In this special episode of Rural Matters, Michelle chats with Brian Alexander, author of the powerful best-selling book, “The Hospital: Life, Death, and Dollars in a Small American Town.”  During the National Organization of State Offices of Rural Health (NOSORH) annual meeting on October 13, 2021, Michelle and Brian were featured speakers for a session they called, “Candid Conversations.”  During this episode, Michelle talks with Brian about his book as told through the lens of a small town hospital in Bryan, Ohio.  The critically-acclaimed book covers how an individual’s race, social/economic standing, and zip code can affect or determine their health and whether or not they can access vital health care services.

"The Hospital shows how fragile our country’s health care was even before the pandemic, and how that fragility affects staff and administration as well as patients."―The Washington Post

Continuing the conversation, Michelle and Brian discuss his take on NOSORH’s National Rural Health Day theme of the 4 R’s: Resiliency, Relationships, Readiness, and Resolve.  They also discuss Brian’s views on the challenges that rural communities and health care face in the future and field questions from listeners.

“Nobody would make this (health care) system 100 years ago. If you start with that… there may be room to say, let’s blow it up. But we need to be honest about what disruptions that would cause. It is 19% of the American economy… the disruption would be enormous. If we are willing to do that, we can have a much better system, but I think that we can start with the commonality that nobody likes it.” - Brian Alexander.

Stay tuned for more Candid Conversations in 2022.  To follow Michelle and today’s guest, you can find them @MRBImpact and @BrianRAlexander on Twitter.  You can also read about NOSORH’s 2021 Community Stars here.

In Part VII of our landmark series on rural higher education and workforce development, produced in collaboration with the Ascendium Education Group, Michelle explores a key issue for rural communities — building transfer and career pathways for rural learners with two experts in the field: Dr. Erica Orians and Dr. Lia Wetzstein. Orians is Executive Director of the Michigan Center for Student Success at the Michigan Community College Association. In her role, Orians supports Michigan’s 28 community colleges in their efforts to improve equitable student outcomes while emphasizing the linkages between policy, practice, and research including rural colleges that serve vibrant communities across the state.  The MCCA has helped lead several statewide transfer initiatives in Michigan including the Michigan Transfer Agreement, the Michigan Transfer Network, and the MiTransfer Pathways. Dr. Wetzstein is the Director of Community College Research Initiatives (CCRI) at the University of Washington. She engages in education equity research on postsecondary education reform, vertical transfer, STEM education, and community college outcomes. She leads CCRI’s equity agenda to enhance degree attainment and living wage careers for low-income learners and minoritized students. The discussion involves important issues in transferring between colleges; lessons learned from the pandemic; a STEM transfer partnership project; and improving rural student transfer success in the rural space. This episode and the entire eight-part series is sponsored by the Ascendium Education Group. For more information, visit ascendiumphilanthropy.org.

In Part VI of this landmark series produced in collaboration with and supported by the Ascendium Education Group, Michelle discusses the challenges and opportunities involved in postsecondary partnerships in rural America with three recognized experts in the field: Dr. Sheila Martin, Vice President for Economic Development and Community Engagement at the Association of Public and Land-grant Universities; Dakota Pawlicki, the Director of Talent Hubs at CivicLab;  and  Dr, Gretchen Schmidt, a Senior Fellow with the National Center for Inquiry and Improvement and a  national leader in higher education transformation. Martin works with university leaders and policy stakeholders to improve university practices related to economic and community engagement. She describes the unique opportunities for building human capital in rural communities and the exciting activities being undertaken by Cooperative Extension at many universities. Pawlicki serves a network of almost 100 local and regional cross-sector partnerships focused on postsecondary attainment and also hosts Lumina Foundation's podcast, Today's Students, Tomorrow's Talent.  He describes why Talent Hubs are an exemplary cross-sector partnerships and CivicLab’s recent launch of a new capacity-building initiative to support rural partnerships. NCII has worked alongside a group of community college leaders in the last year to highlight issues facing rural institutions post-COVID, notes Schmidt, adding how rural colleges, working in collaboration with local communities, can develop and integrate higher education, with financial resources and social services to enable students and residents to thrive and not just survive. This episode and the entire series is sponsored by the Ascendium Education Group. For more information, visit ascendiumphilanthropy.org.

In Part III of our four-part series on rural funding, produced in collaboration with and supported by Thomas USAF, Michelle chats with ChadParker, who has worked with USDA Rural Development for 30 years and is currently serving as the Acting Rural Housing Service Administrator, overseeing all Rural Housing Service’s programs including the Community Facilities Program. She also speaks with Thomas Kimsey, President and CEO of Thomas USAF Group, who manages more than $100 Million+ annually in loan production. In his usual role as the Deputy Administrator of Community Programs, Parker is responsible for Community Facilities Direct Loans, Guaranteed Loans and Grants, Economic Impact Initiative Grants, Tribal College Grants, and the Rural Community Development Initiative. The guests discuss the Emergency Rural Health Care Grant Program and other funding opportunities available from the USDA to assist rural health care facilities. This episode and the entire four-part series are sponsored by the Thomas USAF Group. With 40 years of experience working in the government guaranteed loan space, Thomas USAF Group is uniquely positioned to offer exceptional services to meet your business needs. For more information, visit www.thomasusaf.com .

In Part V of our landmark series on rural higher education and workforce development, produced in collaboration with and supported by the Asscendium Education Group, Michelle chats with Danielle Vetter, Senior Program Officer and Kirstin Yeado, Program Officer, at Ascendium Education Group, both supporting partnerships focused on rural education and workforce training; Emily Cole, a higher education researcher and a Project Director with Sova; and Dr. Allen Pratt, Executive Director of the National Rural Education Association (NREA). The riveting discussion focuses on Ascendium’s research initiatives, including its rural postsecondary education agenda and partnerships; themes and stories that informed the agenda; what rural leaders and communities can take away from the agenda; and NREA’s rural research projects. This episode and the entire series is sponsored  by the Ascendium Education Group, a nonprofit organization committed to helping learners from low-income backgrounds reach their educational and career goals.  For more information, visit ascendiumphilanthropy.org.

Synopsis; In the concluding segment of our four-part  series, Viewing Rural Health, Education, and Business Through an Equity Lens. produced in collaboration with and supported by Grantmakers In Health. Michelle chats with four riveting guests: Ann McMillan, Program Director at Grantmakers In Health (GIH), responsible for access and quality programs; Allen Smart, national spokesperson and advocate for improving philanthropic practice under his group. PhilanthropywoRx; Debby Warren, Executive Director of the Southern Rural Development Initiative (SRDI) and the Community Reinvestment Association of NC;  and Emily Hinsey, Director of Operations and Program Development of Grantmakers In Aging (GIA), the national membership organization of philanthropies amplifying the voices of older people and issues of aging.. McMillan discusses the GIH’s role in advancing health initiatives and how organizations can seek funding from her organization. Smart describes how his organization is helping rural stakeholders deal with the pandemic and the future challenges that will be presenting themselves in the rural space. 

Warren discusses her group’s two-year initiative involving the United Philanthropy Forum, funded by the Robert Wood Johnson Foundation to strengthen and expand philanthropic investments that promote rural racial, social economic, and health equity. Hinsey details the key focus areas GIA has been elevating within rural aging philanthropy and some of the strategies that have worked well in this space.  This episode of Rural Matters and the entire series is sponsored by Grantmakers In Health, a nonprofit, educational organization dedicated to helping foundations and corporate giving programs improve the health of all people. Its mission is to foster communication and collaboration among grantmakers and others, and to help strengthen the grantmaking community’s knowledge, skills, and effectiveness. Learn more by visiting www.gih.org

In Part III of our groundbreaking fabulous four-part series on Viewing Rural Health, Education, and Business Through an Equity Lens, produced in collaboration with Grantmakers in Health, Michelle chats with Kim Davis, Senior Advisor (Home Region Team) at the Walton Family Foundation; Shao-Chee Sim, Episcopal Health Foundation’s Vice President for Research, Innovation and Evaluation; Adam Linker, director of programs at the Kate B. Reynolds Charitable Trust, and Dr. Gary Nelson, President of Healthcare Georgia Foundation, Inc. Nelson describes The Two Georgias Initiative, which represents the Foundation’s focus on rural health and is opening the door to its work on the social determinants of health. Linker talks about a variety of important rural grassroots issues, including supporting rural entrepreneurship, providing innovative transportation solutions, fostering equity. and building more viable economies. Davis describes several innovative projects, including howe a long-time Arkansas business, Delta Dirty Distillery, which is launching a vodka spirit business based on utilizing sweet potatoes on their family-owned farm, and emphasizes the importance of coalition building. Shao Chee Sim details how the Episcopal Health Foundation get involved in addressing rural hospital closures and what the foundation learned from its first commissioned research report on this topic.  This episode of Rural Matters and the entire series is sponsored by Grantmakers in Health, GIH's mission is to foster communication and collaboration among grantmakers and others, and to help strengthen the grantmaking community’s knowledge, skills, and effectiveness. Learn more by visiting www.gih.org

In the second of our fabulous four-part series on Viewing Rural Health, Education, and Business Through an Equity Lens. produced in collaboration with and supported by Grantmakers in Health, Michelle talks with  Heather Dimeris. the Director for the Office for the Advancement of Telehealth (OAT), in the Health Resources and Services Administration (HRSA) at the U.S. Department of Health and Human Services and a Commander in the United States Public Health Service (USPHS); Marilyn Werber Serafini, director of the Health Project at the Bipartisan Policy Center and an adjunct professor at Johns Hopkins University; Mei Wa Kwong  Executive Director for the Center for Connected Health Policy (CCHP), the federally designated National Telehealth Policy Resource Center; and Walter Panzirer, a Trustee at the Helmsley Charitable Trust and grandson of Leona Helmsley. During the pandemic, Dimeris notes, telehealth expanded exponentially in utilization.  In 2020, health centers saw telehealth visits increase to more than 28 million, equating to a nearly 6,000% increase — with more than 5.7 million of these additional telehealth visits occurring in health centers serving rural communities This increase in telehealth services was possible because of the temporary flexibilities with telehealth reimbursement during the pandemic.  She also discussed the many ways that HRSA is seeking to address equity issues in rural areas in the further expansion of telehealth services, including a focus on tele-emergency care last year and on direct-to-consumer care this year,  in 2021. In addition, just last month, HRSA announced funding more than $19 million in key telehealth investments in rural and underserved communities. (Check out telehealth.hhs.gov for more information about telehealth and broadband resources for both patients and providers.) BPC recently conducted a national survey about lessons learned about telehealth use during the pandemic, Serafini notes, which found that about one in seven people (14%) who used telehealth said they would have sought care in an emergency department or urgent care if telehealth was not available, and that more than half of those people had their primary health issue resolved. The survey also found that consumers are likely to use telehealth in the future as it has served as a valuable tool for accessing routine and preventive care during the pandemic, she adds  Kwong says that the pandemic broadened awareness of telehealth and its breadth of utilization, but adds that  while telehealth is a terrific tool for providing these virtual services, it is important to note that many rural residents do not have the capability to access broadband. Panzirer describes how the Helmsley Foundation is funding needed health projects to address equity access in the rural upper Midwest.  This episode and the entire series is sponsored by Grantmakers In Health (GIH),  a nonprofit, educational organization dedicated to helping foundations and corporate giving programs improve the health of all people. Learn more by visiting www.gih.org

Michelle chats with Mike Shimmens, Executive Director for 3RNET, the nation’s most trusted resource for health professionals in rural and underserved communities, about an increasingly important topic in rural communities: assisting health care professionals to find jobs and careers and helping health care employers to find qualified workers.  In the last four months, Shimmens says, 3RNET is seeing fewer applications from health care professionals, but it’s unclear whether there is just a blip or the result of increasing burnout in this space as the pandemic continues to plague communities. Shimmens notes that many states are experiencing health professional shortages, according to HIPSA scoring that is monitored by governmental primary care offices. If you’re a stakeholder in a rural or underserved area, you may want to look into the J1 visa program, he adds. On a positive note on shortages, Shimmens says, in terms of loan repayment assistance,  there recently has been an infusion of $800 million into the National Health Service Corps, which is available to subsets of health professionals, as well as from state agencies. 3RNET, a nonprofit, is a valuable resource for its members in this area as well, providing educational information and job listings. If you’re an employer that wants to participate in this effort, you can reach out to a 3RNET network coordinator in your state, explains Shimmens. This episode is sponsored by 3RNET. Whether you’re looking for a job or searching for the perfect candidate, 3RNET is here to help. Get started today at 3RNET.org.  

In another special Rural Matters Bonus Brief, Michelle meets with White House Senior Policy Adviser for COVID-19 Equity Dr. Cameron Webb to discuss how COVID-19 and the Delta variant continues to challenge rural America.  “We’ve got so many states now with surges and cases, and it tends to track pretty closely to the vaccine rates in states... It is because this Delta variant is really less forgiving... if you are not vaccinated, you are not protected,” said Webb.

They also discuss how staffing shortages effect the number of beds available in rural hospitals.  As a result of less elective surgeries during the pandemic, rural hospitals have been hit extra hard.  This has resulted in hospitals being forced to cut staffing, leaving some rural residents with less-than-ideal care available to them. 

Dr. Webb talks on his belief that the recent FDA approval of the Pfizer MRNA COVID-19 vaccine will help ease the minds of some remaining individuals that haven’t received the shot yet.  Michelle brings up the misinformation involving vaccines and COVID-19 treatments, and what messengers of information should be trusted.  Dr. Webb suggests trusting local health providers, and the CDC for guidance. 

Lastly, they discuss how the Delta variant impacts children.  “...more kids are being hospitalized... If you think that just because you made it through 2020 just fine doing things a certain way, what I need (for) you to understand is this is a game changing variant, it spreads with twice the transmissibility,” Dr. Webb stated. 

Click the below links to listen to more Rural Matters Bonus Brief episodes with Biden-Harris Administration officials Secretary of Agriculture Thomas Vilsack, Deputy Secretary of Commerce Don Graves, Secretary of the Interior Deb Haaland, White House National Climate Advisor Gina McCarthy, Chief Science Officer of COVID Response Dr. David Kessler, Member of the Council of Economic Advisers Heather Boushey, NIH Director Francis Collins, Secretary of Commerce Gina Raimondo, and Secretary of Labor Martin Walsh.