rural wisconsin health cooperative tim size, executive director rural wisconsin health cooperative...

Rural WisconsinRural WisconsinHealth CooperativeHealth Cooperative

Tim Size, Executive DirectorTim Size, Executive Director

Rural Wisconsin Health CooperativeRural Wisconsin Health Cooperative

Sauk City, WisconsinSauk City, Wisconsin

Rural Health Advocacy Rural Health Advocacy 24 hours a day24 hours a day7 days a week7 days a week


Outline of PresentationOutline of PresentationOutline of PresentationOutline of Presentation

• Myths About Rural Are Alive & WellMyths About Rural Are Alive & Well

• ““Almost Worst Rural Health Policy” Awards for 2005Almost Worst Rural Health Policy” Awards for 2005

• Cross Section Public-Private Rural Health IssuesCross Section Public-Private Rural Health Issues Medicare AdvantageMedicare Advantage Physician SupplyPhysician Supply Healthcare CostsHealthcare Costs Population HealthPopulation Health

• Becoming More Effective & Active AdvocatesBecoming More Effective & Active Advocates

• Myths About Rural Are Alive & WellMyths About Rural Are Alive & Well

• ““Almost Worst Rural Health Policy” Awards for 2005Almost Worst Rural Health Policy” Awards for 2005

• Cross Section Public-Private Rural Health IssuesCross Section Public-Private Rural Health Issues Medicare AdvantageMedicare Advantage Physician SupplyPhysician Supply Healthcare CostsHealthcare Costs Population HealthPopulation Health

• Becoming More Effective & Active AdvocatesBecoming More Effective & Active Advocates


RWHC Eye On Health

Rural?Pay them less.

They grow their own vegetables.

RWHC Eye On Health

Rural?Pay them less.

They grow their own vegetables.

MYTHS ABOUT RURALMYTHS ABOUT RURAL


Myths that Mislead Public & Private PolicyMyths that Mislead Public & Private PolicyMyths that Mislead Public & Private PolicyMyths that Mislead Public & Private Policy

• Rural is west ( TX, NC, PA, OH, MI, NY top rural pop )Rural is west ( TX, NC, PA, OH, MI, NY top rural pop )• Rural Americans are naturally more healthy Rural Americans are naturally more healthy • Rural economy is mostly about agriculture Rural economy is mostly about agriculture • Rural health care costs less than urban care Rural health care costs less than urban care • Rural health care is inordinately expensive Rural health care is inordinately expensive • Rural health care is lower quality; urban is better Rural health care is lower quality; urban is better • Rural hospitals are just band-aide stations Rural hospitals are just band-aide stations • Rural hospitals & clinics are poorly managed/governedRural hospitals & clinics are poorly managed/governed• Rural residents don’t want to get care locallyRural residents don’t want to get care locally

• Rural is west ( TX, NC, PA, OH, MI, NY top rural pop )Rural is west ( TX, NC, PA, OH, MI, NY top rural pop )• Rural Americans are naturally more healthy Rural Americans are naturally more healthy • Rural economy is mostly about agriculture Rural economy is mostly about agriculture • Rural health care costs less than urban care Rural health care costs less than urban care • Rural health care is inordinately expensive Rural health care is inordinately expensive • Rural health care is lower quality; urban is better Rural health care is lower quality; urban is better • Rural hospitals are just band-aide stations Rural hospitals are just band-aide stations • Rural hospitals & clinics are poorly managed/governedRural hospitals & clinics are poorly managed/governed• Rural residents don’t want to get care locallyRural residents don’t want to get care locally

* U.S. 2000 Census, Non-Metro Population By State* U.S. 2000 Census, Non-Metro Population By State


2005 “Almost Worst Rural Health Policy” Awards2005 “Almost Worst Rural Health Policy” Awards2005 “Almost Worst Rural Health Policy” Awards2005 “Almost Worst Rural Health Policy” Awards

First Draft of June MedPAC ReportFirst Draft of June MedPAC Report

1st Launch of “Hospital Compare” Web Site 1st Launch of “Hospital Compare” Web Site

Proposed CMS Rural Hospital Building BanProposed CMS Rural Hospital Building Ban

Federal Appropriations Bill for FFY 2006Federal Appropriations Bill for FFY 2006

First Draft of June MedPAC ReportFirst Draft of June MedPAC Report

1st Launch of “Hospital Compare” Web Site 1st Launch of “Hospital Compare” Web Site

Proposed CMS Rural Hospital Building BanProposed CMS Rural Hospital Building Ban

Federal Appropriations Bill for FFY 2006Federal Appropriations Bill for FFY 2006


Medicare Payment Advisory CommissionMedicare Payment Advisory CommissionMedicare Payment Advisory CommissionMedicare Payment Advisory Commission

• CAH payment designation ended two decades of failed CAH payment designation ended two decades of failed attempts to retro-fit to rural the PPS Medicare payment attempts to retro-fit to rural the PPS Medicare payment methodology designed for large urban hospitals methodology designed for large urban hospitals

• MedPAC is an advisory commission to CongressMedPAC is an advisory commission to Congress • The initial draft of the June MedPAC report was seen The initial draft of the June MedPAC report was seen

as inaccurate, hostile review of the CAH programas inaccurate, hostile review of the CAH program• Draft framed CAH designation as Federal charity with Draft framed CAH designation as Federal charity with

recipients having to prove they were “deserving poor”recipients having to prove they were “deserving poor”• The pushback from Commissioners, with technical help The pushback from Commissioners, with technical help

from the field, was substantial and effectivefrom the field, was substantial and effective

• CAH payment designation ended two decades of failed CAH payment designation ended two decades of failed attempts to retro-fit to rural the PPS Medicare payment attempts to retro-fit to rural the PPS Medicare payment methodology designed for large urban hospitals methodology designed for large urban hospitals

• MedPAC is an advisory commission to CongressMedPAC is an advisory commission to Congress • The initial draft of the June MedPAC report was seen The initial draft of the June MedPAC report was seen

as inaccurate, hostile review of the CAH programas inaccurate, hostile review of the CAH program• Draft framed CAH designation as Federal charity with Draft framed CAH designation as Federal charity with

recipients having to prove they were “deserving poor”recipients having to prove they were “deserving poor”• The pushback from Commissioners, with technical help The pushback from Commissioners, with technical help

from the field, was substantial and effectivefrom the field, was substantial and effective


Hospital Compare Labled CAH as 2nd ClassHospital Compare Labled CAH as 2nd ClassHospital Compare Labled CAH as 2nd ClassHospital Compare Labled CAH as 2nd Class


NRHA Responded with Reporting GuidelinesNRHA Responded with Reporting GuidelinesNRHA Responded with Reporting GuidelinesNRHA Responded with Reporting Guidelines

•Need to actively prepare for future when payers and Need to actively prepare for future when payers and consumers pay attention to public reportingconsumers pay attention to public reporting

• Rural hospitals should fully engage in the quality Rural hospitals should fully engage in the quality improvement and public reporting movement improvement and public reporting movement

• CAHs and PPS are both “acute care hospitals”CAHs and PPS are both “acute care hospitals”

• CAH or PPS difference not relevant to quality reportCAH or PPS difference not relevant to quality report

• Compare service outcomes, not institution sizeCompare service outcomes, not institution size

• Consumers should be able, at a minimum, to readily Consumers should be able, at a minimum, to readily compare all hospitals in their “hospital referral region”compare all hospitals in their “hospital referral region”

•Need to actively prepare for future when payers and Need to actively prepare for future when payers and consumers pay attention to public reportingconsumers pay attention to public reporting

• Rural hospitals should fully engage in the quality Rural hospitals should fully engage in the quality improvement and public reporting movement improvement and public reporting movement

• CAHs and PPS are both “acute care hospitals”CAHs and PPS are both “acute care hospitals”

• CAH or PPS difference not relevant to quality reportCAH or PPS difference not relevant to quality report

• Compare service outcomes, not institution sizeCompare service outcomes, not institution size

• Consumers should be able, at a minimum, to readily Consumers should be able, at a minimum, to readily compare all hospitals in their “hospital referral region”compare all hospitals in their “hospital referral region”

NRHA Policy Brief Approved 5/20/06NRHA Policy Brief Approved 5/20/06


RWHC Eye On Health

"No need to rebuild old rural hospitals whenwe have Army Surplus MASH Tents."

Proposed Building BanProposed Building Ban


Appropriations Fight in 2005 for 2006Appropriations Fight in 2005 for 2006Appropriations Fight in 2005 for 2006Appropriations Fight in 2005 for 2006

• President proposed to eliminate 8 programs worth $232 President proposed to eliminate 8 programs worth $232 million and dramatically cut 3 others.million and dramatically cut 3 others.

• House of Representatives followed many of those House of Representatives followed many of those recommendations; the Senate did not. recommendations; the Senate did not.

• The first Conference Report eliminated 6 programs The first Conference Report eliminated 6 programs worth $134 million and dramatically cut several others. worth $134 million and dramatically cut several others. But it was defeated 209 to 224 in the House!But it was defeated 209 to 224 in the House!

• The final bill restored funding for research and policy The final bill restored funding for research and policy and AHECS, and added money for outreach and and AHECS, and added money for outreach and community health centers. Some programs still cut.community health centers. Some programs still cut.

• President proposed to eliminate 8 programs worth $232 President proposed to eliminate 8 programs worth $232 million and dramatically cut 3 others.million and dramatically cut 3 others.

• House of Representatives followed many of those House of Representatives followed many of those recommendations; the Senate did not. recommendations; the Senate did not.

• The first Conference Report eliminated 6 programs The first Conference Report eliminated 6 programs worth $134 million and dramatically cut several others. worth $134 million and dramatically cut several others. But it was defeated 209 to 224 in the House!But it was defeated 209 to 224 in the House!

• The final bill restored funding for research and policy The final bill restored funding for research and policy and AHECS, and added money for outreach and and AHECS, and added money for outreach and community health centers. Some programs still cut.community health centers. Some programs still cut.

Jennifer Friedman, VP Government Affairs and PolicyJennifer Friedman, VP Government Affairs and PolicyNational Rural Health AssociationNational Rural Health Association


President’s Again Slashes Rural HealthPresident’s Again Slashes Rural HealthPresident’s Again Slashes Rural HealthPresident’s Again Slashes Rural Health

$160$160

$27$27

$0$0

$50$50

$100$100

$150$150

$200$200

FY06 FY07President'sRequest

Dollars in Millions

Does not include $29 Does not include $29 million cut from million cut from

eliminating AHECs; eliminating AHECs; total cuts are over total cuts are over

$160 million.$160 million.



Cross Section Rural Health Issues


RWHC Eye On Health

"Why is it legal for our only doctors to be denied payment from our only insurance?"

HometownRural Clinic

Challenges of a Privatized MedicareChallenges of a Privatized Medicare


* CMS Medicare Managed Care Manual, Chpt. 4, page 57* CMS Medicare Managed Care Manual, Chpt. 4, page 57

Strong Access Standards Are KeyStrong Access Standards Are KeyStrong Access Standards Are KeyStrong Access Standards Are Key

• Beneficiary rights to local access, even if “out of Beneficiary rights to local access, even if “out of network,” is key for beneficiaries and for local network,” is key for beneficiaries and for local providers to have any clout in plan negotiationsproviders to have any clout in plan negotiations

• ““Plans must… ensure that services are Plans must… ensure that services are geographically accessible and consistent with geographically accessible and consistent with local community patterns of care.” *local community patterns of care.” *

• Need to open up current “black-box” which Need to open up current “black-box” which limits beneficiary awareness and evaluation of limits beneficiary awareness and evaluation of CMS enforcement of consistency of access CMS enforcement of consistency of access standards across plans, markets and timestandards across plans, markets and time

• Beneficiary rights to local access, even if “out of Beneficiary rights to local access, even if “out of network,” is key for beneficiaries and for local network,” is key for beneficiaries and for local providers to have any clout in plan negotiationsproviders to have any clout in plan negotiations

• ““Plans must… ensure that services are Plans must… ensure that services are geographically accessible and consistent with geographically accessible and consistent with local community patterns of care.” *local community patterns of care.” *

• Need to open up current “black-box” which Need to open up current “black-box” which limits beneficiary awareness and evaluation of limits beneficiary awareness and evaluation of CMS enforcement of consistency of access CMS enforcement of consistency of access standards across plans, markets and timestandards across plans, markets and time


Protecting CAH/RHC ReimbursementProtecting CAH/RHC ReimbursementProtecting CAH/RHC ReimbursementProtecting CAH/RHC Reimbursement

• HR 880 (Ron Kind): pay for CAH & RHC at a HR 880 (Ron Kind): pay for CAH & RHC at a rate that is > 101 percent traditional Medicarerate that is > 101 percent traditional Medicare

• SB 2819 (Coleman/Durbin) is comparable to HR SB 2819 (Coleman/Durbin) is comparable to HR 880; adds option of “103 percent of the applicable 880; adds option of “103 percent of the applicable interim payment rate”interim payment rate”

• Right to local access still key; payment rates are Right to local access still key; payment rates are meaningless if patients can be steered elsewhere meaningless if patients can be steered elsewhere

• AHA & NRHA SupportingAHA & NRHA Supporting

• HR 880 (Ron Kind): pay for CAH & RHC at a HR 880 (Ron Kind): pay for CAH & RHC at a rate that is > 101 percent traditional Medicarerate that is > 101 percent traditional Medicare

• SB 2819 (Coleman/Durbin) is comparable to HR SB 2819 (Coleman/Durbin) is comparable to HR 880; adds option of “103 percent of the applicable 880; adds option of “103 percent of the applicable interim payment rate”interim payment rate”

• Right to local access still key; payment rates are Right to local access still key; payment rates are meaningless if patients can be steered elsewhere meaningless if patients can be steered elsewhere

• AHA & NRHA SupportingAHA & NRHA Supporting


Other Needed Medicare Advantage ImprovementsOther Needed Medicare Advantage ImprovementsOther Needed Medicare Advantage ImprovementsOther Needed Medicare Advantage Improvements

1.1. Major increase beneficiary decision-making assistance Major increase beneficiary decision-making assistance

2.2. Immediate on-line verification beneficiary coverageImmediate on-line verification beneficiary coverage

3.3. Restore State’s Rights to question plan behaviorRestore State’s Rights to question plan behavior

4.4. Regional CMS Office role as source of definitive infoRegional CMS Office role as source of definitive info

5.5. Regional CMS Office handle provider complaintsRegional CMS Office handle provider complaints

6.6. Plan applications on-line within 30 days of approvalPlan applications on-line within 30 days of approval

7.7. Full/timely transparency re enrollment and quality dataFull/timely transparency re enrollment and quality data

8.8. Encourage collaboration amongst rural providers to Encourage collaboration amongst rural providers to level playing field re contract development/reviewlevel playing field re contract development/review

1.1. Major increase beneficiary decision-making assistance Major increase beneficiary decision-making assistance

2.2. Immediate on-line verification beneficiary coverageImmediate on-line verification beneficiary coverage

3.3. Restore State’s Rights to question plan behaviorRestore State’s Rights to question plan behavior

4.4. Regional CMS Office role as source of definitive infoRegional CMS Office role as source of definitive info

5.5. Regional CMS Office handle provider complaintsRegional CMS Office handle provider complaints

6.6. Plan applications on-line within 30 days of approvalPlan applications on-line within 30 days of approval

7.7. Full/timely transparency re enrollment and quality dataFull/timely transparency re enrollment and quality data

8.8. Encourage collaboration amongst rural providers to Encourage collaboration amongst rural providers to level playing field re contract development/reviewlevel playing field re contract development/review

DHHS National Advisory Committee on Rural Health & Human DHHS National Advisory Committee on Rural Health & Human Services, Medicare Advantage Sub-Committee, 6/13/06Services, Medicare Advantage Sub-Committee, 6/13/06


PHYSICIAN SUPPLYPHYSICIAN SUPPLY


Wisconsin Academy of Rural MedicineWisconsin Academy of Rural MedicineWisconsin Academy of Rural MedicineWisconsin Academy of Rural Medicine

Builds on pioneering work of Howard Rabinowitz at Builds on pioneering work of Howard Rabinowitz at Jefferson Medical College in Philadelphia.Jefferson Medical College in Philadelphia.

Result of 25 years asking land grant UW be true to rootsResult of 25 years asking land grant UW be true to roots

Goal: rural focused medical school within the Madison Goal: rural focused medical school within the Madison based University of Wisconsin medical schoolbased University of Wisconsin medical school

• Recruit students with rural background and career goalsRecruit students with rural background and career goals• Locate education and training programs in rural areas of Locate education and training programs in rural areas of

WI during 3rd and 4th years of Med SchoolWI during 3rd and 4th years of Med School Use rural appropriate curriculumUse rural appropriate curriculum

Builds on pioneering work of Howard Rabinowitz at Builds on pioneering work of Howard Rabinowitz at Jefferson Medical College in Philadelphia.Jefferson Medical College in Philadelphia.

Result of 25 years asking land grant UW be true to rootsResult of 25 years asking land grant UW be true to roots

Goal: rural focused medical school within the Madison Goal: rural focused medical school within the Madison based University of Wisconsin medical schoolbased University of Wisconsin medical school

• Recruit students with rural background and career goalsRecruit students with rural background and career goals• Locate education and training programs in rural areas of Locate education and training programs in rural areas of

WI during 3rd and 4th years of Med SchoolWI during 3rd and 4th years of Med School Use rural appropriate curriculumUse rural appropriate curriculum


RWHC Eye On Health

"He's a third generation Conservative but his firm's health care costs just outstripped payroll."

HEALTHCARE COSTSHEALTHCARE COSTS


Health Care Costs - Review of RealityHealth Care Costs - Review of RealityHealth Care Costs - Review of RealityHealth Care Costs - Review of Reality

• In 2005, employer-based health insurance premiums In 2005, employer-based health insurance premiums rose by 9%, the fifth consecutive year over 9% rose by 9%, the fifth consecutive year over 9%

• HMOS, PPOs and POS plans all showed this increaseHMOS, PPOs and POS plans all showed this increase• Annual premium charges an employer for a health plan Annual premium charges an employer for a health plan

covering a family of four averaged $10,800 in 2005covering a family of four averaged $10,800 in 2005• Gross earnings, full-time, minimum-wage = $10,712Gross earnings, full-time, minimum-wage = $10,712• Since 2000, premiums have increased 73%, vs 14% Since 2000, premiums have increased 73%, vs 14%

cumulative inflation & 15% cumulative wage increasecumulative inflation & 15% cumulative wage increase• The average employee contribution has increased more The average employee contribution has increased more

than 143% since 2000than 143% since 2000

• In 2005, employer-based health insurance premiums In 2005, employer-based health insurance premiums rose by 9%, the fifth consecutive year over 9% rose by 9%, the fifth consecutive year over 9%

• HMOS, PPOs and POS plans all showed this increaseHMOS, PPOs and POS plans all showed this increase• Annual premium charges an employer for a health plan Annual premium charges an employer for a health plan

covering a family of four averaged $10,800 in 2005covering a family of four averaged $10,800 in 2005• Gross earnings, full-time, minimum-wage = $10,712Gross earnings, full-time, minimum-wage = $10,712• Since 2000, premiums have increased 73%, vs 14% Since 2000, premiums have increased 73%, vs 14%

cumulative inflation & 15% cumulative wage increasecumulative inflation & 15% cumulative wage increase• The average employee contribution has increased more The average employee contribution has increased more

than 143% since 2000than 143% since 2000

National Coalition on Health Care http://www.nchc.org/National Coalition on Health Care http://www.nchc.org/


What To Do About Unsustainable Cost Trends?What To Do About Unsustainable Cost Trends?What To Do About Unsustainable Cost Trends?What To Do About Unsustainable Cost Trends?

• Most agree that health care costs must be controlled but Most agree that health care costs must be controlled but disagree on the best ways to address rapidly escalating disagree on the best ways to address rapidly escalating health spending and health insurance premiums: health spending and health insurance premiums:

Price controls and imposing strict budgets on health Price controls and imposing strict budgets on health care spending?care spending?

Free market competition solves the problem?Free market competition solves the problem? With healthier lifestyles, less medical care required?With healthier lifestyles, less medical care required?

• Cost of inaction will Cost of inaction will severelyseverely affect employer's bottom affect employer's bottom lines, business location and consumer's pocketbookslines, business location and consumer's pocketbooks

• How do different approaches effect rural health care?How do different approaches effect rural health care?

• Most agree that health care costs must be controlled but Most agree that health care costs must be controlled but disagree on the best ways to address rapidly escalating disagree on the best ways to address rapidly escalating health spending and health insurance premiums: health spending and health insurance premiums:

Price controls and imposing strict budgets on health Price controls and imposing strict budgets on health care spending?care spending?

Free market competition solves the problem?Free market competition solves the problem? With healthier lifestyles, less medical care required?With healthier lifestyles, less medical care required?

• Cost of inaction will Cost of inaction will severelyseverely affect employer's bottom affect employer's bottom lines, business location and consumer's pocketbookslines, business location and consumer's pocketbooks

• How do different approaches effect rural health care?How do different approaches effect rural health care?

National Coalition on Health Care http://www.nchc.org/National Coalition on Health Care http://www.nchc.org/


RWHC Eye On Health

"Your test results confirm that you are more careful about what you put in your car than your mouth."

POPULATION HEALTHPOPULATION HEALTH


Health Outcomes Driven By Multiple DeterminantsHealth Outcomes Driven By Multiple DeterminantsHealth Outcomes Driven By Multiple DeterminantsHealth Outcomes Driven By Multiple Determinants

• Access to Health Care (est 10%)Access to Health Care (est 10%)

• Health Behaviors (est 40%) e.g. smoking, physical Health Behaviors (est 40%) e.g. smoking, physical inactivity, overweight, sexually transmitted disease, inactivity, overweight, sexually transmitted disease, motor vehicle crashesmotor vehicle crashes

• Socioeconomic factors (est 40%) e.g. education, Socioeconomic factors (est 40%) e.g. education, poverty, divorce ratespoverty, divorce rates

• Physical environment (est 10%)Physical environment (est 10%)

• Access to Health Care (est 10%)Access to Health Care (est 10%)

• Health Behaviors (est 40%) e.g. smoking, physical Health Behaviors (est 40%) e.g. smoking, physical inactivity, overweight, sexually transmitted disease, inactivity, overweight, sexually transmitted disease, motor vehicle crashesmotor vehicle crashes

• Socioeconomic factors (est 40%) e.g. education, Socioeconomic factors (est 40%) e.g. education, poverty, divorce ratespoverty, divorce rates

• Physical environment (est 10%)Physical environment (est 10%)

2005 Wisconsin County Health Rankings2005 Wisconsin County Health Rankings , University of Wisconsin , University of Wisconsin Population Health InstitutePopulation Health Institute


Critical Link Population & Economic HealthCritical Link Population & Economic HealthCritical Link Population & Economic HealthCritical Link Population & Economic Health

““Businesses will move to where healthcare coverage is Businesses will move to where healthcare coverage is less expensive, or they will cut back and even terminate less expensive, or they will cut back and even terminate

coverage for their employees. Either way, it's the coverage for their employees. Either way, it's the residents of your towns and cities that lose out,” Thomas residents of your towns and cities that lose out,” Thomas DonohuePresident & CEO, U.S. Chamber of CommerceDonohuePresident & CEO, U.S. Chamber of Commerce

““If we can change lifestyles, it will have more impact on If we can change lifestyles, it will have more impact on cutting costs than anything else we can do,” Larry cutting costs than anything else we can do,” Larry

Rambo, chief executive officer of Humana’s Wisconsin Rambo, chief executive officer of Humana’s Wisconsin and Michigan health insurance markets.and Michigan health insurance markets.

““Businesses will move to where healthcare coverage is Businesses will move to where healthcare coverage is less expensive, or they will cut back and even terminate less expensive, or they will cut back and even terminate

coverage for their employees. Either way, it's the coverage for their employees. Either way, it's the residents of your towns and cities that lose out,” Thomas residents of your towns and cities that lose out,” Thomas DonohuePresident & CEO, U.S. Chamber of CommerceDonohuePresident & CEO, U.S. Chamber of Commerce

““If we can change lifestyles, it will have more impact on If we can change lifestyles, it will have more impact on cutting costs than anything else we can do,” Larry cutting costs than anything else we can do,” Larry

Rambo, chief executive officer of Humana’s Wisconsin Rambo, chief executive officer of Humana’s Wisconsin and Michigan health insurance markets.and Michigan health insurance markets.


Initial Local Hospital & Community StepsInitial Local Hospital & Community StepsInitial Local Hospital & Community StepsInitial Local Hospital & Community Steps

• Devote a periodic Board meeting to review available Devote a periodic Board meeting to review available population health indicatorspopulation health indicators

• Add Board members with specific interest in population Add Board members with specific interest in population health measurement and improvementhealth measurement and improvement

• Create a “population health” subcommittee of the Create a “population health” subcommittee of the hospital board to explore opportunities for hospital hospital board to explore opportunities for hospital partnerships with other community organizationspartnerships with other community organizations

• With local employers, develop interventions to improve With local employers, develop interventions to improve employee health; expand experience to the larger employee health; expand experience to the larger communitycommunity

• Devote a periodic Board meeting to review available Devote a periodic Board meeting to review available population health indicatorspopulation health indicators

• Add Board members with specific interest in population Add Board members with specific interest in population health measurement and improvementhealth measurement and improvement

• Create a “population health” subcommittee of the Create a “population health” subcommittee of the hospital board to explore opportunities for hospital hospital board to explore opportunities for hospital partnerships with other community organizationspartnerships with other community organizations

• With local employers, develop interventions to improve With local employers, develop interventions to improve employee health; expand experience to the larger employee health; expand experience to the larger communitycommunity

““Population Health Improvement & Rural Hospital Balanced Scorecards”Population Health Improvement & Rural Hospital Balanced Scorecards”by Size T, Kindig D, MacKinney C., by Size T, Kindig D, MacKinney C., Journal of Rural HealthJournal of Rural Health; 3/06; 3/06


Strong Rural Communities InitiativeStrong Rural Communities InitiativeStrong Rural Communities InitiativeStrong Rural Communities Initiative

• Sponsored by state’s Rural Health Development Council Sponsored by state’s Rural Health Development Council embedded in Wisconsin Department of Commerceembedded in Wisconsin Department of Commerce

• Acquired $700K from 3 sources with 4th looking goodAcquired $700K from 3 sources with 4th looking good

• The goal: improve health of rural communities and The goal: improve health of rural communities and reduce healthcare cost inflation by accelerating use of reduce healthcare cost inflation by accelerating use of collaboration among medical, public health and business collaboration among medical, public health and business organizations that enhance preventive health servicesorganizations that enhance preventive health services

• Six local community projects chosen from 22 proposalsSix local community projects chosen from 22 proposals

• Variety approaches to modifying poor fitness, nutrition Variety approaches to modifying poor fitness, nutrition habits through wellness programs at work/communityhabits through wellness programs at work/community

• Sponsored by state’s Rural Health Development Council Sponsored by state’s Rural Health Development Council embedded in Wisconsin Department of Commerceembedded in Wisconsin Department of Commerce

• Acquired $700K from 3 sources with 4th looking goodAcquired $700K from 3 sources with 4th looking good

• The goal: improve health of rural communities and The goal: improve health of rural communities and reduce healthcare cost inflation by accelerating use of reduce healthcare cost inflation by accelerating use of collaboration among medical, public health and business collaboration among medical, public health and business organizations that enhance preventive health servicesorganizations that enhance preventive health services

• Six local community projects chosen from 22 proposalsSix local community projects chosen from 22 proposals

• Variety approaches to modifying poor fitness, nutrition Variety approaches to modifying poor fitness, nutrition habits through wellness programs at work/communityhabits through wellness programs at work/community

RWHC RWHC Eye On HealthEye On Health Newsletter, 7/06 Newsletter, 7/06


ADVOCACY SKILLSADVOCACY SKILLS


Besides Funding, What Drives Advocacy?Besides Funding, What Drives Advocacy?Besides Funding, What Drives Advocacy?Besides Funding, What Drives Advocacy?

• Need to Correct BiasNeed to Correct Bias - MedPAC Report - MedPAC Report• Opportunity to ReframeOpportunity to Reframe - Hospital Compare - Hospital Compare• Short-term Fix Needed/PossibleShort-term Fix Needed/Possible - Building Ban - Building Ban• Broad Coalition PossibleBroad Coalition Possible - R.H. Appropriations - R.H. Appropriations• Address Core NeedAddress Core Need - Physician Supply - Physician Supply • Anticipate ProblemsAnticipate Problems - Medicare Advantage - Medicare Advantage• Can’t Be AvoidedCan’t Be Avoided - Healthcare Costs - Healthcare Costs• Long-term SignificanceLong-term Significance - Population Health - Population Health

• Need to Correct BiasNeed to Correct Bias - MedPAC Report - MedPAC Report• Opportunity to ReframeOpportunity to Reframe - Hospital Compare - Hospital Compare• Short-term Fix Needed/PossibleShort-term Fix Needed/Possible - Building Ban - Building Ban• Broad Coalition PossibleBroad Coalition Possible - R.H. Appropriations - R.H. Appropriations• Address Core NeedAddress Core Need - Physician Supply - Physician Supply • Anticipate ProblemsAnticipate Problems - Medicare Advantage - Medicare Advantage• Can’t Be AvoidedCan’t Be Avoided - Healthcare Costs - Healthcare Costs• Long-term SignificanceLong-term Significance - Population Health - Population Health


Your Advocacy Behaviors MatterYour Advocacy Behaviors MatterYour Advocacy Behaviors MatterYour Advocacy Behaviors Matter

• Be BriefBe Brief• Be Accurate - NEVER false or misleading infoBe Accurate - NEVER false or misleading info• Personalize Your Message - cite examplesPersonalize Your Message - cite examples• Be Prepared - know your issueBe Prepared - know your issue• Be Aware Every Issue Has Two Sides - there Be Aware Every Issue Has Two Sides - there

are voters on other sideare voters on other side• Be Courteous/Don’t ThreatenBe Courteous/Don’t Threaten• Be Patient - long process; be in for long haulBe Patient - long process; be in for long haul

• Be BriefBe Brief• Be Accurate - NEVER false or misleading infoBe Accurate - NEVER false or misleading info• Personalize Your Message - cite examplesPersonalize Your Message - cite examples• Be Prepared - know your issueBe Prepared - know your issue• Be Aware Every Issue Has Two Sides - there Be Aware Every Issue Has Two Sides - there

are voters on other sideare voters on other side• Be Courteous/Don’t ThreatenBe Courteous/Don’t Threaten• Be Patient - long process; be in for long haulBe Patient - long process; be in for long haul

Wisconsin Hospital Associations Grass Roots HandbookWisconsin Hospital Associations Grass Roots Handbook


NRHA’s Three Prong Advocacy StrategyNRHA’s Three Prong Advocacy StrategyNRHA’s Three Prong Advocacy StrategyNRHA’s Three Prong Advocacy Strategy

Make your best caseMake your best case: Develop concise, credible, : Develop concise, credible, persuasive, fiscally responsible, but emotive persuasive, fiscally responsible, but emotive arguments.arguments.

Make friends and form alliancesMake friends and form alliances: Find Congressional : Find Congressional champions, develop agency contacts, form alliances champions, develop agency contacts, form alliances with a diverse set of groups.with a diverse set of groups.

Make it happenMake it happen: Use some or all of your advocacy : Use some or all of your advocacy tools – government relations, grassroots and media tools – government relations, grassroots and media advocacy – based on your level of engagement.advocacy – based on your level of engagement.

Make your best caseMake your best case: Develop concise, credible, : Develop concise, credible, persuasive, fiscally responsible, but emotive persuasive, fiscally responsible, but emotive arguments.arguments.

Make friends and form alliancesMake friends and form alliances: Find Congressional : Find Congressional champions, develop agency contacts, form alliances champions, develop agency contacts, form alliances with a diverse set of groups.with a diverse set of groups.

Make it happenMake it happen: Use some or all of your advocacy : Use some or all of your advocacy tools – government relations, grassroots and media tools – government relations, grassroots and media advocacy – based on your level of engagement.advocacy – based on your level of engagement.



Rural Health Needs Your Advocacy 24/7Rural Health Needs Your Advocacy 24/7Rural Health Needs Your Advocacy 24/7Rural Health Needs Your Advocacy 24/7

• Rural advocates have an ongoing challenge, Rural advocates have an ongoing challenge, an attitude in parts of Washington, and an attitude in parts of Washington, and around the country (including CMS) that is around the country (including CMS) that is frequently ill informed, about rural health frequently ill informed, about rural health and the reality of improving rural health and the reality of improving rural health and health careand health care

• Rural advocates must not become Rural advocates must not become complacent, all of us must become more complacent, all of us must become more skilled and more active.skilled and more active.

• Rural advocates have an ongoing challenge, Rural advocates have an ongoing challenge, an attitude in parts of Washington, and an attitude in parts of Washington, and around the country (including CMS) that is around the country (including CMS) that is frequently ill informed, about rural health frequently ill informed, about rural health and the reality of improving rural health and the reality of improving rural health and health careand health care

• Rural advocates must not become Rural advocates must not become complacent, all of us must become more complacent, all of us must become more skilled and more active.skilled and more active.


Questions/Discussion?Questions/Discussion?

For a free electronic subscription of the For a free electronic subscription of the RWHC RWHC Eye On HealthEye On Health monthly newsletter, monthly newsletter,

send an email to [email protected] an email to [email protected] with with ““subscribe” on the subject line.subscribe” on the subject line.

Questions/Discussion?Questions/Discussion?

For a free electronic subscription of the For a free electronic subscription of the RWHC RWHC Eye On HealthEye On Health monthly newsletter, monthly newsletter,

send an email to [email protected] an email to [email protected] with with ““subscribe” on the subject line.subscribe” on the subject line.

rural wisconsin health cooperative tim size, executive director rural wisconsin health cooperative...

Documents

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