1. Rural and Border Health: Duel Challenges for the Health Care Workforce Marcia K. Brand, Ph.D. Office of Rural Health Policy Health Resources and Services Administration

2. Background About the Office of Rural Health Policy (ORHP) About the Office of Rural Health Policy (ORHP) HRSA’s border health activities: a new responsibility for the Office of Rural Health Policy (ORHP) HRSA’s border health activities: a new responsibility for the Office of Rural Health Policy (ORHP)

3. Rural Health and Border Health as “Policy Arenas” Rural health – a health policy focus since the early mid-l980s, addressing challenges unique to providing health services to underserved rural and frontier areas Rural health – a health policy focus since the early mid-l980s, addressing challenges unique to providing health services to underserved rural and frontier areas Border health – a health policy focus since early interest in community and migrant health, coming into greater awareness (NAFTA, globalization) Border health – a health policy focus since early interest in community and migrant health, coming into greater awareness (NAFTA, globalization) Similarities and differences in policy concerns Similarities and differences in policy concerns

4. Rural and Border Health: Shared Challenges Workforce Workforce Infrastructure and community development Infrastructure and community development Provider viability and reimbursement Provider viability and reimbursement Geographic barriers Geographic barriers Health conditions reflect poverty and poor living conditions Health conditions reflect poverty and poor living conditions

5. Rural and Border Health: Shared Opportunities Context: extraordinary commitment at the Federal, State and local to address these challenges Context: extraordinary commitment at the Federal, State and local to address these challenges

6. Rural and Border Health: Opportunities at the Federal Level HHS interest in rural health – Task Force, National Advisory Committee HHS interest in rural health – Task Force, National Advisory Committee HHS interest in border health – Office of Global Health Affairs, HRSA collaboration HHS interest in border health – Office of Global Health Affairs, HRSA collaboration The provisions of the Medicare Modernization Act (MMA) The provisions of the Medicare Modernization Act (MMA) Health center initiative Health center initiative

7. Rural and Border Health: Other Opportunities Providing information: Rural Assistance Center www.raconline.org Providing information: Rural Assistance Center www.raconline.orgwww.raconline.org Providing technical assistance: Providing technical assistance: –Program of All Inclusive Care for the Elderly (PACE) –Rural Health Clinics –Small hospital performance improvement –340 B program –EMS

8. Rural and Border Health: Other Opportunities (cont.) Recruiting providers: Recruiting providers: –Rural Recruitment and Retention Network (http:www.3rnet.org) –A focus on community colleges Targeting resources: Rural urban commuting areas (RUCAS) Targeting resources: Rural urban commuting areas (RUCAS) Supporting research: Mujer Y Corazon: Community Health Workers and their Organizations Supporting research: Mujer Y Corazon: Community Health Workers and their Organizations

9. Rural and Border Health: Other Opportunities (cont.) Testing new service delivery models: Frontier extended stay clinics Testing new service delivery models: Frontier extended stay clinics Working with frontier communities: Frontier Center Working with frontier communities: Frontier Center –Seasonal changes in population –Using distance technology

10. What do you need to make it easier to provide quality health care in border communities? Technical assistance Technical assistance Resources Resources Research Research Other? Other?

11. For additional information contact Marcia K. Brand, Ph.D. Director, Office of Rural Health Policy HRSA301-443-4619mbrand@hrsa.gov