Issue link: http://accesshealth.uberflip.com/i/1162524
PAGE 9 September 2019 Richard's journey at HCC began in November of 2007 in a small office inside of the Lexington 4Life Center. The organization consisted of one other employee. However, there was a hitch: Her position was funded for only one year. A grant application had been submitted to the Health Resources and Services Administration (HRSA) on HCC's behalf for a three-year round of funding. The HCC board felt confident about its chances of getting funded. "I showed up my first day and had no idea what to do," she said. "I soon realized my job was to figure out how to make this thing go." Richard, three months into her first year at HCC, and two other colleagues were returning from a meeting in Jefferson City when she learned that the promising grant application sent to HRSA was denied – certain areas in Lexington were not recognized as rural. "I remember sitting in the back seat on the drive back thinking, 'Oh no! What are we going to do?'" But in the car with Richard was someone who happened to be an expert in licensing and accreditations for health departments. (At the time, Lafayette County Health Department was HCC's fiscal agent.) "She called HRSA and said, 'What do you mean we aren't rural? I'm looking out of my window and all I see are cows!' I remember thinking, 'This woman is so brave. She just called Washington, D.C., and read these people the Riot Act.'" Richard contacted current HCC Human Resources Director Brook Balentine, who at the time was working for Senator Claire McCaskill. Once apprised of the situation, McCaskill, the late Senator Ike Skelton, and former Senator Kit Bond agreed to fight HRSA's rurality score for Lexington. They won. HCC received its first substantial grant award of $540,000. "We got a lot of momentum out of that," Richard said. "I also saw that it's okay to ask questions and push back." The Making of a Rural Health Network HCC found itself on the fast track after that. In 2009, President Barack Obama signed into law the American Recovery and Reinvestment Act (ARRA). Title XIII of ARRA, called the Health Information Technology for Economic and Clinical Health Act (HITECH), allocated $19.2 billion toward health internet technology (IT) development. The goal was to improve health care delivery by incentivizing the implementation of electronic health records (EHRs) for use in meaningful ways. The HITECH funds HCC received enabled the organization to forge relationships with Carroll County Memorial Hospital, Lafayette Regional Health Center, Fitzgibbon Hospital and the recently closed I-70 Hospital in Sweet Springs. "This is when we started making a name for ourselves in D.C.," Richard said. "People were impressed that hospitals were working [together] to share data. This was at a time when rural leaders were having a hard time getting on board with technology. We were lucky because our partners embraced it and met on a monthly basis to figure things out." HCC had managed to create a group of health IT experts. Richard admits the learning curve was grueling. "We brought technology leaders to the table and I couldn't understand what they were talking about," she said. "I would go home at night and just google words to try and figure out what they meant." The other challenge was internet connectivity – or lack of it – that often hampers rural areas. The very first telemedicine equipment HCC purchased cost $125,000. Unfortunately, the area's broadband issues made the technology virtually impossible to use. At the time, DSL was slowly making its debut into the rural commercial space. Even with these challenges, HCC was bringing technology leaders and health care professionals to the same table. This caught HRSA's attention coupled with the fact that HCC was one of the only vertically integrated networks, where community-based programming was the driver. Setting a Place at the Table With help from the Health Forward Foundation (formerly known as the Health Care Foundation of Greater Kansas City) and REACH Healthcare Foundation, along with other funding sources, HCC found its financial footing and started expanding its programming and staff to accommodate direct services. "The potential for opening a clinic came when we started seeing the push and pull between hospitals and clinics," Richard said. "The conversation at the national level was hospitals don't really get along with clinics. I thought that was dumb. They don't even do the same thing. Why wouldn't they get along? Do we not serve the same purpose?" These issues were discussed at length with HCC's board. What they found was people didn't understand that hospitals and clinics each bring different value to the table. With that, HCC focused on service delivery -- particularly the appropriate time and place for individuals to receive services regardless of socioeconomic factors. The complexities of payment reform were layered on top of that. "It just made sense," Richard said. "When we started thinking about the clinic and then looked at opportunities with the board to actually open one, the focus was around making sure people had access to what they needed." With that, the table was set. HCC's comprehensive programming and direct service model has played a crucial role in helping individuals not only navigate the health care system, but also receive social services and other community resources. From creating a complex rural health network, to owning and operating four federally qualified health centers (FQHCs), HCC has created the framework for others to follow. Recognized as a National Leader Today, HCC is a formidable player in rural health care policy on a national scale. "We looked at the National Rural Health Association (NRHA) and tried to model their strategic plan, mission and values because we knew they were an industry leader." Richard regularly works with research and policy leaders around the country who are focused on reform. Those ideas are recycled on the local level and leveraged to drive health policy that precisely impacts direct services at HCC's Live Well Community Health Centers in Buckner, Carrollton, Concordia, and Waverly as well as other rural health care entities statewide. "We work with high level research and policy experts," she said. "I love the fact that we can talk about the challenges of just being working parents living on limited resources in rural communities and it not be used to compromise us as rural leaders. We are saying this is the realty of how we live and we're proud of it." Recently, the National Opinion Research Center (NORC), an affiliate of the University of Chicago's Welsh Center for Rural Health Analysis, published a report as a part of the National Association of Community Rural Health Centers' implementation guide for hospital collaboration. The report consisted of two case studies – HCC was one – making the Network and its FQHCs a national model. Under Richard's leadership, HCC has grown from 2.5 FTEs in 2007 to nearly 75 FTEs and has raised nearly $16 million in grant funds. Its Live Well Centers have also earned the distinction of Patient-Centered Medical Homes (PCMH) from the National Committee for Quality Assurance. "When it comes down to achievements, we're going in the direction God wants us to go," Richard said. "I get validation from being a servant- leader. And that's all that I feel I need."