Rural health networks: adapting to a changing health care environment.

Unemployment and financial struggles affect big and small communities alike. The current economic climate, coupled with changes to the health care environment, presents a unique opportunity for health care providers and community leaders to collaborate, integrate and network. The benefits of health networks are and can be tremendous during times of economic hardships. It takes great effort to assimilate different entities, but the effort is well worth the positive health impact on a community. The Rural Health Network Development Program (RHND) in the federal Office of Rural Health Policy (ORHP) provides an opportunity not only to assist rural communities in meeting unmet health needs, but also to collect data to document health impact in a way that can allow duplication of successes in both rural and urban communities. A rural health network is defined as “a formal organizational arrangement among rural health care providers (and possibly insurers and social service providers) that uses the resources of more than one existing organization and specifies the objectives and methods by which various collaborative functions are achieved.” Rural health networks are designed to respond to an unmet community need and provide benefits to both network partners and the community served by the network in a collaborative or integrative matter. Rural health care providers and rural communities have a plethora of stories relating to how networks have provided substantial benefit in the form of cost savings, implementation of electronic health records, integration of behavioral health care in primary care settings, and a multitude of other healthrelated projects. Yet, there is very little evidence-based data to support the claim that networks can and have improved the rural health care system, which limits the duplication of many of these rural health network projects. The RHND Program was initially created in the late 1990s in response to modifications to the health care delivery system that directly impacted rural providers. During that era, changes were being made to the underlying system of health care financing and delivery, including: a move from fee-for-service payments to capitation and other risk-sharing payment methods; the implementation of market-based strategies for containing costs; an increase in integrated health care organizations; and a move toward more managed care. Rural stakeholders were concerned that the shift to more managed costs would cause people to lose sight of the unique needs of rural patients and providers. Similarly, there are significant changes to our current health care environment, and rural communities and their providers will need to adapt to ensure adequate health services. The current changes that may affect rural health care providers and communities include: (1) improving the quality of care by focusing on patient value as opposed to patient volume;