Initiatives-Rural Health

The Rural Health Initiative (RHI), introduced in March 2012, is focused on identifying strategies for significantly improving health care access and reducing health inequities in three rural counties that are part of the Foundation’s service area. In 2012, the REACH Foundation will provide grants and other technical assistance to support planning activities involving local leaders and community stakeholders in Cass and Lafayette counties in Missouri, and Allen County, Kansas. Each county will establish a planning team charged with assessing their county’s health needs, creating a network of stakeholders, and establishing a climate for experimentation and innovation. Each planning team will develop proposals for strategies and initiatives aimed at increasing access to health services and improving conditions that contribute to health inequities in their counties. In 2013, the Foundation will work with the teams to fund strategies with the highest potential to achieve improvements. (Read the press release and initiative overview.)

Background

National statistics and local data reveal a concerning portrait of health care and health outcomes in rural communities. These data sources confirm the growing inequities between rural and urban communities. Rural communities have a lower ratio of health care providers to patients than urban communities, and face geographic barriers that may further limit access to health care.

The 2012 County Health Rankings for Allen, Cass and Lafayette note a serious shortage of primary care physicians. The ratio of population to primary care physicians in the three counties are three times higher than the national benchmark. Allen, Cass and Lafayette counties also have higher rates of preventable hospital stays, and lower rates of diabetic screenings and mammography. Life expectancy is lower than the national average in two of the three rural counties. Each county exceeds the national average for premature death. Across virtually all indicators of quality of health, residents of rural counties suffer from lack of high-quality, affordable health care and poorer health outcomes than people in more urban communities. When comparing health outcomes against national data, persons living in Allen, Cass and Lafayette counties die more often from chronic and/or preventable conditions, such as colon cancer, coronary heart disease, lung cancer and stroke. (See rural health data)

Phase I – Local Leadership Development and Planning

The planning phase of the initiative (March-December 2012) is designed to:

• Develop county leadership and collaborative processes for carrying out the initiative;
• Engage a cross-section of county stakeholders in contributing ideas to the proposals of county leadership teams;
• Build effective networks within counties that can implement coordinated systems of care for residents;
• Increase discussion and deliberation within counties and across the three initiative counties through learning communities and electronic networks, and develop a common framework for understanding how rural communities can tackle inadequate health care systems;
• Identify high-impact strategies, the evidence for their potential, and an action plan for moving into implementation.

 Phase II – Investment in Innovations

Based on work plans and frameworks developed during the planning phase, the Foundation will provide additional funding and engage other public and private partners to support high-impact strategies and strengthen the network of supports for the rural communities. The Foundation also will engage evaluators to document the work of the initiative, and provide information that can be used to adjust program strategies and track changes in health care access and health outcomes.

Resources and Reports

The REACH Foundation reviewed the work and research of numerous organizations in planning for the initiative. One useful report is  “Modernizing Rural Health Care: Coverage, Quality and Innovation” (July, 2011), a working paper published by UnitedHealth Center for Health Reform & Modernization. The report identifies the following areas of focus for increasing health care access in rural communities:

1. Provide supports and incentives to expand the availability of rural primary care physicians.
2. Encourage greater teamwork in rural primary care, including making full use of the skills of advanced nurse practitioners and other health professionals.
3. Increase clinical collaboration across rural regions and with urban providers.
4. Support greater integration and coordination of rural health care with health information technology.
5. Use mobile infrastructure to bring care to rural areas.
6. Adopt new approaches to improving consumer health and wellness, including new alliances with third-sector/non-traditional partners.

Other reports and resources consulted include:

Network Weaver Handbook, June Holley, 2012.

County Health Rankings & Roadmaps: A Healthier Nation, County by County, Robert Wood Johnson Foundation and University of Wisconsin: Population Health Institute, 2012.

Quality Through Collaboration: The Future of Rural Health Care, National Research Council, 2005. Read the Executive Summary. 

Rural Health Care: Innovations in Policy and Practice, Grantmakers In Health, March, 2009.

HHS Health Resources and Services Administration-Rural Health Policy

Rural Policy Research Institute

National Rural Health Association