Federal Health Policy Department is offering this grant to conduct analysis and provide technical assistance for rural health systems.

The health care delivery system is undergoing dramatic change, with an emphasis on finding new approaches and organizational frameworks to improve health outcomes, control costs, and improve population health. Financial incentives are changing from a focus on volume-based services to value-based services. There is a concurrent need to better measure and account for quality of care in all settings and improve transitions of care as patients move from one care setting to another. Advances in technology and new approaches to organizing care delivery are occurring quickly, with examples like the patient-centered medical home, accountable care organizations, and patient-safety organizations. Most early adopters have been large, urban-based integrated delivery systems. Less is known about how these changes and environmental factors will affect rural health care delivery systems. Early pilots and demonstrations supported by private foundations or the Centers for Medicare and Medicaid Services (CMS) focused largely on providers paid under traditional administered pricing systems and for whom quality indicators are well established. Because rural health care providers are often paid outside of the traditional prospective payment systems and fee schedules, there is less known about how new and emerging models might function in rural communities. As a result, policy makers and rural providers need to better understand the implications of new and emerging models for low-volume rural settings. Also, rural providers need to be supplied with the technical assistance and information necessary to take part in new and emerging pilots and demonstrations.

Specifically, the RHSATA Cooperative Agreement will:

1) Assess the distinct characteristics of the current rural health care delivery system;
2) Analyze recent rural and non-rural national, regional, State and local demonstrations and pilots, including those established under Section 434 of the Medicare Modernization Act of 2003 and Section 123 of the Medicare Improvements to Patients and Provider’s Act of 2008, as amended, for key lessons learned that might inform future rural health policy development;
3) Conduct modeling of payment and quality proposals to inform rural health care policy makers and rural health care delivery systems and assess alternative ways of delivering services in rural communities;
4) Provide technical assistance to rural health care providers who are developing demonstrations and pilots that can help improve care coordination, enhance patient outcomes, and potentially lower health care costs; and
5) Promote key findings to stakeholder groups and public policy leaders.

The RHSATA awardee will conduct policy-oriented health services research and analysis on the current and emerging rural health care delivery system. The awardee will catalog key features of the current infrastructure (i.e. types of health care providers, locations, financial data, service mix, etc.), as well as general information about the health status of rural populations. Therefore, applicants must demonstrate capabilities in manipulating and linking national data sets, and in performing complex financial and quality modeling for rural health care providers that takes into account the financial reimbursement systems under which they operate.

The RHSATA awardee will examine recent and emerging pilots and demonstrations to identify key lessons learned as well as barriers and policy challenges. This will include an assessment of the demonstrations funded under Section 434 of the Medicare Modernization Act of 2003 and Section 123 of the Medicare Improvements to Patients and Provider’s Act of 2008, as amended, and their broad implications for the evolving rural health care delivery infrastructure.

The RHSATA Cooperative Agreement findings will inform national, State and regional policy makers and local officials, as well as rural health care providers. The findings and technical assistance will assist applicants for a variety of public and private pilots and demonstrations at the national, State and local levels, including programs funded under Section 330A of the Public Health Service Act.