Rural Wisconsin Rural Wisconsin Health Cooperative Health Cooperative Tim Size, Executive Directo Tim Size, Executive Director Rural Wisconsin Health Cooperativ Rural Wisconsin Health Cooperative Sauk City, Wisconsi Sauk City, Wisconsin Rural Health Rural Health Advocacy Advocacy 24 hours a day 24 hours a day 7 days a week 7 days a week
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Rural Wisconsin Health Cooperative Tim Size, Executive Director Rural Wisconsin Health Cooperative Sauk City, Wisconsin Rural Health Advocacy 24 hours.
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Myths that Mislead Public & Private PolicyMyths that Mislead Public & Private PolicyMyths that Mislead Public & Private PolicyMyths 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 healthy Rural Americans are naturally more healthy • Rural economy is mostly about agriculture Rural economy is mostly about agriculture • Rural health care costs less than urban care Rural health care costs less than urban care • Rural health care is inordinately expensive Rural health care is inordinately expensive • Rural health care is lower quality; urban is better Rural health care is lower quality; urban is better • Rural hospitals are just band-aide stations Rural hospitals are just band-aide stations • Rural hospitals & clinics are poorly managed/governedRural hospitals & clinics are poorly managed/governed• Rural residents don’t want to get care locallyRural residents don’t 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 healthy Rural Americans are naturally more healthy • Rural economy is mostly about agriculture Rural economy is mostly about agriculture • Rural health care costs less than urban care Rural health care costs less than urban care • Rural health care is inordinately expensive Rural health care is inordinately expensive • Rural health care is lower quality; urban is better Rural health care is lower quality; urban is better • Rural hospitals are just band-aide stations Rural hospitals are just band-aide stations • Rural hospitals & clinics are poorly managed/governedRural hospitals & clinics are poorly managed/governed• Rural residents don’t want to get care locallyRural residents don’t want to get care locally
* U.S. 2000 Census, Non-Metro Population By State* U.S. 2000 Census, Non-Metro Population By State
• CAH payment designation ended two decades of failed CAH payment designation ended two decades of failed attempts to retro-fit to rural the PPS Medicare payment attempts to retro-fit to rural the PPS Medicare payment methodology designed for large urban hospitals 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 The initial draft of the June MedPAC report was seen
as inaccurate, hostile review of the CAH programas inaccurate, hostile review of the CAH program• Draft framed CAH designation as Federal charity with Draft framed CAH designation as Federal charity with
recipients having to prove they were “deserving poor”recipients having to prove they were “deserving poor”• The pushback from Commissioners, with technical help The pushback from Commissioners, with technical help
from the field, was substantial and effectivefrom the field, was substantial and effective
• CAH payment designation ended two decades of failed CAH payment designation ended two decades of failed attempts to retro-fit to rural the PPS Medicare payment attempts to retro-fit to rural the PPS Medicare payment methodology designed for large urban hospitals 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 The initial draft of the June MedPAC report was seen
as inaccurate, hostile review of the CAH programas inaccurate, hostile review of the CAH program• Draft framed CAH designation as Federal charity with Draft framed CAH designation as Federal charity with
recipients having to prove they were “deserving poor”recipients having to prove they were “deserving poor”• The pushback from Commissioners, with technical help The pushback from Commissioners, with technical help
from the field, was substantial and effectivefrom the field, was substantial and effective
Hospital Compare Labled CAH as 2nd ClassHospital Compare Labled CAH as 2nd ClassHospital Compare Labled CAH as 2nd ClassHospital Compare Labled CAH as 2nd Class
NRHA Responded with Reporting GuidelinesNRHA Responded with Reporting GuidelinesNRHA Responded with Reporting GuidelinesNRHA Responded with Reporting Guidelines
•Need to actively prepare for future when payers and Need to actively prepare for future when payers and consumers pay attention to public reportingconsumers pay attention to public reporting
• Rural hospitals should fully engage in the quality Rural hospitals should fully engage in the quality improvement and public reporting movement improvement and public reporting movement
• CAHs and PPS are both “acute care hospitals”CAHs 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 Consumers should be able, at a minimum, to readily compare all hospitals in their “hospital referral region”compare all hospitals in their “hospital referral region”
•Need to actively prepare for future when payers and Need to actively prepare for future when payers and consumers pay attention to public reportingconsumers pay attention to public reporting
• Rural hospitals should fully engage in the quality Rural hospitals should fully engage in the quality improvement and public reporting movement improvement and public reporting movement
• CAHs and PPS are both “acute care hospitals”CAHs 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 Consumers should be able, at a minimum, to readily compare all hospitals in their “hospital referral region”compare all hospitals in their “hospital referral region”
Appropriations Fight in 2005 for 2006Appropriations Fight in 2005 for 2006Appropriations Fight in 2005 for 2006Appropriations Fight in 2005 for 2006
• President proposed to eliminate 8 programs worth $232 President proposed to eliminate 8 programs worth $232 million and dramatically cut 3 others.million and dramatically cut 3 others.
• House of Representatives followed many of those House of Representatives followed many of those recommendations; the Senate did not. recommendations; the Senate did not.
• The first Conference Report eliminated 6 programs The first Conference Report eliminated 6 programs worth $134 million and dramatically cut several others. worth $134 million and dramatically cut several others. But it was defeated 209 to 224 in the House!But it was defeated 209 to 224 in the House!
• The final bill restored funding for research and policy The final bill restored funding for research and policy and AHECS, and added money for outreach and and AHECS, and added money for outreach and community health centers. Some programs still cut.community health centers. Some programs still cut.
• President proposed to eliminate 8 programs worth $232 President proposed to eliminate 8 programs worth $232 million and dramatically cut 3 others.million and dramatically cut 3 others.
• House of Representatives followed many of those House of Representatives followed many of those recommendations; the Senate did not. recommendations; the Senate did not.
• The first Conference Report eliminated 6 programs The first Conference Report eliminated 6 programs worth $134 million and dramatically cut several others. worth $134 million and dramatically cut several others. But it was defeated 209 to 224 in the House!But it was defeated 209 to 224 in the House!
• The final bill restored funding for research and policy The final bill restored funding for research and policy and AHECS, and added money for outreach and and AHECS, and added money for outreach and community health centers. Some programs still cut.community health centers. Some programs still cut.
Jennifer Friedman, VP Government Affairs and PolicyJennifer Friedman, VP Government Affairs and PolicyNational Rural Health AssociationNational Rural Health Association
President’s Again Slashes Rural HealthPresident’s Again Slashes Rural HealthPresident’s Again Slashes Rural HealthPresident’s Again Slashes Rural Health
$160$160
$27$27
$0$0
$50$50
$100$100
$150$150
$200$200
FY06 FY07President'sRequest
Dollars in Millions
Does not include $29 Does not include $29 million cut from million cut from
eliminating AHECs; eliminating AHECs; total cuts are over total cuts are over
$160 million.$160 million.
Jennifer Friedman, VP Government Affairs and PolicyJennifer Friedman, VP Government Affairs and PolicyNational Rural Health AssociationNational Rural Health Association
* CMS Medicare Managed Care Manual, Chpt. 4, page 57* CMS Medicare Managed Care Manual, Chpt. 4, page 57
Strong Access Standards Are KeyStrong Access Standards Are KeyStrong Access Standards Are KeyStrong Access Standards Are Key
• Beneficiary rights to local access, even if “out of Beneficiary rights to local access, even if “out of network,” is key for beneficiaries and for local network,” is key for beneficiaries and for local providers to have any clout in plan negotiationsproviders to have any clout in plan negotiations
• ““Plans must… ensure that services are Plans must… ensure that services are geographically accessible and consistent with geographically accessible and consistent with local community patterns of care.” *local community patterns of care.” *
• Need to open up current “black-box” which Need to open up current “black-box” which limits beneficiary awareness and evaluation of limits beneficiary awareness and evaluation of CMS enforcement of consistency of access CMS enforcement of consistency of access standards across plans, markets and timestandards across plans, markets and time
• Beneficiary rights to local access, even if “out of Beneficiary rights to local access, even if “out of network,” is key for beneficiaries and for local network,” is key for beneficiaries and for local providers to have any clout in plan negotiationsproviders to have any clout in plan negotiations
• ““Plans must… ensure that services are Plans must… ensure that services are geographically accessible and consistent with geographically accessible and consistent with local community patterns of care.” *local community patterns of care.” *
• Need to open up current “black-box” which Need to open up current “black-box” which limits beneficiary awareness and evaluation of limits beneficiary awareness and evaluation of CMS enforcement of consistency of access CMS enforcement of consistency of access standards across plans, markets and timestandards across plans, markets and time
• HR 880 (Ron Kind): pay for CAH & RHC at a HR 880 (Ron Kind): pay for CAH & RHC at a rate that is > 101 percent traditional Medicarerate that is > 101 percent traditional Medicare
• SB 2819 (Coleman/Durbin) is comparable to HR SB 2819 (Coleman/Durbin) is comparable to HR 880; adds option of “103 percent of the applicable 880; adds option of “103 percent of the applicable interim payment rate”interim payment rate”
• Right to local access still key; payment rates are Right to local access still key; payment rates are meaningless if patients can be steered elsewhere meaningless if patients can be steered elsewhere
• AHA & NRHA SupportingAHA & NRHA Supporting
• HR 880 (Ron Kind): pay for CAH & RHC at a HR 880 (Ron Kind): pay for CAH & RHC at a rate that is > 101 percent traditional Medicarerate that is > 101 percent traditional Medicare
• SB 2819 (Coleman/Durbin) is comparable to HR SB 2819 (Coleman/Durbin) is comparable to HR 880; adds option of “103 percent of the applicable 880; adds option of “103 percent of the applicable interim payment rate”interim payment rate”
• Right to local access still key; payment rates are Right to local access still key; payment rates are meaningless if patients can be steered elsewhere meaningless if patients can be steered elsewhere
6.6. Plan applications on-line within 30 days of approvalPlan applications on-line within 30 days of approval
7.7. Full/timely transparency re enrollment and quality dataFull/timely transparency re enrollment and quality data
8.8. Encourage collaboration amongst rural providers to Encourage collaboration amongst rural providers to level playing field re contract development/reviewlevel playing field re contract development/review
1.1. Major increase beneficiary decision-making assistance Major increase beneficiary decision-making assistance
6.6. Plan applications on-line within 30 days of approvalPlan applications on-line within 30 days of approval
7.7. Full/timely transparency re enrollment and quality dataFull/timely transparency re enrollment and quality data
8.8. Encourage collaboration amongst rural providers to Encourage collaboration amongst rural providers to level playing field re contract development/reviewlevel playing field re contract development/review
DHHS National Advisory Committee on Rural Health & Human DHHS National Advisory Committee on Rural Health & Human Services, Medicare Advantage Sub-Committee, 6/13/06Services, Medicare Advantage Sub-Committee, 6/13/06
Wisconsin Academy of Rural MedicineWisconsin Academy of Rural MedicineWisconsin Academy of Rural MedicineWisconsin Academy of Rural Medicine
Builds on pioneering work of Howard Rabinowitz at Builds on pioneering work of Howard Rabinowitz at Jefferson Medical College in Philadelphia.Jefferson Medical College in Philadelphia.
Result of 25 years asking land grant UW be true to rootsResult of 25 years asking land grant UW be true to roots
Goal: rural focused medical school within the Madison Goal: rural focused medical school within the Madison based University of Wisconsin medical schoolbased 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 Locate education and training programs in rural areas of
WI during 3rd and 4th years of Med SchoolWI during 3rd and 4th years of Med School Use rural appropriate curriculumUse rural appropriate curriculum
Builds on pioneering work of Howard Rabinowitz at Builds on pioneering work of Howard Rabinowitz at Jefferson Medical College in Philadelphia.Jefferson Medical College in Philadelphia.
Result of 25 years asking land grant UW be true to rootsResult of 25 years asking land grant UW be true to roots
Goal: rural focused medical school within the Madison Goal: rural focused medical school within the Madison based University of Wisconsin medical schoolbased 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 Locate education and training programs in rural areas of
WI during 3rd and 4th years of Med SchoolWI during 3rd and 4th years of Med School Use rural appropriate curriculumUse rural appropriate curriculum
Health Care Costs - Review of RealityHealth Care Costs - Review of RealityHealth Care Costs - Review of RealityHealth Care Costs - Review of Reality
• In 2005, employer-based health insurance premiums In 2005, employer-based health insurance premiums rose by 9%, the fifth consecutive year over 9% 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 Annual premium charges an employer for a health plan
covering a family of four averaged $10,800 in 2005covering 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% Since 2000, premiums have increased 73%, vs 14%
cumulative inflation & 15% cumulative wage increasecumulative inflation & 15% cumulative wage increase• The average employee contribution has increased more The average employee contribution has increased more
than 143% since 2000than 143% since 2000
• In 2005, employer-based health insurance premiums In 2005, employer-based health insurance premiums rose by 9%, the fifth consecutive year over 9% 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 Annual premium charges an employer for a health plan
covering a family of four averaged $10,800 in 2005covering 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% Since 2000, premiums have increased 73%, vs 14%
cumulative inflation & 15% cumulative wage increasecumulative inflation & 15% cumulative wage increase• The average employee contribution has increased more The average employee contribution has increased more
than 143% since 2000than 143% since 2000
National Coalition on Health Care http://www.nchc.org/National Coalition on Health Care http://www.nchc.org/
What To Do About Unsustainable Cost Trends?What To Do About Unsustainable Cost Trends?What To Do About Unsustainable Cost Trends?What To Do About Unsustainable Cost Trends?
• Most agree that health care costs must be controlled but Most agree that health care costs must be controlled but disagree on the best ways to address rapidly escalating disagree on the best ways to address rapidly escalating health spending and health insurance premiums: health spending and health insurance premiums:
Price controls and imposing strict budgets on health Price controls and imposing strict budgets on health care spending?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 Cost of inaction will severelyseverely affect employer's bottom affect employer's bottom lines, business location and consumer's pocketbookslines, 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 Most agree that health care costs must be controlled but disagree on the best ways to address rapidly escalating disagree on the best ways to address rapidly escalating health spending and health insurance premiums: health spending and health insurance premiums:
Price controls and imposing strict budgets on health Price controls and imposing strict budgets on health care spending?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 Cost of inaction will severelyseverely affect employer's bottom affect employer's bottom lines, business location and consumer's pocketbookslines, 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/National Coalition on Health Care http://www.nchc.org/
Health Outcomes Driven By Multiple DeterminantsHealth Outcomes Driven By Multiple DeterminantsHealth Outcomes Driven By Multiple DeterminantsHealth 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 Health Behaviors (est 40%) e.g. smoking, physical inactivity, overweight, sexually transmitted disease, inactivity, overweight, sexually transmitted disease, motor vehicle crashesmotor vehicle crashes
• Socioeconomic factors (est 40%) e.g. education, Socioeconomic factors (est 40%) e.g. education, poverty, divorce ratespoverty, divorce rates
2005 Wisconsin County Health Rankings2005 Wisconsin County Health Rankings , University of Wisconsin , University of Wisconsin Population Health InstitutePopulation Health Institute
Critical Link Population & Economic HealthCritical Link Population & Economic HealthCritical Link Population & Economic HealthCritical Link Population & Economic Health
““Businesses will move to where healthcare coverage is Businesses will move to where healthcare coverage is less expensive, or they will cut back and even terminate less expensive, or they will cut back and even terminate
coverage for their employees. Either way, it's the coverage for their employees. Either way, it's the residents of your towns and cities that lose out,” Thomas residents of your towns and cities that lose out,” Thomas DonohuePresident & CEO, U.S. Chamber of CommerceDonohuePresident & CEO, U.S. Chamber of Commerce
““If we can change lifestyles, it will have more impact on If we can change lifestyles, it will have more impact on cutting costs than anything else we can do,” Larry cutting costs than anything else we can do,” Larry
Rambo, chief executive officer of Humana’s Wisconsin Rambo, chief executive officer of Humana’s Wisconsin and Michigan health insurance markets.and Michigan health insurance markets.
““Businesses will move to where healthcare coverage is Businesses will move to where healthcare coverage is less expensive, or they will cut back and even terminate less expensive, or they will cut back and even terminate
coverage for their employees. Either way, it's the coverage for their employees. Either way, it's the residents of your towns and cities that lose out,” Thomas residents of your towns and cities that lose out,” Thomas DonohuePresident & CEO, U.S. Chamber of CommerceDonohuePresident & CEO, U.S. Chamber of Commerce
““If we can change lifestyles, it will have more impact on If we can change lifestyles, it will have more impact on cutting costs than anything else we can do,” Larry cutting costs than anything else we can do,” Larry
Rambo, chief executive officer of Humana’s Wisconsin Rambo, chief executive officer of Humana’s Wisconsin and Michigan health insurance markets.and Michigan health insurance markets.
Initial Local Hospital & Community StepsInitial Local Hospital & Community StepsInitial Local Hospital & Community StepsInitial Local Hospital & Community Steps
• Devote a periodic Board meeting to review available Devote a periodic Board meeting to review available population health indicatorspopulation health indicators
• Add Board members with specific interest in population Add Board members with specific interest in population health measurement and improvementhealth measurement and improvement
• Create a “population health” subcommittee of the Create a “population health” subcommittee of the hospital board to explore opportunities for hospital hospital board to explore opportunities for hospital partnerships with other community organizationspartnerships with other community organizations
• With local employers, develop interventions to improve With local employers, develop interventions to improve employee health; expand experience to the larger employee health; expand experience to the larger communitycommunity
• Devote a periodic Board meeting to review available Devote a periodic Board meeting to review available population health indicatorspopulation health indicators
• Add Board members with specific interest in population Add Board members with specific interest in population health measurement and improvementhealth measurement and improvement
• Create a “population health” subcommittee of the Create a “population health” subcommittee of the hospital board to explore opportunities for hospital hospital board to explore opportunities for hospital partnerships with other community organizationspartnerships with other community organizations
• With local employers, develop interventions to improve With local employers, develop interventions to improve employee health; expand experience to the larger employee health; expand experience to the larger communitycommunity
““Population Health Improvement & Rural Hospital Balanced Scorecards”Population Health Improvement & Rural Hospital Balanced Scorecards”by Size T, Kindig D, MacKinney C., by Size T, Kindig D, MacKinney C., Journal of Rural HealthJournal of Rural Health; 3/06; 3/06
• Sponsored by state’s Rural Health Development Council Sponsored by state’s Rural Health Development Council embedded in Wisconsin Department of Commerceembedded 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 The goal: improve health of rural communities and reduce healthcare cost inflation by accelerating use of reduce healthcare cost inflation by accelerating use of collaboration among medical, public health and business collaboration among medical, public health and business organizations that enhance preventive health servicesorganizations 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 Variety approaches to modifying poor fitness, nutrition habits through wellness programs at work/communityhabits through wellness programs at work/community
• Sponsored by state’s Rural Health Development Council Sponsored by state’s Rural Health Development Council embedded in Wisconsin Department of Commerceembedded 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 The goal: improve health of rural communities and reduce healthcare cost inflation by accelerating use of reduce healthcare cost inflation by accelerating use of collaboration among medical, public health and business collaboration among medical, public health and business organizations that enhance preventive health servicesorganizations 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 Variety approaches to modifying poor fitness, nutrition habits through wellness programs at work/communityhabits through wellness programs at work/community
RWHC RWHC Eye On HealthEye On Health Newsletter, 7/06 Newsletter, 7/06
Besides Funding, What Drives Advocacy?Besides Funding, What Drives Advocacy?Besides Funding, What Drives Advocacy?Besides Funding, What Drives Advocacy?
• Need to Correct BiasNeed to Correct Bias - MedPAC Report - MedPAC Report• Opportunity to ReframeOpportunity to Reframe - Hospital Compare - Hospital Compare• Short-term Fix Needed/PossibleShort-term Fix Needed/Possible - Building Ban - Building Ban• Broad Coalition PossibleBroad Coalition Possible - R.H. Appropriations - R.H. Appropriations• Address Core NeedAddress Core Need - Physician Supply - Physician Supply • Anticipate ProblemsAnticipate Problems - Medicare Advantage - Medicare Advantage• Can’t Be AvoidedCan’t Be Avoided - Healthcare Costs - Healthcare Costs• Long-term SignificanceLong-term Significance - Population Health - Population Health
• Need to Correct BiasNeed to Correct Bias - MedPAC Report - MedPAC Report• Opportunity to ReframeOpportunity to Reframe - Hospital Compare - Hospital Compare• Short-term Fix Needed/PossibleShort-term Fix Needed/Possible - Building Ban - Building Ban• Broad Coalition PossibleBroad Coalition Possible - R.H. Appropriations - R.H. Appropriations• Address Core NeedAddress Core Need - Physician Supply - Physician Supply • Anticipate ProblemsAnticipate Problems - Medicare Advantage - Medicare Advantage• Can’t Be AvoidedCan’t Be Avoided - Healthcare Costs - Healthcare Costs• Long-term SignificanceLong-term Significance - Population Health - Population Health
• Be BriefBe Brief• Be Accurate - NEVER false or misleading infoBe Accurate - NEVER false or misleading info• Personalize Your Message - cite examplesPersonalize Your Message - cite examples• Be Prepared - know your issueBe Prepared - know your issue• Be Aware Every Issue Has Two Sides - there Be Aware Every Issue Has Two Sides - there
are voters on other sideare voters on other side• Be Courteous/Don’t ThreatenBe Courteous/Don’t Threaten• Be Patient - long process; be in for long haulBe Patient - long process; be in for long haul
• Be BriefBe Brief• Be Accurate - NEVER false or misleading infoBe Accurate - NEVER false or misleading info• Personalize Your Message - cite examplesPersonalize Your Message - cite examples• Be Prepared - know your issueBe Prepared - know your issue• Be Aware Every Issue Has Two Sides - there Be Aware Every Issue Has Two Sides - there
are voters on other sideare voters on other side• Be Courteous/Don’t ThreatenBe Courteous/Don’t Threaten• Be Patient - long process; be in for long haulBe Patient - long process; be in for long haul
NRHA’s Three Prong Advocacy StrategyNRHA’s Three Prong Advocacy StrategyNRHA’s Three Prong Advocacy StrategyNRHA’s Three Prong Advocacy Strategy
Make your best caseMake your best case: Develop concise, credible, : Develop concise, credible, persuasive, fiscally responsible, but emotive persuasive, fiscally responsible, but emotive arguments.arguments.
Make friends and form alliancesMake friends and form alliances: Find Congressional : Find Congressional champions, develop agency contacts, form alliances champions, develop agency contacts, form alliances with a diverse set of groups.with a diverse set of groups.
Make it happenMake it happen: Use some or all of your advocacy : Use some or all of your advocacy tools – government relations, grassroots and media tools – government relations, grassroots and media advocacy – based on your level of engagement.advocacy – based on your level of engagement.
Make your best caseMake your best case: Develop concise, credible, : Develop concise, credible, persuasive, fiscally responsible, but emotive persuasive, fiscally responsible, but emotive arguments.arguments.
Make friends and form alliancesMake friends and form alliances: Find Congressional : Find Congressional champions, develop agency contacts, form alliances champions, develop agency contacts, form alliances with a diverse set of groups.with a diverse set of groups.
Make it happenMake it happen: Use some or all of your advocacy : Use some or all of your advocacy tools – government relations, grassroots and media tools – government relations, grassroots and media advocacy – based on your level of engagement.advocacy – based on your level of engagement.
Jennifer Friedman, VP Government Affairs and PolicyJennifer Friedman, VP Government Affairs and PolicyNational Rural Health AssociationNational Rural Health Association
Rural Health Needs Your Advocacy 24/7Rural Health Needs Your Advocacy 24/7Rural Health Needs Your Advocacy 24/7Rural Health Needs Your Advocacy 24/7
• Rural advocates have an ongoing challenge, Rural advocates have an ongoing challenge, an attitude in parts of Washington, and an attitude in parts of Washington, and around the country (including CMS) that is around the country (including CMS) that is frequently ill informed, about rural health frequently ill informed, about rural health and the reality of improving rural health and the reality of improving rural health and health careand health care
• Rural advocates must not become Rural advocates must not become complacent, all of us must become more complacent, all of us must become more skilled and more active.skilled and more active.
• Rural advocates have an ongoing challenge, Rural advocates have an ongoing challenge, an attitude in parts of Washington, and an attitude in parts of Washington, and around the country (including CMS) that is around the country (including CMS) that is frequently ill informed, about rural health frequently ill informed, about rural health and the reality of improving rural health and the reality of improving rural health and health careand health care
• Rural advocates must not become Rural advocates must not become complacent, all of us must become more complacent, all of us must become more skilled and more active.skilled and more active.
For a free electronic subscription of the For a free electronic subscription of the RWHC RWHC Eye On HealthEye On Health monthly newsletter, monthly newsletter,
send an email to [email protected] an email to [email protected] with with ““subscribe” on the subject line.subscribe” on the subject line.
Questions/Discussion?Questions/Discussion?
For a free electronic subscription of the For a free electronic subscription of the RWHC RWHC Eye On HealthEye On Health monthly newsletter, monthly newsletter,
send an email to [email protected] an email to [email protected] with with ““subscribe” on the subject line.subscribe” on the subject line.