Andrew F. Coburn, PhD

Director, Maine Rural Health Research Center

Phone: 207.780.4435
Fax: 207.228.8138
Email: coburn@maine.edu

University of Southern Maine
PO Box 9300
34 Bedford Street
Portland, ME 04104-9300


Current Projects - (3)

  • Healthcare Use and Access Among Rural & Urban Non-elderly Disabled Medicare Beneficiaries
    This project will explore healthcare use and barriers to healthcare access among disabled Medicare beneficiaries under 65 in rural and urban areas. The study will be based on quantitative analyses of the 2009-2013 Medicare Current Beneficiary Survey.
    Research center: Maine Rural Health Research Center
    Topics: Disabilities, Health disparities, Medicare
  • Rural Health Clinics Chartbook: Community Characteristics and Financial and Operational Performance
    Rural Health Clinics (RHCs) address geographic access barriers for rural Medicare and Medicaid beneficiaries and, over time, have come to be recognized for their role in serving vulnerable rural populations. This project will produce a comprehensive, descriptive chartbook detailing the characteristics and status of RHCs nationally.
    Research center: Maine Rural Health Research Center
    Topic: Rural Health Clinics (RHCs)
  • Use of Telehealth Services Among Rural Medicaid Enrollees: A Baseline Inventory
    Uses data from the Medicaid Analytic Extract (MAX) for 2011 to create a 50-state, baseline inventory of telehealth services provided to Medicaid enrollees in rural and urban settings. Provides important information on the feasibility of using MAX data to study the effects of Medicaid telehealth policies.
    Research center: Rural Telehealth Research Center
    Topics: Medicaid and S-CHIP, Telehealth

Completed Projects - (23)

  • Access To and Use of Home and Community-Based Services in Rural Areas
    This study will use data from the 2010 Medicaid Analytic eXtract (MAX) file and in-depth policy reviews and interviews in four states to examine differences in the use of institutional and home and community-based service (HCBS) use by older adults across urban and rural areas, and the policy and community factors that contribute to differences or comparability in use.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Home health, Long term care
  • Analysis of 2004-2005 State Flex Grant Plans
    This project will analyze state Flex grant applications and related budget and work plan revisions focusing on state activities in the core Flex program areas of networks, quality improvement, and EMS.
    Research centers: Maine Rural Health Research Center, University of Minnesota Rural Health Research Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Networking and collaboration, Quality
  • Assessing Health Information Technology (HIT) Strategies to Improve Access for Rural Veterans
    Rural veterans face unique barriers to care including insufficient communication and coordination of care provided across multiple settings—both within and outside of the Veteran’s Administration. To help reduce these barriers, multiple agencies within the federal government have promoted technology as an opportunity to improve access and care coordination to veterans living in remote areas. Most recently, programs in Maine, Montana and Alaska have received grants to use health information technology (HIT) to expand and integrate services—including mental health services—for rural Veterans. However, little is known about the challenges these programs face on the ground, or what conditions and program strategies may facilitate success. This study will consist of case studies of these programs in each of the three states, and will identify best practices and barriers for implementing rural HIT initiatives that could inform future strategies in this area.
    Research center: Maine Rural Health Research Center
    Topic: Veterans
  • 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.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Health policy, Long term care
  • Development of State Flex Program Logic Models and Related Toolkit
    Research center: Maine Rural Health Research Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  • Expanding Rural Health Insurance Coverage: How Do Insurance Reform Strategies Stack Up?
    This purpose of this study is to inform policymakers about the current state of health insurance coverage in rural America, and to assess how specific reform strategies may differentially affect rural residents. Using a combination of analytic strategies, we will provide policymakers and rural health advocates with the necessary tools to develop reform strategies that meet the needs of rural residents.
    Research centers: Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    Topics: Health insurance and the uninsured, Health policy
  • Financial Impact of Mental Health Services on Rural Individuals and Families
    This project will use the Medical Expenditure Panel Survey (MEPS) to examine the financial burden that rural residents face in seeking mental health services, compared to urban residents. Implications of financial burden for access to needed mental health services for rural residents will be assessed.
    Research center: Maine Rural Health Research Center
    Topics: Health insurance and the uninsured, Healthcare financing, Mental health
  • Health Insurance Coverage and Access to Health Services for the Rural Near Elderly
    Research center: Maine Rural Health Research Center
    Topics: Aging, Health insurance and the uninsured, Health services
  • Health Insurance Dynamics of Uninsured Rural Families
    To better understand the dynamics of insurance coverage among rural and urban families, this study will use the Medical Expenditure Panel Survey (MEPS) to compare family health insurance coverage among non-elderly rural and urban families.
    Research center: Maine Rural Health Research Center
    Topic: Health insurance and the uninsured
  • 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.
    Research center: Maine Rural Health Research Center
    Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP
  • Impact of Employment Transitions on Health Insurance Coverage of Rural Residents
    This project aims to examine rural-urban differences in the proportion of employed adults with private health insurance who experience an employment transition (defined as a change in jobs or hours worked, or no job) and the impact of that change on health insurance status.
    Research center: Maine Rural Health Research Center
    Topic: Health insurance and the uninsured
  • Measuring Rural Underinsurance
    Research center: Maine Rural Health Research Center
    Topic: Health insurance and the uninsured
  • Measuring the Community Benefits and Impact of Critical Access Hospitals
    This project will develop, test, and implement a set of community benefits and impact indicators for Critical Access Hospitals (CAHs). These indicators will assist CAHs, policymakers, and rural stakeholders to understand the impact of CAHs on their communities and local health care delivery systems.
    Research center: Maine Rural Health Research Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  • National Rural Hospital Flexibility Program Tracking Project: Tracking State Policy and Program Development
    Research center: Maine Rural Health Research Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  • 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.
    Research center: Maine Rural Health Research Center
    Topics: Disabilities, Health policy, Medicare
  • Patterns of Individual Health Plan Coverage Among Rural Residents
    Research center: Maine Rural Health Research Center
    Topics: Health insurance and the uninsured, Rural statistics and demographics
  • Prevalence and Impact of High Deductible Health Insurance Plans in Rural Areas
    This study will use national health survey data to examine whether privately insured rural residents are more likely than their urban counterparts to have plans with high deductibles. It will also assess whether high deductible health plans create health care barriers for rural residents, and if these differ from the barriers experienced by those in urban areas.
    Research center: Maine Rural Health Research Center
    Topics: Health disparities, Health insurance and the uninsured
  • Role and Early Impact of CO-OPs in the Rural Health Insurance Marketplace
    This study will combine quantitative analysis with administrative health plan practice data with targeted case studies to examine the rural availability and pricing of CO-OP plans, and the early experiences of these plans.
    Research center: Maine Rural Health Research Center
    Topic: Health insurance and the uninsured
  • 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.
    Research center: Maine Rural Health Research Center
    Topics: Aging, Disabilities, Medicaid and S-CHIP
  • Special Study of EMS Issues
    This study will focus on state, community, and hospital level initiatives designed to build the infrastructure to support EMS service capacity and encourage the integration of these services into the rural healthcare infrastructure in the areas of quality improvement, financing, staffing, medical control, and networking and integration.
    Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Networking and collaboration
  • State Flex Program Quality Improvement Activities
    Research center: Maine Rural Health Research Center
    Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  • Urban and Rural Differences in Utilization Patterns, Risk Factors and Expenditures of the Dually Eligible Elderly and Non-Elderly Persons with Disabilities
    Research center: Maine Rural Health Research Center
    Topics: Aging, Disabilities, Medicaid and S-CHIP, Medicare
  • Using Program Logic Models to Monitor the Performance of State Flex Programs
    This project will use a program logic model approach to track state program activities and develop tools that allow states to systematically monitor and manage their accomplishments in the context of Flex Program goals.
    Research center: Maine Rural Health Research Center
    Topic: Critical Access Hospitals and Rural Hospital Flexibility Program

Publications - (48)

  • After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2017
    A new paper describing opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from hospital-based locus of care to new models of care delivery in rural places.
  • Are Rural Older Adults Benefiting from Increased State Spending on Medicaid Home and Community-Based Services?
    Policy Brief
    Maine Rural Health Research Center
    Date: 06/2016
    Little is known about variations in the availability or use of Medicaid Home and Community-Based Services (HCBS) within states, across rural and urban areas. This study used national claims data to examine differences in HCBS use and expenditures among rural and urban older adult Medicaid beneficiaries receiving LTSS.
  • Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    This Policy Paper summarizes the positions of various rural health advocates and recording the actions taken by Congress and the Health Care Financing Administration (HCFA) to improve the wage index. Finally, it outlines the research needed to energize the policy discussion of the uses and methods of calculating the hospital wage index. Report produced by the RUPRI Rural Health Panel.
  • Assessment of Proposals for a Medicare Outpatient Prescription Drug Benefit: The Rural Perspective
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2003
    This Policy Paper assesses legislative proposals to add an outpatient prescription drug benefit to the Medicare program and their implications for the delivery of services and the welfare of beneficiaries in rural areas. Report produced by the RUPRI Rural Health Panel.
  • Care Coordination in Rural Communities Supporting the High Performance Rural Health System
    Report

    Date: 06/2015

    Care coordination has emerged as a key strategy under new healthcare payment and delivery system models that aspire to achieve Triple Aim objectives—better patient care, improved population health, and lower per capita cost. Achieving these objectives requires conceptualizing and planning care delivery in a new way that not only involves coordinating medical care, but helping people get the care and the support services they need to address the “upstream” social determinants of health. In rural places, these are especially important considerations. While care coordination models vary, all include multidisciplinary teams and networks, a person-centered focus, and timely access to and exchange of information. The purpose of this paper is to examine care coordination programs and processes that affect rural people and places to discover what is happening now in rural communities, how different programs and approaches are working, who benefits, and make policy recommendations that will facilitate care coordination efforts in support of high performance rural health system development.

  • Challenges and Opportunities for Improving Mental Health Services in Rural Long-Term Care
    Maine Rural Health Research Center
    Date: 06/2013
    Explores practices for increasing the quality, quantity, and accessibility of mental health services in rural long-term care.
  • The Characteristics and Roles of Rural Health Clinics in the United States: A Chartbook
    Maine Rural Health Research Center
    Date: 01/2003
    Reports on the results of a national survey of Rural Health Clinics (RHCs). Information was collected on a wide range of topics of concern to RHCs including: 1) the characteristics and operations of the clinics; 2) their location relative to the underservice problems and access needs of rural areas; 3) safety net functions of RHCs; 4) staffing, recruitment and financial issues; and 5) involvement in the training of health care professionals. Among the findings: most RHCs continue to serve rural, underserved communities; RHCs are filling a valuable safety net role by serving Medicaid, uninsured, and low-income patients and providing free and reduced cost care; recruitment and retention is a problem for RHCs, and some RHCs face continued financial challenges despite cost-based reimbursement. RHCs continue to be an important source of primary care and safety net services in rural communities. Legislative efforts to address concerns about the program have included the refinement of the shortage area criteria used by the RHC program (Balanced Budget Act of 1997) and the implementation of a Medicaid prospective payment system (Benefits Improvement and Protection Act of 2000). Additional research is needed to understand the impact of these changes on the RHCs and the residents of rural communities served by them.
  • Comments on the June 2001 Report of the Medicare Payment Advisory Commission: Medicare in Rural America
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2001
    Comments on and critiques the findings in MedPAC's Medicare in Rural America. The authors believe that while the MedPAC report helps set a framework for analysis, it is not a definitive treatise on the role of Medicare in rural health. Among its findings: most of MedPAC's recommendations would have positive impacts on health care for rural beneficiaries, others would do no harm, others could be strengthened, and a few, particularly those relating to access to services, "suffer from disparities and weaknesses." Report produced by the RUPRI Rural Health Panel.
  • The Community Impact of Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 02/2007
    Discusses the findings of a project to understand the community involvement and impact of Critical Access Hospitals (CAHs) and the Medicare Rural Hospital Flexibility Program (Flex Program). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Comparative Performance Data for Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
    Date: 2004
    Discusses the potential use of comparative performance data for critical access hospitals (CPD-CAH) to facilitate performance and quality improvement. Covers potential benefits and drawbacks of CPD-CH and identifies issues in the development and implementation of CPD-CAH.
  • Creating Program Logic Models: A Toolkit for State Flex Programs
    Maine Rural Health Research Center
    Date: 04/2006
    Provide states with a tool for planning, managing, reporting on, and assessing their Flex Program goals, activities, and accomplishments; assistance in identifying and defining measurable outcomes; information linking state-level Flex Program strategies to specific and measurable outcomes; and a consistent program-reporting framework to convey results to both internal and external stakeholders. The Program Logic Model (PLM) Toolkit is organized according to the steps in the PLM development process and guides the user through each section. Included in the Toolkit is an overview of PLMs, their component parts, and the application of the PLM framework to the planning, implementation, and evaluation of the Flex Program. The bulk of the Toolkit provides a step-by-step approach to developing a Program Logic Model. The final section of the Toolkit lists resources for additional information on PLMs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • The Current and Future Role and Impact of Medicaid in Rural Health
    Rural Policy Analysis and Applications
    Date: 09/2012
    Outlines and describes the current Medicaid program and its importance to rural America. Also discusses rural implications of program expansion, including whether and how states choose to implement changes.
  • Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria, and Assessment
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    The purpose of this paper is to offer a rural perspective on the current debate over the design and implementation of a Medicare prescription drug benefit. Background information on rural Medicare beneficiaries' need for, and access to, prescription drugs is provided, along with a set of rural-oriented principles for use in evaluating how different prescription drug proposals may meet the needs of rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
  • Exploring the Community Impact of Critical Access Hospitals
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 01/2007
    Reports on a series of site visits to six diverse rural communities and Critical Access Hospitals (CAHs) to assess the experiences and impact of these hospitals in responding to their community's health infrastructure needs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Health Care Access and Use Among the Rural Uninsured
    Maine Rural Health Research Center
    Date: 08/2012
    Examines whether uninsured rural residents have different patterns of healthcare use than their urban counterparts, and the factors associated with any differences.
  • Health Care Access and Use Among the Rural Uninsured (Policy Brief)
    Maine Rural Health Research Center
    Date: 11/2011
    Using data from the 2002-2007 Medical Expenditure Panel Survey (MEPS), this study examined access to care and service use among non-elderly, uninsured rural and urban residents. Key Findings include:
    • Uninsured residents of both rural and urban areas face serious barriers to care compared to those with health insurance coverage.
    • The rural uninsured are more likely to have a usual source of care and to have used ambulatory care in the past year than the urban uninsured.
    • Insured or not, rural residents have difficulty accessing after hours care and traveling to see their usual provider
  • Health Information Exchange: A Strategy for Improving Access for Rural Veterans in the Maine Flex Rural Veterans Health Access Program
    Maine Rural Health Research Center
    Date: 05/2016
    This paper reports on the design and implementation of a first-in-the-nation project to expand rural veterans’ access to healthcare by establishing a bi-directional connection between Maine’s statewide health information exchange (HIE) and Veterans Administration facilities and centers.
  • Health Insurance CO-OPs: Product Availability and Premiums in Rural Counties
    Policy Brief
    Maine Rural Health Research Center
    Date: 10/2016
    We describe regional distribution and market prevalence of CO-OP products in rural and urban counties, and compare the number of products available in counties with and without CO-OP plans in 2014 and 2015.
  • Health Insurance Coverage Of The Rural And Urban Near Elderly
    Maine Rural Health Research Center
    Date: 10/2003
    Reports the results of a study that used data from the 1996-1998 Medical Expenditure Panel Survey (MEPS) to address two principal research questions related to health insurance coverage for the rural near elderly. Findings indicate that the rural near elderly are both more likely to be uninsured and to be in fair or poor health, and when the near elderly become uninsured they may have a much more difficult time regaining health insurance than younger groups. This issue may be even more problematic in rural areas as the findings indicate that 14% of the rural near elderly are uninsured for the entire survey year, compared to 10% of the urban near elderly.
  • Health Insurance Profile Indicates Need to Expand Coverage in Rural Areas (Policy Brief)
    Maine Rural Health Research Center
    Date: 07/2009
    Rural residents-particularly in the most remote rural communities-are in greater need of health reform, as demonstrated by an uninsured rate higher than that of urban residents. The rural-urban disparity in coverage is driven by higher uninsured rates among rural adults, a group that should be part of any strategic effort to improve coverage. This brief provides information on the health insurance status of rural Americans, summarized from a more detailed chartbook. Analyses are based on the 2004-05 Medical Expenditure Panel Survey.
  • High Deductible Health Insurance Plans in Rural Areas
    Maine Rural Health Research Center
    Date: 05/2014

    Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing healthcare costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket healthcare costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.

    Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces.

  • The High Performance Rural Health Care System of the Future
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2011
    Describes a future rural system that would be built on foundations of affordability, accessibility, community focus, high quality, and patient centeredness.
  • Impact of Employment Transitions on Health Insurance Coverage of Rural Residents
    Maine Rural Health Research Center
    Date: 10/2010
    Explores the impact of changes in employment status on insurance coverage for rural and urban workers.
  • Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives for Legislative Proposals
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    Date: 06/2000
    This Policy Paper combines the work from current projects of the Maine Rural Health Research Center (MRHRC) and the Rural Health Panel of the Rural Policy Research Institute (RUPRI) to provide a statement of specific rural considerations and objectives for any proposal that would add a prescription drug benefit to the Medicare program. Our intent is to establish a framework for assessing the effects of proposals on rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
  • Integrated Care Management in Rural Communities
    Maine Rural Health Research Center
    Date: 05/2014

    Reviews the opportunities and challenges reform initiatives under the Affordable Care Act present for rural communities. Assesses four types of organizational models for delivering integrated care management. Each model has different strengths and drawbacks, weighing for and against implementation in rural areas.

    Key Findings:

    • Introducing an integrated care model in a rural community requires an investment in building relationships with local providers and adapting to local culture and services.
    • Integrated care models that cannot adapt to the local delivery system are more likely to face resistance from local providers and those they serve and potentially duplicate or displace existing rural capacity.
    • Most models of integrated care management have an inherent bias toward larger organizations and infrastructure. Most are built on an investment in health information technology and other systems and capacities.
    • The potential success of any integrated care model is limited by gaps in the continuum of health care services and long term services and supports available in a rural community.
    • “Wraparound” integrated care models can fill gaps in existing care coordination capacity, offering a flexible approach that can adapt to a local rural delivery system.
    • An investment of public resources in shared supports can lower the cost of integrating care in rural delivery systems.
  • Many Urban and Rural Workers Lose Health Insurance During Job Transitions (Policy Brief)
    Maine Rural Health Research Center
    Date: 10/2010
    Explores the impact of changes in employment status on insurance coverage for rural and urban workers, and the factors behind any differences.
  • Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems
    Report
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2015

    In January, 2015, Department of Health and Human Services (HHS) Secretary Burwell announced new goals and timelines for moving Medicare reimbursement from fee-for-service to value-based payment. These payment changes are driving delivery system reforms (DSR) by making health care organizations more accountable for patients’ health as well as population and community health. Payment and delivery system reform, however, is concentrated in urban centers, and Medicare rural payment policies that were designed to strengthen rural health providers and systems are now complicating payment and delivery system reform in rural areas. The inclusion of rural providers in Medicare payment reform is critical for the program and for the 23 percent of Medicare beneficiaries who reside in rural areas. Rural Medicare beneficiaries should have the same opportunity as their urban counterparts to benefit from payment reform’s positive effects including strengthened primary care, embedded care coordination, and improved clinical quality. In this paper, we describe five recommendations to facilitate rural inclusion in value-based payment and delivery system reform:

    1. Organize rural health systems to create integrated care.
    2. Build rural system capacity to support integrated care.
    3. Facilitate rural participation in value-based payments.
    4. Align Medicare payment and performance assessment policies with Medicaid and commercial payers.
    5. Develop rural appropriate payment systems
  • Monitoring the Community Benefits of CAHs: A Review of the Data (Briefing Paper)
    Maine Rural Health Research Center
    Date: 03/2010
    There is a growing national interest in the benefits provided by nonprofit and public hospitals to their communities in exchange for the tax benefits or public funding that they receive.
  • Monitoring the Community Benefits of Critical Access Hospitals: A Review of the Data
    Policy Brief
    Maine Rural Health Research Center
    Date: 03/2010

    This brief examines the community benefit activities of Critical Access Hospitals (CAHs) using data from the Flex Monitoring Team's (FMT) pilot test of a set of community benefit data collection tools and performance indicators, the Internal Review Service's (IRS) 2006 Hospital Compliance Study, and the 2007 FMT CAH survey.

  • Out-of-Pocket Health Care Spending and the Rural Underinsured
    Maine Rural Health Research Center
    Date: 12/2005
    Reports the results of a study to identify whether and to what extent there are rural-urban differences in underinsured rates among the privately insured, and, where differences exist, to understand what characteristics of rural residents are related to their likelihood of being underinsured. Using the 2001 and 2001 Medical Expenditure Panel Survey (MEPS), the authors examined the annual out-of-pocket healthcare expenditures for U.S. residents under age 65 that were continuously insured by a private plan in either 2001 or 2002. Findings showed that, despite having private health insurance coverage, those who use medical services continue to pay for a substantial portion of their own healthcare costs, particularly those living in rural areas. The average rural non-adjacent individual paid for 39% of their care in 2001 or 2002, compared to 35% for rural adjacent and 32% for urban individuals. Additional findings showed that one out of eight non-adjacent residents is underinsured (12.4%), compared to 10% of rural adjacent and 7% of urban residents.
  • Out-Of-Pocket Health Spending And The Rural Underinsured
    Maine Rural Health Research Center
    Date: 11/2006
    Estimates underinsurance rates among privately insured rural residents and the characteristics associated with rural underinsurance.
  • Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look
    Rural Policy Analysis and Applications
    Date: 09/2010
    Summarizes six issue areas of the Affordable Care Act (ACA) and discusses implications for access to services and improving the health status of rural residents. These issue areas are: health insurance coverage; Medicare and Medicaid payment; quality, financing, and delivery system reform; public health; healthcare workforce; and long-term care.
  • Patterns of Health Insurance Coverage Among Rural and Urban Children
    Maine Rural Health Research Center
    Date: 11/2001
    Assesses differences in the patterns of insurance coverage and uninsured spells among rural and urban children in 20 states. Also examines the implications of those differences for the design and implementation of public insurance programs. Among its findings: Although the average duration of new uninsured spells was shorter among rural than urban children, rural children were more likely to experience protracted spells of uninsurance. Rural children were also more likely than urban children to move between public and private coverage. These findings have important implications for designing insurance expansion programs and outreach strategies to effectively enroll and retain rural children.
  • Pilot Testing a Rural Health Clinic Quality Measurement Reporting System
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2016
    More than 4,000 Rural Health Clinics (RHCs) serve the primary care needs of rural communities. Unfortunately, the Rural Health Clinic Program is plagued by a lack of data participating clinics. This reports on the results with a focus on assessing the feasibility and utility of the reporting system and quality measures for the participating RHCs.
  • Prioritizing Patient Safety Interventions in Small Rural Hospitals
    Maine Rural Health Research Center, Upper Midwest Rural Health Research Center
    Date: 12/2006
    Determines if 26 patient safety practices recommended by an expert panel as relevant to rural hospitals would be validated in terms of rural relevance and implementability by administrators and quality managers. This research was supported by funding from the Agency for Healthcare Research and Quality and the Office of Rural Health Policy.
  • Private Health Insurance in Rural Areas: Challenges and Opportunities (Policy Brief)
    Maine Rural Health Research Center
    Date: 04/2009
    Rural residents are less likely than their urban counterparts to have private health insurance coverage. This difference is driven by the unique characteristics of rural places that make it challenging to create and sustain viable private insurance pools, including the predominance of small businesses and self employed, part time, and low wage workers. This brief discusses the challenges of expanding private coverage in rural areas, and describes policy options to address them.
  • Profile of Rural Health Insurance Coverage: A Chartbook
    Maine Rural Health Research Center
    Date: 06/2009
    As the nation considers whether and how to reform the healthcare system, it is important to consider differences in health insurance coverage for those living in rural and urban areas. Analyses of persons under age 65 from the 2004-05 Medical Expenditure Panel Survey reveal a greater proportion of rural residents than urban residents who are uninsured or covered through public sources, especially among those living in remote areas. Rural adults are at high risk of being uninsured compared to rural children. Uninsured rates are highest among adults over age 50 in the most remote rural places. Compared to urban adults, rural adults are less likely to be in employment situations where private coverage is offered.
  • Profile of Rural Residential Care Facilities: A Chartbook
    Chartbook
    Maine Rural Health Research Center
    Date: 05/2014

    As federal and state policymakers consider their most cost-effective options for strengthening rural long-term services and supports (LTSS), more information is needed about the current system of care. Using data from the 2010 National Survey of Residential Care Facilities, this chartbook presents information on a slice of the rural LTSS continuum—the rural residential care facility (RCF). Survey results identify important national and regional differences between rural and urban RCFs, focusing on the facility, resident and service characteristics of RCFs and their ability to meet the LTSS needs of residents. Rural RCFs are more likely to have private pay patients compared to urban facilities and their residents have fewer disabilities as measured by their functional assistance needs. Compared to urban facilities, the policies of rural RCFs appear less likely to support aging-in-place.

  • Redesigning Medicare: Considerations for Rural Beneficiaries and Health Systems
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2001
    Provides a framework to help shape proposals to redesign Medicare to the benefit of rural beneficiaries and providers. Chapters focus on equity, quality, choice, access, and cost. Each chapter outlines the current situation, analyzes the implications of various approaches to changing the program, and makes recommendations for developing a Medicare program of greatest benefit to rural residents. Report produced by the RUPRI Rural Health Panel.
  • Redesigning the Medicare Program: An Opportunity to Improve Rural Health Care Systems?
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    With this paper, the RUPRI Rural Health Panel is presenting a well-defined framework for what should be included in any discussion of Medicare policies.
  • A Review of State Flex Program Plans, 2004-2005
    Maine Rural Health Research Center, University of Minnesota Rural Health Research Center
    Date: 03/2006
    Examines the objectives and project activities proposed by states in their Medicare Rural Hospital Flexibility Program (Flex Program) grant applications for Fiscal Year 2004 to strengthen the rural healthcare infrastructure in their states. Highlights recent trends in State Flex Program planning, development, and implementation. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
  • Rural Adults Face Parity Problems and Other Barriers to Appropriate Mental Health Care
    Maine Rural Health Research Center
    Date: 11/2008
    Findings suggest that a multi-level approach is essential for meeting the mental health service needs of rural residents.

    Key facts include: 8% of rural adults say that they are in "fair" or "poor" mental health versus 6% of urban adults;
    Among those using mental health services, rural residents are more likely than urban residents to use medication but not therapy. Practice guidelines for quality mental health treatment recommend that medications be given in combination with therapy;
    Both rural and urban adults have greater cost sharing for their mental healthcare than for their total healthcare use. The percentages do not differ by residence; however, rural residents may be at greater risk of forgoing mental healthcare due to costs.
    This Research & Policy Brief is based on a longer study by the authors. For more information about this study, please contact Erika Ziller at eziller@usm.maine.edu

  • Rural Assessment of Leading Proposals to Redesign the Medicare Program
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2000
    This Policy Paper provides a critique of two proposals to redesign the Medicare program: the "Medicare Preservation and Improvement Act of 1999" (S. 1895, introduced by Senator Breaux and others) and "The President's Plan to Modernize and Strengthen Medicare for the 21st Century." Rural implications of the proposals are discussed, specifically how they affect rural Medicare beneficiaries and rural providers of health care services. Report produced by the RUPRI Rural Health Panel.
  • Rural Coverage Gaps Decline Following Public Health Insurance Expansions (Policy Brief)
    Maine Rural Health Research Center
    Date: 02/2009
    This brief uses the Medical Expenditure Panel Survey (MEPS) to compare the health insurance coverage of rural and urban residents in 1997 and 2005 to assess how uninsured rates and sources of coverage have changed since SCHIP was enacted. The authors also discuss the characteristics of the rural uninsured and the implications for health insurance reform. Rural is defined as living in a non-metropolitan county, as designated by the Office of Management and Budget (OMB). All presented results are statistically significant at p. = .05.

    Findings: Between 1997 and 2005, the uninsured rate among rural children declined more dramatically than among urban children, following increases in public health insurance. Public health insurance growth among rural adults was much more modest and uninsured rates remained the same. Nearly 60% of the rural uninsured have family incomes below 200% of the federal poverty level suggesting the potential for expanding public coverage. For those with higher incomes, policy strategies to strengthen private coverage will need to account for the unique employment and insurance market characteristics of rural areas.

  • Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2015

    The patient-centered medical home (PCMH) model both reaffirms traditional primary care values such as continuity of care, connection with an identified personal clinician, provision of same day- and after-hours access and also prepares providers to succeed in the evolving healthcare system by focusing on accountability, continuous quality improvement, public reporting of quality data, data exchange, and patient satisfaction. However, little is known about the readiness of the over 4,000 Rural Health Clinics (RHCs) to meet the PCMH Recognition standards established by the National Council for Quality Assurance (NCQA). This policy brief reports findings from a survey of RHCs that examined their capacity to meet the NCQA PCMH requirements, and discusses the implications of the findings for efforts to support RHC capacity development.

    Key Findings:

    • Based on their performance on the “must pass” elements and related key factors, Rural Health Clinics (RHCs) are likely to have difficulties gaining National Center for Quality Assurance’s (NCQA) Patient-Centered Medical Home (PCMH) Recognition.
    • RHCs perform best on standards related to recording demographic information and managing clinical activities, particularly for those using an electronic health record.
    • RHCs perform less well on improving access to and continuity of services, supporting patient self-management skills and shared decision-making, implementing continuous quality improvement systems, and building practice teams.
    • RHCs are likely to need substantial technical assistance targeting clinical and operational performance to gain NCQA PCMH Recognition.
  • Rural Hospitals and Long-Term Care: the Challenges of Diversification and Integration Strategies
    Maine Rural Health Research Center
    Date: 2006
    There are many contemporary challenges experienced by older rural residents and their communities in accessing and providing services. However, the issue is not in comparing rural older adults to their urban counterparts; rather, it is that rural people have unique characteristics that must be considered when planning and providing services.
  • Securing High Quality Health Care in Rural America: The Impetus for Change in the Affordable Care Act
    Rural Policy Analysis and Applications
    Date: 12/2010
    The ACA calls for the development of a National Health Care Quality Strategy and Plan (National Quality Strategy) that will affect healthcare that is delivered to millions of Americans who live in rural areas and thousands of healthcare providers who care for them.
  • Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis, Upper Midwest Rural Health Research Center
    Date: 2005
    The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in 2004 to identify a set of researchable questions concerning rural healthcare.