Characteristics & Challenges of Rural Ambulance Agencies. RUPRI Health Panel. January 2021.

The RUPRI Health Panel has released a new brief, Characteristics and Challenges of Rural Ambulance Agencies. Every year, nearly 10 million rural Americans receive EMS care. There are 23,272 ambulance agencies in the U.S. and 73 percent of those agencies report serving rural areas. Thus, rural Americans rely on EMS professionals to deliver life-saving emergency […]

Advancing Population Health in Rural Places: New from RUPRI Health Panel. January 2021.

The RUPRI Health Panel has released a new paper, Advancing Population Health in Rural Places: Key Lessons and Policy Opportunities. This paper advances policy discussion of population health in rural places, focusing on the role of rural health care organizations. Lessons from ongoing programs provide policy considerations. Medicare and Medicaid programs should prioritize staff and […]

The Evolving Landscape of National Telehealth Policies during a Public Health Emergency: Responsiveness to Rural Needs

The coronavirus pandemic precipitated significant but temporary changes in telehealth policy and the use of telehealth services to ensure access to needed health services during a public health emergency (PHE). Extending the temporary policy changes will require statutory and regulatory action. This paper takes stock of current telehealth policies and assesses options for expanding the […]

Considerations for Defining Rural Places in Health Policies and Programs

The RUPRI Health Panel has released a new brief that identifies key questions to ask when creating, modifying, or using a definition. Rural definitions in statute and policy are used to direct resources to underserved peoples. But changes in population behavior and Census processes have led to concern about historic methods of defining rural. This […]

Behavioral Health in Rural America: Challenges and Opportunities

The prevalence of mental health and substance use diagnoses and unmet treatment needs are not equally distributed, with rural residence being one factor associated with these differences. Moreover, the rural context has proven challenging for ensuring the availability of and access to prevention, diagnosis, treatment, and recovery services in rural areas. This paper reviews the […]

Toward a High Performing Rural Health Care System: Key Issues and Recommendations from Rural Health Care System Innovators. Roundtable with Rural Health Innovators. RUPRI Rural Health Panel. December 2018.

Toward a High Performing Rural Health Care System: Key Issues and Recommendations from Rural Health Care System Innovators View Report On December 6-7, 2018, the Rural Health Policy Research Institute’s (RUPRI) Health Panel convened a meeting in Washington, DC, of rural health leaders from around the country to discuss strategies and models for rural health […]

Assessing the Unintended Consequences of Health Policy on Rural Populations and Places

The RUPRI Rural Health Panel, through the support of the Federal Office of Rural Health Policy (FORHP) in the Department of Health and Human Services, has released a new Policy Brief, Assessing the Unintended Consequences of Health Policy on Rural Populations and Places. The purpose of this paper is to illuminate the unintended consequences of health […]

Primary Care: The Foundation for a High-Performance Rural Health Care System

This paper will review elements of a robust rural primary care system, including development and maintenance of a high performance rural primary care system and workforce as well as policy considerations and opportunities that address the sustainability of rural primary care. Written by Keith J. Mueller (PhD), Charlie Alfero (MA), Andrew F. Coburn (PhD), Jennifer […]

Insuring Rural America: Health Insurance Challenges and Opportunities

This paper discusses the realities and challenges of designing a market structure that will result in affordable health insurance being offered in rural markets, and reviews the rural implications of policies affecting rural health insurance markets and health systems. Written by Keith J. Mueller (PhD), Charlie Alfero (MA), Andrew F. Coburn (PhD), Jennifer P. Lundblad […]

Taking Stock: Policy Opportunities for Advancing Rural Health

This paper examines the progress of health system transformation and the gaps that remain as they affect rural people, places, and providers. The health system transformation activities examined here are not limited to the Patient Protection and Affordable Care Act of 2010 (PPACA), but also touch upon activities undertaken by states, insurance plans, and public […]

Primer on Rural Long-Term Services and Support

 Rural Long-Term Services and Supports: A Primer provides policymakers and other interested stakeholders a primer on rural long-term services and supports (LTSS): (1) the fundamentals of the rural LTSS system, (2) rural access to and use of LTSS, and (3) discussion of the opportunities within and limitations of current Federal and State LTSS policy for advancing […]

After Hospital Closure: Pursuing High Performance Rural Health System without Inpatient Care

The RUPRI Health Panel describes 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 a hospital-based locus of care to new models of care delivery in rural places. After Hospital Closure: Pursuing High Performance Rural Health System without Inpatient Care This paper describes […]

Medicaid Payment and Delivery System Reform: Challenges and Opportunities for Rural Health Systems

Medicaid has grown significantly in its importance to rural health systems and communities; a higher proportion (22 percent) of rural residents was enrolled in Medicaid than Medicare (20 percent) in 2014. At the same time, the use of payment and delivery innovations has grown significantly, but varies across the U.S. As a result of expansions […]

Policy Brief: Medicare Value-Based Payment Reform

Medicare Value-Based Payment Reform: Priorities for Transforming Rural Health Systems View Policy Brief | Related: View Full Report 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 by making healthcare […]

Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems

View Report | Related: View Policy Brief In recognition of unsustainable healthcare cost growth and sub-optimal delivery system performance, the Patient Protection and Affordable Care Act of 2010 (ACA) contains provisions that redesign healthcare payment and delivery. ACA payment change provisions are driving delivery system reform by making healthcare organizations more accountable for patients’ health […]

Accountable Care Communities in Rural: Laying the Groundwork in Humboldt County, CA – 2015

This joint paper was authored by members of both the Health and Human Services Panel in June 2015. The paper presents a case for the viability of Accountable Care Community (ACC) models in rural communities, including in rural Humboldt County, California. Accountable Care Communities reflect a unified approach to improving the health and reducing the […]

Transitioning to a High Performance Rural Health System

This presentation discusses how hospitals should respond and why response should be other than incremental adjustment. It will touch base on change and how it creates opportunities as well as threats. Presented by Keith J. Mueller, PhD (Director, RUPRI Center for Rural Health Policy Analysis) and Charles W. Fluharty, M. Div. (President, Rural Policy Research […]

Advancing the Transition to a High-Performance Rural Health System. RUPRI Health Panel. November 2014.

In Advancing the Transition to a High-Performance Rural Health System, the RUPRI Health Panel discusses strategies and options for creating a pathway to a transformed, high-performing rural health system. This paper builds on the RUPRI Health Panel’s earlier paper that conceptually defined the core elements of a high-performance rural health system. We have also incorporated […]

Access to Rural Health Care – Literature Review and New Synthesis

This report reviews important access definitions and frameworks from the literature. The review serves as a concept map to create a unique synthesis of perspectives that may be used by researches and policy makers to design or clarify access to health care providers. Prepared in August 2014 by the RUPRI Health Panel: A. Clinton MacKinney, […]

The Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: 2010 First and 2014 Second Look

These two policy documents from 2010 and 2014 take a first and second look at the implementation of the Patient Protection and Affordable Care Act of 2010 and how it contributes to reshaping the health care delivery landscape, particularly in rural areas. Prepared in September 2010 and April 2014 by the RUPRI Health Panel: Andrew […]

The Current and Future Role and Impact of Medicaid in Rural Health

This brief outlines and describes the current Medicaid program and its importance to rural America. It also discusses rural implications of program expansion, including whether and how states choose to implement changes. View Report This report was written by Health Panel Members Keith Mueller, Andrew Coburn, Jennifer Lundblad, A. Clinton MacKinney, Timothy McBride, Sidney Watson […]

The High Performance Rural Health Care System of the Future

The RUPRI Health Panel offers an aspirational vision, for a highperformance rural health care system. The RUPRI Health Panel envisions rural health care that is affordable andaccessible for rural residents through a sustainable health system thatdelivers high quality, high value services. A high performance rural healthcare system informed by the needs of each unique rural […]

Place-Based Policies and Public Health

Place-Based Policies and Public Health: The Road to Healthy Rural People and Places View Report This joint paper by the RUPRI Health Panel and Human Service Panel examines how effective place-based policies can influence how rural and metropolitan areas develop, how well they function as places to live, work, operate a business, preserve heritage, and […]

Securing High Quality Health Care in Rural America: The Impetus for Change in the Affordable Care Act

View Report The ACA calls for the development of a National Health Care Quality Strategy and Plan (National Quality Strategy) that, by definition, will affect health care that is delivered to millions of Americans who live in rural areas and thousands of health care providers who care for them. The goal of this paper is […]

Assessment of Proposals for a Medicare Outpatient Prescription Drug Benefit: The Rural Perspective

View Report 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. Included are comments on five proposals introduced in the 107th Congress: one that was passed by the House of Representatives, […]

Comments on the June 2001 Report of the Medicare Payment Advisory Commission: “Medicare in Rural America”

View Policy Paper The Rural Health Panel is publishing this policy paper to provide a foundation for a discussion of the recommendations and findings presented in the June 2001 report (Report) of the Medicare Payment Advisory Commission (MedPAC), Medicare in Rural America. In this paper, the Panel comments on MedPAC’s recommendations and offers a critique […]

Redesigning Medicare: Considerations for Rural Beneficiaries and Health Systems

View report The enactment of the Balanced Budget Act of 1997 (BBA) dramatically changed the context for discussions of Medicare policy. Two major pathways for discussion were identified: Appropriate and equitable payment for services, either through traditional fee-for service (FFS) Medicare payments or through Medicare+Choice monthly premiums; and Appropriate and necessary changes to the program […]

Rural Implications of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000

View Report This paper summarizes provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) and assesses the impact of those provisions on rural health care delivery. Congress passed BIPA on December 15, 2000, and President Clinton signed it on December 21. This report was written by Health Panel members: […]

Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria and Assessment

View Report This paper was jointly prepared by the Maine Rural Health Research Center and the RUPRI (Rural Policy Research Institute) Rural Health Panel 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, […]

Redesigning the Medicare Program: An Opportunity to Improve Rural Health Care Systems?

View Draft Report The enactment of the Balanced Budget Act of 1997 (BBA) changed dramatically the context for discussions of Medicare policy. Policy discussions since the BBA have sharpened two major pathways for dialogue/debate: appropriate and equitable payment for services, either through traditional Medicare fee-for-service payments or through Medicare+Choice monthly premiums; and appropriate and necessary […]

The Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System

The Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices View Policy Paper This policy paper discusses the positions of various rural health advocates on the wage index and recording the actions taken by Congress and the Health Care Financing Administration (HCFA) to improve the wage index.Finally, it outlines […]

Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives For Legislative Proposals

View Policy Paper 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 […]

Calculating and Using the Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System

View policy brief This policy brief explains how the area wage index is calculated and used, and identifies the major unresolved issues related to its calculation and use. This report was written by Anthony Wellever (Delta Rural Health Consulting and Research) in collaboration with RUPRI Health Panel Members: Andrew Coburn, Charles Fluharty, J. Patrick Hart, […]

A Rural Assessment of Leading Proposals to Redesign the Medicare Program

View Report 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 […]

A Report on Enrollment: Rural Medicare Beneficiaries in Medicare+Choice Plans

View Report This policy brief describes the experience to date with the Medicare+Choice program, focusing on changes in enrollment and plan formationthrough Fall 1999. We include a particular focus on changes occurring inrural counties. This updates previous reports by the RUPRI Health Panelon the progress of the Medicare+Choice program. This report was written by Health […]