Taking Action Summit: HRSA—Using Policy and Programs to Improve Health Outcomes and Address Disparities
Well, I wanna thank you for the opportunity to be here, and I appreciate the University of Rochester Recovery Center of Excellence for hosting this meeting. I'm really quite pleased to see the focus on stigma, and for those dealing with SUD, and related challenges that creates. You know, the sense of connection, and the close bonds are really a hallmark of rural life. And at the same time, there's no doubt that that can be a challenge when it comes to dealing with people in addiction, and trying to provide services, because of the lack of anonymity.
And, you know, we're now four years into the implementation of the Rural Community Opioids Response Program, and it's been eye opening, really watching what all of our grantees have gone through. There's no doubt they face challenges even when we weren't in a pandemic, but those certainly doubled, especially during the early years of isolation during the pandemic. I think one of the things we've really learned from all of the folks we're funding, is that the face of these efforts really vary community by community. They all really have a different story.
There may be some commonalities here and there, but by and large they share a lot of the same essential truths, but it always comes out a little bit differently in their unique circumstance. So I've just been amazed, you know, talking to our project officers and our program coordinators about what they've been able to accomplish against some really tough challenges. And, you know, it reminds me, in many ways, I hear these stories of the work I did as a small town newspaper reporter in an earlier phase of my career when I was working in Eastern North Carolina. I think the stories that really resonated the most with me were the ones where we saw people standing up and really taking on a tough challenge in their community, because it really mattered to them.
And I was always amazed at the difference, you know, a group of committed individuals could make. And I see that same sort of spirit in a lot of the grantees we have, and it's really quite rewarding to see. And I think one of the best things about a meeting like this is the opportunity you have to hear each other's stories, to learn from each other, to take some of that back to your community, and perhaps apply it, but to apply it in the unique context in which you're operating. And so I can also say that, you know, we have staff at the meeting, Anna Swanson is attending, and we're gonna listen and try to learn as much as we can in this, and then factor that into a lot of our future investments.
So a little bit first about who we are. The Federal Office of Rural Health Policy is located in the Health Resources and Services Administration, and we're part of the US Department of Health and Human Services. And we have a really, what I think, is a unique role within HHS, in the sense that we're charged with advising the secretary on rural issues, and yet, we also operate a range of grant programs all with a goal of increasing capacity and, you know, the state at a local level for rural communities. And so that is a great opportunity for us, because a lot of times what we learn in our programs informs our policy work as we make those recommendations.
And likewise, if we understand the policies, we know how it impacts programs. And so it's really been a good fit for us, and I think it's been a good fit for the work we do on behalf of rural communities. It's been an interesting journey for our office, as part of the response to the opioid and substance use epidemic. Really, as it was ramping up, you know, we were starting to hear stories from a lot of our rural stakeholders about the challenges they were seeing in this.
And at the time, we didn't really have any formal programming to really jump in and do much. We had a program, ironically, that was designed to get automatic external defibrillators into rural communities, and the Congress decided that around 2015, that it wanted to change that program, and turned it into a program where, essentially, we funded communities to acquire Narcan, train people in its use, and then deploy it around the community. And that was really our first foray into this larger work that really was starting to take over a lot of the activities of the Department of Health and Human Services.
And I think we were sort of overwhelmed by the interest in the program, but then quickly understood why, because of the great need out there. And so we started to think about what else we might be able to do in that regard. And one of the programs that we've operated for years, is a really unique program authority within government, in the sense that, it's very flexible. It's called the Rural Outreach Authority, and we've been funding grant programs in rural communities in that for probably 20 plus years, and one of the unique aspects of it is that it allows the community to determine the focus of the funding.
And so we can do special competitions within that, and focus on different areas. And so after learning what we could with the program that we did, in terms of getting Narcan into rural communities, we decided to take some of the money from that outreach line and put it into what became two successive cohorts of Rural Health Opioids Program grants, and, it was not a significant investment nationally, but for the communities that got the funding, it was important and it gave us a chance to feel like we could play a role in supporting rural communities. It enabled us to really build on what we'd learned with that Narcan distribution program.
And this was right about the same time that a lot of the funding was ramping up with SAMHSA, with the Centers for Disease Control and Prevention. Elsewhere, in HRSA, where our community health centers were starting to receive additional funding to add substance use services to their mix of behavioral health and primary care services. And, so it was our small way to begin to play a role, but, we kept thinking that there was a larger activity out there for us, and that there was more that we could do on behalf of rural communities. And, you know, we came into a situation in which we were able to really act on that.
And so what happened was, you know, we did these small programs that got us into the game, so to speak, but we realized that the need was greater than those two small programs could really meet. And so, you know, I've been working on federal budget process for most of my 25 year career, and, theoretically, you can propose something in the budget, and make a case for it, and you know, eventually you might have a chance of getting that in the President's budget. It had never happened in the 20 years I'd been doing it in rural health circles. But I think, you know, because of the experience we gained with the Narcan program, and with the two rural health opioids programs, we had a track record to build on.
We had that experience of really using flexible funding to meet, you know, community need in rural areas. And so we put together a budget proposal, and lo and behold, it got approved by HHS and the secretary, and then it went to the Office of Management and Budget. And for the first time in my career, it actually got approved. And the timing was really interesting on this, because in the year that it passed, what happened was the President released his budget, and then just a couple of weeks later, the Congress was late in enacting its annual budget.
And they picked up this Rural Community Opioids Response Program idea, and dropped it right into the enacted budget. And so we went from a very modest investment of a few million dollars, to $130 million investment, and 30 million of that was for loan repayment for clinicians working in substance use services. And the a 100 million was for us to invest directly in rural communities. And the way that we really designed this initiative, was, we wanted to be complimentary of what was already being done across HHS.
And so, a lot of the funding that was going out, not all of it, but a lot of it was being distributed to states either via statewide grants, or block grants. And that was true for parts of SAMHSA, also part true for CDC. And what we thought our program could fill an important need was, directing the investment into rural communities directly, and really allowing them to build infrastructure. Because the one thing we were hearing consistently was, the opioid epidemic was playing out differently in rural communities, we were dealing with people who were having to travel greater distance to care, more geographic isolation, and really, a much less limited clinical infrastructure to handle that.
And so in the course of this, our program was seen as complimentary in terms of matching those state grants, and really giving a lot of communities different ways to address the epidemic. And so since 2018, you know, you can see from the information on this slide, we've really been able to invest in a lot of rural communities. We're now in 47 states and two territories, we are serving more than two million rural patients, and that includes 71,000 patients that are receiving medication assisted treatment as a result of our grant investments. And the bulk of our early grant programs were really focused on two mechanisms.
One was a planning grant, we felt like there was a need to just get communities together, and all the stakeholders, to think about what they should be doing. And then we also wanted to have a series of implementation grants of one million dollars each. And that would give, hopefully give communities enough to act on their good ideas, try out the approaches that work for their communities, and in fact, that's exactly the way it played out. That flexibility proved to be essential, because, you know what would work in, say, Georgia, may not work as well as what was going on in Ohio or West Virginia.
And certainly, you'd have a different solution in the the northeast than you would in the southwest. And the flexibility of the way that the program was designed by the staff who led that, I think really made a difference in being really relevant to the communities in terms of being able to then use those dollars in the ways that they saw fit. And so the other feature we built in was, we wanted to have a feedback loop, so that as we learned more from the grantees, that we might then do special competitions within that. And so, we were able to also do a limited competition that focused on Neonatal Abstinence Syndrome.
We did another one that looked at psycho stimulants, because we're hearing from folks that, while opioids were still a real challenge, they were also seeing a lot of use of psychostimulants in a way that they weren't able to deal with in the regular grants that we were offering. And then this year, we're gonna make awards that look at behavioral integration, because as all of us know, we're unfortunately siloed in the healthcare delivery system. And so we wanted to provide some grants to make sure that substance use services were not independent of the larger focus on behavioral health services, given that there's so much interaction between behavioral health conditions and people who end up in addiction.
And so, we're really happy to have the flexibility to be able to do that, moving forward. Now, no doubt, the need is still out there. Unfortunately, you all have seen the same data that we've seen, and that is that overdose deaths went up, you know, dramatically during the epidemic for COVID, the pandemic, and so you know, we're continuing to invest in rural communities. I've been amazed at the ability of many of the communities we've funded, who've been able to do the best they can in sort of switching to virtual services, when they couldn't meet in person.
And it was a real lifeline in many places, and yet, not always the perfect solution, right? I mean, people made do with what they could, and the virtual care certainly maintains services. But we also know that the sense of community in treatment is really important, and that direct human relationship is really important, and you can only replicate that to a degree through a computer. And so, we're happy as we seem to be coming out of the other side of this pandemic, that our grantees, and everybody working in this field is getting back to group meetings and services the way that we had originally started.
And our hope is that, by doing that, we'll be able to move forward and really start turning the tide on all of this, and that these figures will look differently, hopefully, in the next couple of years. And so toward that end, we're gonna continue to offer a range of our funding, and we'll be making a number of awards later this year. A number of them will be for our regular implementation awards, but then we'll also have that new Substance Use Behavioral Health Integration grant. As we look towards FY 23, we're planning on doing another round of funding to get medication assisted treatment up and going in rural hospitals and rural clinics.
This was an effort we began a couple years ago, because we'd seen, in our community health center programs at HRSA, that with a little startup funding, many of the health centers were able to offer substance use services, and MAT services. And so, we're doing the same thing right next year, starting next year, doing a second cohort of providing those sort of startup grants that cover the initial operating costs, until those programs can become somewhat financially sustainable on their own, by building up enough patient base, and building for services. But the startup dollars really are essential.
So we'll be doing that again, and we're also gonna do our first ever tribally-focused opioid program. And, we think there'll be a lot of interest in this, and look forward to being able to release the guidance. And so with that, I just wanna thank you for your time. Thank you for the opportunity to present to you virtually.
I hope you have a great rest of the conference. Please seek out my work colleague Anna Swanson, who will be at the meeting, and we would love to have your feedback on other things we can do moving forward, and again, just best of luck on the rest of this conference.
Tom Morris, MPA
Associate Administrator for Rural Health Policy, Health Resources & Services Administration, U.S. Department of Health & Human Services