The Maine Rural Health Action Network is a group of rural health experts and stakeholders from business, philanthropy, education, health and social services. There is a growing rural health care crisis in Maine that must be addressed. Throughout the past year, we have conducted dozens of stakeholder interviews and analyzed a variety of reports and blueprints that have been created by other stakeholder groups with similar concerns. Our findings confirm that there is a wealth of informed and solid recommendations that have been identified in the past however a lack of sustained leadership has created barriers for implementing them. Our call to action addresses these barriers and outlines five immediate actions needed to improve rural health and build a strong and sustainable system of rural health care in Maine.  

Filled with hard-working families and neighbors helping neighbors, Maine’s rural communities are essential to our economy and our way of life.

Our rural communities – the heart of Maine – are at unprecedented risk. Every rural hospital, every rural provider, every rural community is at risk.  The future of rural Maine and the State is threatened. Because of this, a group of concerned stakeholders made up of business, philanthropy, education, health and social services has been gathering for over a year in an effort to develop pragmatic, actionable steps to address this growing crisis.

Across the State rural communities are hit harder by challenges like insufficient insurance coverage, the opioid epidemic, and an aging population with more chronic illnesses. Health-related workforce shortages place additional stress on the system.

The health of rural Mainers is compromised. Several hospitals are on the brink of failure. Health clinics and nursing homes have closed. Local emergency medical services are strained. The availability of fundamental health services, such as primary care, and even obstetrical services, is no longer assured. Many rural residents travel long distances for essential care and have limited access to specialty services.

Access to basic health care is central to the economic viability of rural Maine. We can’t sustain and build local economies without a healthy workforce. We can’t attract businesses in the absence of accessible basic services.  Further, health care is an economic engine in itself: local health-related spending and jobs help fuel Maine’s rural economy and sustain rural communities.

Historic models for organizing and delivering rural health services are increasingly difficult to sustain. Traditional approaches must be reconsidered if Maine is to have a sustainable, high-performing rural health system.

We must act now. Some rural communities are collaborating and innovating to expand local services and make their system of care and coordination more efficient and effective. We must accelerate this momentum and confront the growing crisis in rural health and health care.

Everyone has a role to play in strengthening Maine’s rural health care system and giving hard-working rural communities the opportunities to raise healthy families, grow their economies, and build a hopeful future for generations to come.

• Empower leaders in rural communities to find local solutions and partnerships for protecting rural health.

• Expand the role and capacity of the Maine Rural Health and Primary Care Program to work with rural leaders, policymakers, and stakeholders to support local communities and providers to pursue new approaches to providing essential care in rural areas.                     

2.  Rethink Rural Health Service Delivery

Produce a blueprint for addressing the driving forces that determine rural health, including the necessary restructuring of rural health care delivery.  Incorporate the findings of the Rural Health Commission, MaineCare planning and other assessment and planning resources (e.g., Title V assessment, SCHNA, etc.)

• Adopt a basic set of Fundamental Rural Health Services* to ensure access to essential health services within reasonable distances and timeframes.  *Sprague, J. (2018, October 31). Building Blocks for Healthy Rural Communities

• Create a Rural Innovation Program to test new approaches to providing essential services in rural areas, align current delivery systems with future needs, and enhance integration of physical, behavioral, oral, and public health services.

 3.  Redesign Payment Systems

Engage MaineCare and other payers to develop alternative payment models that support access to a more integrated and sustainable rural health system that better addresses the health and health care needs of rural communities and citizens.

• Explore Medicaid waiver and other options for better integrating health, social service, and public health services in rural communities.

• Assess the viability and effectiveness of new rural-payment models.

 4.  Leverage Data and Technology

Advance the use of technology, including broadband, Electronic Health Records, HealthInfoNet, and telehealth, to support access throughout Maine’s rural areas to core services and decision and management support.

• Expand broadband capacity in rural areas.

• Promote the use of telehealth to expand access to primary care, specialty and other services in rural areas.

• Build data systems that foster accountability and learning.

 5.  Build the Essential Rural Health Workforce

Create a comprehensive cross-sector plan for assuring Maine’s rural workforce capacity.

• Emphasize the use of health providers at the full scope of their licenses; strong but innovative credentialing and licensing; expanded support for team-based care; and extension of lay care into homes and communities.

• Establish a continuum of health-related professional development, from high school pipelines to continuing education for working clinicians and health workers.  

• Align and expand investments in innovative and targeted recruitment, retention, and loan repayment.

Maine Rural Health Action Committee Members

Arthur Blank, President/CEO, Mount Desert Island Hospital

Nicole Breton, Director, State Office of Rural Health, Oral Health and Primary Care, Maine CDC

Jeff Brown, Principal, Safer Healthcare LLC

Andrew Coburn, Professor Emeritus, Senior Fellow, Maine Rural Health Research Center, University of Southern Maine

Charles Dwyer, Program Officer, Maine Health Access Foundation

Rick Erb, President, Maine Healthcare Association

John Gale, Senior Research Associate, Population Health and Health Policy, University of Southern Maine

Thomas Judge, Executive Director, Lifeflight Foundation

Carol Kelly, Managing Director, Pivot Point, Inc.

Kim Mohan, Executive Director, New England Rural Health Association

Maureen O’Connor, Director of Resource and Member Development, Maine Primary Care Association

Diana Prescott, Clinical Psychologist, Hampden Psychological Consultation, PLLC

Martin Sabol, Director of Health Services, Nasson Health Care

Shaun St. Germain, Director, Maine Emergency Medical Services

Jonathan Sprague, President, Rocky Coast Consulting, LLC