Planning with Purpose: Leveraging FORHP's Rural Health Network Development Planning Program for Lasting Community Impact

Featured Speakers

	Nkem Osian, MPH, Program Coordinator, Federal Office of Rural Health Policy
	Kim Shuler, LCSW, CEO, Arkansas Behavioral Health Integration Network
	Rachel Blanton, MHA, Arkansas Behavioral Health Integration Network
	Peter Maney, Executive Director, Butte Spirit Center
	Jennifer Rolfes, DBH, MS, MHA, Butte Spirit Center
	Joelle Hutson, Coordinator of Community Health, Oswego County Opportunities
	Subi Gandhi, PhD, MPH, Professor of Public Health and Co-Director of the Center for Rural Resilience, Tarleton State University

Moderator

Amanda Phillips Martinez, MPH, Assistant Project Director, Georgia Health Policy Center

The Federal Office of Rural Health Policy's (FORHP) Rural Health Network Development Planning Program (Network Planning Program) grant brings together key parts of a rural healthcare delivery system to establish and improve local capacity and coordination of care. The program supports one year of planning, with the primary goals of helping networks create a foundation for their infrastructure and bringing focus to member efforts to address important community health needs.

Goals of the webinar:

• Learn how the Network Planning Program helps rural communities build sustainable, collaborative healthcare networks.
• Hear directly from former grantees about how they leveraged their planning year to launch partnerships, strengthen infrastructure, and improve access to care.
• Explore practical strategies and lessons learned that can help organizations maximize the impact of a Network Planning Program.

From This Webinar

• PowerPoint Handout
• Listen to or download an audio version [MP3]

Transcript

Kristine Sande: I'm Kristine Sande and I'm the program director of the Rural Health Information Hub. I'd like to welcome you to today's webinar, Planning with Purpose: Leveraging FORHP's Rural Health Network Development Planning Program for Lasting Community Impact. And we're excited today to be partnering with the Federal Office of Rural Health Policy and the Georgia Health Policy Center to bring you this webinar. And at this point, I'll turn it over to Nkem Osian from the Federal Office of Rural Health Policy. Nkem, take it away.

Nkem Osian: Thank you, Kristine. And like Kristine mentioned, my name is Nkem Osian and I serve as a public health analyst with the Federal Office of Rural Health Policy. And we are so excited to have you all join us today as we spotlight the powerful work happening across rural communities through strategic network planning. Before we dive into our presentations, I'd like to quickly run through our agenda for today's webinar. So we'll start with welcome and opening remarks from FORHP leadership. And then from there, I will provide a brief program overview highlighting the goals and reach of the Rural Health Network Development Planning Program. Then we'll move into our grantee spotlight where former grantees will share their experiences, key lessons learned, and strategies for creating long-term impact. And then finally, we'll wrap up with an interactive fireside chat and open audience Q&A session where you can engage directly with our featured speakers.

And to ground us in today's session, I would like to turn things over to Katherine, AKA known as Katy, Lloyd who serves as the deputy director of the community-based division at FORHP, which is where the network planning program is housed. Katy will share opening remarks on the strategic importance of network planning and rural health. Katy, turning it over to you.

Katy Lloyd: Thank you so much, Nkem, and thank you everyone for tuning in this afternoon. I can't say enough about our speakers today and all of the incredible innovations that happen on the ground through this program. It might be familiar to some of you, but for those who it is not, it is authorized through section 330A of the Public Health Services Act. And really what that boils down to is the fact that it's flexible non-categorical discretionary funding, which really allows the rural communities to present proposed projects for grants for one-year startup funding that's really centered around fostering partnerships among diverse healthcare entities that develops networks for a strategy for that critical linking of Rural Healthcare Network participants to achieve that greater collective capacity and improve the local capacity that's greatly needed, expanding that access to improve the quality of care in rural communities and the organizations that they serve.

It's no shocking surprise that our speakers today will have a lot to offer, so I really encourage everyone to tune in, ask questions, and listen through the end. And really thank you again for all of our presenters today and sharing your lessons learned. I'll turn it back to Nkem.

Nkem Osian: Thank you so much, Katy. And to expand on what Katy has just mentioned, I just wanted to provide a quick foundation on why we are here. The Rural Health Network Development Planning Grant, or the Network Planning Program, is designed to support the planning and development of integrated healthcare networks in rural areas. The goal of these collaborative efforts is to help communities achieve administrative and clinical efficiencies, expand access to care, coordinate and improve basic health services, and ultimately strengthen the rural healthcare system as a whole to build lasting impact and resiliency. And one thing that I did want to highlight and mention here is that these funds are only used for planning purposes only. They cannot be used for the direct provision of clinical services. However, this program lays the groundwork for successful and effective program implementation.

And we are thrilled to highlight our incoming FY2026 cohort today for this, for our newest cohort, they just started in July. So for this cycle, FORHP awarded 10 grants, each up to $100,000, spanning a performance period from July 1st, 2026 to June 30th, 2027. And as you can see on the map, this cohort represents nine states across the country who are focused on a range of different areas, including food insecurity, chronic disease management, and oral health among many other areas.

And as our new cohort embarks on their journey, today's showcase centers on three critical outcomes of a successful planning year. First, is building sustainable infrastructure, which means establishing clear governance structures, operational agreements, and shared leadership models that ensure long-term network survival. Second, is cultivating strong multi-sector partnerships by uniting clinical providers, behavioral health specialists, public health and social service organizations, and many other entities. And third, is transitioning to implementation, positioning organizations to move seamlessly from planning strategies into active, scalable programs that drive long-term community health impact.

Now to move us into the heart of today's webinar, of course, which is our grantee spotlight and panel discussion, I am delighted to introduce Amanda Phillips Martinez who serves as the assistant project director at the Georgia Health Policy Center. Amanda brings extensive technical assistance expertise working directly with rural health networks and grantees. She will introduce our featured former grantee speakers, guide us through their brief project presentations, moderate our fireside chat, and lead the audience Q&A session. Amanda, I will hand the floor over to you.

Amanda Phillips Martinez: Thank you Nkem, Katy, and Kristine, and thank you so much to everyone who was able to join us today. This has been a brainchild of Nkem and the team at FORHP reflecting a desire to really hold up this very unique Rural Health Network Development Planning Grant and the impacts that a measly year of planning can have for access and quality and better coordinated care in rural communities.

So I am going to be moderating the panel today and introducing our esteemed panelists. The folks we have in the virtual room with us today represent four organizations who have recently wrapped up and graduated from the network planning year. And they're here today to talk about their experience of structuring their year, really leveraging a year of funding to make some pretty significant impacts in the way that organizations, individuals work together, and structure themselves to improve health in rural communities.

So first I'd like to introduce from the Arkansas Behavioral Health Integration Network, Kim Shuler, who is the chief executive officer of ABHIN. She has served as project director on four health resources and services projects. Her colleague, Rachel Blanton, has worked with teams across rural communities for the past 10 years as an evaluator and project consultant and played a central role in the network planning efforts for this most recent network planning grant that Arkansas Behavioral Health Integration Network implemented.

From Montana, representing Recovery Access Montana, we have Peter Maney, who is the executive director of RAM. RAM is Montana's state affiliate for the National Alliance for Recovery Residences and is a state-recognized certifying organization for recovery residences. He is joined today by Dr. Jennifer Rolfes, who is the president and CEO of Health Equity Solutions. She served as technical assistance, evaluation, and implementation partner for RAM's Network Planning Award.

From upstate New York, we have Joelle Hutson representing Oswego County Opportunities. Joelle serves as the coordinator of the Community Health at Oswego County Opportunities and the director of the Rural Health Network of Oswego County. She was the network director for their most recent network planning grant.

And finally, from Texas, Dr. Subi Gandhi from Tarleton State University is a professor of public health and the co-director of the Center for Rural Resilience at Tarleton State University, which is part of Texas A&M University System.

So the goal of our panel today is to highlight the different ways that rural network, both experienced and emerging networks, use the network planning year to advance the work of improving health in their community. We have four grant organizations representing four unique regions of the country and implemented very distinct approaches with different types of partnerships. What we've asked them to do today is take about two to three minutes to give a very high level overview of the scope and focus of their network planning grant, and then we'll move into our fireside chat panel discussion. And I'll invite Rachel and Kim from the Arkansas Behavioral Health Integration Network.

Kim Shuler: Thank you for those introductions, Amanda. We're so excited to be here today to talk about our project, and we just wanted to say thank you for the opportunity to participate in a planning grant this past year. We have learned so much. And so as we start to tell you about our project, we just wanted to set the stage for a moment and tell you a little bit about our organization.

We are the Arkansas Behavioral Health Integration Network, and we are a nonprofit organization primarily serving rural counties in Arkansas. We serve the whole state, but this project in particular focused on three individual rural counties. We are an education training and technical assistance center that provides resources on behavioral health integration and really had an opportunity to develop this proposal based out of limited access in Arkansas and unmet needs. And with that, I'm going to turn it over to Rachel, and Rachel's going to tell you a little bit about our project.

Rachel Blanton: Thanks, Kim. And so really what we focused on with the planning grant in this planning year was digging into the question that, well, the issue that we kept hearing from primary care providers across rural communities in Arkansas, which is behavioral health is taking up more and more and more of my plate, and I don't know how to access resources. Resources are constrained. I don't have them in clinic. I don't have them in my community. What can we do to address this? Because it is really taking up so much of my practice and I don't have the resources to address the influx of the issues that we see coming in.

So really what we centered on is how do we address behavioral health access centering on those points within primary care practice communities? So we had wonderful practice partners that had been thought partners in this question for several years. They had participated with us on previous grants and previous projects, and we really worked with them to think about what are some of those solutions or opportunities around behavioral health integration now in the moment and our short-term, medium-term, and long-term opportunities as well.

So with that, we really were able to achieve some outcomes, some tangible outcomes, which aligned really well, and we'll talk about this later, with some of what's happening at the federal and state level. So some strategy related to emerging practice within the state health billing context, alignment with our RHTP funds, and enhanced engagement from other sectors. So if the solution's not to drop a psychiatrist in every county, what else can we do? So how do we bring in other sector, other opportunities? And that was really important for us, and we were really able to begin to develop a strategy around that as well. So that's what we did with our bid. That's the work that we've done, and looking forward to hearing from the other panelists throughout the presentation.

Amanda Phillips Martinez: Thanks, Kim and Rachel. So Peter and Jen from Recovery Access Montana.

Peter Maney: Hey, it's good to be here with everybody. Thanks for the invitation. I'm always pleased to be able to talk about our work in Montana. So RAM, or Recovery Access Montana, was a statewide network. As was mentioned, we're the state affiliate for the National Alliance for Recovery Residences. So primarily our work has been certifying recovery homes or recovery residences, sober livings over the past few years to national standards.

And so what our project was about was really looking at the other pieces of recovery, including other community-based recovery support services. So recovery community centers, peer support, reentry work, and workforce initiatives, and really how do we link those together, form a network that's statewide? Montana's a really rural state. We're a big rural state. And so we were fortunate enough that our board represents a lot of those sectors already. And so unfortunately, there's a lot of geographical areas in Montana that still don't have services or maybe have one service or just a couple. But what we know is that recovery is lifelong. It's not treatment, so it's not time-oriented where it's 30 days in an inpatient or maybe four months in an outpatient. Recovery is done in the community and it's done through the rest of your life.

So how do we find those supports and link them together, integrate them in a rural state when it's really multiple supports that we're talking about? And so we really focused on that, bringing in partners from criminal justice, from treatment, from workforce, and then from other demographics. We have eight Native American reservations here in Montana, so we really integrated those populations as well.

And then as far as some of the outcomes, we identified a real need for support services here in Montana. And so we started working on what's called Compass Care, which is part of also something called the Angel Initiative, which really provides a hotline for individuals to be able to either go into a law enforcement office or really anywhere and ask for help, ask for treatment services or for recovery services rather than in some cases being arrested.

And so we really worked on that, and that's going to be a game changer here in Montana. It's really forced us to link even really rural, or frontier areas, as well as urban areas too. So being able to link people who are in crisis or in that frame of mind to be able to seek treatment instead of being arrested is a really good thing. So that's some of the things that we worked on here with our planning grant over the last year. I'm happy to answer any questions as the presentation continues. So thank you.

Amanda Phillips Martinez: I'll introduce Dr. Subi Gandhi from Tarleton State University.

Subi Gandhi: Thank you, Amanda, and thank you for this opportunity. Good morning, afternoon, everyone. I am Subi Gandhi. I'm with Tarleton State. Tarleton State University is under the Texas A&M system. We are a part of a larger system. And Tarleton is ideally situated in a rural county, which is really ideal for us in that we can target all the other counties around us, which are also rural in terms of launching health initiatives and other projects through the university.

And for this particular network initiative, we partnered with three other behavioral health entities, including Comanche County Medical Center represented by Kristine Bremer, AccelHealth, represented by Dr. Esther Taylor, and Center for Life Resources represented by Mr. Joey Smith. And we also had a support from two amazing consultants from UT Health, Dr. Shreela Sharma and Heidi McPherson. Amazing folks that really helped us with the inception of the project as well as planning the phases of the project successfully.

So in the planning year, our goal was to establish a robust mental health network to improve the outcomes of these three counties that are in proximity to Tarleton State University, which is in Erath County. So we targeted Erath and then also Brown and Comanche counties in this particular initiative. And the planning phases were very intentional and very linear in that we wanted to focus on the governance pieces first. How do we build a robust infrastructure for our network? And aligned with that, how do we assess the community needs?

So that was part of phase one. And then we moved into strategic plan development as phase two, which really was informed or will be informed by the data collected in phase one. And then eventually our plan is to integrate the information collected from phases one and two and work on a toolkit that could be used by other rural health counties and organizations in the future.

And so the key outcomes that we have really focused on are, of course, building the infrastructure. Like I said, the development of the network itself, identifying key partners in the process in addition to who we are working together with already, and also to develop a data-informed strategic plan, obviously guided by a regional care coordination as well as barrier assessments such as what does the staff capacity look like in these behavioral health organizations? What are some of the pain points of the local communities in accessing mental health services? Are the directories current at these different organizations, including behavioral health units? And collecting all of that information to guide a sustainable and coordinated care beyond the planning period.

So we are very structured in the longevity part of the project as well. So we'll share more with the other panelists as the questions are being asked, but thank you so much.

Amanda Phillips Martinez: And finally, Joelle Hutson from Oswego County Opportunities.

Joelle Hutson: Good afternoon everybody. Thank you to Amanda and Nkem for inviting us to present here today. And thank you to all of the other planning grantees. I think it's so cool that we got to go along with one another and see each other's projects, so super fun to see some friendly faces.

So yes, my name is Joelle Hutson and I work for Oswego County Opportunities. And within that role, I serve as the administrative oversight for the Oswego County Integrated Delivery Network. So Oswego County Opportunities was the grantee for our planning grant, but the work was done through the OCIDN network, Oswego County Integrated Delivery Network.

So I have our partners listed over there on the left-hand side, and then our key outcomes on the right. Our planning year, the Oswego County Integrated Delivery Network is an independent practice association LLC. We are a for-profit entity, and we were formed in 2021 out of a desire to engage in value-based payment contracting. And the landscape in New York State, and I'm sure anybody who works in the Medicaid world can attest to this, even at a federal level, has changed a lot over the last several years. And really OCIDN as a concept started in probably 2013 to 2015. It just took us a while to get our IPA certification off the ground.

So over the last 10 plus years, the landscape has really changed. And we found ourselves in a position in January, February of 2025 where we were really examining if our IPA structure suited us well enough or if we could move our network to the rural health network of Oswego County. Something to note about New York is that we are lucky enough to have funding from the State Department of Health. The Charles D. Cook Office of Rural Health has 30 rural health networks across New York State, and so we are blessed to have one in Oswego County.

So we really set out to ask the hard questions and really examine, do we need our IPA structure to do the work that we're doing? We had just come off of a four-year HRSA rural healthcare outreach grant that we were really successful in. We saw about 450 patients with chronic illness in comorbidities mostly. And so we saw some really good outcomes there, but we were really, I don't want to say we had an identity crisis, but we really needed to take a moment to pause and evaluate our structure. And that's precisely what the planning year allowed us to do.

So we asked ourselves, is our IPA structure aligned with the evolving healthcare that we see in New York State? And we did that through strategic planning. We hired strategic planning consultants and completed that process. We ultimately ended up preserving the network, not the structure. So our IPA will fold. We will not have an independent practice association anymore. And this is where I led with we're lucky enough to have funding for a dedicated rural health network. We will move back under the structure of the Rural Health Network of Oswego County, and that is really a great success for sustainability in our network. Even we ended this grant 6/30. Even since then, we've really gotten a lot of momentum and even leading up to the closing of that grant around the opportunities that we had when we took ourselves out of the IPA box.

And then we started to build for what comes next. So we were doing really great work under the IPA structure. We were doing clinical case conferencing. You can see our partners on the left, they really run the gamut. We have CBOs, we have FQHC hospital representation, our county's only substance use disorder provider. And so those activities will also move under the Rural Health Network of Oswego County.

And so we saw this opportunity really, which is a blessing in a world where we're constantly driven by a grant outcome or seeking that next pot of funding to take a moment to pause and not just write for another pot of funding. It's also important to note the outreach grant came back out, the Rural Healthcare Outreach Grant came back out in a four-year iteration. We were back and forth about whether or not we should reapply for another iteration of outreach because we did really successful work. We intentionally chose to pause and to utilize this planning grant to say, "Do we need this anymore? Or are we going to be more impactful if we remove ourselves from the confines of that box?"

So much like the rest of everybody else, I'll have a lot more for you when we go through our fireside chat and look forward to your questions. Thank you.

Amanda Phillips Martinez: Thanks, Joelle. All right, so we really wanted to spend most of our time today in conversation with these Rural Health Network leaders and to draw out their experience, their wisdom, the learning curve, and to try to paint a really clear picture about what it means to suck the marrow out of this planning year and really get a lot of good work and impact from it.

And so we've got a set of pre-planted questions that I'm going to share and they're going to answer and maybe chime in across the arc of that panel. And then we are planning to reserve a significant portion of time to have questions from the audience and to let them ask questions of each other.

So Joelle, I'm going to come back to you and dig a little deeper into what you ended with, which is how you use a planning year to take on and try to explore and answer a really big question that you carve out a full year to wrestle with and then to gauge partners with. If you could paint a picture of what it looks like to use a planning year to answer a big question and what has come out of that work since.

Joelle Hutson: Sure. It was funny when we were prepping for this, Amanda, I remember you and I talking about how did you prepare the network to head into this really heavy, just this work. And I literally led them through a meditation. I remember whatever the third Thursday in 2025, July of 2025 was, that was our first board meeting that we had as a network after receiving the planning grant. And we had started it and I sat them down. And at the beginning of the meeting, I asked them to close their eyes and I asked them to really envision what would be different a year from now if we really gave it our all and we really dove in and we were open and curious about what could come from this year.

And I was so nervous heading into that. But afterwards they all were like, "We really needed that to center ourselves." There's six board members and then certainly various subcommittees of the network, but they really needed that to center themselves and to really sit with, "We have a really good opportunity in front of us to do some good work over the next 12 months. Let's put our nose down and do it."

And so from there, we had a lot of uncomfortable conversations. I think I'd probably start there. You have to be okay with uncomfortable conversation. It's okay, especially if you have some relationships built with folks, find those people that you have relationships with and start there. But we were okay having those uncomfortable conversations. We had to have conversations with our clinical partners about life attribution that has money tied to it. And that's really kind of getting down into the nitty-gritty of business with one another.

And so we continued that momentum forward. We continued to have the hard questions and we continued to have fidelity with one another. I think that's really important. It was not just me as the project director that was out there saying like, "Hey, you haven't done this or you haven't held your weight here." They really held one another accountable. And I think that's a really important piece to a network because if you have a network director who is just saying, "You do this and you do this and you do this," we're going to get tired. You need some folks in your network who will stay in fidelity with one another and hold each other to their word and their promises.

And so our hard question was, like I had mentioned in my overview, is the network structure that we currently have, is that still the right fit for us? When we went into this planning year, we recognized that the network was about to start costing all six of our agencies a considerable amount of money. Our D&O insurance, for example, for one year is about $3,600. And so we were about to start doing some capital calls and asking our network members to fork some money back over. And they started saying, "Do we need this structure to write grants together? Do we need this structure to subcontract with one another?"

We've historically written all of our grants through Oswego County Opportunities, which is just a member of OCIDN. So Oswego County Opportunities could subcontract with any of those partners and particularly under the Rural Health Network. And so I'll never forget when our board president was like, "Maybe we really need to think about going back to our roots in the Rural Health Network of Oswego County, because that is a place that has sustainability, it has direction, has strategic alignment." A lot of our strategic goals in the Rural Health Network of Oswego County are aligned with OCIDN's priorities. And so that's where the wheels started turning of, what does this look like under a different structure? And actually, are we doing ourselves a disservice by living in this vertical line versus a horizontal line where we can have some more impact?

We also talked a lot about the triangle where you see the high utilizers in that top portion of the triangle, and they're a small piece. And we had spent so much time focusing on those folks that are the folks that are costing our healthcare system a lot of money and they're in out of our ERs or in and out of our social services agencies. And when we really got to the point where we were like, okay, it's going to shift to the network, that's when we were like, we have a lot of room to be impactful in this middle section of the triangle where there's a lot more patient volume and just more room for impact, and we're not confined to that IPA value-based payment drive.

And so we hired strategic planning consultants. They were amazing. They had really good knowledge of IPAs in general. They've worked with IPAs across New York State. IPAs are kind of beastly if you're not familiar with them. If you know one IPA, you know one IPA. They're all very different. And so having their expertise was really, really key. Actually, when we did our debrief as a board, that was one of the things that the board said that was really, really important to this process was having somebody from the outside kind of peek at us and see, do you see what we see when you see us coming back to the Rural Health Network? And the answer was yes. But that process was incredibly helpful to have them as a third party outside of our network. So I think that I've hit all of my points there.

Amanda Phillips Martinez: Key learnings. Yeah. So a long-term network engaging neutral facilitators to lead them through a deliberate meditative process of really confronting a new future and the best structure, the best form to support function moving forward.

Joelle Hutson: Yeah, absolutely.

Amanda Phillips Martinez: Are there others of our panelists who have something to share about how you use the planning year to take on a big, big question head on?

Subi Gandhi: I can add to what Joelle has shared. I think part of the process is having those hard conversations and just being realistic about what is achievable is very, very important because in our rural communities we do more with less. And sometimes it's good to have these amazing dreams and vision, but are those going to be met at the end of the planning period? Even as a framework or a structure it's really important because we are given this one year to plan this amazing project. So building sustainability and being honest with each other is I think absolutely critical in this planning period.

Amanda Phillips Martinez: Thank you, Dr. Gandhi. A few of you alluded to big recent shifts and priorities and funding patterns at both the state and federal levels over the past few years. Rachel and Kim, you all mentioned that within the context of Arkansas. So I would love to hear how you all in Arkansas with the Behavioral Health Integration Network leveraged the planning year to adjust and align and better understand the changing context for rural health in your state.

Kim Shuler: Absolutely. Thank you, Amanda. So for us, one of the things that we know is the funding structures have changed and we know the way behavioral health services, payment reimbursement is an issue. It seems to be a big issue with our network partners. And we know that sometimes some of the reimbursement isn't at a point where our partners felt like they could provide these services and they could bill.

So one of the things that we did is we looked at what types of behavioral services were available in these rural areas. We looked at what the current landscape was. We talked about resources, we talked about needs. We took time to sit down and hear from them specifically what they were needing to provide best possible healthcare to their patients. One of the things that I think was a key piece is listening intentionally about what are those specific needs and then trying to align what we heard with our network plan.

We also know, one of the things that I think is really critical and for me was a key moment ... And I just want to give a shout-out. We worked with three different primary care sites in three different areas in Arkansas. We worked in the southwest corner, we worked in the southeast, and then we worked in the Ozark Highlands. And one of the things that, as they were talking about limited access, we really asked them about solutions.

And so what I was getting ready to say, the unique piece of this was seeing how they came together and they brought resources to each other. They supported each other. There was a lot of peer-to-peer learning. They talked about how they were managing different situations. And so to see the problem solving starting to happen and the brainstorming happening, that was such a critical piece of our project. And so I think, of course, the reimbursement piece and looking at funding has really been important. But I think this helped us think about how to strategically develop a plan that could address what types of funding would be needed in order to start addressing these behavioral health gaps in our rural communities. And with that, I'm going to pass it off to Rachel so Rachel could add to this as well.

Rachel Blanton: Sure. Thanks so much, Kim. And I think I'm going to echo a lot of what Kim said, but just dial in on a few features that I think are particularly helpful as you're thinking about your planning year. And the thing that I always come back to, I've done a planning grant or two before, and each time I have to remind myself, it essentially buys you time to think. Because when you work within particularly rural health systems, you're wearing 15 different hats because you have less personnel than if you were working in a large population center to work with. You might have less tools, less specialists, less referral resources. And so people end up wearing a lot of different hats and so that you're running through different programs and resources.

And so I always like to think about this program buying you time to think. And I think particularly in times where it feels like there's a lot of moving parts and pieces, and I would say the last couple of years with different funding priorities and shifts in really the healthcare landscape, having this planning grant buy us time to think as a group and strategize as a group was profound. So it really made a difference in terms of us being able to…if you think about a rural primary care office, it's not like they have three half days of admin to sit down and take meetings. It's one or two providers that are seeing patients all day, getting calls in the afternoon, in the evening. It's really tough to sit down and have a strategizing conversation with the folks that are really at the nexus of some of the issues that we're concerned about, behavioral health access in rural communities.

And so what we did with our grant was buy time to think strategically with those leaders within community. So I just want to emphasize to me, that's the core of this grant. And when we think about funding priorities, what we did specifically around behavioral health integration with this planning year was we came in with the idea of how do we increase access within your community?

And like Kim said, there's all these different ideas coming in all at once, resource sharing, but that gets to more of the program piece. So we kind of zoomed back and said, okay, what are the resources now? What's the time horizon that we need it by? What are the resources? What's our vision? And I feel like a lot of those questions don't get asked of this group. It's what do we need to do today?

And so we were able to do that and I think really open up some of the different opportunities, open up seats at the table with planning around those codes, with state leadership. Like I said, the timing around being able to build a network that's thinking about these questions and has a strategy with RHTP funding. So to get a seat at some of those planning tables was huge. And I think that's a huge outcome that I want to highlight from this work.

And then finally, I would say broadening the view of who should be at the table. We started with this really targeted group, primary care providers in rural communities that are interested in behavioral health. And from there, the network planning grant also allowed us to think about, again, in the shifts with funding, who could be our first responder law enforcement partners? Because that's a funding priority within our state in a lot of ways. How can we work with workforce development partners? Because again, that's a funding priority and it can align with what we need to do with behavioral health integration. How can we work around some of these high emphasis populations that the state and the feds are really emphasizing?

And so it allowed us to think about, okay, we're going to bring in faith partners, we're going to bring in first responders, we're going to bring in workforce development. And so we got a bigger tent. And I think that that's really made a difference in where we're going to go in the next couple of years as a network.

Amanda Phillips Martinez: Thank you so much, Kim and Rachel. I hear a lot of a theme about really listening to primary providers and frontline staff and then being flexible to recognize what it looks like to be a more truly integrated network. So lots of flexibility and flexible thinking and good listening happening. Thank you.

Jen and Peter, in your overview slide, you all talked about, or you mentioned you came away with some pretty concrete specific interventions, activities that you're looking to scale up. So I'd love to hear about how you used your planning year to explore scaling up your work beyond your local or regional focus and looking to a broader state lens.

Jennifer Rolfes: Yeah. So I'm going to answer quickly and then I'll hand it over to Peter. So Peter was talking a little bit about Compass Care, and I know it's a little bit different, but I also wanted to just mention about Compass Care and the Heartland Alliance. It's actually two organizations that have come out of this planning grant that have their own focus and their own strengths in addressing a lot of the issues that we're seeing in rural Montana.

So one thing about Compass Care, Peter had mentioned that you can present at a law enforcement office. Well, because I know a lot of people probably wouldn't present themselves to the law enforcement office. I also just wanted to quickly mention that really it's anywhere. A mom can call a 24-hour warm line and get help accessing resources for their son. So the people answering the line would be trained. They would be trained, and there would also be an LCSW who could have things escalated to even 24 hours a day.

So I just wanted to mention a little bit more about Compass Care because it is an entire branch of work that we are going to be doing. And I do hope that that can also spread. But RAM itself spreading to 14 additional states is the Heartland Alliance, which is the other major work stream that came out of this planning grant. And I'll let Peter talk about that.

Peter Maney: Yeah, I'm happy to talk about Heartland. This exposed a number of things, like Jen was saying, just the need for centralized access to resources. So one thing about Compass Care too is the need for what we call non-clinical peer support service providers, peer support specialists. So in Montana, peer support specialists typically are attached to a licensed facility, so a licensed SUDF or a substance use disorder facility. So to be able to bill.

And I know peer support's different across all different states. Some have a really robust program, some of them don't. Montana's is emerging, but it's merging in a clinical model. Well, SUD or people with substance use disorder really benefit from peers, from people with lived experience in those same situations who are walking them through all these resources and a lot of times for the very first time. And we know people in recovery, especially early recovery, need everything. It's really how do you help someone rebuild their life after years of addiction? What does that entail? And the short answer is really everything. And so the non-clinical peer support service providers are really, really going to be key to this, and that exposed this.

As far as Heartland is concerned though, so what RAM was able to build and really identify and strengthen through this planning grant, we now have an opportunity to bring that work to 14 other rural states. So it's all the surrounding states. NARR, as was mentioned earlier, RAM is a state affiliate for the National Alliance For Recovery Residences. So it's a national organization. And so there's a few states, the 14 that didn't have a state affiliate. Because of this, we're able to, actually went to NARR's board and said, actually we're kind of crazy to even ask for it, but can we do this and do it to form a regional super affiliate and really provide services and oversight and certification, technical assistance to 14 rural states? And they said yes, which is amazing. It's fantastic, but it's also a big lift to be able to do this from Montana in 14 surrounding states.

And so we're really excited about it. We're making progress. We meet every week as that project continues to move forward. And yeah, so I think between that, what Jen was talking about with Compass Care, and then also really identifying the need for non-clinical peer support service specialists, that's really led into a lot of legislative work. We've really coalesced around, and actually we built a coalition. We're heading into the 2027 legislative session in Montana to really address those things, to put some definitions in statute, like community-based recovery support services. There's not a definition of that in Montana. So just so we're all talking about the same thing. What is that? So that's something that we're working on through the coalition and something that was identified really through this planning grant. So really thankful for it.

Amanda Phillips Martinez: Thank you, Peter and Jen. I know you all are rushing off to a board meeting, so thank you so much. Yeah, I heard a range of impacts there from opportunities to educate and align around state policy definitions to support sustainability, building capacity, not just within your own state, but in 13 to 14 additional states to set up and certify and provide quality care through residency programs, and then a coordinated care model or a care coordination model that you're exploring as well. Thank you so much.

Dr. Gandhi, you are at a university and are part of more of an emerging rural health network, and you all really worked hard and focused on exploring the full possibility of academic community partnerships with your network planning year. So I'd love to hear from you about how you can use a network planning year to really explore this type of partnership and how it relates to planning, developing relationships, integrating data into decision-making. So thanks for sharing your insight here.

Subi Gandhi: Thank you, Amanda, for that question. I think the greatest strength of an academic community partnership is that each partner brings something unique to the table. Our community and healthcare partners understand their populations, their systems, and also the realities of delivering care in under-resourced communities. And on the other hand, as an academic partner, our responsibility is not to go in conversations with a very predetermined solution.

So basically our part is to listen to the communities and integrate research data and evaluation pieces, and also adding to that convening capacity to support what communities identify as their priorities. So in this planning year, it was a very, very excellent planning period for us where those pieces became very important for us. We were able to move beyond simply saying things like, "We know there are behavioral health access challenges in these communities that we serve," to strategizing and working with specific questions like, where are these gaps in the communities? What happens to a patient after a referral is made? Where do they go next? Where does communication breakdown in the process? And also what resources already exist? Are they outdated? Are they current? And what can realistically be strengthened within the existing rural healthcare infrastructure? Those are some of the strategic questions we framed.

So data were really extremely important in these evaluation processes. And also we learned that data are most meaningful when paired with the lived and operational experiences of our partners. So community level data can tell us where a gap exists, but our community partners often help us understand why those gaps exist and what solutions are actually feasible for the community. So the academic community partnership also allowed us to think about evaluation from the beginning rather than towards the end. We could ask questions like, how will we know whether this network is actually making a difference or will make a difference out there? And what are some of the metrics we need to work on to measure impact?

And also another important question was what baseline information do we need now to track towards the future during the planning period and beyond? And can our partners realistically collect those measures without creating additional burden? That's something we'd have to be intentional about asking is that they already have so much on their plate. By asking to do this one thing more, are they going to be able to bring the data points to us and still stay in the partnership, in the network?

So ultimately, I think successful academic community partnerships create kind of a bridge between evidence and implementation. Academia can contribute to evidence-based practices with evaluation, data analysis, grant development — sometimes our community-based organizations don't have that capacity — and also access to broader resources. So community partners bring trust, context, relationships, and practice expertise. When those strengths are genuinely integrated, the planning process becomes much stronger. And importantly, the resulting initiative has a much bigger chance of being sustainable.

Amanda Phillips Martinez: Thank you, Dr. Gandhi. One thing I really appreciate about the planning grant that I think your comments reflected was the opportunity to really go deep into the assessment. So yes, system level, county level, region level, what do we have? What are we missing? But also to dig into the experience of the end users, the families, the clients, the patients, and where they fall out of the system and what their barriers are in access to care and the quality of experience.

And then I love the theme of this open exchange of capacity where folks are working at the top of their license to build a stronger system. The university is doing what it does best with bringing data capacity, assessment capacity, grant writing capacity, and the community is doing what it does best, which is opening doors to more deeply and better understand the need and design more elegant solutions to that. So I think you guys did some lovely work in that space and it's nice to hear that reflected. Thank you.

I want to make sure, I know, I assume some folks will have to fall off at the end of the hour, that we still have 15 minutes. I would love to do a round-robin here with our panelists and ask each of you to take a minute to share your best piece of advice to folks who are starting their network planning grant here in July, or folks who are hoping to be applicants for future cohorts of this grant. What's your best piece of advice for people coming into the Rural Health Network Development Planning Program? Jen?

Jennifer Rolfes: I wanted to follow up on what Dr. Gandhi was just saying and really the importance of data and evaluation because as a statistician, that is really my heart as well.

So my one piece of advice is really that data and evaluation should be built from the very beginning, which I think is what Dr. Gandhi was saying. But in rural communities, of course, resources are limited and needs very significantly. So throughout a thoughtful evaluation framework, we can identify what is working, what needs to change, and where resources should be directed.

The other thing I want to say is that Dr. Gandhi's framework that was put together of the needs of the different counties and everything, we've become colleagues and friends, and she shared it with me, and I think it was a beautiful example of how data can impact and influence future funding opportunities.

So always think about data as an opportunity for long-term sustainability, for funding, for partnerships. And it's a really important component, and it's really not just for what HRSA wants or what we're asked to report. It's really about your community, what the community needs, and how we can continue to support them.

Amanda Phillips Martinez: Thank you. Thank you, Jen. Who else would like to share a piece of advice?

Subi Gandhi: And I can just echo what Jen just highlighted. And like she said, we have become really great colleagues and we chat about nerdy stuff over time.

But one of the piece of advice I would give to the future grantees is not to rush the planning period. It's a very strategic thinking period because other grant opportunities, you're not going to get this planning time. So it's all about how you want to make a bigger impact in the future. So take every day and minute very thoughtfully and bring the right people in the conversation. Identify those first and bring them to the conversation because more than likely there are more people like you trying to do the same exact thing, but not having that connectivity. So yeah, just don't rush it.

And then the other part is about having leverage or having support from amazing folks from Georgia Health Policy Center as our TAs and having access to our program officers who instantly jump back to support you, whether it's via phone call or via email. It's an extremely valuable opportunity to be successful, not only for the planning period, but for all future opportunities that are going to come down for you in the pipeline in the future. So thank you.

Amanda Phillips Martinez: Thank you. Kim, I see you off mute.

Kim Shuler: Yeah. I just wanted to tag on to Dr. Gandhi because I think the technical assistance services that we have received have been invaluable. And so for me, one of the pieces of advice would be whether you have participated in a grant in the past or this is the first time, really making sure you're attending all of the educational resources, webinars, opportunities that are available.

When you go to the conference, or excuse me, the reverse site visit, I think is what we call it, really looking for opportunities to connect with your project officer, to connect with the person providing you technical assistance, to connect with your colleagues, because that's where you are going to receive such invaluable information. You're going to take that with you and you're not only going to use it on this project, but you'll be using it in the future.

And so I say for me personally, working in this space on HRSA projects, having the opportunity to brainstorm when we're stuck or saying, "Gosh, this didn't work." So I'll give an example. We talked about when we were first going to have our network meetings realizing we work with busy primary care providers. And so we had the opportunity to brainstorm with Amanda and Nkem and talk about maybe we should be doing this at the end of the day or the beginning of the day. And so just realizing you have a lot of resources. Don't be afraid. Reach out, utilize them. They're there to support you. And if you do, you'll learn so much.

Amanda Phillips Martinez: Thank you. Joelle?

Joelle Hutson: I would add, I echo the sentiments about the TA providers and the project officers on this grant. I've had that experience with any HRSA grant that I've had. I've had five. They've all been amazing. So utilize your TA providers. They really are incredible.

Maybe in that same vein, remaining open to change and being very malleable. So you're going to write a grant much like you write other grants, and then things are going to change and the trajectory might look a little bit different. I found a lot of value, and shout out to Amanda and Nkem for creating a safe space and being very honest with our TA and our project officer about where we were at so that we could have, Kim, I think what you're alluding to, some of those conversations where you really get some good information and connection to peers or just the right people that you need to sit with and solve the problem.

So being open to change and then understanding your members or potential members. If you have your sights set on an organization or a member that you really want to engage, you really have to take the time to understand not only whoever the contact is there, take them to lunch, take them to coffee, get to know them a little bit, but you have to understand that organization's needs and desired outcomes. I think that's something that's really important to me when I think about the Rural Health Network of Oswego County. We have about 68 organizations represented in that. And I'm not going to tell you that I understand all of their needs and desired outcomes, but I will tell you that those key players who show up for me again and again and again, I really make it a point to understand what are you trying to achieve? What does your organization need? Where is your organization struggling? How could a network solve a problem that maybe no organization alone can solve? Because that's really where the network provides the most value is that we don't have the, I'm going to air quote, "selfish needs or wants" of any one organization. We really are a network of providers that help hold one another up. And so really as a project director who's trying to maybe start a new network or reinvigorate a network, really, really understanding what each organization stands to gain or lose.

Amanda Phillips Martinez: Thank you. Thanks, Joelle. Thank you both. Any other last pieces of advice before we go to the Q&A?

Rachel Blanton: I'll be just quick on this and just say, again, use it as a chance to slow down, treat this as an opportunity to slow down, think and be intentional. I'm a checklist person. I'm super happy at the end of the day if I've got 20 boxes checked. And the TA providers, the project officers, they kind of outline that for you. So it is a success if you had 10 conversations with people. It's not that you developed a program or delivered services right in that moment, but that's meaningful work that's building the foundation of something that's really going to stick.

So really treat it as time to think to make the right next strategic step for your network and the communities that you work with. When you look at this spectrum of development, I'm really impressed by what RAM has done with local state region.

Peter, can you talk a little bit about how you stay grounded in that rural identity with that multi-state footprint that the network's really growing into in so many ways?

Peter Maney: Yeah, that's a good question. For me, Montana might have HRSA designated urban areas, but are they? Are they really? I think Missoula is, where I live, it's about 80,000 people. The second-largest city is 120,000. So we're always in rural mode because we have to be. So it's rural frontier and tribal are really all the ... So that's in all of our thinking.

As we expand into some other areas, in fact, I think the challenge might be how do you think urban? I mean, it kind of will be. So when we expand to Colorado with Denver or Utah with Salt Lake and some of these other areas that really have more urban areas, it might be actually kind of a challenge to think differently. I heard on the call earlier about urban programs, and I don't even know what that's like here. So I might be interested to see how we adapt, what we do to more urban areas. So I don't know if that really answers your question because we really don't have a lot of experience with anything other than that.

Amanda Phillips Martinez: Thanks, Peter. We've got three questions. So I'll start with the big one. What was your biggest challenge in network planning process? And maybe we'll try to get one to two quick answers so we can get through these questions. So what was your biggest challenge in the planning process?

Subi Gandhi: I can start. I think the biggest challenge is obviously time. We all are wearing many different hats, and I mentioned that in rural communities we have to do more with less and asking people to show up for convenings and deliberations is another to-do list, an item on the to-do list like Rachel mentioned. But you have to be persistent, I think, in this initiative and be very intentional about how you want to make that elevator pitch to your audience. I think that's super critical, but I think time management is really key. And also respecting somebody else's time is also key in the grand scheme of things.

Rachel Blanton: I think related to that is really the competing attention for network members and within your internal team. So we think about how the landscape has been so in flux over the last few years and new programs coming on and changing. And so I would just say keeping that true north and that focus. So it's that balance of being open to what about this idea, but also, okay, is that moving us towards behavioral health integration in rural Arkansas centered around primary care? So I think it's that balance of keeping attention and keeping focus within your network and within your internal core team.

Kim Shuler: I was just going to tag onto that. I think for us, partner fatigue, and Rachel talked a little bit about that, but making sure that partners have the availability. And I think that that definitely is a barrier and we have to all be aware and conscious of that and conscious of time limits. So that's all.

Amanda Phillips Martinez: Can anyone speak to how to handle management of data collection and capturing data when they're not robust systems? And this person would love to see Dr. Gandhi's assessment toolkit as well.

Subi Gandhi: So thank you for that. Data collection is probably not on the priority list for a lot of community-based organizations simply because they don't have the capacity. They might value data and the evidence-based practices. So that is where academia and other systems that do analysis or evaluations come into play. And there are many organizations that provide services even remotely. I would say that if you don't have an anchor institution such as the academic institution that I work for, you certainly have these choices to connect with experts via Zoom or virtual settings to establish that connection and having that deep conversation with the experts as to what data can bring to the project and also in creating that toolbox down the road that could be replicated by other communities as evidence-based practices. And I'm happy to chat with whoever has posed that question after this. Thank you.

Amanda Phillips Martinez: Thank you, Dr. Gandhi. I love this question because I think this gets to a lot of the challenges starting out. We're new to this grant and our partners are curious for examples of exactly what a network might do. Does anyone have some very simple examples of what a network might do that I could use as an illustration? And this is someone talking about an oral healthcare focused network, but I think the examples could be for anything.

Joelle Hutson: I have kind of a cool example that is in oral health. A rural health network in New York State recently, they're a dental provider shortage area certified. Their network identified that school-aged kids were no longer going home with, you used to get the toothpaste and the toothbrush and some oral health items. And so their network, it was in Broome County, New York. Their network came together and put together grab bags, but it was based off of one provider was able to purchase the dental floss and one provider was able to purchase the toothbrushes and the FQHC donated all the toothpaste. So it's a good example of something that none of those providers would have or could have done alone without a significant cost, but collectively could.

Broome County also did a dental needs assessment really specific to dental care. And out of that, that's how they got their designation as a dental provider shortage area. Those are just a couple of examples.

Amanda Phillips Martinez: Excellent. They kind of shared, everyone putting their resources in a shared pot to benefit the network of providers. Thank you. Does anyone want to speak to how their work connects to the RHTP or Rural Health Transformation Initiative?

Rachel Blanton: When you do network planning, you build out some wonderful assessment and strategic plans. And depending on what state you're in, the rapid fire release of those funding opportunities, I felt like that was a pick and choose strategy list for us in terms of rolling out different proposals, looking at that wide network. So people that we hadn't been talking to before, the ambulance association, faith groups, workforce development agencies. We had that pick list ready to go. And so that was incredibly helpful to think about where those high-value, high-target solutions were. And I felt so much more prepared than if I didn't have that framework from HRSA, from the TA team. It was so, so helpful. Still stressful, so helpful.

Amanda Phillips Martinez: Yes. And Arkansas, man, y'all hit the ground running for RHTP. Okay, I am showing we are just right at time, so I will turn it over to Nkem. Thank you so much to all of our very generous panelists for your time and preparation and wisdom today. Nkem, I will turn it back over to you.

Nkem Osian: Thank you so much, Amanda, and a huge thank you to all of our grantee speakers today. Thank you for sharing your invaluable insights, your strategies, your lessons learned, best practices, and all of your wisdom with us today. For me, I think it reinforced that the network planning program is truly a gem. It is the cornerstone for rural healthcare transformation across the country.

Based on the conversation, the groundwork that you lay or that is laid in this planning phase really sets the stage for meaningful, lasting community impact. We deeply appreciate your commitment to advancing rural healthcare, and we look forward to supporting you as you continue making strides towards creating lasting change within your communities. So thank you once again. We look forward to seeing you all again, and we hope that you have an amazing day and a weekend ahead. I will now turn it back over to Kristine from RHIhub. Kristine?

Kristine Sande: All right, thank you. So on behalf of RHIhub, thank you so much to all our speakers today for sharing such great information. The slides used in today's webinar are currently available at www.ruralhealthinfo.org/webinars. So thanks again for joining us and have a great day, everyone.