by Beth Blevins
The Oregon Office of Rural Health (OORH) has created a new repository that houses state and federal telehealth policy and payment resources in response to rapidly evolving changes during the COVID-19 pandemic.
COVID-19 Telehealth Policy and Payment for Oregon Clinics and Hospitals uses ArcGIS StoryMaps, an interactive platform with sections on the CARES Act, the Oregon Disaster Relief Waiver, state and federal payment resources, and pertinent webinars and events. It went live on April 3, 2020.
“When COVID-19 started, there was a rapid fire of policy changes coming out,” said Rose Locklear, OORH Field Services Program Manager. “I wanted to create a resource to organize all the information in a way that made sense to me. And I realized that just putting them up on our website as links wasn’t going to be useful—if I couldn’t quickly find what I was looking for others would probably experience the same thing.”
Locklear said she also realized that the situation was constantly evolving, meaning that something published at the beginning of March would no longer be relevant a couple of weeks later. “So I wanted to put these resources in something that was easy to navigate and update on my end without having to go through our IT, because by the time they might update it I would need to make another change,” she said.
Locklear chose the ArcGIS StoryMaps platform because it offered her “something to throw everything into,” she said. “The story map allows you to import text, images, hyperlink to sources, and embed multimedia content. On the left side you can import text and on the right side you can put in maps, web pages, or videos. It’s not perfect, but works well to organize and house quality information, and it’s free.” (The public account of the ArcGIS platform, which she used for the story map, is free for personal, noncommercial use.)
“I’m not a data person—my background is in public health,” Locklear said, “but I enjoy visualizing data and making it easy for people to understand. In public health, in general, that’s often a challenge. We’ve got so much information—how do we organize it and display it so people can easily find it?”
Another challenge was that the CARES Act has increased the number of healthcare facilities that can provide telehealth services during the pandemic. “You’ve now got folks who never did telehealth before, who need to understand the basics about payment rules and regulations because these differ by payer,” Locklear said. “So, I had to create something that incorporated all these pieces.”
The intended audience is anyone who wants a crash course in telehealth policy or any Oregon providers impacted by the state and federal policy changes. Other State Offices of Rural Health (SORHs) are welcome to use and adapt this story map.
“There are a lot of inventive things a state could do to make it their own,” Locklear said. “There’s definitely a learning curve if you’ve never worked with ArcGIS StoryMaps. However, replicating one like this without geographical data is much easier. There are tutorials online that offer help, and I would be more than happy to answer any questions from anyone who might be interested in the project.”
The telehealth policy and payment resource is a component of ORH COVID-19 Resources for Rural Health. Other sections on that site include information on EMS, Critical Access Hospitals, Grants, Policy, and Rural Health Clinics.
After the pandemic subsides, OORH will keep using the story map as a repository for telehealth policy and information.
The South Carolina Office of Rural Health (SCORH) created its Coronavirus Resources for Rural Communities and Providers website in the early days of the state’s pandemic response to provide a clearinghouse of critical information specific to rural healthcare providers, said Bridget Winston, SCORH Director of Communications.
“We wanted to cut through the overwhelming quantity of information being disseminated, and just share what our providers needed to be able to serve their rural patients—guidance on testing, PPE, billing, etc.,” Winston said. “Once we got past the first few weeks of the crisis response, we reorganized the page to share information by topic, rather than by source, and included information relevant to both rural healthcare providers and rural social service providers.”
Topics on the page now include behavioral health, food access, employment, financial assistance for small businesses and individuals, legal resources, resources for the elderly, and resources for veterans.
When asked how the site could evolve in the future, Winston said, “I imagine we will be in response mode for months (maybe years) to come, so we will likely keep the page, although we will continue to edit and tweak the information included so that we remain relevant and useful to our rural communities.”
The Arizona SORH (AZ SORH) at the Arizona Center for Rural Health is implementing multiple COVID-19 information gathering and dissemination activities.
“We are reviewing and sharing timely resources and information related to COVID-19 and secondary emerging issues, and are working to keep our website updated,” said Jennifer Peters, AZ SORH Program Manager.
An example of this is the resource spreadsheet AZ SORH created using Google Sheets, which is being updated with Arizona-relevant information, Peters said.
“We were receiving so much information and were looking for a way to organize it for our own office and for our partners,” she said. “We are also using synchronous technology such as webinars and Zoom conferencing, and have co-hosted one virtual town hall with tribal health leadership. We expect to be doing more events like this in the coming weeks and months.”
AZ SORH also is using its website (https://crh.arizona.edu/ppe) to provide information on PPE donations.
By Beth Blevins
In rural and frontier Oregon, as in many other parts of the country, the aging population is rising, bringing new challenges to healthcare and other services. To address these needs, the Oregon Office of Rural Health (ORH) hosts the annual Forum on Aging in Rural Oregon.
“We bring people together who are working on aging issues, to share best practices and learn from each other,” said Robert Duehmig, ORH Interim Director. “It’s important that Oregon’s rural and frontier communities are supportive of the aging population, so folks don’t have to leave when their care needs increase. There’s not a lot of assisted living or senior homes in rural and frontier communities, so when somebody has to leave their home for care, it usually means going quite a distance.”
The Forum was the vision of Scott Ekblad, former ORH Director, Duehmig said. “His vision was to highlight and share rural organizations’ programs with other communities that have similar resources and geographies.” In this way, he said, “rather then keep that innovative work siloed, the Forum offers a way for other folks to hear about this great work—there are a lot of really cool programs and projects going on in rural and frontier communities.”
To address as many aging-related topics in as many communities as possible, each year the Forum is held in a different region of the state, said Rosalee Locklear, ORH Field Services Program Manager. “We rotate to a different area of the state to highlight communities in and around that specific region,” she said. “And we rotate committee members to bring in folks from that local area, because they know the needs of their community best, and they help us spread the word about the Forum.”
The topics chosen for each Forum are based on evaluations from the previous year’s Forum, in conjunction with feedback from the Planning Committee, Locklear said. “After the Forum we ask attendees to fill out evaluations to understand what they liked and what they want to see in the future. Then the Planning Committee and I discuss the data,” she said.
In the evaluations, attendees also share how they will use what they learned at the Forum. After last May’s Forum, which included presentations on loneliness and grief, aging and disability, and clinical considerations for cannabis use, their comments included: “I’m more motivated to work harder against loneliness and social isolation in our community,” and “The pharmacology was helpful, knowing when a client is taking too many medications and who to contact regarding this.”
Tied in with and awarded after the annual aging forums, ORH’s Elder Service Innovation Grants are intended to fund new projects or those building upon existing services. “Through the grants, we’re able to support small organizations that do innovative projects,” Locklear said. “There’s not a lot of funding for those sort of programs.”
The Forum is funded through three sources: paid registrations, organization partnerships, and the Medicare Rural Hospital Flexibility Program, Duehmig said. “We absolutely have to have partners to make it possible,” Locklear said. “We like to reach out to organizations in communities where we host the Forum to showcase their support of this event.” Partners have included hospital and health systems, health care organizations and foundations, government aging organizations, and education institutions, she said.
Right now, ORH is the only State Office of Rural Health (SORH) that hosts a forum dedicated to aging in rural and frontier communities. “To my knowledge there are not a lot of SORHs that are specifically addressing their aging population this way, but other states are interested in supporting their aging communities,” Locklear said. ”For example, the Washington SORH has done an evaluation of their state’s home health and hospice agencies.”
“I’d be happy to have a conversation about what we do with anyone who is interested, and to help other people do something similar,” she added.
When ORH first began the Forum on Aging in Rural Oregon, Duehmig said, they did not know it would be an annual event. “But as long as the need is out there and we can meet that need through this particular mechanism, we will keep doing it,” he said. “I think the support for it is still strong and the need for that kind of information remains vital.”
Want to know what to expect at an Oregon Office of Rural Health (ORH) conference? Check the ORH app! The app offers information on the ORH-sponsored Oregon Rural Health
Conference and Forum on Aging in Rural Oregon, including meeting agendas, speaker bios, and sponsor information. The app also includes information on ORH and ORH staff, and instant access to ORH videos and ORH’s Twitter and Instagram accounts.
According to Robert Duehmig, ORH Interim Director, the app was created as part of ORH’s larger goal to become more paperless. “We don’t want to waste paper so we can be environmentally sound,” Duehmig said. “But the other reason is that our conferences are never near the office, so we would have to travel with all that stuff or ship it out.” Additionally, he said, “more and more people don’t want to go to a conference and bring home tons of stuff, so we make it easier for them to view that information on their mobile devices.”
The content of the app changes with each new conference. Since the last conference (as of this writing) was the ORH Rural Aging Forum, it is now featured on the app.
Currently, ORH is the only SORH that offers its own app and it is one of the few apps devoted to “rural health events.” The app is available on both Android and iOS platforms. (Search for “Oregon Office of Rural Health” in either app store).
What I’m working on right now: My SORH grant
Who inspires you? My kids
What I’m currently reading: White Trash:The 400-Year Untold History of Class in America
Favorite thing about working at a SORH: Opportunity to visit rural Oregon
Best advice I ever received: Just relax
If I weren’t doing this, I would be: Teaching
Last place I traveled to: Etlan, Virginia
Favorite Quote: “The difference between stupidity and genius is that genius has limits.”- Albert Einstein
People would be surprised if they knew: I am a really nice guy
What’s your secret talent? If only……
Are you interested in discussing how State Offices of Rural Health can help rural people age in place? NOSORH is developing an interest group on aging in rural America to assist SORH in sharing experiences and resources on the unique issues surrounding the topic.
The Oregon Office of Rural Health recently conducted a study on long term care facilities finding there are few available and they are not sustainable. “Fighting ageism, understanding the value added for retirees and enabling aging in place were the themes that emerged the more conversations we had about aging in rural Oregon,” said Scott Ekblad, Executive Director for the Oregon SORH.
In response, Oregon is hosting the first annual Forum on Aging in Rural Oregon for community members, family caregivers, elder care professionals, primary care providers, policy makers and philanthropists interested in making it easier for seniors to age in place. “I am interested in talking with others who are also interested in sharing their ideas, experiences and resources on aging in rural,” continues Ekblad.
If you would like to join the conversation, starting in mid-May, please email Kassie Clarke.
The Oregon Office of Rural Health (OORH) has learned that the simple act of listening can be a powerful tool for change. With Listening Tours conducted in 2014 and again this year, OORH has met with Oregon rural facilities to see what their most pressing challenges are, and has brought together stakeholders who can help them.
“In the first Listening Tour, we invited our rural hospital association (the Oregon Association of Hospitals and Health Systems, OAHHS) and the Oregon Health Authority’s then Chief Financial Officer to go with us to rural hospitals to discuss concerns around their financial sustainability,” said Meredith Guardino, OORH Director of Field Services. The focus, Guardino said, was going to be on the recent change from cost-based reimbursement to an alternative payment methodology for some rural hospitals. But the meetings became more open-ended, she said, and OORH realized the focus could be much broader and the results used in a variety of ways.
The resulting report from each Listening Tour is distributed to state and federal legislators, in addition to organizations and offices across the state. “We want to make sure that our constituents’ voice is out there,” Guardino said. “We distribute the reports as widely as we can so that everybody in the state is aware of what is going on and can respond appropriately.”
In 2016, the state legislature invested a one-time $10 million to rural hospitals to implement rural hospital transformation and sustainability recommendations. The first report, , was used to develop the projects funded by this state investment.
This year, OORH has a new Field Services Program Coordinator, Rebecca Dobert. One of her primary responsibilities is coordinating the tour, which has expanded to encompass other types of rural facilities, including tribal clinics, Rural Health Clinics, and Federally Qualified Health Centers (FQHCs), in addition to rural hospitals. A big change this year was that each facility was asked which stakeholders they wanted OORH to bring to the meetings. “This way, they can explain their challenges to all the relevant stakeholders at one time,” Dobert said. The tour, to date, has included 16 stakeholder organizations including Oregon’s Legislators, Coordinated Care Organizations, multiple offices within the Oregon Health Authority, the Oregon Medical Board, OAHHS, and local housing authorities. Coordination became a challenge since the stakeholders were required to appear in person—no one could simply call or Skype in.
“It’s important for these stakeholders to be on-site and have the context of the facility, and it’s important for the facilities to see the stakeholders coming to them,” Dobert explained. “We are incredibly fortunate to have dedicated partner organizations in Oregon with people who have traveled all over the state with us.”
Going forward, Guardino said, OORH has three goals with the Listening Tours. “We want to make sure that the facilities have a platform to talk to everybody at once and explain what their challenges are, so that they aren’t regurgitating the same challenges year after year, depending on who is in the room,” she said. “We want to make sure we are documenting those challenges. And, most importantly, we want to make sure we are all collaboratively helping to address those challenges.”
According to Guardino, the next steps following the Listening Tour site visits are to compile key challenges of all the facilities, and to find data to back up what rural facilities have shared anecdotally. Some of the key challenges identified in the first Listening Tour report included the availability of mental health care and long-term care, and the sustainability of health reform. “This year,” Guardino said, “we hope to improve the data component and to make sure that we talk about what is already being done around those challenges. We want everybody on the same page with what the issues are and what various people are doing to address them so that everyone knows what the gaps are, and what we need to focus on to move forward.”
OORH has used three sources of funding for the Listening Tours: a designated part of their FLEX grant was used for the Critical Access Hospitals that participated; the clinic portion was built into their SORH grant; the rest (e.g., professional publication of the final report) is funded by the Oregon Rural Health Association.
According to Guardino, the Listening Tour has had additional, unexpected benefits. One is that it offers an easy way to publicize their office. “We created a of what our office does and we brought it to everyone on the tour to make sure they knew what our office could provide—so there’s a marketing component,” she said. In addition, she said, “Listening offers a unique way to develop stronger partnerships with your state stakeholder organizations. We now have partnerships with people who didn’t know we existed and we didn’t know existed. Traveling to facilities together and listening to these challenges has sometimes enabled a level of collaboration that didn’t exist before.”