Initiative: Ohio Rural School Based Health Centers (SBHCs)

• Pilot the use of new, innovative technology that screens for autism spectrum disorder (ASD).
• Operate SBHCs on college campuses serving rural communities. Each site will staff a community health worker or similar navigator to provide care and resource coordination for patients, conduct community outreach to engage residents in primary care at the SBHC, and to provide patient education and support for utilization of consumer tech and remote monitoring equipment.
• Provides technical assistance support for school districts and their partners during a planning phase to ensure that best practices are utilized in site and equipment selection, service delivery models, staffing, school and community engagement, and sustainability strategies.

Initiative: OH SEE, vision, hearing, and dental services for rural students

Expand mobile optometric services to students in rural areas, add hearing and dental services. Services are delivered either via mobile unit or via a roll-off/on approach with equipment brought into a school setting short-term.

Initiative: Ohio Rural Health Innovation Hubs

Provide start-up funds for Clinically Integrated Networks (CINs) and Rural Health Regional Centers of Excellence (RHRCEs) that become self-sustaining, ensure that providers have the infrastructure they need to operate as part of a robust network, and to provide the supports needed for clinical professionals and paraprofessionals to operate at the highest level of their knowledge and credential.

• Tier One – CINs/RHRCEs currently operating a small integrated alliance can utilize funding to scale to a regional network for a maximum of 3- years when they should be fully operational and financially independent.
• Tier Two – CINs/RHRCEs with partners and a foundational plan, or have operated a limited alliance for a short period of time can utilize funding for start-up costs to prepare the network to scale regionally for 2-3 years, with full implementation and scaling to take place in years 3-5.
• Projects are required to establish collaborative agreements that provide frameworks for shared services, implementation of practices to achieve value-based care for member practitioners, coordinated patient transfer models, telemedicine and remote patient monitoring, interoperability of data systems, and continuous improvement of care quality.
• Funding can also be awarded to organizations with experience or interest needed to prepare rural pharmacies to integrate into the CINs/RHRCEs.
• Allow rural hospitals who do not have birthing centers to provide labor and delivery care, provided by physicians or midwives, for low-risk births. To protect the safety of mothers and babies, specific safety policies will be enforced. Midwives will be required to complete additional training and participating hospitals must have specific transfer agreements in place to facilitate specialty care if a mother or baby would need it. We anticipate implementation of this process in year two and Ohio will plan to provide financial supports to hospitals who need to equip maternity rooms.

Initiative: Rural Ohio Emergency Care Transformation

Scale alternate destination transport (ADT) or treat-in-place (TIP) pilot to rural communities across the state. A vendor will provide 911 system upgrades that allow for dispatcher-initiated triage of patients while the medic unit is enroute responding to a scene.

Protocols for each EMS provider are established by the respective local EMS medical director and include considerations for ensuring that patients receive the right care, in the right place, at the right time. This can include TIP by appropriately trained paramedics (with an option to utilize telehealth) or a behavioral health crisis mobile unit, or ADT to sites like urgent care, primary care/FQHC, behavioral health provider, or transport to an emergency department.

Provide one-time funding to the providers to support development of protocols to include ADT and TIP, and training of dispatchers, medics, and ADT sites. Data collection will identify utilization of ADT and TIP. Tech upgrades to provide enhanced connectively between providers across jurisdictions have been recommended by EMS providers and we are exploring options to address the need for potential year two implementation.

Initiative: Rural Health Workforce Pipeline and Development Projects

• (1) Coordinate workforce pipeline activities between high schools, universities, community colleges, career technical schools, and healthcare employers.
• (2) Provide upskilling to community health workers (CHWs) to address rural specific needs and to support RHTP projects including training on consumer facing technology and remote monitoring devices.
• (3) Provide upskilling to pharmacists, per Ohio’s policy initiative to increase pharmacists’ ability for point-of-care test-to-treat models.
• (4) Rural recruitment and retention incentives and 6-month housing stipends for those who relocate to serve in rural communities for 5-year commitments (minimum). This project will support filling workforce needs for a variety of healthcare capacities, e.g. MD/DO, nurses, pharmacists, therapy providers, dietitians, behavioral health, oral health, optometry, audiology, CHWs/navigators, etc.
• (5) Provide CME resources for physicians on nutrition (to support the Policy Action to adopt a CME requirement).

Initiative: Maternal and Infant Wellness Home Visiting in Rural Ohio

Start-up investments to support training and upskilling for nurses to provide evidence-based home visiting models. Funds will complement State general revenue funds that are available to pay for services once the nurse workforce is in place. Home visiting curriculum provides families with education on a variety of topics, including safe sleep demonstrations(using the family’s actual crib/bedroom), lactation support, and infant early childhood mental health. Mothers participating in the program can also receive peer recovery and behavioral health supports and other resources to promote wellbeing of the mother and child(ren).

Initiative: Rural Hospital Training and Technical Assistance Center (RHTAC)

Resource for hospitals to receive no-cost technical assistance, training, and guidance for developing sustainability plans. The RHTAC will conduct workshops for healthcare administration professionals to equip them with best practices in addressing hospital solvency, which can include joining an integrated network to achieve value-based payment structures and other efficiencies (described in an earlier initiative) and the RHTAC can assist with that transition. The RHTAC will also be available to help with ad hoc hospital needs such as addressing emergent issues or upskilling for new administration leaders. Finally, a requirement of the vendor selected for this initiative is to work with Ohio’s critical access hospitals (CAHs) to develop formal sustainability plans for them.

These funds will also support the previously referenced RHTP annual summit, bringing together all recipients/vendors of RHTP funds to share outcomes, best practices, lessons learned, and to clarify ongoing expectations of program participants.

Initiative: Electronic Medical Record Access for Pharmacies

Provide fundamental tools and training for pharmacists to operate under the expanded scope of practice that we are proposing as part of our policy actions. Pharmacists will utilize EMRs to become an integrated part of patient care, providing point-of-care testing and prescribing, and utilizing Ohio’s Automated Rx Reporting System (OARRS) to prevent misuse and diversion of prescription drugs and to promote improved patient care in rural communities. Consumer-facing technology and remote monitoring devices are available strategies for pharmacists to utilize in monitoring patient health indicators.

The Ohio Board of Pharmacy and Ohio Pharmacists Association will conduct readiness assessments, provide training, and oversee the implementation of the prescription drug monitoring program (PDMP).

Initiative: Healthier Ohio Initiatives

Implement evidence-based initiatives that focus on Lifestyle Medicine’s six pillars:

• Optimal Nutrition - Eating Well
• Being Active
• Restorative Sleep
• Positive Outlook – Stress Management
• Belonging – Social Connectedness
• Avoiding risky behaviors

Clinical settings will adopt integrated care models and focus on behavior improvements for any or all of the six pillars.

• Training and certification of rural clinicians in Lifestyle Medicine.
• Standardiz the six pillars into well-visits and medical home services.
• Establish coordinated care teams that are multidisciplinary, patient centered, with clear communication, and have clearly defined roles and responsibilities.
• Utilize remote patient monitoring through technological devices, including remote care services that build interoperable data and analytics that integrate with electronic health records and deploy consumer-facing engagement tools that drive adherence and self-management. Wearable devices must be FDA approved.
• Hire CHWs to assist with accessing resources related to social determinants of health and supporting use of technological devices.
• Add new services such as culinary classes, grocery shopping planning, exercise classes, support groups, biofeedback coaching, and healthy food access support.

Schools will serve as a hub for the whole community that invite students, staff, and families to participate in initiatives that support physical, mental and social health.

• Implement Governor’s Healthy Ohio Team Tressel Fitness Challenge and associated activities to support behavior modification.
• Professional development for teachers supporting education on nutritive value of foods, including natural and organically produced foods, the relation of nutrition to health, and the use and effects of food additives.
• Support students and families in accessing clinical health services and adopting behaviors related to the six pillars.

Community-serving agencies will implement evidence-based programs that support individual behavior change and improve access to services.

• Infrastructure coordination to improve and increase preventive services to facilitate collective impact, leverage resources utilization across agencies in their geographic area.
• Access to specialists like dietitians, fitness experts, and CHWs to increase skills, improve outcomes of the six pillars.
• Outreach to residents to increase participation in clinical and community-based strategies.
• Access to sustainable healthy food, and physical activity opportunities.
• Skills-based marketing strategies to improve the behaviors related to the six pillars.

The Ohio Department of Health will create a competitive bid process for the three system types to apply. Selection of more than one strategy as well as proof of cross-system collaboration will be encouraged.