Podcasts about rural health policy

Today's podcast features an interview with Kristen Dillon, MD, Chief Medical Officer of the Federal Office for Rural Health Policy. In this special National Rural Health Day episode, we get an overview of the current state of rural maternal health, including access barriers and disparities in health outcomes, as well as exploring the ways that the Health Resources and Services Administration is working to improve outcomes for rural mothers. The transcript and a list of resources and organizations mentioned in the episode can be found at: https://www.ruralhealthinfo.org/podcast/maternal-health-nov-2024 Exploring Rural Health is an RHIhub podcast.

People in rural areas have higher rates of certain chronic conditions and disabilities and can expect to live a couple years shorter, on average, compared to people in urban areas. The health disparities facing rural Americans stem from many factors – including geographic, economic, social, and systemic issues.  But in the midst of all this, there is hope. There's greater awareness of the importance of rural health care and public health resources, and a growing number of federal agencies dedicated to supporting data-driven solutions aimed at addressing rural health challenges. Two individuals behind some of those efforts join the Health Disparities podcast to discuss rural health challenges and opportunities: Tom Morris, Associate Administrator for the Federal Office of Rural Health Policy at HHS Diane Hall, Director for the Office of Rural Health in CDC's Public Health Infrastructure Center “There's been a lot of focus on access to health care in rural areas, which is absolutely incredibly important,” Hall says. “But I also think we need to really pay attention to the public health infrastructure, which has also been decreased because of budget issues [and] because of the impact of the pandemic.” Addressing rural health needs is a bipartisan issue, says Morris. “There may be disagreements about how you get to the outcome, but there's no disagreement about what the challenges are,” Morris says. “...The partisan divide sort of falls apart when you dive into the issues.” Morris and Hall speak with Health Disparities podcast host Bill Finerfrock about the priorities of their respective offices, common myths about rural America, and what gives them hope as they consider the future of rural health. Never miss an episode – be sure to subscribe to The Health Disparities podcast from Movement Is Life on Apple Podcasts, YouTube, or wherever you get your podcasts.

Christie is joined by Dr. Kristen Dillon, Chief Medical Officer at the Federal Office of Rural Health Policy within the U.S. Department of Health and Human Services (HHS). With an extensive background in rural healthcare, public health, and health policy, Dr. Dillon shares her journey from an urban upbringing in the San Francisco Bay Area to a dedicated career in rural medicine, including her experience overseeing Oregon's Pandemic Response Unit and working on health policy in Speaker Nancy Pelosi's office. Dr. Dillon discusses the unique challenges and solutions in providing quality maternity care in rural areas, the importance of telehealth and collaborative networks, and the critical role of emergency care providers.Check out the Maternal Mental Health Hotline here.  This show is brought to you by the Alliance for Innovation on Maternal Health (AIM). Join us in the journey toward safer, more equitable maternal care and learn more about AIM at saferbirth.org.This podcast is supported by the Health Resources and Services Administration, HRSA, of the United States Department of Health and Human Services, HHS, as part of an initiative to improve maternal health outcomes.

Rural communities in the U.S. are diverse, full of innovation, and each face their own unique health challenges. In this episode, we discuss some less commonly discussed rural health topics with Amy Elizondo, the Chief Strategy Officer for the National Rural Health Association (NRHA). In our conversation we discuss topics such as oral health, the scarcity of dentists in rural areas, behavioral health, substance abuse, and the health concerns of the rural indigenous population Amy highlights some of the amazing work being coordinated through the NRHA to address these health issues in rural communities, both through initiatives and health policy advocacy. Check out the NRHA's Faces of Rural video here: https://www.youtube.com/watch?v=pXpJ4fXRakU “Rural communities are far more diverse than anyone could ever imagine, truly that is where innovation can happen.” -Amy Elizondo Amy Elizondo serves as the Chief Strategy Officer for the National Rural Health Association (NRHA), a non-profit membership organization with the mission to provide leadership on rural health issues to improve access to care. Ms. Elizondo received a Bachelor of Science in Community Health Education from Texas A&M University in 2000 and a Master of Public Health in Social and Behavioral Health from the Texas A&M University System Health Science Center, School of Rural Public Health in 2002. She is currently pursuing her Doctorate in Public Health at the University of Illinois Chicago.  Before joining the NRHA, Ms. Elizondo served as the primary analyst for rural health care and post-acute care issues at the Centers for Medicare and Medicaid Services within the United States Department of Health and Human Services. This position afforded her the opportunity to work as a liaison with Congress during the landmark passing of the Medicare Modernization Act of 2003, also known as the Medicare Prescription Drug Benefit. She also completed a fellowship at the Health Resources and Services Administration's Federal Office of Rural Health Policy where she took part in implementing a rural leadership program.

Health policies play a crucial role in shaping the well-being of rural populations. On Rural Health Leadership Radio, we love to learn about significant policies affecting rural communities and ways to engage in advocacy. In this episode, we have a conversation with Carrie Cochran-McClain, the Chief Policy Officer for the National Rural Health Association (NRHA), to gain insights into the impactful world of rural health policies.  Carrie provides an overview of current rural health policies at the federal level, offering insights into key developments expected in 2024. In our conversation, Carrie emphasizes the influential role of individual voices in shaping policy decisions, and highlights NRHA's efforts to equip advocates with resources. Carrie also shares some fun things to look forward to at the upcoming NRHA Policy Institute on February 13th -15th, exploring the noteworthy events and discussions slated for this gathering.  If you haven't already registered, you can do so here: https://www.ruralhealth.us/events/event-details?eventId=17 . To find out more about NRHA's Advocacy efforts visit their website: https://www.ruralhealth.us/advocate.  “Your voice matters, members of congress need to hear from you and NRHA is here to help you do that”  -Carrie Cochran-McClain Carrie joined NRHA staff in 2020 where she is the head lobbyist for the association and is responsible for driving the organization's rural health policy agenda. Carrie has more than 20 years of experience working in federal health policy development, including leadership roles at Health Management Associates, the U.S. Department of Health and Human Services, and the Federal Office of Rural Health Policy. In her previous positions she has focused on improving health care outcomes, promoting health equity for vulnerable populations, and advising on health care policy issues. Carrie earned a BA in sociology from Willamette University and an MPA with a concentration in health policy and management from the Maxwell School at Syracuse University, and a Doctor of Public Health at the UNC Gillings School.

Who in Washington DC is working to support healthcare in rural communities?  Tom Morris from the Federal Office of Rural Health Policy joined RHV to discuss how his staff provide support through information, data, and of course, grant opportunities. Additional resources: TAGGS - Government grant tracking website HRSA data warehouse Rural Health Information Hub VRHA membership  

Rural hospitals and healthcare providers are constantly facing new challenges as the healthcare industry changes and as regulations shift. At the same time, legislators and federal agencies need to hear from rural hospitals if any new action needs to be taken for their benefit or if coming changes will impact them. Our guest today is Carrie Cochran-McClain, Chief Policy Officer for the National Rural Health Association.  Make your voice heard to promote NRHA's rural health FY 2023 Appropriations requests and priorities including extension of LVH/MDH hospitals, rural ambulance payments, 340B protections, telehealth provisions, and sequestration relief. NRHA has developed pre-prepared materials and talking points as guides for these conversations. Follow Rural Health Rising on Twitter! https://twitter.com/ruralhealthpod https://twitter.com/hillsdaleCEOJJ https://twitter.com/ruralhealthrach Follow the National Rural Health Association on social media! https://www.facebook.com/ruralhealth/ https://twitter.com/ruralhealth https://twitter.com/NRHA_advocacy https://www.linkedin.com/company/national-rural-health-association/ https://instagram.com/nrha_advocacy Follow Hillsdale Hospital on social media! https://www.facebook.com/hillsdalehospital https://www.twitter.com/hillsdalehosp https://www.linkedin.com/company/hillsdale-community-health-center https://www.instagram.com/hillsdalehospital/ Audio Engineering & Original Music by Kenji Ulmer https://www.kenjiulmer.com/

Rural healthcare faces unique challenges. Patients need to travel further to access care and attracting talent to more remote areas can be difficult. Issues that existed before the start of the COVID-19 pandemic have grown as the healthcare workforce struggles to regain job losses over the past two years and more facilities close their doors. In a new episode of Sustaining Capitalism, Tom Morris, Associate Administrator for Rural Health Policy in the Health Resources and Services Administration of the US Department of Health and Human Services, sits down for a conversation with Jessica Nicholson, Senior Economist at the Committee for Economic Development, the public policy center of The Conference Board. Morris oversees the work of the Federal Office of Rural Health Policy, which is charged with advising the HHS Secretary on rural health issues. Morris shares some of the latest trends and how the Federal Office of Rural Health Policy is working to overcome the challenges.

The healthcare industry is not homogenous and rural hospitals know that better than anyone. Legislations that paint with a broad brush often leaves rural hospitals unsupported at best and disadvantaged at worst. This week, we welcome Josh Jorgensen, Government Affairs & Policy Director for the National Rural Heath Association, who engages in the important work of advocating for rural health on a daily basis.

This week we welcome a passionate advocate for rural health who continually brings awareness to the healthcare challenges, successes and opportunities facing rural America. Our guest today is Carrie Cochran-McClain, Chief Policy Officer for the National Rural Health Association.

On episode 35 of All Ears at Child's Voice: A Hearing Loss Podcast, Wendy and Elise are joined by Dr. Matthew Bush. , Dr. Bush is the University of Kentucky Endowed Chair in Rural Health Policy and professor and vice chair for research in the Department of Otolaryngology, head and neck surgery at the University of Kentucky. He completed his otolaryngology residency along with doctoral and master's degrees at the University of Kentucky. And otology neurotology fellowship training at the Ohio State University. He is an NIH funded hearing health disparity expert. Dr. Bush cares deeply about health disparities in the medical field, specifically when it comes to hearing loss. He is a wealth of knowledge who's passion drive his research.

RMOMS is a federally funded grant program that seeks to improve maternal health in rural communities. The Texas and Missouri RMOMS representatives with us today that you'll hear from our awardees of the initial pilot between the federal Office of Rural Health Policy and the Maternal and Child Health Bureau. Today, we discuss innovative solutions these teams are implementing to address issues facing birthing people in rural areas.Today's guests are Anna Taranova, Barb Gleason, Mariluz Martinez, Susan Kendig, Rebecca Burger, and Morgan Nesselrodt.Today's episode is hosted by Tanisa Adimu, assistant project director at the Georgia Health Policy Center and is a co-leader of the Community Health Systems Development team. Learn more about us, explore our resource center and find support for all maternal health professionals at MaternalHealthLearning.org.Maternal Health Innovation is a product of the Maternal Health Learning and Innovation Center and is produced by Earfluence.Music provided by Graham Makes.This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U7CMC33636 State Maternal Health Innovation Support and Implementation Program Cooperative Agreement. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

We are on part 2 of our series on the 5Ps we learned from Mark Holmes of the North Carolina Rural Health Research Center. We covered population in part 1 and now we've made it to policy.Our guest today is Representative Tim Walberg, United States Congressman representing Michigan's seventh congressional district.

Kristen Bigelow-Talbert, from Bi-State Primary Care Association, and Katy Davis, from Hunger Free Vermont, discuss screening for hunger and food insecurity. If poor diet leads to poor health, and health care providers want their patients to stay well, then it makes sense that we would screen for poor diet just like we screen for high blood pressure, cholesterol, BMI, etc. - simple, right? Clearly not simple or we wouldn't be podcasting about it. This episode provides background on the interest in screening for hunger / other social factors in our overall health, and some considerations for selecting screening tools. The second installment will look at implementation, including lessons we might learn from trying new models during COVID-19. Some references from this episode:Community Health Needs Assessments - Definitely helpful as a prelude to this episode, in fact if you have a moment, start here.EHRs - This will be more important in Part 2, but you might as well get ahead.Hunger Vital Sign - One thing that didn't make it into the finished episode was Katy praising Children's HealthWatch on their work with this screening tool. Children's HealthWatch has a lot of excellent resources.PRAPARE - Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences. The Community Health Centers screening tool.  SBINS from Blueprint for Health - Screening, Brief Intervention, and Navigation to Services (acronym or to-do list? This sent me down a rabbit hole of looking up the precise definition of 'mnemonic' and I'm no closer to knowing what to call SBINS)Examples of other screening tools can be found in this toolkit from the Rural Health Information Hub. This season of the Policy in Plainer English podcast is made possible through a grant from the Federal Office of Rural Health Policy to plan for a rural health network that increases communication around the intersection of food and health care in Vermont.

This episode gives a short introduction to our topic for Season Three. If you want more background information on food access in general here are some good starting places:Feeding America - includes Hunger and Health exploring health connections and the Map the Gap site for statisticsFood Research and Action Center USDA Food Security - includes definitions of commonly used terms like "food insecurity"Food is Medicine Coalition - this is for a very specific area of food work, but it's useful to know as an example of food prescribed to treat particular diseasesNFACT - A UVM led project that uses survey data to capture food insecurity and concerns during COVID-19 response, including stay at home ordersAnd a few other items of interest referenced in the episode:If We All Ate Enough Fruit and Vegetables, There'd Be Big Shortages - NPR, 2019The Great Nutrient Collapse - Politico, 2017Behind Belle Gibson's Cancer Con - The Guardian, 2017 - I keep reading these stories because what I really want to know is, are the recipes any good? They didn't cure cancer, but how did they taste? It's not easy to write a cookbook you know. Columbia and the Problem of Dr. Oz - The New Yorker, 2015One topic we won't cover, but one where Vermont is particularly awesome, is food literally in health care - what food we serve at our hospitals. There's a whole movement around that (Healthy Food in Health Care) and a Vermont network. "Healthy" food in this context includes environmental health along with nutrition. It's a great set of initiatives, but beyond the scope of this series, so we're mentioning it now and for more details you'll have to follow the links above to learn more. This season of the Policy in Plainer English podcast is made possible through a grant from the Federal Office of Rural Health Policy to plan for a rural health network that increases communication around the intersection of food and health care in Vermont.

First, Neil Campbell, Executive Director of the Georgia Council On Substance Abuse and Beverly Ragland, CARES Warm Line Manger at the Georgia Council On Substance Abuse, share how their organization is ramping up efforts to provide virtual recovery sessions and resources statewide.Then, Tom Morris, Associate Administrator for Rural Health Policy in the Health Resources and Services Administration of the U.S. Department of Health and Human Services, discusses how new federal funding aims to fight the opioid crisis in rural areas of the state.

This week on Rural Health Leadership Radio we’re talking about COPD prevalence and policy in rural areas. We’re having that conversation with Paul Moore, Senior Health Policy Advisor at the Federal Office of Rural Health Policy. "This right here is an opportunity to both bend that healthcare cost curve and while we’re doing that, improve the health and reduce the burden on millions of folks suffering or soon to suffer with COPD." ~Paul Moore Paul brings a lifetime of experience related to rural healthcare from both his family heritage and more than forty years in community and hospital pharmacy. His experience reaches beyond pharmacy as he has also been the CEO of a County Healthcare Authority, consisting of one of the nation’s earliest Critical Access Hospitals, EMS, a physician clinic and a Home Health Agency. "I’m optimistic that in a payment environment where providers are incentivized to provide what will make the most difference, we’ll see more investment, improving prevention and treatments." ~Paul Moore Paul is also a Past President of the National Rural Health Association and currently serves as the Executive Secretary for the National Advisory Committee for Rural Health and Human Services. He has seen the progression of COPD first-hand and as a pharmacist for over 30 years and hopes to garner national attention for the disease.

Today we are discussing social determinants of health and rural disparities research with Jan Probst, PhD, Distinguished Professor Emerita at the University of South Carolina Arnold School of Public Health and Director Emerita of the Rural and Minority Health Research Center.Journal Article: Structural Urbanism Contributes to Poorer Health Outcomes for Rural America Journal Article: Declines in Pediatric Mortality Fall Short for Rural US Children Disparities in Rural Child Mortality Rates Persist Despite Improvements Rural and Minority Health Research CenterGarrett Lee Smith Campus Suicide Prevention Grant Child Access Prevention Laws for Guns Corridor of Shame American Medical Informatics Association ArtFields Rural Health Information Hub (RHIhub) Federal Office of Rural Health Policy

In this final segment of our four-part, in-depth series.  “Rural Communities: Conquering Challenges, Optimizing Opportunities,” produced in association with the Robert Wood Johnson Foundation, Michelle talks to three major thought leaders about pressing challenges and the future of living in rural America: Tom Morris, the Associate Administrator for Rural Health Policy in HHS’s Health Resources and Services Administration (HRSA), who oversees the work of the Office of Rural Health Policy; Dr. Allen Pratt, Executive Director of the National Rural Education Association (NREA); and Whitney Kimball Coe, the director of National Programs at the Center for Rural Strategies, where she leads the Rural Assembly, a nationwide movement striving to build better policy and more opportunity for rural communities. The three big challenges in rural education today are teacher shortages, broadband and connectivity, and access to jobs in rural regions, according to Pratt. He notes Montana is trying to make it easier for potential teachers from rural areas to get licensed. Morris says that if you train people in rural areas, it’s more likely that they’ll stay in rural communities, noting that his office funded 27 new rural residency planning grants this year. Through its grant authority. Morris’s office engage in outreach in rural communities, such as it recent four-year pilot on obstetric services, which links the major stakeholders in this area. As far as success stories are concerned, Pratt cites a coding program in Montana, a wildlife initiative outside of Buffalo, NY, and scholarship to teacher aides in Arizona, while Morris mention what rural communities in Missouri and Maine are doing to combat COPD and projects in rural areas in Washington and Kentucky that are improving the population’s health status. Coe discussed the takeaways from the recent Rural Women’s Summit in Greenville, NC, including the leadership roles played by women in creating healthier rural communities (with or without the leadership titles) and the fact they should be better supported and the level of optimism that was bursting at the seams at the conference and how that could lead to changing of the narrative on rural communities. Finally, Coe cited the influence of the nonpartisan Vote, Run, Lead, which held a workshop at the Summit for women considering running for public office. This episode and the entire four-part series was sponsored and supported by the Robert Wood Johnson Foundation, rwjf.org.

Subscribe through iTunes and Google Play.   In the latest ASCO in Action Podcast, ASCO’s President, Dr. Monica Bertagnolli, FACS, FASCO sat down with ASCO CEO Dr. Clifford A. Hudis to discuss cancer care in rural America. Improving cancer care access in rural America has been a signature issue in Dr. Bertagnolli’s presidential year, during which she has held town halls in communities across the country to discuss the real-world challenges facing patients in rural America and their cancer care teams. The podcast reveals some of Dr. Bertagnolli’s learnings from her town halls, and she explains what rural cancer care in America looks like today and offers steps to improve rural cancer outcomes in the future. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  Welcome to this ASCO in Action podcast. This is ASCO's monthly podcast series where we explore policy and practice issues that impact oncologists, the entire cancer care delivery team, and the individuals we care for, people with cancer. My name is Clifford Hudis, and I'm the CEO of ASCO, as well as the host of the ASCO in Action podcast series.   For today's podcast, I am delighted to have with me today ASCO's current president, Dr. Monica Bertagnolli. And we're going to be talking about cancer care in rural America. Dr. Bertagnolli has long been a champion for improving access to cancer care in rural America, and it has been a signature issue for her throughout her presidency at ASCO. Indeed, she has held town halls in communities across the US to discuss the real-world challenges that face patients and the entire care team in these locations.  She shared some of those learnings recently at ASCO's State of Cancer Care in America event, which we entitled Closing the Rural Cancer Care Gap. Today, we're going to talk about what rural cancer care looks like in America and how we can take steps to improve outcomes in these many communities. Dr. Bertagnolli, welcome and thank you for joining me today to discuss this important topic.  It's great to be here, Cliff.  So, to kick off our discussion, I'm going to ask you to describe briefly some of the disparities that currently exist between patients with cancer in rural areas compared to those who live in urban or suburban areas.  Well, just imagine that you live in a town where most things are certainly like they are anywhere else, except the hospital is a very small one. The medical care is a primary care physician and maybe a general surgeon. They can do X-rays. They can diagnose most things. But if you have a need for anything beyond the basics of care, you have to drive three, four, six hours in order to reach it.  I think, throughout our country, we really do have a health care system that gets to most people. But particularly when it's an issue of specialty care, such as a cancer diagnosis, that's not always available.  Finally, there's a lot of our country that fits in this category. By the one government agency that looks at these things, the Federal Office for Rural Health Policy, 84% of the country, of the geographic area of the United States, is a rural location. And in that 84%, 18% of the population lives. So, we think, in oncology, it's very important that we understand more about the people who live in these locations so that we can figure out how to get them what they need.  So, starting in a quantitative way is an interesting mathematical representation, that about a fifth of the country in population is distributed over more than 4/5 of the landmass. And I think that's a way of visualizing the lack of density. But there are common challenges that patients in rural areas face that go beyond just distance and geography. What are some of those that you have uncovered and thought about this year?  You know, it's important not to overgeneralize, because certainly, there are people from every single socioeconomic status and walk of life that live in rural locations, no question. But when you go into big generalities, people who live in rural locations tend to have less education level. They tend to be less affluent. They tend to have more risky behaviors, more smoking and alcohol use. And some of the things that we know are associated with cancer development in general seem to be more predominant in rural locations. And finally, citizens who live in rural locations are, again, generally less likely than those who live in urban locations to have health insurance.  Yeah, so that's a long list of challenges that are only compounded by the geographic challenges that we spoke about before. We go and look at the most recent data that I think you shared at ASCO's State of Cancer Care in America. As we noted a moment ago, just under a fifth of the US population lives in these rural areas. But going one step further, not focusing on landmass but now focusing on the oncology workforce, fewer than 10%-- in fact, we think it's about 7%-- of oncologists practice in those areas. So, on the one hand, there's a lower distribution of American citizens into that space, but there's even proportionately a lower distribution of oncologists. How does this impact patients with cancer?  Well, it's a little bit of what I was referring to before. Going to see a specialist when you've got a disease such as cancer, where knowledge outside of the usual primary care physician's scope is really important, and by the fact that such a small percentage of oncologists live in rural areas and the fact that, in rural areas, distance is so great between various locations means that patients who have cancer just don't have access to the experts that they need.  To get that access, they have to travel. And there's not really public transportation that works between cities that might be 100 miles apart in some rural locations. So, the single greatest issue I hear from many patients in rural locations is the challenge of distance.  Yeah, it's really amazing. So of course, as I'm sure we're going to talk about, at ASCO, we don't enumerate these problems just to make a list. We do this to try to take action, to do something about it. And I guess the first question, and I know one that you've started to think about with ASCO volunteers and staff, is the fundamental one. How can we support the existing infrastructure, the existing oncology workforce in those areas? And taking it a step further, what can we do to possibly expand this workforce, at least bring it to parity with the population distribution?  We were really fortunate to have a very talented team of physicians within ASCO take this task to heart over the last year. And they formed a task force to look at issues of rural access to cancer care. It was led by Dr. Bhatia, who's from the University of Alabama-- Birmingham. And they produced a really great roadmap for us. The one area you're alluding to now is workforce. How do we get care providers? Or how do we get our patients in rural locations access to the care providers that they need?  There's a couple of different approaches the task force identified. The first is to think about education opportunities for rural health care providers. For example, one of the gaps that the task force identified is people with knowledge for the particular needs of cancer patients who live in rural locations.  Well, knowledge is something that ASCO is-- that's our core mission to provide. And so, the task force brought together a whole list of things like expanding ASCO meetings to locations throughout the United States, making it easier for rural care providers to attend, designing and implementing virtual tumor boards. Telephones are everywhere, either web-based or telephone-based communication networks that will allow those taking care of patients in rural locations to get information that they need specifically and support them there.  And then finally, every community is different. Every rural location is different. And one of the things we realized we needed to do as an organization is reach out more to everyone and just find out, what are the individual needs of our care providers?  So, in a way, you're raising the issue of complexity in terms of the built and available infrastructure. But that's paralleled, as was pointed out in the State of Cancer Care in America event, by complexity in terms of our understanding of cancer and how we treat it. So, what challenges does this increased complexity bring to those oncologists and other clinicians who care for patients in rural areas. That is, is it different for them or just more of the same?  So, I can give you some snapshots, because I visited seven different rural communities during my year as ASCO president. And some of the common things all have to do with distance and have to do with access to specialists. But there are other specific issues to each location. Let me just give you some quick examples.  In South Dakota, near the Pine Ridge Indian Reservation, there was a great need for programs that could help address cancer control, screening for cancer, smoking cessation, education for diet and overall wellness, and providers who could engage with the Native American population in order to educate the population and provide those services.  At the complete other end of the spectrum for that community, there was no access whatsoever to palliative care services. So the oncologists, who were about 100 miles away in Rapid City, were struggling with, what do we do when we have an elderly resident of Pine Ridge who has a terminal illness, and we don't have the ability to support them to get palliative care?  And what the community is doing is partnering with health providers that work through the tribal council to provide these services. But when someone needs advice, needs a consult, they have to have someone to reach out to. And that is networking through the teams in Rapid City. That's the way they're beginning to solve those problems, kind of a regional network of support and help.  Another quick example I can give you is in Appalachia. There is a rural community I visited with Electra Paskett in the Appalachian counties of Ohio, where, again, it's about a two-hour drive to the nearest large cancer center. There, it's a combination of regional hospitals who provide services to cancer patients and the Ohio State University, where the most acute patients with very high-level specialty needs can go for consultation.  A patient, let's say, with acute leukemia who's from rural Appalachia and needs to be treated would be transported to Ohio State. Others with more routine care are cared for by providers who are oncologists locally.  So, it's different in every location. I think the underlying theme is collaboration with whatever resources are closest, and finally, the ability to have people who really go deep into the community and problem solve. They all kind of have the whatever-it-takes attitude and come up with very creative solutions particular to the patients that they're serving.  It sounds like, as you described all that, that it's awareness, knowing your limits, and then it's networks and connections that really are the pieces of the solution. Does that make sense to you?  Yeah, that's very well said. And one size absolutely does not fit all. The other thing that you notice is, it's about the whole community, not just the individual patients and their doctor. I heard so many stories of neighbors helping out, somebody arranging to drive someone who was ill to a doctor's visit hours away, neighbors being willing to take care of-- one situation was where the neighbors chipped in to take care of an entire family while the mother was away having radiation therapy for her cancer at a city two hours away. These are the kinds of special challenges that you see in rural locations.  Yeah, I mean, you're really just drifting back and forth in and out of conventional, mainstream medical system infrastructure into the broader community. As I think about that, everybody who's listening to this, of course, knows you because of your years of leadership in the realm of clinical research, which is another component of all this we haven't yet touched on. But often, access to clinical research is a surrogate marker for access to high-quality care-- not always, but often-- and it's certainly an indicator of access to cutting-edge care. So I wonder if you want to talk a little bit about access to clinical research in these disadvantaged rural communities?  I'm so glad you brought that up, Cliff, because we're completely in the dark without research. Like I said, I've gone around and visited these various locations and realized that even though I grew up in a rural area, very rural area of Wyoming, when I visited rural Appalachia and rural Texas and rural even North Dakota, which is very similar to Wyoming, I realized that I really couldn't fully understand the challenges in those different locations. And the only way to understand what patients really need, what they're facing, and how to best help is by research.  It's a way-- in this, I'm saying that one of the most important things we can offer our cancer patients everywhere is the ability to have their challenges addressed by research so that we truly understand them. That's the only way we're ever going to make progress.  So, one of the things that the US government, I think, has done well is the National Cancer Institute has a network of research groups under the National Clinical Trials Network that are centered within community practices and community locations. It's the National Clinical Oncology Research Program, or the NCORP. And almost all of the NCORP sites spread throughout the United States have at least significant outreach components into rural communities for cancer research.  Finally, the US Comprehensive Cancer Centers also have a really important mandate to serve their community, and their community for most of the Comprehensive Cancer Centers includes rural locations. So, it's a hub-and-spoke model that's been developed for research. I won't say that it's perfect, because it certainly could be broader and more comprehensive. But it's a very, very good start, and right now, it definitely covers a large portion of rural America.  And I'm just curious. Is it too soon, or do we yet have data that shows that there's been an uptick or a change in registration out of those rural communities to clinical research trials?  We do know that we have more-- that when you look at the National Clinical Trials Network participants, the patients who enroll on those studies, that the proportion from rural locations is higher than it is in most clinical trials that are done by, say, the industry. So we do definitely know that it's been helpful.  We still don't have the numbers of rural residents in clinical research that meet their population needs. I mean, the patients who live in rural locations are still vastly underrepresented in clinical research. But this goes along with the multifactorial issues of being in a rural location. We know that it's harder for uninsured patients to be in clinical trials. It's harder for anyone who has to travel to participate in clinical trials. And it's certainly harder for individuals of lower socioeconomic status to be in trials. So we've still got a long way to go.  Well, you raised the one that's always in these discussions, the 800-pound gorilla, and that's insurance. Residents in rural areas are less likely to have employer-sponsored health insurance. They're more likely to live in states that have not chosen to expand Medicaid. And the issue, of course, is that when we don't have adequate insurance, that puts a strain on the system in terms of access to care and reimbursement to those who are in the area trying to care for them. So how does that reality affect patients? Is that just another layer on top of everything we've said? Or are there specific places where you see that impact?  Oh, it's another part of this very multifactorial problem of citizens living in rural locations. And it translates into something very, very real. So one of the best data that I've seen recently is that from 2011 to 2015-- I believe this is the last time it was looked at comprehensively-- the CDC looked at death rates from cancer and compared death rates in cancer between urban and rural areas. And the death rates in rural areas were 180 deaths per 100,000 patients, persons, people-- sorry-- to cancer compared to urban areas where it was 158.  So there's a significantly higher death rate from cancer for citizens who live in rural areas. So it's not just access to research. It's not just the availability of specialists. It truly is access to care in a way that translates into survival.  Well, as I mentioned earlier, enumerating all of these challenges is just a first step. And I want to talk a little bit about what we can do to start to address them. Before I make that pivot with you, I just want to make sure that we don't leave anything important behind.  You've been in communities all around the country. You've interacted with patients, other caregivers, oncologists about the challenges of delivering care in rural communities, and you've already detailed a lot of this. Is there anything that we haven't touched on that you want to essentially put on the board before we pivot to solutions?  Only that the overwhelmingly positive thing I found in all of my travels is that the communities-- the rural communities-- truly value the interaction with their care providers. And it is very moving to see how medical care providers in a rural setting are absolutely essential components of the community.  We take it for granted when you live in an urban location that if you have appendicitis or you have a cancer diagnosis, somebody's going to be there to take care of you. That is never taken for granted in these rural locations. And it's very moving and very special as a physician to be able to witness that.  Well, so we'd like to have more of those places, in a sense, where they're lucky enough to take care for granted. And to that end, last fall, ASCO convened a group of our volunteers and board members-- you alluded to this already-- to take a closer look at the issue of rural cancer care. The group identified four primary areas where ASCO could better support rural oncology providers and their patients. And these included-- you touched on this already-- provider education and training, but also workforce development, a tighter embrace, if you will, of tele-oncology, and a focus on rural cancer research.  Further, as you know, during the recent State of Cancer Care in America event, we kicked it off with an announcement that ASCO was convening a Rural Cancer Care Task Force. This is different from the board task force earlier in the year. This one is going to focus on building on that work and making recommendations for specific tools and projects that we can launch.  So knowing what a priority this has been for you throughout your presidential year, I have a question for you, which is, where do you think ASCO can best serve patients in rural areas? That is, what resources would be most useful to our members, the providers who are serving those populations?  So I think ASCO is in a wonderful position to be in a forum, to listen to and enlist the help of those providers who really work with patients from rural locations, and to be able to hear from them directly what they need to better support their patients.  In South Dakota, I heard it was better support for palliative care and better support for access to preventive cancer prevention and cancer control programs. In Laredo, Texas, it was about figuring out how to get people health insurance coverage for the very expensive medications that were involved in cancer care. In other places, it was about being able to have someone available for consultation when they needed it, either by a telemedicine approach or by something as simple as being able to know exactly who to pick up the phone and contact when someone on the front lines had a specific patient need.  Finally, there are a lot of problem-solving strategies that certain providers and provider groups are implementing that are working well for them, but they seem to be still in a bit of a vacuum. Getting providers from across the United States to be able to come together and talk about these issues and share what's working for them, I think, will be very powerful for everyone else in this field.  It sounds like at least part of this is something I've taken to calling ORFA, which is organized resources for access. That is fundamentally what I think we find is a repetitive, recurrent need across all communities, but maybe even more pointed in rural communities in America. Is that fair?  I think that's very fair. And I think there are going to be some things that are truly unique to the rural locations, that are decisions that are going to be made that will be different than medicine practiced in more urban locations. For example, there are different ways to deliver radiation therapy. That may be a trade-off that someone who lives in a very rural location will pick rather than someone who lives in an urban area, where they have the ability to have five weeks of radiation therapy.  Some of the brachytherapy approaches, for instance, to breast cancer or to prostate cancer would be more-- might be chosen by patients who live in rural locations more than they would someone who lives in an urban area. I mean, there are even very specific modalities such as this that we may end up seeing practiced differently in a rural versus an urban setting.  Well, I can't thank you enough for taking the time to talk to me and enlighten our listeners on the topic of cancer care in rural America. As I've remarked throughout the year, your presidential year has been both consequential and engaging. And you manage to not only focus on, I think, critical problems, but also on plausible solutions. And I think that's the mark of a real leader, and we're very grateful to you for that.  Cliff, thank you so much. It's been a great honor, and I really enjoyed talking to you today.  I want to encourage our listeners to go and watch a recording of the State of Cancer Care in America event Closing the Rural Cancer Gap. The full-length recording is available on our Facebook page, or you can find it directly at ASCO.org/stateofcancercare. Until next time, thank you for listening to this ASCO in Action podcast. 

John has an extremely informative discussion with Tom Morris, Associate Administrator for Rural Health in the Human Resources and Services Administration at the U.S. Department of Health and Human Services. Rural Americans are dying at an earlier age and at a higher rate than urban Americans, notes Morris, and also are victims disproportionately of “excess deaths,” such as certain chronic diseases and opioid addiction, which could be prevented through timely intervention. Education and better access to health care, however, can improve outcomes, Morris explains. You just can’t take an urban model and apply it to rural areas, he stresses. Check out the Rural Community Health Gateway (ruralhealthinfo.org), and you’ll find models that work in rural health. And Morris’s office is combining funds for grass-roots efforts at improving health. Finally, the good news: the health care sector is a high-growth employment area, so rural areas need to work with high schools and colleges to take advantages of this development.

This webinar provides research-based observations and state-based examples of rural accountable care organizations (ACOs) and how they are relevant to state Flex Programs. In addition to the topic, this TASC 90 webinar will also include updates from the Technical Assistance and Services Center (TASC), the Flex Monitoring Team and the Federal Office of Rural Health Policy (FORHP), to include both the Flex program and policies impacting critical access hospitals (CAHs). Download webinar slides from The Center's website. Speakers: Tracy Morton, MPH, Program Manager, National Rural Health Resource Center Sarah Young, MPH, Flex Program Coordinator, Federal Office of Rural Health Policy, Health Resources and Services Administration Wakina Scott, PhD, MPH, Policy Coordinator, Federal Office of Rural Health Policy, Health Resources and Services Administration Karla Weng, MPH, Senior Program Manager, Stratis Health John Gale, MS, Researcher, University of Southern Maine, Flex Monitoring Team Xi Zhu, PhD, Researcher, University of Iowa College of Public Health, Rural Policy Research Institute Pat Schou, MS, Executive Director, Illinois Critical Access Hospital Network (ICAHN) This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,100,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

  This presentation walks through a strategic planning toolkit to support the development of a strategic plan for networks that have received Rural Health Network Development grants from the Health Resources and Services Administration’s Federal Office of Rural Health Policy. The toolkit includes a guide, a template and samples to help networks write effective and dynamic strategic plans. The strategic plan grant deliverable for Network Development grantees is due to the Electronic Handbook (EHB) by December 31, 2017. Download podcast slide decks from the Network TA website. Speakers: Debra Laine, Program Specialist II, Rural Health Innovations

This webinar includes tips and best practices from the Technical Assistance and Services Center (TASC) and the Federal Office of Rural Health Policy (FORHP) for Flex Programs to wrap up the current Flex program year and start the new program year on September 1st. The webinar also includes updates from TASC, the Flex Monitoring Team (FMT), Rural Quality Improvement Technical Assistance (RQITA), Rural Health Value and FORHP, to include both the Flex Program and policies impacting critical access hospitals (CAHs). Download webinar slide decks from The Center's website. Host Tracy Morton, MPH, Program Manager, National Rural Health Resource Center Speakers Wakina Scott, MPH, PhD, Policy Coordinator, Federal Office of Rural Health Policy, Health Resources and Services Administration Kristin Reiter, PhD, Research Fellow, North Carolina Rural Health Research Program, Flex Monitoring Team Laura Grangaard Johnson, MPH, Research Analyst, Rural Quality Improvement Technical Assistance, Stratis Health Mike McNeely, Deputy Director, Federal Office of Rural Health Policy, Health Resources and Services Administration Sarah Young, MPH, Flex Program Coordinator, Federal Office of Rural Health Policy, Health Resources and Services Administration Caleb Siem, MHA, Program Specialist, National Rural Health Resource Center This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $957,510 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

Health care is on a path to value, regardless of health care reform uncertainties. Thus, critical access hospitals need to understand accountable care, especially if considering joining an ACO. This webinar will present a new Excel-based tool developed by the Rural Health Value team and Premier, Inc. The Critical Access Hospital Pro Forma for Shared Savings assesses the financial implications of joining a Medicare Shared Savings Plan Accountable Care Organization (ACO). The publicly available, free tool highlights five-year revenue and expense forecasts financial projections that compare current state to Medicare ACO participation and an easy to understand table and chart summary outputs, including hospital and physician financial projections. Download podcast slide decks from the SRHT website. Speakers: Clint MacKinney, MD, MS, Clinical Associate Professor in the Department of Health Management and Policy at the College of Public Health, University of Iowa and Deputy Director of the Rural Policy Research Institute (RUPRI) Center for Rural Health Policy and Analysis Jane Jerzak, CPA, RN, Partner, Wipfli LLP This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $957,510 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

This webinar features a state coordinator of the Small Rural Hospital Improvement Grant Program (SHIP) to discuss collaboration efforts involved with pooling SHIP funds for a shared project. The presentation also includes a summary of program recommendations submitted as part of the Fiscal Year 2017 Non-Competing Continuation progress reports, along with an opportunity for SHIP coordinators to provide additional feedback and insights. Download the slide deck from this webinar on the SHIP website. Hosts: Federal Office of Rural Health Policy and National Rural Health Resource Center

Representative Martha Stevens, of Columbia, is joined by Missouri Rural Crisis Center's Dina Van Der Zalm for a discussion on realities of rural health policy. They cover economics, opioid epidemic, and how to get involved.

This webinar discusses a recent Lean project conducted at a critical access hospital in Arizona and how similar quality improvement initiatives can be undertaken using SHIP funding. Presenters review the process of implementing the project as well as measurable outcomes seen by the hospital as a result. In addition, this webinar outlines key trends of SHIP funding in fiscal year 2016 and reviews helpful SHIP resources. Hosts: Federal Office of Rural Health Policy and National Rural Health Resource Center

This webinar reviews the guidance for the Small Rural Hospital Improvement Grant Program (SHIP) Fiscal Year 2017 Non-Competing Continuation (NCC) progress report, which is due on February 10, 2017. In addition, presenters will share information on how to complete the FY17 State Spreadsheet of SHIP Applicants and provide grant-writing resources.   Speakers: Federal Office of Rural Health Policy and National Rural Health Resource Center  

  With the support of the Federal Office of Rural Health Policy, The Rural Hospital Toolkit for Transitioning to Value-based Systems (Toolkit) was developed to disseminate consultant recommended best practices and transition strategies identified through the Small Rural Hospital Transition (SRHT) Project. The Toolkit shares best practices for improving financial, operational and quality performance that position rural hospitals and networks for the future, as well as outlines strategies for transitioning to value-based payment and population health. Rural providers and leaders should use the Toolkit to identify performance improvement opportunities for their hospitals and networks, and develop strategies for successfully transitioning to population health.    Speakers:  Terry Hill, Senior Advisor for Rural Health Leadership and Policy, National Rural Health Resource Center Michael McNeely, Deputy Director, Hospital-State Division , Federal Office of Rural Health Policy