Paper looks at rural health policy initiatives, future opportunities

A recent paper from the Rural Policy Research Institute (RUPRI) Health Panel examines the progress of national health policy initiatives and the gaps that remain as they affect rural people, places, and providers.

Professor and Interim Dean Keith Mueller.
Keith Mueller

According to Keith Mueller, RUPRI Health Panel Chair, professor of health management and policy, and interim dean at the University of Iowa College of Public Health, the paper lays out clear policy trajectories in seven major subject areas that can enhance access and affordability of high quality services in rural America into the future. The subject areas included are Medicare, Medicaid and CHIP, Insurance Coverage and Affordability, Quality, Health Care Finance and System Transformation, Workforce, and Population Health.

Each chapter begins with a summary of policy opportunities, followed by a background section on rural trends and challenges that summarizes rural-related policy advances and continued gaps. Each chapter concludes with a “Looking Ahead” section that highlights the most pressing issues in today’s rural health care system environment and suggests future policy directions related to each issue.

“We wanted to take a look at national policy initiatives such as Medicare, Medicaid, and insurance reform to take stock of progress made for rural communities and to develop clear statements of remaining challenges,” says Mueller. “Ultimately our goal is to help build a roadmap to achieve a high performance health system in all of rural America.”

A PDF of the paper is available at http://www.rupri.org/wp-content/uploads/TAKING-STOCK-2018.pdf

Co-authors are Charles Alfero, Hidalgo Medical Services (HMS); Dr. Andrew F. Coburn, University of Southern Maine; Dr. Jennifer P. Lundblad, Stratis Health; Dr. A. Clinton MacKinney, University of Iowa; Dr. Timothy D. McBride, Washington University in St. Louis; and Dr. Paula Weigel, University of Iowa.

This report was funded by the by the Leona M. and Harry B. Helmsley Charitable Trust, grant number 2017PG-RHC006.

RUPRI named one of four NEA Research Labs

The University of Iowa has been selected by the National Endowment for the Arts (NEA) to receive one of the first projects funded through a new program, NEA Research Labs. The cross-sector projects supported through the program investigate how the arts contribute to positive outcomes for individuals and communities. The NEA will fund four inaugural projects totaling $598,600 that will yield insights for the arts sector and for non-arts sectors such as healthcare, education, business, and management.

The Rural Policy Research Institute (RUPRI) at the University of Iowa College of Public Health, in partnership with the organization Art of the Rural, will look at the intersection of the arts, entrepreneurship, and innovation in rural contexts. RUPRI also will work with its Rural Intracultural Policy Council to develop pilot studies of rural “cultural ecologies.” The pilot studies may use social network analysis, structured interviews, and respondent-driven survey sampling to test hypotheses about cultural and social capital as preconditions to innovation.

Other labs recommended for funding are: Drexel University, Philadelphia, PA; University of Arkansas, Fayetteville, AR; and Vanderbilt University, Nashville, TN.

Each of the labs will design and implement a research agenda and prepare reports in one of three areas:

  • The Arts, Health, and Social/Emotional Well-Being
  • The Arts, Creativity, Cognition, and Learning
  • The Arts, Entrepreneurship, and Innovation

The NEA Research Labs initiative is intended to fulfill milestones of the agency’s new five-year research agenda.

RUPRI researchers examine Medicaid reform in rural settings

A new research report by the Rural Policy Research Institute’s Health Panel, which includes University of Iowa faculty and is supported by research staff in the UI Department of Health Management and Policy, outlines the challenges and opportunities confronting rural providers, policymakers, and health systems as they work to implement reforms in rapidly expanding state Medicaid programs.

The report notes that efforts to reform the health care delivery system are gaining momentum among all payers and within Medicaid programs in particular, given their significance to a growing population as well as to state budgets.  The report calls on policymakers to “recognize both the desirability and shortcomings of new delivery system models for rural patients and providers.”

“While both national and state policymakers shape Medicaid reform, state-level policies have the potential to encourage a broader statewide focus on population health by connecting Medicaid to other important and impactful state-level resources, like human and social support services and public health,” the report states. “In implementing policies that promote delivery system reform, it is important to consider how certain models may be capable of either promoting access for rural populations or diminishing it.”

According to the report, broadened eligibility under the federal Affordable Care Act (ACA) nearly doubled the percentage of people covered by Medicaid programs — from 10.4 percent of the U.S. population in 2000 to 19.5 percent in 2014. As of January 2016, more than 72 million people nationwide were enrolled in Medicaid.

The significance of state Medicaid programs is even greater in rural areas where, as of 2014, 22 percent of residents were enrolled. Medicaid has surpassed Medicare as the largest source of public health coverage in rural areas, and is second in coverage only to employer-sponsored insurance plans. The program is also a crucial source of provider payments in rural communities.

The report identifies six recommendations for rural policymakers, providers, and communities. The recommendations are:

  1. Promote integrated and comprehensive primary care delivery.
  2. Promote integrated and comprehensive care across the health care continuum.
  3. Promote accountability for the health of the Medicaid population in rural communities.
  4. Promote measures, reporting standards, and payment approaches relevant to rural providers.
  5. Promote payment designs that recognize the nature and circumstances of rural providers and systems.
  6. Provide technical assistance to rural providers during the Medicaid transition to value-based payment.

The report was authored by the RUPRI Health Panel, which is chaired by Dr. Keith Mueller, professor and head of health management and policy at the University of Iowa College of Public Health. The work was supported by the Leona M. and Harry B. Helmsley Charitable Trust. The full report is available at the RUPRI website.

Fluharty honored for distinguished leadership in rural development

Charles Fluharty, clinical professor of health management and policy, and founder, president, and CEO of the Rural Policy Research Institute (RUPRI), was recently honored by Iowa Wesleyan University as the inaugural recipient of the Presidential Medal for Outstanding Merit.

Portrait of Chuck Fluharty
Charles Fluharty

The award, conferred during the Iowa Wesleyan University commencement ceremony on May 7, recognizes Fluharty for “lifelong and exemplary leadership and commitment to advancing the development of rural life and communities.” The award also acknowledges the extensive work of RUPRI over the past 26 years to address “the full range of policy and program dynamics affecting rural people and places.”

Fluharty’s career has focused on service to rural people, primarily within the public policy arena. A seasoned policy analyst and practitioner, he has authored numerous policy studies, journal articles and policy briefs addressing the rural differential in public policy decision making. He is also a frequent speaker before national and international audiences, having delivered major public policy speeches in over a dozen nations, and has provided senior policy consultation to most federal departments, state and local governments, associations of government, planning and development organizations, and many foundations.

He was a German Marshall Fund Transatlantic Fellow from 2007 to 2011, and recently coordinated a collaboration between former Kentucky Gov. Steve Beshear and U.S. House Appropriations Chairman Hal Rogers to address the severe economic dislocation resulting from the decline in the eastern Kentucky coal industry. His two-year engagement resulted in the establishment of Shaping Our Appalachian Region (SOAR), a public/private/philanthropic intermediary collaborating across 60 counties in the Appalachian mountains.