NOSORH is documenting efforts of SORHs in a Regional Meeting state sharing compilation to increase collaboration between states.

Region A

Several SORHs in Region A were interested in how Massachusetts shares information from RAC and other resources with their constituents.  Kirby Lecy from the MA SORH provided a brief tutorial on the templates she has set up to easily share rural health news in her state.  Click here to watch a brief web demo on Massachusetts’s listserv efforts.  Read more for a complete compilation on all the state sharing from Region A.

Region A Regional Partnership Meeting State Sharing:

Connecticut

Last year, the Connecticut SORH provided Smart Triage Training.  Meeting facilitation began in August with 3 face-to-face meetings and 1 teleconference. From October through November, they held 5 consecutive trainings on Saturdays throughout the state in rural areas.  122 people representing 34 EMS organizations were trained.  11 additional EMS providers representing 10 more EMS organizations were trained in the NW part of the state through train-the-trainer education.  A regional mass casualty training with a mock explosion was held in an elementary school.  There were 165 participants, 16 agencies, 6 hospitals, long-term care facilities, and local health departments during the 7-hour event.  The event was video recorded and will be turned into a training.

 

Delaware

The Delaware Division of Public Health has submitted for Public health accreditation.  Delaware’s Health Care Commission received a SIM grant to develop a Delaware Center for Health Innovation and have established a board and 5 committees.  The DE SORH is following the workforce and education committee who are retraining the current workforce to develop a team-based model in a primary care home and will utilize theater training for chronic care conditions to develop core competencies for care coordinators, building workforce planning capabilities and cultural competencies.

The DE SORH is also working on recruitment with NHSC.  SLRP is not in their office but work with collaboratively.  They are working with J1 sites to build capacity and continuity of care and are conducting a customer satisfaction survey with J1 clinicians and sites.  The DE SORH is focusing lots of work around conferences and training and a focus on mental health and want to have quarterly based meeting to work on an issue at a time.

 

Massachusetts

The Massachusetts Rural Council on Health is ramping up for this year. The restructuring of the group a few years back allowed it to be a smaller group that could not only advise the office on issues and concerns of rural health, but work as a collective voice around rural health for the state.

The MA SORH is revamping 3RNet efforts in their state by getting out to talk to their health centers and hospitals about it. They have visited almost all in state and provide a weekly retention update with a list of candidates. The MA SORH is targeting certain areas having issues and have found it helpful to talk about skills. They are starting to tackle helping facilities utilize community-based groups to help with retention.

The MA SORH has partnered to foster a rural scholars program for 10 years and are taking a look back and re-contacting all the graduates and finding out if rural training track was helpful for where they went for residency and to practice.

In light of the recent hospital closure in the Northern Berkshires, the Northern Berkshire Community Coalition was just awarded a network grant to help bring the regional hospital system, regional community mental health provider and regional community health center together to listen to the community’s needs, plan strategically around models and types of service going forward and to share that plan with community members to help garnish support around a more population health approach to health in the Northern Berkshires. One focus they are looking at specifically is community mental health.  The MA SORH is in contact with the office of EMS around community paramedicine. Two urban based pilots are currently running, a future rural site is a possibility.

The MA SORH offered a CEO/CFO forum with CAH and SHIP hospitals that was very successful. The shaky bridge project was facilitated by Stroudwater and focused on getting from FFS to value-based. They discussed what concrete steps they need to do to get there. Stroudwater also developed a tool to evaluate online assessment to help target training and resources. Additional work is being done within those hospitals to look at the individual needs found in using the assessment tools.

 

Maine

There has been a significant change in Matt’s role. He is now the Assistant Director of the Maine DHHS, Division of Licensing and Regulatory Services and remains as the Director of the Maine Rural Health and Primary Care Program.

The Maine Office has hired Nicole Breton, formerly of the Maine DHHS, Oral Health Program to oversee Flex and SHIP.  They also administer a pilot Rural Veteran’s Health Access Program grant, which offers veterans the opportunity to receive healthcare services through the Maine Veteran’s Healthcare Administration or through local healthcare and their health records will follow them.  Data is now being collected to show the number of veteran’s records entering the health exchange and being shared by various healthcare entities in Maine.

This is the 25th year of the Maine Rural Medical Access Program which supports OB/GYN and Family Practice Physicians who practice in underserved areas with their malpractice rates. Since 1999, the Program has supported an unduplicated 163 physicians who have completed 277,396 prenatal visits and have delivered 25,737 babies.

Additionally, Maine applied for and received the State Loan Repayment Program grant totaling $350,000/ year in 2014 and are supporting thirteen primary care providers in Health Professional Shortage Areas with their student loan debt.  Eleven of the providers are at community health centers and two are at hospitals.

 

Maryland

The Maryland SORH is working collaboratively with the AHECs to develop a program that includes tax incentives for primary care preceptors in rural areas, gain funds for continuing medical education, gain funds for continuing education for ancillary health professions, training of community health workers, gain funds for pipeline (educational tracking) development, and specifically research avenues to investigate the educational needs of mid level providers. The SORH, in conjunction with the AHECs, is advocating for more state matching funds that will support the rural residency track, which will bolster rural recruitment and retention.

The SORH is partnering with rural communities to inform them about the J1 foreign medical graduate program, National Health Service Corp scholarships, and state loan repayment programs that will allow rural hospitals and practitioners to attract physicians to their communities. The SORH is working closely with the Office of Population Health Improvement to link into already existing community groups such as the Local Health Improvement Coalitions, local health departments, and other rural community groups.

The SORH is actively seeking the results of a workforce retention study that includes cultural competencies to understand why providers are leaving the community after their initial obligation and how the community can better engage the provider and their family.

The SORH is updating its’ Maryland rural health plan with an expected completion date of Winter 2016. The SORH continues to participate in the Rural Maryland Council (RMC), maintain membership on the RMC health committee, participate in tele-health development for the state of Maryland, maintain membership in the Maryland Rural Health Association and its’ legislative and health committees.

 

New Hampshire

New Hampshire launched their first RHC Technical Assistance network through a combined contract with the CDC funded chronic disease program. The NH SORH is providing basic technical assistance – and also funding a quality improvement project focused on hypertension control (NQF 18). New Hampshire has 14 RHCs with 13 already on board. The SORH is conducting in-person interviews with a webinar on the 29th .

The NH SORH has received $1.6 million in funding for the State Loan Repayment Program from unreimbursable malpractice insurance premiums and are working on expanding to offer loan repayment to substance abuse providers (MLADC and LADC).

The NH SORH has launched the NH Health Professions Data Center and completed surveying physicians to establish a baseline and will be surveying the other licensed provider types as well. The NH SORH built the surveys around the minimum data sets that HRSA had available – the data will be used for shortage designation, collecting information on workforce diversity, and measuring retention of SLRP and J1s.

 

New Jersey

In the last year, New Jersey has seen lots of changes in the Department of Health by rejoining Primary Care with the Department of Health.  The NJ SORH worked with the Rutgers School of Public Health to conduct a statewide rural health assessment and are in the process of finishing up focus groups with a stakeholder advisory council.  The statewide rural health assessment will be completed this summer and the recommendations will be incorporated in the Rural Health Plan to be completed by the end of the fiscal year.  The NJ SORH is matching the community health needs assessments that have identified high rates of suicide, behavioral health, increase in domestic violence, and high dental caries and moving to evidence-based projects that are outcome driven.

Expansion of Medicaid in NJ has allowed many eligible New Jerseyans access to affordable health coverage. However for the undocumented, coverage is not available. ACA implementation has gone well and the uninsured rate went down 26% with an additional 1.4 million insured.  However, the post ACA has showed that many NJ residents that initially applied for coverage are having difficulties paying for the premium fees and have now opted out of this coverage and are now willing to pay the penalties.

 

New York

The New York SORH is working with rural health networks throughout the state as they develop clinically integrated systems and accountable care organizations. The SORH is also working with hospitals to help them remain viable as the state transitions to a new payment system under a Medicaid waiver. There have been no rural hospitals that have closed and the SORH has worked with many as they reconfigure services and develop affiliations to continue providing services to their communities. The NY SORH is currently participating in a telehealth workgroup. Telehealth parity legislation was recently passed to address the physician shortage situation.  Additionally, NY was awarded a large SIM grant. The SORH is on the workforce advisory board.

 

Pennsylvania

Earlier this year, Pennsylvania surveyed the state’s RHCs to determine their areas of need for information and technical assistance. The PA SORH is contracting with the South Carolina SORH to do a series of webinars in July and August for the RHCs on RHC management and billing and on ICD-10 conversion. Based on the hoped-for success of those, the PA SORH will be continuing that series of webinars. In collaboration with partners in the state, the SORH held a statewide Community Health Worker Summit and a Community Health Worker strategic planning meeting. The workgroups established at the strategic planning meeting will be working in the next year to develop a plan for Pennsylvania to integrate Community Health Workers into health care policy, practice, and payment. The state has a new governor and secretary of health. The state is considering Medicaid expansion and establishing a state-based exchange.

Larry Baronner, Rural Health Systems Manager, has established a population health initiative and has contracted with the Healthy Communities Institute at the University of California-Berkeley to assist counties and communities to collect and assess county data and develop programs to address specific areas of need.  To date, 11 of the state’s 67 counties are participating in the project.

 

Rhode Island

The Rhode Island SORH is working with tobacco control to do outreach in the rural areas where youth smoking rates were 3x the urban rates.  New data shows the rates were lowered from an average of 15.5% in rural areas to 11%.  They secured a seat on the Oral Health Commission, and are working with them on a series of Senior Outreach projects to begin this fall.

Last Fall, they began face-to-face meetings with FQHC’s to understand the needs of these health centers and learn how we can help. Key needs include recruitment and retention.  The RISORH created materials with 3RNET and has provided TA to the health centers in regards to this.  They had 13X as many jobs posted this past year!

RISORH met with all State Loan Repayment recipients to tell them about our work and listen to their goals and priorities for their continuing work in our state and had a celebration to honor them.  RISORH is re-evaluating their scoring criteria, as the geographic distribution of FQHC’s has changed.

RISORH track each time a candidate reaches out to them and follow up to see if they have registered with 3RNET and consider these referrals to the 3RNET site as invaluable to the candidate and to the rural workforce, both locally and nationally.

RISORH is working with the USDA, the Fisherman’s Association, and the WIC farmer’s market program to connect services and facilitate contacts.  The USDA is currently funding a Central Falls project in RI.

RISORH are currently interviewing candidates for a Public Health Epidemiologist position.

The impact of the ACA in Rhode Island includes:

  • The FQHC’s have seen a surge in the number of patients and those enrolled. This has put pressure on our office for HPSA rescoring and helping with capacity around staffing at these facilities.
  • RISORH has worked with HealthSource RI to improve the health of all Rhode Islanders by connecting them to brand-name, affordable health insurance, making sure that our rural areas received guidance.

 

Vermont

Vermont recently received a 3-year RWJF grant and has added 2 new staff to the Planning and Healthcare unit to explore “Health in All Policies” across state government. Vermont has had a Medicaid waiver for years, allowing for expanded coverage and funding to support free clinics, clinician loan repayment and FQHC expansion through the SORH/PCO, among other health services to under-served populations. The VT Department of Health became accredited in 2014, and is preparing for its second review. Vermont Health Connect (our insurance marketplace) is not working as well as hoped, and is looking at other options, including partnering with Connecticut. In 2013, Vermont mandated the reporting of FTE by location with re-licensing with 40 different healthcare professions, instead of three professions. The VT SORH is using some SIM funds for an additional data analyst to assist in that work, and will issue their first report on dentists relicensed in 2013 this summer, followed by physicians by Fall, for primary care and mental health shortage designations. This Summer/Fall, they are convening rural health summits in 12 of 14 counties with leadership from CAHs, FQHCs, RHCs, long-term care, home health and other human service agencies that share the same patients. John is Co-chairing the New England Rural Health conference in November, and the New England states are hosting a summit for rural and CAHs making the transformation from volume to value, as part of their Federal Partner Day as pre-conference events.

 

Virginia

The Virginia SORH is revitalizing their SORH program and looking at programs to come up with a new way of thinking about it to be fully engaged. A large component of this work is identifying critical needs and developing programs to address those needs using innovative approaches, evidence based programs, and new and renewed partnerships across the state.

Telehealth is in a good environment with strong community partners and regulatory support. The VA SORH is in the process of conducting a needs assessment for local health districts to determine the best strategy to increase telehealth uptake and utilization across the state in the VA Department of Health.

The Community Service Boards (CSB’s) and Veteran’s Administration have been connected via telehealth to improve access to mental and behavioral health services for veterans in a needed region in Southwest Virginia. Through this program Veterans can now go to their local CSBs’s to receive services from the Veterans Administration, reducing travel time and expense and expanding access for veterans in a rural and mountainous region of Virginia.

The VA SORH is very data driven now and with direction from the health commissioner to make sure they use data, incorporate in everything they do. They have a couple of great data people in the office, and this knowledge has been shared openly with every VA SORH staff member. As part of this work the VA SORH is developing a comprehensive Health Opportunities Index that combines a litany of indexes of social determinants of health to document and identify the areas within the state with a low Health Opportunities. This index will be finalized in Fall 2015.

The VA SORH are in the early stages of developing a rural health pipeline, with the goal of tracking and understanding in detail the spread and flow of students across the health education continuum for various health professions. They are looking a data to see trends in workforce and what they can practically do for recruitment and retention.

 

West Virginia

West Virginia has a successful CAH network with 20 CAHs in state working on MBQIP and balanced scorecard.  The WV SORH is working with the

J1 Program and SLRP, but they still always have more available spots than they can fill.

The WV SORH is helping with a statewide initiative called Try This – West Virginia. www.trythiswv.com.  West Virginia usually has the lowest health outcomes and this effort is trying to get off the worst lists by promoting healthy solutions to chronic disease.

West Virginia is also working on recruitable communities to improve community development to improve economic health.

7 of 20 CAHs have RHCs that they are helping with ER admissions.

7 CAHs are level IV trauma and 4 more will be converting.

On NRHD, they are working with the School of Medicine – Marshall in Huntington to have recruitment fair on their campus.

The WV SORH surveyed J1 retention and learned 80-90% are staying in WV.

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