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1994.09.26 :  Rural Health Improvement

Contact:   PHS - AHCPR -301/594-1364
                 Bob Isquith  ext. 173
                 Bob Griffin  ext. 169
                 Paula Zeller  ext. 148 
Monday, Sept. 26, 1994


        $9.7 MILLION FROM AHCPR TO HELP IMPROVE RURAL HEALTH

     The Public Health Service's Agency for Health Care Policy and
Research today announced grants totaling $9.7 million to support
demonstrations of innovative ways to deliver health care services in
rural areas of Maine, West Virginia, Oklahoma, Nebraska, Iowa and
Arizona.

     Philip R. Lee, M.D., HHS assistant secretary for health and
director of the Public Health Service, said, "These grants will help
show what innovations in the organization, financing and delivery of
health care services can do to improve care in rural areas.  Many of
the innovations, such as managed care, are of proven value and
available in metropolitan areas, but are frequently unavailable to
rural populations."

     AHCPR Administrator Clifton R. Gaus, Sc.D., said the focus will
be on innovations that have been introduced in urban areas as a
result of market forces, but that for economic or other reasons are
not generally available in rural areas.  

     "A significant activity of the centers will involve promoting
establishment of managed care institutions and development of rural
health networks," Dr. Gaus said.   He said he expects the efforts by
the rural centers will lay the groundwork for planning future
statewide or regional managed care systems, that will make primary
care and clinical preventive care services more available to rural
residents.

     Rural populations have been found to be in poorer health than
most groups in urban and suburban communities.  "There are many,
complex reasons why this may be so," Dr. Gaus said.  "Limited public
transportation, unemployment rates above the national average, and a
shortage of health professionals in rural areas may all play a
role."  

     He indicated that rural center researchers will help identify
these factors more precisely.

     In addition to demonstrating innovations in delivery of health
care services, the rural centers will develop information systems to
provide essential data on health care costs and other information. 
Such systems could allow health care administrators to monitor the
quality and overall performance of rural health care systems, and to
make improvements in them.

     The following institutions have entered into cooperative
agreements with AHCPR and are recipients of rural center grants:

University of Southern Maine, Portland, Maine (Grant No. HS 08612-
01, David Hartley, principal investigator, Tel. 207/780-4430):  $2
million to support the Maine AHCPR Rural Center, which will develop
and implement rural managed care demonstrations at sites located in
Washington County and Northern Androscoggin/Franklin County, Maine.
Technical assistance for the demonstrations will be provided by a
consortium, including the University of Southern Maine, the Maine
Department of Human Services, the Maine Medical Center and the Maine
Medical Assessment Foundation.

     Activities at the two demonstration sites will include: 
establishing health care networks for rural residents; planning 
and developing health care information systems; developing managed
care and financial management systems for use by health care
providers; and developing community outreach and education programs
to acquaint rural residents with health care issues, and disseminate
practical advice and information on health maintenance and
preventive health care.

West Virginia University, Robert C. Byrd Health Sciences Center,
Morgantown, W.Va. (Grant No. HS 08627-01, Hilda R. Heady, principal
investigator, Tel. 304/293-6753): $1.9 million to support the West
Virginia Rural Managed Care Demonstration Center, which will sponsor
activities to encourage delivery of high-quality, cost-effective
health care in rural areas by regional health care networks on a
competitive basis.  The center will complement and build upon other
health-related projects in the state that are planned or underway.

     Specific activities will include: instructing health care
providers on the principles of managed care, with emphasis on
quality improvement and cost-savings; developing an ombudsman
program within rural health care networks to investigate consumer
complaints; facilitating development of a regional data processing
center and data infrastructure to integrate health care information
systems among health care providers; and developing a "consortium
for rural health services" to identify the needs for health services
research, and to recommend research projects of value to rural
managed care demonstration networks.

University of Oklahoma Health Sciences Center, Oklahoma City, Okla.
(Grant No. HS 08633-01, Edward N. Brandt Jr., principal
investigator, Tel. 405/271-3230): $1.9 million to support the
Oklahoma Rural Managed Care Demonstration Center, which will
identify factors associated with successful implementation of rural
primary care networks.  The center also will provide technical
assistance to community-based, public-private partnerships for
delivery of primary health care in rural areas. Assistance may
include negotiating with health care providers for delivery of
primary care services in local communities.

     The Rural Research Center is comprised of faculty and staff
from the University of Oklahoma Health Sciences Center and the
Center for Health Policy Research and Development, Oklahoma State
University, and the Oklahoma State Department of Health. It will
monitor two demonstration projects carried out through a consortium
including the Cherokee Nation Health Care Network and First Health
West, a rural hospital alliance serving portions of Oklahoma.

     Center participants may utilize services of the Oklahoma
Telemedicine Network and its telemedicine training center. The
Telemedicine Network is integrated with the Eastern Oklahoma Rural
Health Network, a federally funded pilot program to link major
osteopathic providers, rural communities and Indian Health Centers
in the state.

University of Nebraska Medical Center, Omaha, NE/University of Iowa,
Iowa City, Iowa (Grant No. HS 08610-01, Keith J. Mueller, principal
investigator, Tel. 402/559-5260):  $1.9 million to support the
Program of Rural Health Demonstration Activities, which will
demonstrate innovative ways of assisting primary care practitioners
in implementing health reform measures.  Technical assistance will
be provided to newly established rural managed care networks.  The
program will be managed by a consortium comprised of the Center for
Rural Health Research at the University of Nebraska Medical Center;
the Nebraska Office of Rural Health; the University of Iowa's Health
Services Research Center; and the Iowa Office of Rural Health.

     Program staff will identify potential interventions that could
assist primary care providers in developing networks for managed
care.  These may include, for example, educational activities to
explain changes in public policy and effects on the health care
delivery system; assistance in meeting needs for health care data
and information; assistance with legal issues; and information or
advice on issues relating to quality-of-care, practice management,
and marketing of health care services.  Focus groups and surveys
will be used to determine the degree to which primary care providers
have need and desire for such services.

     One rural area in Nebraska and one area in Iowa will be
targeted for demonstration activities.  Within each area,
demonstration activities will target the needs of primary care
practitioners.  Data will be collected in both states using the same
sources, programmed for comparative analysis.  After completing one
demonstration in each state, two additional demonstrations will be
implemented on the Nebraska-Iowa border.

University of Arizona, Tucson, Ariz. (Grant No. HS 08620-01, Andrew
W. Nichols, principal investigator, Tel. 602/626-7946):  $2 million
to support the Arizona Rural Managed Care Center, whose goal is to
expand access to primary care services by increasing the
availability of managed care in rural areas.  Center activities
include: technical assistance to counties to help facilitate the
establishment and growth of health care networks; expanding the
Arizona Health Care Cost Containment System, a capitated managed
care program available to qualified citizens of Arizona in lieu of
Medicaid; and providing incentives to private managed health care
organizations to develop demonstration projects in rural areas.

     Access to primary care in the two initial rural sites will be
increased using a number of strategies, including recruitment of
providers and expansion of the health care financing base.  
Private employers and other organizations will be encouraged to 
develop managed care initiatives -- for example, by linking future
contracts for managed care benefits in urban areas to provision of
services in rural areas.  The center will monitor the
appropriateness of care by managed care groups serving rural areas,
and disseminate information to them through an established computer
information network.
     
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