Health: Rural Health

Knowledge of Health Insurance Concepts and the Affordable Care Act among Rural Residents

Unpublished
Abstract: 

Health insurance literacy is central to identifying eligibility for coverage and subsidies, choosing a plan, and using optimal healthcare services under the Affordable Care Act (ACA) or other insurance reform initiatives. To fully benefit from policy efforts to improve health insurance access, rural residents must have the ability to select the plan that best meets their healthcare needs. However, a higher proportion of rural residents possess characteristics that may put them at risk of lower health insurance literacy, including lower incomes and educational attainment, less experience with private insurance, and historically higher uninsured rates. Using Health Reform Monitoring Survey data from 2013 and 2014, researchers at the Maine Rural Health Research Center examined whether rural and urban residents demonstrated different knowledge and/or use of the ACA Marketplace and subsidies; enrollment information sources (e.g., Healthcare.gov, the Marketplace); the health insurance mandate; and health insurance terms and concepts. Additionally, they examined whether knowledge and use changed between the fourth quarters of 2013 and 2014.

Findings indicate that familiarity with Healthcare.gov and the Marketplace increased dramatically among both rural and urban residents between 2013 and 2014. However, knowledge in rural areas lagged somewhat behind that of urban residents. Rural and urban residents appear to have comparable levels of health insurance literacy. While this study focuses on some concepts that are specific to ACA policy changes, its results have implications for alternative reforms under consideration by Congress that may require consumer awareness and input.

Contact Information: Erika Ziller, PhD, Maine Rural Health Research Center

Suggested Citation: Ziller EC, Lenardson JD, Burgess AR. Knowledge of Health Insurance Concepts and the Affordable Care Act among Rural Residents. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; July, 2017. PB-68.

Publication Type: 
Research and Policy Brief
Publish Date: 
July 25, 2017
URL: 
http://usm.maine.edu/sites/default/files/muskie/PB68_Rural-Health-Insurance-Literacy.pdf

Innovations in Rural Health System Development

Unpublished
Abstract: 

cover photo for Innovations in Rural Health System Development

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.

Suggested citations:

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.

Publication Type: 
Report
Publish Date: 
November 10, 2016
URL: 
http://www.mehaf.org/learning-resources/reports-research/

Access to Health Care Services for Adults in Maine

Abstract: 

On October 17, 2016, the Maine Health Access Foundation (MeHAF) released a new research brief developed with the University of Southern Maine that found significant inequality in the ability of people in Maine to access quality health care. "Our research shows the devastating inequalities in whether people in Maine can get health care,” said Barbara Leonard, president and CEO of the MeHAF. “If you’re young, have a low-income, lack higher education or are a racial or ethnic minority, health care maybe a luxury that you struggle to afford. Many are just one health care crisis away from financial hardship. To make improvements that help people to live better, healthy and happier lives, we have to change the way we approach health care delivery, especially for those facing the greatest barriers to care.”

The authors, Barbara Leonard from MeHAF and Erika Ziller from the USM Muskie School, found that income, age and education are all closely associated with Maine people’s ability to receive appropriate and timely health care. Specifically, they found that among Maine adults 18 and older, those with family incomes less than $25,000 a year, young adults, racial and ethnic minorities, and people with less education are much more likely to:

  • Delay seeking health care even when sick;
  • Be unable to afford prescription medication;
  • Lack access to preventative check-ups and screenings or have a regular health care provider.

In addition, their analysis also found that Maine people, of all income groups, have reported difficulties in paying medical costs.

The brief is available for download on the Maine Health Access Foundation website.

FMI: Barbara Leonard, (207) 620-8266, ext. 102 or Erika Ziller, (207) 780-4615

Suggested Citation: Ziller E, Leonard B. Access to Health Care Services for Adults in Maine. Augusta, ME: Maine Health Access Foundation and USM Muskie School; October, 2016.

Publication Type: 
Report
Publish Date: 
October 17, 2016
URL: 
http://www.mehaf.org/content/uploaded/images/reports-research/Access%20to%20Health%20Care%20Brief_Oct%202016.pdf

Health Insurance CO-OPs: Product Availability and Premiums in Rural Counties

Abstract: 

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.


Key Findings:

  • 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.

Suggested Citation:
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.

 

Publication Type: 
Research and Policy Brief
Publish Date: 
October 28, 2016
URL: 
http://muskie.usm.maine.edu/Publications/rural/Health-Insurance-CO-OPs-Rural-Availability.pdf

Developing Program Performance Measures for Rural Emergency Medical Services

Unpublished
Abstract: 

 Prehospital Emergency Care

Developing Program Performance Measures for Rural Emergency Medical Services

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]

Suggested citation:

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

Publication Type: 
Journal Article
Publish Date: 
September 9, 2016
URL: 
http://dx.doi.org/10.1080/10903127.2016.1218978

Mental Health First Aid in Rural Communities

Unpublished
Abstract: 

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

Publication Type: 
Journal Article
Publish Date: 
January 28, 2016
URL: 
http://onlinelibrary.wiley.com/doi/10.1111/jrh.12173/abstract?campaign=wolearlyview

Understanding the Business Case for Telemental Health in Rural Communities

Unpublished
Abstract: 

Telemental health has been promoted to address long-standing access barriers to rural mental health care, including low supply and long travel distances. Examples of rural telemental health programs are common; there is a less clear picture of how widely implemented these programs are, their organization, staffing, and services. There is also a need to understand the business case for these programs and assess whether and how they might realize their promise. To address these gaps, a national study was conducted of rural telemental health programs including an online survey of 53 programs and follow-up interviews with 23 programs. This article describes the current landscape and characteristics of these programs and then examines their business case. Can rural telemental health programs be sustained within current delivery systems and reimbursement structures? This question is explored in four areas: need and demand, infrastructure and workforce, funding and reimbursement, and organizational fit and alignment. [Journal Abstract]

Suggested Citation: Lambert, D., Gale, J., Hartley, D., Croll, Z., & Hansen, A. (2015). Understanding the business case for telemental health in rural communities. Journal of Behavioral Health Services and Research. doi: 10.1007/s11414-015-9490-7 [epub ahead of print].

FMI: John Gale

Publication Type: 
Journal Article
Publish Date: 
December 22, 2015

Exploring the Business Case for Children's Telebehavioral Health

Unpublished
Abstract: 

This brief, authored by John Gale, M.S. and David Lambert, Ph.D. from the University of Southern Maine's Muskie School of Public Service, Maine Rural Health Research Center, explores terminology, reimbursement and business issues, and provides examples from the field in the development of telebehavioral health services. In the first section, the authors place children’s telebehavioral health within the context and demands of today’s rural healthcare system, where the majority of children’s telebehavioral health services are delivered. They then describe three examples of the use of telebehavioral health to serve children, adolescents, and families in rural communities. The brief concludes by exploring the business case for telebehavioral health including the issues and challenges of service delivery, coordination, and financing. This brief is informed by a national study of telemental health (serving children, adults, and older persons) in rural health systems conducted by the authors and updated to reflect the latest information on three case examples.

For more information, please contact John Gale at john.gale@maine.edu

Suggested citation: Gale J, Lambert D. Exploring the Business Case for Children's Telebehavioral Health. Washington, DC: The Technical Assistance Network for Children's Behavioral Health, The Institute for Innovation & Implementation; March, 2015. Brief.

Publication Type: 
Research and Policy Brief
Publish Date: 
March 2, 2015
Author: 

Rural and Remote Food Environments and Obesity

Unpublished
Abstract: 

Researchers at the Maine Rural Health Research Center Rural have published a review in the January 2015 issue of Current Obesity Reports describing the rural community, home, and individual food environments and what is known about their roles in healthy eating.

Abstract: Rural residents are more likely to be obese and overweight compared to their urban counterparts. Studies of specific rural communities have found that the limited availability of healthy foods in the community and home as well as individual characteristics and preferences contribute to poor diet and overweight. The rural food environment is varied and may be affected by climate, regional and cultural preferences, transportation access, and remoteness among other factors. Given this diversity and the vulnerabilities of rural residents, who are more likely to have low-income, substandard housing or low educational attainment compared to their urban counterparts, policy and programmatic interventions should target specific needs and communities.

Suggested Citation: Lenardson, J. D., Hansen, A. Y., & Hartley, D. (2015). Rural and remote food environments and obesity. Current Obesity Reports. doi: 10.1007/s13679-014-0136-5

Publication Type: 
Journal Article
Publish Date: 
January 30, 2015
URL: 
http://link.springer.com/article/10.1007%2Fs13679-014-0136-5#page-1

Profile of Rural Residential Care Facilities: A Chartbook

Unpublished
Abstract: 

As federal and state policymakers consider their most cost-effective options for strengthening rural long-term services and supports (LTSS), more information is needed about the current system of care. Using data from the 2010 National Survey of Residential Care Facilities, this chartbook from the Maine Rural Health Research Center presents information on a slice of the rural LTSS continuum—the rural residential care facility (RCF).  Survey results identify important national and regional differences between rural and urban RCFs, focusing on the facility, resident and service characteristics of RCFs and their ability to meet the LTSS needs of residents.  Rural RCFs are more likely to have private pay patients compared to urban facilities and their residents have fewer disabilities as measured by their functional assistance needs.  Compared to urban facilities, the policies of rural RCFs appear less likely to support aging in place.

Suggested Citation: Lenardson JD, Griffin E, Croll Z, Ziller EC, Coburn AF. Profile of Rural Residential Care Facilities: A Chartbook. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2014.

Publication Type: 
Report
Publish Date: 
May 20, 2014
URL: 
http://muskie.usm.maine.edu/Publications/rural/Chartbook-Rural-Res-Care-Facilities.pdf

Pages

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