1. All Aboard for Rural Health Indiana Rural Health Association 17 th Annual Rural Health Conference June 10, 2014 DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS. Sherilyn Pruitt, Director, Office for the Advancement of Telehealth, Office of Rural Health Policy

2. 1983 Inpatient PPS begins 1985-1994 Swing Beds, SCH, MDH, MAF, EACH/RPCH Demos Physician fee schedule spurs growth of RHCs 1997s-2000s BBA (CAH designation created) BBRA, BIPA, MMA refinements, etc. Expansion of CHCs 2010 2011 ARRA EHRs and MU Growth of CHCs and NHSC 2013 ACA Coverage Expansion QHP Networks VBP PfP Changing Environment for Rural Health 1983-1987: Wave of Rural Hospital Closures 1999: First of a series of IOM Reports on Quality Mid-2000s: First small steps toward pay for reporting 2014 & Beyond -Industry Consolidation -Quality Penalties -Heavy Focus on CAHs -Changing Nature of Fee for Service and New Models -Possible Workforce Shortages -Medicaid Decisions -Changing Payer Mix -DSH Reductions

3. Emerging Questions & Challenges Moving Beyond Fee for Service Reimbursement & the Increasing Link to Quality Outcomes Value-Based Purchasing Patient-Centered Medical Homes Accountable Care Organizations And … Changing Payer Mix Post ACA Newly Insured DSH Reductions Fitting into the Many New Networks Role in Ongoing Outreach and Enrollment Helping Educate about Insurance Basics Changing Dynamics of Workforce Team-Based Care Community-Based Training Emergence of New Training Models Disconnect with Existing Training Models Scope of Practice Transitional and Volatile Environment Mergers & Acquisitions Moving to Employed Clinician Model Market Segmentation Changes and Variability in Federal and State Policy Arenas Role of Health IT EHR Implementation Reaching Meaningful Use Role of Telehealth What Might This Mean for Rural Health?

4. Our Goal…. Helping Rural Providers Make the Transition Grants Flex SHIP Outreach Network Network Development Quality Improvement Telehealth Network State Offices of Rural Health Technical Assistance TASC Flex Monitoring Team RHSATA Rural Assistance Center Telehealth Resource Centers Telehealth Licensure and Technology Assessment National Center for Rural Health Works Rural Health Clinic TA Link Rural Communities to Other Federal Resources State Offices of Rural Health Policy Regulation Review White House Rural Council National Advisory Committee on Rural Health and Human Services Collaboration with NRHA, AHA and NOSORH

5. How ORHP Programs Support Rural Hospitals Finance & Quality Policy Technical Assistance Special Projects  Flex  SHIP  Small Health Care Provider QI  State Office of Rural Health  Technical Assistance & Services Center  Rural Assistance Center  RHC TA Series  Regulation Review  Flex Monitoring Team  National Advisory Committee on Rural Health & Human Services  Outreach  Network  Network Planning  Telehealth Networks  USDA Capital Loans  Workforce

6. HHS and Rural Health http://www.hrsa.gov/ruralhealth/index.html The Office of Rural Health Policy HRSA HHS Other Key Federal Players Section 711 Of the Social Security Act Sec. 711. [42 U.S.C. 912] (a) There shall be established in the Department of Health and Human Services (in this section referred to as the “Department”) an Office of Rural Health Policy (in this section referred to as the “Office”).

7. Collaboration HHS Partners Federal Partners External Partners

8. http://www.whitehouse.gov/administration/eop/rural-council

9. Finance Variable National Picture Identifying and Promoting Successful Interventions Monitoring “At-Risk” Communities Helping Rural Health Clinics

10. Finance Where Does Rural Fit In … ACOs Medical Homes Bundling Value-Based Payment Deficit Reduction

11. Community Health Community Need Demonstrate value Act as a “catalyst” Sustainability Community Health Gateway Evidence-Based

12. President’s Budget FY 2015 Modernizing Graduate Medical Education Expanding the National Health Service Corps (NHSC) Extending Enhanced Medicaid Primary Care Payments Other provisions include $4 million to fund a new Rural Physician Training Grant program

13. Rural Health Quality Quality Measurement Quality Improvement Improved Patient Outcomes Special Projects in Critical Access Hospitals and Rural Health Clinics

14. Supporting Rural Health Quality Small Rural Hospital Improvement Program The Future of the Flex Grant

15. Health Information Technology and Telehealth Leveraging Telehealth Technology Grants as a Test Bed A New Focus on the Evidence-Base A Special Focus on Veterans Connecting Communities with National Experts Identifying Ongoing and Emerging Policy Challenges

16. Policy and Research Ensuring a Voice for Rural Picking Through the Annual Payment Updates Translating the Larger Policy Context Evolution of the ORHP Research Role Informing Policy.

17. Research Processes Portfolio development Programs and cooperative agreements Products – Briefs, peer-reviewed journal articles, used to provide: advice to HRSA, Department information to other Federal policymakers, e.g., MedPAC, CMS, GAO Information to other rural stakeholders

18. FY14 Competitive Grant Programs Evidence-Based Telehealth Network Program Guidance Available in Late Spring September Award Date 3-5 Awards; @ $400K per year, 4-year project period Contact: cmena@hrsa.gov Competitive Grant Opportunities

19. FY 2015 Competitive Grant Programs Rural Health Care Services Outreach Program 3 years $200,000 per year To deliver health care services in rural communities – Evidence-based – Outcomes oriented Eligibility: rural, non-profit or public entity, partner with 2 other entities FOA available Fall/Winter 2014 Start date: May 2015 Contact: Linda Kwon, lkwon@hrsa.gov, 301-594-4205 Rural Health Network Development Planning Program 1 year $100,000 help to promote the planning and development of healthcare networks Eligibility: rural, non-profit or public entity FOA available Fall/Winter 2014 Start date: June 2015 Contact: Amber Berrian, aberrian@hrsa.gov, 301-443-0845

20. FY15 Competitive Grant Programs Ongoing Rural Hospital Grant Funding The Rural Hospital Flexibility Grant Program $25 million to 45 States with CAHs The Small Hospital Improvement Grant Program $15 million to More Than 1,500 Small Rural Hospitals Contact: kmartinsen@hrsa.gov

21. The Rural Assistance Center http://www.raconline.org

22. Flex Monitoring Team Studies and Data on Critical Access Hospital Issues and State Flex Programs http://www.flexmonitoring.org/indicators.shtml

23. RHC TA Series ORHP funded through the National Association of Rural Health Clinics Listserv o Exchange info, ask questions o Sign up at http://03672e4.netsolhost.com/?page_id=712 Conference Calls o 6 per year on range of topics o Sign up and review previous calls at http://www.hrsa.gov/ruralhealth/policy/confcall/index.html

24. National Organization of State Offices of Rural Health http://www.nosorh.org

25. Community Health Gateway Toolkits Resources and best practices to help you identify and implement public health programs Rural Health Models and Innovations Hub Find examples of approaches you can adapt for your program, including models shown to be effective, as well as new and emerging ideas. Sustainability Tools The tools provided here are intended to help you consider the sustainability of programs that address community needs and to engage your partners and stakeholders in this planning process. Economic Impact Tool Show how your program’s grant funding affects your community’s economic well-being http://www.raconline.org/communityhealth/

26. Policy and Research Resources http://www.ruralhealthresearch.org/

28. How to be a Grant Reviewer ORHP has multiple grant program reviews each year We need reviewers with rural experience to be a part of our Objective Review Committee panels You must register to be a reviewer: http://www.hrsa.gov/grants/reviewers/ Indicate “rural health” as one of your specialties in the background information

29. Sherilyn Pruitt Office for the Advancement of Telehealth Office of Rural Health Policy, HRSA spruitt@hrsa.gov 301-594-0819