The Maine Rural Health Action Network is a group of rural health experts and stakeholders from business, philanthropy, education, health and social services. There is a growing rural health care crisis in Maine that must be addressed. Throughout the past year, we have conducted dozens of stakeholder interviews and analyzed a variety of reports and blueprints that have been created by other stakeholder groups with similar concerns. Our findings confirm that there is a wealth of informed and solid recommendations that have been identified in the past however a lack of sustained leadership has created barriers for implementing them. Our call to action addresses these barriers and outlines five immediate actions needed to improve rural health and build a strong and sustainable system of rural health care in Maine.
New Report on Rural Health-Related Social Needs Now Available
Health-related social needs (HRSNs) among patients, particularly vulnerable and historically disadvantaged populations in rural areas, impact health care access, outcomes and costs. While awareness of the links between health care and social needs are widely recognized, little is known about how to effectively address patients' social needs in the context of the healthcare system.
Conceived by the Rural Health Action Network and conducted under the auspices of the New England Rural Health Association with funding from the Maine Health Access Foundation, the report describes a project that focused on identifying strategies to inform the design of a demonstration in Maine.
Two key influencers of transformational reform (community partnerships and governance and financing approaches) are examined in detail in the report, drawing on published literature, reports and interviews with leaders in multiple sectors in Maine and three other rural states. A 5-year, $5M rural, community-based demonstration in rural Maine was proposed to generate evidence that is critically needed to advance the field.
Andrew F. Coburn, PhD, Research Professor Emeritus and Senior Fellow, Maine Rural Health Research Center at the University of Southern Maine and Deborah A. Deatrick, MPH, Public Health Consultant, served as project leads and co-authors of the report. A copy of the report is accessible below.
January 2020
Filled with hard-working families and neighbors helping neighbors, Maine’s rural communities are essential to our economy and our way of life.
Our rural communities – the heart of Maine – are at unprecedented risk. Every rural hospital, every rural provider, every rural community is at risk. The future of rural Maine and the State is threatened. Because of this, a group of concerned stakeholders made up of business, philanthropy, education, health and social services has been gathering for over a year in an effort to develop pragmatic, actionable steps to address this growing crisis.
Across the State rural communities are hit harder by challenges like insufficient insurance coverage, the opioid epidemic, and an aging population with more chronic illnesses. Health-related workforce shortages place additional stress on the system.
The health of rural Mainers is compromised. Several hospitals are on the brink of failure. Health clinics and nursing homes have closed. Local emergency medical services are strained. The availability of fundamental health services, such as primary care, and even obstetrical services, is no longer assured. Many rural residents travel long distances for essential care and have limited access to specialty services.
Access to basic health care is central to the economic viability of rural Maine. We can’t sustain and build local economies without a healthy workforce. We can’t attract businesses in the absence of accessible basic services. Further, health care is an economic engine in itself: local health-related spending and jobs help fuel Maine’s rural economy and sustain rural communities.
Historic models for organizing and delivering rural health services are increasingly difficult to sustain. Traditional approaches must be reconsidered if Maine is to have a sustainable, high-performing rural health system.
We must act now. Some rural communities are collaborating and innovating to expand local services and make their system of care and coordination more efficient and effective. We must accelerate this momentum and confront the growing crisis in rural health and health care.
Everyone has a role to play in strengthening Maine’s rural health care system and giving hard-working rural communities the opportunities to raise healthy families, grow their economies, and build a hopeful future for generations to come.
Five Immediate Actions Needed to Improve
Rural Health and Build a Strong and Sustainable System of Rural Health Care in Maine
1. Mobilize State and Local Leaders to Address the Crisis in Rural Health and Health Care
Create and empower a Rural Health Commission to lead, promote, and engage stakeholders in building a modern, sustainable, equitable, and accountable rural health system in Maine.
Empower leaders in rural communities to find local solutions and partnerships for protecting rural health.
Expand the role and capacity of the Maine Rural Health and Primary Care Program to work with rural leaders, policymakers, and stakeholders to support local communities and providers to pursue new approaches to providing essential care in rural areas.
2. Rethink Rural Health Service Delivery
Produce a blueprint for addressing the driving forces that determine rural health, including the necessary restructuring of rural health care delivery. Incorporate the findings of the Rural Health Commission, MaineCare planning and other assessment and planning resources (e.g., Title V assessment, SCHNA, etc.)
Adopt a basic set of Fundamental Rural Health Services* to ensure access to essential health services within reasonable distances and timeframes. *Sprague, J. (2018, October 31). Building Blocks for Healthy Rural Communities
Create a Rural Innovation Program to test new approaches to providing essential services in rural areas, align current delivery systems with future needs, and enhance integration of physical, behavioral, oral, and public health services.
3. Redesign Payment Systems
Engage MaineCare and other payers to develop alternative payment models that support access to a more integrated and sustainable rural health system that better addresses the health and health care needs of rural communities and citizens.
Explore Medicaid waiver and other options for better integrating health, social service, and public health services in rural communities.
Assess the viability and effectiveness of new rural-payment models.
4. Leverage Data and Technology
Advance the use of technology, including broadband, Electronic Health Records, HealthInfoNet, and telehealth, to support access throughout Maine’s rural areas to core services and decision and management support.
Expand broadband capacity in rural areas.
Promote the use of telehealth to expand access to primary care, specialty and other services in rural areas.
Build data systems that foster accountability and learning.
5. Build the Essential Rural Health Workforce
Create a comprehensive cross-sector plan for assuring Maine’s rural workforce capacity.
Emphasize the use of health providers at the full scope of their licenses; strong but innovative credentialing and licensing; expanded support for team-based care; and extension of lay care into homes and communities.
Establish a continuum of health-related professional development, from high school pipelines to continuing education for working clinicians and health workers.
Align and expand investments in innovative and targeted recruitment, retention, and loan repayment.
Two-Part Live Webinar Series Sponsored by NERHA
Community Partnerships and Financing Strategies to Address Health-Related Social Needs
On June 20th and June 29th, 2023 from 12 noon -1 pm ET we hosted two live webinars examining strategies for using community partnerships and innovative financing approaches to address health related social needs. In the first webinar, Effective Strategies to Address Individual and Community Health, we explored how communities in California, Vermont and Maine are using Whole Person Care to coordinate health and social services and the lessons learned about creating, mobilizing and managing aligned and equitable partnerships. The second webinar, Financing Health and Social Services to Address Health Related Social Needs delved into how multisector partnerships are being funded, examples of Federal and state initiatives, and more.
June 20th 2023 - “Effective Strategies to Address Individual and Community Health”
Topics covered:
Whole Person Care and the importance of coordinating health and social needs
California Accountable for Health – Lessons from Cohort 1
Caledonia and South Essex County Vermont ACH – Rural Partnership Model
Community Caring Collaborative – Engaging Health Care, CBOs and Public Health in Washington County, Maine
Presenters: Barbara Masters, MA, Director, California Accountable Communities for Health Initiative, Shawn P. Tester, MSOL, CEO, Northeastern Vermont Regional Hospital, Charley Martin-Berry, Executive Director, Community Caring Collaborative Moderator: Deborah Deatrick, MPH, Consultant
June 29th 2023 - “Financing Health and Social Services to Address Health Related Social Needs”
Topics covered:
Innovative funding strategies to pay for connecting and providing health and social services
Braiding and blending funding streams – why and how
Pending CMS payment policies for assessing and reimbursement
R-CHIP – Maine’s new rural HRSN demonstration initiative
Presenters: Elaine Chhean, MPH National Academy for State Health Policy, Anne Ekedahl, MHA, Health Policy Consultant and Senior Fellow, WE in the World, Michelle Probert, MPP, Director, Office of MaineCare Services, Maine Department of Health and Human Services
Moderator: Andrew Coburn, PhD, Professor Emeritus, University of Southern Maine
Maine Rural Health Action Network Members
Arthur Blank, Former President and CEO, Mount Desert Island Hospital - arthur.blank@mdihospital.org
Jeff Brown, Principal, Safer Healthcare LLC - jbrown@systemsafetygroup.com
Andrew Coburn, Professor Emeritus and Senior Fellow, Maine Rural Health Research Center, University of Southern Maine - coburn@maine.edu
Andy Lowe, Executive Director, New England Rural Health Association - andy@newenglandrha.org
Ann Marie Day, Chief Operating Officer, New England Rural Health Association - amday@newenglandrha.org
John Gale, Senior Research Associate, Maine Rural Health Research Center, University of Southern Maine - jgale@usm.maine.edu
Morgan Hynd, Director, The Bingham Program - morgan@binghamprogram.org
Becca Matusovich, Executive Director, Partnerships for Children’s Oral Health - becca@mainepcoh.org
Danielle Louder, Director, Northeast Telehealth Resource Center - dlouder@mcd.org
Yvonne Jonk, Deputy Director, Maine Rural Health Research Center - yvonne.jonk@maine.edu
Thomas Judge, Executive Director, Lifeflight Foundation - tjudge@lifeflightmaine.org
Laurie Kane-Lewis, Chief Executive Officer, DFD Russell Medical Centers - laurie.kane-lewis@dfdrussell.org
Kevin McGinnis, Rural EMS Advisor, National Association of State EMS Officials - kevin@mcginnis.ws
Maureen O’Connor, Northern Light Health
Diana Prescott, Clinical Psychologist, Hampden Psychological Consultation, PLLC - dlprescottphd@gmail.com
Jonathan Sprague, President, Rocky Coast Consulting, LLC - jonathansprague@rockycoastconsulting.com
Other Participants
Nicole Breton, Director, State Office of Rural Health, Oral Health and Primary Care, Maine CDC - nicole.breton@maine.gov
Charles Dwyer, Senior Program Officer, Maine Health Access Foundation - cdwyer@mehaf.org
Carol Kelly, Managing Director, Pivot Point Inc. (facilitator) - carolkelly12@msn.com
•• This effort is supported by the New England Rural Health Association.