“Margaret” is 35 years old and is in relatively good health when compared to her neighbors in the Appalachian region of West Virginia. She is raising three children, making do with the little income she receives for working a local flea market and the paltry sum sent along by social services. For someone who always prided herself on the concept of self-sufficiency, it was a huge step for her to even consider welfare, but she could not let her kids go hungry. In fact, she still makes all the clothing for the entire household, given her ability with a sewing needle. Margaret has lost a mother and one sister to breast cancer at very young ages. While she knows this puts her at a very high risk, she has not followed through with basic routine breast cancer screening. The issue is not one of coverage, as her entire household is on Medicaid. She finds it difficult to find spare time from raising the children to travel 45 minutes to the nearest healthcare facility. Even if she were able to find the time or bring the kids along, she does not have a reliable vehicle or any means of reliable transportation to make the trip.
Margaret is not an actual person, but her story is representative of healthcare in rural America. As the statistics demonstrate, Margaret likely will not find out about her cancer until it has advanced to the point where a cure is improbable. While this situation is both common and tragic in and of itself, it is also likely that her children will experience a similar plight. Even when measures, such as social services and Medicaid are put in place by governments, there are still gaping holes in rural healthcare service delivery. While some people equate insurance with access to the healthcare system, the truth is that there are a wide variety of social and economic determinants of health status.
The goal of the Rural Health Care Services Outreach Grant Program (ROGP) is to improve healthcare delivery in these rural underserved areas, so that Margaret's children encounter a much more robust system when they access healthcare services as adults. The idea is that when healthcare providers and ancillary organizations form effective partnerships, these complex multi-dimensional issues in rural areas can be addressed. Unlike other funding from the Health Resources & Services Administration (HRSA), the ROGP does not limit eligibility to formal rural health networks. The program does require that at least three separate entities join together to arrange health services in rural areas through formal memorandums of understanding/agreement. However, it does not mandate a network board, bylaws and other requirements that are necessary to pursue Rural Health Network Development grants. In order to be competitive, the collaborating organizations should be able to demonstrate some historical evidence of cooperation and joint participation on other projects. Every participating project partner must have a real and meaningful role in the project. Simply providing letters of support will not allow a collaborative to be competitive. HRSA wants to see that every partner has an identified role and is actively involved; whether it be through the provision of money, personnel, space or other valuable resources. Approximately 80 successful coalitions will be able to access up to $600,000 over a three year project period to fund their rural outreach project.
The good news about ROGP is that it is wide open in terms of the models that you can employ to address health care in rural areas. The program will fund foot soldiers on the ground in outreach efforts (personnel) to technology-based solutions, like telemedicine (note: 40% cap on equipment). The major point of emphasis in the 2015 competition is the focus on utilizing evidence-based or promising practice models. Thus, applicants must do their due diligence in reviewing the academic literature, provider case studies, and self-contained pilot data to ensure they are meeting these standards. The goal is to promote creativity, as HRSA encourages applicants to innovate while simultaneously ensuring there is some type of evidence base for the model or promising practice being proposed.
If you have the components to piece together a comprehensive project to address rural health care needs, the application deadline for ROGP is November 14, 2014. Successful applicants will be able to tell Margaret's story, or a similar one, using local demographic data that documents the underserved status of the rural population in a defined region. HRSA will fund those projects that can make the largest impact on the lives of people like Margaret. Comprehensive projects will account for an actual health care delivery mechanism in addition to the socioeconomic factors that impact the ability of a rural resident to access providers. Finally, winners will be selected based on the strength of their consortia and the evidence-base of the models they are deploying. The goal is to be able to build a bridge that connects rural residents to important health services such as primary/preventative care and chronic disease management.