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Rural Health Philanthropy Partnership

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HHS Secretary Kathleen Sebelius

Washington, D.C.
May 13, 2014

Thank you so much, Tom.

As you may know, Tom Morris runs the Office of Rural Health Policy.

It’s a relatively small office but with a big responsibility — to engage across HHS on rural health issues.  Tom makes sure we’re supporting health care services in rural areas and raises policy issues when they are likely to have an impact on rural health care.

He is also the Department’s representative to the White House Rural Council, which focuses high-level attention on issues impacting rural communities, including health care. HHS is lucky to have Tom and his leadership on these issues.

Our mission at HHS is to improve access to health care services, and that goal is especially important to people living in rural America. But our job is made much easier when we have partners like those here today.

Expanding Coverage

I know that there are a lot of very dedicated individuals here, committed not just to your organizations, but also to that same mission of ensuring access to health care.  

Many of you were very active in reaching out to your networks about the Affordable Care Act and how individuals and families could sign up for coverage, and I want to thank you for that. There’s no way we would have gotten to 8 million Americans signed up through the Marketplace if it hadn’t been for the help of our partners.

And when we’re talking about rural communities, that engagement was especially critical.

The data is clear: A disproportionate number of people who live outside of metropolitan areas are uninsured. In fact, nearly 1 in 5 of America’s Marketplace-eligible uninsured people fall into that category.

And their health care needs are different. Rural residents are often older and more likely to live in low-income households than their urban neighbors. They are more likely to work physically taxing jobs like agriculture, mining and manufacturing, and they are less likely to hold college degrees.

But of all the health challenges that rural America faces, one of the most daunting has been finding access to affordable care.

So coverage expansion is a very big deal for these communities. Whether through a Marketplace plan or Medicaid expansion, rural Americans had more to gain from new insurance options. It’s not about the 8 million; it’s about the individuals behind that number — the moms and dads, the farmers and factory workers, and all of the people whose lives have been changed.

So thank you again for your help with those efforts.

Access to Care

With that said, I don’t need to tell anyone in this room that the health issues in rural communities don’t end with access to insurance. Rural residents make up nearly 20 percent of America’s population, yet are served by less than 10 percent of the nation’s physicians.

Insurance is important, but if your nearest doctor is an hour and a half away, how realistic is a regular check-up? What good are no-cost preventive services if it takes an entire day just to get a breast exam?

At HHS, we’ve made some progress in addressing these challenges. In large part as a result of Affordable Care Act funding, we now support more than 9,500 community health centers, approximately 40 percent of which serve rural areas. 

But they’re not alone.

We also help ensure rural residents have access to almost 4,000 rural health clinics and 1,300-plus Critical Access Hospitals across the country. Without these facilities, many communities would have few care options, and some, no options at all.

The Affordable Care Act has also allowed us to use the 340B drug discount program to help rural providers, like Critical Access Hospitals, stretch scarce federal resources and improve access to services.

And we’re working to support the front-line clinicians in a few ways. For example, we have increased primary care providers who are committed to practicing in underserved areas.  We were able to do that because Affordable Care Act provisions helped double the number of clinicians in the National Health Service Corps. Since nearly half of those clinicians choose to practice in rural areas, expanding the Corps means more boots on the ground where they are needed most.

We have also partnered with the National Rural Health Association to expand the number of Rural Training Track residency programs. And we’re looking at new ways to leverage telehealth technology to expand the reach of clinicians and expand access to specialty care.

Partner Contributions

For all of this work, we rely on the expertise and on-the-ground knowledge of our partners. Coalitions like this one help shape policy and strengthen public and private sector collaborations.

In fact, just over two years ago, Secretary Vilsack and I held a rural health event at the White House and asked for suggestions from the doctors, nurses, and administrators who had joined us from across the country. With the ideas we gathered, along with some we generated through our own research, we put together a regulation package to reduce the burden on health care providers. This regulation is expected to generate $660 million of savings for providers annually.

We finalized that regulation just last week, and I can tell you that the feedback we received from the rural health community was crucial to a number of the changes implemented.

For example, we’ve provided more flexibility for physicians being onsite at Critical Access Hospitals and rural health clinics, which are often in isolated areas. Rather than drive to distant clinics to meet with nurse practitioners and physician assistants regularly, physicians can use technology like telehealth links. This change deploys physicians and other health professionals much more efficiently, which is important given their scarcity in a many rural communities.

HHS Impact

With input from providers, clinics, institutions, foundations, and other organizations, we are able to get information that can directly inform federal policy.  Together, we can help reduce health care costs, improve efficiencies, and increase our ability to help patients get the care they need when they need it — regardless of where they live.

With that in mind, I want you to know that your agenda today aligns closely with the mission of the White House Rural Council.

I believe Doug McKalip of the Domestic Policy Council spoke yesterday on the government-wide focus on rural communities, and HHS is proud to be a part of that effort. I know many of you have worked with our staff in HRSA, SAMHSA, and AHRQ on a variety of issues.

Across HHS, rural health is one of our most important priorities. During my time here, I’ve met with the National Rural Assembly and I’ve spoken at meetings of the National Rural Health Association and the National Advisory Committee on Rural Health and Human Services.

And I’ve been able to see the impact of our work at the community level, both in my home state of Kansas and in my travels.

A few years ago, I had the chance to visit St. John’s Health System in Missouri, which serves a generally rural community. They went through a huge electronic health records overhaul, something that wasn’t particularly easy for Critical Access Hospitals and doctors who didn’t have much of an IT department.

But St. John’s converted, and they finished just weeks before the catastrophic, multiple-vortex tornado hit Joplin and surrounding areas.

They lost the regional medical center, but in the aftermath, they were able to set up mobile units and continue meeting the urgent needs of the community. The staff said the electronic records couldn’t have come at a better time — being able to access critically important information meant a world of difference to treating patients.

Through all of our travels and work, here’s what has been reinforced for me, over and over: Rural communities are resilient. They are determined. They are innovative. And they ready for better policies that will meet their needs.

Moving Forward

That’s why the work happening here is so critically important. We are entering a new era of health care and delivery. Coverage is no longer just a privilege of the lucky and the wealthy. It’s time to solve the problems of long-standing health disparities that still persist.

As we move toward a more value-driven health care system, we have more opportunities to work together and build the kind of safety net that will meet this community’s needs.

Now is the time to ask:

  • How can we improve transitions of care?
  • How do we help rural providers use health IT to improve health care outcomes?
  • How do we best train the next generation of rural health care clinicians?

The partnership that you have developed through this initiative, founded in direct engagement with those of us in the public sector, can address these and other important questions.

And, as you all know, that means that the work doesn’t end with the conclusion of this meeting.

Your charge is to develop a blueprint for how our collective resources can be best leveraged to improve the delivery and accessibility of health care services in rural areas.

You know many of our goals: continuing to help individuals and families sign up for coverage, as well as helping them learn how to use their coverage. We are equally focused on improving health care delivery and expanding access to primary and preventive care. We want to hear your ideas on how to reach those goals.

I am encouraged by this coalition of organizations. I know that you have already rolled up your sleeves and done so much for rural America. In fact, there are few better examples of how government and the philanthropic community can work together to create real progress. 

Thank you for your attendance today and for your work on these issues. Rural America is better with you on their side.