Current and Ongoing Projects
funded by the federal Office of Rural Health Policy.
Assessing HIT Readiness of Rural Health Clinics: A National Survey. We will design and conduct a national survey of rural health clinics, both independent and provider-based, to determine the current level of health information technology adoption and readiness in these clinics.
Challenges and Opportunities for Improving Rural Long-Term Services and Supports under the Affordable Care Act. This project will examine strategies, models, and policy options for improving access to, and quality of, rural long-term services and supports. Through focused policy analyses, we will highlight the rural options, opportunities, and barriers of implementing the coordinated care, health home, and long-term services and supports provisions in the Affordable Care Act.
Developing a Sentinel Cohort of Rural Health Clinics for Use in Developing Relevant Quality Measures and Monitoring Program Performance. This two year project will assemble a cohort of Rural Health Clinics (RHCs) from ten to thirteen states to participate in a sentinel quality measurement process. During the first year of the project, the cohort of RHCs will participate in the identification, development, and refinement of a discrete set RHC quality measures in conjunction with the project team and an expert panel of RHC and quality measurement experts. During the second year, the cohort will be asked to implement, report, and evaluate the measures.
Eligibility Transitions under the Affordable Care Act: Policy Considerations for Ensuring Coverage Continuity Among Rural Residents. This study will assess rural versus urban income volatility, the potential effects on states’ efforts to ensure continuous health insurance coverage to individuals enrolled in Medicaid expansions or Exchange plans under the Affordable Care Act, and develop policy recommendations to address any observed differences.
Health Insurance Stability among Rural Children Following Public Coverage Expansions. While estimates indicate that the uninsured rate among rural children has dramatically decreased since the 1997 passage of the State Children's Health Insurance Program (CHIP), it is not clear whether or not coverage has become more stable and uninsured spells shorter. The purpose of this study is to investigate changes in insurance stability among rural and urban children following CHIP, and whether this is affected by specific state eligibility and enrollment policies or clusters of policies. Using the 1996, 2001, and 2004 panels of the Survey of Income and Program Participation (SIPP), we will measure rural-urban differences in uninsured spell length and frequency, sources of coverage before and after uninsured spells, movement between sources of coverage, how these measures of stability have changed over time, and the factors that relate to greater continuity of coverage among rural children.
Implications of Mental Health Comorbidity and Rural Residence for Health Care Use Patterns of Individuals with Chronic Disease. This study will use the 2005-2010 panels of the Medical Expenditure Panel Survey (MEPS) to compare the prevalence of concurrent mental health and chronic illnesses across rural and urban populations and to describe relationships among comorbidity, residence, and health care use. Findings will inform public and private decisions on how best to allocate new resources available for mental health/primary care integration efforts.
Out-of-Pocket Costs Among Rural Medicare Beneficiaries. The purpose of this project is to examine out-of-pocket spending among Medicare beneficiaries, to identify whether there are rural-urban differences in out-of-pocket costs, and to explore what factors account for these differences. Should Medicare redesign occur, this study will provide important information against which to assess the possible impact of different design options on rural Medicare beneficiaries.
Role of Rural Health Clinics in a Changing Rural Primary Care Landscape. This project builds upon our past work with Rural Health Clinics (RHCs) to examine the challenges faced by RHCs in serving as part of the rural health care safety net; expanding service capacity to include mental health, dental, and obstetrical care; coping with primary care and other workforce shortages; implementing health information technology; and preparing for proposed changes in conditions of participation requirements and payment provisions. This study will use data collected from a national telephone survey of RHCs, data from past surveys of RHCs; and Medicare cost reports.
Rural E-Mental Health: Models That Enhance Access, Service Delivery, and Integration of Care. E-mental health programs have been developed in rural areas as a promising approach to address the chronic challenges of low availability of mental health clinicians, long travel distances, and stigma surrounding mental health care. The literature has established the technical feasibility of these programs and interest remains strong in developing and implementing them more broadly. However, we lack a clear understanding of the viability of current rural e-mental health programs--both the business case for starting and sustaining them and the clinical case for what services and functions may be provided--and what impact they have had. The current rural health environment is changing significantly and it is important to understand where and how e-mental health programs have been established and sustained, what impact they have had, and what value they may add to other initiatives. To address this gap we will conduct interviews with between 24-30 current rural e-mental health programs.
Rural Residential Care: The Implications of Federal and State Policy Changes. This project will assess the impact on Medicaid-funded rural residential care options of new and proposed federal policy guiding state compliance with the Americans with Disabilities Act (ADA). The extent to which rural facilities are able to comply with the proposed guidelines may affect their eligibility for funding through Home and Community-Based Services waiver programs.
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Policy Brief on Federal Health Care Reform
In this policy brief, Dr. Andrew Coburn of the Muskie School discusses three of the main components of the Patient Protection and Affordable Care Act (ACA): health insurance coverage, delivery system improvement, and cost containment, highlighting some of the provisions of the law that have already been implemented and those where important implementation decisions will have to be made.