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GHPC Presents at the National Rural Health Association

Continuing a long tradition of supporting rural communities in community health systems development, researchers from the Georgia Health Policy Center made several presentations at the National Rural Health Association Conference held in San Diego, Calif. May 9-12, in partnership with project officers from the U.S. Health Resources and Services Administration’s Federal Office of Rural Health Policy (FORHP).

Collaborations Improve Health Coverage, Access to Care
Rural-based organizations can build effective partnerships that improve health insurance coverage and access to care for those living in rural communities.

From 2013 to 2016, FORHP awarded grants to 78 rural and frontier communities to expand enrollment (in Medicare, Medicaid, the Children’s Health Insurance Program, and private health insurance) and provide benefits counseling to educate newly insured about their coverage and how to use services. The Georgia Health Policy Center (GHPC) provided technical assistance to these communities and evaluated the success of their initiatives.

The grantees developed partnerships to ensure outreach and education activities would build awareness and maximize capacity and reach. Partnerships included traditional health partners (local and state health departments, clinics, and nonprofits), as well as nontraditional partners, such as Legal Aid offices, insurance agencies, tax preparers, faith-based organizations, schools, and employers.

But, GHPC found that communities developed different approaches to partnerships. The partnership arrangements were characterized as

  • Plug-in partnerships, where grantees focused on extending their reach beyond the populations they typically serve by building partnerships with organizations that had existing relationships with uninsured target populations
  • Wrap-around partnerships, where grantees with an existing singular focus on outreach and enrollment formed partnerships to expand their scope to ensure that clients better understand their benefits, are able to maintain coverage, and access care
  • Capacity-building partnerships, focused on training navigators and building staff capacity. These learning opportunities met annual training, certification and continuing education requirements.
  • Closed-loop partnerships, included health systems, hospitals, or clinics, engaging in insurance coverage and access to care efforts within their own entities. These initiatives involved a reorganization of relationships across departments and establishment of new referral processes to “close the loop” between enrollment and access to care.

“Partnerships are an efficient way to build individual, agency, and local community capacity and establish an integrated support system for the newly insured,” says lead author Tamanna Patel, from GHPC. “Rural health organizations that build upon partnerships are better positioned to understand and address the factors related to obtaining coverage, accessing care, and creating a local system to integrate the newly insured into care.”

Study co-authors included Amanda Phillips Martinez, from GHPC, and Normandy Brangan, from FORHP.

Rural Communities Adapt Evidence-Based Practices
Rural communities must often adapt evidence-based health interventions to fit the unique circumstances of rural settings.

GHPC researchers reviewed the projects of 60 grantees of FORHP’s Rural Health Care Services Outreach Program. This evaluation explored how rural, community-based programs are implementing innovative program models, in areas such as behavioral health and chronic disease, in spite of health care delivery barriers faced by rural communities.

Grantees tailored evidence-based or promising practice models to meet community needs by

changing the order/sequence of process steps and increasing collaboration with stakeholders. Translating evidence-based practices to rural settings were most often challenged by: a lack of provider buy-in, limited staff capacity, lack of cultural appropriateness, low patient/participant volume, and state / local policy.

“As Outreach grantees continue to implement initiatives modeled after evidence-based practices, there is an opportunity to improve efficiencies in health care delivery, maximize outcomes for greater health and community impact, and cultivate a collection of rural-specific models and interventions,” writes coauthor Tanisa Adimu, from GHPC. “However, more work is needed to address the challenges communities face in tailoring interventions to their rural-specific needs and interests.”

The study was coauthored by Amber Berrian, from FORHP.

Rural School-based Innovations Impact Childhood Obesity
School-based interventions can help rural communities address child obesity by increasing physical activity, building partnerships between health and education professionals, and engaging students in health-enhancing behaviors.

The Illinois CATCH onto Health! (ICH) initiative was launched in 2007 as part of the Illinois Delta Project to improve the health of the state’s youth, particularly in the rural Delta region, and has grown to now reach more than 75 percent of the 106 schools in region. The initiative combines the Coordinated School Health framework, the evidence-based Coordinated Approach to Child Health program, and the U.S. Centers for Disease Control and Prevention’s assessment tool, the School Health Index, to create positive impact. These impacts included:

  • Increased moderate to vigorous physical activity during the school day in kindergarten through 5th grade students.
  • Increased aerobic capacity among students from kindergarten through grade 5.
  • Increased standardized test scores among students grades 3 through 5.
  • Built capacity in school administrators, teachers, and staff through organizing health and wellness efforts to focus on policy, system and environmental changes, resulting in over 30 wellness policies being strengthened or established.

This combined approach received statewide recognition with the development of the We Choose Health initiative, which has reached over 300 schools throughout Illinois,” says Rachel Campos, a study coauthor and technical assistance provider at GHPC. “This implementation framework, while developed in a rural area, has proven to be equally as effective in the more urban areas of Illinois.”

This study was coauthored by Jeff Franklin, from Southern Illinois University Medicine’s Center for Rural Health and Social Service Development, and Alexa Ofori, from FORHP.