Rural Wisconsin Health Cooperative A Personal View of Rural Health Leadership: It’s All About Collaboration & Advocacy Tim Size Executive Director Rural

Rural WisconsinRural WisconsinHealth CooperativeHealth Cooperative

A Personal View of Rural Health Leadership: A Personal View of Rural Health Leadership: It’s All About Collaboration & AdvocacyIt’s All About Collaboration & Advocacy

Tim SizeTim SizeExecutive DirectorExecutive Director


Rural Voices Leadership Rural Voices Leadership & Policy Meeting & Policy Meeting

Washington DCWashington DC3/30 – 4/1/093/30 – 4/1/09


Outline of PresentationOutline of PresentationOutline of PresentationOutline of Presentation

1.1. Presenter’s PerspectivePresenter’s Perspective

2.2. Rural Advocacy Often Deals With MythsRural Advocacy Often Deals With Myths

3.3. Why Collaboration & Advocacy Needed?Why Collaboration & Advocacy Needed?

4.4. Community Collaboration Not NewCommunity Collaboration Not New

5.5. Why Aren’t We Doing It?Why Aren’t We Doing It?

6.6. Starting or Expanding CollaborationStarting or Expanding Collaboration

7.7. Become a More Active & Effective AdvocateBecome a More Active & Effective Advocate

8.8. Anticipate Barriers to ChangeAnticipate Barriers to Change

1.1. Presenter’s PerspectivePresenter’s Perspective

2.2. Rural Advocacy Often Deals With MythsRural Advocacy Often Deals With Myths

3.3. Why Collaboration & Advocacy Needed?Why Collaboration & Advocacy Needed?

4.4. Community Collaboration Not NewCommunity Collaboration Not New

5.5. Why Aren’t We Doing It?Why Aren’t We Doing It?

6.6. Starting or Expanding CollaborationStarting or Expanding Collaboration

7.7. Become a More Active & Effective AdvocateBecome a More Active & Effective Advocate

8.8. Anticipate Barriers to ChangeAnticipate Barriers to Change


1. Presenter Perspective1. Presenter Perspective1. Presenter Perspective1. Presenter Perspective

Advocacy at Advocacy at RWHC is based RWHC is based on the evidence on the evidence but like us all, but like us all, we have a set of we have a set of experiences and experiences and beliefs that drive beliefs that drive our work.our work.

Advocacy at Advocacy at RWHC is based RWHC is based on the evidence on the evidence but like us all, but like us all, we have a set of we have a set of experiences and experiences and beliefs that drive beliefs that drive our work.our work.


Founding Principle: “Strength in Numbers” Founding Principle: “Strength in Numbers” Founding Principle: “Strength in Numbers” Founding Principle: “Strength in Numbers”

RWHC - Eye On Health

Before

After

RWHC Eye On Health

Before

After

First RWHC Cartoon First RWHC Cartoon shortly after being shortly after being founded in 1979. founded in 1979.

First RWHC Cartoon First RWHC Cartoon shortly after being shortly after being founded in 1979. founded in 1979.


RWHC Mission & VisionRWHC Mission & Vision RWHC Mission & VisionRWHC Mission & Vision

Specifics re services available at http://www.RWHC.comSpecifics re services available at http://www.RWHC.com

MissionMission: Rural WI communities will be the : Rural WI communities will be the healthiest in America. healthiest in America.

VisionVision: RWHC is a strong and innovative : RWHC is a strong and innovative cooperative of diversified rural hospitals; it is cooperative of diversified rural hospitals; it is (1) the “rural advocate of choice” for its members (1) the “rural advocate of choice” for its members and (2) develops & manages a variety of products and (2) develops & manages a variety of products and services.and services.

MissionMission: Rural WI communities will be the : Rural WI communities will be the healthiest in America. healthiest in America.

VisionVision: RWHC is a strong and innovative : RWHC is a strong and innovative cooperative of diversified rural hospitals; it is cooperative of diversified rural hospitals; it is (1) the “rural advocate of choice” for its members (1) the “rural advocate of choice” for its members and (2) develops & manages a variety of products and (2) develops & manages a variety of products and services.and services.


RWHC by the NumbersRWHC by the NumbersRWHC by the NumbersRWHC by the Numbers

• Founded 1979Founded 1979

• Non-profit coop owned Non-profit coop owned by 35 rural hospitals by 35 rural hospitals (net rev ≈ $3/4B; ≈ 2K (net rev ≈ $3/4B; ≈ 2K hospital & LTC beds)hospital & LTC beds)

• ≈ ≈ $7M RWHC budget $7M RWHC budget (≈70% member fees, (≈70% member fees, 20% fees from others, 20% fees from others, 5% dues, 5% grants)5% dues, 5% grants)

• 6 PPS & 29 CAH; 24 6 PPS & 29 CAH; 24 freestanding; 11 system freestanding; 11 system owned or affiliated owned or affiliated

• Founded 1979Founded 1979

• Non-profit coop owned Non-profit coop owned by 35 rural hospitals by 35 rural hospitals (net rev ≈ $3/4B; ≈ 2K (net rev ≈ $3/4B; ≈ 2K hospital & LTC beds)hospital & LTC beds)

• ≈ ≈ $7M RWHC budget $7M RWHC budget (≈70% member fees, (≈70% member fees, 20% fees from others, 20% fees from others, 5% dues, 5% grants)5% dues, 5% grants)

• 6 PPS & 29 CAH; 24 6 PPS & 29 CAH; 24 freestanding; 11 system freestanding; 11 system owned or affiliated owned or affiliated


RWHC Collaborative ServicesRWHC Collaborative ServicesRWHC Collaborative ServicesRWHC Collaborative Services

• Advocacy (Market, Government)Advocacy (Market, Government)

• CAHPS Hospital Survey (AHRQ)CAHPS Hospital Survey (AHRQ)

• Clinical: Audiology, Speech, PTClinical: Audiology, Speech, PT

• Coding Consulting ServiceCoding Consulting Service

• Compliance (Medicare)Compliance (Medicare)

• Credentials Verification (NCQA)Credentials Verification (NCQA)

• EHR Shared Platform & SupportEHR Shared Platform & Support

• Financial Consulting ServiceFinancial Consulting Service

• H2H Learning from Each OtherH2H Learning from Each Other

• Advocacy (Market, Government)Advocacy (Market, Government)

• CAHPS Hospital Survey (AHRQ)CAHPS Hospital Survey (AHRQ)

• Clinical: Audiology, Speech, PTClinical: Audiology, Speech, PT

• Coding Consulting ServiceCoding Consulting Service

• Compliance (Medicare)Compliance (Medicare)

• Credentials Verification (NCQA)Credentials Verification (NCQA)

• EHR Shared Platform & SupportEHR Shared Platform & Support

• Financial Consulting ServiceFinancial Consulting Service

• H2H Learning from Each OtherH2H Learning from Each Other

• Health Careers Web TemplateHealth Careers Web Template

• Health Plan Insurer Contracting Health Plan Insurer Contracting

• IT Services, Wide Area NetworkIT Services, Wide Area Network

• Legal ServicesLegal Services

• Peer Review ServicePeer Review Service

• Professional & Staff RoundtablesProfessional & Staff Roundtables

• Quality Indicators (JCAHO)Quality Indicators (JCAHO)

• Recruitment (Nursing/Allied)Recruitment (Nursing/Allied)

• Reimbursement CredentialingReimbursement Credentialing

• Health Careers Web TemplateHealth Careers Web Template

• Health Plan Insurer Contracting Health Plan Insurer Contracting

• IT Services, Wide Area NetworkIT Services, Wide Area Network

• Legal ServicesLegal Services

• Peer Review ServicePeer Review Service

• Professional & Staff RoundtablesProfessional & Staff Roundtables

• Quality Indicators (JCAHO)Quality Indicators (JCAHO)

• Recruitment (Nursing/Allied)Recruitment (Nursing/Allied)

• Reimbursement CredentialingReimbursement Credentialing


RWHC Current Advocacy PrioritiesRWHC Current Advocacy PrioritiesRWHC Current Advocacy PrioritiesRWHC Current Advocacy Priorities

• Mitigate Work Force Shortages & MaldistributionMitigate Work Force Shortages & Maldistribution• Promote Fair Federal & State Payments & PoliciesPromote Fair Federal & State Payments & Policies• Broaden Focus from Healthcare to Community HealthBroaden Focus from Healthcare to Community Health• Fight Exclusionary Market PracticesFight Exclusionary Market Practices• Keep Local Care Local Keep Local Care Local • Support Fair Quality/Price TransparencySupport Fair Quality/Price Transparency• Resist Inappropriate Regulation of HospitalsResist Inappropriate Regulation of Hospitals

• Mitigate Work Force Shortages & MaldistributionMitigate Work Force Shortages & Maldistribution• Promote Fair Federal & State Payments & PoliciesPromote Fair Federal & State Payments & Policies• Broaden Focus from Healthcare to Community HealthBroaden Focus from Healthcare to Community Health• Fight Exclusionary Market PracticesFight Exclusionary Market Practices• Keep Local Care Local Keep Local Care Local • Support Fair Quality/Price TransparencySupport Fair Quality/Price Transparency• Resist Inappropriate Regulation of HospitalsResist Inappropriate Regulation of Hospitals


Collaboration & Advocacy Use Similar SkillsCollaboration & Advocacy Use Similar SkillsCollaboration & Advocacy Use Similar SkillsCollaboration & Advocacy Use Similar Skills

Identify PartnersIdentify Partners

CollaborateCollaborate

Take ActionTake Action

InnovateInnovateEvaluateEvaluate

PerseverePersevere

Identify Need Identify Need

A Leadership CycleA Leadership Cycle

Above “leadership Cycle” is a variation of the traditional PDSA Above “leadership Cycle” is a variation of the traditional PDSA (plan, do, study, act).(plan, do, study, act).


Rural Advocates Work in Private & Public SectorsRural Advocates Work in Private & Public SectorsRural Advocates Work in Private & Public SectorsRural Advocates Work in Private & Public Sectors

RWHC Eye On Health

"Why is it legal for our only doctors to be denied payment from our only insurance?"

HometownRural Clinic

• Rural Health exists Rural Health exists in and is driven by in and is driven by both private and both private and public sector beliefs, public sector beliefs, behaviors and behaviors and policies.policies.

• Focus is on taking Focus is on taking action for a desired action for a desired future.future.

• Rural Health exists Rural Health exists in and is driven by in and is driven by both private and both private and public sector beliefs, public sector beliefs, behaviors and behaviors and policies.policies.

• Focus is on taking Focus is on taking action for a desired action for a desired future.future.


Rural Advocacy Needs to Be 24/7Rural Advocacy Needs to Be 24/7Rural Advocacy Needs to Be 24/7Rural Advocacy Needs to Be 24/7

Rural advocates have an ongoing challenge:Rural advocates have an ongoing challenge:

• Public and private sector policy nationally, Public and private sector policy nationally, and even in our states, can be ill informed and even in our states, can be ill informed about or not attend to rural health.about or not attend to rural health.

• We must not become complacent; all of us We must not become complacent; all of us must become more skilled and more active.must become more skilled and more active.

Rural advocates have an ongoing challenge:Rural advocates have an ongoing challenge:

• Public and private sector policy nationally, Public and private sector policy nationally, and even in our states, can be ill informed and even in our states, can be ill informed about or not attend to rural health.about or not attend to rural health.

• We must not become complacent; all of us We must not become complacent; all of us must become more skilled and more active.must become more skilled and more active.


2. Rural Advocacy Frequently Deals With Myths2. Rural Advocacy Frequently Deals With Myths2. Rural Advocacy Frequently Deals With Myths2. Rural Advocacy Frequently Deals With Myths

RWHC Eye On Health

Rural?Pay them less.

They grow their own vegetables.

RWHC Eye On Health

Rural?Pay them less.

They grow their own vegetables.


Myths that Mislead Public & Private PolicyMyths that Mislead Public & Private PolicyMyths that Mislead Public & Private PolicyMyths that Mislead Public & Private Policy

• Rural is west (TX, NC, PA, OH, MI, NY top rural pop.)Rural is west (TX, NC, PA, OH, MI, NY top rural pop.)• Rural Americans are naturally more healthy Rural Americans are naturally more healthy • Rural economy is mostly about agriculture Rural economy is mostly about agriculture • Rural health care should cost Rural health care should cost lessless than urban care than urban care • Rural health care is inordinately expensive Rural health care is inordinately expensive • Rural health care is lower quality; bigger/urban is better Rural health care is lower quality; bigger/urban is better • Rural hospitals are just band-aide stations Rural hospitals are just band-aide stations • Rural hospitals & clinics are poorly managed/governedRural hospitals & clinics are poorly managed/governed• Rural residents don’t want to get care locallyRural residents don’t want to get care locally

• Rural is west (TX, NC, PA, OH, MI, NY top rural pop.)Rural is west (TX, NC, PA, OH, MI, NY top rural pop.)• Rural Americans are naturally more healthy Rural Americans are naturally more healthy • Rural economy is mostly about agriculture Rural economy is mostly about agriculture • Rural health care should cost Rural health care should cost lessless than urban care than urban care • Rural health care is inordinately expensive Rural health care is inordinately expensive • Rural health care is lower quality; bigger/urban is better Rural health care is lower quality; bigger/urban is better • Rural hospitals are just band-aide stations Rural hospitals are just band-aide stations • Rural hospitals & clinics are poorly managed/governedRural hospitals & clinics are poorly managed/governed• Rural residents don’t want to get care locallyRural residents don’t want to get care locally

* U.S. 2000 Census, Non-Metro Population By State* U.S. 2000 Census, Non-Metro Population By State


3. Why Collaboration & Advocacy Needed?3. Why Collaboration & Advocacy Needed?3. Why Collaboration & Advocacy Needed?3. Why Collaboration & Advocacy Needed?

““We must help all reach We must help all reach highest potential for highest potential for

health and reverse the health and reverse the trend of avoidable trend of avoidable

illness. Individuals must illness. Individuals must achieve healthier achieve healthier

lifestyles; take lifestyles; take responsibility for health responsibility for health

behaviors and choices… behaviors and choices… and act.”and act.”

““We must help all reach We must help all reach highest potential for highest potential for

health and reverse the health and reverse the trend of avoidable trend of avoidable

illness. Individuals must illness. Individuals must achieve healthier achieve healthier

lifestyles; take lifestyles; take responsibility for health responsibility for health

behaviors and choices… behaviors and choices… and act.”and act.”

American Hospital Association’s “Health for Life, American Hospital Association’s “Health for Life, Better Health, Better Health Care”Better Health, Better Health Care” August, 2007August, 2007


Spending Trend Is Widely Seen As UnsustainableSpending Trend Is Widely Seen As UnsustainableSpending Trend Is Widely Seen As UnsustainableSpending Trend Is Widely Seen As Unsustainable

Centers for Medicare and Medicaid Services, Office of the Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/http://www.cms.hhs.gov/NationalHealthExpendData/


Chronic Illness On The RiseChronic Illness On The RiseChronic Illness On The RiseChronic Illness On The RiseA Sicker America

• Half of Americans have one or more chronic illnesses• 80% of spending is linked to chronic illness• Much of this is avoidable• Obesity has doubled; Diabetes is on the rise

American Hospital Association, "Health for Lie, Better Health, Better American Hospital Association, "Health for Lie, Better Health, Better Health Care"" 2008 Data: Centers for Disease Control and Prevention.Health Care"" 2008 Data: Centers for Disease Control and Prevention.


Health Status in Wisconsin CountiesHealth Status in Wisconsin CountiesHealth Status in Wisconsin CountiesHealth Status in Wisconsin Counties

CMS Estimates as of 7/07CMS Estimates as of 7/07Above calculated from the 2007Above calculated from the 2007 “Wisconsin County Health Rankings,” “Wisconsin County Health Rankings,” UW Population Health InstituteUW Population Health Institute

Worst Quartile (white)Worst Quartile (white)Second Quartile (red)Second Quartile (red)Third Quartile (redder)Third Quartile (redder)Best Quartile (reddest)Best Quartile (reddest)

75% urban counties 75% urban counties better than average better than average compared to 33% of compared to 33% of rural counties better rural counties better than average.than average.

Worst Quartile (white)Worst Quartile (white)Second Quartile (red)Second Quartile (red)Third Quartile (redder)Third Quartile (redder)Best Quartile (reddest)Best Quartile (reddest)

75% urban counties 75% urban counties better than average better than average compared to 33% of compared to 33% of rural counties better rural counties better than average.than average.


Healthy Rural Communities More Than Health CareHealthy Rural Communities More Than Health CareHealthy Rural Communities More Than Health CareHealthy Rural Communities More Than Health Care

Above calculated from the 2007Above calculated from the 2007 “Wisconsin County Health Rankings,” “Wisconsin County Health Rankings,”University of Wisconsin Population Health InstituteUniversity of Wisconsin Population Health Institute

Rural counties in Wisconsin are predicted to have Rural counties in Wisconsin are predicted to have worse health status and they do because individual worse health status and they do because individual behaviors like smoking and exercising matter, as behaviors like smoking and exercising matter, as do education, jobs and income.do education, jobs and income.

These factor influence individual and community These factor influence individual and community health as much or more than access to quality health as much or more than access to quality health care.health care.

Rural counties in Wisconsin are predicted to have Rural counties in Wisconsin are predicted to have worse health status and they do because individual worse health status and they do because individual behaviors like smoking and exercising matter, as behaviors like smoking and exercising matter, as do education, jobs and income.do education, jobs and income.

These factor influence individual and community These factor influence individual and community health as much or more than access to quality health as much or more than access to quality health care.health care.

Rural WisconsinRural WisconsinHealth CooperativeHealth Cooperative2005 Wisconsin County Health Rankings2005 Wisconsin County Health Rankings , University of Wisconsin , University of Wisconsin

Population Health InstitutePopulation Health Institute


Critical Link of Community & Economic HealthCritical Link of Community & Economic HealthCritical Link of Community & Economic HealthCritical Link of Community & Economic Health

““Businesses will move to where healthcare Businesses will move to where healthcare coverage is less expensive, or they will cut back coverage is less expensive, or they will cut back and even terminate coverage for their employees. and even terminate coverage for their employees. Either way, it's the residents of your towns and Either way, it's the residents of your towns and cities that lose out.”cities that lose out.”Thomas Donohue, President & CEO, U.S. Chamber of CommerceThomas Donohue, President & CEO, U.S. Chamber of Commerce

““If we can change lifestyles, it will have more If we can change lifestyles, it will have more impact on cutting costs than anything else we can impact on cutting costs than anything else we can do.” do.”

Larry Rambo, CEO, Humana Wisconsin and MichiganLarry Rambo, CEO, Humana Wisconsin and Michigan

““Businesses will move to where healthcare Businesses will move to where healthcare coverage is less expensive, or they will cut back coverage is less expensive, or they will cut back and even terminate coverage for their employees. and even terminate coverage for their employees. Either way, it's the residents of your towns and Either way, it's the residents of your towns and cities that lose out.”cities that lose out.”Thomas Donohue, President & CEO, U.S. Chamber of CommerceThomas Donohue, President & CEO, U.S. Chamber of Commerce

““If we can change lifestyles, it will have more If we can change lifestyles, it will have more impact on cutting costs than anything else we can impact on cutting costs than anything else we can do.” do.”

Larry Rambo, CEO, Humana Wisconsin and MichiganLarry Rambo, CEO, Humana Wisconsin and Michigan


•Business community & public policymakers Business community & public policymakers essential components for healthy communities. essential components for healthy communities. BenjaminBenjamin•Need to go beyond history of governmental Need to go beyond history of governmental public health and private practitioner animosity public health and private practitioner animosity to achieve benefits of public-private partnership. to achieve benefits of public-private partnership. McGinnisMcGinnis•Key link between worker health, productivity Key link between worker health, productivity and economic benefit. and economic benefit. Simon & FieldingSimon & Fielding

•Business community & public policymakers Business community & public policymakers essential components for healthy communities. essential components for healthy communities. BenjaminBenjamin•Need to go beyond history of governmental Need to go beyond history of governmental public health and private practitioner animosity public health and private practitioner animosity to achieve benefits of public-private partnership. to achieve benefits of public-private partnership. McGinnisMcGinnis•Key link between worker health, productivity Key link between worker health, productivity and economic benefit. and economic benefit. Simon & FieldingSimon & Fielding

Health Affairs,Health Affairs, July/August, 2006 July/August, 2006

Rural Jobs Need New Rural Health StrategyRural Jobs Need New Rural Health StrategyRural Jobs Need New Rural Health StrategyRural Jobs Need New Rural Health Strategy


Community Health a Rural Opportunity ( 1 of 2 )Community Health a Rural Opportunity ( 1 of 2 )Community Health a Rural Opportunity ( 1 of 2 )Community Health a Rural Opportunity ( 1 of 2 )

We See . . .We See . . .• Advances are being made both in outcomes Advances are being made both in outcomes

measurement as well as in understanding health measurement as well as in understanding health determinants. determinants.

• More attention is being paid to the value questions of More attention is being paid to the value questions of what we get for what we invest.what we get for what we invest.

But . . .But . . .• Little policy time/money devoted to these issuesLittle policy time/money devoted to these issues• No public or private entity has accountability for over all No public or private entity has accountability for over all

community health outcomescommunity health outcomes

We See . . .We See . . .• Advances are being made both in outcomes Advances are being made both in outcomes

measurement as well as in understanding health measurement as well as in understanding health determinants. determinants.

• More attention is being paid to the value questions of More attention is being paid to the value questions of what we get for what we invest.what we get for what we invest.

But . . .But . . .• Little policy time/money devoted to these issuesLittle policy time/money devoted to these issues• No public or private entity has accountability for over all No public or private entity has accountability for over all

community health outcomescommunity health outcomes

““What Would You Do If ‘Pay For (Population Health) Performance’ What Would You Do If ‘Pay For (Population Health) Performance’ Came To Your Community?,” David Kindig MD, Phd, Came To Your Community?,” David Kindig MD, Phd, University of Wisconsin at NRHA in Reno on 5/17/06University of Wisconsin at NRHA in Reno on 5/17/06


Community Health a Rural Opportunity ( 2 of 2 )Community Health a Rural Opportunity ( 2 of 2 )Community Health a Rural Opportunity ( 2 of 2 )Community Health a Rural Opportunity ( 2 of 2 )

And . . .And . . .

• Managerial and financial structures which have as their Managerial and financial structures which have as their goal community health outcome improvement are goal community health outcome improvement are primitive and need significant attention in the near futureprimitive and need significant attention in the near future

• Rural communities have opportunities for national Rural communities have opportunities for national leadership on this issueleadership on this issue

And . . .And . . .

• Managerial and financial structures which have as their Managerial and financial structures which have as their goal community health outcome improvement are goal community health outcome improvement are primitive and need significant attention in the near futureprimitive and need significant attention in the near future

• Rural communities have opportunities for national Rural communities have opportunities for national leadership on this issueleadership on this issue

““What Would You Do If ‘Pay For (Population Health) Performance’ What Would You Do If ‘Pay For (Population Health) Performance’ Came To Your Community?,” David Kindig MD, Phd, Came To Your Community?,” David Kindig MD, Phd, University of Wisconsin at NRHA in Reno on 5/17/06University of Wisconsin at NRHA in Reno on 5/17/06


4. Healthy Community Collaborations Not New4. Healthy Community Collaborations Not New4. Healthy Community Collaborations Not New4. Healthy Community Collaborations Not New

RWHC Eye On Health

"It's not about being conservative or liberal, it's about building our community or 'just moving through.' "

But now But now there is a fair there is a fair amount of amount of evidence it is evidence it is moving from moving from a third tier a third tier to a first tier to a first tier focus.focus.

But now But now there is a fair there is a fair amount of amount of evidence it is evidence it is moving from moving from a third tier a third tier to a first tier to a first tier focus.focus.


It Has Been Around for Decades in BackgroundIt Has Been Around for Decades in BackgroundIt Has Been Around for Decades in BackgroundIt Has Been Around for Decades in Background

Association for Community Health Improvement, Association for Community Health Improvement, a program of AHA’s Health Research and a program of AHA’s Health Research and Education Trust, has long focused on:Education Trust, has long focused on:• health care delivery and preventive health health care delivery and preventive health

systems to ensure accessibility and are systems to ensure accessibility and are accountable to local needsaccountable to local needs

• careful planning for and measurement of careful planning for and measurement of progress toward defined community health progress toward defined community health goals, and;goals, and;

• broad community engagement to resolve broad community engagement to resolve systemic challenges to community healthsystemic challenges to community health

Association for Community Health Improvement, Association for Community Health Improvement, a program of AHA’s Health Research and a program of AHA’s Health Research and Education Trust, has long focused on:Education Trust, has long focused on:• health care delivery and preventive health health care delivery and preventive health

systems to ensure accessibility and are systems to ensure accessibility and are accountable to local needsaccountable to local needs

• careful planning for and measurement of careful planning for and measurement of progress toward defined community health progress toward defined community health goals, and;goals, and;

• broad community engagement to resolve broad community engagement to resolve systemic challenges to community healthsystemic challenges to community health

Association for Community Health Improvement Association for Community Health Improvement http://www.communityhlth.org/http://www.communityhlth.org/


2002 - Federal DHHS Rural Task Force2002 - Federal DHHS Rural Task Force2002 - Federal DHHS Rural Task Force2002 - Federal DHHS Rural Task Force

““The strong relationship between adequate The strong relationship between adequate income, sufficient food, strong social networks, income, sufficient food, strong social networks, and good health necessitates coordination among and good health necessitates coordination among various health care and social service various health care and social service agencies…” agencies…”

““In many rural communities, service providers In many rural communities, service providers often make alliances with one another and often make alliances with one another and exhibit extraordinary resourcefulness and exhibit extraordinary resourcefulness and resilience.”resilience.”

““The strong relationship between adequate The strong relationship between adequate income, sufficient food, strong social networks, income, sufficient food, strong social networks, and good health necessitates coordination among and good health necessitates coordination among various health care and social service various health care and social service agencies…” agencies…”

““In many rural communities, service providers In many rural communities, service providers often make alliances with one another and often make alliances with one another and exhibit extraordinary resourcefulness and exhibit extraordinary resourcefulness and resilience.”resilience.”

HHS Rural Task Force. One department serving rural America. Report to the HHS Rural Task Force. One department serving rural America. Report to the Secretary; July 2002. Available at http://ruralhealth.hrsa.gov/PublicReport.htmSecretary; July 2002. Available at http://ruralhealth.hrsa.gov/PublicReport.htm


2004 - IOM Committee on Future of Rural Health2004 - IOM Committee on Future of Rural Health2004 - IOM Committee on Future of Rural Health2004 - IOM Committee on Future of Rural Health

““Rural communities must reorient their quality Rural communities must reorient their quality improvement strategies from an exclusively improvement strategies from an exclusively patient- and provider-centric approach to one patient- and provider-centric approach to one that also addresses the problems and needs of that also addresses the problems and needs of rural communities and populations.” rural communities and populations.”

““A wide range of interventions are available to A wide range of interventions are available to improve health in rural America, but priorities improve health in rural America, but priorities for implementation are not yet clear.”for implementation are not yet clear.”

“… “… catalogue and evaluate the potential catalogue and evaluate the potential interventions to improve health care quality and interventions to improve health care quality and population health in rural communities.”population health in rural communities.”

““Rural communities must reorient their quality Rural communities must reorient their quality improvement strategies from an exclusively improvement strategies from an exclusively patient- and provider-centric approach to one patient- and provider-centric approach to one that also addresses the problems and needs of that also addresses the problems and needs of rural communities and populations.” rural communities and populations.”

““A wide range of interventions are available to A wide range of interventions are available to improve health in rural America, but priorities improve health in rural America, but priorities for implementation are not yet clear.”for implementation are not yet clear.”

“… “… catalogue and evaluate the potential catalogue and evaluate the potential interventions to improve health care quality and interventions to improve health care quality and population health in rural communities.”population health in rural communities.”

Committee on the Future of Rural Health Care. Quality through collaboration: Committee on the Future of Rural Health Care. Quality through collaboration: the future of rural health care; National Academies Press; 2004.the future of rural health care; National Academies Press; 2004.


Quality AimQuality Aim Personal HealthPersonal Health Population HealthPopulation Health

SafetySafety Reduce medication errors.Reduce medication errors. Reduce auto accidents.Reduce auto accidents.

EffectivenessEffectiveness Use best practices to care Use best practices to care for diabetic patients.for diabetic patients.

Public school policies reduce Public school policies reduce risk obesity/diabetes.risk obesity/diabetes.

Individual-Individual-CenteredCentered

Improve provider & patient Improve provider & patient communication.communication.

Regional networks respect Regional networks respect community preferences.community preferences.

TimelinessTimeliness Appointments available Appointments available within reasonable limits.within reasonable limits.

Epidemics and other threats Epidemics and other threats to community as whole to community as whole identified earlier than later.identified earlier than later.

EfficiencyEfficiencyInvesting in electronic Investing in electronic health records as a means to health records as a means to more efficient care.more efficient care.

Public reporting of Public reporting of population-based measures population-based measures of health status.of health status.

EquityEquity Treat all patients with Treat all patients with equal respect.equal respect.

Public policies that Public policies that encourage appropriate encourage appropriate distribution of providers.distribution of providers.


The National Steering Committee on Hospitals The National Steering Committee on Hospitals and the Public's Health, convened by Health and the Public's Health, convened by Health Research and Education Trust, recommends that: Research and Education Trust, recommends that:

““hospitals engage in community-based hospitals engage in community-based collaboration bridging gaps in the public health collaboration bridging gaps in the public health care system. The report also emphasizes the need care system. The report also emphasizes the need for innovation and collaboration between hospitals for innovation and collaboration between hospitals and other private and public health care and other private and public health care organizations in order to expand access to care, organizations in order to expand access to care, reduce health disparities and prevent chronic reduce health disparities and prevent chronic disease.”disease.”

The National Steering Committee on Hospitals The National Steering Committee on Hospitals and the Public's Health, convened by Health and the Public's Health, convened by Health Research and Education Trust, recommends that: Research and Education Trust, recommends that:

““hospitals engage in community-based hospitals engage in community-based collaboration bridging gaps in the public health collaboration bridging gaps in the public health care system. The report also emphasizes the need care system. The report also emphasizes the need for innovation and collaboration between hospitals for innovation and collaboration between hospitals and other private and public health care and other private and public health care organizations in order to expand access to care, organizations in order to expand access to care, reduce health disparities and prevent chronic reduce health disparities and prevent chronic disease.”disease.”

2007 - Traditional Providers & Public Health?2007 - Traditional Providers & Public Health?2007 - Traditional Providers & Public Health?2007 - Traditional Providers & Public Health?

The National Steering Committee on Hospitals and the Public's HealthThe National Steering Committee on Hospitals and the Public's Healthhttp://www.hret.org/hret/programs/nschph.htmlhttp://www.hret.org/hret/programs/nschph.html


1.1. Eliminate health disparitiesEliminate health disparities

2.2. Coordinate careCoordinate care

3.3. Promote primary preventionPromote primary prevention

4.4. Optimize access to care for allOptimize access to care for all

5.5. Advocate payment for preventionAdvocate payment for prevention

6.6. Build the community’s capacity to stay healthyBuild the community’s capacity to stay healthy

7.7. Support recreating the public health infrastructure andSupport recreating the public health infrastructure and

8.8. Expanding capacityExpanding capacity

1.1. Eliminate health disparitiesEliminate health disparities

2.2. Coordinate careCoordinate care

3.3. Promote primary preventionPromote primary prevention

4.4. Optimize access to care for allOptimize access to care for all

5.5. Advocate payment for preventionAdvocate payment for prevention

6.6. Build the community’s capacity to stay healthyBuild the community’s capacity to stay healthy

7.7. Support recreating the public health infrastructure andSupport recreating the public health infrastructure and

8.8. Expanding capacityExpanding capacity

““Hospitals & Public’s Health” RecommendationsHospitals & Public’s Health” Recommendations““Hospitals & Public’s Health” RecommendationsHospitals & Public’s Health” Recommendations

The National Steering Committee on Hospitals and the Public's HealthThe National Steering Committee on Hospitals and the Public's Healthhttp://www.hret.org/hret/programs/nschph.htmlhttp://www.hret.org/hret/programs/nschph.html


5. Why Aren’t We Doing It?5. Why Aren’t We Doing It?5. Why Aren’t We Doing It?5. Why Aren’t We Doing It?

Because we Because we follow $$$ follow $$$ incentives and incentives and mostly think mostly think of health of health coming from coming from providers who providers who fix us when fix us when broken.broken.

Because we Because we follow $$$ follow $$$ incentives and incentives and mostly think mostly think of health of health coming from coming from providers who providers who fix us when fix us when broken.broken.

RWHC Eye On Health

"Get over the Doc Welby thing, what you do makes a lot more difference to your health than what I do."

RWHC Eye On Health

"Get over the Doc Welby thing, what you do makes a lot more difference to your health than what I do."


Strategic Barriers to Providers Getting InvolvedStrategic Barriers to Providers Getting InvolvedStrategic Barriers to Providers Getting InvolvedStrategic Barriers to Providers Getting Involved

• TraditionTradition. the role of providers has been seen as . the role of providers has been seen as treating individuals. Population health seen as treating individuals. Population health seen as the job of local and state public health the job of local and state public health departments. departments.

• ResourcesResources. Hospitals and clinics struggling to . Hospitals and clinics struggling to address traditional responsibilities are not address traditional responsibilities are not looking for roles “that no one will pay us to do.” looking for roles “that no one will pay us to do.”

• ValuesValues. The discomfort that many of us feel . The discomfort that many of us feel when talking about population health issues, that when talking about population health issues, that relate to individual behaviors – other people’s relate to individual behaviors – other people’s choices and “rights” to make those choices.choices and “rights” to make those choices.

• TraditionTradition. the role of providers has been seen as . the role of providers has been seen as treating individuals. Population health seen as treating individuals. Population health seen as the job of local and state public health the job of local and state public health departments. departments.

• ResourcesResources. Hospitals and clinics struggling to . Hospitals and clinics struggling to address traditional responsibilities are not address traditional responsibilities are not looking for roles “that no one will pay us to do.” looking for roles “that no one will pay us to do.”

• ValuesValues. The discomfort that many of us feel . The discomfort that many of us feel when talking about population health issues, that when talking about population health issues, that relate to individual behaviors – other people’s relate to individual behaviors – other people’s choices and “rights” to make those choices.choices and “rights” to make those choices.

““Population Health Improvement & Rural Hospital Balanced Scorecards,” Population Health Improvement & Rural Hospital Balanced Scorecards,”

Tim Size, David Kindig & Clint MacKinney, Tim Size, David Kindig & Clint MacKinney, Journal Rural HealthJournal Rural Health, Spring, 2006, Spring, 2006


6. Starting or Expanding Collaboration6. Starting or Expanding Collaboration6. Starting or Expanding Collaboration6. Starting or Expanding Collaboration

Collaboration Collaboration isn’t easy; it isn’t easy; it takes more takes more time; if the time; if the “cost” out “cost” out weighs the weighs the benefit, do it benefit, do it on your own, on your own, keep it simple.keep it simple.

Collaboration Collaboration isn’t easy; it isn’t easy; it takes more takes more time; if the time; if the “cost” out “cost” out weighs the weighs the benefit, do it benefit, do it on your own, on your own, keep it simple.keep it simple.


Trust & TimeTrust & Time

Turf WarsTurf Wars

NetworkNetwork CoordinateCoordinate CooperateCooperate CollaborateCollaborateExchange Exchange InformationInformation

Exchange Exchange InformationInformationANDANDHarmonize Harmonize ActivitiesActivities

Exchange Exchange InformationInformationAND AND Harmonize Harmonize ActivitiesActivitiesAND AND Share ResourcesShare Resources

Exchange Exchange InformationInformationAND AND Harmonize Harmonize Activities Activities AND AND Share ResourcesShare ResourcesANDANDEnhance Partner’sEnhance Partner’sCapacityCapacity

How Far Are You Ready To Go?How Far Are You Ready To Go?How Far Are You Ready To Go?How Far Are You Ready To Go?

The Collaboration Primer by Gretchen Williams Torres and Frances MargolinThe Collaboration Primer by Gretchen Williams Torres and Frances Margolin


A Checklist for Successful CollaboratingA Checklist for Successful CollaboratingA Checklist for Successful CollaboratingA Checklist for Successful Collaborating

Host organization ready?Host organization ready? The right partners involved?The right partners involved? Shared vision unifies partners?Shared vision unifies partners? Partners aware what is expected?Partners aware what is expected? Partners know partnership goals Partners know partnership goals

and objectives?and objectives? People to do the work have been People to do the work have been

identified, staffed and made identified, staffed and made accountable?accountable?

““Best practices have been Best practices have been researched and shared?researched and shared?

Assets residing within the Assets residing within the partnership have been mapped?partnership have been mapped?

Host organization ready?Host organization ready? The right partners involved?The right partners involved? Shared vision unifies partners?Shared vision unifies partners? Partners aware what is expected?Partners aware what is expected? Partners know partnership goals Partners know partnership goals

and objectives?and objectives? People to do the work have been People to do the work have been

identified, staffed and made identified, staffed and made accountable?accountable?

““Best practices have been Best practices have been researched and shared?researched and shared?

Assets residing within the Assets residing within the partnership have been mapped?partnership have been mapped?

Partnership encourages Partnership encourages participation in and sustainability participation in and sustainability of its work?of its work?

Partnership actively recruits new Partnership actively recruits new members?members?

Defined governance model?Defined governance model? Leadership is effective?Leadership is effective? Communication/outreach plan?Communication/outreach plan? Financial needs known and Financial needs known and

addressed?addressed? Work evaluated/revised?Work evaluated/revised? Partnership knows challenges Partnership knows challenges

that it faces?that it faces?

Partnership encourages Partnership encourages participation in and sustainability participation in and sustainability of its work?of its work?

Partnership actively recruits new Partnership actively recruits new members?members?

Defined governance model?Defined governance model? Leadership is effective?Leadership is effective? Communication/outreach plan?Communication/outreach plan? Financial needs known and Financial needs known and

addressed?addressed? Work evaluated/revised?Work evaluated/revised? Partnership knows challenges Partnership knows challenges

that it faces?that it faces?

The Collaboration Primer by Gretchen Williams Torres and Frances MargolinThe Collaboration Primer by Gretchen Williams Torres and Frances Margolin


Some Next Steps: StateSome Next Steps: StateSome Next Steps: StateSome Next Steps: State

• Advocate for improved population health measurement Advocate for improved population health measurement techniques and increased population health techniques and increased population health improvement valuation.improvement valuation.

• Assist hospitals and clinics, and other stakeholders, to Assist hospitals and clinics, and other stakeholders, to begin to link the mission of community health begin to link the mission of community health improvement to budget, operations, and performance improvement to budget, operations, and performance measurement.measurement.

• Partner with academic institutions to design research Partner with academic institutions to design research projects around provider performance improvement and projects around provider performance improvement and population health measurementpopulation health measurement..

• Advocate for improved population health measurement Advocate for improved population health measurement techniques and increased population health techniques and increased population health improvement valuation.improvement valuation.

• Assist hospitals and clinics, and other stakeholders, to Assist hospitals and clinics, and other stakeholders, to begin to link the mission of community health begin to link the mission of community health improvement to budget, operations, and performance improvement to budget, operations, and performance measurement.measurement.

• Partner with academic institutions to design research Partner with academic institutions to design research projects around provider performance improvement and projects around provider performance improvement and population health measurementpopulation health measurement..

““Population Health Improvement & Rural Hospital Balanced Scorecards,” Population Health Improvement & Rural Hospital Balanced Scorecards,” Tim Size, David Kindig & Clint MacKinney, Tim Size, David Kindig & Clint MacKinney, Journal Rural HealthJournal Rural Health, Spring, 2006, Spring, 2006


Some Next Steps: Local CommunitySome Next Steps: Local CommunitySome Next Steps: Local CommunitySome Next Steps: Local Community

• Devote a periodic Board meeting or a portion of every Devote a periodic Board meeting or a portion of every Board meeting to review available population health Board meeting to review available population health indicators. indicators.

• Add Board members with specific interest in population Add Board members with specific interest in population health measurement and improvement.health measurement and improvement.

• Create a “population health” subcommittee of the Board Create a “population health” subcommittee of the Board to seek community partnerships.to seek community partnerships.

• Consider employees as a “community” and develop Consider employees as a “community” and develop interventions to improve employee health. Then, interventions to improve employee health. Then, expand the experience to the larger community.expand the experience to the larger community.

• Devote a periodic Board meeting or a portion of every Devote a periodic Board meeting or a portion of every Board meeting to review available population health Board meeting to review available population health indicators. indicators.

• Add Board members with specific interest in population Add Board members with specific interest in population health measurement and improvement.health measurement and improvement.

• Create a “population health” subcommittee of the Board Create a “population health” subcommittee of the Board to seek community partnerships.to seek community partnerships.

• Consider employees as a “community” and develop Consider employees as a “community” and develop interventions to improve employee health. Then, interventions to improve employee health. Then, expand the experience to the larger community.expand the experience to the larger community.

““Population Health Improvement & Rural Hospital Balanced Scorecards,” Population Health Improvement & Rural Hospital Balanced Scorecards,” Tim Size, David Kindig & Clint MacKinney, Tim Size, David Kindig & Clint MacKinney, Journal Rural HealthJournal Rural Health, Spring, 2006, Spring, 2006


Tip #1: Partnership Grants Must Be “Authentic”Tip #1: Partnership Grants Must Be “Authentic”Tip #1: Partnership Grants Must Be “Authentic”Tip #1: Partnership Grants Must Be “Authentic”

1.1. Good grants are good “business” plans.Good grants are good “business” plans.

2.2. They start with an idea about which there is passion and They start with an idea about which there is passion and that you all would do with your own organizations that you all would do with your own organizations money, if you it.money, if you it.

3.3. There needs to be a clear “public purpose” for the There needs to be a clear “public purpose” for the requested use of public/foundation funds.requested use of public/foundation funds.

4.4. If successful, real value added–justifying the funder’s If successful, real value added–justifying the funder’s investment and reviewers time.investment and reviewers time.

5.5. Bold/Innovative is good and characteristic of funded Bold/Innovative is good and characteristic of funded grant. But reviewers as a whole can be conservative.grant. But reviewers as a whole can be conservative.

1.1. Good grants are good “business” plans.Good grants are good “business” plans.

2.2. They start with an idea about which there is passion and They start with an idea about which there is passion and that you all would do with your own organizations that you all would do with your own organizations money, if you it.money, if you it.

3.3. There needs to be a clear “public purpose” for the There needs to be a clear “public purpose” for the requested use of public/foundation funds.requested use of public/foundation funds.

4.4. If successful, real value added–justifying the funder’s If successful, real value added–justifying the funder’s investment and reviewers time.investment and reviewers time.

5.5. Bold/Innovative is good and characteristic of funded Bold/Innovative is good and characteristic of funded grant. But reviewers as a whole can be conservative.grant. But reviewers as a whole can be conservative.


Tip #2: Not Every Group Is a PartnershipTip #2: Not Every Group Is a PartnershipTip #2: Not Every Group Is a PartnershipTip #2: Not Every Group Is a Partnership

1.1.A partnership has a written agreement that defines A partnership has a written agreement that defines its purpose, member roles and responsibilities.its purpose, member roles and responsibilities.

2.2.A partnership works according to an explicit A partnership works according to an explicit strategic plan that includes accountability.strategic plan that includes accountability.

3.3.A partnership is not owned/dominated by one A partnership is not owned/dominated by one entity.entity.

1.1.A partnership has a written agreement that defines A partnership has a written agreement that defines its purpose, member roles and responsibilities.its purpose, member roles and responsibilities.

2.2.A partnership works according to an explicit A partnership works according to an explicit strategic plan that includes accountability.strategic plan that includes accountability.

3.3.A partnership is not owned/dominated by one A partnership is not owned/dominated by one entity.entity.


Tip #3: It’s About Social EntrepreneurshipTip #3: It’s About Social EntrepreneurshipTip #3: It’s About Social EntrepreneurshipTip #3: It’s About Social Entrepreneurship

1.1. Network development is an entrepreneurial activity Network development is an entrepreneurial activity and as such success is not certain. and as such success is not certain.

2.2. The odds can be increased if all participants The odds can be increased if all participants understand that networks are businesses, albeit understand that networks are businesses, albeit typically “non-profit.”typically “non-profit.”

3.3. A key responsibility is to NOT become a small A key responsibility is to NOT become a small business startup that fails after running through its business startup that fails after running through its initial capital (aka grant).initial capital (aka grant).

4.4. Sustainability is too often thought of as just one of Sustainability is too often thought of as just one of those annoying questions one has to answer at the end those annoying questions one has to answer at the end of the applications about “life after the grant.” of the applications about “life after the grant.”

1.1. Network development is an entrepreneurial activity Network development is an entrepreneurial activity and as such success is not certain. and as such success is not certain.

2.2. The odds can be increased if all participants The odds can be increased if all participants understand that networks are businesses, albeit understand that networks are businesses, albeit typically “non-profit.”typically “non-profit.”

3.3. A key responsibility is to NOT become a small A key responsibility is to NOT become a small business startup that fails after running through its business startup that fails after running through its initial capital (aka grant).initial capital (aka grant).

4.4. Sustainability is too often thought of as just one of Sustainability is too often thought of as just one of those annoying questions one has to answer at the end those annoying questions one has to answer at the end of the applications about “life after the grant.” of the applications about “life after the grant.”


TipTip #4:#4: CommunicationCommunication isis CoreCore CompetencyCompetencyTipTip #4:#4: CommunicationCommunication isis CoreCore CompetencyCompetency

RWHC Eye On Health

"You're too dumb to understand why you're wrong and I'm right, even if I could explain it."

RWHC Eye On Health

"You're too dumb to understand why you're wrong and I'm right, even if I could explain it."

RWHC Meeting Guidelines from Tercon, Inc.RWHC Meeting Guidelines from Tercon, Inc.

• Everyone Participates, No Everyone Participates, No One Person DominatesOne Person Dominates

• Listen As An Ally–Work To Listen As An Ally–Work To Understand Before Understand Before EvaluatingEvaluating

• An Individual’s Silence Will An Individual’s Silence Will Be Interpreted As AgreementBe Interpreted As Agreement

• Assume Positive Intent First Assume Positive Intent First When Things Go WrongWhen Things Go Wrong

• Minimize Interruptions And Minimize Interruptions And Side ConversationsSide Conversations

• Everyone Participates, No Everyone Participates, No One Person DominatesOne Person Dominates

• Listen As An Ally–Work To Listen As An Ally–Work To Understand Before Understand Before EvaluatingEvaluating

• An Individual’s Silence Will An Individual’s Silence Will Be Interpreted As AgreementBe Interpreted As Agreement

• Assume Positive Intent First Assume Positive Intent First When Things Go WrongWhen Things Go Wrong

• Minimize Interruptions And Minimize Interruptions And Side ConversationsSide Conversations


Tip #5: Strategy is Both Art & ScienceTip #5: Strategy is Both Art & ScienceTip #5: Strategy is Both Art & ScienceTip #5: Strategy is Both Art & Science

Strategy is both the Strategy is both the artart and and sciencescience of of employing the employing the politicalpolitical, , economiceconomic and and psychologicalpsychological forces of a group to afford the forces of a group to afford the maximum support to adopted policies.”maximum support to adopted policies.”

Strategy is both the Strategy is both the artart and and sciencescience of of employing the employing the politicalpolitical, , economiceconomic and and psychologicalpsychological forces of a group to afford the forces of a group to afford the maximum support to adopted policies.”maximum support to adopted policies.”


Tip #6: Balanced Portfolio of Services/AdvocacyTip #6: Balanced Portfolio of Services/AdvocacyTip #6: Balanced Portfolio of Services/AdvocacyTip #6: Balanced Portfolio of Services/Advocacy

Green: “Low Risk - High Value Added” Do it!Green: “Low Risk - High Value Added” Do it!

Red: “High Risk - Low Value Added” Non-starter.Red: “High Risk - Low Value Added” Non-starter.

Yellow: “Low Risk - Low Value Added” helpful in Yellow: “Low Risk - Low Value Added” helpful in short run; “High Risk - High Value Added” short run; “High Risk - High Value Added” provides real value over the long run. provides real value over the long run.

L - LL - L

L - HL - H H - HH - H

L - HL - H

LL HH

LL

HHRiskRisk

Value AddedValue Added


Tip #7: Seeking the Win-Win is NecessaryTip #7: Seeking the Win-Win is NecessaryTip #7: Seeking the Win-Win is NecessaryTip #7: Seeking the Win-Win is Necessary

RWHC Eye On Health

"OK. I understand a lot is going to change. But how do I stay the same?"

*Anne Woodbury, Chief Health Advocate for Newt Gingrich's *Anne Woodbury, Chief Health Advocate for Newt Gingrich's Center for Health TransformationCenter for Health Transformation

““Say ‘Yes, if …’ Say ‘Yes, if …’ rather than rather than

‘‘No, because…’ No, because…’ ””

““Say ‘Yes, if …’ Say ‘Yes, if …’ rather than rather than

‘‘No, because…’ No, because…’ ””


7. Become a More Active & Effective Advocate7. Become a More Active & Effective Advocate7. Become a More Active & Effective Advocate7. Become a More Active & Effective Advocate


What Drives Advocacy?What Drives Advocacy?What Drives Advocacy?What Drives Advocacy?

• Need to Correct Bias – Critical Access HospitalsNeed to Correct Bias – Critical Access Hospitals• Opportunity to Reframe – Binge DrinkingOpportunity to Reframe – Binge Drinking• Short-term Fix Possible – Provider PaymentsShort-term Fix Possible – Provider Payments• Broad Coalition Possible – Workforce DataBroad Coalition Possible – Workforce Data• Address Core Need – Physician Supply Address Core Need – Physician Supply • Anticipate Problems – Medicare Managed CareAnticipate Problems – Medicare Managed Care• Can’t Be Avoided – Healthcare CostsCan’t Be Avoided – Healthcare Costs• Long-term Significance – Healthier CommunitiesLong-term Significance – Healthier Communities

• Need to Correct Bias – Critical Access HospitalsNeed to Correct Bias – Critical Access Hospitals• Opportunity to Reframe – Binge DrinkingOpportunity to Reframe – Binge Drinking• Short-term Fix Possible – Provider PaymentsShort-term Fix Possible – Provider Payments• Broad Coalition Possible – Workforce DataBroad Coalition Possible – Workforce Data• Address Core Need – Physician Supply Address Core Need – Physician Supply • Anticipate Problems – Medicare Managed CareAnticipate Problems – Medicare Managed Care• Can’t Be Avoided – Healthcare CostsCan’t Be Avoided – Healthcare Costs• Long-term Significance – Healthier CommunitiesLong-term Significance – Healthier Communities


Your Advocacy Behaviors MatterYour Advocacy Behaviors MatterYour Advocacy Behaviors MatterYour Advocacy Behaviors Matter

• Be BriefBe Brief• Be Accurate - NEVER false or misleading infoBe Accurate - NEVER false or misleading info• Personalize Your Message - cite examplesPersonalize Your Message - cite examples• Be Prepared - know your issueBe Prepared - know your issue• Be Aware Every Issue Has At Least Two Sides - Be Aware Every Issue Has At Least Two Sides -

there are stakeholders on the other sidethere are stakeholders on the other side• Be Courteous/Don’t ThreatenBe Courteous/Don’t Threaten• Be Patient - long process; be in for long haulBe Patient - long process; be in for long haul

• Be BriefBe Brief• Be Accurate - NEVER false or misleading infoBe Accurate - NEVER false or misleading info• Personalize Your Message - cite examplesPersonalize Your Message - cite examples• Be Prepared - know your issueBe Prepared - know your issue• Be Aware Every Issue Has At Least Two Sides - Be Aware Every Issue Has At Least Two Sides -

there are stakeholders on the other sidethere are stakeholders on the other side• Be Courteous/Don’t ThreatenBe Courteous/Don’t Threaten• Be Patient - long process; be in for long haulBe Patient - long process; be in for long haul

Wisconsin Hospital Associations Grass Roots HandbookWisconsin Hospital Associations Grass Roots Handbook


Three Prong Advocacy StrategyThree Prong Advocacy StrategyThree Prong Advocacy StrategyThree Prong Advocacy Strategy

Make your best caseMake your best case: Develop concise, credible, : Develop concise, credible, persuasive, fiscally responsible, but emotive persuasive, fiscally responsible, but emotive arguments.arguments.

Make friends and form alliancesMake friends and form alliances: Find Congressional : Find Congressional champions, develop agency contacts, form alliances champions, develop agency contacts, form alliances with a diverse set of groups.with a diverse set of groups.

Make it happenMake it happen: Use some or all of your advocacy : Use some or all of your advocacy tools – government relations, grassroots and media tools – government relations, grassroots and media advocacy – based on your level of engagement.advocacy – based on your level of engagement.

Make your best caseMake your best case: Develop concise, credible, : Develop concise, credible, persuasive, fiscally responsible, but emotive persuasive, fiscally responsible, but emotive arguments.arguments.

Make friends and form alliancesMake friends and form alliances: Find Congressional : Find Congressional champions, develop agency contacts, form alliances champions, develop agency contacts, form alliances with a diverse set of groups.with a diverse set of groups.

Make it happenMake it happen: Use some or all of your advocacy : Use some or all of your advocacy tools – government relations, grassroots and media tools – government relations, grassroots and media advocacy – based on your level of engagement.advocacy – based on your level of engagement.

Jennifer Friedman, VP Government Affairs and PolicyJennifer Friedman, VP Government Affairs and PolicyNational Rural Health AssociationNational Rural Health Association


8. Anticipate Barriers to Change8. Anticipate Barriers to Change8. Anticipate Barriers to Change8. Anticipate Barriers to Change


Examples of Barriers to Change (1 of 2)Examples of Barriers to Change (1 of 2)Examples of Barriers to Change (1 of 2)Examples of Barriers to Change (1 of 2)

• Constituencies Often Trump “Good Sense”Constituencies Often Trump “Good Sense”• Hope of Gain Must Exceed Fear of LossHope of Gain Must Exceed Fear of Loss• Trends You See Must Be Made RealTrends You See Must Be Made Real• Impact on Personal Incomes MatterImpact on Personal Incomes Matter• Sometimes Agencies Have Own AgendaSometimes Agencies Have Own Agenda• Collective Denial Trumps Raw NumbersCollective Denial Trumps Raw Numbers• Never Underestimate Prevalence of BiasesNever Underestimate Prevalence of Biases• ““Analysis” May Be Obvious, Action HarderAnalysis” May Be Obvious, Action Harder

• Constituencies Often Trump “Good Sense”Constituencies Often Trump “Good Sense”• Hope of Gain Must Exceed Fear of LossHope of Gain Must Exceed Fear of Loss• Trends You See Must Be Made RealTrends You See Must Be Made Real• Impact on Personal Incomes MatterImpact on Personal Incomes Matter• Sometimes Agencies Have Own AgendaSometimes Agencies Have Own Agenda• Collective Denial Trumps Raw NumbersCollective Denial Trumps Raw Numbers• Never Underestimate Prevalence of BiasesNever Underestimate Prevalence of Biases• ““Analysis” May Be Obvious, Action HarderAnalysis” May Be Obvious, Action Harder


Examples of Barriers to Change (2 of 2)Examples of Barriers to Change (2 of 2)Examples of Barriers to Change (2 of 2)Examples of Barriers to Change (2 of 2)

• Important to Share “Ownership” of ProblemImportant to Share “Ownership” of Problem• Stated & Underlying Intent May DifferStated & Underlying Intent May Differ• Politics Reflects Our Conflicting ValuesPolitics Reflects Our Conflicting Values• Tradition Conceals Important QuestionsTradition Conceals Important Questions• Reasons Policymakers May Stay UninformedReasons Policymakers May Stay Uninformed• Change Tougher if Ignore Cultural NormsChange Tougher if Ignore Cultural Norms• Challenge to Move Dollars “Upstream”Challenge to Move Dollars “Upstream”• Shooting Messenger Sometimes 1st ResponseShooting Messenger Sometimes 1st Response

• Important to Share “Ownership” of ProblemImportant to Share “Ownership” of Problem• Stated & Underlying Intent May DifferStated & Underlying Intent May Differ• Politics Reflects Our Conflicting ValuesPolitics Reflects Our Conflicting Values• Tradition Conceals Important QuestionsTradition Conceals Important Questions• Reasons Policymakers May Stay UninformedReasons Policymakers May Stay Uninformed• Change Tougher if Ignore Cultural NormsChange Tougher if Ignore Cultural Norms• Challenge to Move Dollars “Upstream”Challenge to Move Dollars “Upstream”• Shooting Messenger Sometimes 1st ResponseShooting Messenger Sometimes 1st Response


Partial List Of ResourcesPartial List Of ResourcesPartial List Of ResourcesPartial List Of Resources

• Association for Community Health ImprovementAssociation for Community Health Improvement http://www.communityhlth.org/http://www.communityhlth.org/

• What Counts as Community Benefit? At What Counts as Community Benefit? At http://www.chausa.org/http://www.chausa.org/• (1) (1) National Steering Committee on Hospitals and the Public's HealthNational Steering Committee on Hospitals and the Public's Health

& (2) & (2) Where Do We Go from Here? The Hospital Leader's Role in Where Do We Go from Here? The Hospital Leader's Role in Community EngagementCommunity Engagement at http://www.hret.org/ at http://www.hret.org/

• The Collaboration Primer: Proven Strategies, Considerations and The Collaboration Primer: Proven Strategies, Considerations and Tools to Get You StartedTools to Get You Started at at http://www.hret.org/programs/content/colpri.pdfhttp://www.hret.org/programs/content/colpri.pdf

• The Community Tool BoxThe Community Tool Box at http://ctb.ku.edu/ at http://ctb.ku.edu/• VHA Health FoundationVHA Health Foundation

http://www.vhahealthfoundation.org/vhahf/resources.asphttp://www.vhahealthfoundation.org/vhahf/resources.asp• Kellogg Leadership for Community Change Kellogg Leadership for Community Change

http://www.klccleadership.org/http://www.klccleadership.org/

• Association for Community Health ImprovementAssociation for Community Health Improvement http://www.communityhlth.org/http://www.communityhlth.org/

• What Counts as Community Benefit? At What Counts as Community Benefit? At http://www.chausa.org/http://www.chausa.org/• (1) (1) National Steering Committee on Hospitals and the Public's HealthNational Steering Committee on Hospitals and the Public's Health

& (2) & (2) Where Do We Go from Here? The Hospital Leader's Role in Where Do We Go from Here? The Hospital Leader's Role in Community EngagementCommunity Engagement at http://www.hret.org/ at http://www.hret.org/

• The Collaboration Primer: Proven Strategies, Considerations and The Collaboration Primer: Proven Strategies, Considerations and Tools to Get You StartedTools to Get You Started at at http://www.hret.org/programs/content/colpri.pdfhttp://www.hret.org/programs/content/colpri.pdf

• The Community Tool BoxThe Community Tool Box at http://ctb.ku.edu/ at http://ctb.ku.edu/• VHA Health FoundationVHA Health Foundation

http://www.vhahealthfoundation.org/vhahf/resources.asphttp://www.vhahealthfoundation.org/vhahf/resources.asp• Kellogg Leadership for Community Change Kellogg Leadership for Community Change

http://www.klccleadership.org/http://www.klccleadership.org/


For more info about RWHC go to to For more info about RWHC go to to www.rwhc.com www.rwhc.com

For the free RWHC For the free RWHC Eye on Health Eye on Health e-newsletter, email e-newsletter, email [email protected]@rwhc.com with “subscribe” on subject line. with “subscribe” on subject line.

Rural Assistance Center Rural Assistance Center at at www.raconline.org/ www.raconline.org/ is an is an incredibleincredible federally supported information resource. federally supported information resource.

The The Health Workforce Information Center Health Workforce Information Center is RAC’s is RAC’s new “sister,” a comprehensive online library re health new “sister,” a comprehensive online library re health workforce programs, funding, data, research & policy workforce programs, funding, data, research & policy

http://www.healthworkforceinfo.org/http://www.healthworkforceinfo.org/

For more info about RWHC go to to For more info about RWHC go to to www.rwhc.com www.rwhc.com

For the free RWHC For the free RWHC Eye on Health Eye on Health e-newsletter, email e-newsletter, email [email protected]@rwhc.com with “subscribe” on subject line. with “subscribe” on subject line.

Rural Assistance Center Rural Assistance Center at at www.raconline.org/ www.raconline.org/ is an is an incredibleincredible federally supported information resource. federally supported information resource.

The The Health Workforce Information Center Health Workforce Information Center is RAC’s is RAC’s new “sister,” a comprehensive online library re health new “sister,” a comprehensive online library re health workforce programs, funding, data, research & policy workforce programs, funding, data, research & policy

http://www.healthworkforceinfo.org/http://www.healthworkforceinfo.org/

Documents

Rural Wisconsin Health Cooperative A Personal View of Rural Health Leadership: It’s All About Collaboration & Advocacy Tim Size Executive Director Rural