Hill is the director of the National Rural Health
Resource Center (NRHRC), a position he has
held since its inception in 1990, as the Minnesota Center
for Rural Health. Hill leads all the federally funded
projects at the Center and has led the development of two
rural health networks. In addition, he serves as Chair of
the National Rural HIT Coalition and co-leads the HIT
Regional Extension Center for Minnesota and North Dakota.
He has served as president of the National Cooperative of
Health Networks and as president of the Minnesota Public
Health Association, and has worked with rural health
providers in 45 states. He received his Master of Public
Administration from Shippensburg University and a
Bachelor of Arts, History/Journalism from the University
Hill grew up in a wilderness community in the
interior of Alaska, where his mother was the postmaster
and his father worked for the Alaska Road Commission. He
experienced “culture shock” when his
family moved to Minnesota, where he later attended the
University of Minnesota.
His wife and two daughters are all teachers. He and
his wife live 20 miles north of Duluth, in a woodsy area
on a wild and scenic river a mile off the highway. In his
spare time, he enjoys running, kayaking, biking and
Your Center offers many services—but what do
you primarily do, or what is your main focus right now?
I've been focusing a lot lately on health care
reform—and HIT is a big part of the reform. I'm
particularly interested in Accountable Care Organizations
(ACOs), and how rural providers are gearing for inclusion
in ACOs—and what's beyond that, which is
population health management. Much of the public speaking
I do is on that topic. We're seeing a huge interest from
rural providers on this. It's a question of whether they
will survive in the new value-based models. Part of the
message we're trying to get across is that it will be
difficult, but rural providers have the potential to be
very successful in the value-based system that is
emerging. The hazard is with the immediate two to four
What are some of the potential hazards facing rural
providers that spring from health care reform?
We're concerned that we are seeing significant closures
in some parts of the country. We're going to lose a
number of hospitals. We'd like to help as many of them as
we can with the transition.
But what rural providers have is a huge value. Primary
care physicians (PCPs) are a scarce
commodity—we've got to work with our PCPs and
keep them out in rural areas. Our concern is that the
salaries are going to go up significantly for
PCPs—we're already seeing a steady rise in what
Minnesota PCPs are going to get paid. The formula for
what a PCP is worth on the ACO model is startling.
We're going to have to develop strategies, and form
partnerships. Then we're going to have to reach out to
public health and other providers in the community. We'll
need to see partnerships between provider types like
FQHCs, CAHs and rural health clinics that have not
strongly communicated previously. They'll need to work
together on whole care coordination, particularly for
high-risk Medicare patients. By definition, care
coordination requires better cooperation between provider
types. It's going to be important to reach out to
communities, to physicians and other providers and
community collaborators—there's work to be done
I don't see these as high-cost changes. It's increasing
linkages with the community and becoming more efficient.
We must also make sure we're partnering with providers
and communities, and making informed choices about
whether to form an ACO. We've been seeing rural providers
forming ACOs—right now there is an emerging
rural hospital ACO that has enrolled close to 20
hospitals from across the country.
The hospitals that have closed so far—is it
because of health care reform? And can you predict which
will close in the future?
It could be attributed to the complexity of running a
hospital in the current system, maybe also indirectly
from health care reform and any additional pressures it
brings. But many rural hospitals have been doing poorly
for years—there have been at least nine that
have closed in the South in only recent months.
Any hospital that seems content with the status quo, that
thinks that they are powerless to do anything, that these
changes coming down are only temporary—I
anticipate those hospitals won't be able to survive the
profound changes ahead.
I also believe that hospitals increasingly will need to
partner with other hospitals and other systems, but I'm
not confident that all big systems will take care of
their rural providers. I think that rural providers need
to take care of themselves. Rural providers have
the potential to provide big value. One really good
option for hospitals might be to be part of an
independent network like the Rural Wisconsin Health
Cooperative, where they can provide support for each
other, and have collective volume advantages.
Partnerships are going to be huge.
What is your Center doing to help rural facilities adopt
HIT solutions as part of health care reform and beyond?
We are currently working in the field with hundreds of
hospitals and clinics. We're also developing a rural HIT
knowledge center in partnership with the Rural Health
Information Hub (RHIhub), trying to identify resources
for more hands-on technical assistance. We've sponsored
national rural HIT coalition meetings since 2006, and
held a summit meeting on the rural HIT workforce and
rural broadband. There's very little research being done
on rural HIT. Because it's changing so rapidly, we're
trying to identify tools and other resources, so that we
can be the go-to source for technical knowledge. We have
a HRSA contract to support 41 rural HIT networks, so we
do HIT and quality work all over the country.
What other services does your Center offer? And what were
its original goals?
Our services and programs are designed to provide
comprehensive support for our customers, the state
Medicare Flex programs, as well as individual rural
health providers. We're designed to be a one-stop
shopping center and go-to resource for them. Our basic
focus is on technical assistance for providers and state
programs. We have a current staff of 20 people, both full
time and interns, with two people based in Florida and
one in Utah, who are there to work directly with
hospitals in those states. We do 40 to 50 educational
sessions per year, by webinar and in-person, which are
either national or for multiple states, with topics like
rural hospital quality reporting, ICD-10, retention and
recruitment, HIT and EHRs, and financial improvement for
Our major federal programs include the Technical
Assistance and Services Center (TASC), the Rural
Hospital Performance Improvement project (RHPI) for the
Mississippi Delta, and Rural HIT Network Development. In
addition, we do strategic planning with state programs,
rural health networks, and under contract with the
clinics and the network itself, beyond federal contracts.
We've got a broad background in quality—we held
initial quality summit meetings with federal funding on
HIT—we've been doing that since 2005 as part of
the regional, external center for Minnesota and North
Dakota. In 1992 we received a national quality award for
developing an early model of a medical home. Also in
1992, we started the medical home model with funding and
in partnership with another physician group. We had
physicians following patients into home care—it
was innovative at the time. We've been involved with
community development—we've done community
assessments for over 120 communities since 1987. We're
also involved in rural hospice—particularly VA
hospice. We have our hands in a lot of different things
because solutions to rural health challenges will require
multi-faceted, systematic approaches.
From the very beginning, we were to be a shared national
resource. The development of this center was
partially driven by NRHA years ago. The
concept was to be a national knowledge center, so that
what was happening and innovative in California could be
shared with North Carolina and the rest of the country.
Tell me about starting the National Rural Health Resource
Center. In the beginning, did you run it solo? And
how has it changed since then?
It started in 1985. I was the first employee and laid the
organizational groundwork. We started as a health care
network—the Northern Lake Health Consortium. We
were entirely self-funded. We got our first FORHP grant
in 1995—a network grant. So the Center really
took off in 1995 with our first funding from them.
We started out as a cooperative initiative for Northeast
Minnesota and Northwest Wisconsin, focused on physician
recruitment, quality and community engagement. We're
still the 3RNet recruitment agency for Minnesota.
A friend of mine said, 'you've got to have a lot of irons
in the fire, because you never know which is going to get
hot.' I'm not surprised we have broadened to a lot of
different areas; we are finding the niche where we
How did you become interested in health and health care
My interest in health started when I was growing up in
the interior of Alaska in the very small wilderness
community of Tok. The public health nurse estimated that
almost 50 percent of the Native population there had TB.
Since then, I've also worked with migrant
farmworkers in Pennsylvania, done work with developmental
disabilities programs, and started the program for
medical service systems for Wisconsin and
Minnesota—I've had a pretty eclectic
Are you planning to retire soon? If so, what do you plan
to do next?
I'm going to pass the CEO role to Sally Buck and go to
three or four days a week. So I'm not going to be the
leader of this center anymore. This will give me the
opportunity to do some slightly different things. I don't
see myself retired, period. I want to continue to
contribute to rural health and rural communities. We've
had a long transition at the Center. The board decided to
do it this way rather than go out and do a national
search, because they felt very comfortable with Sally
I do triathlons—so retirement will give me more
time for them. On Aug. 17th, I will have exercised
for 5,000 consecutive days. Even through Lyme disease,
and a MRSA infection, I've been able to
exercise—I just cut down on the intensity. I
spend at least 30 to 60 minutes a day exercising.
What do you think are the greatest accomplishments of
your career and/or the Center?
I think our organization is helping to preserve and
enhance health services to people who live in rural
communities. I'm proud that we're playing a role in
enhancing rural health care. Our organization is made up
of people who care about these issues. If they don't have
that passion when they begin, they develop it along the
way. It is gratifying that there are communities
and people out there that we have helped.
Opinions expressed are those of the interviewee
and do not necessarily reflect the views of the Rural
Health Information Hub.
Back to: Summer 2013 Issue