The Maine Rural Health Action Network is a group of rural health experts and stakeholders from business, philanthropy, education, health and social services. There is a growing rural health care crisis in Maine that must be addressed. Throughout the past year, we have conducted dozens of stakeholder interviews and analyzed a variety of reports and blueprints that have been created by other stakeholder groups with similar concerns. Our findings confirm that there is a wealth of informed and solid recommendations that have been identified in the past however a lack of sustained leadership has created barriers for implementing them. Our call to action addresses these barriers and outlines five immediate actions needed to improve rural health and build a strong and sustainable system of rural health care in Maine.  

New Report on Rural Health-Related Social Needs Now Available 

Health-related social needs (HRSNs) among patients, particularly vulnerable and historically disadvantaged populations in rural areas, impact health care access, outcomes and costs. While awareness of the links between health care and social needs are widely recognized, little is known about how to effectively address patients' social needs in the context of the healthcare system.

Conceived by the Rural Health Action Network and conducted under the auspices of the New England Rural Health Association with funding from the Maine Health Access Foundation, the report describes a project that focused on identifying strategies to inform the design of a demonstration in Maine. 

Two key influencers of transformational reform (community partnerships and governance and financing approaches) are examined in detail in the report, drawing on published literature, reports and interviews with leaders in multiple sectors in Maine and three other rural states. A 5-year, $5M rural, community-based demonstration in rural Maine was proposed to generate evidence that is critically needed to advance the field. 

Andrew F. Coburn, PhD, Research Professor Emeritus and Senior Fellow, Maine Rural Health Research Center at the University of Southern Maine and Deborah A. Deatrick, MPH, Public Health Consultant, served as project leads and co-authors of the report. A copy of the report is accessible below.

Health Related Social Needs Final Report

Call to Action & Legislative Priorities - CLICK HERE!

January 2020

Filled with hard-working families and neighbors helping neighbors, Maine’s rural communities are essential to our economy and our way of life.

Our rural communities – the heart of Maine – are at unprecedented risk. Every rural hospital, every rural provider, every rural community is at risk.  The future of rural Maine and the State is threatened. Because of this, a group of concerned stakeholders made up of business, philanthropy, education, health and social services has been gathering for over a year in an effort to develop pragmatic, actionable steps to address this growing crisis.

Across the State rural communities are hit harder by challenges like insufficient insurance coverage, the opioid epidemic, and an aging population with more chronic illnesses. Health-related workforce shortages place additional stress on the system.

The health of rural Mainers is compromised. Several hospitals are on the brink of failure. Health clinics and nursing homes have closed. Local emergency medical services are strained. The availability of fundamental health services, such as primary care, and even obstetrical services, is no longer assured. Many rural residents travel long distances for essential care and have limited access to specialty services.

Access to basic health care is central to the economic viability of rural Maine. We can’t sustain and build local economies without a healthy workforce. We can’t attract businesses in the absence of accessible basic services.  Further, health care is an economic engine in itself: local health-related spending and jobs help fuel Maine’s rural economy and sustain rural communities.

Historic models for organizing and delivering rural health services are increasingly difficult to sustain. Traditional approaches must be reconsidered if Maine is to have a sustainable, high-performing rural health system.

We must act now. Some rural communities are collaborating and innovating to expand local services and make their system of care and coordination more efficient and effective. We must accelerate this momentum and confront the growing crisis in rural health and health care.

Everyone has a role to play in strengthening Maine’s rural health care system and giving hard-working rural communities the opportunities to raise healthy families, grow their economies, and build a hopeful future for generations to come.

Five Immediate Actions Needed to Improve

Rural Health and Build a Strong and Sustainable System of Rural Health Care in Maine

1.  Mobilize State and Local Leaders to Address the Crisis in Rural Health and Health Care

• Empower leaders in rural communities to find local solutions and partnerships for protecting rural health.

• Expand the role and capacity of the Maine Rural Health and Primary Care Program to work with rural leaders, policymakers, and stakeholders to support local communities and providers to pursue new approaches to providing essential care in rural areas.                     

2.  Rethink Rural Health Service Delivery

Produce a blueprint for addressing the driving forces that determine rural health, including the necessary restructuring of rural health care delivery.  Incorporate the findings of the Rural Health Commission, MaineCare planning and other assessment and planning resources (e.g., Title V assessment, SCHNA, etc.)

• Adopt a basic set of Fundamental Rural Health Services* to ensure access to essential health services within reasonable distances and timeframes.  *Sprague, J. (2018, October 31). Building Blocks for Healthy Rural Communities

• Create a Rural Innovation Program to test new approaches to providing essential services in rural areas, align current delivery systems with future needs, and enhance integration of physical, behavioral, oral, and public health services.

 3.  Redesign Payment Systems

Engage MaineCare and other payers to develop alternative payment models that support access to a more integrated and sustainable rural health system that better addresses the health and health care needs of rural communities and citizens.

• Explore Medicaid waiver and other options for better integrating health, social service, and public health services in rural communities.

• Assess the viability and effectiveness of new rural-payment models.

 4.  Leverage Data and Technology

Advance the use of technology, including broadband, Electronic Health Records, HealthInfoNet, and telehealth, to support access throughout Maine’s rural areas to core services and decision and management support.

• Expand broadband capacity in rural areas.

• Promote the use of telehealth to expand access to primary care, specialty and other services in rural areas.

• Build data systems that foster accountability and learning.

 5.  Build the Essential Rural Health Workforce

Create a comprehensive cross-sector plan for assuring Maine’s rural workforce capacity.

• Emphasize the use of health providers at the full scope of their licenses; strong but innovative credentialing and licensing; expanded support for team-based care; and extension of lay care into homes and communities.

• Establish a continuum of health-related professional development, from high school pipelines to continuing education for working clinicians and health workers.  

• Align and expand investments in innovative and targeted recruitment, retention, and loan repayment.

Maine Rural Health Action Network Members

Other Participants