The Membership Organization of State Offices of Rural Health
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.
Homepage of the StoryMap
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.
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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.”
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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.
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For additional information on COVID-19, please visit NOSORH’s COVID-19 Resources and SORH COVID-19 Response pages.
by Beth Blevins
Funding from HRSA’s Rural Communities Opioid Response Program (RCORP) program has helped several State Offices of Rural Health (SORHs) recently start—or strengthen—their work related to substance use disorder and opioid use disorder (S/OUD). Those who receive the RCORP Planning grant have a year to create or strengthen a consortium focused on SUD/OUD. (HRSA currently offers an RCORP Implementation grant that some SORH have received as well.)
The new “SORH Response to the SUD Crisis” issue brief provides a scan of what SORH are doing to engage in the recent substance use disorder (SUD) and opioid use disorder (OUD) initiatives in their state.
For example, the South Carolina Office of Rural Health (SCORH) had never focused on S/OUD activities prior to receiving the RCORP Planning grant, according to Lindsey Kilgo, SCORH Director of Network Development. For them the grant was “about how we can understand what’s going on in the state,” Kilgo said. “There’s been a lot of information gathering, a lot of consortium and office conversations, a lot of convening and bringing folks together.”
Forging Stronger Partnerships
While creating their consortium, the Virginia SORH (VA SORH) discovered new partners. “There are additional people at the table who might not have been there because of the consortium,” said Heather Anderson, VA SORH Director. “We added to the conversation and got community health centers and other folks that maybe weren’t involved before. We have stronger partnerships in the region.”
Anderson continued, “Because of our experience with the planning grant, another agency was willing to run with the implementation grant. So we said, ‘Go for it. You’re local, you know all the people. We will support you any way we can, give you technical assistance, and help you convene people.’”
For the Michigan Center for Rural Health (MCRH), the planning grant “has allowed us to really bring everybody to the table and wrap our arms around the importance of the challenges in those counties we are working in,” said Crystal Barter, MCRH Director of Performance Improvement. “I think everyone has really bought into it, whereas before everyone was working in their own silo. And now we are working as a consortium and starting to leverage the resources each organization has.”
Hanneke Van Dyke, former SORH Coordinator at the Texas SORH, also talked about the importance of community outreach. “It was important to use relationships we already had and having an openness to expanding relationships to new project areas,” Van Dyke said. “In both of our (RCORP) project areas, community advisory councils—made up of community members and community leaders who are there for every step of the process—have been central. Making sure we built in a few back routes tied back to the community was very important for us.”
No Prior Expertise Needed
When asked what skills are needed for SORHs to engage with S/OUD work, Kilgo replied, “Having the determination to make things better and to make change—and then not being afraid to ask questions, in an effort to build knowledge, partnerships, and relationships.” Kilgo added, “For folks who work in this particular realm, it requires a level of passion and commitment. And when you have that shared passion and commitment, the relationship and trust come fairly easily. We all have a common vision and common theme. We’re moving forward together in a positive manner.”
The ability to seek out experts was also key for Van Dyke. “None of us on staff had worked on an S/OUD issues or had any particular training or experience with it,” she said. “As project coordinator, I’ve taken it on to educate myself through reading and talking with experts. I’m not an expert but I’m pretty comfortable now, knowing who to go to to get the right information.”
Although the North Dakota Center for Rural Health (NDCRH) has been involved with S/OUD activities for the state for a few years, they had no broad expertise in their office when they started their RCORP work, said Lynette Dickson, NDCRH Director. “Our knowledge has grown and continues to grow,” Dickson said.
“Even if you are not an expert in the field you can still have an impact in this arena,” Dickson explained. “Because what we (SORHs) do is convene people, and reach out and find the resources. You can have more confidence that you can have an active role in this—you can convene and connect like we do with anything else.”
For more information, see the new NOSORH Issue Brief, SORH Response to the National Substance Use Crisis. A full spectrum of NOSORH resources to address rural SUD/OUD are available in the Rural Opioids Educational Resources library on the NOSORH website.
NOSORH Member Since: 2010
What I’m working on right now: My dissertation! If all goes as planned, I will graduate with my PhD in Public Health from the University of South Carolina in the next year.
My Top 3 Goals for 2018: I love setting New Year’s Resolutions! For 2018, I’m going to have one big personal goal, which is to complete a 52 Hike Challenge (one hike per week for the whole year).
Favorite thing about working at a SORH: Hands down the people we work with in our rural communities. As a bonus, we have a great state and national partners and friends too!
Favorite quote: “Far and away the best prize that life offers is the chance to work hard at work worth doing.” -Theodore Roosevelt
People would be surprised if they knew: I got a tattoo this past summer honoring my grandmothers, both of whom gave me a love of rural (among other things).
3 great things about rural health in South Carolina:
Want/need to read: With school there is a never ending pile of research articles, books, and general geeky reading that I need/want to do. Also, Quint Studer spoke at our conference in November and we all got a copy of “A Culture of High Performance” which I haven’t gotten to yet. I want to finish BJ Novak’s “One More Thing” when I have time for a lighter read.
Favorite blogs: I read the Daily Yonder and The Health Care Blog when I can; my favorites though are always from The New Yorker.
Twitter: I am new to Twitter so I am still learning a lot (and open to suggestions). Mostly I follow news sites or our partners in the state. I definitely enjoy catching odd news on Slate or odd places on Atlas Obscura.
I am doing 3 things to develop as a SORH leader.
I attended the ORHP Rural Voices meeting that brought grantees from a wide variety of backgrounds to work on leadership development.
I am working on my PhD in health services, policy and management at the School of Public Health, which is one of 7 rural research centers across the nation
I also serve on the NOSORH board and just transitioned to the Region B Representative.
What skill sets do you think SORH staff need—and how did you achieve them?
I feel strongly that SORH leaders need to have passion for what you do. You need to be committed in an intrinsic way with a positive outlook with lots of patience and flexibility. We worked on community paramedicine project recently. We worked with a community and worked at the state level to help program. We would make one step forward and then one or two steps back. You have to stay committed and be an advocate. You have to see things through to the end with perseverance and positive attitude. Our communities see us as committed leaders.
What are three great things about rural health in your state? What are the current challenges?
Our state office is a leader in our state. We have to credit Graham for creating a place for us at the table. There is a lot of innovation in our state. Rural communities are test beds of innovation. We really get to do a lot of face-to-face work in our rural communities, which helps spur innovations since we get to do one-on-one work. The people that we work with are a true inspiration. I love going out to the communities and helping providers making sure their communities have healthcare. We get to be their coach, extra pair of hands, or shoulder to cry on. This is what gets me out of bed each day.
NOSORH’s Educational Exchange Program offers support for SORH staff to meet with another SORH to develop or enhance their expertise or knowledge, leadership skills, adopt a promising practice, or improve effectiveness of program management, strategy planning and implementation. This is an excellent opportunity for SORHs to learn from each other and enhance their ability to better serve their rural constituents.
In continuation of the Educational Exchange that happened in the Fall of 2014 between the 3 non-profit SORHs (MI, SC, and CO), Sherri Cox visited the Colorado Rural Health Center to learn new communications and marketing skills. She learned how to produce story telling marketing videos, improve social medial skills, event planning tips, and how to develop a communications plan. She also learned some integrated marketing best practices, how to utilize data and produce infographics, email marketing campaign tips and website design. They discussed SCORH’s future goals and how to practically apply all of the educational resources learned over the two day period.
Sherri feels the trip was very beneficial and says, “The staff at the Colorado Rural Health Research Center went to great lengths to make sure I made the most of my trip and their mentorship was invaluable to me. I am extremely grateful to NOSORH for letting me have this opportunity to visit with them and am already applying many of these new skills here at the SC Office of Rural Health.
Do you want to learn more about an activity another SORH is working on? Are you interested in the NOSORH Educational Exchange program? Travel scholarships may be used by NOSORH members to visit another SORH in order to:
Click here to access the application.
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Back to 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.”
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Back to November Branch
Graham Adams is the CEO of the South Carolina Office of Rural Health (SC SORH). He has been with the SC SORH since 1995.
You’ve said that SORHs should do all they can to improve their “brand.” Why is it important that you market your Office?
I have a different perspective as a not-for-profit State Office. I am a small employer, with 42 employees, but no state appropriation. Every dime we have, we bring in–we always have to work for that next dime. We’ve grown the office over the years through trying to be a good partner. I think every SORH director can work to carve out a position of respect and power within their states regardless of whether their SORH is nonprofit, university or state government-based. We all should be striving to provide great value–it maximizes the influence of the office.
You may be an office of only three people, but if you brand the office, and position yourself to be an advocate for rural health issues in your state, it brings more value to those you serve. It can be more than just administering the Flex and SORH grants. You’re a resource and a player at the table at the state-level discussions. We work hard to show that we’re an organization that is advocating on behalf of rural providers and for rural providers.
How you market the office, the things you produce, how you talk about it–all can have a big impact. If you perceive yourself as being a small fish in a big pond, that’s how others will perceive you. Positioning the office as an advocate for rural providers in state level discussions eventually makes you a bigger fish. Look at other SORHs and what they’re doing to increase their brand… a
lot of what we do in South Carolina we’ve learned from fellow State Offices.
What are the best ways to market a SORH?
Being a good partner, and doing what you say you’ll do. Being knowledgeable. Not saying ‘I can’t help you with that,’ and that being the end of the discussion-successful offices will help you find the solution. Our office tries to do a lot of social media marketing, with Twitter, Facebook, Hubspot, SalesForce and a blog. We’re also trying to ensure the consistency of the brand. Making
sure that every piece of printed material, every PowerPoint, portrays the office in a consistent manner. We’ve worked very hard at this.