Maine Rural Health Research Center
In an effort to inform and promote local discussions and strategic planning for transforming health and healthcare in rural communities, the Maine Health Access Foundation commissioned the Maine Rural Health Research Center to develop five issue briefs profiling innovative approaches to rural health. The briefs present innovative approaches from Maine and other parts of the United States to the provision of behavioral health services, recruitment and retention of health care workers, service delivery, governance, and health care payment and financing in rural areas. Examples of innovative approaches profiled in the briefs include: the use of new health workers such as community paramedics and community health workers, rural-focused medical education models, alternative models of emergency care, telehealth, care coordination initiatives, Accountable Care Organizations, and Medicaid Accountable Communities.
The aim of these briefs is to assist rural communities and regions to proactively envision and develop strategies for transforming rural health in the state. In preparing these briefs the Maine Rural Health Research Center consulted experts, interviewed key informants, and reviewed the professional and research literature to find robust and innovative models and strategies that could be replicated in rural Maine.
Burgess A, Coburn A. Innovations in Rural Health System Development: Maine’s Behavioral Health Services. Portland, ME: University of Southern Maine, Muskie School of Public Service, MaineRural Health Research Center; November 2016.
Burgess A, Coburn A. Innovations in Rural Health System Development: Recruiting and Retaining Maine’s Health Care Workforce. Portland, ME: University of Southern Maine,Muskie School of Public Service, Maine Rural Health Research Center; November 2016.
Burgess A, Coburn A. Innovations in Rural Health System Development: Service Delivery Advances in Care Coordination, Emergency Care, and Telehealth. Portland, ME: University of SouthernMaine. Muskie School of Public Service, Maine Rural Health Research Center; November 2016.
Kahn-Troster S, Coburn A. Innovations in Rural Health System Development: Governance. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine RuralHealth Research Center; November 2016.
Kahn-Troster S, Coburn A. Innovations in Rural Health System Development: Moving Rural Health Systems to Value-Based Payment. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; November 2016.
Created by the Affordable Care Act (ACA), Consumer Operated and Oriented Plans (CO-OPs) are private, non-profit health insurers that were designed to increase insurance plan choice and lower premiums in the Health Insurance Marketplaces. Early analyses of the ACA suggested that CO-OPs may be particularly beneficial for rural communities, where fewer individual and small group health insurance options have traditionally been available.
This Research and Policy Brief, authored by research staff at the Maine Rural Health Research Center, explores the early availability and role of CO-OPs in rural and urban counties. We describe the regional distribution and market prevalence of CO-OP products in rural and urban counties and compare the number of products available in counties with and without CO-OP plans in 2014 and 2015. We also examine the proportion of lowest cost silver products for 27 year olds offered by CO-OPs in both years. To better understand the impact of CO-OP closures on consumer choice in the 2016 Marketplaces, we examine how these closures may have affected the prevalence of CO-OP products in rural versus urban counties and overall product availability.
- CO-OPs represented a larger overall share of Marketplace products available in rural versus urban counties in 2014 and 2015.
- From 2014 to 2015, CO-OP products increased in absolute numbers and grew modestly as a proportion of offerings in both rural and urban counties.
- In 2014 and 2015, CO-OPs were more likely to offer the lowest cost silver product available for purchase in rural counties than in urban counties.
- Recent closures of CO-OPs are likely to disproportionately reduce product availability in rural counties.
Ziller EC, Croll Z, Coburn A. Health Insurance CO-OPs: Product Availability and Premiums in Rural Counties. Portland, ME: University of Southern Maine, Maine Rural Health Research Center; October, 2016. PB-66.
In an effort to inform and promote local discussions and strategic planning for transforming health and health care in rural communities, the Maine Health Access Foundation commissioned the Maine Rural Health Research Center to conduct a study of Maine’s health resources and health status. The result of this study, Maine Rural Health Profiles, presents a summary look at the health status of the state and each of the 16 Maine counties' health system, health system resources (such as workforce and facilities for health services provision), health care economy, and access to care.
Maine Rural Health Profiles uses a combination of narrative and maps to discuss and illustrate both the degree of rurality in each county and how the data reported reflect rural health challenges and opportunities. Many indicators at the county level, such as per capita hospital bed counts and per capita supply of various health professionals, are compared to the state as a whole. By design, the profiles focus on health care delivery sites, with special attention to hospital-based resources, and long-term services and supports. The profiles were developed using secondary data—combining federal and state licensure and provider information with resources such as the Maine Shared Health Needs Assessment & Planning Process (SHNAPP) Project reports and the University of Wisconsin Population Health Institute and Robert Wood Johnson Foundation’s County Health Rankings.
Kahn-Troster S, Burgess A, Coburn A, et al. Maine Rural Health Profiles. Portland, ME: University of Southern Maine, Muskie School, Maine Rural Health Research Center; September, 2016.
Authors: John Gale, MS; Andrew Coburn, PhD; Karen Pearson, MLIS, MA; Zach Croll, BA; George Shaler, MPH
University of Southern Maine, Muskie School of Public Service
Background: The development of measures to monitor and evaluate the performance and quality of emergency medical services (EMS) systems has been a focus of attention for many years. The Medicare Rural Hospital Flexibility Program (Flex Program), established by Congress in 1997, provides grants to states to implement initiatives to strengthen rural healthcare delivery systems, including better integration of EMS into those systems of care.
Objective: Building on national efforts to develop EMS performance measures, we sought to identify measures relevant to the rural communities and hospitals supported by the Flex Program. The measures are intended for use in monitoring rural EMS performance at the community level as well as for use by State Flex Programs and the Federal Office of Rural Health Policy (FORHP) to demonstrate the impact of the Flex Program.
Methods: To evaluate the performance of EMS in rural communities, we conducted a literature search, reviewed research on performance measures conducted by key EMS organizations, and recruited a panel of EMS experts to identify and rate rurally-relevant EMS performance measures as well as emergent protocols for episodes of trauma, ST Elevation Myocardial Infarction (STEMI), and stroke. The rated measures were assessed for inclusion in the final measure set.
Results: The Expert Panel identified 17 program performance measures to support EMS services in rural communities. These measures monitor the capacity of local agencies to collect and report quality and financial data, use the data to improve agency performance, and train rural EMS employees in emergent protocols for all age groups.
Conclusion: The system of care approach on which this rural EMS measures set is based can support the FORHP's goal of better focusing State Flex Program activity to improve program impact on the performance of rural EMS services in the areas of financial viability, quality improvement, and local/regional health system performance. [Journal abstract provided by authors]
Gale, J., Coburn, A., Pearson, K., Croll, Z., & Shaler, G. (2016). Developing program performance measures for rural emergency medical services. Prehospital Emergency Care, 1-9. doi: 10.1080/10903127.2016.1218978
FMI: John Gale
Mental Health First Aid (MHFA), an early intervention training program for general audiences, has been promoted as a means for improving population-level behavioral health (BH) in rural communities by encouraging treatment-seeking. This study, conducted by researchers at the Maine Rural Health Research Center, examined MHFA's appropriateness and impacts in rural contexts.
Findings: MHFA appears aligned with some key rural needs. MHFA may help to reduce unmet need for BH treatment in rural communities by raising awareness of BH issues and mitigating stigma, thereby promoting appropriate treatment-seeking. However, rural infrastructure deficits may limit some communities’ ability to meet new demand generated by MHFA. MHFA may help motivate rural communities to develop initiatives for strengthening infrastructure, but additional tools and consultation may be needed.
Conclusions: This study provides preliminary evidence that MHFA holds promise for improving rural BH. MHFA alone cannot compensate for weaknesses in rural BH infrastructure.
Article first published online: January 28, 2016
Suggested Citation: Talbot, J. A., Ziller, E. C. and Szlosek, D. A. (2016), Mental Health First Aid in Rural Communities: Appropriateness and Outcomes. The Journal of Rural Health. doi: 10.1111/jrh.12173