Wyoming has sent an application to the federal government for a slice of the $50 billion Rural Health Transformation Program, created in the Republican-backed spending bill signed into law in July.
The state’s four priorities, based on input gathered at town hall meetings around the state and surveys, include:
- funding to increase access to basic care
- building the healthcare workforce
- improving people’s health
- using technology to bring care closer to home
Wyoming Public Radio News Director Kamila Kudelska caught up with Wyoming Department of Health Director Stefan Johansson to hear about the specifics. They started with the first bucket: access to basic care.
Editor’s Note: This interview has been edited for clarity and brevity.
Stefan Johansson: What we heard from the public was with our smaller rural or frontier hospitals, we want our emergency department to be there. That just makes all the sense in the world.
But emergency departments are very expensive, especially in low-volume counties or communities. So you'll see in our Critical Access Hospital – Basic incentive program, we're really looking at those core services: emergency department, OB-GYN, labor and delivery care, and emergency medical services. Those types of things, to say, if you already do those, we want to help invest in the sustainability of those. If you're not doing those, or if you've recently had to stop providing services like that, would this incentive program attract that coming back? We can now essentially offset or pay for some of that high fixed cost infrastructure to deliver that service that could, in the future, be less reliant on the volume of billing.
Also, within that first category, we're looking to expand primary care that integrates behavioral health with physical health or preventive medicine. I think that's again an important point of feedback that we received from the public, that access to reasonable primary care that also has a behavioral health component was a pretty common theme that we heard.
And then finally, we've proposed a concept that I think is very interesting. We've proposed both for individuals and for small businesses to design a public health benefit that would essentially protect people who have emergency care because of an accident. Essentially, protect them from financial ruin. We've proposed a benefit plan called BearCare that we think could be an innovative concept, not as a replacement to the ACA [Affordable Care Act], not as a replacement for private insurance, but as an alternative to folks who might otherwise go uninsured.
Kamila Kudelska: The second bucket is building up the healthcare workforce. How are you hoping to do this? Any specifics?
SF: We struggle to solve the out-migration problem, where folks go to bigger markets down in Colorado or out west in Utah or up north to Billings or wherever that might be. We really want folks to see this career pipeline coming from Wyoming and staying in Wyoming.
To that end, we're looking at individual education awards in these different trades to let someone potentially invest in their CNA [certified nursing assistant] program, in their nursing degree, in their medical school for physicians and a host of other types of professionals in the workforce.
Then selfishly on the back end, by nature of that, this has retention requirements in Wyoming, so you need to stay for five-plus years to essentially take advantage of that full award.
But in addition to that, working with high schools and vocational programs – do folks know this is a career path? And also the demand that the communities around Wyoming have for healthcare professionals, that you can start young and really build a career in this and also have a way to start a life and raise a family in Wyoming in a sustainable way.
KK: The third bucket is improving people's health. It's pretty general. What are some specific ways you're hoping to do this?
SF: First of all, we are very rich in the outdoors. We are very rich in the ability to enjoy the outdoors and enjoy physical exercise and those types of things.
So both in terms of exercise and diet promotion, we're looking to expand on efforts that the Department of Health has had in the past, but really in a new light, where for nonprofits or charitable organizations that organize things that encourage people to exercise, community centers or senior centers that have that type or want to have that type of service in the winter, for example, when the weather's bad, to be able to provide some cost offsets for them to do that at a higher scale.
In addition, we've proposed a statewide, what we're calling a tele-specialist platform, and this is something we would explore how it could be scaled and how it could be used. Really taking advantage of technology to do that. With certain types of specialty behavioral health, we know it's very difficult to have access to those things, especially in interior and rural Wyoming.
Telehealth and telemedicine can really improve our access to that. I'll give you a few examples. We've seen folks with pretty high behavioral needs ending up in the criminal justice system. And just over the last year or two, we've partnered with a lot of sheriffs and detention centers to try to offer at the Department of Health access to a telepsychiatry service, where an actual doctor can review and even provide direct care to an inmate of a county detention center, for example, and recommend a course of treatment. So we have a little bit of experience with that and it's exciting with this program to potentially be able to really expand that, but also expand its concept. A huge geography like Wyoming with a pretty small population, those specialty services are just hard to come by. If we're approved, we would be looking to scale that up, not just with telepsychiatry but with other tele-specialties.
KK: And last but not least, the last bucket is using technology to improve chronic disease management and bring care closer home. I guess you just mentioned telehealth, but any other technology specific solutions?
SJ: We didn't want to be in the position as the state or the Department of Health to pick winners and losers when it comes to technology.
We came up with a program that we proposed in this application called the Technology Adoption Challenge. It kind of flips the script a little bit and instead of the state picking the seven, eight or nine technology products that we're gonna push down from the top down around Wyoming, to really make it bottom up and have provider groups and communities come together and signal their interest that then the state, through this program, could provide those sort of matching funds for that effort. So that's number one.
Then number two, on the technology side, we're looking at designing and procuring a non-emergency transportation and coordination platform. It's something that's exciting because we know we have basically a state that is one small town with unusually long streets. Getting from place to place can be a challenge and can really restrict access to care. So we're looking to potentially, again, use the power of technology to maybe coordinate a platform that at least makes the logistics and the organization around transportation a bit easier for our seniors, our disabled communities, and essentially our remote and frontier communities as well.
KK: Anything I missed? Anything you feel like you need to add?
SJ: We're excited with a really creative idea that we came up with to propose to the federal government of essentially what we're calling a rural health transformation perpetuity.
When we talk about access to basic emergency care at our rural hospitals, OB-GYN and labor and delivery care, EMS and ambulance services, and the workforce issue, we would really like to set something up where the state of Wyoming reaps the benefits of that over decades as opposed to a five-year funding period.
The way that we think we do that is to invest much more conservatively in the beginning so that we can stretch those benefits out beyond five years.
