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Network Spotlight: Rural Health Network of Oklahoma

June 2017
Organization: 
Rural Health Network of Oklahoma

Network Name

Rural Health Network of Oklahoma

Location Hugo, OK
Key Contacts Stacie Pace, Executive Director, and Josh Braziel, Chief Information Officer
Website rhnofoklahoma.org
Mission The mission of Rural Health Network of Oklahoma is to act as a convener and facilitator of change within the rural healthcare system in order to ultimately improve the health of rural Oklahoma.
Vision RHN of Oklahoma is seeking population health in rural Oklahoma ranked at the top of the State’s health outcomes.

Stacie Pace and Josh Braziel of Rural Health Network of Oklahoma were interviewed by the Network TA team to share information on the network’s characteristics, key learnings, accomplishments, and challenges.

Q: In a nutshell, how would you describe your network?

A: The Rural Health Network of Oklahoma is a vertical network consisting of members that include hospitals to community organizations, and everything in between, that deals with health care in rural southeast Oklahoma. We provide a wide range of services to assist health providers, from helping with telemedicine encounters to infrastructure for their disaster recovery plan, based on what our membership determines that they need. We also help bring vendor services to them from other sources as needed through a vetting process. We try to find solutions tailored to the individual health care provider.

The network has been involved in three HRSA grants in recent years: a telehealth grant, an HIT grant, and a network development grant. The Little Dixie Community Action Agency, which is the parent organization for RHN of Oklahoma, has been the catalyst to start these health care initiatives. The grants were written for the RHN of Oklahoma to spin out of the parent organization and become a separate 501(c)(3) as the network matured. Currently the Rural Health Network Development grant provides diabetes education and telehealth capabilities as well as expanding our other services and our membership.

Q: What benefits do network members receive?

A: Hospitals and clinics are able to save money by being a member and have access to many of opportunities that they wouldn't otherwise have access to. We are able to cut their IT costs in most areas by a huge percentage. Thinking just in terms of internet and telecommunications, it's not uncommon for us to save a small county hospital an amount in the six-figure range on an annual basis. For the facilities that are running on a shoestring budget and doing their best to stay open with all the reimbursement cuts and the challenges there are for small hospitals right now, anything you can do to affect the bottom line just helps them stay in business. That's the heart of it.

One of the other main benefits that our network members get is the opportunity to network between each other within a region and within a state. Our staff goes to trainings and conferences to be sure we up to date on the changes within health care on a state and federal level and the technologies that are available. Most of our rural health providers don’t have time to leave their businesses and go to these trainings. For that same reason, we plan to be providing on-site CMEs for members by the end of this year. We’re a conduit for the health care providers to put the all the pieces together to help them be successful. RHN of Oklahoma has a diverse group of partners within the state that we work closely with such as the Department of Health and several Oklahoma colleges. We have also established relationships with other health networks across the nation. Working with these networks helps us to find solutions that are working elsewhere to bring back to Oklahoma.

Q: As a vertical network, what do you see as the benefits of having a diverse membership?

A: Each of our communities is based upon a type of camaraderie where they can work together to provide services for the patients within the community. You have your community members. In a small rural community, the hospital in many cases is the hub of health care services. It provides services as well as jobs, which has a huge economic impact to the community. Many times your local doctors work within those hospitals. We have noticed, at least in our corner of the state, those communities and those health care providers work with the city government, the county government, and other nonprofit organizations to ensure the people of the community are provided the services needed.

In fact, there's a group called Turning Point Coalition operating in several of our communities. They are a group of volunteers who get together and try to help with community projects. Health care is one of the projects they work on. The county coalition helps organize volunteers, fundraise, and coordinate events and programs that benefit the community. We also have community organizations that donate money to the network for specific endeavors, such as the Remote Area Medical Oklahoma event, an annual event that provides free dental and vision services. In rural areas, there are many people who do not have insurance for dental or vision. Dental and vision are great indicators of a patient’s health status. By providing these services, we are able to help these people get plugged back into local services and into primary care. We are fortunate our community members work together to help organize that event.

Q: What other types of collaborations are you involved in?

A: [Josh] We established the rural health network as a consortium with the FCC, so we're able to bid group rates for telecom services, and we work closely with USAC and Oklahoma Universal Service Fund. I serve on the board of directors for the Telehealth Alliance of Oklahoma as the one rural representative there, so they come to expect my input on the rural matters. I do my best there to make sure that the rural perspective is well represented.

For instance, several years ago, the Oklahoma Corporation Commission took over oversight of the Oklahoma Universal Service Fund. During that transition, some significant expenses for telecom services across the state were retroactively passed down to all of the rural providers. These rural providers were unexpectedly billed for as much as $600,000, and a lot of them thought it was just them. In a joint effort between the Telehealth Alliance of Oklahoma and the Oklahoma Hospital Association, we have had a set of hearings with the Corporation Commission to voice the local impact there. The end result has been very positive. It's improved the service and availability in rural areas of the state.

[Stacie] I sit on the board for MyHealth, the health information exchange for the state. I have been involved from early on to help in the development of the HID. I also sit on an advisory board for primary care in Oklahoma. This collaborative advisory board is made up of physicians, state health leaders, and patients, providing direction to the Oklahoma Primary Healthcare Improvement Cooperative (OPHIC), with the goal of strengthening the state’s primary health care delivery system. I’m also very involved in the Rural Health Association of Oklahoma. Our network roles have given both of us an opportunity to be a part of the health leadership in Oklahoma.

The network development grant is all about becoming sustainable to continue moving the work in health care forward. As we were considering our next steps after the Network Development grant ends in August, we were contacted by Oklahoma State University wanting to partner with us. They were looking at more expansion of their health care services and programs into rural Oklahoma. The rural health network is the perfect vehicle to help reach the rural providers and hospitals. I felt that was quite a testimony for what this HRSA funding has provided to the community in rural Oklahoma, when one of your top universities comes calling and asks how they can be involved.

Q: What has been a surprising insight over the course of your network’s development?

A: Our members are business competitors; they operate in the same space. It’s been a real surprise to see their level of network involvement and how they help each other through the challenges. With us working as the intermediary, they've been surprisingly willing to lend resources to their competitors when they're in a time of need. There's a group of hospitals that consistently lend us their IT staff and their other resources for use at competing facilities if that facility has a need, and I am proud that they trust us to do that.

Q: Tell me about a roadblock your members have faced. How has the network helped to address it?

A: There are a lot of health care vendors or consultants taking advantage of our rural health care providers. When you're trying to take care of your patients, are barely keeping afloat, and in order to be compliant you need to hire a consultant or find a vendor to help, they come in charge an exorbitant amount or are not truthful and upcharge after the contract is signed. This type of behavior is very predatory and is costing our providers unnecessary expense. It's a struggle with rural providers to even find the correct vendor to fulfill those needs.

This is the reason we’ve made vetting vendors one of the main services we provide. We try to make sure they're a reputable firm and they actually can do what they say. We find out what exactly they do offer. We’ve had to go to bat several times for our members to help work out contracts or reconcile overcharges. There are instances where the provider could have employed a physician on the yearly cost that was overbilled or overcharged by a technology vendor.

That’s been a major stumbling block our members have to deal with that we can assist with. We serve as a mouthpiece for a number of providers. No one has to do it on their own; they can send us to speak in plain language with these vendors and know that we're doing everything we can to change it.

Q: What other challenges do you face working in rural health care?

A: With the budget and staffing challenges in rural health care, many organizations are only able to work reactively. But if you're well-staffed and have experts in certain operational areas, then you're able to work more proactively. That's a cheaper way to do it in the long term, to predict when things are going to fail and to be on top of the problem, versus just fixing things as they break.

We’re working on providing a certification for members’ IT staff and training that will help them. Ideally, we'll have an “army” that we're able to deploy and share, so if someone has expertise in coding or in a certain EHR, we're able to deploy that person. Even though they're employed by one system, we're able to send them to another place to help get them on track to save time and money. We will roll out this service later this year.

Q: On the flip side, what are the advantages of working in your rural area?

A: We’ve found that our health providers and our members are very passionate about their community and their patients. They will try to do everything that they can to make sure that their patients get what they need. You can see it every day. These physicians make financial decisions that benefit the community instead of themselves personally. A case worker in one of our hospitals recently gave her small refrigerator to a diabetic patient so that their insulin could stay refrigerated. They are a community. These are people who are family or friends, or they've known them for generations, and they will go above and beyond.

Q: Based on your experiences as network leaders, what advice would you give to a developing rural health network?

A: Keep close contact with other networks throughout the nation. They've been there, done that. They know how to help you through the important and sometimes taxing issues. We've had a change of membership from time to time, and you get frustrated and feel like you're burned out. It’s helpful being able to talk to organizations like NCHN, or call and talk to your project officer or your TA providers. Reach out. Don't feel like you're alone. Even just the opportunity to talk through the issue and get another perspective.

It’s also really important to listen to the membership, especially when it comes to services. You can have your offerings and you can put together systems that you think are great, but your members are only going to use the things that they perceive as a need. Taking their suggestions and providing what they want is important.

The other thing is trying to make sure that you find staff with the same passion about health care and community that you have. If it's just a job for them, you can't help to grow the network and they will not stick around. You have to believe in what you're doing and be passionate about it.

 

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