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Outline

EVALUATING RURAL HEALTH CARE ACCESS: Are there Sustainable Achievements? 3rd Regional Delta Summit Conference Delta Health Education Partnerships April 4, 2002 – Tunica, MS Presented by Michael Beachler Director – Southern Rural Access Program

OVERVIEW Brief summary of Regional Access and Policy   Trends:  Progress and Pitfalls Progress Report on Southern Rural Access   Program (SRAP) University of North Carolina’s Community  Access Surveys in Delta States Other New Investments in Delta States – How   can we maximize the collective impact?

Selected Progress – Health Care Access in Past Several Years Children’s Coverage/Medicaid Investments Tobacco $ - Devoted to Health and Health Care (MS, AR) Some Progress on Health Workforce Issues Select Investments by State Policy Makers

Select Investments by State Policy Makers AR – CHIP and Other Coverage Expansions,            DHEC becomes an AHEC; College of            Public Health; Minority Health Program LA – CHIP expansion to 200% Poverty Level             800K for State Loan Repayment Program             Act 1024 – Changes in DSH Program for             Small Rural Hospitals

Select Investments by State Policy Makers MS – Scholarships/Loan Forgiveness Programs            CHC Investments - $4M/Year            PA Licensure            Coverage Expansions TN – Somehow Tenn Care has Survived

Other Promising Developments Greater Ability to Leverage Grant Resources   from Existing Federal Programs Growth in Philanthropy Interested in Rural   Issues ECD/Kellogg – Emerging Market Partnerships

Promising Developments Federal Delta Regional Authority Delta State Rural Development Network   Program Bush Administration Interest in CHC’s

Storm Clouds on the Horizon Bleak State Budget Situations This is Happening in Most Regions of the Country

Storm Clouds on the Horizon Federal Policy Issues Medicare Payment Cutbacks Other than the CHCs – Little Consensus   on Policy Direction

Storm Clouds on the Horizon Medical School Student Primary Care   “Backlash” Nursing Shortages Oral Health Provider Shortages 2001/2002 Malpractice Crisis

Robert Wood Johnson Foundation’s Southern Rural Access Program (1998 – 2006) Goal:  Improve access to basic care and strengthen capacity in eight of the most underserved states.

"Eight States - AL," Eight States - AL, AR, GA, LA, MS, SC,   East TX, WV National Program Office – Penn State   College of Medicine 1st Three Year Phase - $13.9 Million January 2002 Reauthorization - $18.9M   over 4 Years

Major Program Components Build Rural Leaders Pipeline Improve Provider Recruitment & Retention Rural Health Network Development Revolving Loan – Improving Access to   Capital 21st Century Challenge Fund

Some Key Performance Measures Southern Rural Access Program – Phase I – July 2001 Leaders              829 health professional students participate in pipeline activities Recruitment    313 practitioners recruited or & Retention received practice management or other TA Networks 42 networks received $, leaders training or other TA

Some Key Program Performance Measures Southern Rural Access Program November 2001 Loan Fund 53 loans approved or closed for $18 million + Additional $3.87 million in public/private seed capital leveraged 21st Century 14 grants for $2.1 million (oral Challenge health, transportation, disparity Fund reduction) 26 funding partners for $3.5M

LEADERS Mississippi Medical Enrichment and Development Project Summer Enrichment Program for Rural and Disadvantaged College-Level Students Mentorship Program

Multiple Partners Funding – Phil Hardin Foundation Academic – Coahoma, Co-Lin Meridian,                      Alcorn State, University of MS                      Medical Center Community – Aaron Henry CHC, Greater                         Meridan Health Clinic and Natchez Regional Medical Center

Select MMED Accomplishments 57 Students Participated Increase Post Tests Scores 4 Students – employed in health care                        (part-time) At Least 6 Students in Health Professional   Schools Design of MMEDII Program/Alcorn State

Recruitment and Retention Mississippi  Primary Health Care Association/State Office   of Primary Care Partnership   - Helped recruit 24 providers   - Practice Sights Medical Placement Software   - Helped design state loan repayment program   - Regional recruiting

MS Hospital Association –    Practice Management TA  1.0 FTE Pilot to 4.0 FTE  Kidney Care Foundation of MS + MHA    Support  Helped 29 providers by October 2001  Movement toward sustainability

Arkansas River Valley Rural Health Cooperative 3 county area in Arkansas 4 small hospitals (3 are CAH) Physicians, Community 2 City Hospitals (Ft. Smith) Full-time staff

Arkansas River Valley Rural Health Cooperative Prescription Assistance Program – 420   clients served last quarter Medical Management Disease Prevention   Program Community Health Link – Limited benefit   adult health plan – Fills Medicaid gaps

Arkansas River Valley Rural Health Cooperative Community Health Link   - Changes in state law   - Subsidies from Providers   - 150 member pilot @Medicaid 1115      Waiver Goal Leveraged $1.13 million in cash match

Louisiana Community Health Network Development Strong Community Development Approach –   Mobilizing both community leaders and key   providers By Net Network – St. Mary’s Parish   - Pharmaceutical Discount Program   - Consumer Education – Information and      Referral Call Center   - Parish Wide Transportation Plan – Leverage     $260,000 Additional State Federal $   - Telemedicine Link

l Vermilion Parish Network   - Vermilion Policy Jury investment in primary care market       analysis     - Pilot pharmaceutical access program     - Free clinic unfolding     -Spring 2002 anticipate $600,000 network grant  l Receipt of $245K Pfizer grant to foster   network development in three more   parishes.

Arkansas Southern Development Bancorporation Southern Financial Partners Revolving Loan Fund Mission:  Foster Economic Development in   Distressed Rural Communities Bank Holding Company – 3 Banks - $238M   in Assets – Certified Development Financial   Institute Start-up (1986) – Winthrop Rockefeller   Foundation - $5M Grant

Southern Financial Partners Loan Fund Status 9 Loans Approved and/or Closed Since   November 1999 $5,874,000 – Dollar Value of Loans Ranged from $25K for nurse midwife start-   up to $1.1 million CHC construction to   $2.17M outpatient services expansion   project

Refinements in Second Phase Sites Target SRAP Funded Interventions to a   Specific Geographic Region Emphasize Movement Toward Sustainability Planning for Single Regional Forum to   Promote Access in the Southeast

Summary SRAP Phase II Funding April 2002 – March 2006 $13.3M Core component grants $3.5M Revolving Loan Fund $1.5M 21st Century Challenge Fund $750K Regional Forum Planning

Phase Target II Regions Arkansas 14 county area in Eastern Delta Region - 317,000 (pop.) Louisiana 14 parish region, South Central and six parishes in federal Delta initiative - 580,000 (pop.) Mississippi 31 counties in Northwest (Delta) region and southwest MS - 690,000 (pop.)

Mississippi Target Region

Arkansas Target Region

Louisiana Target Area

Phase II, Round I Grants April 2002 – March 2004 AR, LA, MS $961K - $1.05M Southern Financial $500K Partners (Loan Fund)

University of North Carolina at Chapel Hill Cecil Sheps Center for Health Independent Evaluators of Southern Rural   Access Program One Key Component of Evaluation – Community   Access Surveys Focusing on “New” Target   Regions in Phase II 4800 Telephone Surveys – 600 per state –   Baseline Surveys in field, Summer 2002

Survey Questions Include Health Status Health Care Coverage Health Care Utilization Health Care Satisfaction and Propensity to  Seek Health Care -Access and Barriers to Other Types of Care -Demographics States Can Add Questions

Community Access Surveys Regions will probably also be surveyed in 2006   or 2005 (?) Survey is sensitive and adjusts to households   without homes issue Will provide important information on Southern   Rural Access Program and other access   improvement activities Can also be valuable community and state   policy advocacy/education tool

New Investments in Delta States Delta State Rural Development Network Program   (Federal Office of Rural Health Policy) Enterprise Corporation of the Delta/Kellogg Fdn.   Emerging Markets Partnership

Delta State Rural Development Network Program 8 States – AR, LA, MS, TN, AL, MO, IL, KY Target Counties/Parishes Very Similar to SRAP Community/State Level Partnership Use of Community Encourages to Develop   Community Councils – Community Health   Networks $5.3M/Year for 8 States Separate Grant (1.0M/Yr.) Effort to Provide TA   to Small Rural Hospitals

Lead Agency/Partners Southern Rural Access Program and Delta State Rural Development Program AR    SRAP – Arkansas Center for Health Improvement    Delta State – Mid-Delta Community Consortium LA    SRAP – Louisiana State University                  Southeast LA AHEC                  Marsha Broussard – Proj. Dir. (both efforts)

Lead Agency/Partners Southern Rural Access Program and Delta State Rural Development Program MS    SRAP – MS Primary Health Care Association    Delta State – Aaron Henry CHC TN    Department of Health

Enterprise Corporation of the Delta/ Kellogg Emerging Markets Partnership Managed by Enterprise Corporation of the Delta Seeded by $20M – Kellogg Foundation Fannie Mae plans to invest $45M in customized   mortgages in 2002 alone Focuses on Economic Development in 58  counties and parishes in AR, LA and MS

Invest in Training and Financing Strategies that Address: Small business development Home Ownership Child Care Health Care Telecommunications Workforce Development

Very Important Opportunity to Work Together Need to better understand each other’s    programs – Similarities and Key Differences Advantage – Many key players already know and work with each other