Hi Flex Coordinators,

I hope everyone is having a lovely spring...or summer if you are in one of the southern states. Here in DC we are in a middle latitude with summer coming on strong. The fireflies are out in full force; last night on Haines Point the trees looked like they were sprinkled with glitter. They are so pretty and sparkly! We don't have fireflies where I grew up in Oregon, and I always enjoy them when I see them here.

Speaking of things to see in DC, I hope everyone is making travel plans for the 2018 Flex Program Reverse Site Visit and Rural Health Care Improvement Collaboration with the Small Health Care Provider Quality Improvement Program grant recipients. We will still have fireflies around July 17 so watch for them in the grass and under the trees if you take a walk down the hill to Rock Creek in the evening.

Another thing you won't want to miss is our closing speaker, Lieutenant Commander Fred Butler, a senior advisor for integration and quality at the Centers for Medicare and Medicaid Services (CMS). His talk will finish at 3:30 p.m. on July 18 so account for that session in your travel plans.

Owmy, Christy, Yvonne, and I look forward to learning from you and with you at the annual Flex meeting. Let me know if you have any questions about the Flex Program, and I'll do my best to address them in my program coordinator's update.

Sarah Young

Flex Program Coordinator

Rural Communities Opioid Response Program-Planning Funding Opportunity 

The Federal Office of Rural Health Policy (FORHP) will provide approximately $15 million to support approximately 75 one-year awards (up to $200,000 per award) in rural communities across the United States through the Fiscal Year (FY) 2018 Rural Communities Opioid Response Program-Planning (RCORP-Planning). Under RCORP-Planning, multi-sector consortiums will develop plans to implement opioid use disorder prevention, treatment and recovery interventions in rural counties at the highest risk for opioid use disorder. This program is part of a multi-year, $130 million opioid-focused effort by HRSA. In FY 2019 and beyond, there will be additional funds available to provide continued support, including additional grants and National Health Service Corps (NHSC) Loan Repayment Program awards.

Eligible applicants include all domestic public or private, non-profit or for-profit entities, including faith-based and community-based organizations, tribes and tribal organizations. The applicant organization must be part of a group of four or more separately-owned entities that have committed to forming a consortium or are part of an established consortium. All services provided by the grant must target HRSA-designated rural areas. 

Consortium are expected to identify the needs of their communities and opportunities to coordinate with other entities currently addressing opioid use disorder to include, but not limited to: Single State Agencies, Ryan White Clinics, Federally Qualified Health Centers and State Offices of Rural Health. Applicants should take into account the various manifestations of opioid use disorder to include injection drug users at risk for Hepatitis C and HIV infections.

A technical assistance webinar for applicants will be held Thursday, June 28th, 2018 from 12:00 to 1:00 p.m. Central Time. 
Call-in Number: 1-888-600-4866
Participant Code: 391986
Weblink: Link
Playback Number: 1-888-203-1112
Passcode: 2758241

The Notice of Funding Opportunity (NOFO) is available on Grants.gov .

Applications are due July 30, 2018, with a program start date of September 30, 2018.

Please contact [email protected] with any questions

2018 Flex Program Reverse Site Visit 

The 2018 Rural Health Care Improvement Collaboration is scheduled for Tuesday, July 17, 2018 at 8:30 a.m. Eastern Time to Wednesday, July 18, 2018 at 3:30 p.m. Eastern Time in Washington, DC. 

Different from prior years, this will be a shared meeting.  The purpose of this collaborative meeting is to create a shared learning environment that supports innovations and discovery of successful rural health improvement and program implementation across Federal Office of Rural Health Policy (FORHP) programs.   The meeting will engage participants from two rural health care improvement grant programs: the Medicare Rural Hospital Flexibility (Flex) Program in the FORHP Hospital State Division (HSD) and the Small Health Care Provider Quality Improvement Program (SHCP) in the FORHP Community-Based Division (CBD).  In addition to program-specific meeting objectives, this meeting will also provide participants with an enhanced opportunity to make connections, share best practices and gather lessons learned from fellow rural programs across the country that are focusing on improving rural health care services.

Overall Learning Objectives 

• Discover ways to communicate the value of your FORHP Program
• Understand the future direction of the national transition to value in health care
• Identify opportunities to implement best practices and lessons learned
• Strengthen the leadership of your FORHP program
• Share and learn from the experiences of fellow rural programs
• Make connections and identify opportunities for collaboration with fellow rural programs across FORHP

Flex Program Reverse Site Visit (RSV)

FORHP HSD's RSV is an opportunity for state Flex Program recipients to convene and share information about the Flex Program and critical access hospitals (CAHs). This event will focus on the latest information in the Flex Program including discussion of strategies to engage CAHs in measurement and performance improvement to deliver value in rural health care. States will share stories of their Flex Program experiences and successes with one another, with their FORHP project officers and with other rural partners and stakeholders. We look forward to your attendance at this educational and informative event.

Flex Program  RSV Learning Objectives

Intended Audience

The intended audience for the Flex Program Reverse Site Visit is State Office Directors, Flex Coordinators/other key Flex personnel (two per state), SCHP Program grantees, the Flex Monitoring Team, Stratis Health's Rural Quality Improvement Technical Assistance (RQITA), the TASC Advisory Committee and FORHP staff.

The 2018 Reverse Site Visit webpage will be updated as additional information becomes available. Please don't hesitate to contact us if you have any questions. We look forward to seeing all of you in Washington, DC in July! 

Stroke Care Quality Improvement Initiatives in Critical Access Hospitals 

The findings are based on a review of existing literature, a survey of all state Flex Program Coordinators and interviews with key informants who are implementing stroke care quality improvement initiatives. FMT identified 11different programs currently being implemented, as well as three additional initiatives that are in an early planning phase. The policy brief identifies key elements of these programs, data being collected and CAH participation. 

Population Health Portal Updated: Two New Data Scenarios Added 

The Population Health Portal is continually updated with new resources and data scenarios to Get Motivated, Get Informed and Get Going to help your facility or county navigate the journey towards improved population health along each milestone. The new data scenarios are: Emergency Department Utilization and Mental Health Shortage and Transportation and Health Status. The 11 scenarios listed below have been updated with new data and now include benchmarks for hospital or county-level users to compare their metrics to state and national benchmarks. All scenarios include explanations and instructional videos on how to export and use the data. Be sure to view the videos on how to analyze claims data.

This brief uses data from 2014-2016 Medicare Cost Report Worksheet S-10 to compare uncompensated care in rural and urban hospitals and describe how it varies across regions of the country. This study finds substantial differences in reported uncompensated care as a percent of operating expense between rural and urban hospitals and among regions of the country. Between 2014 and 2016, median uncompensated care as a percentage of operating expense declined across critical access hospitals (CAHs), other rural hospitals, urban hospitals and also declined across census regions.

Rural Response to the Opioid Crisis 

The Rural Response to the Opioid Crisis shares activities underway to address the opioid crisis at the national, state and local levels. The guide, developed by Rural Healt Information Hub (RHIhub), identifies initiatives and funding opportunities, rural program examples and tools and resources focused on prevention, harm reduction and treatment. 

 

TASC Tasks 

Please feel free to post your questions in the Flex Program Forum. If you have a question, someone else likely does too and will benefit from seeing the question and answer.

New Substance Use Resources 

• The Opioid Crisis in Rural and Small Town America
• This research provides data on opioid mortality rates in 2016 and changes in opioid mortality from 1999 through 2016 for metropolitan and nonmetro counties. It also provides metro/nonmetro data on drug overdoses by type of opioid - heroin, prescription opioids, synthetic opioids and unspecified opioids - from 1999 through 2016. Additionally, challenges rural areas face in addressing the opioid crisis are addressed.

• Opioid Misuse Resource Map
• This map details opioid resources available by state and features programs providing emergency services, treatment and prevention

• HHS 5-Point Strategy to Combat Opioid Crisis
• Learn about the federal Health and Human Services (HHS) multi-level strategy to combat the opioid crisis and gain access to resources within each strategy. The strategies of HHS are:
• Better addiction prevention, treatment and recovery services
• Better data
• Better pain management
• Better targeting of overdose reversing drugs
• Better research

• Encouraging Substance Use Disorder Treatment in Primary Care through Value-Based Payment Strategies
• This brief examines how states and health plans are exploring VBP to promote substance use disorder (SUD) treatment in primary care, and offers considerations for implementing these models

• Opioid Overdose Prevention Toolkit
• This toolkit offers strategies to health care providers, communities and local governments for developing practices and policies to help prevent opioid-related overdoses and deaths. Access reports for community members, prescribers, patients and families and those recovering from opioid overdose.

• Prevention Conversations: Changing the Conversation about Addiction

• A series of short videos produced by the Substance Abuse and Mental Health Services Administration (SAMHSA), new videos are added regularly including mostly recently:

  • Addiction as a Disease-Not a Moral Failure
  • Addressing the Opioid Crisis: Prioritizing What Works
  • Examining Our Biases About People Who Misuse Opioids

Weekly Rural Health Leadership Radio Program 

 

A weekly radio program, Rural Health Leadership Radio , was launched a year ago to support rural health leaders to share stories and information about what is working and what is not. To read the story of the program's development, please visit an article promoting the resource from the National Organization of State Offices of Rural Health. Here are a few recent speakers:

• Mike Leventhal, Men's Health Network
• Mark Diamond, National Rural Health Alliance
• Christy Hopkins, Greeley County Community Development

Connect Peer to Peer in Flex Program Forum 

Do you have a question, idea, success or challenge to share with your Flex Program peers? Don't miss the ongoing discussions on the Flex Program Forum .  Please note, you need to log in to read recent postings, which include:

If you have questions about the Flex Program Forum, please contact TASC.  

Critical Access Hospital (CAH) Recognition 

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