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AHA Future of Rural Health Care Task Force: Final Recommendations

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AHA Future of Rural Health Care Task Force: Final Recommendations AHA FUTURE OF RURAL HEALTH CARE TASK FORCE | FINAL RECOMMENDATIONS FINAL RECOMMENDATIONS FUTURE OF RURAL HEALTH CARE TASK FORCE MAY 2021 2021 AHA Future of Rural Health Care Task Force www.aha.org/rural | 1 AHA FUTURE OF RURAL HEALTH CARE TASK FORCE | FINAL RECOMMENDATIONS TABLE OF CONTENTS 4 Executive Summary 7 Introduction 7 Background 9 Solutions Public-Private Funding for Core Services ............... 9 Flexible Funding Programs to Support Rural Hospital Infrastructure Transformation ................................. 12 Create A Rural Design Center Within CMMI ........... 15 Grant-Writing Gig Economy .................................... 17 19 Promising Practices Global Budget Payment Model ............................... 19 Rural Hospital Federal Tax Credit Program ............ 22 Telemedicine ............................................................. 24 Broadband and Mobile Technology ........................ 27 Strategic Partnerships and Affiliations ................... 29 Leadership Transformation ..................................... 32 Maternal Health ........................................................ 35 Rural Philanthropy .................................................... 39 40 Conclusion 2 | www.aha.org/rural May 2021 AHA FUTURE OF RURAL HEALTH CARE TASK FORCE | FINAL RECOMMENDATIONS AHA TASK FORCE ON THE FUTURE OF RURAL HEALTH CARE Kris Doody, R.N. (Chair) William Ferniany, M.D. Carrie Saia CEO, Cary Medical Center CEO CEO Caribou, ME UAB Health System Holton Community Hospital Birmingham, AL Holton, KS Nancy Agee President and CEO Keith Heuser David Schreiner Carilion Clinic Market President President and CEO Roanoke, VA CHI Mercy Health Katherine Shaw Bethea Hospital Valley City, ND Dixon, IL Benjamin Anderson Vice President Rex McKinney Joanne Schroeder Rural Health and Hospitals President and CEO President Colorado Hospital Association Decatur County Memorial Hospital Munson Charlevoix Hospital Greenwood Village, CO Greensburg, IN Charlevoix, MI Kimberly Hupp Bordenkircher Timothy Moore Rachelle Schultz Former CEO President and CEO President and CEO Henry County Hospital Mississippi Hospital Association Winona Health Napoleon, OH Madison, MS Winona, MN Thomas Buckingham Karen Murphy Terry Scoggin Former EVP, Strategy Chief Innovation Officer CEO Select Medical Corporation Geisinger Titus Regional Medical Center Mechanicsburg, PA Danville, PA Mount Pleasant, TX Christina Campos Jon Ness Erik Thorsen Administrator CEO CEO Guadalupe County Hospital Kootenai Health Columbia Memorial Santa Rosa, NM Coeur D’Alene, ID Astoria, OR Casey Cooper Kirk Norris Roxie Cannon Wells, M.D. CEO President and CEO CEO Cherokee Hospital Iowa Hospital Association Cape Fear Valley Hoke Healthcare Cherokee, NC Des Moines, IA and Valley Bladen Healthcare Fayetteville, NC Elaine Couture Greg Poulsen Regional CEO SVP, Policy Thomas Worsley Providence St. Joseph Health Intermountain Health President Spokane, WA Salt Lake City, UT Regional Spearfish Hospital and Hills Markets David Dill Mary Ellen Pratt Rapid City, SD President and CEO CEO LifePoint Health St. James Parish Hospital Brentwood, TN Lutcher, LA Christopher Dorman David Ressler President and CEO CEO Tift Regional Health Systems Aspen Valley Hospital Tifton, GA Aspen, CO 2021 AHA Future of Rural Health Care Task Force www.aha.org/rural | 3 AHA FUTURE OF RURAL HEALTH CARE TASK FORCE | FINAL RECOMMENDATIONS EXECUTIVE SUMMARY Association in July 2019, the group of 28 rural hospital CEOs and state hospital association executives was charged with exploring the challenges and strengths in rural hospitals and As we write this report in December 2020, health identifying and developing bold solutions and care providers across the nation are working promising practices to help ensure ongoing access around the clock to battle the COVID-19 pandemic. to care for the 60 million2 U.S. residents who live in More than 2.2 million rural residents have tested rural areas. The critical nature of their task became positive since the beginning of the pandemic — more evident as COVID-19 quickly revealed 15.6% of U.S. cases, even though rural residents weaknesses in our health care system, especially represent only 14% of the overall population.1 in rural areas. With cases and hospitalizations surging, hospitals and health care providers have worked tirelessly Envisioning Rural Health Care to respond to the growing demand for care. In Transformation rural areas, with fewer providers of both primary and specialty care, the situation has been doubly In early 2019, the American Hospital Association challenging. (AHA) released “Rural Report: Challenges Facing Rural Communities and the Roadmap to Ensure Local Access to High-quality, Affordable Care.” The report identified the obstacles and opportunities in rural health care and laid out a roadmap for We’ve been waving the flag action, including proposed federal policies and for years about vulnerability in investments to support rural hospitals and 3 rural hospitals. The pandemic communities. really exposed those gaps in But, as the 2019 report acknowledged, federal the system. policy alone will not ensure the future of rural health care. Creative thinking and innovation on − Member Observation at December 2020 Rural a state, community and institutional level are Health Care Task Force Meeting − essential to the operational transformation of rural health care in America — as well as the improved health of rural residents. Rural providers have stepped up despite those The Future of Rural Health Care Task Force challenges. Not only have rural hospitals taken the was tasked with envisioning a range of bold lead in testing and public health messaging in their solutions and promising practices to achieve that own communities, but many have also received transformation. This report is the result of that patients from urban hospitals overwhelmed with visioning process. It depicts the landscape of complex COVID cases. rural health care today, then describes a set of Against this backdrop, the Future of Rural Health innovative solutions and promising practices for Care Task Force met regularly to focus on care delivery as well as financial models to ensure long-range solutions for rural health care while the financial stability of rural hospitals and access simultaneously immersed in the crisis of the to care for rural residents. pandemic. Convened by the American Hospital 4 | www.aha.org/rural May 2021 AHA FUTURE OF RURAL HEALTH CARE TASK FORCE | FINAL RECOMMENDATIONS The four innovative solutions include: payment and delivery models to improve quality of care while lowering costs. However, rural 1. Public-private Funding for Core Services. hospitals rarely meet the patient volumes and Recognizing that some of the most essential other requirements for participation in these health care services in rural areas are also programs. Creating a Rural Design Center would costly to deliver because of geography and low provide CMMI with the expertise and insights population density, the Task Force proposes a necessary for developing programs to adapt new funding system by which public and private existing projects to a rural framework and also payers pool funds to pay for a defined set of give rural hospitals the opportunity to innovate essential services to a particular community. on the local level. Designed in collaboration with payers, providers and communities themselves, this bold 4. Grant-Writing Gig Economy. Government solution reframes both health and health care, agencies, non-profit organizations and promotes preventive care, addresses the social philanthropic groups have grant programs determinants of health and builds a community available for health care organizations, including investment in improving health and health those in rural areas. However, many rural outcomes. facilities do not have the staff time or expertise necessary to successfully apply for, receive and 2. Flexible Funding Programs to Support Rural manage grant funds. An online platform and Hospital Infrastructure Transformation. Rural corresponding app that matches rural hospitals hospitals face a perennial problem: low patient with qualified grant writers may help smaller volumes drive up the cost of care delivery facilities secure funding for needed services and while low reimbursement rates necessitate thin programs. margins. As a result, rural hospitals often do not have access to the capital needed to maintain In addition to these four innovative solutions, the and adapt infrastructure, including buildings, Task Force identified eight promising practices — clinical equipment and technology. The Task programs and initiatives already underway in parts Force recommends developing new ways of the country — that should be scaled up and to fund infrastructure by promoting existing spread nationally to support rural hospitals. These resources (e.g., Community Development include: Financial Institutions and other government programs and philanthropic opportunities), 1. Global Budget Payment Model. Global Budget while building regional collaborations with other Payment Models — like the Pennsylvania providers to develop complementary rather than Rural Health Model and All Payer ACOs in competitive services. The eventual goal would Maryland and Vermont — have been credited be to develop a rural health care infrastructure with providing a more reliable funding stream that blends people, processes and technology that gives hospitals more flexibility and allows and allows for clinical
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