Rural Health Advisory Committee Meeting Minutes


RURAL HEALTH ADVISORY COMMITTEE
Tuesday, September 29, 2009 10 a.m.-2 p.m.

Location: Metro Counties Government Center

Members Present: John Baerg, Tom Boe, Deb Carpenter, Tom Crowley, Jode Freyholtz, Jeffrey Hardwig, Diane Muckenhirn, Tom Nixon, Nancy Stratman.

Members Absent: Ray Christensen, M.D.; Rep. Steve Gottwalt; Margaret Kalina; Rep. Mary Ellen Otremba; Sen. Yvonne Prettner Solon; Sen. Julie Rosen.

MDH Staff Present: Doug Benson, Kristine Gjerde, Jill Myers, Tamie Rogers, Mark Schoenbaum, Kristen Tharaldson.

Guests: Brian Bruner and Elise Bruner, Aronson & Associates Immigration Attorneys

WELCOME AND INTRODUCTIONS

Tom Crowley was given a plaque and thanked for his service as RHAC chair. Margaret Kalina will be the RHAC chair for 2009-2010.

REVIEW OF 2007-2009 WORK PLAN
Members discussed the RHAC priorities from two years ago and how things have changed since then. The economic recession is making a huge impact on health care costs and access and this is the biggest change between then and now. Members agreed each of the priorities still have merit, but differences may exist in the details within those priorities. Workforce needs to remain a top priority because no matter what issue is addressed, people ultimately make the health care system work.

Members discussed the value of the committee. It is sometimes hard to quantify the impact of their work. RHAC recommendations have been used for grant writing, to highlight local rural health issues, to support graduate level research and to inform the Legislature and commissioner of Health about rural health concerns. Some members provided examples of the value they find in communicating with the group and in bridging RHAC discussions with their facilities, employers, communities and professional associations.

Members discussed how RHAC priorities reflect the commissioner of Health’s priorities. Health reform is a top priority and RHAC has illuminated the rural angle on that issue. RHAC members bring important rural health issues to the commissioner and can tailor recommendations to support the commissioner’s priorities.

ROLE OF RHAC AND EFFECTIVE APPROACHES
Members discussed their understanding of and expectations for the committee. The following summarizes the key points of this discussion:

  • One RHAC member recently hosted a meeting in his community to inform hospital staff, county commissioners, directors of human services, veteran’s clinic representatives, community members and the local media about rural health issues. Members agreed that this “grassroots of health care” approach to understanding local issues is a good model for encouraging wider involvement in rural health care decisions. Additional community meetings may be organized in the future.
  • Members like being part of a multi-disciplinary forum and learning about priorities in other parts of the state. Members also appreciate the diversity of the committee and hearing what is important from other perspectives. RHAC provides a network for health care providers and consumers. RHAC members do experience commonality within their rural perspectives.
  • This committee provides a good format for restating the concerns of other health associations and bringing broader RHAC concerns back to the associations. RHAC connections are valuable for work with the Healthier Minnesota Community Clinic Fund because it reaffirms the importance of support to maintain the safety net in rural areas.
  • Members noted the statutory purpose of RHAC (which is to advise the commissioner of Health and other state agencies on rural health issues), and suggested improved and more meaningful communication between the RHAC and the commissioner be sought to achieve this purpose. In addition, members agreed on the great value of having two state representatives and two state senators on the RHAC, and expressed their concern about the importance of legislative participation in the RHAC meetings, discussions, and communications. 
  • Members are grateful that the committee is taking on high need issues related to mental health, oral health and EMS.

HEALTH REFORM UPDATE: STATE AND NATIONAL
Members compared RHAC recommendations with progress made through Minnesota’s Health Reform efforts. In the RHAC report “Health Care Reform: Addressing the Needs of Rural Minnesotans,” one recommendation was to “develop and incorporate rural relevant measures for quality into pay for performance strategies.” The baskets of care formed out of the state health reform legislation include rural relevant quality measures (for pneumonia and depression) with other measures that are not as relevant (knee replacement).

ENVIRONMENTAL SCAN: 2009-2011
Members participated in a review and planning exercise. Topics relevant to rural health were placed on a curve to demonstrate whether they were new, pre-peak, peak, post-peak, outgoing, or past trends and issues. These trends and issues were discussed and led to the committee’s identification of top issues and priorities.

RHAC WORK PLAN: RURAL HEALTH ISSUES IDENTIFICATION
The context for this work plan includes national Health Care Reform (e.g., potential for universal coverage and/or coverage for pre-existing conditions) and Minnesota Health Reform (e.g., health care homes, baskets of care).

Focus areas based on the environmental scan include:

  • Workforce 1:  Health care provider statistics, demographics, scope of practice
  • Workforce 2:  Processes and programs pertaining to recruitment, loan forgiveness, access to education, etc.
  • Access 1: Service specific issues (e.g., dental, mental health, obstetrics, primary care) and integration of services with primary care
  • Access 2: Infrastructure issues ( e.g., insurance, transportation, community-based services)
  • Access 3: Population-specific issues (e.g., culture, language, immigrant and special populations)
  • Wellness and prevention:  Promotion of wellness and prevention as a necessary component of health care quality, costs, access and reform (e.g., mental health and physical health, caregiver and peer support, chronic disease management)
  • Health information technology: Telehealth, electronic health records, rural specific needs to offset workforce and access issues
  • Communication and education: Inform on rural issues, ensure communication links, accountability, broader communication regarding RHACs work, promote public health (frontline protection and prevention, H1N1). 

RHAC WORK PLAN: PRIORITIZATION OF TOP ISSUES
Members rated each focus area on a scale of one (high) to five (low) according to member value, ease to address, benefit, and RHAC fit. The table below captures the combined scores.

FOCUS AREA

Member Value

Ease

Benefit

RHAC Fit

Overall

Workforce 1

2.56

3.56

2.67

2.00

2.69

Workforce 2

2.56

3.00

2.22

1.89

2.42

Access 1

1.33

3.11

1.67

1.78

1.97

Access 2

1.56

3.33

1.89

1.89

2.17

Access 3

2.89

3.44

2.67

3.22

3.06

Wellness/ Prevention

1.22

2.22

1.33

1.22

1.50

HIT & Telehealth

1.78

2.11

1.78

1.56

1.81

Communication/Education

1.67

2.22

1.67

1.22

1.69

Overall, Wellness/ Prevention consistently scored high in the prioritization exercise.  Access (1 and 2), Communications/ Education, and HIT & Telehealth round out the highest priority focus areas.

 

Focus Area

Average Score

Member Value

Wellness/Prevention

1.22

 

Access 1

1.33

 

Access 2

1.56

     
Ease

HIT & Telehealth

2.11

 

Wellness/Prevention

2.22

 

Communications/ Education

2.22

     
Benefit

Wellness/Prevention

1.33

 

Access 1

1.67

 

Communications/Education

1.67

     
RHAC Fit

Wellness/Prevention

1.22

 

Communications/Education

1.22

 

HIT & Telehealth

1.56

RHAC WORK PLAN: APPROACHES TO TOP ISSUES
RHAC staff will identify likely approaches to the top priorities and provide to members for feedback. RHAC staff will attempt to get the commissioner’s feedback on these priorities and how they fit in with MDH priorities.

Upcoming RHAC meetings: Structure, Format and Content
RHAC staff will send out a survey to identify the best schedule for the year and preferences around agendas, length of meetings and related topics.

HANDOUTS

RHAC Meeting Scenarios (PDF:7KB/1pg)
RHAC Meeting Schedule Scenarios (PDF:7/KB/1pg)
RHAC Work Plan Approaches (PDF:8KB/1pg)
September 2008 Work Plan Discussion (PDF:12KB/1pg)
2007-2009 Work Plan Outcomes (PDF:23KB/3pgs)
2007-2009 Work Plan Summary (PDF:12KB/1pg)
2007-2009 Work Plan Update (PDF:15KB/2pgs)

NEXT MEETING

The meeting adjourned at 1:56 p.m. The next RHAC meeting will be November 24, 2009, and will include a legislative update from various health associations.