Rural Health Insurance and Competitive Markets: Not Always Compatible?

Health Insurance, Rural Health, Health Markets, Competition, Health Policy, Health Economics and Policy,

Experiences of Rural Non-VA Providers in Treating Dual Care Veterans and the Development of Electronic Health Information Exchange Networks Between the Two Systems

Findings are presented from two focus group discussions with rural non-VA (Veterans Administration) primary care providers to better understand their experience with treating dual care veterans, those who receive care from both VA and non-VA providers. Participants reported challenges related to a lack of communication and coordination between the VA and non-VA providers. Participants agreed that improvements must be made to the current healthcare delivery model for rural dual care veterans to support seamless care. Two case studies involving VA-supported projects currently focused on bridging the two systems through the establishment of electronic health information exchange (eHIE) networks in rural areas are discussed. Challenges encountered while developing these networks and ways these challenges have been overcome are described. Successful implementation of methods designed to facilitate communication and coordination between the VA and non-VA systems is needed to deliver seamless care to rural dual care veterans in a timely and effective manner

Diverse Stakeholder Perspectives on Rural Health Care Reform in a U.S. State that Rejected the Affordable Care Act: A Case Study

Purpose: This case study identifies rural health care stakeholder perspectives on the Affordable Care Act (ACA) and describes the health policy context in Idaho, the only state in the United States to reject Medicaid expansion yet develop a state-run health insurance exchange. Sample: The sample included 20 rural health care stakeholders, including clinicians, elected officials, state agency administrators, health care facility administrators, and interest group leaders. Method: A single-case study of stakeholder perspectives on the ACA and rural health care access in Idaho was conducted from 2014 to 2016. Data sources include qualitative interviews with 20 rural health care stakeholders and public documents relating to the ACA and rural health care from Idaho governmental and nongovernmental entities’ websites. Findings: Since the 2010 passage of the ACA, opposition to “Obamacare” became associated with a conservative stance on health care reform. However, in this case study, diverse health care stakeholders who criticized aspects of the ACA identified several components of the policy, including Medicaid expansion, as essential in ensuring access to rural health care. Some stakeholders called for federal legislation authorizing nurse practitioners to practice as independent primary care providers. However, the politics of medical sovereignty present challenges to this relevant strategy and to full implementation of Idaho’s Nurse Practice Act for increasing access to primary care in a rural state. Conclusions: The case study approach can be effective in illuminating stakeholder perspectives and policy strategies that may fall outside of polarized health care policy debates. Examination of the state-level political context of rural health care must consider concurrent battles about state sovereignty over health care policy and professional-clinical battles about sovereignty over primary care

Characteristics of Children With Cancer Discharged or Admitted From the Emergency Department

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136395/1/pbc25872_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136395/2/pbc25872.pd

Characteristics of Children With Cancer Discharged or Admitted From the Emergency Department

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136395/1/pbc25872_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136395/2/pbc25872.pd

Pursuing High Performance in Rural Health Care

In 2001, the Institute of Medicine (IOM) called for transformation of the United States health care system to make it safe, effective, patient-centered, timely, efficient, and equitable.1 The journey toward these six aims in public policy and the private sector is underway, but fundamental challenges detailed by the IOM remain. Patients are injured at alarming rates, wide variation in care exists across geographies, patients complain of insensitive and/or inaccessible health care providers, health care costs are nearly twice that in other developed countries, and nearly 50 million Americans lack health insurance. As a result, our health care is often fragmented, uncoordinated, and excessively costly. In fact, the United States health care system has been called a “non-system.” The rural health care landscape is additionally challenged by independent and autonomous providers often struggling to survive financially, burdensome geographic separations in health care services, and incompatible information technologies. As a result, resources are wasted, patients are harmed, and rural communities are neglected. Despite persistent rural challenges, public policies during the past 30 years have helped build and stabilize rural health care services. New payments have increased revenue for physicians practicing in shortage areas, rural hospitals certified as Critical Access Hospitals (very small hospitals in isolated places), Sole Community Hospitals (larger hospitals also in isolated areas), and Rural Health Clinics (primary care clinics staffed by nurse practitioners and/or physician assistants). New programs continue to provide technical assistance and grants to rural hospitals (Medicare Rural Hospital Flexibility Program), fund installation of telemedicine equipment, and promote rural health professions education. These successes have required political capital and developmental resources to support a system that delivers discrete and uncoordinated health care services, provided by specific professionals and institutions, each paid on a per-service basis. Yet, progressive work by the Institute of Medicine (especially the Rural Health Committee document Quality Through Collaboration: The Future of Rural Health Care), the Commonwealth Commission on a High Performance Healthcare System, and other organizations suggest more effective strategies to improve and sustain the health of rural people..

Advancing the Transition to a High Performance Rural Health System

There are growing concerns about the current and future state of rural health. Despite decades of policy efforts to stabilize rural health systems through a range of policies and loan and grant programs, accelerating rural hospital closures combined with rapid changes in private and public payment strategies have created widespread concern that these solutions are inadequate for addressing current rural health challenges. The rural health system of today is the product of legacy policies and programs that often do not “fit” current local needs. Misaligned incentives undermine high-value and efficient care delivery. While there are limitations related to scalability in rural health system development, rural communities do have enormous potential to achieve the objectives of a high performance rural health system. This brief (and a companion paper at http://www.rupri.org/areas-of-work/health-policy/) discusses strategies and options for creating a pathway to a transformed, high performing rural health system

Pursuing High Performance in Rural Health Care

Rural Futures Lab Foundation Papers are intended to present current thinking on the economic drivers and opportunities that will shape the future of rural America. They provide the foundation upon which it will be possible to answer the question that drives the Lab’s work—What has to happen today in order to achieve positive rural outcomes tomorrow

Observation of Parametric Instability in Advanced LIGO

Parametric instabilities have long been studied as a potentially limiting effect in high-power interferometric gravitational wave detectors. Until now, however, these instabilities have never been observed in a kilometer-scale interferometer. In this work we describe the first observation of parametric instability in an Advanced LIGO detector, and the means by which it has been removed as a barrier to progress

Executive Summary: Therapeutic Monitoring of Vancomycin for Serious Methicillin- Resistant Staphylococcus aureus Infections: A Revised Consensus Guideline and Review of the American Society of Health- System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154898/1/phar2376.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154898/2/phar2376_am.pd