NOSORH offered an informative webinar on Improving Rural Health Network Adequacy in February. In case you missed it, all the materials and recording have been posted to NOSORH’s website. The Patient Protection and Affordable Care Act (PPACA) has changed the regulatory environment for health network adequacy. New regulations and guidance are being issued at the both Federal and State levels. The webinar explored opportunities for State Offices of Rural Health to participate in the new efforts and approaches to assuring that health networks, including Qualified Health Plans (QHPs) and Accountable Care Organizations (ACOs), have adequate providers and facilities.
As the PPACA continues to rollout, we see that special arrangements are needed to meet inadequate numbers of providers or facilities in rural shortage areas to ensure appropriate access to enrollees. SORHs are knowledgeable about services in these communities and are well placed to participate in efforts to assure appropriate rural health care.
There are several new initiatives designed to improve the regulation of health network adequacy nationwide. There will be new opportunities at the State and Federal level for SORHs to address this issue with State Medicaid programs, State Insurance Commissioners and Health Exchanges.
Listen to the first webinar on the requirements for Network Adequacy and how SORHs can get involved and help implement strategies that makes the most sense for rural areas. As this process unfolds, NOSORH will provide more learning opportunities to review the changes in the coming year.
Back to March Branch
In an effort to provide consistent medical care to thousands of underserved residents, South Carolina’s “Medicaid System” has implemented a statewide program designed to coordinate care and provide a medical home for some of its most at-risk residents.
Now in its second year, the Healthy Outcomes Plan (HOP) asked every hospital in the state to identify a predetermined number of low-income, uninsured residents who visited the emergency department at least five times in the last year, and who suffered from a chronic condition such as diabetes, cardiovascular disease, hypertension, sickle cell or HIV/AIDS. The size of the hospital determined the number of residents they were required to identify, with 50 being the minimum for the state’s smallest hospitals. All of South Carolina’s hospitals are participating in the program. The state’s three largest metropolitan hospitals had to identify at least 750 residents. “Activity always follows the dollar,” said Graham Adams, Ph.D, CEO of the South Carolina Office of Rural Health (SCORH). “The hospitals were incentivized to get on board or they would lose the Disproportionate Share Hospital (DSH) money they were already receiving. Plus, the state gave additional money to every hospital involved in the program. Our 19 rural hospitals received 100% of their DSH money.”
Dr. Adams went on to say that HOP is particularly important in the rural areas, where residents are less likely to have a medical home and often wait until they are very ill before visiting an emergency department for care. SCORH provided technical assistance to rural hospitals in the development of the program. “Rural providers have a close relationship with their patients and as a result were more successful in identifying and bringing new patients into the program.” The goal for the first year of HOP was to enroll 8,500 residents.
Now in its second year, Dr. Adams said the program has been beneficial because it provides a medical home and a system of care for people who really need it. “It gives incentives for medical providers to work together for these folks well-being. Controlling the chronic illnesses of our residents is one of the biggest benefits so far,” he said. “Overall, it’s been a very positive thing.”
Back to November Branch
THE WHITE HOUSE
Office of the Press Secretary
FOR IMMEDIATE RELEASE
April 17, 2014
FACT SHEET: Affordable Care Act by the Numbers
The Affordable Care Act is working. It is giving millions of middle class Americans the health care security they deserve, it is slowing the growth of health care costs and it has brought transparency and competition to the Health Insurance Marketplace.
HEALTH CARE BY THE NUMBERS
HEALTH CARE COST GROWTH IS LOWEST IN DECADES
THE SECURITY OF HEALTH INSURANCE FOR MILLIONS OF MIDDLE CLASS FAMILIES
An online brochure, created by the Southwest Rural Policy Network (SWRPN) and distributed by the Arizona State Office of Rural Health, aims to provide quick and easy information on the Affordable Care Act (ACA) for a rural audience there.
The brochure was a response to a W.K. Kellogg Foundation initiative called Rural People, Rural Policy and was developed by the SWRPN’s Health Action Team, according to Joyce Hospodar, AZ SORH Health Systems Development Manager and SWRPN Action Team Chair. Using money from that initiative, the AZ SORH was able to make printed copies to distribute in the state, which so far it has distributed to many organizations including AHECs, FQHCs and hospitals. “All the other material we are seeing on the ACA is so complicated,” Hospodar said. “We’re trying to get the information more understandable to people living in rural communities. As people become more aware of the ACA, we’ll be able to increase their participation in what they’re eligible for, so more people will be getting insurance and be involved with the benefits of the ACA.”
Feedback on the brochure has been positive, Hospodar said. “The momentum is increasing, more people are wanting it. It has been lauded for ease of use.” By popular demand the brochure is being translated into Spanish, and public service announcements are being written from it in both English and Spanish, which will be targeted for national distribution.
Funding for development of the brochure came from the Kellogg Initiative. Despite the up-front costs of web development and printing, Hospodar said, she thinks it will be a good investment. “So many organizations are working to get the word out about the ACA that there’s lots of duplication. We’re trying to streamline it. The brochure can be used to answer questions that patients—and citizens—have about the ACA quickly and easily.”
Hospodar said that both the online and print brochure versions can be modified and used by other State Offices of Rural Health (SORHs), but it will require some funding for the modifications. The New Mexico members of the Health Action Team have tailored the brochure for their state and have made it available online. To access the Arizona and New Mexico ACA brochures, visit the SWRPN Affordable Care Act page. SORHs that are interested in adapting the brochure for their use can contact Hospodar for more information, at email@example.com or 520- 626-2432.
The Kentucky Office of Rural Health (KORH) is helping get the word out about the Kentucky Health Benefit Exchange (KHBE), the state-run health insurance program, by helping facilitate information sessions in different regions of the state.
The sessions are geared toward health care providers, administrators, boards of directors, community agencies, coalitions, navigators, mid-level managers, front-line staff and other health care workers. “Our partners wanted more community-type events, so we thought, if they’re willing to put forth the effort, we’re going to give it a shot,” said Kayla Combs, KORH rural project manager. “The people working within the exchange have been wonderful to work with. Since they have been so willing to help we
decided to do a roadshow of sorts.”
The sessions have featured KHBE leaders and staff doing a two-hour presentation, with the first half outlining details of the exchange, followed by a question and answer session. Two sessions have been held so far. The first session, held at the UK Center of Excellence in Rural Health in Hazard, where KORH is located, had 100+ attendees, including some that joined in over iTV. The second was held in Paducah, in the western part of the state, and had around 85 attendees. KORH staff has been on hand at the
sessions to register participants and help facilitate.
Although Kentucky has been one of the most successful states in signing up people for insurance, with more than 10 percent of its estimated 640,000 uninsured signed up by the end of November (an average of 1,000 a day), Combs said that she has been surprised that many providers have been unaware of KHBE, its kynect web site, and how it works. “In smaller practices, the providers are so busy that it just crept up on them, so this educates them on the basics,” she said.
KORH Director Ernie Scott attributes the success of the sessions to “a simplified marketing strategy, as well as great partnering organizations.” KORH has sent out invitations to all area healthcare providers and rural stakeholders. The one-page flyer for the sessions is simple, with meeting information, the kynect logo at the top and a list of sponsors at the bottom. “We encourage everyone to forward it on and distribute it within their communities,” Scott said. “But, locally, we’re finding that email is not the only option.” KORH has been faxing the flyer to doctors’ offices. “Doctors in smaller practices are so busy, they otherwise miss a lot of electronic communications,” he explained.
The next session, planned for January 16th in Morehead, KY, will be the first to offer an additional evening session for the general population. “We’ve been putting out local ads, putting flyers in beauty shops, any place where folks who would benefit can see them,” Scott said. “And kynectors (Kentucky patient navigators) will be available to sign people up on the spot.”
Both Combs and Scott feel an urgency to assist and educate rural providers in getting the uninsured signed up for coverage. Scott said that a local hospital chain recently sent out notice that it will “no longer see patients for non-emergency services next year since everyone is expected to have some form of insurance, ‘consistent with the Affordable Care Act’. “If this hospital takes a stand, others will certainly follow,” he said.