1. Rural Strategic Planning

2. A New Rural Health Care Model It is time to develop a new blue-print for rural health care delivery. –The current disjointed “system” is unsustainable. –A redesigned and more integrated health care system can deliver superior care at lower cost.

3. A New Rural Health Care Model Rural communities may be uniquely prepared to step into a new model. Rural communities may be uniquely prepared to step into a new model. –Most health services are already integrated under one organizational model. –Policy and political leaders are asking regions to plan together.

4. Membership Vic Dirksen, CHAIRJefferson Healthcare John Anderson, MDCle Elum Medical Center Joan Baird GloverKittitas Valley Community Hospital Gladys CampbellNWONE Bill Dowling, Ph.D.U of W (Prof. & Chair) Leo GreenawaltWSHA Claudia HaglundProvidence Health & Services Peter HouseUniversity of Washington Karen JensenDOH Tom Locke, MDClallam County Health & Human Services Mary LookerWA Assoc’n. of Community and Migrant Health Centers Tom MartinLincoln Hospital Jeff MeroAWPHD Kris SparksDOH Mike LeeDOH Robb MenaulWSHA Brenda SuiterWSHA Cheri BerthonOFM

5. Process Vision & Principles (Completed) Vision & Principles (Completed) –Environmental Assessment: DOH & WSHA –Mega-Issues: 1. Work Force 2. Quality/Care Delivery Processes 3. IT/Technology 4. Community and Population Health 5. Finance

6. Process Study Sessions On Mega-Issues (90% complete) Study Sessions On Mega-Issues (90% complete) Intensive Multi-Day Session to Develop Plan with Recommendations in October Intensive Multi-Day Session to Develop Plan with Recommendations in October

7. PROJECT TIMELINE Develop implementation plan Oct 08 TODAY Nov 08 Develop demonstration project proposals Initiate demonstration projects Jun 09 Develop principles, mission, goals May 08 Study Mega-Issues Communicate Plan

8. VISION& GUIDING PRINCIPLES

9. Vision For Our Rural Health Care System We envision a health care system that is: – strong – reliable – publicly accountable

10. Vision For Our Rural Health Care System The system will: ensure those who need care receive the right care at the right time in the right place ensure those who need care receive the right care at the right time in the right place provide personal and population health services responsive to the unique needs of each community (including dental and mental health care) provide personal and population health services responsive to the unique needs of each community (including dental and mental health care) provide a medical home for all people in the local community provide a medical home for all people in the local community deliver planned access to the full continuum of care through regional systems that formally link primary and specialty services. deliver planned access to the full continuum of care through regional systems that formally link primary and specialty services.

11. Vision For Our Rural Health Care System The system will produce: high quality outcomes high quality outcomes promote healthy communities promote healthy communities merit the confidence of the community merit the confidence of the community The leadership to create and support a better rural health care system will come from communities and providers working together.

12. To achieve this vision, the rural health care system will embody the following principles: 1. The rural health care system will be community- centric while recognizing the essential role of providers in achieving community health. Rural health care will take advantage of the inherent strengths of rural communities including close integration of physicians and the other health and human service providers in the community with the local hospital, community resources, community leadership, and community self- reliance. 2. The rural health care system will actively promote personal and family health in homes, schools, workplaces, and in the community at large.

13. To achieve this vision, the rural health care system will embody the following principles: 3. The rural health care system will provide services as close to the community as possible whenever they can be delivered safely, effectively, and in a timely manner at a high level of quality. 4. As the centerpiece of the rural health care system, the role of primary care will be broadened to become “medical homes” providing access to comprehensive, patient-centered primary care, health information, health promotion, chronic care management, and coordination of primary and specialty services to ensure seamless integration of care.

14. To achieve this vision, the rural health care system will embody the following principles: 5. Formally-structured relationships and integrated information systems will link primary and specialty care providers in each region to assure rural residents seamless access to care across the full range of services. 6. The rural health care system will be sufficiently financed to assure access to appropriate care, promote continuous improvement, and support the principles outlined here.

15. To achieve this vision, the rural health care system will embody the following principles: 7. Payment methods and formal linkages between primary and specialty care providers will align incentives while supporting the medical home model and care coordination within the regional systems. 8.Investments in prevention and health promotion will address physical, oral, and mental health and reflect both the short term and long term payoffs of health promotion.

16. To achieve this vision, the rural health care system will embody the following principles: 9. The rural health care system will develop, attract, and retain an adequate supply of well-trained providers; advance new provider roles; provide professional development opportunities locally; and employ organizational structures that attract providers and promote good care. 10. Community health assessment and evidence- based care protocols will drive the planning of care, decisions about services, performance measurement, and accountability for care provided both in the local community and through formal linkages with other providers in each regional system.

17. To achieve this vision, the rural health care system will embody the following principles: 11. Responsibility and accountability for community health will be shared by community leaders, health care providers, public health, and the community at large. 12. Community leaders, employers, providers, and payers will work together to ensure private and public health care coverage and access to care for all members of the community.

18. To achieve this vision, the rural health care system will embody the following principles: 13. Rural health care leaders will assume an active voice in seeking public policies that support a strong, reliable, publicly accountable rural health care system consistent with these principles. 14. Quality health care available locally will continue to be essential to the social and economic integrity and vitality of rural communities.

19. FEEDBACK

20. FEEDBACK What questions or concerns do you have about the principles? Is their meaning clear? Is their meaning clear? Is the rural health care system described worth reaching for? Is the rural health care system described worth reaching for?

21. FEEDBACK How should community-level leadership be activated and organized? What are the characteristics of leadership needed to drive this vision forward? How do we ensure that this leadership involves meaningful participation by all elements of the community? What examples are there of how this leadership might be structured?

22. FEEDBACK How might local leadership need to be augmented, assisted, or supported if the vision is to be implemented? What help would you need to move this vision forward? What role might AWPHD and WSHA play?

23. FEEDBACK What questions or concerns do you have about the medical home model?