This announcement solicits applications for the Rural Health Network Development Planning Grant Program (“Network Planning”). The purpose of the Network Planning program is to assist in the development of an integrated healthcare network, if the network participants do not have a history of
formal collaborative efforts. Health care networks can be an effective strategy to help smaller rural health care providers and health care service organizations align resources and strategies, achieve economies of scale and efficiency, and address challenges more effectively as a group than as single providers. The Network Planning program promotes the planning and development of healthcare networks in order to:
(i) achieve efficiencies; (ii) expand access to, coordinate, and improve the quality of essential health care services; and (iii) strengthen the rural health care system as a whole. The health care system is undergoing a significant amount of change and this can be particularly challenging for small rural providers.
The goals of the Network Planning program are to help rural providers better serve their communities given changes taking place in health care, as providers move from focusing on the volume of services to focusing on the value of services. This program will bring together key parts of a rural health care delivery system, particularly those entities that may not have collaborated in the past under a formal relationship, to establish and improve local capacity and coordination of care. The program will support one year of planning with the primary goal of helping networks create a foundation for their infrastructure and focusing member efforts to address important regional or local community health needs.
To appropriately address emerging community health needs and challenges, systemic efforts are key. This program will assist communities in establishing a rural health network of health care providers committed to forming relationships with each other and stakeholders. It is expected that the rural health networks will maintain the highest level of access to care, increase the use of health information technology, explore alternative health care delivery models and continue to achieve a high level of quality health care across the continuum of care from prevention and wellness to acute and long term care.
A rural health network is defined as an organizational arrangement among at least three separately owned regional or local health care providers that come together to develop strategies for improving health services delivery systems in a community. For example, a critical access hospital, a community health center, and a public health department may collaborate to form a network around a shared purpose. Networks may include a wide range of community partners providing health care including social service agencies, faith-based organizations, mental health agencies, charitable organizations, educational institutions, employers, local government agencies or other entities with an interest in a community’s health care system. Strong partnerships at the community level with organizations such as those mentioned above, are essential to the overall success of improving population health through alignment of goals and resources.
The passage of the Affordable Care Act has provided opportunities for expanded insurance coverage in rural areas. This law has the potential to positively change the payer mix for rural providers but may also create a surge in demand for the existing providers in rural areas. The Affordable Care Act also focuses heavily on improving quality through new incentives in the Medicare program, ranging from avoidable re-admission and hospital-acquired condition penalties for hospitals to value-based reimbursement systems in acute, ambulatory and post-acute reimbursement.
In addition to improving the way providers are paid by promoting value-based payment systems; improving the way care is delivered by encouraging integration and coordination of clinical services, population health and patient engagement is another paradigm shift with the passage of the Affordable Care Act. There are also new delivery models related to Accountable Care Organizations, Patient-Centered Medical Homes and payment. At the same time, there is greater consolidation in the health care market and increasing efforts across payers and employers to focus on health promotion and chronic disease management in order to improve patient outcomes and reduce downstream costs. The increasing focus on showing value in health care delivery creates incentives to develop regional systems of care that preserve local autonomy for rural communities while also ensuring access to the appropriate continuum of care for the local service population. Thus, it is more important now than ever for rural providers to participate in efforts such as implementing population health strategies to demonstrate the quality and value they provide rural residents. Each of the aims listed below offer activities that can help rural providers work together to adapt to the larger changes in the health care delivery system. Applicants must clearly identify one of the following focus areas that their network planning activities will address:
i. Population Health 1. Care Coordination 2. Patient Engagement 3. Data Analytics/Health Information Technology 4. Physician and health care provider-hospital alignment ii. Alleviating Loss of Local Services and Access to Care 1. Rural Hospital Closure / Conversion 2. Rural Hospital Financially at-risk of closing 3. Enhancing sustainable Emergency Medical Services 4. Telehealth Applicants must describe planning activities that support at least one of the legislative aims described below:
Achieve efficiencies The network will focus on identifying ways to achieve better system efficiencies and improve regional and/or local rural health care services.
Planning activities may include, but are not limited to:
1. Conducting a community health and/or provider needs assessments at the regional and/or local level:
· Develop and implement a needs assessment in the community; · Identify the most critical need of network partners to ensure their viability; · Identify additional collaborating network partners in the community/region; · Identify and develop a plan to address workforce issues; or · Identify financial resources or gaps available to support services.
2. Updating a health information technology plan, which helps to improve outcomes for rural patients, based on the current standards of care, reporting enhancements and/or capacity.
3. Collaborating with the local charitable hospital to develop an implementation plan for addressing community needs identified by the triennial community health needs assessment.
4. Identifying a plan for developing regional systems of care to better meet rural patient concerns. Aim #2:
Expand access to, coordinate, and improve the quality of essential health care services The network will focus on ways to build capacity and a network infrastructure that enables entities to coordinate care and increase access to care for rural communities both locally and regionally. Planning activities may include, but are not limited to:
1. Developing a network business and/or operations plan, which may include:
· A formal memorandum of agreement or understanding (MOA/MOU); · A shared mission statement; · A network/governance board or decision making structure; · A set of network bylaws; · The roles and responsibilities of the network partners; or · A business model.
2. Identifying the degree to which the network members are ready to integrate their functions and share clinical and/or administrative resources.
3. Assessing appropriateness/readiness for Patient Centered Medical Home accreditation.
4. Identifying strategies to communicate with the community about changes in the health care landscape and how to maintain access to viable health care services.
5. Developing a plan to expand the role of emergency medical services within the community.
6. Developing a plan to ensure access to essential services in communities that have lost a hospital or consider options for ensuring access in areas where the hospital is at risk of closing.
Strengthen the rural health care system as a whole Network members will focus on ways to enhance community and partner relationships to promote involvement and participation in network planning activities. Planning activities may include, but are not limited to:
1. Identifying ways to encourage cross-organizational collaboration and leadership commitment.
2. Assessing the network’s sustainability and viability.
3. Identifying opportunities for the network to better address regional and/or local population health needs.
4. Identifying and establishing ways to obtain regional and/or local community support/buy-in around the development of the network.
5. Identify a strategy to leverage broadband connectivity to support health information technology applications in rural communities. This may include developing partnerships to leverage broadband funding through the Federal Communications Commission Health Care Connect program and the United States Department of Agriculture Broadband Program.
6. Developing a transition plan that assures seamless access to care across a full range of services, in the event of a hospital closure/conversion.
Network planning activities that model evidence-based frameworks or models that work are encouraged. Proposals should emphasize innovations and creative approaches in adapting to a changing health care environment that may serve as a model to other rural communities.
Management Criteria The applicant organization must have financial management systems in place and demonstrate the capability to manage the grant. The applicant organization must:
· Exercise administrative and programmatic direction over grant-funded activities; · Be responsible for hiring and managing the grant-funded staff; · Demonstrate the administrative and accounting capabilities to manage the grant funds; · Have at least one permanent staff at the time a grant award is made; and · Have an Employer Identification Number (EIN) from the Internal Revenue Service.