The U.S. Census Bureau released new statistics from the 2017-2021 American Community Survey (ACS) 5-Year Estimates, now available at https://data.census.gov/. These estimates provide data for all Pennsylvania counties, municipalities, and other geographic areas regardless of population size.

Some highlights from the Pennsylvania State Date Center include:

• Approximately 47.0% of renter households in PA spent more than 30.0% of their income on housing costs, compared to 40.0 percent of renter households nationally.
• The counties with the highest percentage of renters experiencing a housing cost burden were Centre (58.0%), Pike (57.4%), Lawrence (52.5%), Monroe (51.9%), and Philadelphia (51.9%).
• Between 2012-2016 and 2017-2021, 43 counties experienced a statistically significant increase in median household income.

Visit the Data Center’s Research Briefs page to read this brief and past releases.

 This brief from the RUPRI Center for Rural Health Policy Analysis shows a significant rise in the percent of Rural Health Clinics providing telehealth services during the pandemic – 23% pre-pandemic increasing to 92.2% during the pandemic.  However, roughly one in five of the more than 150 RHCs examined experienced a temporary closure.  Cancer-related prevention and control services including cancer screening, HPV vaccination, and tobacco cessation services dropped pre- vs. peri-pandemic.

  This policy brief from the University of Minnesota Rural Health Research Center examines existing disparities in the supply of home health aides and nursing assistants in rural areas compared to urban areas.

The Rural Health Value team recently released a new policy brief:

Medicare Shared Savings Program: Rule Changes and Implications for Rural Health Care Organizations
A summary of the changes made to the Medicare Shared Savings Program taking effect January 2023 and 2024. This Rural Health Value analysis outlines how the changes would reduce barriers to participation for potential or reentering ACOs that operate in rural contexts.

Related resources on the Rural Health Value website:

• Catalog of Value Based Initiatives for Rural Providers – One-page summaries describe rural-relevant, value-based programs currently or recently implemented by the Department of Health and Human Services (HHS), primarily by the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare & Medicaid Innovation (CMMI).
• MaineHealth ACO – Integrating and Using Data to Support Care Delivery – A predominantly rural network of hospitals and clinics in Maine integrates clinical and claims data to support improvements in care delivery and target patient needs as part of their Accountable Care Organization.
• Vermont’s All-Payer Accountable Care Organization Model – Mt. Ascutney Hospital and Health Center’s (MAHHC) Experience – Vermont’s dominant payers have partnered to test an alternative payment model statewide that requires health care organizations like MAHHC to innovate health care delivery and achieve shared goals. Participation in the ACO has allowed MAHHC to implement strategies to better meet community needs ranging from prevention to complex care management.

The U.S. Department of Agriculture (USDA) released the Rural America at a Glance report. The report notes a change in the composition of the rural labor force over the past decade due to an overall decline in population growth, aging of the population, and changing industry structure. Rural America has become more economically diverse over time, with increasing employment in health care, hospitality, and other service industries. There is also evidence that the rural workforce is changing in terms of diversity. The report is helpful when considering new ways to strengthen the rural health pipeline.

Rural America is continuing to get older, and a new report shows the extent has hit a new high.

The U.S. Department of Agriculture’s annual Rural America at a Glance report shows more than 20% of rural residents are over age 65 compared to 16% in urban areas.

“The aging of the baby-boom generation will continue to contribute to the loss of working-age adults through the end of this decade,” the report from the USDA’s Economic Research Service stated.

The report also said there is a corresponding decrease in the working-age population, with those 18 to 64 making up 58% of non-metro residents, compared with 61% of metro residents.

Fixing the problem will take a lot of work from a lot of different areas, said Mary Hendrickson, a professor of rural sociology at the University of Missouri.

“There’s federal issues, there are state issues, there are community issues, there are regional issues. Can we start thinking about regional networks? There really is not just one thing,” she said.

Hendrickson said rural areas need to make things better for families, and that can include such improvements as better broadband access and reliable day care and preschool options, which are not only lacking but often nonexistent in rural areas.

“If we’re going to talk about wanting to be family friendly, then we’re going to need to have some policies that are helpful,” Hendrickson said.

Some rural communities have tried creative ways to attract younger people to make their home away from urban areas, including offering grants to new homeowners and establishing recruiting committees to entice former residents to move back.

“Those kinds of programs are essential,” Henrickson said. “Folks who live in these rural areas sometimes look around and think more of the challenges rather than thinking about what are the opportunities for helping and making their place attractive for a younger generation.”

Other rural advocates caution those kinds of projects won’t be enough and argue for more systemic change at the federal level.

“We learned during COVID that many people can work from anywhere, and that gave a lot of hope to rural communities looking to increase their population,” said Chris Merritt, executive director of the Illinois Institute of Rural Affairs at Western Illinois University.

“But state and federal governments need to get more involved to make sure these communities have health care, schools, transportation and grocery stores. Those things can’t happen at just the community level.”

While rural communities look to increase their younger population, they will also have to deal with new challenges of having more older residents.

“Declines in the working-age population may make it harder to meet labor demands in some rural industries and local labor markets. At the same time, many rural areas lack sufficient health care capacity, broadband service, community centers and other services to address the challenges associated with an aging population,” the USDA report said.

This story was produced in partnership with Harvest Public Media, a collaboration of public media newsrooms in the Midwest. It reports on food systems, agriculture and rural issues. Follow Harvest on Twitter: @HarvestPM.

 The Rural Health Value team recently released a report that describes interviews with five health systems supporting value-based care in their rural affiliates. Interview topics included organizational structure, governance and decision-making, operations, data and communication, contracts, and social determinants of health. The report includes common health system tensions and opportunities as they facilitate rural affiliate success in value-based care. The Rural Health Value team is funded by the Federal Office of Rural Health Policy.

 This new report from the CMS Innovation Center provides an update on the Innovation Center’s progress in the implementation of its new strategy, describes areas of focus for the coming year, and begins the process of measuring progress against the strategy’s five objectives. This update includes a discussion of the Community Health Access and Rural Transformation (CHART Model). A companion supplemental document describes the rationale, methods, and limitations for each of the metrics, baselines, and targets described in this report. The supplemental document includes information on rural innovation models and the inclusion of safety-net providers like Rural Health Clinics (RHCs).

Last month, the Congressional Research Service (CRS), Congress’s nonpartisan research arm, released two reports on 340B. The first report details the conflicting decisions from recent court cases related to 340B contract pharmacies and also give options on how Congress can intervene given the uncertainty with the program. The second report gives an overview of the 340B program as a whole, providing details on program data sales and entity participation, statutory requirements, changes to the 340B statute over time, Government Accountability Office reports and recommendations, and the contract pharmacy litigation. NACHC is actively working on a federal legislative strategy for 2023 to address the instability in the 340B Program. This week’s elections will determine who the key players are in Congress that health centers will need to work with to get 340B legislation passed.