MERRIAM – Faced with stubbornly poor rural-health indicators, the REACH Healthcare Foundation has overhauled its funding strategy in the three outlying counties it serves.

“We are not going to continue throwing dollars at things that just won’t change the status quo,” said Bill Moore, REACH’s vice president of programs, policy and evaluation. “And we have to be urgent about it because people are dying.”

Through its Rural Health Initiative, the foundation is targeting Allen County, Kan., along with Cass and Lafayette counties in Missouri. The combined population of the three counties is less than 150,000.

The foundation has purposely left the program guidelines open-ended to spur innovation, officials said.

Likewise, REACH has not said how much funding will be available through the initiative.

Moore would only say that the foundation “fully expects a multi-million investment over the next five years.”

Using data from the annual county health rankings produced by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, REACH found that the three counties fared worse than the national average in a number of categories.

For instance, according to the county health rankings, communities across the United States annually lose about 6,000 years of life per 100,000 residents among people who die from preventable causes before age 75.

According to REACH, that figure in Allen County was more than 10,000 years per 100,000 residents, while Lafayette and Cass were around 8,000 years.

REACH’s research also determined that residents in the three counties have far more preventable hospital stays per year than the national average, based on Medicare data.

Medicare patients average about 50 preventable stays per 1,000 patients per year, according to REACH, while the rate was about double that in Allen and Lafayette counties and about 60 percent higher in Cass County.

Moore joined REACH a little more than year ago, and it seemed to him that REACH needed to rethink the way it funded rural providers, given the persistent health problems in those counties.

Three of REACH’s main partners in the Rural Health Initiative are Thrive Allen County, ConnectCASS and the Health Care Collaborative of Rural Missouri, which serves Lafayette County and surrounding areas.

One of the main charges REACH has given to those organizations through the initiative is that they must incorporate new voices into a planning process designed to identify barriers to care in their counties.

Each organization has received a planning grant, and REACH has pledged to pay for facilitators. REACH program officers also will provide technical assistance and feedback throughout the process.

REACH’s approach earned applause from Alan Morgan, chief executive officer of the National Rural Health Association, which has offices in Kansas City, Mo., and Washington, D.C.

“I love the concept of bringing in leaders … and equipping them with the expertise and the background knowledge they need in public health,” he said. “That is exciting stuff.”

Here’s how the head of each of the three county organizations described the ideas that have emerged from the planning groups that have met as part of the initiative:

• Toniann Richard said Lafayette County was looking to expand primary care, dental opportunities, and behavioral health services to more Medicaid recipients and uninsured patients. They hope to incorporate the services of the faith-based community and long-term care providers more than they have in the past.
• Kate Maricle at ConnectCASS said a key focus there was expanding telemedicine by tapping into a broadband initiative in the county. New partners would include public-safety officials and an economic development representative.
• David Toland at Thrive Allen County said the group would like to establish a program that uses middle-class mentors to help low-income families with issues such as financial literacy and navigating unfamiliar bureaucracies. It also would like to establish better ties with the county health department and the mental health center in Iola.

The rollout of the initiative has not come without hitches.

In Cass County, Maricle said the open-endedness of the project was making it hard to keep all the players engaged.

“It would be nice to hear directly from REACH that this is what we want as far as deliverables and this is what we are working towards,” she said. “I don’t think anyone is angry at REACH. There’s just a lot of scratching of heads going, ‘What?’”

The Health Care Foundation of Greater Kansas City is proud to partner with the Kansas Health Institute news service to provide weekly health stories about health and policy issues impacting the greater Kansas City region. This News Service is an editorially independent program of the Kansas Health Institute and the Health Care Foundation of Greater Kansas City and is committed to objective coverage of health issues.