The Rural Health Care Landscape Today
The well-known challenges that confront our nation’s health care system are compounded in rural America by disproportionally ill and disabled rural citizens, higher poverty rates, lower-income adults, and lower levels of insurance coverage. The rural health care system, in turn, is burdened by under-financed primary care, geographically isolated rural providers, and general health care access challenges.
Despite persistent rural challenges, public policies during the past 3 decades have helped build and stabilize rural health care services. New payments have increased revenue for physicians practicing in shortage areas; rural-specific hospital and clinic designations and payments have addressed place-specific delivery challenges; and federal and state programs have provided technical assistance and grants to rural hospitals, funded installation of rural telemedicine equipment, and promoted rural health professions education.
Many of the current rural-specific payment policies are not likely to be sustained over the long-term, however, and can hinder innovations in delivery that can lead to a sustainable rural place-based delivery system for the future. The RUPRI Health Panel envisions a high performance rural health care system built on the foundations of affordability, accessibility, community focus, high quality, and patient centeredness. These foundations are supported by a robust primary care system that rewards clinical quality, population-based care, and efficient resource utilization.
RUPRI Rural Health Panel
RUPRI Rural Health Panel has developed a unique role in providing policy relevant analysis of rural health services delivery to nonprofessional audiences. Since 1993 the Panel has built a particular expertise linking policy suggestions to broader conceptual frameworks. The Panel has received support from the Federal Office of Rural Health Policy, the US Department of Agriculture, the Robert Wood Johnson Foundation, the Agency for Healthcare Research and Quality, and the Leona M and Harry B Helmsley Charitable Trust.
The RUPRI Health Panel envisions rural health care that is affordable and accessible for rural residents through a sustainable health system that delivers high quality, high value services. A high performance rural health system, informed by the needs of each unique rural community, will lead to greater community health and well-being.
RUPRI Rural Health Panel Members
Andrew F. Coburn, PhD, is a professor of Health Policy and Management, directs the Institute for Health Policy in the Muskie School of Public Service at the University of Southern Maine, and is a senior investigator in the Maine Rural Health Research Center.
Jennifer P. Lundblad, PhD, MBA, is president and CEO of Stratis Health, an independent non-profit quality improvement organization based in Bloomington, Minnesota, that leads collaboration and innovation in health care quality and patient safety.
A. Clinton MacKinney, MD, MS, Clinical Assistant Professor, University of Iowa, and a board-certified family physician delivering emergency medicine services in rural Minnesota.
Timothy D. McBride, PhD, is a professor of public health in the George Warren Brown School of Social Work, and a faculty scholar in the Institute for Public Health at Washington University in St. Louis.
Keith J. Mueller, PhD, is the Rural Health Panel chair. Dr. Mueller is the head of the Department of Health Management and Policy in the University of Iowa College of Public Health, where he is also the Gerhard Hartman Professor and the director of the RUPRI Center for Rural Health Policy Analysis.
Charlie Alfero, Director of the Center for Health Innovations, Hidalgo Medical Services, Silver City, NM.
RUPRI Rural Health Panel Documents
RUPRI Rural Health Panel Presentations
RUPRI Center for Rural Health Policy Analysis
The RUPRI Center for Rural Health Policy Analysis conducts original research in the topical areas of access to health care services, Medicare policies, development of rural delivery systems (including effects of national policy), and public health. The mission of the Center is to provide timely analysis to federal and state health policy makers, based on the best available research.
Specific objectives for the Center’s work include: conducting original research and independent policy analysis that provides policy makers and others with a more complete understanding of the implications of health policy initiatives, and disseminating policy analysis that assures policy makers will consider the needs of rural health care delivery systems in the design and implementation of health policy. The Center, in partnership with Stratis Health (a Quality Improvement Organization based in Minnesota), provides research, analysis, and technical assistance important to rural providers adapting to changes in healthcare finance and delivery. The Center also evaluates innovations in healthcare delivery (including telehealth programs) and finance (including shared savings programs).
The RUPRI Center for Rural Health Policy Analysis is based at the University of Iowa, in the College of Public Health, Department of Health Management and Policy. The Center receives core funding from the Federal Office of Rural Health Policy, which also supports the Rural Health Value Program partnership with Stratis Health. Center projects are now or have been funded by the Veterans’ Health Administration, the Agency for Healthcare Research and Quality, the Leona M and Harry B Helmsley Charitable Trust, and State Offices of Rural Health.
Program of Work
The research of the RUPRI Center has included studies of Medicare managed care (currently Medicare Advantage plan enrollment and analysis of quality ratings), the Medicare Shared Savings Program, characteristics of new health insurance marketplaces in rural areas, classification of rural areas as unlikely to generate financial support for health care providers, and patterns of admission to hospitals for conditions treatable in an outpatient environment.
Rural Health Value Center
Rural Health Value is a cooperative agreement between the Office of Rural Health Policy, the RUPRI Center for Rural Health Policy Analysis (RUPRI Center), and Stratis Health. The RHVTeam will analyze rural implications of changes in the organization, finance, and delivery of health care services and will assist rural communities and providers in the transition to a high performance rural health system. The RUPRI Center brings experience from a variety of research strategies including survey design, qualitative analysis, simulation development, and large national database query and report design. Stratis Health leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities
To build and distribute a knowledge base through research, practice, and collaboration that helps create high performance rural health systems.
- Assess rural implications and facilitate rural adaptability to changes in health care delivery, organization and finance.
- Develop and test technical assistance tools and resources to enable rural providers and communities to prepare for and take full advantage of public policy changes and private sector initiatives.
- Inform further developments in public policy and private action through dissemination of findings.