Publications by CHI staff

After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care

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Our CEO, Charlie Alfero sat on a RURPI panel to discuss “After Hospital Closure: Pursuing High
Performance Rural Health Systems without Inpatient Care”. The panel focuses on the opportunities for rural communities to develop a high performance rural health system after hospital closure. Communities with hospitals that are vulnerable to closure may also find the approaches outlined here constructive when considering options for optimal care delivery.

Health Education Centers promote rural practice in primary care

A new project report from Rural and Remote Health Journal , by JD Taylor and SE Goletz, found that health education centers (AHEC) promote interest in rural practice in medical students. CHI hosts the regional AHEC in southern New Mexico, part of our efforts to promote health education in rural communities. Read the abstract and conclusion to learn how “significantly positive association between participation in medical clerkship experiences in a rural primary care setting and the intent to practice in a rural setting upon graduation.”

Medicaid Payment and Delivery System Reform: Challenges and Opportunities for Rural Health Systems

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Compared to their urban counterparts, rural populations tend to be older, poorer, and sicker and have less access to employer-sponsored insurance plans. Consequently, a higher proportion of rural people are potentially eligible for Medicaid. Indeed, as of 2014, 22 percent of rural residents were enrolled in Medicaid while 20 percent were enrolled in Medicare, signifying that Medicaid has surpassed Medicare as the largest source of public health coverage in rural areas, and is second in coverage only to employer-sponsored insurance plans.

The Role of Community Health Centers in Assessing the Social Determinants of Health for Planning and Policy: The Example of Frontier New Mexico

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This article examines the experience of a frontier-based community health center when it utilized the Tool for Health and Resilience in Vulnerable Environments (THRIVE) for assessing social determinants of health with a local health consortium. Community members (N = 357) rated safety, jobs, housing, and education among the top health issues. Community leaders integrated these health priorities in a countywide strategic planning process. This example of a frontier county in New Mexico demonstrates the critical role that community health centers play when engaging with local residents to assess community health needs for strategic planning and policy development.

Advancing the Transition to a High Performance Rural Health System

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Despite decades of policy efforts to stabilize rural health systems through a range of policies and funding programs, accelerating rural hospital closures combined with rapid changes in private and public payment strategies have created widespread concern that these solutions are inadequate for addressing current rural health challenges. This paper presents strategies and options that rural health providers may use in creating a pathway to a transformed, high performing rural health system, which are then categorized into four distinct approaches. We elaborate each approach, and discuss a related set of public policy implications that should be considered when following each strategy. We follow the discussion of policy implications with four demonstration ideas that reflect the essential elements of each strategic approach in achieving the aims of a high performing rural health system.

Community Health Workers and Medicaid Managed Care in New Mexico

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We describe the impact of community health workers (CHWs) providing community-based support services to enrollees who are high consumers of health resources in a Medicaid managed care system. We conducted a retrospective study on a sample of 448 enrollees who were assigned to field-based CHWs in 11 of New Mexico’s 33 counties. The CHWs provided patients education, advocacy and social support for a period up to 6 months. The incorporation of field-based, community health workers as part of Medicaid managed care to provide supportive services to high resource-consuming enrollees can improve access to preventive and social services and may reduce resource utilization and cost.

Health Extension in New Mexico: An Academic Health Center and the Social Determinants of Disease

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The Agricultural Cooperative Extension Service model offers academic health centers methodologies for community engagement that can address the social determinants of disease. The University of New Mexico Health Sciences Center developed Health Extension Rural Offices (HEROs) as a vehicle for its model of health extension. Health extension agents are located in rural communities across the state and are supported by regional coordinators and the Office of the Vice President for Community Health at the Health Sciences Center. The role of agents is to work with different sectors of the community in identifying high-priority health needs and linking those needs with university resources in education, clinical service and research. Community-based health extension agents can effectively bridge those needs with academic health center resources and extend those resources to address the underlying social determinants of disease.

The Health Commons and Care of New Mexico’s Uninsured

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A seamless system of social, behavioral, and medical services for the uninsured was created to address the social determinants of disease, reduce health disparities, and foster local economic development in 2 inner-city neighborhoods and 2 rural counties in New Mexico. We helped urban and rural communities that had large uninsured, minority populations create Health Commons models. These models of care are characterized by health planning shared by community stakeholders; 1-stop shopping for medical, behavioral, and social services; employment of community health workers bridging the clinic and the community; and job creation.