Rural Health Transformation in Action: Cross-Sector Leaders on Preparing for What’s Next

Good afternoon or good morning, everyone. Thank you for joining us today for this important conversation on rural health transformation. We’ll get started in a couple of minutes to allow a few more attendees to join, but we’re glad you’re here and we look forward to the discussion. We’re two minutes past the hour, so hopefully that allowed folks to join. Hello again, and thank you so much for joining us today.

To kick things off, I’ll briefly introduce myself. My name is Jordan Murray, and I’m the associate vice president of customer success here at Unite Us. And I’ll be your moderator for today’s discussion. It is an extreme privilege to be the moderator. I am a product of a rural community in a small town in Kentucky, and I’m actually in rural Missouri as we speak.

So I will tell you I’ve been spotty Wi-Fi a few times today, so I apologize if that happens, which hopefully isn’t the case. But just for a few housekeeping notes before we dive in, we will be monitoring the chat throughout the session and we reserve some time at the end for Q&A. We have some great panelists, so if we don’t have time for the Q&A, we will definitely get back to you as a follow-up. So please submit your questions in the Q&A box as we go and then we’ll also answer as many as time allows along the way.

You’ll also see in that same box there will be a survey pop-up throughout for three survey questions and we’ll periodically ask for your feedback for those things as well. So the topic for today is around rural communities. And we know that they’ve always led with innovation and collaboration really long before new funding opportunities were announced. Organizations have really been building strong partnerships to improve outcomes and meeting the real needs rooted in the communities that they’re serving.

So as Rural Health Transformation Program initiatives continue to take shape, we know organizations are focused on scaling what is already working while preparing for new funding requirements, policy shifts, and accountability expectations. Each sector is experiencing the moment differently, though. Government agencies are thinking about oversight and funding flow. Payers are focused on outcomes and sustainability. Providers are looking at integration and workflows.

And we can’t forget about the community based organizations who are planning for capacity and long term stability. So today, we’ll talk about how rural leaders are demonstrating measurable impact now and how they’re aligning strategy, partnership, and infrastructure for what’s next. So while we wait for a few others to join, I’d like to invite you all to answer the first of three poll questions, which will be in the window to the side of your screen next to the q and a, box. And the first question is, what are you hoping to learn today?

So as you all fill that out, I I would also like to get us started by taking a moment to introduce you to our stellar panelists who are leading this work across the country. We have with us today Amanda McCarthy, director of social determinants of health at Advanced Health in Oregon doctor Paula Masters, chief health disparities officer at Ballad Health in Tennessee doctor Laurie Stradley, CEO of Impact Health in North Carolina. Thank you very much. Barnes, program supervisor, at Calaveras Health a Medicaid coordinated Human Services, Agency in California. and we’re serving the Southern know doctor Masters. had a little audiovisual, We serve about 26,000, so hopefully she’ll be able to join us shortly.

Coos and, Curry, Counties. thank you all for being here for your leadership and, really, frontier, what you do in your communities. cover about 3,200 with that said, miles. let’s go ahead and jump on in with the first question. the ground us all in your work, is an effort mind Medicaid members about make sure they’re receiving serve and what makes it distinctly distinctly health, rural? behavioral health, And if you don’t mind, Amanda, we’d love other start with, you. including oral health. And we are we do experience challenges in the areas of access to care, especially when it comes to time and distance standards and specialty care.

And we also have transportation and general poverty or generational poverty here in our area as well. Good afternoon. I’m Laurie Stradley, and I serve as the Chief Executive Officer here at Impact Health. We’re based in Asheville, North Carolina, and serve the 18 to 19 westernmost counties of the state. North Carolina has the second largest rural population in the country, and a third of those live out here with me in the mountains.

Even though Asheville is not where I was born, I also am a product, of a. rural community. How grew up on the other side, of these mountains? all the way up in Northern New York in the Adirondacks. And it’s a great privilege to get to do this work here in the mountains where my husband and his family were born and raised. And when I, you know, think about what we’re doing, Impact Health is predominantly a bridge. We’re a social care hub that works with community based organizations across the region, and we work with health care and payers and all other types of folks to try and make it as easy and cost effective and outcomes driven as possible to ensure that folks are having their complete care needs met from clinical and behavioral health to social care, like housing, food, transportation, and including family safety.

So that has been a part of our work here in North Carolina, helping individuals transition out of homes that are experiencing violence. Just to add a few things I would say, you know, with respect to the challenges that we’re facing here, I would love to say they’re unique, but I don’t think there are that many unique challenges anymore in rural care provision. You’ve already brought up, Jordan, that, access to broadband is a real driver of health out here, and the same places that are really far from a health care system are really far from broadband access.

And so a lot of the solutions that have been applied around, virtual care and, sort of home based care are really a struggle out here in Western North Carolina. But our opportunities are even greater. We’re really optimistic about what rural health transformation can mean. And for us, it’s particularly about building the most resilient systems possible during a time when health care spending programs and interventions are really volatile. They’re changing every day, some for the good and some are much more difficult changes to face.

Yes. And hello, everyone. So sorry for my my issues, but I’m happy to be on. But yes. So, you know, I’m the chief health disparities officer here at Ballad Health, great points and Ballard appreciate Health sharing that. one of the largest health systems in the area.

So questions as well. 29 see Doctor. across four able to join. and primarily you. 21 the in Virginia and in Tennessee. is working now. We are right to remind middle of Central question here, Appalachia. really grounding us in the work, rural, do you mind sharing exactly the community we are. serve and so, what makes know, it distinctly think? around what it’s like to have a health system that has 20 hospitals and over 13,000 team members and 800 providers and where we really have been on the journey to not just be a traditional health care delivery system, but to really be a community health improvement organization.

Trying to figure that out here in this community is something that comes with its challenges. Obviously, rurality, but the other elements that really come into rural. So, you know, those things around lower socioeconomic status, those things around the fact that every one of our counties that we serve is either a medically underserved area or a health professional shortage area or both. And then just thinking about, you know, really those social drivers of health that even make things more complex in really being able to improve the health and outcomes and well-being of of our rural populations.

You know, I I like to always tell people that, you know, where we are, we’ve always had to figure it out, and now everybody is definitely trying to figure it out. And so we’re really excited that there is a lot of attention now for rural outcomes and that we’re all actually networking together to have some really collaborative solutions. So happy to be here. Of course. Thanks for having me here, Jordan.

So I know a lot of people when they think of California, they probably don’t think of rural America necessarily. But in California, we have rural communities as well. I work for Calaveras County Public Health, which is housed in our county health and human services agency. Calaveras is a small county in Northern California. We have about 45,000 residents.

Thank you so much, Doctor. in. the foothills of the Sierra Nevada Mountains. continue to go back to the West Coast to Justin, a little bit older. would you mind sharing of our residents are 60. your perspective as well? We have about 9% of our population are military veterans. And I think you’re gonna hear some some recurring themes in this webinar, and ours is certainly our challenges related to health care access. And one of the things that plays into that health care access issue is transportation access.

Calaveras has extremely limited transportation infrastructure. Less than 1% of our residents utilize public transit because it’s just not something that’s actionable for them to do. Additionally, we have about 2,570 residents for every one primary care provider in our county and about, 2,250 residents for every dental provider. So that’s just to paint the picture of we have way more people that need care than we have providers capable of bringing that care to our community. So we at Public Health are always looking at addressing, those social drivers of health that Dr.

Paula Masters mentioned to because, obviously, those are driving the health disparities in our community, which are leading to the downstream consequences, when access to care is limited. The the long and short of it is when you have to drive three hours to see a specialist, you’re probably not gonna see that specialist. And we’re hoping with rural health transformation and some of the things we’re trying to do here at public health, we can ameliorate some of those barriers and improve access to care.

I appreciate that. And I think we can all agree the commonality. Despite where you may be across the country, the rural communities are impacted very. similarly to. just I think that’s these barriers. right is that, So know, before we move into our next panel question, working in the rural hear from, you again. you know, So a long time, is that we’ve your organization it work for a long time. rural so, health transformation, I think that? it really leans into those things to build on that, always hold true that rural while we’re rural is that we’re very resourceful. for transformation very collaborative. to really begin that innovation. very resilient.

So I’d, love to turn it, over to our panelists to really discuss of infrastructure are you currently I’m sure all of my colleagues have to be able to? be ready for, And if know, you don’t mind, anything Masters would love to start with you. at us. And I think that, you know, one of the biggest things that we have done here in our area is exactly that is, you know, being collaborative. How do we create a different infrastructure architecture here to be able to solve for the access issues, to really be able to bring down innovative and different reimbursement models, to really set up different systems of care that include that social care piece, that those social drivers of health.

And I think, you know, one of the things that we have really done over the past five ish years, if you will, is to have an evidence based model for collaboration. So we’ve we’ve leaned very heavily into the collective impact model and, you know, being able to, you know, those are the that it centers around five things, a common agenda, a shared measurement, mutually reinforcing activities, open and continuing communication, and then really having some strong backbones. And Ballad Health, we serve as a backbone to one of the largest collective impact models.

It’s called a strong accountable care community that crosses the states in which we work. And what that has really allowed for us to do is be able to be more intentional with how we collaborate with community based organizations and how we better network them together and create that common agenda and those mutually reinforcing activities. You know, we we’ve been able to use and leverage that network of community based organizations to really have a community prong to our social care strategy. And that’s so important in rural areas because we don’t have all of those resources.

We don’t have all of the technology and all of all of the the bells and whistles, if you will, that a lot of times lend themselves in other areas. And so being able to be very intentional in your structure is something that we really have have leaned into. And, you know, for us, a big part of that has been being able to bring different data and technology. And so we, over the past five years, has really worked hard to create a different infrastructure here in our rural area. And so, you know, Unite Us has been a big part of that, is that we, in our health system, we use Epic as our electronic medical record, but, you know, we also needed that social record.

And that was a first of its kind in this area. And so being able to to have that and come in and be able to have it truly integrated, not just sitting on top, And then bring that to our community based partners so that way it helps for them to solve for issues that they’re having as well. Because what we may be experiencing from the health system side or from the health care side is that our community health partners, our public health partners, our social service partners, they may be looking at different issues or or different not just different issues, but ways to address those issues.

And so being able to have a coordinated solution is something that, you know, it has worked really, really well for us. And, you know, I think being able to demonstrate results from that is something that we’ve been able to talk about a lot recently. But I’ll pull up there and let my colleagues weigh in on that, but I think it’s definitely around that evidence based, that architecture model that allows for intentional collaboration is how rural areas are really set up for success. It’s it’s, it’s an important conversation, and I think, I think doctor.

Masters. spoke appreciate this a. little bit. And, One of, the strengths of, rural, communities emphasis our ability intentionality forge relationships. the architecture? and the structure. That’s sort you, start to think about the rural America, design lot of people, the front end kind of evokes gonna dictate, of tight knit relationships, you positioning your, programs know each other. You went to high school together. outcomes have those relationships, outputs, and you can build on that. doesn’t move the needle? that’s what we see at, You know, Calaveras Health continue Public Health, when we’re to pass it over to you, relationships. to coordinate across know, sectors are your thoughts on that? leaning into our strength as a rural community by, tapping those personal relationships we have with different providers across different sectors, our CBO partners.

And, that’s where Unite Us was very useful to us is it gave us the infrastructure to finally have something concrete that does connect us, all and give us the ability to ameliorate those access gaps. One of the sort of innovative ways we’ve looked at, improving access to care is we have a mobile, programs and services van, which is something we’re seeing across California in general, ameliorating that transportation barrier by bringing the services to the communities that need them instead of expecting them to come to us.

And then when we’re able to get to them, having something like Unite Us in place where now we’re able to not only screen them for chronic disease, identify what, issues are they may be dealing with, and then getting them referred to our, our partners across different sectors, whether it’s social determinants of health related resources or health care related resources, getting them connected to care. And most importantly, now we have the outcome of that. We have the data to kind of support what’s going on, how that’s working, where the deficits are, which is definitely placing us a better position to be more agile and to go after other opportunities that come along the way.

You know, rural health transformation is huge, and we’re gonna seize the moment to the best of our ability, but there will be other opportunities down the road. And what we build with RHT now is gonna inform how a how, well we’re able to access those future opportunities that will inevitably come. So that’s kind of what we’ve been looking at, coordinating across sectors to make sure our partners see our vision, get on the same infrastructure as us digitally, which is very new to Calaveras County.

That was a that was a lot a lot of conversations and a lot of kinda education on why that’s important, why that’s needed. Because in a lot of rural communities, there’s this thing where things have been working a certain way this way, and we’re gonna stick with that because that’s what we know. And sometimes it’s tough to put something new and innovative out there and sell all your partners on it, but that goes back to having those strong relationships, being able to show them the outcomes and how that can benefit their the people they serve, and then, everyone seems to benefit.

Our I really appreciate both doctor Laurie Stradley and Justin on how you’re framing up the relationship side of it because that is definitely where it all starts out here in Western North Carolina. I I love I love that you, pointed that out. in every? meeting, Like, you sit down and figure out who your people are and how. you’re connected. And And, again, who, are lot of that can’t even of those questions, without it it doesn’t always. mean your family. Right?

That can be anything, human component. but creating relationships I would love to kinda, you know, continue those thoughts. of everything, that Stradley, we do out here, you know, how would you kind. of, North Carolina perspective, is a really diverse state geographically, your region? economically. And so if you’re not grounded in Western North Carolina, you’re an outsider, and it’s really tough to break that. And so one of the ways that at Impact Health, what we really try to do is find the safest places for people and build trust with them.

So to sort of go backwards a little bit and how we have been doing work in rural health for the last five years and how that’s prepared us for this transformation work is to talk a little bit about North Carolina’s eleven fifteen waiver. And that, the eleven fifteen waivers, I think you probably all know, are, ways to let us demonstrate and test out new models for leveraging Medicaid dollars to get better health outcomes at lower costs. And in North Carolina, ours was sort of a three pronged approach.

We moved to a managed care model. We implemented a tailored plan model which supports folks who have much more complex health care needs in the Medicaid framework. But the piece that I worked on the most was called the healthy op is called the healthy opportunities pilot. And that gave us a chance to look at 29 services, social care services, between food, housing, transportation, family safety, to really test the waters. One, could we even stand this up?

Was it possible to create a system that could effectively, refer complete services, bill for those services, track them, and follow the outcomes? Could we even do that? And, thankfully, the answer was a resounding yes. Of course, we couldn’t have done that without partnership from Unite Us who created the NC Cares three sixty platform in North Carolina. So not only did it have a referral system, it also incorporated the billing aspects of the work that is important for our community based organizations to get reimbursed for that work.

But Medicaid is this big state and federal program that doesn’t always engender trust in communities when you hear that sort of big name. And so really quickly, we moved to what we call the no wrong door approach. So if somebody is already coming into a food bank and, you know, let’s say, they haven’t seen miss Sarah for three weeks, And so she finally comes back, and the person working at the pantry says, we haven’t seen you in a few weeks. What’s going on?

And Sarah says, well, I have flat tire, and I haven’t been able to get here to get my food box. It’s been an incredibly hard three weeks. After And a little bit of discussion, that food bank may say, you you might be eligible for some support either in transportation or food deliveries. And so that is how a lot of our rural community members got connected into this Medicaid resource. They might already have Medicaid and get screened into Healthy Opportunities, or they might be eligible for Medicaid and start there, so they now start to get clinical care as well.

And originally, when North Carolina launched that program, it wasn’t intended to be a rural health strategy, but that is what it became because we are operating in three regions across the state, and all three of those are predominantly rural. And that let us build the foundation for how North Carolina is intending to operate the Rural Health Transformation Program with this local hub model that is deeply embedded in community, partnered with the state, partnered with payers and clinical health systems, comfortable with all of the variety of technologies that are gonna be necessary to do this, ultimately, with the goal of making sure that everybody gets to do what they do best.

We don’t want our community based organizations bogged down in billing and negotiating value based care models and all of that. We want them in relationship, food sources, getting them out the door, building community. We want our payers focused on the best, most innovative funding structures to make sure that their folks are getting great health outcomes. And we sit in the middle of that to try and make it as easy as possible to have this all happen. And again, with our rural health, initiatives prior to this funding, we were able to show that having a local partner who is connected in all these ways makes it easier for everybody to get the work done, to track it, and to tell the story.

And that’s we’re just we’re really proud to be a part of it and to recognize, again, the reason we do it this way is because Western North Carolina looks very different from the Piedmont, from the East Coast on the ocean, and we just have very different needs. I know I said at the beginning, we have a lot of rural health, in common, but we have different cultures. We have different food preferences. We have different local foods. We have, you know, different ACC affiliations.

We always have to say that during March Madness. So it’s really wonderful to have those local groups. And then for us to get to work together so that we can roll that up into a statewide picture that allows for better investment in the gaps and service needs across the state. And that’s another place where Unite Us has really come into play for us is that if each of the regions are tapping into these resources, we can really look at a regional and state level on where we’re providing services, where the gaps are, and how we can do it as effectively as possible.

Because with the way health care budgets are right now, there is no room for, double spend or, overlap between services. We have to be precise in the way we’re delivering these resources. No. I think you’re absolutely right. And I’ve you know you know, one big takeaway that I had from that is, like, you know, obviously, all of the differences that occur throughout that regional kind of, you know, makeup, you know, all the rural environments are different.

And the way that you leverage the the technology and infrastructure is gonna be different based on the needs of that local community and having that convening entity to bring everybody together, again, to that human element to and that’s where the technology can really help support the the fall on activity. So I know Amanda had to step away real quick. We’ll jump to the next question. And I do want to share from the last poll, the top. answer was a majority of the folks main ways actively looking to be part of the solution is by looking at our existing partnerships and seeking to expand expanding. existing work.

This is a can see, you know, most of our listeners here are rural really, on the cutting the of what can they do to get started. truly operationalize as we’ve talked about resources, the many moving, pieces, this opportunity Unite Us as just being one part of the broader the table, and have an understanding of the needs funding the of, the communities, we serve, is your organization preparing doctor Stradley a role, the varying needs? too. I mean, I can say, And if you don’t, mind, I’m, not talking to start with you. whole state necessarily, even in our small community.

We have differences from community to community that we have to keep at top of mind, and we have to tailor how we approach our services to them. And that, that idea just kinda compounds with the greater scale you have. And so along with that, the scale of your partnerships has to follow because those are your subject matter experts that are gonna be able to give you that vital information on how to best operationalize, this RHT to reach those communities. None of this matters if we can’t reach those highest need communities.

And I am not able to access every single high need community we have, so having all our partners at the table is huge. So we try to meet early and often with our partners to understand, you know, I was talking to one of our managed care plan partners just the other day about Medicaid. We call it Medi Cal in California redetermination and how that’s gonna affect our communities. And, you know, it’s trying to stay on top of these rapidly evolving changes, and the best way to do that is to have everyone at the table and have conversations about it as often as possible.

We’re also looking to improve our data and reporting capabilities to just stay agile, stay on top of this kinda ever changing environment that we find ourselves in. One of the big hurdles that I think many rural communities face is capturing that relevant data, capturing what’s going on to be able to actualize the resources we are getting and use them in the most appropriate manner. I think we’ve all heard I know I’ve heard many stories, many anecdotal tales of struggles to access, people missing appointments they desperately need because they can’t afford the gas money to get to a provider.

They’re having to make those kind of decisions. Do I go to my get specialty care, or do I have enough money to go to work the day after? You know, and having issues accessing food sources, housing, mental health care. But historically, particularly in Calaveras County, we’ve struggled to have the data infrastructure and reporting capabilities to capture those stories, translate them into data, and then use that to access opportunities. So I think, an opportunity like this comes along.

And in my mind, when I think rural communities, I think improving our ability to turn those stories into data points that we can then operationalize to find the best way to serve our communities to stay on top of their needs as they change and to access the future opportunities down the road. I think if rural communities can lean into improving that capability so that the the story of our health disparities has more granular detail, because I think a lot of times we have some kind of high level outcomes, we know access is bad, but but why?

And what are the sort of nuances between populations? Historically, we just haven’t had the resources to get that granular with it, and it’s very hard to turn that into tangible change when you don’t have the detailed granular information to work off of. So we have an opportunity through Rural Health Transformation and working with organizations like Unite Us to kinda break out of this feedback loop of we can’t get data, so we can’t access opportunities. So we can’t get data, and we’re just stuck in that.

And this is our opportunity to break out by accessing this funding, by working with our Unite Us partners, having that cross sector collaboration to make those tangible improvements in health disparities that we’ve seen for many, many years in rural America. No. I appreciate that, Justin. I think some things that stood out to me really is is, like, leveraging data and infrastructure to be able to tell a true story, and not just a story of it makes you feel good, but also, like, real impact and value.

So I would like I’d love to direct you all to the documents in the in the right side of the you know, those are a lot of case studies. And I think that’s something that, you know, we really pride ourselves on is empowering our partners to take that data and insights and show real ROI and impact so that we can then scale it. Because. that was another, piece that really appreciate what you said about the data challenges in scaling. because that is absolutely a priority we’re us for rural health transformation the first year region. of the five year health transformation, that was one of the missing pieces, just now getting things really disconnected. pieces of the Healthy Opportunities think, you know, and our ability to tell that story, clearly think, Dr.

Laurie Stradley, I think you have unique legislators given make good decisions about funding. with healthy opportunities. was a huge amount of, data, like, but the connections go back to the the the question is, where know, we’re all. these new funding so, that’s one of the ways that we hope to use the Rural Health Transformation role, funding. in this solution, as well? know, it really also speaks to our intention to build on what works. Now is actually it’s not necessary for us to technically innovate.

We know what works. We know how it works, and now is the time to sort of more deeply invest in what works. So the the innovation is probably alignment and connectivity and, transparency. You know, when we do this work, a lot of us have to come together in spaces that would sometimes be competitive. Even the process that we’re going through right now in Western North Carolina trying to identify who that hub is has been really interesting.

It’s been a four week turnaround, to identify the hubs in each of the six regions in the state. And I was speaking with a a health care executive earlier this week, and he said, you know, all the conversations I have, I feel like if we had four months to write this application, there would only be one from our region. Because we really do work together that closely, we don’t intend to be competitive, but in some cases, it it becomes competitive when it doesn’t need to be. So if we could build this better infrastructure, share data more transparently, make the right investment at the right time, then all of us become more sustainable in the long term investments in rural health transformation.

So those are really my two highlights, is build on what works. North Carolina is going to receive up to $213,000,000 annually for five years. And one of my friends who is a former Medicaid director at a state says that’s Medicaid dust. It’s hardly anything relative to the whole big picture of Medicaid spend. So we have to be incredibly intentional in how we invest that money, or it could get swallowed up by other interests that are not as deeply embedded in compute in community.

So, you know, keeping those connections alive and making sure that we have, really we speak with one voice, and we do it very clearly based on the data that we have, really brought together, and to make it useful data. So one of the areas of bringing those threads together is to make sure that everybody has access to multiple layers of data without having to visit seven or eight different platforms. Because when you’re talking to a primary care physician who really should be the medical home for an individual, especially in rural spaces where access to other layers of care is more difficult to come by, they need to know that that referral for a food box, that loop closed and that the family is receiving it.

They would already know if that MRI they sent someone off to get came back. That system has been around for a long time, but we need them to really trust the social care systems and make sure that that data is actually getting back to the people who have the opportunity to shape the health outcomes of these individuals. No. That’s great. And I think, you know, we’re seeing the consistency, right, of, like like, the data is is is incredibly important, but, like, how can you make the data actionable?

Right? And, again, I think as we you know, Yeah. our our. our think that, partners know, being the steering committee, from Gravity Project, the health, system standards just like doctor Stradley and just the, continued evolution that, you know, being very collaborative. that ecosystem think that for us, collaboration was really being. able?

That we’re honestly what, role know, we needed, to play because I, think that it looks different depending upon what we’re trying, to accomplish know, with these dollars. looking forward to know, in some of the areas, that continues may evolve the quarterback. to really other areas, the communities at. the most. really being, able to, have turn to you, Dr. Paula Masters, you know, that guess with all these new funding opportunities, to just be, organic, how are you all prepared to play, a role? and to be successful.

You know, since this since all of this has come about, we’ve had just like Justin was talking about, we’ve had so many meetings with so many different partners to try to get everybody on the same page and realizing too is that we need to be all at the table, all one voice, but we need to be very specific in what we’re all trying to accomplish and what we’re all trying to say. I think that’s the biggest piece that we have really been seeing. You know, I I completely agree that we’re trying to you know, it goes back to where we started this conversation.

Rural has been figuring it out for a while. We already knew that we needed to have very individualistic, customizable solutions. We needed to have it based on evidence. We need to have it based on what works. So now it’s not that we’re innovating.

It’s that we’re optimizing. It’s that we’re scaling, and it’s that we’re doing it together. Because you’re right about the all votes is that we don’t want anyone to be left behind. We don’t wanna further marginalize our already vulnerable populations. And so being able to really do that.

So that’s that’s where we’re really leaning into. Completely agree about data and infrastructure and technology and really thinking around a systems approach. How do we get more interoperability? That’s the one thing that I would add on there for this is that it’s one thing to have this great technology over here and another data system over here, but it doesn’t do anyone good if they don’t talk to each other or that we don’t have the right agreements in place for them to share because I think the other thing that we’re gonna have to solve for is to allow for bidirectional sharing of data and and information because social service agencies have great data, community based organizations have great data, health systems have great data.

Where where does it come together to tell the true story? And I think that’s the piece is, like, really looking at and how do we play a big role there is what we have really been leaning into. And and really looking at added capacity for each other is that I don’t have to do all of these things because I have great partners. How do we create a a completely different continuum of care to where there’s no there’s no blips, there’s no barriers between the clinical care to the physical care to the spiritual care to the social care?

And I think that is where we lean into what we all have seen as what works and what role we need to play in it. No. I I love that. Right? Like, it’s not about, like, just the innovation, like, we know what works.

And it’s like, how do we go. ahead and lean into scaling and optimizing? Can I hear a part of that question. one more I? will give you. credit, It cut out, on me. when I use it elsewhere. So, I mean, just for the sake of time, obviously, Amanda, glad you’re able to join back with us. We’d love to lead off with the next question with you. Really, I mean, this is a really exciting moment.

Right? We know it’s. a tremendous. opportunity. So our our community has, been, I guess, where here, do you see the biggest opportunity in to figure, out what sustainability your region, looks like for, and then also nationally with, traditional health care workers? and community health workers and how to really increase access to those services for our population. There’s such a need for navigating. through. not only. social services, Not at all. but the health services, you know, our region. what excites you the most about the rural health transformation? about some of, the, changes do you see as the biggest opportunity, not just for your region, but also nationally? for those mid level community health workers and how we’re able to actually add more to our our network and and increase that access for for our population.

It really opens up. And then if they’re able to bill for it, then they can be sustainable. So we’re seeing these little community benefit organizations that are rooted in faith based or they’re rooted in culturally specific organizations be able to stand up programs that help community members really navigate through the services, and then they’re actually receiving funding for that to sustain the program internally. And so it’s really wonderful to see them not have to work so so hard to try to figure out, you know, how to financially sustain themselves.

And because those smaller community benefit organizations are able to play in the same area, they can, bring populations that we haven’t seen to access those services as well. And that’s been really great to see, here in our our local region. And then, I think that same thought just kind of nationally and watching the smaller grassroots organizations, you know, stand in the spaces they’ve never been able to stand before because they’re able to be sustainable. I I I wanna thank you for pointing out the the community health worker approach because, like, as you think about that, right, you can I’d, direct everybody to look at the documents.

The Ballad Health case study actually articulates the ROI on folks in the community getting connected to care through community health workers knowing that they can look at their entire think it’s this unified journey, focus on rural health. and clinical, So, you know, to optimize think about. the work that we’ve all been doing even you know, I just came from the Missouri Community Health our regions to try and we actually presented nut to make sure that study, people who was a packed room. wanna live in cities that just validates not only what can happen and have an impact on the. regional level, but on a national level as well. sometimes a matter of making said, our own, connections love to pass it over to doctor Stradley. a conference who is working on the same thing you are.

And most excites you about sort of uplifted Transformation? national conversation, I think, is gonna allow us to accelerate. And, Doctor. Masters, I am also gonna be stealing that, optimize instead of innovate. It’s just exactly right because the innovation has been unending for a long time out here. So I would say that’s the thing I’m the most excited about is to to really highlight this opportunity and bring us together, and to bring, honestly, more folks into this who maybe didn’t know that they could have an impact or be a part of it.

So that’s the broader level. And then the other piece is the investment in exactly, you know, what you’ve mentioned. Our our community health workforce has sort of been behind the scenes for also for generations. And, really, in North Carolina, we were able to make a deeper investment in our community health workers during COVID, and that that really lifted up this recognition of the you know, there’s medical value. It feels really tangible to say that, but also the care and comfort and really seeing people that comes along with community health workforce.

So that’s my really high level and my really in the weeds folks who know how to care for each other. Those are my really two things that I’m so excited about for this. Awesome. I appreciate you sharing your thoughts. And, yeah, I think, again, continued alignment with everybody here.

I really appreciate your perspective. And, again, for the sake of time, we’d love to just kinda go into the final question. And obviously, Justin and doctor Masters, like, please share your excitement too and your and your last response here about what’s most exciting. But as you know, building on all of this, you know, many of you are actively thinking through strategy, funding alignment, cross sector collaboration. So what advice would you offer to organizations preparing for rural health transformation in their own communities?

And I guess I forgot to ask the the last poll question too, so I’m gonna pivot back for a second. You know, Yeah. also I think that to the attendees, you know, I I think that’s such an know, we’d love to still. hear from? you. Because, we’ve are your biggest challenges? doing this for a while and I still seek it’s gonna still provide insight. But I’ll this give my continually some thoughts. optimizing, And I think it really leans, into a lot of the things that we’ve. been talking about anyway, is is very much, of again restate the the the. last question, So apologize. really looking into what you’re thinking about strategy, and really thinking, about it from cross sector collaboration, piece.

You know, you’ve heard all of us talk about, advice would, the offer to the organizations the story. And what I would say is transformation in their own communities? look at the difference of the value equation in which you’re communicating and making sure that it’s always numbers and people, people and numbers. And I think that’s a big piece. You know, you talked about the case study that, you know, we were part of. We saw that demonstrated.

And so we’re gonna be very much leaning into that. I think the other element that, you know, I I would add on to that is allowing things to be okay with being data informed and mission driven. Those things are not in opposition of one another, but a lot of times we allow ourselves to be okay with somebody telling us that it is. And I would say, no, it’s not. And that’s where we that’s where that optimization really comes into play and allowing for those things to be community derived and community driven.

And and and I think the last one that I would say, and I think it just, again, underlines what we’ve been talking about when we’re talking about collaboration and being intentional, but really being okay with getting outside of your walls and getting outside of your box and being able to get with folks that are doing this work that may not be doing this work exactly how you would see it done. I think I’ve learned some of I think I’ve learned some of my most important lessons and some of the most useful pieces for community health improvement and social care integration from those those partners that I just happened upon versus being intentional in going and talking to them.

So that’s that’s that’s the advice that I would give. I think one thing that’s important to keep in mind during these times of transformation and change and being able to access more resources and and do more is to not reinvent the wheel necessarily. You know, we’ve been talking about how we’ve all seen in rural communities all across the country for many years that, you know, rural communities figure it out. They find ways. to make things work. that. They’ve found about your yourself, that work? for their community, what advice would found recommend to implement organizations models rural health transformation funding, resources, gets it well underway? capacity.

So now that we have all this, now we have access to more of these resources and we can do something that is hopefully transformative, it doesn’t mean we have to invent something brand new out of whole cloth. I mean, one thing I love doing is I love I love stealing ideas, frankly. I love seeing what professionals like the people on this panel are doing, and I pull bits and pieces out, and I try to build it into our programs, services, our policies that we offer to our community because they’re they’re battle tested.

They work. They’re evidence based. The evidence is speaking to professionals like we have here, hearing how they implemented it, what challenges they ran into, being able to have that information at the forefront and plan for it ahead of time. You know, and I think that’s why it’s important to have all your partners involved too, is they know things that work, and they know they know the mistakes to avoid. You a lot of times, you don’t have to ask people like us.

There’s people in your community that can tell you the mistakes to avoid. You gotta listen to them. And I think, sometimes people forget that, and I think the other part of it is bringing the community along for the ride. I think we we talk about cross sector collaboration and working with our partners and CBOs and these large systems, but this is all to serve the the broader community. But that’s what all this is aimed at.

And if they have no way to be a part of the conversation as you build systems and scale up, you’re there’s gonna be gaps. You’re just gonna miss things. It’s inevitable. If, you know, one thing we talk about in public health a lot is things like, you know, community based participatory research, and the whole crux of that is bring the community along for the ride, center them in all conversations, and kinda let them steer the ship to the degree, that that’s feasible and possible. And you’ll naturally avoid a lot of mistakes because they’ll tell you what they are, and they’ll tell you they’ll tell you how they happen, when they happen, what they look like, and why it drives them crazy.

And then our job is to take that information and actualize it in a way to make our systems work better. So that that would be my advice from my perspective. No. I love that. And that, you know, coming off. the heels of the conference.

I was at, think that with one of our Missouri Torch always, try to start with the end in mind. they emphasized. So what am I actually giving the community based organizations a seat at the table that, and you know, that have, the right people at the you know, We’re bringing the, community, into the conversation. able to learn for from everyone our, members. you? know, They will history and experiences said, and, they’re happy, mistakes, to share with us the things of a better term, are passionate really continue the things that. they’re very much against.

How about yourself, Amanda? And most, you know, a lot, of of what, really saying, the same things and and understanding your far as advice to the organizations are. around they health? are they able to take on a new technology? Are they able to to stand up a new program?

Where where they are and understanding what their barriers are will will help us all come come together and build something that actually will last instead of rolling it from the top down and saying, you know, all of these organizations have to do all of these things. So really just understanding who your partners are and where they are in the process and and really where they best fit into the the build of of any programming. I I saw the. question there, like, that, I think the emphasis, we’re not currently really talks about you, know, we discussed, and that’s, program. design, like, But we are. still operating under you you eleven fifteen in mind first. through. really, I think, helps And so we’re still having. great conversations Stradley, with our legislators, kinda, and there’s, obviously recognition piggyback on, this program know, what advice, would you recommend. and it’s time to refine poll focus, it. we did see that, I am know, some of the biggest challenges will get that done. alignment to that funding, and sustainability. it is important from day one to engage, whatever advice, funding streams those two things in mind, working with in your work, the organizations just sending? reports and giving updates or publications, but inviting people out into the community, inviting them into spaces where lives are being changed.

So tell your story from day one. Don’t wait until you have outcomes because the process matters too. And, you know, to to put a fine point on some of the pieces that have already come up about making sure you’re maintaining relationships and and not disrupting them, if you find yourself in a room talking about a health outcome that you intend or a program intervention that you want and the people being affected by that, there’s no one in the room from that community, stop what you’re doing. Wait.

Get those folks reconnected. There are so many quiet things happening in your community that you may not know about unless you are of the community, and that can be very specific. It could be, broadly farm workers, or it could be Spanish speaking farm workers. So, like, getting narrowed in on on where the intervention is really matters. So you have to, create space to be wrong and to stop and to engage people.

Otherwise, you absolutely will disrupt because this is a really fast moving intervention. There is expectation that we will move to action quickly. This is not a planning investment. And so, you know, being willing to acknowledge a mistake, repair it, and then get back to work together is, really my advice for how we can do this well. Don’t be afraid to say, ugh.

I missed that one. I am sorry. There’s no room for defensiveness or, you know, refusing to hear what people have to say. So we’re really excited about that, and that’s that’s definitely a core value of Impact Health is that, let’s talk because we’ve already made some mistakes, and let’s share those so that you can make a whole new list of mistakes, and then we’ll learn from you. We’ll try just not to make the same mistake twice.

No. Thanks so much for that insight. And, I I I you know, as we wrap up here, I really just wanna thank all of the panelists here, really not just for sharing your ideas, but these are real world examples and really this cross sector impact in action. And so what’s really clear from today’s discussion is that rural communities, they’re not starting from zero. Again, going back to Doctor.

Masters, it’s not innovation. It’s really refining and optimizing. So these partnerships, infrastructure, and measurable outcomes, they’re already in many places in many regions. So really, how do we strengthen, align, and scale the work to meet these new expectations and opportunities?

So thank you again for everyone who joined us today. We appreciate your partnership and your commitment to advancing rural health. This session was recorded and will be shared with you soon. You will also see a survey we would love for you to participate in about your experience here. And if you’re interested in learning more