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Dobrynya Shiryaev
Dobrynya Shiryaev

Assess The Area Of Options In Seeking Your Next Foundation Service Provider

The majority of states (40 of 49 responding) rely on state or local government agencies to perform the functional needs assessment for waiver services, and most (32 of 49 responding) states rely on a combination of entities across waiver programs (no data shown).62 Thirteen states rely solely on state or local government agencies to perform assessments. Other entities include community-based organizations (11 states), health care providers (8 states), and managed care plans (4 states).

Assess The Area Of Options In Seeking Your Next Foundation Service Provider

Over half of states (32 of 51) states report challenges with meeting the EVV requirements for personal care and/or home health services. Common challenges include issues related to provider outreach and education (22 states), establishing an EVV system in rural areas (21 states), accommodating enrollees who self-direct services (21 states), and enrollee outreach and education (18 states). About half (24) of states cite multiple challenges with EVV implementation. Provider outreach and education can be challenging given the diversity and often high turnover rate of HCBS providers. Challenges in rural areas include establishing systems that can accommodate enrollees and providers who may lack cellphone or internet access. EVV for enrollees who self-direct services can be challenging to align with the system used by fiscal agents.

While a community needs assessment serves to identify the challenges and gaps in services within a community, it can also help you understand unutilized or under-utilized resources and assets available to your organization and community.

The range of home-based and school-based treatments and interventions for autism spectrum disorder can be overwhelming, and your child's needs may change over time. Your health care provider can recommend options and help identify resources in your area.

The supply of primary care providers per capita is lower in rural areas compared to urban areas, according to Supply and Distribution of the Primary Care Workforce in Rural America: 2019. Travel to reach a primary care provider may be costly and burdensome for patients living in remote rural areas, with subspecialty care often even farther away. These patients may substitute local primary care providers for subspecialists or they may decide to postpone or forego care. Access in Brief: Rural and Urban Health Care compares access to care and use of services for rural and urban adults and children with Medicaid coverage and shows that from 2013-2015 34% of urban adults utilized the emergency room (ER) for care compared to 43.5% of rural adults who utilized the ER. The high number of ER visits can be an indicator that the patient lacks a usual source of care or has developed emergent health problems due to foregone care.

In rural areas, because there is little anonymity, social stigma and privacy concerns are more likely to act as barriers to healthcare access. Rural residents can have concerns about seeking care for mental health, substance use, sexual health, pregnancy, or even common chronic illnesses due to unease or privacy concerns. Patients' feelings may be caused by personal relationships with their healthcare provider or others working in the healthcare facility. Additionally, patients can feel fear or concerns about other residents, who are often friends, family members, or co-workers, who may notice them utilizing services for health conditions that are typically not openly discussed, such as counseling or HIV testing services. Co-location or the integration of behavioral health services with primary care healthcare services in the same building can help ease patient concerns. Understanding Rural Communities, a 2018 podcast from the Hogg Foundation for Mental Health, features an interview with Dennis Mohatt, the Vice President for Behavioral Health at the Western Interstate Commission for Higher Education (WICHE), discussing rural health and the stigma surrounding mental healthcare in rural communities.

Access to mental health providers and services is a challenge in rural areas. As a result, primary care providers often fill the gap and provide mental health services. However, primary care providers may face challenges that may limit their ability to provide mental health care access, such as inadequate financial reimbursement or lack of time with patients.

Due to the lack of mental health providers in rural communities, the use of telehealth to deliver mental health services is increasing. The June 2016 Agency for Healthcare Research and Quality technical brief, Telehealth: Mapping the Evidence for Patient Outcomes from Systematic Reviews, found that mental health services can be effectively delivered via telehealth. By using telehealth delivery systems, mental health services can be provided in a variety of rural settings, including rural clinics, schools, residential programs, long-term care facilities, and individual patient homes. Additionally, the Calendar Year (CY) 2022 Medicare Physician Fee Schedule Final Rule made permanent the ability for FQHCs and RHCs to be reimbursed by Medicare for telemental health appointments. RHIhub's Telehealth Use in Rural Healthcare topic guide has many more resources on how telehealth can improve access to care. For additional resources on access to mental health services in rural areas, see RHIhub's Rural Mental Health topic guide.

Detoxification is an initial step of substance use disorder treatment that involves managing acute intoxication, withdrawal, and minimizing medical complications. A 2009 Maine Rural Health Research Center research and policy brief, Few and Far Away: Detoxification Services in Rural Areas, found that 82% of rural residents live in a county without a detox provider. The lack of detox providers in rural areas creates a barrier to care that could result in patients forgoing or delaying needed treatment. In lieu of a detox provider in a rural community, the local emergency room or county jail, although not the most appropriate location for detoxification services, must often serve as a substitute.

A 2020 case study Making it Work: Models of Success in Rural Maternity Care discusses 3 rural obstetric service providers, highlighting the importance of strong partnerships, collaboration, and community support to maintaining successful rural maternity care. The RHIhub Rural Maternal Health Toolkit also discusses access to maternity care in rural areas.

The 2019 National Rural Health Association (NRHA) policy brief, Access to Rural Maternity Care, provides an overview of the decline in access to maternity care in rural areas and factors contributing to the decline in access. The brief offers policy considerations to support maternity care services and address barriers to access in the rural U.S., such as increasing research funding, rural OB practice challenges, workforce issues, and quality of OB care. The report Restoring Access to Maternity Care in Rural America discusses strategies to improve maternal care, such as creating maternity care networks, promoting visibility for care, helping rural providers care for patients with high-risk pregnancies, utilizing telemedicine, expanding and training the rural healthcare workforce, enlisting nonclinical partners, and more.

Alternative models and provider types may be needed to meet access needs in rural areas in the event of closures. A 2016 Medicare Payment Advisory Commission presentation, Improving Efficiency and Preserving Access to Emergency Care in Rural Areas, describes policies and strategies to ensure access to emergency department services in rural areas. The presentation provides discussion on alternative healthcare delivery models. The 2020 research brief Alternatives to Hospital Closure: Findings from a National Survey of CAH Executives explores options to maintain access in rural communities whose hospitals are encountering negative profit margins.

RHIhub's Rural Healthcare Workforce topic guide discusses how rural areas can address workforce shortages, such as partnering with other healthcare facilities; increasing pay for staff; adding flexibility and incentives to improve recruitment and retention of healthcare providers; and using telehealth services. The guide also discusses state and federal policies and programs to improve the supply of rural health professionals, such as loan repayment programs and visa waivers.

Telehealth is considered to be a key tool to help address rural healthcare access issues. Through telehealth, rural patients can see specialists in a timely manner while staying in the comfort of their home or local facility. Local healthcare providers can also benefit from subspecialists' expertise provided via telehealth. However, the temporary changes to telehealth policy in response to the COVID-19 pandemic has made visible potential for unequal access to these services due to a lack of broadband internet access in some rural areas. According to the Federal Communications Commission 2020 Broadband Deployment Report, 22.3% of rural Americans and 27.7% of Americans living in tribal areas lack fixed terrestrial broadband coverage, compared to 1.5% of Americans who lack coverage in urban areas.

Many private foundations work to improve healthcare access by funding transportation services, improving workforce, and addressing other factors that affect rural healthcare access. Investing in existing safety net providers and programs, offering grants to develop and implement innovative healthcare delivery models, and funding research to study policy implications as they relate to rural healthcare access are all examples of actions foundations can take to support rural healthcare access.

Key Courses. An obvious method of exploring careers is to enroll in specific courses which are directly related to the field of knowledge used in certain occupations. Through use of general education and electives, you have the opportunity to explore several career options. General education is intended to give all college graduates comprehensive skills and abilities (i.e., oral and written communication) and a foundation of knowledge in a variety of disciplines regardless of the ultimate major. While some careers require a specific college major, many are not tied to any specific degree. Therefore, in choosing course work and finally a major, examine your skills, values, and interests, along with academic requirements and potential career choices.


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