clinical Assessment Veterans Health Access Improvement, Outreach Hospital Transitions

HRSA and Rural Health HRSA and Rural Health Nearly 26 million One in 2 Over 61 million Eleven million people receive people pregnant women and people living in primary medical, diagnosed children in the U.S. health dental, or with HIV are supported by the professional behavioral receives care Maternal and Child shortage areas health care from through the Health Block Grant. receive primary a health center. Ryan White medical, dental or More than 160,000 HIV/AIDS mental health care parents and children Program . from a National participate in the Federal Health Service Home Visiting Program. Corps clinician in the past year.

Key Challenge: Rural Hospital Viability Key Challenge: Rural Hospital Viability

Key Challenge: Obstetric Access Key Challenge: Obstetric Access

Key Challenge: Workforce Key Challenge: Workforce • MDs/DOs 5.5/10K non metro vs. Physicians 7.9/10K in metro • MD/DO/NP/PA 11.6/10K in non All Primary metro vs. 16.2/10K in metro Care • 3.6/10K non metro vs. 5.9/10K in Dentists metro Dental • 4.5/10K in non metro vs. Hygienists 5.0/10K in metro http://depts.washington.edu/fammed/rhrc/wp ‐ content/uploads/sites/4/2016/09/RHRC_DB160_Larson.pdf

Key Challenge: Behavioral Health Key Challenge: Behavioral Health • <> Source: WWAMI Rural Health Resource Center

Rural Ame ric a and the Opioid Epidemic Rural Ame ric a and the Opioid Epidemic Though opioid abuse and opioid ‐ related death has been on the rise nationally, rural communities face unique challenges Rural Dimensions of the Opioid Crisis The Rural Community Opioids Response 2018 President’s Budget and the 2018 Opioid ‐ related overdose deaths in rural • • Final Budget included a targeted focus areas increased more than 10% from for HRSA to address rural opioid crisis 2015 to 2016 challenges Rural residents are most likely to be • Targeted key HRSA populations prescribed, and overdose on, • Rural Underserved; People with prescription painkillers • HIV, pregnant women Rural residents with opioid use disorder • Multi ‐ Pronged Approach tend to be younger, less wealthy and • Prevention educated, un or uninsured • Treatment More than 60% of rural counties lack a • • Recovery single physician that can prescribe • Capacity Building buprenorphine, < 10% of opioid • Workforce treatment programs in rural •

USDA: A Key Rural Partner USDA: A Key Rural Partner for Rural Opioid Challenges for Rural Opioid Challenges NORC tool link: https://opioidmisusetool.norc.org/ USDA: https://www.usda.gov/topics/opioids

Resources Resources www.ruralhealthinfo.org www.telehealthresourcecenter.org www.hrsa.gov/advisory ‐ committees/rural ‐ www.ruralhealthresearch.org health/index.html

Potential Rural Partners Potential Rural Partners • State Offices of Rural Health • State Rural Health Associations www.nosorh.org www.ruralhealthweb.org/programs/state ‐ rural ‐ health ‐ associations

CMS Rural Health Strategy CMS Rural Health Strategy May 2018 ‐ CMS launches Agency’s first rural health strategy to improve access and quality of care for rural Americans. go.c ms.gov/ r ur alhealth

CMS Rural Health Strategy Objectives CMS Rural Health Strategy Objectives 1. Apply a rural le ns to CMS pro grams and po lic ie s 2. I mpro ve ac c e ss to c are thro ugh pro vide r e ngage me nt and suppo rt 3. Advanc e te le he alth and te le me dic ine 4. E mpo we r patie nts in rural c o mmunitie s to make de c isio ns abo ut the ir he alth c are 5. L e ve rage partne rships to ac hie ve the go als o f the CMS Rural He alth Strate gy

Other Federal Partners Other Federal Partners • Centers for Disease Control and Prevention https://www.cdc.gov/ruralhealth/index.html – https://www.cdc.gov/nchs/data ‐ visualization/potentially ‐ excess ‐ – deaths / • National Cancer Institute – Rural Cancer Control Initiative https://cancercontrol.can – cer.gov/research ‐ emphasis/rural.html • HRSA Programs

Thank you Thank you T om Mor r is tmo rris@hrsa.go v www.hrsa.go v/ rural-he alth/ inde x.html