Health Policy

Health Policy

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.

PDF – All Health Panel

RUPRI Rural Health Panel Presentations

Continued Evolution of Transformation in Healthcare Delivery and Finance: Rural Primary Care Implications. Keith J Mueller. Omaha, NE. March 2017.

Making the Most of Evolving Payment Policies to Enhance Hospital-based Care in Rural Communities. Keith J Mueller. Phoenix, AZ. February 2017. 

Rural Healthcare Delivery Focused on Social Determinants of Health. Keith J. Mueller. Albuquerque, NM. September 2016.

How the Changing Marketplace Creates Challenges and Opportunities in Rural Health. Keith J. Mueller. Dickinson, ND. August 2016.

Advancing Policy Through Research: Program Evaluation and Outcomes in Rural Telehealth. Keith J. Mueller. Nashville, TN. August 2016.

Forces Shaping the Future of Critical Access Hospitals: A Journey to Oz. Keith J. Mueller. Columbia, MO. July, 2016.

Continuing the Journey to Oz: Finance and Organization Change as a Means to an End. Dr Keith Mueller. June 2016.

Pathways to Success In a New World of Healthcare Finance. Dr. Keith Mueller. April 2016.

Testimony to the Alaskan Senate Subcommittee on Medicaid Reform. Dr. Clinton MacKinney. February 2016.

Tectonic Shifts in Rural. Keith J Mueller. Colombia, MO. November 2015.

Transitioning to a High Performance Rural Health System. Keith J Mueller / Charles W. Fluharty. St. Louis, MO. October 2015

Rural Delivery System Reform. Jennifer Lundblad. White Earth Reservation, MN. September 2015.

Laying the Bricks on the Road to a High Performance System. Keith J. Mueller. MT. July 2015

Designing and Implementing the Rural Health System of the Future. Keith J. Mueller. Peoria, IL. April 2015

Designing and Implementing the Rural Health System of the Future. Keith J. Mueller. Phoenix, AZ. February 2015

Navigating the Turbulent Waters of Change in Healthcare. Keith J. Mueller. Sacramento, CA. December 2014

Health Systems and Population Health. Keith J. Mueller. Charles City, IA. November 2014

The Times They Are a-Changin’. A. Clinton MacKinney. Coudersport, PA. September 2014

The Affordable Care Act and Marketplace Coverage: Implications for Rural Areas. RUPRI Center for Rural Health Policy Analysis. Omaha, NE. April 2014.

A Second Look at the Patient Protection and Affordable Care Act of 2010. RUPRI Health Panel. Las Vegas, NV. April 2014.

Rural Health Strategies for a Value-Based Future. A. Clinton MacKinney. Anchorage, AK. April 2014.

Improving Health in a Climate of Change. A. Clinton MacKinney. San Diego, CA. January 2014.

The Impact of Payment Reform on Rural Medicare Advantage Enrollment and Quality. RUPRI Center for Rural Health Policy Analysis. June 2013.

Frontier Extended Stay Clinics: A Sustainable Community Model. A. Clinton MacKinney. Louisville, KY. May 2013.

ACOs and Much More: Health Reform Comes to Rural America. Keith J. Mueller. Colorado Springs, CO. May 2013.

How to Succeed by Trying: Adapting to Change. Keith J. Mueller. Colorado Springs, CO. May 2013.

Impact on Health System Market Changes on Rural Health: ACO, PCMH, VBP Consolidation. Keith J. Mueller. San Diego, CA. May 2013.

Rural Emergency Care: Stepping Up to the Challenge. A. Clinton MacKinney. April 2013.

Research to Policy and Practice: Sustaining Rural Health Services. Keith J. Mueller. Des Moines, IA. February 2013.

Transforming Health Care in Rural America: Turning Change into Improvement for Rural Residents. Keith J. Mueller. Phoenix, AZ. February 2013.

Transferring Risk – the Road to Health Care Value. A. Clinton MacKinney. February 2013.

ACOs and Much More: Health Reform Comes to Rural America. Keith J. Mueller. Helena, MT. January 2013.

Delivering Value: Primary Care’s Opportunity for Greatness – but only if… A. Clinton MacKinney. Birmingham, AL. January 2013.

The Impact of Health Care Reform on Rural Communities. Keith J. Mueller. Sioux Falls, SD. October 2012.

Rural Perspectives on Reform – from Volume to Value. A. Clinton MacKinney. Anchorage, AK. September 2012.

Understanding the Use of Accountable Care Organizations in Rural Health Care Settings. Keith J. Mueller. Chicago, IL. August 2012.

The Future of Rural Health. Keith J. Mueller. Washington, DC. July 2012.

Accountable Care Organizations: A Viable Model for CAH Participation? Keith J. Mueller. Spokane, WA. March 2012.

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.

Visit the RUPRI Center for Rural Health Policy Analysis

Rural Health Value Center

Rural Health System Analysis and Technical Assistance 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 RHSATA Team 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.

Three Aims

  1. Assess rural implications and facilitate rural adaptability to changes in health care delivery, organization and finance.
  2. 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.
  3. Inform further developments in public policy and private action through dissemination of findings.

Visit the Rural Health Value Center