By Stacy LoCastro, Tom Harlow, Josh Miller, Tracey Dorff, Janice Walters
Background
In 2022, the Health Resources and Services Administration (HRSA), in coordination with the Norther Border Regional Commission (NBRC), released a Notice of Funding Opportunity (NOFO) for the Rural Northern Border Region Healthcare Support Program. The purpose of the program is to provide technical assistance (TA) to rural communities in the Northern Border Region to help enhance access to healthcare (including behavioral health), improve recruitment and retention of healthcare providers, and assist rural hospitals and clinics in their efforts to take part in healthcare value efforts.
In response to this NOFO, the Rural Health Redesign Center was awarded a Cooperative Agreement by HRSA to establish the Northern Border Region Technical Assistance Center (NBR-TAC). The NBR-TAC has since been providing tailored technical assistance to rural healthcare providers across four states in the Northern Border Region: Maine, New Hampshire, Vermont, and significant areas in New York. In order to offer rural healthcare organizations, complete and multifaceted technical assistance, the RHRC partnered with a wide range of technical professionals and subject matter experts through the NBR-TAC.
Technical Assistance
The RHRC team works closely with State Offices of Rural Health, Consortium Partners, Hospital Associations, and other key stakeholders to identify communities and healthcare organizations who would benefit from the comprehensive TA services provided through the TAC. As a result of this collaborative identification process, The NBR-TAC has engaged twenty healthcare organizations and initiated over forty projects, all geographically dispersed across the eligible counties in the region.
“The NBR-TAC provides essential strategic and operational support to rural healthcare organizations, helping them continue to thrive and be sustainable.”
Tom Harlow, RHRC Program Director
Figure 1 shows the communities and healthcare organizations across the four-state region that have received support from the NBR-TAC over the last two years. Some communities and organizations have benefited from multiple engagements with the NBR-TAC, as indicated by their bubble size.
Figure 1: Communities and Healthcare Organizations Served by the NBR-TAC
The NBR-TAC has supported various healthcare organizations including hospitals, dental centers, and community-based organizations. As demonstrated in Figure 2, a wide range of needs have been addressed by the TA provided, including financial modeling, revenue cycle evaluations, value-based readiness assessments, substance use disorder (SUD) treatment, sexually transmitted infection (STI) testing, grant research and writing assistance, and strategic planning.
“Where to start? The strategic planning work was excellent and provided a great foundation from which to build our relationship. All our engagements have been top notch and have helped us significantly improve operations. We could not afford this level of consultative services without the NBR-TAC.”
As the program has developed a stronger presence throughout the region, more organizations are reaching out to the RHRC directly for assistance, often through word of mouth from those who have received TA support. The effectiveness of the services provided is evident as organizations who have already received services are requesting additional and more extensive support. All the NBR-TAC’s TA is deeply rooted in tailored, pragmatic, and impactful approaches that address unique challenges and help to drive sustainable improvements. The NBR-TAC has received positive feedback from TA recipients which has organizations receiving technical assistance also helped drive program referrals and additional requests.Â
In addition to 1:1 TA, the NBR-TAC also worked in coordination with its consortium partners to provide educational webinars for broader capacity building within the region. These webinars covered topics such as preparation and implementation of value-based care, project management for staff development and retention, and innovative approaches to address needs within rural health. Over 400 participants attended these webinars.
Supplemental Funding
Early in 2023, the NBR-TAC was awarded supplemental funding from the HRSA and NBRC to support innovative programs designed to enhance healthcare services to rural residents. This supplemental funding was dispersed from the NBR-TAC via one-year sub-awards to the following projects:
- Community Care Partnership of Maine: ECHO Learning Project (Project ECHO) – Project funding developed an extended-release buprenorphine implementation (ERB) learning community in partnership with the Schmidt Institute.Â
- Daniel Hanley Center for Health Leadership and Education: Provider Executive Leadership Institute (PELI) – PELI’s training provided executives with the leadership and management skills necessary to address challenges such as the state’s substance use disorder (SUD) crisis, workforce shortages, and the implementation of new payment models.
- Ammonoosuc Community Health Services, Inc.: Food is Medicine – ACHS Portable Teaching Kitchen: The initiative addressed several needs such as access to healthy foods, social isolation, transportation, diabetes, and coronary artery disease, particularly prevalent in the highly dispersed, aging population of the service area
- Mary Hitchcock Memorial Hospital: Silver Diamine Fluoride in Primary Care Settings: The Hospital partnered with various health departments and health consortiums in Vermont and New Hampshire to improve oral health care in five rural pediatric primary care practices and included training and capacity-building, enabling them to provide silver diamine fluoride (SDF) oral health care treatment for young children as a part of their routine care.
- Brattleboro Memorial Hospital: Mobile Integrated Healthcare (MIH): A Collaborative Project between Brattleboro Hospital and Rescue, Inc.: The MIH program provided in home assessments and an external support system for patients undergoing total joint replacement (TJR) surgeries.Â
- Fort Drum Regional Health Planning Organization (FDRHPO): Improving Primary Care Access Enhancement: FDRHOP collaborated with primary care and social service entities in the regional Independent Practice Association (IPA) to improve primary care access, patient experience, and address health equity issues.
- Canton-Potsdam Hospital: Peer Support Network Program: The program sought to enhance access to behavioral healthcare/SUD while working to improve recruitment and retention of peer recovery advocates by providing training, funding to meeting modest and immediate needs, and a recruitment/retention mechanism to recognize peers who remain in good standing.
Conclusion
The NBR-TAC has impacted over 1.5 million lives through its expansive range of TA services in its vast geographical coverage area in the Norther Border Region. Through strong partnerships and collaborative efforts, the program optimizes resource utilization and maximizes funding opportunities, setting the stage for ongoing growth and adaptability in addressing the evolving needs of community health and healthcare management in rural healthcare. The ongoing development of the program is supported by financial evaluations that adapt and expand project scopes, ensure long-term resilience, enhance community well-being, and economic viability in rural areas. Currently, five new technical assistance projects are already under discussion. With one year of funding remaining, the NBR-TAC is poised to further its impact and growth across rural communities in the four-state region it serves.
Connect With NBR-TAC
If you are interested in receiving updates about NBR-TAC, you can subscribe to our newsletter or visit our RHRC website. To receive support from the NBR-TAC, contact us at nbrsupport@rhrco.org.
