A recent report from the Centers for Disease Control and Prevention (CDC) documents the ongoing mental health challenges for health workers. From 2018 to 2022, health workers reported an increase of 1.2 days of poor mental health during the previous 30 days (from 3.3 days to 4.5 days) and the percentage who reported feeling burnout very often also increased (11.6% to 19.0%). Improving management and supervisory practices might reduce symptoms of anxiety, depression and burnout. Health employers, managers, and supervisors are encouraged to implement the guidance offered by the Surgeon General (see page 8 of the report) and use CDC resources (see page 20 of the report) to include workers in decision-making, provide help and resources that enable workers to be productive and build trust, and adopt policies to support a psychologically safe workplace.

The HRSA-supported National Telehealth Policy Resource Center released a report that provides an overview of state telehealth policies as of September 2023. The report covers Medicaid reimbursement, private payer laws, and professional requirements.

The Rural Health Value team is pleased to share a new Rural Innovation Profile:

Rural Hospital Experiences in the Colorado Hospital Transformation Program (CO HTP)

This profile summarizes experiences of three rural Colorado hospital participants in the CO HTP, a mandatory statewide five-year program that ties Medicaid supplemental payments to hospitals’ ability to meet performance targets. The goal is to drive change to improve healthcare outcomes, equity, and access for all patients and prepare Colorado hospitals for future value-based care and payment models.

Related resources on the Rural Health Value website:

• Engaging Your Board and Community in Value-Based Care Conversations (uiowa.edu) – this document will help healthcare organization leaders start value-based care conversations with board and community members. These conversations will lay the groundwork for informed strategic planning and operational decision-making.
• RHV Summit: Driving Value through Community-Based Partnerships (uiowa.edu) – this report shared experiences from four rural communities driving value through community-based partnerships. Several opportunities for policymakers, payers, and health system leaders for building and supporting social needs infrastructure in rural communities are highlighted.
• SIM Profiles (uiowa.edu) – this paper discusses State Innovation Model (SIM)Testing Awards from the Centers for Medicare & Medicaid Services Innovation Center, highlighting rural focus and themes.

New from the RUPRI Center for Rural Health Policy Analysis

Medicare Advantage Enrollment Update 2023
Edmer Lazaro, DPT, MSHCA; Fred Ullrich, BA; and Keith Mueller, PhD

The Rural Policy Research Institute (RUPRI) continues to monitor MA enrollment trends and how it is influenced by changes in health policies. More MA plans are being offered in 2023 than in any other year, indicating the appeal of this program for insurers throughout the country. The MA program delivers the program’s benefits to 53.9 percent of metropolitan beneficiaries, and the current rate of growth shows similar trends among nonmetropolitan enrollees. Such plans are attractive because they typically offer extra benefits, often with no additional premium. As the market continues to grow and enrollment rates in MA increase, researchers should continue to examine how well the MA program serves its beneficiaries, especially those living in nonmetropolitan areas. Changes in the MA program highlight the importance of developing policies that aim at improving care access for nonmetropolitan enrollees.

Click here to read the full report.

A new report from the U.S. Department of Agriculture examines three broadband programs and if they were able to reach the target audiences.

The report looked at three programs: The Broadband Initiatives Program (BIP) was the largest of them in terms of funds obligated during the study period, with about $3.6 billion in grants and loans in Fiscal Year 2010. ReConnect obligated $1.5 billion in grants and loans from Fiscal Year 2019 to Fiscal Year 2021, and Community Connect obligated $253 million in grants from Fiscal Year 2009 to Fiscal Year 2021.

“The populations served by all three programs tended to be more rural, less educated, poorer, and older than those in areas not served (for BIP) or ineligible (for Community Connect and ReConnect),” the report stated. “All programs reached a larger share of the American Indian/ Alaska Native (AIAN) and White populations than other races and a larger share of the non-Hispanic than Hispanic population.”

However, only 10% of AIANs who lived in areas eligible for ReConnect in 2020 were in approved project services areas,  the lowest percentage for any racial group. This resulted from a low percentage of the eligible AIAN population in areas proposed to be served in ReConnect applications and not from a greater share of AIANs in areas that would have been served by rejected or withdrawn applications.

“Outreach and technical assistance efforts may help address some of the observed differences across racial and ethnic groups in their tendency to be included in applications to broadband programs and in their likelihood of having applications approved,” the report stated.

Brian Whitacre, a professor and Jean & Patsy Neustadt Chair in the department of Agricultural Economics at Oklahoma State University, said he was pleased to see a report that looks at outcomes.

“In the past, we’ve had all these federal broadband programs, and we’ve never really done an analysis of where that money is going,” he told the Daily Yonder.

This report, he said, looks at whether the money is going to the people it’s intended to.

Read the full article on The Daily Yonder website.

While partisanship remains strong among rural voters, certain messages resonated with voters across the political spectrum. They included battling inflation, bringing good-paying jobs to local communities, and battling corporate greed.

Could Democratic candidates, whose support among rural voters has waned considerably over the past two decades, regain some support utilizing these messages?

Big Takeaways

• The survey suggests as many as 37% of rural voters are swing blue-collar voters who could be swayed by the certain policy proposals and messaging.
• While partisanship remains strong among the rural electorate, voters were aligned on many of their chief concerns: affordable housing, the high cost of food, and corporate greed.
• Three messaging points — lowering prices; bringing good-paying jobs to local communities; and a populist message focused on corporate greed — received such broad support that they rivaled voters’ agreement on core values like family and freedom.
• President Joe Biden is viewed 18 points more unfavorably than Donald Trump, suggesting the Democratic Party has a lot of work ahead if they plan to move rural swing voters.

The Numbers

• 51 percent of Democrats thought the economy was working well for them, compared to 17 percent of Republicans.

• Respondents were asked to pick two issues from a list of 14 that were the most important for themselves and their families. The respondents could also choose “other,” “none,” or “not sure.
  • 54% chose the rising cost of living as one of their most important issues, followed by retirement and Social Security (25 percent), health care (19 percent), dysfunction in government (15 percent), and jobs and the economy (15 percent).

• Respondents were asked to pick two concerns from a list of 11 that were the most important for themselves and their families. The respondents could also choose “other,” “none,” or “not sure.
  • 43% chose the rising cost of food as one of their most important issues, followed by rising gas prices (24 percent), rising energy costs (21 percent), rising housing costs (19 percent), and a lack of good-paying jobs (18 percent).

Click here to read the full report.

When it comes to saving American lives, don’t look to cardiologists, oncologists, or even the made-for-TV heroes in the ER. It’s primary care providers who offer the best hope of reversing the devastating decline in U.S. life expectancy. That’s the conclusion reached by experts who study America’s fractured healthcare system. Read, “Primary care saves lives. Here’s why it’s failing Americans.”

The shortage of available health care services in rural areas in the U.S.  may be mitigated by accessing telehealth services, especially for direct-to-consumer (DTC) telehealth. DTC telehealth is defined as patient-initiated telehealth care, typically from their home. While considerable evidence supports the use of telehealth, additional well-designed studies are needed to identify the best applications of telehealth services to increase access in rural settings. To address these needs, the Office for the Advancement of Telehealth (OAT) in the Health Resources and Services Administration (HRSA) has been offering grant funding to existing telehealth networks to further expand their services to rural areas.

Specific to this project, OAT released a Notice of Funding Opportunity (NOFO) (HRSA 21-082) for the Evidence Based Telehealth Network Program (EB TNP) focused on DTC telehealth. In September 2021, OAT identified 11 grantees to receive 5 years of funding. The NOFO specified that the grantees would submit data to the Rural Telehealth Research Center (RTRC) on patients who receive DTC telehealth and on a comparable group of patients who receive in-person services. The NOFO specified that RTRC would identify data collection elements and protocols, and subsequently serve as the data coordinating center for this grant program.

The objective of this project is to contribute to the evidence base for telehealth in rural settings by pooling data collected across EB TNP grantees on the services they offer through DTC telehealth and in-person care related to primary care, urgent care, behavioral health, substance use disorder, maternal care, and/or chronic care management services. Pooling data will be possible by using a standardized set of data elements related to access/utilization, cost/efficiency, and clinical outcomes.

Please click here to read the brief.

As of August, the Pennsylvania Department of Human Services has completed redeterminations for 30% of the individuals who maintained continuous eligibility through the public health emergency. Of those who had redetermination completed, 54% retained their Medicaid coverage. Of those who did not retain coverage, 53% were due to failure to provide documentation. 7,626 individuals have successfully enrolled through Pennie. One encouraging fact is that the rate of returned mail is lower than expected, indicating that your messages to update contact information are getting through. DHS is increasing direct outreach to Medicaid enrollees ahead of renewals by holding press events with community partners – including FQHCs – to raise awareness of unwinding and what people need to do to stay covered; standing up a partnership with a grassroots outreach partner to hold events in grocery stores, bodegas, faith centers, cultural festivals and more in high Medicaid density communities in the commonwealth; running a long-term paid media campaign and partnering with Pennie to co-brand ads through their media efforts; and working across state agencies to continue to grow the network of partners, advocates, and stakeholders assisting with outreach to reach more Pennsylvanians.

Dive Brief:

• Medicaid beneficiaries who began using buprenorphine, a medication that treats opioid use disorder, via telemedicine early in the COVID-19 pandemic were more likely to stay in treatment than non-telemedicine initiation, according to a study published in JAMA Network Open.
• The study found enrollees faced the same odds of non-fatal overdose when starting buprenorphine through telehealth, suggesting virtual care can improve access to treatment — which can be a major challenge for people who struggle with the disorder.
• The research comes as permanent regulations for telehealth prescriptions of controlled substances remain up in the air. The Drug Enforcement Administration and the HHS announced earlier this month they’ll temporarily extend the pandemic-era flexibilities through 2024.

Dive Insight:

Drug overdose deaths increased during the COVID-19 pandemic, reaching more than 100,000 in 2021, according to the Centers for Disease Control and Prevention. More than 75% of those deaths involved opioids.

Stay-at-home orders and social distancing disrupted healthcare delivery, which might have contributed to the increase in overdose deaths, noted the JAMA study’s authors.

In a bid to avoid lapses in care, regulators and lawmakers created new telehealth rules, like reimbursing visits at the same rate as in-person care and waiving licensing requirements for out-of-state clinicians.

The DEA also granted exceptions to the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which required most practitioners to have at least one in-person evaluation before prescribing controlled substances like buprenorphine.

Those prescription flexibilities were originally set to expire in May alongside the rest of the public health emergency. However, the rules were instead extended until November after regulators received more than 38,000 public comments on proposed rules that would have added more limitations to telehealth controlled substance prescriptions.

Earlier this month, the rules were temporarily extended again through the end of 2024, after organizations like the American Telemedicine Association and the American Hospital Association argued that in-person requirements could limit access to care, particularly for opioid use disorders.

The latest JAMA study, which used Medicaid data on more than 91,000 people from Kentucky and Ohio, is in line with previous research that found expanded telehealth services could improve care for people with opioid use disorder.

“This finding may be especially valuable for improving MOUD [medications for opioid use disorder] access in states such as Kentucky, which has historically had restrictive buprenorphine access policies and restrictive methadone regulations, as well as a large rural population,” the study’s authors wrote. “Telemedicine may also increase access in underserved areas, adding to the workforce for behavioral health services in rural areas.”

However, researchers did note racial disparities when it came to telehealth access and retention. Non-Hispanic Black people had lower odds of telemedicine initiation compared with White individuals, and about half the odds of being retained in buprenorphine treatment at 90 days.