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Pennsylvania Rural Health Model

Model Overview

The Pennsylvania Rural Health Model is an alternative payment model designed to address the financial challenges faced by rural hospitals by transitioning them from fee-for-service to global budget payments. This model aligns incentives for providers to deliver value-based care and provides an opportunity for rural hospitals to transform the care they deliver to better meet community health needs. The model was designed in partnership with the federal Centers for Medicare and Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI).

Pennsylvania is the first state in the country to design and implement a model that is focused entirely on rural hospitals. Over a dozen other states have reached out to the Department to learn about the model and its operations. The Department has worked closely with CMMI, the Pennsylvania Department of Human Services, the Pennsylvania Insurance Department, the Hospital and Healthsystem Association of Pennsylvania, the Hospital Council of Western Pennsylvania and the Pennsylvania Office for Rural Health to develop the model and to ensure its success.

The Model to Date

The Model was successfully launched in January 2019 with five rural hospitals and five payers participating in the initial performance year.  In addition to this, eight new hospitals started in January 2020, and Aetna joined as a new commercial payer as well. Five new hospitals will start in 2021. Currently, a total of eighteen rural hospitals and six payers are participating, and the Model continues to recruit potential hospitals and payers to expand its operations across the state.

Hospitals:
Armstrong Regional Medical Center - https://www.acmh.org/
Barnes-Kasson County Hospital - http://www.barnes-kasson.org/
Bradford Regional Medical Center - https://www.brmc.com/
Clarion Hospital - https://www.clarionhospital.org/
Chan Soon-Shiong Medical Center - https://www.windbercare.org/
Endless Mountains Health Systems - https://www.endlesscare.org/
Fulton County Medical Center - https://www.fcmcpa.org/
Geisinger Jersey Shore - https://www.geisinger.org/patient-care/find-a-location/geisinger-jersey-shore-hospital
Highlands Hospital – https://www.highlandshospital.org/
Indiana Regional Medical Center - https://www.irmc.org/
UPMC Kane - https://www.kanecommunityhospital.com/
Wayne Memorial Hospital - https://www.wmh.org/
Monongahela Valley Hospital - https://www.monvalleyhospital.com/
Meadville Medical Center - https://www.mmchs.org/
Punxsutawney Area Hospital - https://www.pah.org/
Tyrone Hospital - https://tyroneregionalhealthnetwork.org/
Washington and Washington Greene Hospitals - https://whs.org/locations-practices/greene/

Payers:
Highmark - https://www.highmark.com/
Gateway Health - https://www.gatewayhealthplan.com/
Geisinger Health Plan - https://www.geisinger.org/health-plan
Medicare - https://www.medicare.gov/
UPMC Health Plan - https://www.upmchealthplan.com/
Aetna - https://www.aetnabetterhealth.com/pennsylvania

Reports Highlighting the Value and Impact of the Model in Rural Pennsylvania

The PA Rural Health Model Team has worked over the last several months to further analyze multiple components of the Model and the value of its impact to participating communities. The reports referenced below highlight the findings of these analysis.

  1. "The Criticality Reality of PARHM Communities: Comparing social determinant of health & population health metrics to rural state averages" | June 2021
  2. "The Bridge Between Urban and Rural: A closer look at the inequities of rural communities & PARHM's impact on them" | May 2021
  3. "The Economic Impact of PARHM Hospitals" - Reviewing the economic impact of PARHM hospitals on their communities and across the state | April 2021
  4. "PARHM Provider Feedback Analysis" – The value of PARHM based on a 2021 survey sent to participant hospital leadership | March 2021

These reports are available on the home page of the RHRCO website, as well as in the Press Release and Publications Library.

The Rural Health Redesign Center Authority

Act 108 of 2019 establishes the PA Rural Health Redesign Center Authority (RHRCA) and the PA Rural Health Redesign Center Fund. The RHRCA is an independent entity that will administer the PA Rural Health Model, including recruiting hospitals for participation and approving global budgets. The purpose of this act to protect and promote access by the residents of this Commonwealth to high-quality health care in rural communities by encouraging innovation in health care delivery. This legislation was signed into law on November 26th, 2019 by Governor Tom Wolf.

The RHRCA Board and its members have been officially appointed, and the Board held its inaugural meeting on May 26, 2020. Main priorities include working in partnership with CMMI and the Department to ensure the success of the PA Rural Health Model, standing up the RHRCA as an independent entity, and promoting the long-term viability of the Model to support PA rural hospitals.  

Appointed Board Members:
Commonwealth Representatives:

  • Chair, Alison Beam, Acting Secretary, Pennsylvania Department of Health (DOH)
  • Meg Snead, Acting Secretary, Pennsylvania Department of Human Services (DHS)
  • Jessica Altman, Commissioner, Pennsylvania Insurance Department (PID)

Payer Representatives:

  • Sean Burns, VP Reimbursement and Network Infrastructure, Highmark
  • Raymond Prushnok, AVP Program Development, UPMC
  • John Bulger, CFO, Geisinger
  • Megan Richards, Senior Network Director, Aetna
  • Douglas Doyle, Senior Director of Provider Contracting and Provider Relations, Gateway Health
  • Mike Sweeney, VP, UPMC
  • Sarah MacDerment, Actuarial Director, Geisinger
  • Linda Darga, Senior Director, Network Management VBS, Aetna

Hospital Representatives (1 additional representative pending confirmation):

  • Tammy Anderer, CAO, Geisinger Jersey Shore Hospital
  • Lewis John, CEO, Armstrong County Memorial Hospital
  • Jack Sisk, CFO, Punxsutawney Area Hospital
  • Sara Adornato, CEO, Barnes-Kasson County Hospital
  • Kate Slatt, Vice President of Innovative Payment and Care Delivery, Hospital and Healthsystem Association of PA
  • Loren Stone, CEO, Endless Mountains Health Systems
  • James Pettinato, Chief Clinician Director of Patient Care Services, Wayne Memorial Hospital

National Recognized Experts:

  • Donna Kinzer, Global Budget Expert, DK Healthcare Consulting
  • Brock Slabach, SVP-National Rural Health Association

RHRCA Leadership

  • Executive Director:  Gary Zegiestowsky, MBA
  • Chief Operating Officer:  Janice Walters, MSHA, CHFP

 RHRCA Board Public Meeting Agendas and Meeting Minutes

*Future public meetings will occur on a quarterly basis.

Next RHRCA Board Public Meeting Dates:

  • February 16, 2021 from 10:00am-12:00pm
  • May 18, 2021 from 10:00am-12:00pm
  • August 17, 2021 from 10:00am-12:00pm
  • November 16, 2021 10:00am-12:00pm

If you would like to obtain more information please contact Mr. Gary Zegiestowsky, RHRCA-Executive Director at c-gzegiest@pa.gov

The Rural Health Redesign Center Organization

The Rural Health Redesign Organization (RHRCO) was established in the summer of 2020 to serve as a supporting organization to the RHRCA.  The RHRCO is a nonprofit 501c3 corporation structured to support fundraising efforts for the long-term sustainability of the RHRCA and the PARHM.  The RHRCO has a dual focus to:

  1. Continue support of the Pennsylvania Rural Health Model (PARHM) to achieve the financial and health-related goals of the program of this CMMI Demonstration Project. 
  2. Build solutions for rural hospitals and communities across the country to drive financial sustainability while improving the health of the populations in these communities.  This focus area is building on the experience and lessons learned in PA as well as elsewhere in the country to bring scalable, cost-effective solutions to rural communities.

Additional information on the RHRCO can be found at:  https://www.rhrco.org/