New Foundation for Rural Health Leadership

Rural healthcare concerns usually don't top planning agendas for politicians and policy wonks at state and federal levels. They're more interested in bang for the buck.

"If you are at the state and national level, the focus is on ‘Where can I make the biggest difference most quickly if my goal is related to quality or cost savings?'" says Prof. Keith Mueller, who leads the University of Iowa's Department of Health Management and Policy. "So of course you are going to gravitate towards the biggest population concentrations because ‘I can make the biggest splash there first.'"

As a result, the special needs and smaller economies of scales that rural providers face can often get shoehorned into programs and policies designed for larger urban settings.

"I wouldn't call it an afterthought. I'd call it a lack of awareness," Mueller says.

With that awareness gap in mind, the National Rural Healthcare Association formed the Rural Health Foundation in September with $110,000 in seed money that was donated by individuals, with some help from NRHA. As the foundation evolves in the coming months and years, it will provide funding for scholarships, seminars, and other training opportunities for rural healthcare providers and administrators to give them the know-how to adapt national healthcare policy into rural settings.

"The foundation will generate funds that can help in what I would call the continuous training and education for leaders at the local level in rural America who are helping to manage the transition in healthcare delivery and finance," says Mueller, who is a co-chairman of the foundation.

The foundation will address such questions as "How do we adapt to those changes when the scale of the system is somewhat different? Instead of a 600-bed hospital, you are talking about anything from six inpatient beds to maybe into the lower hundreds of beds. How do you take an insurance plan payment change that is based on what they have learned from large hospitals and adapt that to the small hospital?" he says.

The foundation will also help rural healthcare leaders identify and tap into the "natural assets you have locally and use those well in healthcare delivery," Mueller says."In a local rural community you are closer to the population that is being served. Changes that focus around keeping populations healthier take on a different feel when it's a smaller population where people know each other and the providers are closer to the population. There are ways to use that as an asset to implement what the payers want, which is keeping people out of the most expensive forms of acute care because they are getting better services and staying healthy in primary care."

Some of the operational details for the foundation have yet to be finalized. For example, there is no annual budget or locked-down funding source beyond the seed money.

NRHA CEO Alan Morgan says that creating a separate foundation provides a locus that could otherwise get blurred with all that is going on in rural healthcare. "For us at NRHA, we do educational programming, networking, advocacy. There are a lot of activities within the broader nonprofit parent organization, and we wanted to make sure for the purposes of the foundation that the goals and expectations were very targeted toward leadership development," he says. "We felt that creating this separate entity would ensure that that will be able to happen."

Mueller calls NRHA's involvement "exciting," adding that "the affinity between a foundation focused on rural health leadership and its roots in the leading voice for rural America in policy issues will be tremendously beneficial."

Mueller says eligibility standards for foundation scholarships and other awards will likely be "very open and inclusive"—from CEOs to clinicians to middle managers.

"We need to be inclusive, because you are talking about the objectives in healthcare delivery, which include better care at lower cost and better health for the population," he says. "With those overarching goals, you have to be flexible and open about who plays key roles, particularly for that better health objective in the community."

So how will we know if the foundation is a success?

"As all foundations do, we will track the participants as we go forward," Morgan says. "The people involved in these leadership activities, how do they translate that into success in their communities? And how do we translate that at a national level? How do we cultivate these leaders so they can be the future spokespeople for improving access to healthcare in rural America?"

With the training and expertise that rural providers attain with foundation support, Mueller expects that they will become strong advocates for rural healthcare at the state and national policy-setting level.