Maryland Rural Health Implementation Plan (RHIP)

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Maryland Rural Health Implementation Plan (RHIP)

• Michelle G. Clark, MSW, MPH
• Project Director, State Office of Rural Health
• October 2, 2008

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Presentation Overview

• Office of Health Policy and Planning (OHPP) State
  Office of Rural Health (SORH)
• Workforce Programs (Loan Assistance Repayment
  Program LARP)
• Maryland Rural Health Plan
• MRHA Listening Sessions
• Maryland Rural Health Implementation Plan

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State Office of Rural Health

• Mission
• The Maryland State Office of Rural Health (SORH)
  aims to improve the health of rural Marylanders
  through collaboration, networking, outreach,
  education, advocacy, and the development of
  special programs.
• Federally Funded
• State Offices of Rural Health (50 SORHs
  nationwide)
• Small Hospital Improvement Program (SHIP)
• State Matching Funds Area Health Education
  Centers (AHEC)s
• Staff
• Michelle Clark, Michele Pharr, Jessica McKinnie
• Consultants
• Jeanette Jenkins, Director of OHPP
• Liz Vaidya, Primary Care Organization (PCO)
  Director
• Rebecca Love, OHPP Health Policy Analyst

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Workforce Programs Within OHPPLoan Assistance
Repayment Program

• Federal Loan Assistance Repayment Program (LARP)
• Purpose
• To provide repayment of educational loans to
  physicians who agree to practice in an approved
  practice/underserved area for a period of time
• Program is jointly administered by
• Primary Care Office (PCO) in the OHHP in Family
  Health Administration for DHMH
• Maryland Higher Education Commission (MHEC)

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Workforce Programs Within OHPPLARP Funding

• Funding
• Federal funds
• Competitive funding among the states
• Requires state match (5050)
• State funds
• Source is physician licensure fees
• Funds provided to MD Higher Education Commission
  (MHEC) through legislatively mandated Janet L.
  Hoffman Program

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Workforce Programs Within OHPPLARP Eligibility
and Requirements

• Eligibility
• Primarily for practicing physicians, but
  residents also allowed
• Types of health professionals eligible
• Currently only two physician specialties included
  
• primary care and general psychiatrists
• Requirements
• Only non-profits
• Federal funds for practice in a designated Health
  Professional Shortage Area only
• General funds may be used to fund state-only
  awards in state designated shortage areas

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Is LARP effective at recruiting and retaining
providers?

• Each year there are more applicants than funding
• One national study found that physicians serving
  obligations to state programs served in needier
  areas and remained longer in their practices
  (Pathman, Konrad, King, Taylor, and Koch, 2004)
• Another study found that 48 percent of students
  would be more likely to return to their home
  states if expanded loan repayment programs were
  available (Miller and Crittenden, 2001)
• In Maryland, of 24 providers who completed
  service between 2004 and 2006, 22 are still
  practicing

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Workforce Programs Within OHPP

• J-1 Visa Waiver Program
• J-1 visa requires physicians with foreign
  nationalities to return to their home country for
  two years at the end of their medical training.
• The waiver is granted in exchange for the
  physicians work in an underserved area for three
  years
• National Health Service Corp.
• Reviews sites eligibility per federal criteria
• Recommendations to NHSC of eligible sites for
  placement of eligible health professionals, but
  final decision is made by the federal government
  HRSA in DHHS

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Maryland Rural Health Plan
http//www.fha.state.md.us/ohpp/ruralhlth/pdf/DHMH
_Rural_Health_Plan_07.pdf
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Plan Goals

• Raise awareness of rural health issues and
  strategies to address these issues (Vision)
• Assess the health status of Marylands rural
  residents relative to non-rural residents (health
  indicators for rural areas)
• Set forth an agenda to build state consensus on
  the Plan to gain funding and resource support

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Rural Health Priority Areas

• Access to primary and specialty care and pharmacy
  services (availability of workforce and
  affordability)
• Behavioral health (mental health and
  addiction/substance abuse)
• Lifestyle issues (nutrition, obesity, wellness)
• Oral health

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Priority Recommendations

• 1. Increase efforts to improve recruitment and
  retention of rural health providers
• 2. Establish preventive health centers in rural
  areas, especially in those areas lacking or
  underserved by Federally Qualified Health Centers
• 3. Increase accessibility to pharmaceuticals for
  low-income rural residents

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Rural Health Plan in Action

• Maryland Rural Health Association (MRHA)
  Listening Sessions - 7 Total
• October 2007 3 on the Eastern Shore
• December 2007 3 in Western Maryland
• April 2008 Southern Maryland
• Disseminated results
• Rural Health Steering Committee had 5 Meetings in
  last 6 months
• Rural Health Implementation Plan (RHIP)

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Listening Sessions

• Recruitment retention of rural health providers
• Comprehensive Electronic Medical Records
• Provider reimbursement
• Telehealth reimbursement
• Increase and efficiency of Loan Repayment for
  Rural Providers
• Primary preventive health services

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Maryland Rural Health Implementation Goals

• 1. Increase Recruitment and Retention of Rural
  Health Care Providers
• 2. Expand and Enhance telehealth to bring
  primary and specialty care to rural areas through
  technology
• 3. Provide preventive health education and
  resources in rural areas
• 4. Increased dental access to low income rural
  residents, especially the adult population
• 5. Establish preventive health centers in rural
  areas, especially those areas lacking or
  underserved by a Federally Qualified Health
  Center (FQHC)s
• 6. Improve healthcare access for the aging
  population through increased services in rural
  areas and training of health professionals
• 7. Increase access to Pharmaceuticals for low
  income rural residents
• 8. Support the development of a continuous,
  integrated systems of care for co-occurring
  disorders in rural communities

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Maryland Rural Health Plan, June 2007
Priority Strategies
MRHA Statewide Listening Sessions Oct 2007- Apr
2008
Vetted in Community Consensus Priority Goals
Rural Health Steering Committee Summer 2008
Priority Actions
Rural Health Implementation Plan (RHIP) 2009
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Snapshot of Rural Health Listening Sessions
Workforce Issues
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Implementation Framework

• Goal - ONE Rural Recruitment and Retention
• Problem
• Objective
• Rationale
• Action Steps
• Estimated Costs
• Partners
• Relates To
• Evaluation of Success

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Rural Health Implementation PlanGoal Enhance
Rural Recruitment and Retention

• Objectives
• 1.1 Increase funding and efficiency of Loan
  Assistance Repayment Program (LARP)
• 1.2 Increase Scholarships in Maryland health
  professional college and universities for rural
  residents who agree to practice in rural areas
• 1.3 Explore and promote the efficiency in
  portability of health care professional licensing
  between regional states
• 1.4 Expand health professional training and
  education in rural areas, through the use of new
  health programs and distance learning
• 1.5 Establish a coordinated Statewide Healthcare
  Workforce Center
• 1.6 Increase or supplement compensation packages
  for rural health providers including
  reimbursement package

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Objective 1.1Increase funding and efficiency of
Loan Assistance Repayment Program (LARP)

• Increase state funding for LARP for at least 20
  years of additional loan repayment through
  legislation, physician fees, or hospital
  surcharges to allow more flexibility with the use
  of funds and program staff.
• Assess the needs of rural Maryland workforce
  shortages and identify those areas that do not
  qualify for a federally designated shortage area
  but are in need of physicians.
• Restructure Maryland physician LARP program to
  allow more flexibility with state funds and
  repayment in rural areas designated as Maryland
  Health Professional Shortage Areas.

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Objective 1.2Increase scholarships in Maryland
health professional colleges and universities for
rural residents who agree to practice rural areas.

• Assess the number of rural Maryland students
  attending Maryland Graduate Schools in health
  professional programs.
• Create a Rural Health Scholarship Program that
  includes administrative and fiscal support for
  Maryland students committed to practicing in
  rural areas after training.

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Objective 1.3Explore and promote the efficiency
in portability of health care professional
licensing between regional states

• Establish partnerships with other regional states
  adjoining Maryland to specifically address the
  need to have more portable licenses.
• In coordination with neighboring states, identify
  the capacity of health professionals who practice
  in more the one state and serve rural
  populations.

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Objective 1.4Expand health professional training
and education in rural areas, through the use of
new health programs and distance learning

• Assess professional schools that have expanded to
  serve rural areas and identify best practices and
  models for the potential to be replicated across
  the state.
• Explore opportunities to create new health
  professional programs in rural areas.
• Encourage and fund distance learning capabilities
  of health professional schools to expand scope
  training available for of students in rural
  areas. Encourage and fund distance learning
  capabilities of health professional schools to
  expand scope training available for of students
  in rural areas.

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Objective 1.5Establish a coordinated Statewide
Healthcare Workforce Center

• Build upon workforce shortage areas to determine
  specific healthcare shortages
• Develop a statewide healthcare workforce center
  with all agencies involvement to serve as hub for
• Healthcare workforce programs (including
  marketing of programs)
• AHECs
• Educate healthcare providers employers
  regarding recruitment strategies

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Objective 1.6Increase or supplement compensation
packages for rural health providers including
reimbursement package

• Increase state Medicaid payments to providers in
  designated health professional shortage areas
  similar to the CMS Medicare incentive payment
• Provide tax incentives to rural providers working
  within health professional shortage areas

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Questions/Comments!
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Contact Information

• Michelle Clark, MSW, MPH, Project Director, State
  Office of Rural Health, Office of Health Policy
  and Planning
• mclark_at_dhmh.state.md.us 410-767-5121
• Michele Pharr, MA, Health Policy Analyst, State
  Office of Rural Health, Office of Health Policy
  and Planning
• mpharr_at_dhmh.state.md.us 410-767-3543
• http//www.fha.state.md.us/ohpp/ruralhlth/

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References

• Miller, JB and Crittenden, RA. (2001) The
  effects of payback and loan repayment programs on
  medical student career plans. Journal of Rural
  Health, 17(3) 160-164.
• Pathman, DE, Konrad, TR, Taylor, DH Jr., and
  Koch, GG. (2004) Outcomes of states
  scholarships, loan repayment, and related
  programs for physicians. Medical Care, 42(6)
  560-568.