Rural Health Care Coordination Program

goals for the Rural Health Care Coordination Program are to: 1. Expand access to and quality of equitable health care services through care coordination strategies exclusively in rural areas; 2. Utilize an innovative evidence-based, promising practice, and/or value-based care model(s) that is known to, or demonstrates strong evidence to, improve patient health outcomes and the planning and delivery of patient-centered health care services; 3. Increase collaboration among multi-sector and multidisciplinary network partnerships to address the underlying factors related to social determinants of health; and 4. Develop and implement deliberate and sustainable strategies of care coordination into policies, procedures, staffing, services, and communication systems. The Rural Health Care Coordination Program is a four-year program with year one (September 1, 2023 – August 31, 2024) being a planning year and years two – four (September 1, 2024 – August 31, 2027) focused on program implementation. Applicants are required to select one primary focus area from the following: 1) heart disease; 2) cancer; 3) chronic lower respiratory disease; 4) stroke; or 5) maternal health. Applicants are to propose innovative approaches to achieve the program goals, address local health challenges including the underlying risk factors that contribute to the selected primary focus area, and improve population health outcomes through coordinated, community-wide programs that link health and human services within an established or formal network (for the purposes of this program the terms “consortium” and “network” are used interchangeably). Although it is required to select one primary focus area, applicants may include underlying risk factors that contribute to the selected primary focus area understanding care coordination includes the provision of care for individuals with chronic and/or medically complex diseases. At the end of the four years, applicants should be able to contribute to the following outcomes: 1. Expanded access to and affordability of quality comprehensive care coordination leading to cost savings and overall health improvement status; 2. Improved patient health outcomes through the utilization of chronic care management, and/or preventive and wellness services; 3. Institutionalized care coordination strategies within their policies, procedures, staffing, services, and communication systems; 4. Implemented a multidisciplinary and multi-sector referral system; and 5. Identified a variety of funding and financing mechanisms to continue comprehensive care coordination strategies beyond the initial FORHP grant funding.