Table
of Contents
Regional
Commissions Meeting
Executive Summary
Summary Report
Appendix One - Conclusions
and Recommendations
Executive
Summary -- Regional Commissions Meeting
July 27-28, 2006
In two days of focused discussions and presentations,
leadership of the Federal Regional Commissions met to describe their
current health initiatives and find areas of shared interest and
possibilities for continued, coordinated action. The Department
of Health and Human Services, Health Resources and Services Administration
(HRSA), Office of Rural Health Policy (ORHP) sponsored the July
meeting. The Delta Regional Authority (DRA), Appalachian Regional
Commission (ARC), Denali Commission, and US-Mexico Border Health
Commission (USMBHC) provided an overview of the health challenges
faced by the populations they serve and strategies they have developed
for meeting the health needs of these underserved populations.
Dr. Betty Duke, Administrator of HRSA and Dr.
Marcia Brand, HRSA Associated Administrator for rural health, provided
a framework for the meeting's outcomes. The objectives of the meeting
were to continue the health-focused dialogue (which formally began
in 2003) between the Federal Commissions and HRSA and to promote
partnerships between HRSA and the Commissions. Dr. Duke described
HRSA's increased presence in underserved areas and pledged to continue
to expand access to oral and mental health, health centers, and
the National Health Service Corps.
Utilizing poverty as a common proxy, leadership
of each Federal Commission presented an overview of specific initiatives
underway to address the health problems unique to their communities.
From a media-focused diabetes prevention effort in the Delta to
the ARC's community-oriented substance abuse conference, the Commissions
related successful strategies and how these might be translated
across geographic lines. The Denali Commission provided a framework
for detailed, strategic planning and the US-Mexico Border Commission
described its use of research and telemedicine to address the unique
challenges of health along the Border. Additionally, experts from
several health-related areas provided detailed information on such
pertinent issues as the J-1 Visa program, provider performance management,
and regional diabetes care.
At the end of the two days of discussions, participants
examined cross-cutting problems and developed shared strategies
to combat shared or similar challenges. The relationship between
health care and economic development was stressed as a means of
increasing access to health care while at the same time increasing
economic opportunity in rural communities.
The Commissions sought to continue the discussions
and suggested the creation of a commission exchange to promote continued
dialogue and communication. Other possible outcomes included a joint
research initiative between the Commissions and HRSA on promoting
healthy living for children, the development of core measures for
Federal grants accountability standards for the Commissions, and
increased information about coordinating health information technology.
The J-1 Visa program was also cited as a method for increasing provider
access, and its continuation was promoted.
In all, the meeting was marked by an excitement
about the possibility of future collaborative efforts. The Federal
Commissions found willing partners with HRSA and ORHP in their joint
mission of expanding access to health care in underserved communities.
Through collaboration and cooperation, the meeting's participants
have pledged to continue to work together for increased quality
health care throughout the economically challenged areas they represent.
Regional
Commissions Meeting
July 27-28, 2006
The Department of Health and Human Services, Health
Resources and Services Administration (HRSA), Office of Rural Health
Policy (ORHP) hosted a recent two-day meeting to facilitate discussion
of the Federal Regional Commissions' health initiatives. The Appalachian
Regional Commission (ARC), the Delta Regional Authority (DRA), the
Denali Commission and the U.S.-Mexico Border Health Commission (USMBHC)
met to discuss common health and social service issues and to share
their specific strategies for improving access to quality health
care in their regions. Last convened in conjunction with the ORHP
All Programs Meeting of 2003, this meeting was a smaller, more focused
gathering of the Regional Commissions to assess progress and articulate
new strategies.
Dr. Marcia Brand, Associated Administrator for
rural health at HRSA, welcomed the meeting's attendees with a statement
of the conference objectives and proposed outcomes. In these two
days, HRSA and ORHP planned to facilitate a health-focused dialogue
in order to better understand how HRSA could best collaborate with
the Regional Commissions to address the health needs of the communities
they serve. Through the discussions and presentations, the Regional
Commissions planned to identify priority areas for coordinated efforts
with HRSA. The conference also aimed to improve collaboration among
the Commissions through sharing best practices and useful products.
By the meeting's end, HRSA and the Regional Commissions planned
to have developed a strategic plan for partnering to address access
to care priorities and planned to discuss ways different regions
could work together to solve shared problems.
After welcome's to the Regional Commission representatives,
Dr. Brand introduced the current and longest-serving HRSA administrator,
Dr. Elizabeth Duke. Dr. Duke offered an inspiring message of service
and commitment to HRSA's mission of providing health care to the
underserved. "Dream big dreams," she instructed, "and
improve the lives and communities of those most in need."
Describing HRSA's mission to increase access,
Dr. Duke related several programs underway within the Administration.
In 2002 President Bush announced the Health Center Growth Initiative,
and since then HRSA has expanded services through 900 additional
health centers that provide primary and preventive care to all,
regardless of their ability to pay. In a plan to eliminate health
disparities under this initiative, the President has also asked
Congress to support a new $52 million initiative that would pay
for 80 new access points in high poverty counties.
Dr. Duke also reiterated her strong commitment
to finding creative health care access solutions. During her tenure
at HRSA, she has overseen an expansion of the National Health Service
Corps from 2300 to 4600 participants. This loan repayment program
for qualified health service professionals willing to serve in areas
of need has benefited many of the populations served by the Regional
Commissions. HRSA has also focused on increasing access to oral
and mental health care, issues of critical need for many rural and
underserved areas. Dr. Duke ended her inspiring address with a message
to the commissioners, "If your heart and soul is in idea and
people are with you, you can make a difference."
The Delta Regional Commission -
Health Care Development as a Tool for Economic Improvement
Overview of the Commission:
Pete Johnson, Federal Chairperson of the Delta Regional Authority
(DRA), provided the first of the Regional Commission presentations.
Formed four years ago, the DRA serves 240 counties and parishes
in eight States, including 21 counties in Alabama.
Challenges:
Beginning with a history of the region, Johnson discussed the economic
highs and lows of this Mississippi River basin. Using the rich resources
of the river and logging industry, the early settlers profited from
the Delta's fertile farmlands and abundant trees. By 1860, the Delta
was one of the wealthiest regions in the United States, but this
once very prosperous area has since suffered and fallen into economic
decline. A timeline of hardships beginning with infrastructure damage
sustained during the Civil War and continuing to the recent brutality
of Hurricane Katrina has resulted in the Delta Region becoming today
one of the most impoverished regions in the United States. Seventy
to eighty percent of its residents live in persistent poverty, and
the region claims high levels of unemployment alongside low growth
and low educational attainment.
Strategies for Success:
In looking for ways to recover from the economic hardships and reclaim
its history of prosperity, the Delta Region has reaffirmed that
the health care industry is an essential component of its economic
growth and recovery. Health care development has become a cornerstone
of the Delta initiative, with gains in education, transportation,
housing, and access to affordable capital and housing all stemming
from healthcare development. Because of its relative newness, the
DRA is focusing its funding on strategic planning and workforce
solutions while still seeking to fully discover the best avenues
for improving the healthcare of citizens in the Delta Region.
To that end the Healthy Delta Program (HDP) has
focused extensively on diabetes prevention and treatment, approaching
the problem of diabetes from a community perspective and attempting
to reach larger numbers of people than ever before. In an innovative
approach to disease treatment and prevention, the Program uses extensive
media coverage to inform people about the dangers of diabetes and
the economic impact of this disease. The Governors of each of the
eight Delta States have appeared on television to make people aware
of the disease and how and where they can receive treatment. Program
facilitators drive people to call centers to sign up for the Program
and then track improvement using follow-up calls 90 days after each
visit. In an innovative approach to health care promotion, the Program
also uses churches and faith-based organizations to specifically
target diverse demographics, including African American females
over age 45 (those at greatest risk for diabetes).
The DRA believes that improving access to quality
health care requires targeting limited resources. It hopes that
its role as planning and coordinating agency for improved health
care resources can help the Delta return to being one of the most
prosperous regions in the U.S.
The Denali Commission -
An Emphasis on Strategic Planning To Get Results
Overview of the Commission:
With an emphasis on Alaska's great size and inherent geographic
challenges, Krag Johnsen, Chief Operating Officer of the Denali
Commission, spoke about the organization's goal to improve and expand
the healthcare infrastructure of Alaska. Sponsored by Senator Ted
Stevens (AK), the Denali Commission Act of 1998 requires that the
Commission focus fifty to sixty percent of its work on power generation
needs. However, it also heavily emphasizes increased access to social
service facilities and provides training for local residents in
the health care field. The Denali Commission partners with Tribal,
Federal State, and local governments to improve the effectiveness
and efficiency of its health-based services. It also seeks to develop
a well-trained labor force employed in a diversified and sustainable
economy, which will help to build and ensure the operation and maintenance
of Alaska's basic infrastructure
In all of its work, the Denali Commission emphasizes
sustainability. To that end it focuses on investment, cost containment,
open door policies, private enterprise, and community planning.
Since its first Congressional appropriation in 1999, the Commission's
funding has steadily grown, and it now partners with Federal agencies
to maximize funding sources, while improving the health of Alaskan
people.
Challenges:
Alaska faces unique challenges due to its geography and size. Poverty,
isolation, and transportation needs, among other difficulties, continue
to plague the State and its residents. Nelson Angapak, CEO of the
Alaska Federation of Natives (AFN), related his personal story of
how his home community had unemployment rates of 60 to 80 percent
and very limited access to health care. In this region, which is
the size of the State of Washington, there is only one hospital,
accessible only by air. These geographic challenges require coordinated
resources, and the Denali Commission has a core structure meant
to work between agencies to coordinate activities and find solutions
to the needs of each community. Most funding goes to critical core
infrastructure, basic reliable energy, housing, job training, and
economic development
Strategies for Success:
To describe the Commission's specific health agenda, Denali Daniels
shared her work with Denali health organizations. She noted facility
development, especially the development of primary care clinics,
as a priority. Social service provisions including behavioral health,
elder housing, and domestic violence shelters are also top priorities
for the Denali Commission.
The Denali Commission has adopted a policy of
investment in the detailed planning of health facilities. To be
developed, the facilities must first have an approved business plan
and then have a clearly outlined plan for site control issues, including
plans for construction and equipment. In developing their budgets,
she reminds grantees to be aware of the statutory cost share match
requirement and the potential for huge travel costs.
From careful planning and thorough assessments,
the Denali Commission can boast of numerous accomplishments. Its
strategic planning has already led to the creation of 282 primary
care clinics, with 37 projects in construction, 74 in planning or
design, and 101 approved but yet to engage. With an exit strategy
at 40 million dollars per year, the Denali Commission's plan is
to complete all of the clinics by 2012. Their improved methods have
allowed them to increase access, improve provider efficiency, and
create better road systems. They have learned to utilize cost share,
match the appropriate facility size to the service delivery model,
and plan for organizational capacity. The Commission has also increased
the number of community health aides in the State and improved technical
assistance and pre-development.
US-Mexico Border Commission - Using Technology
and Community Partnerships to Overcome Obstacles to Access
Overview:
Four US-Mexico Border Commission (USMBHC) representatives offered
their perspectives on its valuable work-- Mary Lou Valdez, Secretarial
Delegate, U.S. Section and Deputy Director for Policy, Office of
Global Health Affairs, U.S. Department of Health and Human Services;
Héctor Xavier Martinez Sánchez, Executive Secretary,
Mexico Section; and Dr. Larry Kline and Emma Torres, Members, U.S.
Section.
The Commission brings together two sovereign countries,
in a composition of ten Border States (six Mexican States, four
US States), two sections, and twelve individual Commission members.
It was created in July 2000 by an agreement signed by the U.S. Secretary
of Health and Human Services (HHS) and the Secretary of Health of
Mexico. In 2004, the President signed an Executive Order to designate
the Commission as a Public International Organization. The USMBHC
receives no direct Federal line of funding. Instead, it resides
as part of the Office of the Secretary of Health and Human Services
(HHS) and works with HHS to provide needed resources to the U.S.-Mexican
Border region.
The USMBHC's goals are to provide international
leadership to optimize the health and quality of life along the
US-Mexico border. It seeks to institutionalize a domestic focus
on border health from a perspective that is uniquely of the Border,
not American or Mexican. To create an effective venue for bi-national
discussion and address long term key public health issues, the U.S.-Mexican
Border Health Commission emphasizes sharing and collaboration so
that each side can provide successful strategies and find common
solutions to common problems.
Challenges:
The challenges of access, poverty, lack of providers, and language
and cultural barriers, represent huge obstacles to public health
needs in the area. If the US- Mexico Border were a separate state
it would rank first in the number of children living in poverty
and second in tuberculosis prevalence. It is the most crowded border
in the world, with over a million people crossing its line each
day in either direction, making its needs even more pressing by
the sheer number of people seeking access in an area with little
critical infrastructure.
Strategies for Success:
The Commission combats these and other health disparities by facilitating
study and research, raising awareness, and developing partnerships
for action. Their innovative research focus has led to the proposed
Border Telemedicine Initiative led by the Mexican State of Nuevo
Leon. Using technology to reduce modifiable risk factors associated
with diabetes and cardiovascular disease, telemedicine provides
improved health services and increases access for populations most
in need and most difficult to reach. Technological infrastructure
can be an issue, and using top technology like satellites is expensive;
however, relative to other provider methods, this project is more
cost effective and more sustainable. With different languages needs
and other challenges, this could be one of the best tools to serve
the unique needs of the Border.
Other Border initiatives have sought to increase
health literacy through community-based approaches. Healthy Border
2010 promotes healthy lifestyles on the Border by proposing benchmarks
for health outcomes through the promotion of 20 health indicators
in 11 focus areas. Border Bi-national Health Week takes place on
both sides of the border. The 3rd Annual Border Binational Health
Week 2006 will be celebrated from October 9-13th with a focus on
the goal of "promoting sustainable partnerships to address
border health problems." Another program, Ventanillas de Salud
(Health Windows), is working to establish public information stations
within the Mexican consulates on the border to help direct at-risk
populations to appropriate health services. Partnerships between
border agencies and community organizations are also important for
lessening health disparities. For example, the Pfizer Alliance for
a Healthy Border, a public-private partnership, seeks to reduce
modifiable risk factors associated with diabetes and cardiovascular
disease, and the Centers for Disease Control and Prevention has
partnered with the Pan American Health Organization to promote immunizations
along the Border through the annual National Infant Immunization
Week/ Vaccination Week of the Americas during the month of April.
Appalachian Regional Commission -Providing
Community-Based Solutions to Community-Articulated Needs
Overview of the Commission:
In 1965, Congress created the Appalachian Regional Commission (ARC)
as a Federal-State partnership in an effort to increase job opportunities
and per capita income in Appalachia to help the region reach parity
with the rest of the U. S. Henry King, Director of Program Operations
for the Commission, explained its current programs, which focus
on infrastructure, education, and health demonstration projects
and serve more than 22 million people, almost half of whom live
in rural areas. The ARC strives to promote civic entrepreneurship,
believing that if the problem is in the community, the solution
must then come from the community. This belief necessitates sensitivity
in listening to the needs communities themselves voice.
Challenges:
Appalachia faces long-standing economic and health care challenges.
Access to health care is extremely limited, particularly in distressed
counties, with few dentists per capita, limited access to obstetrics,
and limited availability of mental health and substance abuse treatment
services. The economic status of ARC counties reflects need for
more investment and growth. Of the 410 Appalachian counties, 77
are considered distressed, with per capita income two-thirds or
less of the national rate, and poverty and unemployment rates at
150 percent of the national rate. Another challenge stems from the
ARC's limited role in health promotion due to changes in its Federal
Authority. There is no requirement for how States spend their allocated
funds, and a majority of States choose not to spend their ARC money
on health care.
Strategies for Success:
Today the ARC is taking a more active role in health and is tasked
to increase national understanding of the health care problems unique
to the region. Their health program is not project specific, but
a forum for exchanging ideas and information to develop and promote
solutions to regional health care problems. The ARC's public health
initiatives have been aided by its Health Policy Advisory Council's
research and analysis efforts. The Health Policy Advisory Council
recommended that ARC fund studies of the financial viability of
health care institutions in the region and the economic development
role of health care services. Ongoing studies of substance abuse
and hospital closures have provided insights into long-standing
health disparities in Appalachia.
The health care goals of the ARC are closely linked to economic
development. The Commission seeks to enhance entrepreneurial activity
in the region, and has tapped into the human resources of Appalachia
in order to foster civic entrepreneurship and enhance educational
opportunities. A healthy workforce is a productive workforce, and
the ARC seeks to promote health through wellness and prevention
efforts. Providing access to health care professionals is a top
priority, but it is difficult to attract health professionals to
the area. Telemedicine is one solution to the provider gap, as is
a particularly robust J-1 Visa Program, described in more detail
below. This program fills the gap by offering services in the areas
of primary care, family practice, pediatrics, obstetrics, internal
medicine, and psychiatry.
To remain sensitive to the needs of the communities themselves,
the ARC strives to foster a cohesive focus among its States, and
allow for partnerships to grow based these articulated needs. The
ARC has worked with the Centers for Disease Control to develop prevention
and control strategies for diabetes and cervical cancer in the area,
and an ARC-ORHP mental health and substance abuse conference allowed
local organizations to collaborate and develop community-based solutions.
Participants from 26 communities were granted $3000 to develop comprehensive
plans to address their individual substance abuse problems. This
program allowed partnerships and local initiatives, two methods
of health care promotion foundational to the Appalachian Regional
Commission.
Plenary Discussions
J-1 Visa and Conrad 30
Programs
The J-1 Visa Waiver program and health care workforce issues were
the topic of the first panel discussion. R.L. Condra, Washington,
DC representative and manager of the Delta Regional Authority's
J-1 Visa program and Connie Berry, Director of the Texas Primary
Care Office, shared their respective views on these topics. As illustrated
by the Appalachian Regional Commission's presentation, the J-1 Program
operates by allowing underserved communities to request waivers
to allow foreign medical students the chance to waive their three-year
home residency requirement for an agreement to practice within medically
underserved, rural communities. Because of the Conrad 30 program,
a legislative initiative due for reauthorization in 2006, each State
is allowed up to 30 J-1 visas. Urban centers also can receive waivers,
but they must follow a more complex application process.
The J-1 program accounts for over 50 physicians
in the Delta region, and the program pays for itself through a $3000
application fee by the institution recruiting the physician. Concerns
that it may take jobs away from American physicians have been allayed
by ensuring the positions were advertised extensively to domestic
physicians first. J-1 applicants must agree to a three year commitment
to work 40 hours per week, practice within the Delta counties, and
take Medicaid and indigent patients. The DRA hopes to process and
accept 25 applications per year. So far, zero applications have
been denied by the Department of State, the responsible entity for
J-1 Visa applications. The future of the program centers upon marketing
the uniqueness of the Delta to potential J-1 Visa doctors. Using
brochures, J-1 Visa conferences, travel and presentations, and meetings
with health officials and medical schools in the region, the DRA
hopes to promote and expand the J-1 Program.
Connie Barry followed with a less optimistic view
of the future success of the J-1 Visa program. The program has grown
steadily since its inception in 1948, but a final rule adopted in
1995 now allows residents to enter on the H1-B visa instead. The
H1-B program also waives the foreign residency requirement, but
it does not require any service in rural or underserved communities.
Since the H1-B visa's inception, the number of J-1 Visa applications
has dropped by 56 percent, from 11,026 in 1995 to 6,150 in 2004;
the number of year-one participants has dropped to just 680. According
to Berry, if the numbers continue to drop by 100 each year, there
could be no J-1 Visa-placed doctors serving in these communities
in the next five years. Requiring an MSA service obligation for
the H-1B Visa may be a solution to this growing problem.
Provider Performance
Improvement and Sustainability
Christy Crosser of Mountain States Group and Michael Beachler, Director
of the Rural Health Policy Center, at the Penn State College of
Medicine led the second panel, focusing upon performance improvement
and sustainability of rural health care facilities. Helping rural
health care providers improve performance is the key to sustainability.
Current legislation calls for greater attention on sustainability,
and providers who learn to do well in this environment will keep
their facilities viable.
Availability of health services is a key economic
driver in poor rural communities, and financial performance is the
solution to keeping hospitals open. Beachler provided an overview
of Practice Management Technical Assistance (PMTA), a service designed
to help providers improve their operational and financial performance.
Consumers are increasingly demanding that providers make improvements,
and PMTA is an organizational effort to improve the operational
and financial efficiency of rural safety net providers. It is relevant
to community health centers, private physicians, certified rural
health clinics, small hospitals, and not-for-profit organizations.
The effectiveness of PMTA has already been demonstrated.
In Louisiana the Bureau of Primary Care and Rural Health has practiced
management services since fall 2002. After Hurricanes Katrina and
Rita, the State provided continued funding for staff and played
a key strategic role in helping rebuild Louisiana's primary and
secondary care structure. The Mississippi Hospital Association also
started Practice Managed Technical Assistance in the fall of 2000.
Now it has grown to nearly three full-time professionals whose primary,
but not exclusive, focus is on hospitals. Facilities receive considerable
funding support from the host agency and cover costs with any fees
they collect.
Physicians are trained as clinicians, not businesspeople,
but health care is both a vocation and a business. Third party reimbursement
policies and requirements are constantly changing potential revenue.
Loss can be significant if timely modifications are not made. Practice
Management makes sense in helping to bridge the management gap and
bring better services to people. Sponsoring host agencies have embraced
the service, which has helped increase retention and reduce turnover
of primary care physicians in targeted regions. Providers could
also consider charging fees to cover PMTA costs from the outset
and some not for profits could charge fees, improving marketing
for the service as well.
Crosser described the Rural Hospital Performance
Improvement (RHPI) project, which seeks to build health care capacity
in the Delta Region. RHPI is a program funded by the Office of Rural
Health Policy. Its main goal is to provide on-site technical assistance
to eligible rural hospitals in the Delta to help them improve their
financial, clinical and operational performance. It seeks to build
the capacity that will provide ongoing assistance to rural hospitals,
and collects and disseminates tools, including technical improvement
workshops, which hospitals can use to help themselves. Its consultation
services include performance improvement assessments; it helps hospitals
to assess market and clinical services and identify other performance
improvement opportunities that will result in increased financial
stability.
To participate in the RHPI program, hospitals
must undertake an application process. Eighty-four applications
have been received as of July 2006, resulting in more than 40 targeted
consultations. Final evaluations have shown that participants have
better performance, liquidity, and profitability. RHPI works due
to its quality consultants who know the health care industry in
rural areas and can develop trust and through the follow-up the
program provides. It has been successful enough for its implementers
to recommend using it as a model for programs in other regions.
Community Health Plans
for Metabolic Syndrome and Diabetes Care
"Diabetes is only a test case --a foothold for prevention.
To get prevention on the road, you have to get trust and produce
outcomes for people to see." Dr. Marshall Bouldin
The final plenary revolved around regional diabetes
care, with perspectives from Dr. Richard Crespo, Associate Professor
of Community Health at Marshall University, and Dr. Marshall Bouldin,
Associate Professor of Medicine, University of Mississippi Medical
Center.
Diabetes is a health care burden that accounts
for 15 percent of total US health care costs and 25 percent of Medicare
costs. Mississippi has the highest prevalence of diabetes and obesity
in the U.S., but all of the Regional Commissions noted their concern
with the disease, and all have comparatively few health care resources
to help solve this relatively new epidemic. Type 2 diabetes did
not exist 200 years ago, and even just in 1987, its prevalence rate
was 2.8 / 100,000. However, now the disease has hit pandemic levels,
with a ten-fold increase in pediatric diabetes alone. One in three
children born in 2000 will develop diabetes, and one in two African
American children. Diabetes is preventable, but it requires long
term "sugar" control, without treatment it can cause renal
failure, blindness, and symptomatic neuropathy. Metabolic syndrome,
a compilation of conditions including diabetes, has abdominal obesity
as its number one risk factor.
Dr. Crespo related his work with the Appalachian
Diabetes Control and Translation Project, a community, State, and
Federal partnership. This effort has helped county-level coalitions
to organize around the problem of diabetes with help planning, implementing,
and evaluating their projects. The coalitions supported work with
the neediest counties in nine Appalachian States. The States received
$10,000 startup grants to focus on Diabetes Today training, and
training in chronic disease self-management.
Partnership is a critical component to the Diabetes
Today project; it teaches health care educators to walk alongside
people and communities, helping them to articulate what they want
to do in a measurable form. Because of its community nature, base
communities have no affiliation with granting organizations, and
the States may make a number of adaptations. There are no specific
objectives or plans in the application process; planning occurs
after the application is accepted and the program is adapted. The
grants are open ended, meaning there is no specific end date for
the project. It is a one-time money allotment, but a long term relationship
is expected. People learn to leverage funds by asking local agencies
for contributions and have generated over $300,000 in-kind contributions.
The program has progressed into an ongoing relationship
with sets of coalitions. The engagement in health education programs
over the past two years has allowed coalitions to specify projects
towards an increased concern for the welfare of children. Over 20,000
children have now interacted with health communications networks;
more than 954 kids have received health screenings and even more
have signed up for physical activity programs. Coalitions have used
a social marketing campaign that includes billboards, local TV and
radio, church bulletins, and grocery stores to expand and reach
more individuals.
An important component of the program involves
leadership development, which means helping to develop planning
skills, objectives, and promoting measurable outcomes. This empowerment
part of the work trains leaders to plan and facilitate skills for
behavior change. Community involvement is key to sustainability,
and they have learned that coalitions tend to require a minimum
of five partners. For instance, the County sheriff is involved in
one coalition, and even prison labor has built a community walking
track.
Dr. Marshall Bouldin provided reasons to be hopeful in the fight
against diabetes in Mississippi, with a discussion of the Delta
Diabetes Project (DDP), a program that has drawn attention from
the American Diabetes Association (ADA). The DDP uses a multidisciplinary
chronic disease model and non-traditional features that facilitate
role changes to better utilize the State's sparse resources. Its
regional system of diabetes care uses community based participatory
research collaboration. Proper education and management of the program
ensure that patient self-management is attained. Currently the program
in Mississippi has 4500 patients. Data and outcomes drive novel
applications of tele-informatics and can provide excellent quality
of care.
Noting that if you solve diabetes, you can solve
many other health problems, Dr Bouldin asserted that the DDP could
be used as a template for other regional disease initiatives. The
data shows such projects are sustainable and successful by ensuring
that those who are most affected are helped the most. This is a
regional concept of combating disease, and once the coalition is
built, it can be used to combat any health condition. Regardless
of the setting, whether facility based or a mobile program utilizing
lay health workers, when people see their children and neighbors'
diabetes controlled, they will want to get involved and be part
of the solution.
Summary and Next Steps - Regional Collaboration
and Cooperation
At the end of the two days of focused dialogue,
HRSA and the Regional Commission representatives discussed strategies
for partnerships and necessary next steps. A detailed outline of
their proposals is attached in appendix one.
The meeting highlighted the similar missions and
challenges of the Regional Commissions, and the Commissioners sought
to further this productive dialogue through a communication exchange.
This could be either online or through a series of continued meetings.
They also discussed working together to maximize partnerships and
funding sources so that more people could be helped by the services
they offer.
There was a discussion about convening the health
advisory panels of the Commissions for a similar exchange. Both
the DRA and the ARC stressed community development with an emphasis
on economic development, noting that many problems stem from pervasive
poverty. The view that communities should be empowered to help themselves
prevailed as a method of helping the Commissions solve common problems.
Disease management models, such as the Diabetes Today program, were
cited as a method of cross-regional best practices that could be
shared by the Commissions. Other health issues of particular concern
included oral and mental health.
All agreed that long term planning should focus on children's needs
because only by keeping young people at the forefront of health
promotion can long term change be sustained. Utilizing a community-based
approach would allow for the Commissions' health strategies to facilitate
lifestyle change at the family and community level.
Most importantly, the Regional Commissions affirmed
their commitment to continuing to work together to promote health
improvement in their communities. Administrative, as well as program
accountability and transparency standards were stressed as a means
to ensure sustainability. Seeking deliverable outcomes and statements
of continued partnerships, the representatives sought to move forward
on issues of shared concern. Health information technology, telemedicine,
regional disease management strategies, issues of performance and
sustainability-- all necessitate a collaborative approach and play
an important role in the health care of rural and underserved communities.
Only by working together can the problems of endemic poverty and
insufficient access to quality health care be solved.
2006 Regional Commissions Meeting
Outcomes and Recommendations
- Short Term Goals (Three to Six Months)
- Create commission communication exchange
via workgroup, list-serve, or other electronic mechanism:
- Foster a communications network.
- Develop a matrix of Commission issues and
resources.
- Identify foundation partners etc., to increase
funding and capital development.
- Focus Commission activities on mental and
oral health.
- Long Term Goals (One Year)
- Convene Commissions' policy advisory or
research councils:
- Coordinate research with HRSA.
- Focus Commission leadership on common health
problems (e.g., diabetes, mental health, and oral health).
- Ensure community input into Regional Commission
planning.
- Facilitate exchange of health information
technology development.
- Consult with HRSA to convene commissions
with a conference focused on "healthy lifestyles" for children.
- Consider inviting Mexican and international
partners to commissions table.
- Share community economic development strategies
through the lens of community health workers or promotoras/es.
- Coordinate an evaluation workgroup to
develop a strategic plan:
- Coordinate performance measurement with
respect to Federal funding and Congressional earmarks, developing
a core set of measures for regional commission programs.
- Promote accountability of Commission resources
through the lens of performance measurement, while maintaining
a focus on outcome measures and quality controls.
- Help to solve shared administrative challenges
(e.g., PART process, grant making, and transparency).
- Possible Secondary Activities
- Address workforce problems:
- Create new models of facility and workforce
development (pipelines and alternate workforce solutions,
i.e. community health workers).
- Address H1-B expansion with declining numbers
of J1-Visa Program applicants.
- Educate policy makers as a group of Commissions:
(i.e. Appalachia Caucus, Delta caucus,
Border and Alaska representatives.)
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