Federal Office of Rural Health Policy Update: The Current State of Rural Health

1. Federal Office of Rural Health Policy Update: The Current State of Rural Health Nebraska Rural Health Conference April 24th-25th, 2019

2. Health Resources and Services AdministrationOverview • HRSA supports more than 90 programs through grants and cooperative agreements to more than 3,000 awardees • HRSA provides access to health care for people who are: • Geographically isolated • Economically or medically challenged • HRSA programs serve tens of millions of people every year, including: • Pregnant women, mothers and their families • People living with HIV/AIDS • People living in rural communities • Those otherwise unable to access quality health care

3. Health Resources and Services AdministrationOverview • Eleven million people living in health professional shortage areas receive primary medical, dental or mental health care from a National Health Service Corps clinician in the past year. Over 61 million pregnant women and childrenin the U.S. supported by the Maternal and Child Health Block Grant. More than 160,000 parents and children served by the Home Visiting Program Nearly 26 million peoplereceive primary medical, dental, or behavioral health care from a health center. One in four rural residents gets care from a health center. One in 2 people diagnosed with HIV receives care through the Ryan White HIV/AIDS Program.

4. Federal Office of Rural Health Policy New in 2018 & 2019: Rural Community Opioids Response Programs and Rural Residency Programs

5. The Federal Office of Rural Health Policy

6. Resources to Know….. www.ruralhealthresearch.org www.ruralhealthinfo.org

7. What Does Access to Care Look Like in Rural Communities?

8. The Federal Office of Rural Health PolicyHealth Resources and Services Administration Rural Health Workforce Realities Source: WWAMI Rural Health Resource Center

9. The Federal Office of Rural Health PolicyHealth Resources and Services Administration Rural Health Workforce Realities

10. Availability of Behavioral Health Providers

12. Rural Hospital Closures

13. The Federal Office of Rural Health PolicyHealth Resources and Services Administration

14. The Federal Office of Rural Health PolicyHealth Resources and Services Administration

15. Maternal Health – Access to OB Services Between 2004 and 2014: • The percent of rural counties with hospital-based obstetrics services declined from 55% to 46%. • 179 rural counties (9% of all rural counties) lost access to in-county hospital obstetric services. • Women living in rural noncore counties (areas with less than 10,000 residents) were disproportionately affected by the loss of hospital obstetric services. • Only 30.2% of rural noncore counties had continual hospital obstetric services compared to 77.9% of micropolitan counties.

16. Access to OB Services So What Happens After Communities Lose OB Services? In the year after loss of services rural counties not adjacent to urban areas had significant increase in: • Out-of-hospital births • Births in a hospital without obstetric services • Preterm births In the year after loss of services rural counties adjacent to urban areas had significant increase in: • Births in a hospital without obstetric services

17. Access to Obstetrical Services • Rural Maternity and Obstetrics Management Strategies Program (RMOMS) • The RMOMS pilot program intends to demonstrate the impact on access to and continuity of maternal and obstetrics care in rural communities. • Up to three cooperative agreements • 4-year award • Year 1 is forplanning activities (up to $600,000) • Years 2 through 4 are for implementing activities (up to $800,000) TA Webinar: April 30, 2019 Application Deadline: May 24, 2019

18. Pharmacy Closures • 1,231 (16%) independently owned rural pharmacies closed • 631 rural communities that had at least one retail (independent, chain or franchise) pharmacy in March 2003 had no retail pharmacy in March 2018

19. Tracking ACO Coverage in Rural Areas

20. Scope of Practice

21. Rural Health Disparities

22. Life Expectancy at Birth (Years) by Levels of Rurality, United States, 2010-2014 Source: Singh GK, Siahpush M. American Journal of Preventive Medicine. 2014;46(2):e19-e29 (updated data)

23. Potentially Excess Death • In 2015, a higher rate of potentially excess deaths occurred among rural Americans than urban Americans from: Heart disease • More than 26,700 excess deaths • 43.6% in rural areas; 27.9% in urban areas • 56% higher in rural areas than urban Cancer • More than 18,800 excess deaths • Overall cancer deaths declined between 2003 - 2017 • declined less in rural (1% per year) vs. large urban areas (1.6% per year) • Unintentional injuries • More than 13,200 excess deaths • 59.6% in rural areas; 43.5% in urban areas • 37% higher in rural areas than urban • Chronic lower respiratory disease • More than 11,600 excess deaths • 56.0% in rural areas; 31.9% in urban areas • 75% higher in rural areas than urban 23

24. Suicide Mortality

25. Chronic Obstructive Pulmonary Disease • Limited Access to Respiratory Therapy • COPD Underdiagnosed • Significant Driver in Costly Re-Admissions

26. CancerAverage Annual Age-Adjusted Rates of New Cases of Common Cancers (2009-2013) and Deaths from Common Cancers (2011-2015) • Overall, nonmetro rural areas had lower incidence ratesbut higher death rates • Some variation by typeof cancer

27. Addressing the Opioid Epidemic

28. Addressing the Opioid Epidemic

29. Addressing the Rural Opioid Challenge Unique Challenges: • Limited Infrastructure • Access to Needed Services (MAT, DEA-waivered Clinicians, etc.) • Stigma • Scale The Rural Community Opioids Response Program: • Build on Lessons Learned from Early Program Investments • Rural Opioid Overdose Reversal Program • Rural Health Opioids Program • Executive and Legislative Branch Support • 2018: $130 Million • $30 Million for Loan Repayment • 2019: $120 Million

30. Collaborating for Rural Across HHS

31. The challenge…. How will rural providers with special payment types designed to maintain access to services in rural and underserved communities fully participate in new payment models? The concern…. That the very payment policy provided to maintain access in rural and underserved communities may now undermine participation in innovative care delivery and payment models going forward… ….and ultimately undermine access to services in those rural and underserved communities.

32. CMS Rural Health Strategy • Apply a rural lens to CMS programs and policies • Improve access to care through provider engagement and support • Advance telehealth and telemedicine • Empower patients in rural communities to make decisions about their health care • Leverage partnerships to achieve the goals of the CMS Rural Health Strategy

33. Rural Involvement in CMS Innovation Center Models and Programs Rural-Relevant Models • Medicare Shared Savings Program • ACO Investment Model • Comprehensive Primary Care Plus • Accountable Health Communities (AHC) Model • Frontier Community Health Integration Project • Regional multi-payer concepts, e.g., global budgeting (MD, PA)

34. Rural Focus at Centers for Disease Control (CDC)

36. Connecting with HRSA

37. HRSA Needs Your Help Become a HRSA Grant Reviewer https://www.hrsa.gov/grants/reviewers/index.html

38. FORHP Weekly Announcements • Rural-focused Funding Opportunities • Policy and Regulatory Developments Affecting Rural Providers and Communities • Rural Research findings • Policy updates from a Rural Perspective To sign up: Email Michelle Daniels at mdaniels@hrsa.gov

39. www.ruralhealthinfo.org

40. Contact Information Sarah Heppner Director – Policy Research Division sheppner@hrsa.gov Kerri Cornejo Policy Coordinator kcornejo@hrsa.gov Federal Office of Rural Health Policy (FORHP)Health Resources and Services Administration (HRSA) Phone: 301-443-0835 Web: www.hrsa.gov/ruralhealth/ 40

41. Connect with HRSA To learn more about our agency, visit www.HRSA.gov Sign up for the HRSA eNews FOLLOW US: