Rural Communities Help Themselves

Tom Engels, HRSA Administrator addressed attendees of the Rural Partnership Development Meeting
A former volunteer firefighter, HRSA Administrator Tom Engels told rural health advocates on Jan. 14 that grassroots care networks are essential to connecting America's 57 million rural dwellers to care. Engels called his rural hometown in Wisconsin of 1,500 people a "thriving metropolis" compared to many that HRSA serves.

Saddled with chronic health workforce shortages, widespread substance misuse and high HIV transmission rates, rural care networks — often staffed by volunteers and peer counselors — increasingly are the backbone of care delivery in small town America, HRSA Administrator Tom Engels told some 500 conference attendees at the Rockville Hilton last week.

The audience consisted of participants in three outreach programs run by HRSA's Federal Office of Rural Health Policy. The programs have infused some $29 million in seed money into remote pockets of the country to help advocates and providers form local healthcare partnerships.

Often built around a health center or a hospital, the networks can include schools, shelters, wellness centers, police departments — with local Samaritans using novel approaches to connect otherwise isolated populations with providers across miles of desert, bayou, woodland or rugged countryside.

Rural Partnership Development Meeting - Montage

Novel approaches: (at left) English teacher Karen de Brum described how students and parents on the 140-square-mile Hawaiian island of Lana'i — formerly the world's largest pineapple plantation — have formed a volunteer research network with local schools to collect detailed diet and body mass data for a participating health center. The project is part a larger initiative to address an epidemic of obesity, diabetes and hypertension in the islands;

(Center) Roxanne Elliott (left) and Cindy Laton of FirstHealth of the Carolinas, helped link the University of North Carolina School of Social Work to far-flung EMS units, homeless shelters, treatment centers, sheriff's departments, hospitals and clinics across 5 counties in the rural Sandhills region to help address a rampant opioid epidemic. Funded in installments totaling some $2.2 million in FORHP seed money in recent years, the effort has since attracted more than two dozen supporting organizations and $250,00 in private donations;

(Far right) Micheline White of California's Mendonoma Health Alliance said local advocates would do well to track demographic data that can establish "Community Need" and spur buy-in from distant institutional backers like hospitals and universities. White's "network," centered on Santa Rosa Memorial Hospital, now spans more than 60 miles of rocky, wind-swept coastline in the northwest corner of the state. Isolated "frontier" communities as small as 900 people are strung along its length, including three Native American reservations and two low-income housing developments.

A central strategy of the Mendonoma project is to steer patients into member health centers and drug treatment clinics, where they can receive ongoing case management — while reducing emergency room re-admissions, cutting costs for county governments and hospitals, and preventing infectious disease outbreaks of hepatitis and HIV associated with IV drug use.

"We take that data into our partner organization and say, this is what we've done over the last year," White said, "Can you give us, like, 50 or a 100 thousand dollars?"

Mark Boucot, CEO of Garrett County Memorial Hospital in the mountains of western Maryland, applauded the idea of grassroots data collection — both to quantify need across scattered communities in distant counties and substantiate the value of a network's efforts: "I happen to run a hospital," he told White. "If you saved me $850,000, I would be more than happy to give you $50,000."

Crowd listening as FORHP's Kathryn Umali moderated a Town Hall

Full house: FORHP's Kathryn Umali moderated a Town Hall of outreach workers, advocates and health care administrators from 42 states at the three-day Rural Partnership Development conference. Charity hospitals — which rely on community-based health care organizations (like health centers and care networks) to reduce overuse of hospital facilities — were heavily represented.

"The range and breadth of the types of partnerships forged is critical," Engels said, noting that most networks now include at least two clinical service providers. "Your partners range from educational institutions to nursing homes to local government and legal partnerships. As you work together, and strengthen these partnerships, you will positively affect the members of your community."

Engels observed that it is an especially important time for the networks, as the Trump Administration focuses on rural opioid treatment, ending the HIV epidemic and shoring up obstetrics practices in locations where clinical operations are scarce.

Pilot programs already are underway to decrease maternal mortality and morbidity rates in rural Missouri, New Mexico and Texas by improving access and continuity of maternal and obstetric care. Meanwhile, hard to reach populations in seven more mostly rural states — Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma and South Carolina — as well as 48 U.S. "hotspot" counties, Washington D.C. and San Juan, P.R. — have been identified for stepped-up HIV intervention efforts. More than half of all new HIV diagnoses nationwide from 2016 to 2017 occurred in those jurisdictions, the Administrator said.

Date Last Reviewed:  February 2020