A new report from the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC) examines how health insurance coverage varies by age, state, region, and urbanization level. Using data from the 2022 National Health Interview Survey, researchers found that the percentage of uninsured adults aged 18-64 was about 14 percent for those living in both nonmetropolitan counties and large central metropolitan counties. Within the same age range, the percentage of adults with public insurance (i.e., Medicaid, CHIP, Medicare, military plans, and other government-sponsored health plans at the state level) was highest in nonmetropolitan counties, at 30 percent. This new information corresponds with historical data showing higher rates of uninsurance in rural areas and a higher rate of enrollment in public sources of coverage.

Read the full report here.

The Department of Health and Human Services (HHS) outlined the critical actions HHS has taken, and the future work planned, to ensure access to affordable, whole-person primary health care across the country in a recent issue brief (PDF). HHS also expressed its commitment and highlighted its actions to strengthen primary care in a recent article in NAM perspectives. With these publications, HHS aims to share HRSA’s department-wide efforts to strengthen primary care and spark aligned actions from federal partners and external stakeholders.

The November 3 court decision regarding how a “patient” should be defined under 340B is continuing to reverberate through the 340B world. Some media reports are hailing it as a “major victory” for covered entities (CEs), and many CEs are re-examining their current policies to determine if/how they can safely fill more prescriptions with 340B drugs. On the other hand, manufacturers are reportedly very concerned about the decision, pointing to a recent study suggesting that it will cause the program to expand by 50 to 100 percent. It is expected that many manufacturers will respond by further tightening restrictions on the program (e.g., contract pharmacy restrictions) and increase their efforts to convince Congress to address the program. These slides will help explain the decision and its impacts on Community Health Centers. If your health center intends to review your 340B patient definition considering the ruling, this template policy and procedure will help you address what types of services qualify an individual as a patient and how recently an individual must be seen at the health center to retain their “patient” status.

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.

Researchers at Penn State have published a new report, A Conceptual Framework for Optimizing the Equity of Hospital-Based Emergency Care: The Structure of Hospital Transfer Networks.

Emergency care includes two key components: initial stabilization and transfer to a higher level of care. Significant work has focused on ensuring that local facilities can stabilize patients. However, less is understood about transfers for definitive care. To better understand how transfer network structure impacts population health and equity in emergency care, we propose a conceptual framework, the hospital transfer network equity-quality model (NET-EQUITY). NET-EQUITY can help optimize population outcomes, decrease disparities, and enhance planning by supporting a framework for understanding emergency department transfers.

The central thesis of our framework is that the structure of hospital transfer networks influences patient outcomes, as defined by the Institute of Medicine, which includes equity. The structure of hospital transfer networks is shaped by internal and external factors. The four main external factors are the regulatory, economic environment, provider, and sociocultural and physical/built environment. These environments all implicate issues of equity that are important to understand to foster an equitable population-based system of emergency care. The framework highlights external and internal factors that determine the structure of hospital transfer networks, including structural racism and inequity. We also describe ways that NET-EQUITY can be applied to generate research questions and how policymakers can respond should research find inequity.

Authors:  Charleen Hsuan, PhD; Brandan Carr, PhD; David Vanness, PhD; Yinan Wang, PhD; Douglas Leslie, PhD; Eleanor Dunham, PhD; and Jeannette Rogowski, PhD

Read the full article here.

 

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.