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Office of Rural Health Policy

Strategic Plan
FY 2005-2010

The Health Resources and Services Administration's (HRSA) Office of Rural Health Policy (ORHP) was authorized by Congress in December 1987 to promote better health care in rural America. Congress authorized ORHP to advise the Department of Health and Human Services (HHS) on matters affecting rural hospitals and health care, coordinate rural HHS activities, and maintain a national information clearinghouse. ORHP works within government at Federal, State and local levels, as well as with Tribal Nations and the private sector including associations, foundations, providers and community leaders, to increase access to and improve the quality of rural health care.

ORHP administers a range of programs designed to sustain and improve access to quality health care services for rural communities. ORHP currently manages 12 competitive grant programs, the Frontier Extended Stay Demonstration model, and the Denali Commission resources. Through these grant programs, as many as 5,000 rural and frontier communities are assisted in improving access to health services. The Office continuously considers emerging trends, research, and policy to respond to the unique health care needs of rural communities. In the past 5 years, ORHP has added grant programs, engaged in policy making, and sponsored important research to address the challenges faced in accessing health care in rural America. Highlights of recent successes include the following.

  • In 2001, the HHS Rural Task Force was created, comprising representatives from each of the HHS agencies and staff offices that meet quarterly to discuss HHS programs and policies that impact the provision of health care and human services for rural Americans. The Task Force examines ways to improve and enhance HHS services for the 54 million rural Americans through the examination of current program investment, regulatory policy and barriers to providing services, and the development of strategies to improve services. On July 26, 2002, the HHS Rural Task Force Report, "One Department Serving Rural America," was released. The Report highlighted the Task Force's findings and made a number of recommendations for strengthening the Department's rural focus. Many of the cross-cutting recommendations have been implemented or are underway.
  • ORHP serves as a policy and informational resource in order to sustain and improve access to quality health care services for rural communities. Recent rural health policy successes include recognition of the unique role of Rural Health Clinic and Federally Qualified Health Center pharmacies in rural areas, protection of sole community hospital status when specialty hospitals enter the market, definition of rural training tracks within residency programs, and inclusion of Critical Access Hospitals and small rural hospitals in the CMS hospital quality reporting initiative.
  • Over the past 5 years, the rural research program has conducted timely research well aligned with issues that are important to advancing rural health concerns. The Office's expanded portfolio includes research about the rural population, covering such issues as health disparities, health promotion, and mental and behavioral health. In 2003, ORHP developed a new mini-grant research program designed to provide support for policy-relevant rural health research by entities just entering the field.
  • ORHP has supported the National Rural Recruitment and Retention Network (3RNet) which has expanded its membership from 12 to 45 States over the past 5 years. During FY 2004, this not-for-profit organization helped recruit 753 health professionals (459 physicians) into 611 underserved communities.
  • The National Advisory Committee on Rural Health and Human Services (NAC) is a 21-member citizens' panel of nationally recognized experts that provide recommendations on rural health and human services issues to the Secretary. In 2003, ORHP successfully integrated the human services into the NAC. Within the past 5 years the NAC has concluded 10 field visits and 5 reports to the Secretary covering topics such as access to mental health, oral health, program development, health care financing and workforce development. The Committee uses the field visits to focus on the yearly report topics and to devote time to site visits and presentations by the host community.
  • In 2001, ORHP developed and implemented the Delta Initiative created by the FY 2001 appropriation, including a new grant program for eight States in the Delta Regional Authority, and implementation of the small hospital improvement program, to be piloted in the Mississippi Delta. Since it was implemented in 2001 to address the unique needs of providers in the Mississippi Delta region, the Delta Rural Health Performance Initiative has provided on-site technical assistance to 62 of the 122 eligible small rural hospitals. This project has helped hospitals improve their financial, operational and clinical performance and is a model for performance improvement in other areas of the country.
  • ORHP is tasked with establishing and maintaining the Rural Assistance Center (RAC), which acts as a clearinghouse and single point of entry for all rural health and human services programs within the Department. Created in 2002, the RAC assists rural communities in addressing unmet health needs. The RAC provides current information on funding opportunities, policy developments, meetings, best practices, and other information to rural citizens. A current estimate of the total number of clients served annually is over 150,000.
  • Since the implementation of the Small Hospital Performance Program (SHIP) in 2003, ORHP has made more than $45 million available to help 1,450 small rural hospitals in 46 States and Puerto Rico improve HIPAA compliance, quality and patient safety, as well as make investments in computers, software and technical assistance.
  • In July 2003, ORHP, the Agency for Healthcare Research and Quality (ARHQ), and the Substance Abuse and Mental Health Services Administration (SAMHSA) funded an Interagency Agreement with the Institute of Medicine to provide an independent and unbiased assessment of the quality of health care in rural America, and to develop a conceptual framework for a core set of services and the infrastructure necessary to deliver those services to rural communities. The report, titled Quality Through Collaboration: The Future of Rural Health, was released in November 2004 and makes recommendations for an agenda for quality improvement in a rural setting, and identifies the performance characteristics that model 21st century community rural health systems should meet.
  • In 2003, ORHP planned and managed the Agency's first efforts in working with Regional Commissions through a Regional Commissions Conference. ORHP continues its efforts to collaborate with the four regional commissions across the United States. These commissions view access to health care as critical to economic development in rural communities.
  • "Rural Health Works" is a project that helps communities, counties and States understand and measure the importance of health care to the local economy. Over the past 5 years 44 States have received training, 20 States are working with their local communities, and a number of economic impact analysis studies have been completed.
  • ORHP has been instrumental in supporting the Sowing the Seeds of Hope, a seven-State project that provides mental, behavioral, and substance abuse counseling and assistance to farmers and ranchers in the Midwest region of the country. The project works to provide preventive and therapeutic services for farm family members.
  • In 2003, ORHP supported the development of the Healthy People 2010 companion document for rural communities, identifying best practice models for health promotion and disease prevention.
  • In the fall of 2004, HRSA's US-Mexico border efforts were incorporated into ORHP. Soon after, HRSA-through the Office of Rural Health Policy- became the lead Federal agency within HHS in hosting Border Binational Health Week October 11-17, 2004. The theme for this first-ever border-wide week was "Families in Action for Health" and it brought together more than 29 Federal partner agencies and programs, and 310 community organizations-who carried out more than 200 community events, 28 policy forums, 59 health fairs, and 43 trainings/workshops that reached more than 65,000 individuals in 14 sister cities.
  • Through funds provided under the Frontier Extended Stay Clinic (FESC) Cooperative Agreement, a consortium of rural providers in frontier areas of Alaska have come together to demonstrate the viability of a new provider type for remote frontier areas. With the assistance of the Alaska Center for Rural Health and a provider workgroup, the clinics have identified the characteristics of the extended stay services they currently provide, developed a log to track the services and have begun collecting data on the services provided.
  • In 2004, ORHP implemented three new grants programs:
    • Public Access to Defibrillation Grant Program- The intent of this grant program is to support projects that will increase public access to emergency medical devices and services.
    • Rural Emergency Services Training and Equipment Assistance Grant Program- The REMSTEP grant program seeks to fund eligible entities that propose to develop improved emergency medical services (EMS) in rural areas.
    • Network Development Training Grant Program- The Planning Grant Program provides 1 year of funding to rural communities that seek to develop a formal integrated health care network and that do not have a significant history of collaboration.

  • A recently funded study of the Rural Health Care Services Outreach (Outreach) Grant Program examined accomplishments of grantees (years 1994-1996) 4 to 7 years following the expiration of grant funding. The study found that after an average of almost 6 years of post-grant operations, 86 percent of the Outreach Program consortia were still operational. Approximately 60 percent of the surviving consortia exhibited at least two out of the three study criteria including the use of client revenues and third party reimbursement to support operations. The vast majority of initial consortia activities and services (88 percent) were still available up to 4 years later, a variety of new and expanded efforts have been initiated and stable funding was developed for 46 percent of surviving consortia.
  • The Rural Hospital Flexibility Program is a Federal initiative that provides funding to State Governments to strengthen rural health. Through the Flex program ORHP has provided assistance to bring the total number of rural facilities converted to Critical Access Hospitals to over 1, 000 in order to help stabilize their financial status and preserve access to hospital care in rural communities.
  • In the past year, ORHP has encouraged rural TA Centers to coordinate their technical assistance activities. In 2004, ORHP convened all of the Office's TA providers to seek opportunities to collaborate and consider ways to improve efficiency. As a result of this discussion, a planning team of TA experts was selected to continue these efforts. Almost 1 year later, the planning team has developed a TA Center directory and provided services to assist TA Centers with referrals to other TA Centers. The planning team will join the rest of the TA Centers again in September 2005 to update the other centers on their progress and gather feedback about next steps in TA Center coordination.

Office of Rural Health Policy
Strategic Plan FY 2005-2010

Vision, Mission, and Strategic Goals

ORHP Vision
ORHP's vision is to improve the health of Americans by providing national leadership in increasing access to quality health care in rural America.

The mission of the ORHP is to sustain and improve access to quality health care services for rural communities. In addition, the Office coordinates access to quality health care activities along the U.S.-Mexico Border.

To measure its accomplishments the Office has established the following three long-term goals:

Goal 1: Improve the health and wellness of people living in rural communities and in the U.S.-Mexico border region

Goal 2: Improve the financial viability of small rural hospitals, rural health clinics, and other rural providers

Goal 3: Sustain and improve access to outpatient, inpatient, pharmaceutical and emergency room care for rural communities and along the U.S.-Mexico border region

Goals, Objectives, Strategies

Goal 1: Improve the health and wellness of people living in rural communities and in the U.S.-Mexico border region

Objective 1.1: Coordinate rural policy and programs across the Department of Health and Human Services (HHS) and advise the Secretary on policy and regulatory issues

How We Will Accomplish Our Objective

  • Staff the HHS Rural Task Force
  • Address the difficulties of providing health care in rural communities by managing the Office's grant programs as authorized by Congress
  • Analyze the equity of Medicare payment policies to rural hospitals and other provider types
  • Modernize and effectively manage ORHP's information systems and grant making process
  • Staff the National Advisory Committee on Rural Health and Human Services and oversee the production of the Committee's annual reports
Objective 1.2: Coordinate border health programs and activities across HRSA and advise the Administrator on border health issues

How We Will Accomplish Our Objective

  • Strengthen HHS/HRSA relationships with the U.S.- Mexico Border Health Commission and other partners by playing a lead role in the planning and implementation of Border Binational Health Week
  • Assist in capacity building and community development for all HRSA programs and activities along the U.S.- Mexico Border
  • Convene the HRSA border grantees to review best practices and identify gaps in HRSA programs
  • Lead the HRSA Border Workgroup and play a key role on HHS Interagency Action Team
  • Encourage collaborative efforts between the four State Offices of Rural Health in border States with HRSA border health grantees and the border community through technical assistance, information dissemination, outreach, working with key border partners, and general support of border health activities
  • Work to expand the capacity of the health care safety-net in the U.S.-Mexico border region
  • Support immunization programs on the U.S.-Mexico border
Objective 1.3: Improve access to the full range of available programs, funding, and research for rural communities and other rural stakeholders

How We Will Accomplish Our Objective

  • Maintain a national rural health and human services clearinghouse, the Rural Assistance Center (RAC), for collecting and disseminating information as authorized by Congress
  • Create and maintain a technical assistance Web site through the RAC that focuses on Delta States Grant funding opportunities
  • Maintain a technical assistance Web site through the RAC that focuses on border health information
  • Promote innovative models for health services delivery in rural communities
  • Support rural mental health research and services through grant programs, research and partnerships
  • Implement a balanced research portfolio that studies critical issues such as: health/wellness, financing of rural providers, access to care, quality and health workforce
  • Support research studies that encourage new investigators to enter the field of rural health
  • Support the Delta Region States through technical assistance and community-based programs to address specific health needs
Objective 1.4: Improve Rural Health Quality

How We Will Accomplish Our Objective

  • Promote quality in rural communities by working with the national quality establishment and the rural health care community to support the implementation of recommendations from the Institute of Medicine report on Future of Rural Health: Quality through Collaboration
  • Through State FLEX grantees, provide technical assistance to develop quality improvement programs and publicize them in the community
  • Emphasize wellness and prevention in all appropriate ORHP grant programs
  • Through technical assistance and information dissemination, increase the number of rural providers and communities currently serving or interested in serving rural elders through a rural program of all inclusive care (PACE) model
  • Ensure that provider-specific quality measures are rural appropriate or include rural-specific measures
  • Assist small rural hospitals in the Delta Region with operational, clinical, and financial improvements in order to increase the quality of services provided
Objective 1.5: Foster Networking

How We Will Accomplish Our Objective

  • Support networks by encouraging collaboration among rural hospitals and safety net providers through relevant grant programs
  • Work with other Federal partners, private foundations, universities, associations, and private organizations to encourage collaboration among rural or Border interests
  • Foster collaboration, reduce duplication and eliminate gaps in ORHP technical assistance by integrating the Office's efforts in technical assistance through conference calls

Goal 2: Improve the financial viability of small rural hospitals, rural health clinics and other rural providers

Objective 2.1: Improve financial viability of small rural hospitals

How We Will Accomplish Our Objective

  • Support multiple technical assistance projects to increase the proportion of small rural hospitals and critical access hospitals with positive operating margins
  • Support rural research projects on hospital financing issues
Objective 2.2: Improve financial viability of small rural hospitals

How We Will Accomplish Our Objective

  • Work with Rural Health Clinics on issues that relate to MMA changes or initiatives including Health Information Technology (HIT) and managed care contracting
  • Collaborate with CMS regarding on-going development and refinement of Medicare Advantage and Prescription Drug Benefit policy and procedures
  • Collaborate with CMS regarding rural provider education on payment changes, Medicare Advantage and Prescription Drug Benefit
  • Collaborate with HRSA leadership to formulate policy and support outreach for the MMA
  • Support direct assistance to rural providers on understanding MMA changes through presentations at local, State and national meetings
  • Monitor development and evaluation of MMA demonstration projects with a rural focus
  • Work with HRSA's leadership to format policy and support outreach of the MMA

Goal 3: Sustain and improve access to outpatient, inpatient, pharmaceutical and emergency room care in rural communities and along the U.S.-Mexico border region

Objective 3.1: Develop capacity for rural and border health infrastructure at the local provider, community and State levels

How We Will Accomplish Our Objective

  • Support community-level consultation and financial feasibility studies through technical assistance and State grantees
  • Seek to increase access to capital for rural communities
  • Work with rural providers, community leaders and State grantees to develop an understanding of how and where to best implement advancements in HIT
  • Provide technical assistance for local providers, rural communities and State rural EMS and trauma coordinators
Objective 3.2: Improve access to pharmacy services for rural and U.S.-Mexico border communities

How We Will Accomplish Our Objective

  • Establish outreach and partnering efforts related to raising awareness about the expansion of the 340B pharmacy program to more than 300 rural hospitals
  • Provide technical assistance and best practices to improve access to pharmacy services in rural areas
  • Explore issues and trends in access to pharmacy services for rural communities
Objective 3.3: Improve the distribution of health professionals in rural communities and within the U.S.-Mexico border region

How We Will Accomplish Our Objective

  • Continue to support services and activities that specialize in the recruitment and retention of rural health professions
  • Implement and conduct research studies that examine issues relating to the recruitment and retention of rural provider



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