Dave Palm is the director of the Nebraska State Office of Rural Health, a position he has held for two years. Prior to that, starting in 1999, Palm worked as the Flex Coordinator there.  

What do you think is the biggest challenge facing your SORH—and other SORHs, as well?

I feel that our greatest challenge is to understand the changes that are occurring in the health care system (e.g., value-based purchasing, and the shift to population health) and to determine how our office can be most effective in helping rural providers and residents adapt to this new environment. While the path is somewhat “fuzzy,” our office can play a crucial role in helping rural communities overcome resistance to change.

For example, we are trying to figure how our office can promote Patient Centered Medical Homes (PCMHs). We’ll probably use some of our SORH money to leverage this, along with the Nebraska Medical Association, to educate clinics on what it means to be a PCMH. Right now we have between 30 and 40 physician clinics in the state that are at some stage of PCMH.

We also are involved in helping local health departments with their community needs assessments (CNAs). The deadline has passed for Critical Access Hospitals (CAHs) to complete the CNA, and now those hospitals are in process of implementing their plans. We’re compiling information, documenting what the implementation activities are, and helping connect hospitals with other partners in their county area (like local health departments) that are working on similar things. We have funded some of these projects. CNAs generally have three to five priorities, including mental health/substance abuse; access to care; chronic illness or risk factor such as diabetes or obesity; and cancer screening. We have high colon cancer rates here, so that’s a priority.

How can a SORH succeed in meeting these challenges?

To be successful, we must learn to become better change managers, create more effective collaborative partnerships, and know when to lead and when to follow. While all rural communities must change, there is not a single solution that will work in all communities. As a result, we must listen to them and help them meet their unique needs and desires. We need to be a voice of optimism, and understand that communities move at a different pace. Maintaining the status quo is not an option.