Nurse Dawn Daly-Mack tends a patient at the Community Health Center at Halifax Regional in Halifax County, North Carolina. The health center is attached to the hospital's emergency department. Photo by Shawn Poynter

“When It Comes To Health, Rural Areas Getting Left Behind,” read the headline of a recent Forbes article. The story was reporting on the release of the Robert Wood Johnson Foundation’s seventh annual County Health Rankings, which showed that nearly one in five rural counties experienced worsening premature death rates over the past decade. At the same time, the rest of the country saw its premature death rate decline.

Rural America’s health challenges create challenges that, in turn, affect the quality of life of individuals, families and the larger community, in and beyond rural communities.

So how do we improve rural health? For too long the answer of many well intentioned organizations and funders has been to develop programs and community health interventions, some of which had only been tried in urban areas, and then swoop into rural communities and try to implement them on the local level.  But a top-down prescriptive model just doesn’t fit how people in these communities live and think and who they trust. Grantmaking to improve rural health needs to cultivate local assets and foster change from within.

Allen Smart
Allen Smart

Listening to the people who live in the community you’re hoping to serve, cultivating their ideas, and working together as true partners can be extremely rewarding. Their innovations can be shared, adapted, and implemented in other communities across the country. That’s why the Kate B. Reynolds Charitable Trust created The New Rural: Innovations in Rural Health Award to search the country for innovative solutions, ideas and thoughts to drive health improvement. The winner receives $25,000, but more importantly, rural America gets more great ideas to learn from.

A perfect example of local innovation came from a collaboration between Appalachian State University’s undergraduate Health Care Management program and the Medicaid managed care program, AccessCare of the Blue Ridge. They discovered an innovative solution for helping primary care practices become Patient-Centered Medical Homes (PCMH), a complicated designation from the National Committee on Quality Assurance (NCQA) that brings additional resources to local clinics and coordinates patient care better.

Known as the Primary Care Improvement Collaborative, Appalachian students enrolled in an elective course with either academic or internship credit working closely with practices to achieve this designation. Rural and independent practices, and those outside of health systems or large hospital systems, oftentimes don’t have the resources they need to complete the 100-to-200-hour process. The students give them the extra help they need to accomplish the task.

The program won the Innovations in Rural Health Award in 2014 and since winning, AccessCare has expanded the program to 20 mostly rural practices in northwestern North Carolina. With financial assistance from the trust, this past year they expanded the program to East Carolina University where students are working with five rural practices in northeast North Carolina with a special focus on reaching patients living in poverty.

App State and AccessCare recognized a growing issue in their community and decided to tackle it. Their idea was innovative, thought-provoking, inexpensive and addressed a growing issue at hand. And, most importantly, it started at the ground level.

These organizations aren’t the only ones putting on their thinking caps. In New Castle, Pennsylvania, the Mobile Medication Program is a home visiting program started in rural Pennsylvania to serve adults with severe psychiatric illness who have a history of hospitalizations or repeated emergency department visits for mental health needs. It’s taking a very simple concept—visiting patients in their homes and checking in on their medications— that can have a tremendous influence on somebody’s ability to maintain wellness. Transportation challenges, isolation and lack of a nearby support system—barriers for many people living in rural communities—can interfere with a person’s ability to take medication regularly, and the program helps patients overcome those hurdles.

Shortly after the program won the 2013 Innovations in Rural Health Award, the trust awarded a grant to the North Carolina Hospital Association to replicate the successful program in North Carolina. In 2015, a pilot program was started in two rural counties—Vance and Nash— in the eastern part of the state. The North Carolina program is currently serving 100 patients in both counties, enrolling five to 10 patients per week. Results to date show a dramatic decrease in the number of hospitalizations and the number of emergency department visits, as well as a decrease in substance abuse and an increase in quality of life scores for the patients. The program in Pennsylvania continues to be successful, demonstrating that the Mobile Medication model exemplifies the notion that sometimes the simplest idea can have the greatest impact.

Those are just two examples of the many homegrown innovations improving life in rural communities.  We want to learn about more of them. The simple application process for this year’s award is open. We are looking for original, innovative solutions to drive health improvement in rural communities. These do not have to be finalized projects — we encourage submissions that highlight new ideas and emerging innovations. Do you know a great person or organization working to improve rural health? If so, make sure they apply so they can be the next great example of innovation over intervention.

Allen Smart is interim president and vice president of programs at the Kate B. Reynolds Charitable Trust, a North Carolina-focused foundation. The Innovations in Rural Health Award is a national program open to groups and individuals from across the country. The application deadline is April 29.

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