International Rural Nursing Conference July 19, 2016 CAPT Debra Scott, USPHS Regional Nurse Consultant Health Resources and Services Administration Office of Regional Operations , Denver

Health Resources and Services Administration Improving health and health equity through access to quality services, a skilled health workforce and innovative programs

Today’s Discussion HRSA Overview HRSA Support for Rural Health The Role of Nurses in Rural Health Care and Delivery System Reform Questions/Discussion

Agency Objectives Increase Access to Quality Health Care and Services Strengthen the Health Workforce Build Healthy Communities Improve Health Equity Strengthen Program Operations

Office of the Administrator Bureau of Health Workforce Bureau of Primary Health Care Federal Office of Rural Health Policy Healthcare Systems Bureau HIV/AIDS Bureau Maternal and Child Health Bureau

HRSA Regional Offices

Bureau of Health Workforce (BHW) Programs Include: National Health Service Corps Scholarship and Loan Repayment NURSE Corps Scholarship and Loan Repayment Diversity Programs including Centers of Excellence and Scholarship for Disadvantaged Students Inter-Professional Training Behavioral Health Workforce Education and Training Grants to health professions schools and training programs

Repayment Loan Program Program Scholarship The National Health Service Corps (NHSC) provides financial support to providers in exchange for working at NHSC-approved sites. Repayment Loan Program Program Scholarship

More than 9,000 NHSC primary care providers are working in communities with limited access to health care nationwide. For more Information: NHSC@hrsa.gov Physician Nurse Practitioner Mental Health Dentist Physician Assistant Nurse Midwife • 2% 2% • Dental Hygienist 25% 16% 14% 12% 29%

HRSA Nursing Resources Advanced Nursing Education (ANE) Advanced Education Nursing Traineeship (AENT) Advanced Nursing Education Expansion (ANEE) Faculty Development: Integrated Technology into Nursing Education and Practice (ITNEP) Innovative Nurse Education Technologies (INET) Nurse Anesthetist Traineeship (NAT) Nurse Education, Practice, Quality and Retention (NEPQR) Nurse Faculty Loan Program (NFLP) Nurse Managed Health Clinics (NMHC) Nursing Assistant and Home Health Aide (NAHHA) Nursing Workforce Diversity (NWD) Personal Home Care Aide State Training (PHCAST)

Bureau of Primary Health Care (BPHC) Health Center Program grantees – Public and private non-profit health care organizations that meet certain criteria under section 330 of the PHS Act and receive funds under the Health Center Program. Health Center Program look-alikes – Health centers that have been designated as meeting the requirements of a health center, but do not receive grant funding under the Health Center Program

Health Center Program There are 1278 Health Center grantees nationally that serve almost 23 million patients in 2014. Section 330 grant funds (up to $650,000/year) to offset the costs of uncompensated care and other key enabling services Health Centers (CHCs) are not free clinics, but provide services on a sliding fee scale

Healthcare Systems Bureau (HSB) Organ and Blood Stem Cell Transplantation Program Poison Control Program 340B Drug Pricing Program National Vaccine Injury Compensation Program National Countermeasures Injury Program Hill-Burton Program National Hansen’s Disease Program

HIV/AIDS Bureau (HAB) Ryan White HIV/AIDS Program works with cities, states, and local community-based organizations to provide a cohesive system of care for low- income people living with HIV who are uninsured or underinsured.

Maternal and Child Health Bureau (MCHB) Title V Block Grants Healthy Start Programs Maternal, Infant, and Early Childhood Home Visiting Program Family-to-Family Health Information Centers Universal Newborn Hearing Screening Traumatic Brain Injury Emergency Medical Services for Children Children with Autism and Epilepsy

Federal Office of Rural Health Policy (FORHP) Supports and funds State Offices of Rural Health Administers Outreach and Network Development grant programs Funds and conducts research Provides technical assistance Oversees the University of North Dakota’s Rural Assistance Center List of current grantees, sorted by state or type of grant program: http://granteefind.hrsa.gov/

Federal Office of Rural Health Policy (FORHP) Other Major Grant Programs: Hospital – State State Offices of Rural Health, Rural Hospital Flexibility Grant, Small Rural Hospital Improvement Programs Telehealth Licensure Portability, Telehealth Network, Telehealth Resource Center Grant Programs Community Based Rural Health Outreach, Rural Network development, Network Planning, Quality Improvement, Rural Workforce and Delta States Rural Development

Rural Health Information Hub Online Library of funding opportunities and best practices Specific State information and guides Community Health Gateway with evidence based models and tool kits Tools for Success Publications and updates Technical assistance on request. Link: https://www.ruralhealthinfo.org/

HRSA Rural Resources Rural Health Network Development Grant Program Rural Health Network Development Planning Grant Program Rural Health Information Technology Workforce Program Rural Network Allied Health Training Program Rural Training Track- Technical Assistance Cooperative Agreement Small Health Care Provider Quality Improvement Telehealth Network Grant Program Rural Health Research Center Cooperative Agreement Telehealth Resource Center Grant Program Flex Rural Veterans Health Access Program Licensure Portability Grant Program Small Rural Hospital Improvement Grant Program (SHIP)

HRSA Rural Resources Currently funded projects include: Black Lung Clinics Centers of Excellence Black Lung/Coal Miner Clinics Program Public Access to Defibrillation Demonstration Projects Radiation Exposure Screening and Education Program Rural Access to Emergency Devices Rural Opioid Overdose Reversal Grant Program Rural Benefits Counseling Program Rural Health Care Coordination Network Partnership Rural Health Care Services Outreach Grant Program

HRSA Health Promotion Resources Health Literacy Oral Health Bright Futures Prevention & Health Promotion for Children, Adolescents & Their Families (HRSA Grantee Web site) Healthy Tomorrows Partnership for Children: Community- Based Pediatrics (HRSA Grantee Web site) National Adolescent Health Information Center (HRSA Grantee Web site)

Other HRSA Resources Communities of Practice/Collaborative Learning Teams  Culture, Language and Health Literacy Smoking Cessation How to Help Veterans & Their Families Quality Resources: Quality Improvement & Risk Management Training Provider's Guide to Quality & Culture (HRSA-supported partner Web site) Quality Improvement & Safety Net Providers

Find Funding Opportunities Grants.gov (http://www.grants.gov/) HRSA Website (http://www.hrsa.gov/grants/) HHS Forecast http://www.acf.hhs.gov/hhsgrantsforecast/ttp://www .hrsa.gov/grants/ Register to get email notifications when opportunities are available: http://www.grants.gov/web/grants/manage- subscriptions.html

Grant Application Resources The Department of Health and Human Services forecasts its planned grant opportunities: http://www.acf.hhs.gov/hhsgrantsforecast/index.cfm HRSA funding opportunities: http://www.hrsa.gov/grants Alternatively, use the Federal grants source: http://www.grants.gov Overview of the application process, from start to finish: http://www.hrsa.gov/grants/apply/TechnicalAssistance/gr antprocess.pdf

The Role of Rural Nurses in Health Care and Delivery System Reform

Benefits of the Affordable Care Act for Americans Improving Quality and Lowering Health Care Costs Free preventive care Prescription discounts for seniors Protection against health care fraud Small Business Tax Credits New Consumer Protections Pre-existing conditions Consumer Assistance Access to Health Care  Health Insurance Marketplace.

Benefits of Health Reform Benefits for Women Providing insurance options Covering preventive services Lowering costs Young Adult Coverage Coverage available to children up to age 26

Benefits of Health Reform Strengthening Medicare Yearly Wellness Visit Many Free Preventive Services for some seniors with Medicare Holding Insurance Companies Accountable Insurers must justify any premium increase of 10% or more before the rate takes effect

Delivery System Reform The Affordable Care Act is about more than affordable, quality coverage. It includes tools to build a health care system that puts patients at the center by… Paying for Quality Care Changing how doctors and health care systems are paid, so they can focus on making people healthier. Improving Health Care Improving how care is delivered, by encouraging better coordination and focusing on wellness and prevention. Unlocking Data Unlocking health care data and putting it to work when and where doctors, individuals, and hospitals need it.

Health Systems Reform CMS funds for health care innovation and Delivery System Reform Payment Reform- Value Based Purchasing National Prevention and Health Promotion Strategy. Prevention and Public Health Fund supports initiatives and policies: Improve community and clinical prevention Funds for research and data collection Increase primary care and public health professionals. Mandatory funding for public health departments to supplement existing funding. Funds to promote a community health approach to prevention and well-being.

Some Health Reform Concepts Health (Medical) Home Meaningful Use Accountable Care Organizations Value Based Purchasing Quality Improvement Organizations Care Transitions Increasing use of Technology/EMRs

Rural Nursing and Health Reform Health Reform goals have long been the priorities of the nursing profession With 3 million members, nursing profession is the largest segment of health care workforce Critical role in increasing access to primary and preventive health services, while improving quality and controlling costs, especially in rural settings

Rural Nursing and Health Reform Essential that nurses in all roles and settings assume a more active role in health reform Participate in policy discussions Assume leadership roles as decisions are made Be involved in health care reform at the facility, community, and statewide levels As a profession we have an historical opportunity to play a key role in the transformation of an entire health care system Rural nurses can and should assume a fundamental role in this transformation

Opportunities for Nurses with Health Reform The Robert Wood Johnson Foundation (RWJF) and the IOM two- year initiative to assess and transform the nursing profession The committee developed four key messages: Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. Effective workforce planning and policy making require better data collection and information infrastructure

Rural Nurses Have the Ideal Skill Set Focus on prevention Public education/ PH messages Collaboration Surveillance and data collection Community outreach Quality improvement processes In depth knowledge of communities

Emerging Roles in Rural Settings Care coordinator including population health management and tiered coordination.   Faculty team leader; moving inter-professional nursing education to community settings. Informatics specialist-roles in design, data interpretation, and telehealth applications

Emerging Roles in Rural Settings Nurse/family cooperative facilitator; Virtual and in person health care to people where they live and work. Primary care in community health settings.   Nurse Navigator and facilitator of transitions to care.

Emerging Roles in Rural Settings Generate evidence and engage in research.   Leadership at every level, and in all sectors. Administrative, legislative, or policy decision making positions.

. “Today’s nurses are undereducated for demands of practice” Carnegie Foundation Report*

2014 HRSA FUNDED PROGRAM # OF GRANTEES FUNDING LEVEL Nursing Workforce Diversity (NWD) 44 ~ $14.7M Nurse Education Practice Quality Retention- IPCP (NEPQR-IPCP) 53 ~$24.4M Veterans to BSN (VBSN) 19 ~ $5.8M Advanced Nursing Education (ANE) 76 ~ $25.1M Advanced Nursing Education Expansion (ANEE) 26 ~ $31.0M Advanced Education Nursing Traineeship (AENT) 87 ~ $28.6M Nurse Anesthetist Training (NAT) 82 ~ $2.7M Nurse Faculty Loan Program (NFLP) 93 ~ $23.2M

Great Time to Assess Your Career Newly funded programs will required a well trained nursing workforce. Emerging opportunities in academic and nursing leadership roles. Need for increased skills and competencies. Opportunities with new funding for public health and nursing workforce, and faculty training.

The Culture of Health Care The demands on the health care workforce and resources will continue to increase and care will continue to become more complex. Developing well-functioning teams becomes a crucial need throughout the health care system. National Center for Interprofessional Practice and Education provides resources, tools and best practices. https://nexusipe.org/

Interprofessional Practice Health care teams can be created to respond more efficiently to care challenges, ensuring better patient outcomes, improved quality and lower costs.

Culture of Health Care Health care reform provides an opportunity to develop a partnership culture. Communication flows in many ways All Profession’s contributions are valued Successful Interprofessional Practice Models Hierarchies of Actualization Documented difference in outcomes in a healthcare culture of domination and partnership.

“May we hope that when we are all dead and gone, leaders will arise who have been personally experienced in the hard, practical work, the difficulties and the joys of organizing nursing reforms, and who will lead far beyond anything we have done.” Florence Nightingale We have the opportunity to come together now and be the nurses that contribute to the reforms that will take place in our lifetime.

Questions? Debra Scott, RN, MS, MA Captain, US Public Health Service Health Resources and Services Administration (HRSA) Office of Regional Operations in Denver Email: dscott@hrsa.gov Phone: 303-844-7759 Web: hrsa.gov/about/organization/bureaus/oro/ Twitter: twitter.com/HRSAgov Facebook: facebook.com/HHS.HRSA