# [Rural Health Care Concurrent Policy Session]{.underline}

# Tuesday June 3, 8:15 AM-9:30 AM

# Paul Galligos -- Illinois Rural Partners

Laura Branca -- Moderator

Paul Galligos:

-   Council functions: Rural Partners (Illinois) was the original
    501(c)(3) organization, because the concept of being part of
    government was hard to get away from. We have about 210 members, and
    most of our members are organizations, agencies, associations, who
    represent a much larger association. Our board has 35 members
    divided into categories, we also have big and small companies,
    utilities, local businesses, and we make sure there is good
    representation of health care on the board.

-   There are a couple million people in rural areas, but the majority
    of our legislators are in the Chicago area. Our work is cut out for
    us; if we don't have partners in urban/suburban areas we can't
    affect policy.

-   I think there are three ways to get things done. 1. Get the governor
    to decree. 2. You can legislate an initiative, you still have to get
    the governor to agree, and you have to be bipartisan. 3. The grass
    roots can give the fastest change possible, but it is often
    difficult. I think you have to be in all 3 areas.

-   Make sure the rural issues are in the forefront and everyone is
    aware of the rural issues. Especially in our state you have to be in
    people's faces. We developed a strategic plan for Illinois called
    Building Illinois' Future. This is a document in all our libraries
    that is used by agencies. It's not a blueprint for a single
    community; it's a guide for Illinois. Health care is one of the
    issues addressed, and we got the governor to sign off.

-   What we want to do is have every organization in the community have
    a policy level focus. We don't want to have policy and regulations
    not taken into account, and then have to go back and fix them for
    rural.

-   Grassroots changes are difficult to achieve because you have to go
    everywhere. I believe this is the most powerful change because it
    comes from the people. If you get broadband acceptance it can help
    redefine the issue beyond you r own self-serving interests. It also
    allows you to impact changes in agencies internally, because the
    local agency begins to speak about it in their meetings.

-   Examples about how we work:

    -   Health care organizations think of themselves as the sun, around
        which everything else revolves. There are a lot of groups like
        this. What they always say is, we need to bring other community
        members to the table. Most of the people that come to the table
        never really think about how health care really acts as a
        service to the community, and this is an idea we want to change.
        We are then defining a healthy community as a place where you
        can live, work, and play, have quality housing, and good health
        care---which is just one component. It's kind of like a jigsaw;
        if one of the pieces is missing you have a whole.

    -   You need to be persistent and consistent with your message. Our
        message is that health care is an important aspect of the
        community and it needs to be in any community. It's not just a
        service, it is an integral part and brings a lot of money in to
        the business.

    -   You also need data, and it shouldn't necessarily be coming from
        people in the health care association. Sometime it needs to come
        from the outside. I advise you to get some university
        researchers with some interest in health care. I think you need
        to really link health care with economic development.

-   Accomplishments:

    -   We did a study on transportation and looked at where gaps were
        in transportation and where duplicative transportation might be
        happening. Our dept. of health services is a huge, but poorly
        integrated department. No one ever talked about combining
        transportation, but we got them to create a transportation
        committee within the department of human services. The idea was
        to combine resources to give good quality resources in the
        community. In IL there is a coordinating committee on human
        services, and this committee is built-in to help change how
        transportation services are provided. We have an excellent rural
        transportation district called RIDES, where there are actually
        routes, and there is even a water taxi on the river because
        sometimes it's quicker to go that way. We wanted more of these,
        but there was resistance from the DOT, but we are now kicking
        off our second transportation district, with government funds to
        support them, just like the Chicago Transit Authority.

    -   There are things like a governor's rural health council, and
        we're the first non-governmental organization to sit on this. We
        sit on the flex hospital strategic planning committee, and they
        have created an organization called Rural Health Works, and we
        sit on the committee for it. We work in the community partners
        arena and make sure other members of the community come forward.
        We walk the talk. We don't just talk about this, we think state
        rural development councils should be out there supporting all
        the components of the community. These folks in turn promote

Discussion Sections:

1.  Based on Paul's presentation what specific council accomplishments
    or activities helped to inform policy?

    -   Use of board members as advocates.

    -   Make sure you have the proper number of people on the board to
        do these things

    -   Political connections

    -   Network connections that will be effective.

    -   Communication between policy groups: ex. Economic development
        and health care

    -   Keeping story simple and consistent

    -   Involve the grass roots

    -   Events where the council convenes with the different partners.
        So he brings everyone to the table, and continues to ask if all
        the stakeholders are there.

    -   Understanding the informal vs. formal points of authority. So
        many times we don't bring middle management to the table. A
        problem because often they are the ones that really know what is
        going on. If you think about the staff of these agencies that's
        really where the information comes from.

2.  Discuss what you think are long-term concerns or trends focusing on
    health care.

    -   There is a disconnect between the loss of medical capacity in
        rural areas and what citizens expect in their level of health
        care.

    -   HIPAA is having a major impact on rural health care.

    -   The use of healthy communities initiatives as public health
        planning initiatives in certain states, as opposed to having
        public health in rural areas because there is no capacity.

    -   Homeland security

    -   The integration of EMS. EMS is becoming a major factor now that
        it was ignored for a number of years.

    -   An aging population and the changes of composition are huge.

    -   It's the baby boomers.

    -   Medicare and Medicaid crisis

    -   Reimbursement rates

    -   One of the presidential initiatives is to bring the creation of
        federally qualified health clinics to the table. That's another
        issue because President Bush is really pushing the creation of
        this.

    -   1200 more in rural areas

    -   In Maine, health care workforce issues are huge.

    -   Another important factor is mental health services.

    -   Rural oral care

    -   Health insurance---the rural uninsured.

-   One other issue is liability insurance that you might want to add
    this. In Nevada they're limiting the number of patients OB people
    could see, and it almost wiped out our OB.

    -   Tribal health care

3.  What accomplishments or activities may help in the future? What can
    individual SRDCs do in concert in the next several months to respond
    strategically to these in the next several month?

    -   We need to realize that strategic planning takes a long time. I
        think 9 months is about an issue. What you did in Illinois
        didn't take a short time.

    -   The big issue I think right now is Medicare refund. Bush has now
        committed to a rural hospital reimbursement in Medicare reform

    -   The issue of non-emergency medical transportation is a huge
        issue. Medicare does not pay for this, Medicaid does, and there
        are people working on this that you can ally with. You should
        check out CTAA (ctaa.org) to learn more about this.

4.  Can you think about measurable outcomes that come from some of these
    initiatives?

-   Number of pieces of legislation that get pushed through.

-   Being included in the writing of the legislation and testifying
    before legislators.

-   Also be aware that you have to have telecommunications.

-   Recruitment and retention of physicians numbers.

-   In terms of quantifiable data all the health departments maintain
    data on the recruitment and retention of attention. At least with
    the J-1 Visa Program you have to document everything.

-   You can look at is the change in medical care: for example OB/GYN
    info being closed down. Also look at the employment of telemedicine.
    You may have lost prenatal care but have gained telemedicine. These
    are all quantifiable things that you can really look at. Some of
    these numbers may be misleading.

-   There are also federal resources you could bring into the community
    and give people info on. Example USDA telemedicine grants.

-   Tracking the dollar amounts of federal health care amounts to give a
    sense of whether things are going up or down.

-   An increase in the number of communities that have econ development
    included in their health care plans

-   Also number of communities with public health focus in their
    communications