Alan Morgan is
the Chief Executive Officer of the National Rural Health
Association (NRHA) and has been working for NRHA
since 2001. He discusses his organization's work on the
national and global stages and shares his rural health
predictions for 2020.
What are your top rural health concerns right
Well, there are three. First, front, and center would be
the decrease in life expectancies for rural Americans,
and that directs the course of everything we do at NRHA.
That's number one. Number two is workforce shortages,
something we've long addressed and always have to deal
with in a rural context. And then number three, of
course, is hospital closures. Hospital closures obtain
the most media focus, but of course both workforce
shortages and hospital closures directly have an impact
on the declining life expectancies. So those three are
tied together, and they really help drive the direction
of our organization.
Why is access to healthcare a particular
challenge for many rural residents?
When it comes to rural, geography plays a significant
role. The geographic distance to providers —
the distance that providers and patients have to travel
to actually seek care — creates a barrier to
care. Provider shortages create a barrier to access along
with adequate insurance coverage. Those are three
significant factors that impede access to care in a rural
context, and this is important because this impacts not
only the health status of rural Americans but also
directly impacts mortality in a rural context.
Adequate health insurance is both a rural and urban
issue. But the provider shortages and geography are
really unique, I would argue, to rural health policy in
the context of it. But those three interacting together
create an unfortunately unique healthcare environment in
rural America of significant concern.
As we enter 2020, what changes do you foresee (or
would you like to see) for rural health and
I think the easiest prediction would be for the rapid
expansion and adoption of telehealth. It's something
we've been talking about for 30 years, and it has been a
painfully slow process. However, over the last five
years, we've finally seen the technology, the pricing,
and the regulatory burdens or barriers removed. We've
finally seen a real uptick in a rural context for the
adoption of telehealth. I would expect that to continue
and be a significant story at the end of 2020.
Also, I expect us to see a lot of focus and attention on
the expanded use of community health workers. This is
something that has been highlighted and has been proven
to be an effective strategy in multiple sectors but
certainly in a rural context. I'm sure that will be
something we'll be seeing as the year progresses.
I really think we're going to see a renewed focus on
public health. I think a driver behind that is going to
be a private insurance market that sees the financial
benefits of a focus on public health and preventive
health. In the Medicare/Medicaid sector now, you're
seeing a realization of that. The focus on public health
has been there forever, but I think that focus from the
private sector is something we're going to see.
Now, what else would I like to see? Broadband expansion.
You really can't optimize telehealth without broadband
I also would love to see legislation and regulation for
new provider options and new payment models. Wouldn't
that be glorious? I think the concept of a sustainable
healthcare delivery system implemented, or at least the
groundwork of it implemented, in 2020 is something I'd
like to see. There's a tremendous amount of discussion
right now, and it needs to be done: What are the proper
models, what are the proper payment models, and what are
the proper delivery models? Now will that actually
translate into the field, above and beyond the
Pennsylvania Rural Health Model for global budgeting?
But that's what I'd like to see.
How is the rural health community growing in its
response to these issues?
Number one is communication: telling authentic stories to
national media outlets of the relevance and the
importance of how [different] issues would work in a
rural context. Communication is very, very important.
Again, I think there are three areas. Number one is
communication: telling authentic stories to national
media outlets of the relevance and the importance of how
these issues would work in a rural context. Communication
is very, very important.
Number two is collaboration with other membership
organizations across sectors. The National Rural Health
Association is working with organizations such as the
National Organization of
State Offices of Rural Health (NOSORH) and the
Association of Rural Health Clinics (NARHC) but also
expanding beyond our healthcare partners to Farm Bureaus,
Farmers Unions, rural electric, rural broadband
— any time we can get outside of our usual
sector in promoting new models. They're very important,
and that's a strategy that the national organizations are
engaging in at this time.
And this probably is top of the list: promoting research
into rural policy issues, utilizing not just the
federally designated Rural
Health Research Centers but academic institutions
across the United States that are having to focus on
rural policy. There is some great research that's being
published both in our very own
Journal of Rural Health but also in Health
Affairs. Policy drives practice, and it's so
very important to have and to support research in the
areas of rural health policy, to help set the stage for
building a sustainable rural America going forward.
What are some of your proudest accomplishments
during your time at NRHA?
I'm approaching my 20th year with NRHA, so
that's almost two decades. Number one is NRHA's expanded
national focus on rural health and the work that NRHA has
done towards ensuring that the national media covers
rural America. Seeing NRHA on CNN and NBC and Fox News,
any of the national spotlights, and hearing them talk
about opportunities and challenges in a rural context
were really important.
A huge accomplishment of the National Rural Health
Association in the last 20 years is the development of
new payment models. NRHA's been a driving force here with
the development of what we call
The Future of Rural Health policy paper and helping
to design the Community Outpatient Hospital model, which
is a new provider type that we're currently promoting on
Capitol Hill. NRHA has positioned itself as a driving
force of building a sustainable rural tomorrow. And
that's just so rewarding, both personally and from an
NRHA has positioned itself as an organization, as a
driving force of building a sustainable rural tomorrow.
I would say the final item is NRHA hosting the WONCA
World Rural Health Conference in 2019 and seeing NRHA
take a leadership role on the global stage. It's nice to
see the membership really coming together and
collaborating and providing that leadership perspective.
What else would you like people to know about
NRHA was created on this concept of community health
— that the health of a community is as
important as the healthcare within the community
— and the relevance of collaboration across
provider types in business sectors. Moving forward, this
concept of building healthy rural communities is going to
take a center stage for NRHA in 2020.
…the health of a community is as important as the
healthcare within the community…
We're going to be launching a new community health
initiative in collaboration with the Federal Office of
Rural Health Policy (FORHP) to highlight the
successful FORHP community health grant programs that
drive collaboration and create sustainable models of
success. From time to time, organizations tend to focus
into siloes, and NRHA was created as the
organization that would bring all the sectors and all the
provider types together to develop solutions that can be
replicated across the United States. And so we're going
to be focused back on the issue of community health, on
innovative and successful strategies that can be
replicated. It's exciting just to see this come full
circle back to the organization that we were created to
be in the first place.
Opinions expressed are those of the interviewee
and do not necessarily reflect the views of the Rural
Health Information Hub.