Rural Health Grant Opportunities: I Have an Idea But Where s the Money? Wednesday, February 19, 2003

Rural Health Grant Opportunities: I Have an Idea But Where s the Money? Wednesday, February 19, 2003 Brad Gibbens, MPA, Associate Director bgibbens@medicine.nodak.edu http://medicine.nodak.edu/crh Where: Grand Forks, ND When: Established over 20 years ago Focused on Access, Financing and Quality Through: Health services research Health policy Education State and community health services development Information Resource How: Through partnerships 1

Why is the Grant Process Important? Vision is the art of seeing things invisible ~Jonathan Swift Our Focus is on the Following:! Rural Health Outreach Grants! Rural Health Network Development Grants! Rural Hospital Flexibility (FLEX) Grants! Small Hospital Improvement Program (SHIP) Grants! Rural Access to Emergency Devices (RAED) Grants! Telehealth Network Grant Program! Blue Cross Blue Shield of North Dakota Rural Health Grant Program 2

Rural Health Outreach Grants Funded by the federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services ~ Initiated in 1991 Rural Health Outreach Grants What is the Purpose of the Outreach Grant? 1. Support the direct delivery of health care and related services, to expand existing services, or to enhance health service delivery through education, promotion, and prevention programs. 2. Emphasis is on the actual delivery of specific services rather than the development of organizational capabilities. 3

Rural Health Outreach Grants What Types of Ideas Can be Funded? Very, very broad and comprehensive Some subject areas include these: # Case Management # Dementia o Diabetes o EMS o Health Fairs o Mental Health o Mobile Clinics o Preventive Care o Referrals o Self-Esteem o Support Groups o Women s Health B Counseling B Dental o Elderly Health o Health Education o Immunizations o Minority Health o Peer Counseling o Public Health o Screenings o Smoking Cessation o Tobacco Prevention Rural Health Outreach Grants Are the Grants for Single Sites or a Collaborative? Activity must be carried out by a network of organizations (at least three) o Separate employer ID number o Horizontal or vertical o Longstanding and existing networks or new collaboration that can be formal or informal o Public and/or private o For profit and/or non-profit o But the applicant must be public or non-profit and located in a rural area (Outside of Bismarck/Mandan, Fargo, and Grand Forks) 4

Rural Health Outreach Grants Is there a Ceiling on the Amount of the Award? Limited up to $200,000/year for up to three years (Mean = $170,000) How Long do the Grants Operate? One to three years with years two and three being contingent upon the availability of funds. Rural Health Outreach Grants What are the Limitations on Funds? Cannot use funds for the purchase, construction, renovation, or improvement of real property. (Funds can be used, however, for purchase/rental of equipment and vehicles up to 40% of the total annual federal share.) Cannot be used for the delivery of direct patient care. Cannot use federal grant funds to reduce or supplant existing levels of institutional and/or other non-federal financial support. Network members are expected to use grant funds in a collaborative manner and not to pursue individual projects that benefit only one member. 5

Rural Health Outreach Grants What Should I Know About the Narrative? You need to clearly explain what your problem is and what you are going to do, as a network, to address it. Description of Need section addresses unmet health needs, access barriers, and relevant services that are available. Use statistics that are germane to your situation and help to explain it. You can also use information from surveys and even local planning process. Rural Health Outreach Grants What Should I Know About the Narrative? Describe the network in detail. o Identification of credentials of network members o History of network development and collaboration activities o Letters of commitment from network members The concept of networking is as important to the reviewers as is the task to be accomplished under the grant. 6

Rural Health Outreach Grants What Should I Know About the Narrative? Program Description o Describe the planning process (role of the network, role of the community) o Clear and measurable goals, strategies, activities, responsible agents, and completion milestones. o Reviewers need to understand what you are doing, how it will be done, when it will occur, and who is responsible. Rural Health Outreach Grants What are some Examples of North Dakota Outreach Grants? Wellness in the Valley-Suicide Prevention Task Force (Valley City) Network: Mercy Hospital, MeritCare Clinic, City-County Public Health. There are 18 groups working together. Task Force developing a comprehensive suicide prevention program based, in part, on the national effort Strategy for Suicide Prevention County-wide focus Volunteers to be trained to assess and refer at risk individuals to professionals 7

Rural Health Outreach Grants What are some Examples of North Dakota Outreach Grants? Wishek Community Hospital & Clinics (Wishek, ND) Network: Wishek Community Hospital & Clinic, McIntosh District Health Unit, MedCenter One Health Systems, and Moser Drug Pharmacies of Wishek and Napoleon Focus is on preventive care, early detection screenings, chronic disease management, and support services Chronic disease states of diabetes, osteoporosis, heart disease, and cancer Rural Health Outreach Grants What are some Examples of North Dakota Outreach Grants? Good Samaritan Hospital Association (Rugby, ND) Network: Good Samaritan Hospital Association, seven volunteer ambulance services in seven communities, local fire/rescue units, local first responder units, Heart of America Medical Center Covers four counties; 13,000 residents; and 3,500 square miles Strengthen volunteer ambulance services Provide ALS to automobile victims Provide continuing and advanced EMS training Provide community and farm safety education 8

Rural Health Outreach Grants What are some Examples of North Dakota Outreach Grants? Spirit Lake Nation Mobil Prevention Project (Fort Totten, ND) Network: Early Childhood Tracking Program, Maternal and Child Health, Healthy Start Program, Little Hoop Community College, and the ND Maternal and Child Health Program. Established a mobile health clinic for the reservation for health services and education Community development program focused on decreasing substance abuse, child abuse, and domestic violence Mobile staff also provided Early Periodic Screening Diagnostic and Treatment (EPSDT) in cooperation with the other program Network Development Grants Funded by the federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services ~ Initiated in 1997 9

Network Development Grants What is the Purpose of the Rural Health Network Development Grant? Support and strengthen rural health care providers and rural health care systems by finding integration activities across, clinical, financial, technological, and administrative functions of network members. Emphasis is on the actual development of the network and its operations rather than the development or expansion of services. Network Development Grants What Types of Ideas Can be Funded? Focus is more on developing the network but service development is a key function to network development. Some subject areas include these: "Adolescents "Case Management "Counseling Services "Elderly "Health Fairs "Medicare "Preventive Care "Public Health "Advocacy "Children "Dental Care "EMS "Medicaid "Mental Health "Primary Care "Telemedicine 10

Network Development Grants What are the Anticipated Outcomes of a Network Development Grant?! Achieving economies of scale and cost efficiencies of certain administrative functions, such as billing, collections, claim processing, purchasing, etc.! Ensuring continuous quality improvement of care provided by network members.! Enhancing the ability of members to respond positively to changes in the health care marketplace like HIPAA requirements.! Enhancing the continuum of care.! Sharing staff and expertise across the network.! Improving access to capital and new technologies and increasing financial viability. Network Development Grants Are the Grants for Single Sites or a Collaborative? What are the Program Requirements?! Activity must be carried out by a network of organizations (at least three).! Network organizational relationship is formal (e.g. MOA, bylaws, incorporation.) Under Outreach grants the relationship can be formal or informal.! All network members must contribute to each year s budget (federal funds are 80% of the budget.) The 20 percent contribution can be in-kind or cash.! Members must show a strong commitment to network through a history of collaboration and accomplishment. (The section on Prior Collaborative History is worth 20 review points.) 11

Network Development Grants Are the Grants for Single Sites or a Collaborative? What are the Program Requirements?! The network must identify its developmental stage (i.e., formative, evolving, or mature) in the application.! The network has developed a strategic plan (or business plan).! The network has developed a governing body that includes representation from all network members.! The network has considered public accountability and shows in the application how the work of the network will benefit the local community.! The network has identified a permanent network director or has established an interim network director. Network Development Grants What are the Limitations on Funds?! Cannot use funds for the purchase, construction, renovation, or improvement of real property. (Funds can be used, however, for the purchase/rental of equipment up to 20% of the total annual federal share.) Funds may not be used to purchase vehicles.! Funds cannot be used for the direct delivery of inpatient care.! Cannot use federal grant funds to reduce or supplant existing levels of institutional and/or other non-federal financial support.! Generally, funds should be used to support salaries and contractual services.! The grantee must ensure that grant funds for staff and contractual services (e.g., attorneys, accountants, MIS specialists, etc.) are used for the benefit and development of the network as a whole. 12

Network Development Grants What Should I Know about the Narrative? Narrative is similar to the Outreach Grant but there is more emphasis placed on the formal nature and working of the network (20 points) and the sustainability of the network (20 points). Network Development Grants What are some Examples of North Dakota Network Development Grants? Northland Healthcare Alliance 13 rural hospitals and clinics and St. Alexius Medical Center Explored a Medicare Provider Sponsored Organization (PSO) but market forces were changing and managed care did not develop. Through an Outreach Grant to one of the network members, Northland is developing a quality improvement project focusing on diabetes care, prevention services, adult and childhood asthma, and other disease management. Through another Outreach Grant to a network member, Northland is expanding rural behavioral health options. Through a Community Access Program Grant, Northland is addressing safety net access to care issues for uninsured and underinsured rural North Dakotans. 13

Network Development Grants What are some Examples of Other Network Development Grants? Redwood Coast Medical Service Network (Gualala, CA) Network consisted of an FQHC, rural hospital, and EMS Agency. Network later expanded to include a network of six CHC, five local school districts, domestic abuse prevention group, violence prevention initiative, and several other small agencies. Area consisted of 13 towns, isolated coastal area, low population density, difficult geographical terrain, poor transportation infrastructure, high unemployment, low income, limited health care coverage, and HPSA/MUA. Focus on improving access to urgent and emergency medical services. Continued on next page Network Development Grants What are some Examples of Other Network Development Grants? Redwood Coast Medical Service Network (Gualala, CA) Established a formal organizational structure, expanded the formal participation of other service providers, established outcome measures, tracked outcome data, developed capacity to operate in a managed care environment, and worked to lessen cultural and linguistic barriers. Network developed a joint in-service program for providers, telemedicine training, advanced cardiac life support, pediatric advanced life support classes, quality improvement program, health screenings/immunizations, dental program, diabetes education, home health services, hospice services, access to mental health services, drug and alcohol counseling, and community health education. 14

Rural Hospital Flexibility (FLEX) Grants Funded by the federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services ~ Initiated in 1999 Rural Hospital Flexibility (FLEX) Grants Federal grant to the state. In ND the FLEX Steering Committee is comprised of the Center for Rural Health, Department of Health, and the North Dakota Healthcare Association. The grant is administered by the Center for Rural Health. Program has five goals: 1. Develop a state rural health plan 2. Designate CAHs 3. Develop networks 4. Strengthen rural EMS 5. Improve the quality of care 15

Rural Hospital Flexibility (FLEX) Grants What are some Key Facts about North Dakota Critical Access Hospitals? 28 of 37 eligible rural hospitals are designated. CAHs serve over 181,000 rural North Dakotans (43% of the rural population). CAH counties have an average elderly population of 21 percent (state = 14.7%). 96 percent of ND CAHs are in underserved areas (national = 92%). 50 percent of ND CAHs are in frontier counties (national = 33%). Continued on next page Rural Hospital Flexibility (FLEX) Grants What are some Key Facts about North Dakota Critical Access Hospitals? Direct payroll of $58 million and multiplier (1.5) shows impact of $87 million on rural economy CAHs employ 2,500 people and multiplier (1.5) shows employment impact of 3,800 jobs in rural ND. CAHs account for approximately 34 percent of the rural physicians. The average CAH has two primary care physicians and one non-physician provider. All CAHs have a network agreement with an acute care hospital. Significant emphasis on community technical assistance and grants. 16

Rural Hospital Flexibility (FLEX) Grants What are the Types of Grants Available to North Dakota Rural Hospitals? CAH Grants EMS Network Grants Network Enhancement Grants Rural Hospital Flexibility (FLEX) Grants What has been Funded under the CAH Grants? Financial feasibility studies Service diversification " Cardiac rehab " Physical therapy " Pulmonary rehab " Surgery " EMS " Wellness Programs, Education, " Tele-radiology Training " Urgent care Continued on next page.. 17

Rural Hospital Flexibility (FLEX) Grants What has been Funded under the CAH Grants? System stability " Quality improvement " Staff recruitment/retention " Communication systems " Staff training " Community education " Telemedicine Local Health Task Force Rural Hospital Flexibility (FLEX) Grants What has been Funded under the EMS Network Grants?! Capped at $15,000! CAH and at least two independent ambulance units! Regional Mass Casualty Incident Protocol and Operating Plan! EMS equipment (AEDs, mannequins, software)! EMS training (e.g., ACLS, PALS, EMS-C)! EMS marketing and recruitment/retention 18

Rural Hospital Flexibility (FLEX) Grants What has been Funded under the Network Enhancement Grants? Requires a network of a CAH and at least one other organization o o o o o Surgical network Quality Improvement network Shared Service network planning and assessment Provider network planning Cardiac Emergency network Small Hospital Improvement Program (SHIP) Grant Funded by the federal Office of Rural Health Policy, HRSA, USDHHS ~ Initiated in 2002 19

Small Hospital Improvement Program (SHIP) Grant What is the Purpose of the SHIP Grant? Pay for costs related to the implementation of PPS Comply with provisions of HIPAA Reduce medical errors and support quality improvement Small Hospital Improvement Program (SHIP) Grant What has been the Focus in North Dakota? 33 rural hospitals participated (ND grant approximately $340,000) 75 percent of funds addressed HIPAA 20 percent of funds addressed quality improvement 5 percent of funds addressed PPS 20

Rural Access to Emergency Devices (RAED) Grants Funded by the federal Office of Rural Health Policy, HRSA, USDHHS ~ Initiated in 2002 Rural Access to Emergency Devices (RAED) Grants What is the purpose of the RAED Grants? Purchase and placement of Automated External Defibrillators in rural communities An AED is a device that automatically analyzes the heart rhythm and advices the rescuer, through computerized voice instructions, when to push a button or deliver a potentially lifesaving shock to the victim. They are small pieces of equipment that virtually anyone with a small amount of training can operate. They should be found in all ambulances, quick response units, law enforcement units, fire depts, hospitals, nursing homes, clinics, public health units, schools, human service agencies, senior centers, and other public access points. 21

Rural Access to Emergency Devices (RAED) Grants What has been the Focus in North Dakota?! North Dakota received $257,000 in 2002-2003! Statewide Committee (CRH, North Dakota Healthcare Association, ND EMS Association, and the Division of Emergency Health Services). Administered by the CRH and AEDs to be purchased by Advantage.! Received requests for over 400 AEDs (letters to the CRH).! Funds support the purchase of 112 AEDs.! 71 rural communities will receive at least one AED.! AEDs are being placed in ambulance and QRU, law enforcement, hospitals, clinics, fire departments, and nursing homes. Telehealth Network Grant Program Funded by the Office for the Advancement of Telehealth (OAT), HRSA, USDHHS ~ Initiated in 2002 22

Telehealth Network Grant Program What are the Objectives of this Grant? To help communities build the human, technical, and financial capacity to develop sustainable telehealth programs and networks. Demonstrate how telehealth network projects in rural areas, in medically underserved areas, in frontier communities, and for medically underserved populations, can be used to: o Expand access to, coordinate, and improve the quality of health care services, o Improve and expand the training of health care providers, and o Expand and improve the quality of health information available to health care providers, patients, and their families. Telehealth Network Grant Program What is the Available Funding? $5 million for up to 20 grants (average about $250,000) Projects funded for up to three years No matching requirements 23

Telehealth Network Grant Program What are the Eligibility Requirements?! Applicant must be a non-profit.! Network members can be non-profit and/or for-profit.! Faith-based organizations are encouraged to apply.! Services may be provided to rural or urban communities. Continued on next page Telehealth Network Grant Program What are the Eligibility Requirements?! Telehealth network shall include at least two of the following: o Non-profit hospitals (including CAHs) o Clinics (including RHCs) o Community or migrant health centers of FQHCs o Health care providers in private practice (including pharmacists) o Local health departments (public health units) o Long term care o Providers of health care services in the home o Providers of outpatient mental health services o EMS providers o Social service agencies o Institutions of higher education o Dental clinics 24

Telehealth Network Grant Program Are there any Preference Points Awarded? The eligible entity is a rural community based organization or a faith based organization. Establishing a telehealth network that addresses mental health, public health, long term care, home care, preventive health, or case management services Shows how the telehealth network will coordinate with other relevant federally funded projects in the area. Continued on next page. Telehealth Network Grant Program Are there any Preference Points Awarded? Telehealth networks includes and entity that does the following: o Provides clinical health care services or education services for health care providers and for patients or their families, o Is a public school, public library, an institution of higher education, or a local government entity. Continued on next page. 25

Telehealth Network Grant Program Are there any Preference Points Awarded? Addresses the following program priorities: " Chronic conditions like diabetes or asthma " Projects designed to improve health care outcomes (e.g. improved access, productivity, dollars saved) " Clinical telemedicine networks that include distance learning education for health professionals " Electronic medical records Telehealth Network Grant Program What are some Important Dates and Who do I Contact? February 28, 2003 Pre-Application Technical Assistance Conference Call 1:30-3:00 PM. E-mail Heather Gerhart at to register for Conference Call. To receive application kit call HRSA at 1-877-477-2123 and give the Federal Domestic Assistance number 93.211 citing Telehealth Network Grant Program. A letter of intent to submit an application is requested by February 20, 2003. Proposals are due April 7, 2003 26

Blue Cross Blue Shield of North Dakota Rural Health Grant Program What is the Purpose of the BCBSND Rural Health Grant Program? Supports community coalitions working collaboratively through innovative programming to strengthen North Dakota rural health system. BCBSND seeks to encourage community and provider exploration of different organizational arrangements, health services and program development, and enhanced efficiency. The three primary focus areas are: " Improving access to care " Providing cost effective health care " Improving the quality of care Blue Cross Blue Shield of North Dakota Rural Health Grant Program What are the core Attributes of the Program? Alignment: an area coalition or consortium of two independent groups or more. Collaboration: deliberate, conspicuous collaboration among participants working together to address a problem (primary focus areas). Innovation: consider how health services can be delivered differently, emphasis on the development of systems that improve and restructure the current delivery system. 27

Blue Cross Blue Shield of North Dakota Rural Health Grant Program What are some Examples of BCBSND Funded Projects? Cooperstown Medical Center, Union Hospital (Mayville), Hillsboro Medical Center, and Northwood Deaconess Health Center o o o o Established a Coordinated Health Program (CHP) model that involves screening for childhood diseases (childhood obesity and exercise, diabetes, and asthma); community wellness activities including a free wellness screening in the four communities; and staff training and education. Hired an education coordinator to work with the four hospitals Polycom video conferencing for training, education, and communication between the four hospitals and other providers Members of the Valley Rural Health Cooperative; three of the four are CAHs. Blue Cross Blue Shield of North Dakota Rural Health Grant Program What are some Examples of BCBSND Funded Projects? Spirit Lake Health Tracks Program (Spirit Lake Health Tracks Program, Maternal & Child Health Program, Indian Health Service, and Four Winds Community Education System) o Comprehensive respiratory therapy initiative to include individualized baseline data, asthma care, and management, treatment, and home-based follow-up care. o Incidence rate for Native American children, in North Dakota, requiring an emergency response for breathing difficulties is three times the rate for Caucasian children (7.1/1000 compared to 2.3/1000) o Staff are provided training in the diagnosis, care, and management of asthma according to the American Academy of Pediatrics Clinical Practice Guidelines. 28

Blue Cross Blue Shield of North Dakota Rural Health Grant Program What are some Examples of BCBSND Funded Projects? Maddock Drug & Gift (Maddock Drug & Gift, City of Rolette, IsoRX (telecommunication company), and Weibe Electronics (developer of the Rolette minimall) o o o o o Developed a remote based pharmacy in Rolette. Maddock serves as the central pharmacy connected to the Rolette site via a telecommunication system involving two way video and audio linkage. Rolette staffed with a pharmacy technician under the direct supervision of the Maddock pharmacist. 26 rural pharmacies have closed in North Dakota. Enhances health access and addresses rural economic development. Blue Cross Blue Shield of North Dakota Rural Health Grant Program Where do I go to Learn More about this Program? http://medicine.nodak.edu/crh Click on the State Office of Rural Health icon Blue Cross Blue Shield of North Dakota Rural Health Grant Program (upper right side) Program Guidance Grants will be due approximately the end of July, 2003 29

General Contact Information for ORHP Grants Outreach, Network Development, FLEX, SHIP, RAED and other resources http://www.ruralhealth.hrsa.gov Click on Funding (left side of screen) For more information, contact: PO Box 9037 Grand Forks, ND 58202-9037 Tel: (701) 777-3848 Fax: (701) 777-6779 http://medicine.nodak.edu/crh E-mail: bgibbens@medicine.nodak.edu 30