TRANSFORMING CARE FOR RURAL RESIDENTS :

A POLICY PROPOSAL
THERESA ABAH, GIOVANNI DORTCH, CLAIRE FRASER, ROBERT ROOKS, HABEEB SUARA,
VISION

Our vision is to create a comprehensive care facility for rural

residents utilizing private, public and community partnerships,
building on historical and existing models of care delivery. We
envision a community wellness center that provides health
care, education, wellness support and healthy recreation
space. We will be using the area of Hardeman County,
Tennessee as a case study to explore options on health
system transformation
OUTLINE

I. Issue Summary: The Crisis in Health Care (video)

II. Stakeholders & Partners
III. Challenges
IV. Solutions
V. Policy Plan
ISSUE SUMMARY
AREA DESCRIPTION

Bolivar is a rural area, just like all rural areas, it

consistently face a lack of adequate health care.
Currently, Hardeman county has a low education
level, high rate of disability and is affected by
major health issues such as obesity, diabetes,
heart disease, teen pregnancy, and cancer.
DEMOGRAPHICS OF HARDEMAN COUNTY, TN
Population on Medicaid
Population Living in a Health Professional Shortage
Poor General Health
Access to Primary Care Physicians
Access to Mental Health Providers
% Adults with Poor Dental Health
Access to Dentists
Obesity Rates
Diabetes
High Blood Pressure
Current Smokers
Lung Disease Mortality
Heart Disease Mortality
Cancer Mortality
Teen Pregnancy Rates
Chlamydia Rates
Population with Disability
STAKEHOLDERS AND
PARTNERS
 GOAL OF STAKEHOLDERS/PARTNERS
STAKEHOLDERS
Person or group with an interest, involvement or investment in
health service delivery; People who are not directly beneficiaries in
a project, but will be affected by it and have some form of
influence.
PARTNERS
These are individuals or groups involved in collaborative
relationship with the goal of achieving success in a mutual project.
 EMERGING HEALTH TRENDS IN THE UNITED
STATES OF AMERICA

● Expansion of non-physician care roles

● Location of care shifting from the health facilities
● Technological innovations influencing patient involvement
● New health care roles emerging
● New health care challenges as a result of uncoordinated care
 SHIFT IN THE ROLES OF STAKEHOLDERS
● Migration from volume to
quality care in the
marketplace
○ measurable and
meaningful patients
outcomes identified
○ Different approaches to
health care marketplace
● Accessible healthcare
everywhere
● Centralized decision-making
● Involvement of Accountable
Care Organizations (ACOs)
○ ensures patient centered care
○ attend to care transitions
○ monitor data to improve care
○ manage patient population
● Value-added Insurance design
○ Promotes timely use of high-
value care
○ Ensures cost effectiveness of
care
 IDENTIFIED STAKEHOLDERS FOR RURAL HEALTH
TRANSFORMATION

● County Health Department

● County School system
● Nearby Universities – Research, extension services, tertiary health
care services
● Private enterprises / businesses examples physical activity fitness
centers, media outfits, private clinics, etc.
● Department of Health Regional Services
● Community Health Center
● Local health care providers
 STAKEHOLDERS FOR HARDEMAN COUNTY PROJECT

 Hardeman County Community Health Center

 Bolivar General Hospital
 Hardeman County Health Council
● Hardeman County School District
 Community Advocacy groups examples Teens
Against Tobacco Use (TATU), Baby and Me
(preventing teens from smoking during
pregnancy)
 POTENTIAL FUNDING PARTNERS
● Government Funds
○ Human Resources and Services Administration (Grants.gov)

● Health System/Delivery
○ Community Health Centers Fund
○ National Consortium for Health System Development
○ HRSA-18-034 - Rural Health Network Development Planning Program

● Hospital/University Partnerships
○ University of Tennessee Health Center
○ Jackson General Hospital
○ LeBonheur Children’s Hospital
○ Meharry Medical College
POTENTIAL FUNDING PARTNERS
● Patient Payments
○ Medicaid/Medicare
○ Sliding Scale/Income Based Uninsured
○ Insurance
● Health Professional Recruitment
○ National Health Service Corps
○ Tennessee Rural Partnership Rural Clinician Recruitment Assistance
● Private Funds
○ Pew Charitable Trust
○ Robert Wood Johnson Foundation
○ The Assisi Foundation of Memphis, Inc.
○ West Tennessee Healthcare Foundation
○ The Kresge Foundation
○ Tennessee Health Foundation (Blue Cross Blue Shield of Tennessee)
○ Substance Abuse Mental Health Services Administration (SAMHSA)
CHALLENGES
CHALLENGES

● Recruitment of Health Professionals

○ General Shortage of Physicians in HPSAs
○ Currently, Hardeman County only has 7 dentists and 7 physicians
for a population of 25,000

● Proximity to Specialty Care

○ Nearest Tertiary Care Center - 43.1 miles
CHALLENGES

● Infrastructure
○ Proper Facilities
■ Space for Numerous Patient Rooms
■ Classrooms
■ Exercise Space
○ Technology
■ Electronic Medical Record
■ Medical Devices & Equipment
SOLUTIONS
 COMPREHENSIVE MEDICAL FACILITY &
COMMUNITY CENTER

 CARE: Local Health Clinic

 EDUCATION: Community Classes and Training

 ACTION: Exercise Opportunities

SOLUTIONS
● Utilization of Alternative Caregivers
○ Nurse Practitioners, Nurse Midwives, Midwives
○ Physician Assistants
○ Dental Therapists
○ Pharmacists/Pharmacy Technicians
○ Counselors & Therapists

● Staff Training of Local Residents

○ Community Health Workers
○ Community Navigators
○ Training Pipeline for Future Providers

● Current Medical & Dental Providers as Care Team Partners

SERVICES PROVIDED

 Dental Care  Nutritional Care

 HIV/STD Testing  Pharmacy
 Mental Health Services  Social Services
 Family Care  Teen Clinic
● Pediatric Care ● Optometric Services
● Women’s Health/Prenatal Care
COMMUNITY SERVICES

● Community Classes
○ Cooking, Healthy Meal Preparation Classes
○ Healthy Garden
○ Health Education and Disease Management Courses

● Exercise Spaces
○ Basketball Court
○ Fitness Classes
SOLUTIONS

● Telemedicine w/ Partnering Physicians

○ Specialist Physicians
○ Psychologists
○ Dentists

● Pipeline Programs for Aspiring Health Professionals

○ Enrichment & Mentorship
○ Scholarships
○ Motivation to Practice in Local Community
SOLUTIONS

 Legislation: Local and State government would need to approve of the use of
Dental Therapists in Tennessee. We advocate for the State Representative of
Hardeman County to submit a bill in support of the utilization of Dental Therapists
statewide or within the County until state approval.

 Partnerships: This policy builds on existing programs and seeks to expand them.
Partnership with existing care services and organizations is necessary.

 Human Capital Investment: Residents of the community will help solve the issue
of lack of care through accepting training and education, and committing to provide
care in the community
POLICY PLAN
INSPIRATIONS & MODELS

 Rosenwald and Freedman’s Schools and Hospitals

 Delta Community Health Center (Mount Bayou, MS)
 Partnerships with key university partners
 Geisinger Health (Danville, PA)
 Large medical facility within rural Pennsylvania
 Whittier Street Health Center (Boston, MA)
 Community health center with included fitness center
 Jackson Medical Mall (Jackson, MS)
 Church Health Center (Memphis, TN)
FUNDING STRATEGIES

● Contribution from Federal or State Government

○ Medicaid/Medicare
○ NHSC, HRSA, HCOP
○ State Department of Agriculture
● Contribution from Private Partners
○ Robert Wood Johnson Foundation
○ Pew Charitable Trust
○ Ascension Health
● Contribution from University, Hospital, and Community Partners
○ Rosenwald School Model (community)
○ Delta Community Health Model (university)
3-YEAR PLAN

 Build support from local government, school districts, and community organizations
 Form relationships with private, university & hospital sponsors
 Secure Proper Funds
 Create Expansion Plans
 Begin Necessary Renovations and/or Construction
 Initiate Local Programs (cooking classes, exercise programs, pipeline programs)
 Implementation of Community Health Workers and Navigators
5-YEAR PLAN

 Recruitment of Health Professionals

 Expand enrollment of community classes and pipeline Programs at local high schools
 Obtain necessary medical devices and technological services
 Finish building and expansion plans of comprehensive facility
 Consolidation of all services (minus dental), opening of facility by January 2023
10-YEAR PLAN

 Expand Hospital & University Partnerships

 Inclusion of Dental Services
 Collect Annual Health Data, Provide Continuous Quality Improvement
 Health workforce training of at least 50 local residents
 Scholarship support for at least 3 local high school students
 Significant Improvement in Health Outcomes for these Diseases
 Teen Pregnancy
 Diabetes
 Obesity
 Heart Disease
 Cancer
 Promotion of Unique Healthcare Model in Literature, Media
20-YEAR PLAN

 Increase Enrollment in Higher Education by Local High School Students

 Sustainable Workforce, Model of Health for Hardeman County
 Expansion of Model to Other Underserved Areas
 Elimination of Health Disparities, Achievement of Health Equity
POTENTIAL OBSTACLES & FAILURES

 Funding
 Retention
 Economic or Legislative Changes
 Utilization
 Transportation
WHAT WE NEED FROM YOU

 Embrace Comprehensive Care for Rural Communities

 Healthcare, Education/Training, Action
 Push Legislation for lower-level providers (e.g. Dental Therapists) and Medicaid expansion
 Funding (outside of MCMC/ACA, Private Investments and Community Investments)
 Federal Government Partnerships ( D of Ag, HHS, HRSA, CDC, )
 Increased Incentives for Physicians/ Practitioners within HPSAs (subsidized housing, loan
repayment, local partnerships for products)
QUESTIONS
THANK YOU!

FOR MORE INFORMATION VISIT: WWW.GIOVANNIDORTCH.COM/POLICY

CONTACT:
THERESA ABAH, UNIVERSITY OF NORTH TEXAS THERESA.ABAH@UNT.EDU
CLAIRE FRASER, BELMONT UNIVERSITY CLAIRE.FRASER@POP.BELMONT.EDU
GIOVANNI N. DORTCH, UNIVERSITY OF MEMPHIS, GIOVANNI.DORTCH@GMAIL.COM
ROBERT E. ROOKS JR. FISK UNIVERSITY, RROOKSCOLLEGE@GMAIL.COM
HABEEB SUARA, OHIO STATE UNIVERSITY COLLEGE OF MEDICINE, HABEEB.SUARA@OSUMC.EDU