1. Rural Wisconsin Health Cooperative Tim Size, Executive Director Rural Wisconsin Health Cooperative Sauk City, Wisconsin Rural Health Advocacy 24 hours a day 7 days a week

2. Rural Wisconsin Health Cooperative Outline of Presentation Myths About Rural Are Alive & WellMyths About Rural Are Alive & Well Almost Worst Rural Health Policy Awards for 2005Almost Worst Rural Health Policy Awards for 2005 Cross Section Public-Private Rural Health IssuesCross Section Public-Private Rural Health Issues Medicare Advantage Medicare Advantage Physician Supply Physician Supply Healthcare Costs Healthcare Costs Population Health Population Health Becoming More Effective & Active AdvocatesBecoming More Effective & Active Advocates Myths About Rural Are Alive & WellMyths About Rural Are Alive & Well Almost Worst Rural Health Policy Awards for 2005Almost Worst Rural Health Policy Awards for 2005 Cross Section Public-Private Rural Health IssuesCross Section Public-Private Rural Health Issues Medicare Advantage Medicare Advantage Physician Supply Physician Supply Healthcare Costs Healthcare Costs Population Health Population Health Becoming More Effective & Active AdvocatesBecoming More Effective & Active Advocates

3. Rural Wisconsin Health Cooperative MYTHS ABOUT RURAL

4. Rural Wisconsin Health Cooperative Myths 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 healthyRural Americans are naturally more healthy Rural economy is mostly about agricultureRural economy is mostly about agriculture Rural health care costs less than urban careRural health care costs less than urban care Rural health care is inordinately expensiveRural health care is inordinately expensive Rural health care is lower quality; urban is betterRural health care is lower quality; urban is better Rural hospitals are just band-aide stationsRural hospitals are just band-aide stations Rural hospitals & clinics are poorly managed/governedRural hospitals & clinics are poorly managed/governed Rural residents dont want to get care locallyRural residents dont 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 healthyRural Americans are naturally more healthy Rural economy is mostly about agricultureRural economy is mostly about agriculture Rural health care costs less than urban careRural health care costs less than urban care Rural health care is inordinately expensiveRural health care is inordinately expensive Rural health care is lower quality; urban is betterRural health care is lower quality; urban is better Rural hospitals are just band-aide stationsRural hospitals are just band-aide stations Rural hospitals & clinics are poorly managed/governedRural hospitals & clinics are poorly managed/governed Rural residents dont want to get care locallyRural residents dont want to get care locally * U.S. 2000 Census, Non-Metro Population By State

5. Rural Wisconsin Health Cooperative 2005 Almost Worst Rural Health Policy Awards First Draft of June MedPAC Report First Draft of June MedPAC Report 1st Launch of Hospital Compare Web Site 1st Launch of Hospital Compare Web Site Proposed CMS Rural Hospital Building Ban Proposed CMS Rural Hospital Building Ban Federal Appropriations Bill for FFY 2006 Federal Appropriations Bill for FFY 2006 First Draft of June MedPAC Report First Draft of June MedPAC Report 1st Launch of Hospital Compare Web Site 1st Launch of Hospital Compare Web Site Proposed CMS Rural Hospital Building Ban Proposed CMS Rural Hospital Building Ban Federal Appropriations Bill for FFY 2006 Federal Appropriations Bill for FFY 2006

6. Rural Wisconsin Health Cooperative Medicare Payment Advisory Commission CAH payment designation ended two decades of failed attempts to retro-fit to rural the PPS Medicare payment methodology designed for large urban hospitalsCAH payment designation ended two decades of failed attempts to retro-fit to rural the PPS Medicare payment methodology designed for large urban hospitals MedPAC is an advisory commission to CongressMedPAC is an advisory commission to Congress The initial draft of the June MedPAC report was seen as inaccurate, hostile review of the CAH programThe initial draft of the June MedPAC report was seen as inaccurate, hostile review of the CAH program Draft framed CAH designation as Federal charity with recipients having to prove they were deserving poorDraft framed CAH designation as Federal charity with recipients having to prove they were deserving poor The pushback from Commissioners, with technical help from the field, was substantial and effectiveThe pushback from Commissioners, with technical help from the field, was substantial and effective CAH payment designation ended two decades of failed attempts to retro-fit to rural the PPS Medicare payment methodology designed for large urban hospitalsCAH payment designation ended two decades of failed attempts to retro-fit to rural the PPS Medicare payment methodology designed for large urban hospitals MedPAC is an advisory commission to CongressMedPAC is an advisory commission to Congress The initial draft of the June MedPAC report was seen as inaccurate, hostile review of the CAH programThe initial draft of the June MedPAC report was seen as inaccurate, hostile review of the CAH program Draft framed CAH designation as Federal charity with recipients having to prove they were deserving poorDraft framed CAH designation as Federal charity with recipients having to prove they were deserving poor The pushback from Commissioners, with technical help from the field, was substantial and effectiveThe pushback from Commissioners, with technical help from the field, was substantial and effective

7. Rural Wisconsin Health Cooperative Hospital Compare Labled CAH as 2nd Class

8. Rural Wisconsin Health Cooperative NRHA Responded with Reporting Guidelines Need to actively prepare for future when payers and consumers pay attention to public reportingNeed to actively prepare for future when payers and consumers pay attention to public reporting Rural hospitals should fully engage in the quality improvement and public reporting movementRural hospitals should fully engage in the quality improvement and public reporting movement CAHs and PPS are both acute care hospitalsCAHs and PPS are both acute care hospitals CAH or PPS difference not relevant to quality reportCAH or PPS difference not relevant to quality report Compare service outcomes, not institution sizeCompare service outcomes, not institution size Consumers should be able, at a minimum, to readily compare all hospitals in their hospital referral regionConsumers should be able, at a minimum, to readily compare all hospitals in their hospital referral region Need to actively prepare for future when payers and consumers pay attention to public reportingNeed to actively prepare for future when payers and consumers pay attention to public reporting Rural hospitals should fully engage in the quality improvement and public reporting movementRural hospitals should fully engage in the quality improvement and public reporting movement CAHs and PPS are both acute care hospitalsCAHs and PPS are both acute care hospitals CAH or PPS difference not relevant to quality reportCAH or PPS difference not relevant to quality report Compare service outcomes, not institution sizeCompare service outcomes, not institution size Consumers should be able, at a minimum, to readily compare all hospitals in their hospital referral regionConsumers should be able, at a minimum, to readily compare all hospitals in their hospital referral region NRHA Policy Brief Approved 5/20/06

9. Rural Wisconsin Health Cooperative Proposed Building Ban

10. Rural Wisconsin Health Cooperative Appropriations Fight in 2005 for 2006 President proposed to eliminate 8 programs worth $232 million and dramatically cut 3 others.President proposed to eliminate 8 programs worth $232 million and dramatically cut 3 others. House of Representatives followed many of those recommendations; the Senate did not.House of Representatives followed many of those recommendations; the Senate did not. The first Conference Report eliminated 6 programs worth $134 million and dramatically cut several others. But it was defeated 209 to 224 in the House!The first Conference Report eliminated 6 programs worth $134 million and dramatically cut several others. But it was defeated 209 to 224 in the House! The final bill restored funding for research and policy and AHECS, and added money for outreach and community health centers. Some programs still cut.The final bill restored funding for research and policy and AHECS, and added money for outreach and community health centers. Some programs still cut. President proposed to eliminate 8 programs worth $232 million and dramatically cut 3 others.President proposed to eliminate 8 programs worth $232 million and dramatically cut 3 others. House of Representatives followed many of those recommendations; the Senate did not.House of Representatives followed many of those recommendations; the Senate did not. The first Conference Report eliminated 6 programs worth $134 million and dramatically cut several others. But it was defeated 209 to 224 in the House!The first Conference Report eliminated 6 programs worth $134 million and dramatically cut several others. But it was defeated 209 to 224 in the House! The final bill restored funding for research and policy and AHECS, and added money for outreach and community health centers. Some programs still cut.The final bill restored funding for research and policy and AHECS, and added money for outreach and community health centers. Some programs still cut. Jennifer Friedman, VP Government Affairs and Policy National Rural Health Association

11. Rural Wisconsin Health Cooperative Presidents Again Slashes Rural Health Does not include $29 million cut from eliminating AHECs; total cuts are over $160 million. Jennifer Friedman, VP Government Affairs and Policy National Rural Health Association

12. Rural Wisconsin Health Cooperative Cross Section Rural Health Issues

13. Rural Wisconsin Health Cooperative Challenges of a Privatized Medicare

14. Rural Wisconsin Health Cooperative * CMS Medicare Managed Care Manual, Chpt. 4, page 57 Strong Access Standards Are Key Beneficiary rights to local access, even if out of network, is key for beneficiaries and for local providers to have any clout in plan negotiationsBeneficiary rights to local access, even if out of network, is key for beneficiaries and for local providers to have any clout in plan negotiations Plans must… ensure that services are geographically accessible and consistent with local community patterns of care. *Plans must… ensure that services are geographically accessible and consistent with local community patterns of care. * Need to open up current black-box which limits beneficiary awareness and evaluation of CMS enforcement of consistency of access standards across plans, markets and timeNeed to open up current black-box which limits beneficiary awareness and evaluation of CMS enforcement of consistency of access standards across plans, markets and time Beneficiary rights to local access, even if out of network, is key for beneficiaries and for local providers to have any clout in plan negotiationsBeneficiary rights to local access, even if out of network, is key for beneficiaries and for local providers to have any clout in plan negotiations Plans must… ensure that services are geographically accessible and consistent with local community patterns of care. *Plans must… ensure that services are geographically accessible and consistent with local community patterns of care. * Need to open up current black-box which limits beneficiary awareness and evaluation of CMS enforcement of consistency of access standards across plans, markets and timeNeed to open up current black-box which limits beneficiary awareness and evaluation of CMS enforcement of consistency of access standards across plans, markets and time

15. Rural Wisconsin Health Cooperative Protecting CAH/RHC Reimbursement HR 880 (Ron Kind): pay for CAH & RHC at a rate that is > 101 percent traditional MedicareHR 880 (Ron Kind): pay for CAH & RHC at a rate that is > 101 percent traditional Medicare SB 2819 (Coleman/Durbin) is comparable to HR 880; adds option of 103 percent of the applicable interim payment rateSB 2819 (Coleman/Durbin) is comparable to HR 880; adds option of 103 percent of the applicable interim payment rate Right to local access still key; payment rates are meaningless if patients can be steered elsewhereRight to local access still key; payment rates are meaningless if patients can be steered elsewhere AHA & NRHA SupportingAHA & NRHA Supporting HR 880 (Ron Kind): pay for CAH & RHC at a rate that is > 101 percent traditional MedicareHR 880 (Ron Kind): pay for CAH & RHC at a rate that is > 101 percent traditional Medicare SB 2819 (Coleman/Durbin) is comparable to HR 880; adds option of 103 percent of the applicable interim payment rateSB 2819 (Coleman/Durbin) is comparable to HR 880; adds option of 103 percent of the applicable interim payment rate Right to local access still key; payment rates are meaningless if patients can be steered elsewhereRight to local access still key; payment rates are meaningless if patients can be steered elsewhere AHA & NRHA SupportingAHA & NRHA Supporting

16. Rural Wisconsin Health Cooperative Other Needed Medicare Advantage Improvements 1.Major increase beneficiary decision-making assistance 2.Immediate on-line verification beneficiary coverage 3.Restore States Rights to question plan behavior 4.Regional CMS Office role as source of definitive info 5.Regional CMS Office handle provider complaints 6.Plan applications on-line within 30 days of approval 7.Full/timely transparency re enrollment and quality data 8.Encourage collaboration amongst rural providers to level playing field re contract development/review 1.Major increase beneficiary decision-making assistance 2.Immediate on-line verification beneficiary coverage 3.Restore States Rights to question plan behavior 4.Regional CMS Office role as source of definitive info 5.Regional CMS Office handle provider complaints 6.Plan applications on-line within 30 days of approval 7.Full/timely transparency re enrollment and quality data 8.Encourage collaboration amongst rural providers to level playing field re contract development/review DHHS National Advisory Committee on Rural Health & Human Services, Medicare Advantage Sub-Committee, 6/13/06

17. Rural Wisconsin Health Cooperative PHYSICIAN SUPPLY

18. Rural Wisconsin Health Cooperative Wisconsin Academy of Rural Medicine Builds on pioneering work of Howard Rabinowitz at Jefferson Medical College in Philadelphia. Builds on pioneering work of Howard Rabinowitz at Jefferson Medical College in Philadelphia. Result of 25 years asking land grant UW be true to roots Result of 25 years asking land grant UW be true to roots Goal: rural focused medical school within the Madison based University of Wisconsin medical school Goal: rural focused medical school within the Madison based University of Wisconsin medical school Recruit students with rural background and career goalsRecruit students with rural background and career goals Locate education and training programs in rural areas of WI during 3rd and 4th years of Med SchoolLocate education and training programs in rural areas of WI during 3rd and 4th years of Med School Use rural appropriate curriculum Use rural appropriate curriculum Builds on pioneering work of Howard Rabinowitz at Jefferson Medical College in Philadelphia. Builds on pioneering work of Howard Rabinowitz at Jefferson Medical College in Philadelphia. Result of 25 years asking land grant UW be true to roots Result of 25 years asking land grant UW be true to roots Goal: rural focused medical school within the Madison based University of Wisconsin medical school Goal: rural focused medical school within the Madison based University of Wisconsin medical school Recruit students with rural background and career goalsRecruit students with rural background and career goals Locate education and training programs in rural areas of WI during 3rd and 4th years of Med SchoolLocate education and training programs in rural areas of WI during 3rd and 4th years of Med School Use rural appropriate curriculum Use rural appropriate curriculum

19. Rural Wisconsin Health Cooperative HEALTHCARE COSTS

20. Rural Wisconsin Health Cooperative Health Care Costs - Review of Reality In 2005, employer-based health insurance premiums rose by 9%, the fifth consecutive year over 9%In 2005, employer-based health insurance premiums rose by 9%, the fifth consecutive year over 9% HMOS, PPOs and POS plans all showed this increaseHMOS, PPOs and POS plans all showed this increase Annual premium charges an employer for a health plan covering a family of four averaged $10,800 in 2005Annual premium charges an employer for a health plan covering a family of four averaged $10,800 in 2005 Gross earnings, full-time, minimum-wage = $10,712Gross earnings, full-time, minimum-wage = $10,712 Since 2000, premiums have increased 73%, vs 14% cumulative inflation & 15% cumulative wage increaseSince 2000, premiums have increased 73%, vs 14% cumulative inflation & 15% cumulative wage increase The average employee contribution has increased more than 143% since 2000The average employee contribution has increased more than 143% since 2000 In 2005, employer-based health insurance premiums rose by 9%, the fifth consecutive year over 9%In 2005, employer-based health insurance premiums rose by 9%, the fifth consecutive year over 9% HMOS, PPOs and POS plans all showed this increaseHMOS, PPOs and POS plans all showed this increase Annual premium charges an employer for a health plan covering a family of four averaged $10,800 in 2005Annual premium charges an employer for a health plan covering a family of four averaged $10,800 in 2005 Gross earnings, full-time, minimum-wage = $10,712Gross earnings, full-time, minimum-wage = $10,712 Since 2000, premiums have increased 73%, vs 14% cumulative inflation & 15% cumulative wage increaseSince 2000, premiums have increased 73%, vs 14% cumulative inflation & 15% cumulative wage increase The average employee contribution has increased more than 143% since 2000The average employee contribution has increased more than 143% since 2000 National Coalition on Health Care http://www.nchc.org/

21. Rural Wisconsin Health Cooperative What To Do About Unsustainable Cost Trends? Most agree that health care costs must be controlled but disagree on the best ways to address rapidly escalating health spending and health insurance premiums:Most agree that health care costs must be controlled but disagree on the best ways to address rapidly escalating health spending and health insurance premiums: Price controls and imposing strict budgets on health care spending? Price controls and imposing strict budgets on health care spending? Free market competition solves the problem? Free market competition solves the problem? With healthier lifestyles, less medical care required? With healthier lifestyles, less medical care required? Cost of inaction will severely affect employer's bottom lines, business location and consumer's pocketbooksCost of inaction will severely affect employer's bottom lines, business location and consumer's pocketbooks How do different approaches effect rural health care?How do different approaches effect rural health care? Most agree that health care costs must be controlled but disagree on the best ways to address rapidly escalating health spending and health insurance premiums:Most agree that health care costs must be controlled but disagree on the best ways to address rapidly escalating health spending and health insurance premiums: Price controls and imposing strict budgets on health care spending? Price controls and imposing strict budgets on health care spending? Free market competition solves the problem? Free market competition solves the problem? With healthier lifestyles, less medical care required? With healthier lifestyles, less medical care required? Cost of inaction will severely affect employer's bottom lines, business location and consumer's pocketbooksCost of inaction will severely affect employer's bottom lines, business location and consumer's pocketbooks How do different approaches effect rural health care?How do different approaches effect rural health care? National Coalition on Health Care http://www.nchc.org/

22. Rural Wisconsin Health Cooperative POPULATION HEALTH

23. Rural Wisconsin Health Cooperative Health Outcomes Driven By Multiple Determinants Access to Health Care (est 10%) Access to Health Care (est 10%) Health Behaviors (est 40%) e.g. smoking, physical inactivity, overweight, sexually transmitted disease, motor vehicle crashes Health Behaviors (est 40%) e.g. smoking, physical inactivity, overweight, sexually transmitted disease, motor vehicle crashes Socioeconomic factors (est 40%) e.g. education, poverty, divorce rates Socioeconomic factors (est 40%) e.g. education, poverty, divorce rates Physical environment (est 10%) Physical environment (est 10%) Access to Health Care (est 10%) Access to Health Care (est 10%) Health Behaviors (est 40%) e.g. smoking, physical inactivity, overweight, sexually transmitted disease, motor vehicle crashes Health Behaviors (est 40%) e.g. smoking, physical inactivity, overweight, sexually transmitted disease, motor vehicle crashes Socioeconomic factors (est 40%) e.g. education, poverty, divorce rates Socioeconomic factors (est 40%) e.g. education, poverty, divorce rates Physical environment (est 10%) Physical environment (est 10%) 2005 Wisconsin County Health Rankings, University of Wisconsin Population Health Institute

24. Rural Wisconsin Health Cooperative Critical Link Population & Economic Health Businesses will move to where healthcare coverage is less expensive, or they will cut back and even terminate coverage for their employees. Either way, it's the residents of your towns and cities that lose out, Thomas Donohue President & CEO, U.S. Chamber of Commerce If we can change lifestyles, it will have more impact on cutting costs than anything else we can do, Larry Rambo, chief executive officer of Humanas Wisconsin and Michigan health insurance markets. Businesses will move to where healthcare coverage is less expensive, or they will cut back and even terminate coverage for their employees. Either way, it's the residents of your towns and cities that lose out, Thomas Donohue President & CEO, U.S. Chamber of Commerce If we can change lifestyles, it will have more impact on cutting costs than anything else we can do, Larry Rambo, chief executive officer of Humanas Wisconsin and Michigan health insurance markets.

25. Rural Wisconsin Health Cooperative

26. Rural Wisconsin Health Cooperative Initial Local Hospital & Community Steps Devote a periodic Board meeting to review available population health indicatorsDevote a periodic Board meeting to review available population health indicators Add Board members with specific interest in population health measurement and improvementAdd Board members with specific interest in population health measurement and improvement Create a population health subcommittee of the hospital board to explore opportunities for hospital partnerships with other community organizationsCreate a population health subcommittee of the hospital board to explore opportunities for hospital partnerships with other community organizations With local employers, develop interventions to improve employee health; expand experience to the larger communityWith local employers, develop interventions to improve employee health; expand experience to the larger community Devote a periodic Board meeting to review available population health indicatorsDevote a periodic Board meeting to review available population health indicators Add Board members with specific interest in population health measurement and improvementAdd Board members with specific interest in population health measurement and improvement Create a population health subcommittee of the hospital board to explore opportunities for hospital partnerships with other community organizationsCreate a population health subcommittee of the hospital board to explore opportunities for hospital partnerships with other community organizations With local employers, develop interventions to improve employee health; expand experience to the larger communityWith local employers, develop interventions to improve employee health; expand experience to the larger community Population Health Improvement & Rural Hospital Balanced Scorecards by Size T, Kindig D, MacKinney C., Journal of Rural Health; 3/06

27. Rural Wisconsin Health Cooperative Strong Rural Communities Initiative Sponsored by states Rural Health Development Council embedded in Wisconsin Department of CommerceSponsored by states Rural Health Development Council embedded in Wisconsin Department of Commerce Acquired $700K from 3 sources with 4th looking goodAcquired $700K from 3 sources with 4th looking good The goal: improve health of rural communities and reduce healthcare cost inflation by accelerating use of collaboration among medical, public health and business organizations that enhance preventive health servicesThe goal: improve health of rural communities and reduce healthcare cost inflation by accelerating use of collaboration among medical, public health and business organizations that enhance preventive health services Six local community projects chosen from 22 proposalsSix local community projects chosen from 22 proposals Variety approaches to modifying poor fitness, nutrition habits through wellness programs at work/communityVariety approaches to modifying poor fitness, nutrition habits through wellness programs at work/community Sponsored by states Rural Health Development Council embedded in Wisconsin Department of CommerceSponsored by states Rural Health Development Council embedded in Wisconsin Department of Commerce Acquired $700K from 3 sources with 4th looking goodAcquired $700K from 3 sources with 4th looking good The goal: improve health of rural communities and reduce healthcare cost inflation by accelerating use of collaboration among medical, public health and business organizations that enhance preventive health servicesThe goal: improve health of rural communities and reduce healthcare cost inflation by accelerating use of collaboration among medical, public health and business organizations that enhance preventive health services Six local community projects chosen from 22 proposalsSix local community projects chosen from 22 proposals Variety approaches to modifying poor fitness, nutrition habits through wellness programs at work/communityVariety approaches to modifying poor fitness, nutrition habits through wellness programs at work/community RWHC Eye On Health Newsletter, 7/06

28. Rural Wisconsin Health Cooperative ADVOCACY SKILLS

29. Rural Wisconsin Health Cooperative Besides Funding, What Drives Advocacy? Need to Correct Bias - MedPAC ReportNeed to Correct Bias - MedPAC Report Opportunity to Reframe - Hospital CompareOpportunity to Reframe - Hospital Compare Short-term Fix Needed/Possible - Building BanShort-term Fix Needed/Possible - Building Ban Broad Coalition Possible - R.H. AppropriationsBroad Coalition Possible - R.H. Appropriations Address Core Need - Physician SupplyAddress Core Need - Physician Supply Anticipate Problems - Medicare AdvantageAnticipate Problems - Medicare Advantage Cant Be Avoided - Healthcare CostsCant Be Avoided - Healthcare Costs Long-term Significance - Population HealthLong-term Significance - Population Health Need to Correct Bias - MedPAC ReportNeed to Correct Bias - MedPAC Report Opportunity to Reframe - Hospital CompareOpportunity to Reframe - Hospital Compare Short-term Fix Needed/Possible - Building BanShort-term Fix Needed/Possible - Building Ban Broad Coalition Possible - R.H. AppropriationsBroad Coalition Possible - R.H. Appropriations Address Core Need - Physician SupplyAddress Core Need - Physician Supply Anticipate Problems - Medicare AdvantageAnticipate Problems - Medicare Advantage Cant Be Avoided - Healthcare CostsCant Be Avoided - Healthcare Costs Long-term Significance - Population HealthLong-term Significance - Population Health

30. Rural Wisconsin Health Cooperative Your Advocacy Behaviors Matter Be Brief Be Brief Be Accurate - NEVER false or misleading info Be Accurate - NEVER false or misleading info Personalize Your Message - cite examples Personalize Your Message - cite examples Be Prepared - know your issue Be Prepared - know your issue Be Aware Every Issue Has Two Sides - there are voters on other side Be Aware Every Issue Has Two Sides - there are voters on other side Be Courteous/Dont Threaten Be Courteous/Dont Threaten Be Patient - long process; be in for long haul Be Patient - long process; be in for long haul Be Brief Be Brief Be Accurate - NEVER false or misleading info Be Accurate - NEVER false or misleading info Personalize Your Message - cite examples Personalize Your Message - cite examples Be Prepared - know your issue Be Prepared - know your issue Be Aware Every Issue Has Two Sides - there are voters on other side Be Aware Every Issue Has Two Sides - there are voters on other side Be Courteous/Dont Threaten Be Courteous/Dont Threaten Be Patient - long process; be in for long haul Be Patient - long process; be in for long haul Wisconsin Hospital Associations Grass Roots Handbook

31. Rural Wisconsin Health Cooperative NRHAs Three Prong Advocacy Strategy Make your best case: Develop concise, credible, persuasive, fiscally responsible, but emotive arguments. Make friends and form alliances: Find Congressional champions, develop agency contacts, form alliances with a diverse set of groups. Make it happen: Use some or all of your advocacy tools – government relations, grassroots and media advocacy – based on your level of engagement. Make your best case: Develop concise, credible, persuasive, fiscally responsible, but emotive arguments. Make friends and form alliances: Find Congressional champions, develop agency contacts, form alliances with a diverse set of groups. Make it happen: Use some or all of your advocacy tools – government relations, grassroots and media advocacy – based on your level of engagement. Jennifer Friedman, VP Government Affairs and Policy National Rural Health Association

32. Rural Wisconsin Health Cooperative

33. Rural Wisconsin Health Cooperative Rural Health Needs Your Advocacy 24/7 Rural advocates have an ongoing challenge, an attitude in parts of Washington, and around the country (including CMS) that is frequently ill informed, about rural health and the reality of improving rural health and health careRural advocates have an ongoing challenge, an attitude in parts of Washington, and around the country (including CMS) that is frequently ill informed, about rural health and the reality of improving rural health and health care Rural advocates must not become complacent, all of us must become more skilled and more active.Rural advocates must not become complacent, all of us must become more skilled and more active. Rural advocates have an ongoing challenge, an attitude in parts of Washington, and around the country (including CMS) that is frequently ill informed, about rural health and the reality of improving rural health and health careRural advocates have an ongoing challenge, an attitude in parts of Washington, and around the country (including CMS) that is frequently ill informed, about rural health and the reality of improving rural health and health care Rural advocates must not become complacent, all of us must become more skilled and more active.Rural advocates must not become complacent, all of us must become more skilled and more active.

34. Rural Wisconsin Health Cooperative Questions/Discussion? For a free electronic subscription of the RWHC Eye On Health monthly newsletter, send an email to office@rwhc.comwith send an email to office@rwhc.com with subscribe on the subject line. Questions/Discussion? For a free electronic subscription of the RWHC Eye On Health monthly newsletter, send an email to office@rwhc.comwith send an email to office@rwhc.com with subscribe on the subject line.