Rural Network Leadership

NCHN Member
May 18, 2015 07:57 AM
Leadership is the capacity to help transform a vision of the future into reality. The significant challenges we face today in healthcare require a form of leadership that is less authoritative and more collaborative.
To read this article by Tim Size, please click
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Prince of Wales Health Network highlights work at the Annual Health/Wellness Fair

NCHN Member
Apr 21, 2015 09:19 PM

PoW Health Network Highlights Services at the Annual Health/Wellness Fair

The Prince of Wales Health Network (Craig, AK) is a collaborative effort between Southeast Alaska Regional Health Consortium (SEARHC) Alicia Roberts Medical Center, State of Alaska Craig Public Health Center, Community Connections, Alaska Island Community Services (AICS), and PeaceHealth Medical Group Prince of Wales, Whale Tail Pharmacy, and Southeast Dental Center Inc. The mission of the Prince of Wales Health Network is to build a strong and sustainable network of healthcare organizations collaborating to strengthen the healthcare system on Prince of Wales Island and increase access to quality healthcare for all island residents far into the future.

This weekend the island highlighted the many wonderful resources on Prince of Wales at the Annual Wellness/Health Fair in Klawock.  There was food, activities, labs, immunizations, door prizes, and 45 different exhibitors for the whole family.  There were Car Seat Safety Checks and a Fisherman First Aide Class held. In the spirit of helping get our hearts healthy there was also a 3/5K at the event.

One of the upcoming projects in a series of 10 objectives for the POW Health Network is to increase the proportion of children and adolescents who decrease their viewing time of television, videos, or play video games to under 2 hours a day.   We plan to survey students over a three year period and introduce fun alternatives to screen time. We are excited to get individuals committed to helping kids get out and be more active in all communities on POW.   If you have any ideas please email us at or contact us on our Facebook page.

The Prince of Wales Health Network is currently funded from local businesses, individuals, corporation, partnership, in-kind donations and a grant from the Health Resources and Services Administration (HRSA) Office of Rural Health Policy (ORHP).   The Prince of Wales office/conference area is located at West Wind Plaza Craig.


Gretchen Klein
POW Health Network

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ASPIN Health Navigator Program

Apr 21, 2015 07:55 PM

ASPIN Health Navigator Program

The ASPIN Network is a 20 year old, not for profit, behavioral health network, comprised of seven independently managed rural safety net mental health and addiction providers that provide clinical care through a matrix of 47 offices. ASPIN serves 62,000 consumers annually, 19,000 uninsured. All network members sign a memorandum of understanding and utilize a part time navigator for assistance with healthcare insurance enrollment at their facility.

Resources Used

ASPIN was successful in obtaining funding from CMS in both year one and two to establish the ASPIN Health Navigator Program which employs 20 navigators. Data is collected per the cooperative agreement guidelines which include: navigators completing Federal and State certification, consumer enrollments by Marketplace or Medicaid plans, consumer appointments (first time, follow-up and telephone), Small Business Health Option Program (SHOP) appointments, outreach and enrollment events, and marketing activities and consumers reached.


An ASPIN Health Navigator Program is comprised of a project director, three regional supervisors, a human resource coordinator and 15 community based part-time navigators. All the positions maintain Federal and State navigator certifications. Navigators are equipped with Mobile units that include an encrypted laptop, scanner, mobile Mi-fi, marketing banner and office supplies which allow them to respond to locally and attend enrollment events. Policies were developed to address: confidentiality and data security, HIPAA compliance, safety, conflict of interest, education loans, administrative duties, outreach activities, group enrollment events, consent forms, certification and certification renewal. Navigators are required to submit weekly work plans, outreach logs, and consent forms. Each supervisor maintains an ongoing relationship with approximately five navigators in their geographic region to pool resources at large enrollment events. Navigators are required to attend biweekly information update conference calls and two in-house trainings annually.

Lessons Learned


  • Lack of receptivity and understanding of the ACA
  • Indiana Medicaid Expansion did not take place until the middle of 2nd year which left 350,000 consumers in the healthcare coverage gap the 1st year
  • Complex enrollments and consumers unfamiliar with health insurance
  • Indiana required additional navigation certification on top of the required Federal navigator certification

Lessons Learned:

  • Power of Peers: Hire a diverse workforce to interface accordingly with consumers.
  • Collaborations are Golden: Utilize organization’s existing events to market your services. 
  • Identify Champions: Partner with key individuals in communities that can connect and support your program. 
  • Easy Access: Go to your consumer in their community setting. 
  • Share your Successes: Word of mouth referrals are the best form of marketing.


ASPIN Health Navigator Program Results (9/13 through 3/15):

  • Access to healthcare insurance was improved in 90 of the 92 Indiana counties
  • 2,620 consumers enrolled in qualified health plans
  • 4,375 appointments conducted to assist consumers in enrollment or to clarify insurance coverage
  • 1,172 enrollment and outreach events conducted or attended
  • 1,006 marketing or promotional events conducted
  • 1,855,672 individuals received information about healthcare insurance enrollment
Unanticipated Program Outcomes: 
  • Development of a Navigator Marketing Toolkit and Media Campaign; 
  • ASPIN certification by Indiana Department of Insurance to provide state navigator training and continuing education courses;
  • Ability to cross-train navigators as Indiana certified community health workers
  • Successful collaborations with Indiana Minority Health Coalition, Indiana Rural Health Association, and Ivy Tech Community College


Kathy Cook
Ph: 317-471-1890

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Santa Cruz County Adolescent Wellness Network: Taking integrated vertical networking to a new level

NCHN Member
Apr 6, 2015 01:19 PM

This article was written by Cassalyn David, Network Director, Santa Cruz County Adolescent Wellness Network (AWN), for the “Networking News” monthly newsletter. The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.

Even before the Santa Cruz County Adolescent Wellness Network (AWN) had a name or knew what an integrated vertical network was, it was exemplifying cross-sector collaboration. The first connections began between the schools and community organizations that wanted to eliminate disparities by promoting health literacy and healthy lifestyles for youth.

Early on, network members had ambitions beyond just creating a fitness or health literacy program that would last a few years. They saw the need for a lasting, holistic adolescent wellness infrastructure and wanted to be part of the budding nationwide movement for youth empowerment. Grant funding for school health initiatives can be very ephemeral and narrowly service-focused, so the Rural Health Network Development Grant Program has been key to AWN sustainability. With Federal Office of Rural Health Policy (FORHP) support and connections to other rural health networks and national resources, AWN has been able to set and achieve ambitious goals for our infrastructure and services. We could not have accomplished this if we had continued to work in silos. Our broad and well-connected coalition has been our key to success.

Member connections

Since we operate in a rural, small town atmosphere, it is both possible and necessary to have members that are well-connected throughout the community. Chris Bachelier, the representative from the County Superintendent of Schools, has been with the network from the very beginning. She is central to our school partnerships, serving as our liaison with every level of the school system. Through her we have fantastic buy-in from the County Superintendent of Schools, connections with all of the health and wellness programs housed in her office, and personal connections with individual school administrators and health and fitness staff.

Chris has facilitated many of the Network's key projects. Teachers, school health staff, and administrators are some of the busiest people I know, but Chris knows how to find time with them. For our school-linked health care planning, Chris helps the Network understand school and district-level needs and constraints. In order for AWN to reach our goals for school-primary care linkages, we need to be listening to everyone from the front-line service providers to the Superintendent. She conducted key informant interviews with school health staff that answered many of our questions. It was inspiring to hear about the service these nurses and nurse aides provide their students and validated many of the ideas we had about ways we could make their jobs easier. They know it is best in the long run if you can serve the 'whole child,' because they see every day how social and environmental factors are impacting student health. We learned about the challenges families face in accessing health and social services, and are working to create a seamless system of referrals across these disciplines.

Organizational culture

Every organization has its own systems and culture, and AWN has the additional layer of working across disciplines. The challenge for me has been to recognize the differences both between and within health, education and nonprofit service sectors. I actually made the mistake of assuming the three school district boards and administrations would have similar procedures and requirements for our partnership agreements. Fortunately, my members are experienced and supportive.

Talented evaluation

Another advantage for AWN is having an experienced evaluator. Rebecca Drummond is the Program Director for Family Wellness at the University of Arizona Mel and Enid Zuckerman College of Public Health. Rebecca has unique experience in the realms of coordinated school health and youth health systems, having served on the Board of Directors of the Arizona Public Health Association, chairing the School Health Section, and as a board member and President of the Arizona School Based Health Care Council, a state affiliate of the national School Based Health Alliance.

Both Rebecca and Chris have backgrounds that span health and education, so they are excellent at bridging the disciplines. They can relate to the teachers and be champions for schools' role in student wellness, despite funding and time constraints. This showed when AWN created the first-ever implementation and analysis of School Health Profiles at the county level in Arizona. School Health Profiles is a CDC survey that tracks school health and wellness policies and practices. AWN wanted to know where our local schools stood in comparison to their peer institutions and best practices. Through careful outreach, AWN obtained an excellent response rate. Even the process of distributing the surveys and results helped the school health movement gain momentum in our community.

A long history of integrated vertical networking

As a Network Director, it makes my job easier to have respected member organizations and well-connected representatives to provide wisdom and practical guidance. The impetus that brought partners together from the beginning was supporting schools' health and wellness efforts and creating a holistic paradigm for serving and empowering youth. It would have been more difficult if we had started in a narrow mindset and decided later on to expand to include schools. Our mission, vision, goals and programs were conceived and continue to evolve with this broad coalition at the table. To keep them at the table, we are challenging ourselves to continue providing valuable services for our members and community.


The Santa Cruz County Adolescent Wellness Network (AWN) is a group of local agencies that has been working to promote and improve adolescent wellness services through collaboration, education, and advocacy since 2007. The current partner organizations are Mariposa Community Health Center, the lead and fiscal agent, along with Southeast Arizona Area Health Education Center (SEAHEC), Santa Cruz County School Superintendent, Community Intervention Associates, Pinal Hispanic Council, Circles of Peace, and the University of Arizona Cooperative Extension Santa Cruz County. The Arizona State Office of Rural Health provides Technical Assistance. The AWN is a place for partners to collaborate and share resources to identify and respond to adolescent wellness needs. Our mission is to promote adolescent wellness through advocacy, education, and collaboration with schools and community organizations serving youth, ages 12-25. The AWN is funded by a Rural Health Network Development Grant through the Health Resources and Services Administration, Federal Office of Rural Health Policy. AWN has been an active member of NCHN (National Cooperative of Health Networks) since 2010.


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From the Executive Director (March 2015)

Rebecca Davis
Mar 16, 2015 05:08 PM

Rebecca Davis

I think most of us will be happy to see the arrival of Spring on Friday, March 20!  I know I will be.  After last month’s column where I was discussing Kentucky’s weather, we were hit with a second major snow storm on March 4-5. The Governor issued a state of emergency that lasted two days. Snow accumulation records were broken and if you happened to be watching the Weather Channel or national news, you probably heard about the hundreds of folks stranded on the interstates across the Commonwealth.   Here at NCHN headquarters we had approximately 17 inches of snow!  So, yes, so glad to see the longer days and warmer weather. Yesterday it reached 75 degrees. Nice!

I’ve heard the statement, from several parts of the country, “If you don’t like the weather (fill in the blank), just wait a day or two and it will change!” Managing a network is sometimes like dealing with changing weather. However, through your NCHN membership you have access to a number of tools and strategies to support you as you manage the challenges and changes facing your network. 

For those of you that participated on the Informational Calls yesterday, you heard about two new programs available to help you support the healthcare delivery efforts of your members.  The first call was offered by the National Rural Accountable Care Consortium and discussed “Pathway to Sustainability.” Doug Pollock, Regional Executive Director with NationalRuralACO shared information regarding HHS Secretary Burwell’s historical announcement of a CMS goal of having 30% of all Medicare provider payments be in alternative payment models that are tied to how well providers care for their patients, instead of how much care they provide, by 2016!  And the second part of this goal is to have that percentage increase to 50% by 2018!  A second goal is for virtually all Medicare fee-for-service payments to be tied to quality and value, at least 85% in 2016; and 90% in 2018.  How could this be possible? CMS has 114 million dollars in grant funds available to assist rural communities make the transition to this new payment model. Mr. Pollock, summed up the announcement as follows, “Getting paid for population health is the key to your sustainability; community health systems are perfectly poised for success in population health programs; and ACOs are a good transitional program to optimize your delivery system for population health payment models – and if you join now CMS will pay for it.”

The second call was with Nancy Maher, Program Analyst, Office of Rural Health, U.S. Department of Veterans Affairs. Dr. Maher provided an update on the Veterans Access, Choice and Accountability Act of 2014 (VACAA) and spotlighted the Veterans Choice Program.  This is a new program designed to assist the 22 million veterans living in the United States, of which 5.3 million or approximately 24% live in rural areas, more easily access health care closer to home. The “Veterans Choice Fund” has 10 billion dollars available to pay for non-VA provided care. The program sunsets in three (3) years or when the Veterans Choice Fund is exhausted. Network leaders that participated on the call reported already have some veterans enrolled in the program in their network services area. It was helpful that those members already involved in the program shared their experience with others on the call. Networks are  assisting veterans obtain care closer to home.  Additional information about the Veterans Choice Program can be accessed here. And for more information on how to become a Choice provider, click here.

The next NCHN Informational Call is scheduled for June 15 @ 2:00 PM ET.  If you have any suggestions for topics or speakers, please let me know. 

The Call for Nominations for NCHN Directors was distributed last week!  We are looking for a few great network leaders to step up and serve your Association. Directors elected during this year’s election process will serve for three years, May 1, 2015 – April 30, 2018. If you have questions about eligibility requirements to serve as a Director or just questions in general, please feel free to email me or give me  a call to discuss.  Letters of interest are due by Friday, March 27 @ 12:00 PM ET.  The ballot for elections will be distributed in mid-April.

Enjoy the warmer weather and longer days. Take time for yourself - take a walk, take in a spring sporting event, or just sit and listen to the birds sing.  

Rebecca J. Davis, Ph.D.
Executive Director

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Rural Health Network Evaluation: What and Why?

Mar 6, 2015 11:34 AM

This article was written by Christy Sullenberger, MS, Director of Member Services, and Rebecca J. Davis, Ph.D., Executive Director of NCHN, for the “Networking News” monthly newsletter. The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.

Evaluating the network organization or a specific network program is an essential element of performance and process improvement, as well as overall assessment of effectiveness. Evaluations are used to improve programs, build organizational capacity, demonstrate value, and provide a basis for decision-making. While there is no set method for network evaluation, an evaluation typically addresses inputs, processes, outputs, and outcomes. Each of these elements provides insight into a different aspect of the network organization. Taken together, evaluation is a useful tool for the network leader, Board, stakeholders, and present and future funders.

A well-executed evaluation will also provide a statement of value, which is notoriously difficult for many health networks. Historically, health networks can illustrate positive value and promising programs, but quality quantitative data is lacking. In order to provide a good illustration of a network program’s impact, and ultimately the value of the network an evaluation plan should be developed and executed. The process should begin by determining clearly stated and measurable goals for the program, define metrics (how will you measure the impact of project), collect data, analyze the data against program goals and objectives, and then illustrate the connection of the program’s outcomes to the network’s value.

An evaluation should show a direct link between the program activities and outcomes and should address a number of questions, including:

  • What do I need to know to make program decisions and adaptations?
  • What is working well and what is not?
  • How well does the program deliver value to members and stakeholders?

Potential funders, including private foundations and governmental agencies, are seeking justification for the investments they make in rural health networks. A good evaluation plan, along with previous outcomes, assists them in achieving this goal. A good example of the importance of evaluation to HRSA Rural Health Network Development Programs, is stated in a recent RFP Guidance,

“Evaluation is a very important component of the RHND Program. The collection of performance measures from past RHND cohorts and numerous rural health network case studies demonstrated positive outcomes. But, due to the lack of evidence and challenges using traditional quantitative methodologies to measure network outcomes, it is difficult to ascertain the significance and uniqueness of rural health networks that support positive health outcomes in rural communities. Project-level evaluations of RHND grantees will assist in determining and validating the reasons why rural health networks are an important strategy in the improvement of rural healthcare. A comprehensive evaluation approach should contain contextual, implementation and outcome evaluative components. And the process and result of evaluation should not only assist in the understanding of the benefits of rural health networks but be utilized in a manner that enhances and improves the functions and activities of the network.” (p.5, Rural Health Network Development Program Funding Opportunity Announcement, FY 2014, Health Resources and Services Administration, Office of Rural Health Policy (ORHP))

Rural Health Network Evaluation: When and How?

As part of your rural health network development grant proposal, you have already outlined program activities and expected outcomes. Prior to developing the proposal, you likely completed a needs assessment and know exactly what your vision is for the implemented project. You will now need to execute your evaluation plan. The evaluation approach you choose guides you in the collection and organization of data, so it is important to develop an evaluation plan early in the process of implementation. In addition, as you begin collecting data, you can conduct an ongoing evaluation, which determines if implementation is going as expected. This will lead to the final evaluation of the project and will determine if the stated objectives were met.

An evaluation may be goals-based, process-based (formative), outcomes-based (summative), or a combination of these. A goals-based evaluation determines whether you are meeting your overall objectives. A process-based evaluation addresses how your program works and highlights strengths and weaknesses. An outcomes-based evaluation addresses the benefits of your program to network members and/or the community. A final evaluation will often include pieces of all of these approaches.


Before developing your evaluation plan, it is essential to sit down and re-summarize your proposed program’s activities and objectives. One common guideline for developing goals and objectives is the SMART acronym. All objectives should be Specific, Measurable, Attainable, Realistic, and Time bound. Ensure that you have a strong list of realistic goals, achievable objectives, and appropriate activities that link directly to the desired results. Consider the purpose of your evaluation, outline the specific questions that the evaluation will answer, and decide how and how often data will be collected. You may want to consider using a logic model to assist in planning (see more at The Logic Model). Once this template is developed, you can use it to identify specific metrics, determine the kind of data that you want to collect, and choose an evaluation approach that is appropriate to the project.

Evaluation Methods

There are a variety of evaluation methods and models. Each method has strengthens and weaknesses. The important question to answer, is which method will best provide actual data that can be used to determine the effectiveness of the proposed project. An evaluation plan for the proposed project may need to incorporate different approaches.  Some basic methods of program evaluation include the following:

  • Questionnaires and surveys: can be analyzed and presented numerically/quantitatively
  • Interviews: provide primarily qualitative outcomes and can be conducted in person or on the phone and should be targeted and clear
  • Documentation review: can be inexpensive, but may not provide a complete picture
  • Focus groups: can provide a range of feedback, but may be slightly difficult to present analytically
  • Case studies: can provide an in-depth look at a program and many variables
  • Others (see Overview of Methods to Collect Information for a list of  primary methods and the pros and cons of each)

The guiding principle in the selection of an evaluation method/s is to collect and present the most useful information about a program. Throughout the process, keep in mind that the method you choose will determine how the results are collected. And, in order to avoid introducing bias, you will need to develop a process that ensures that data is collected in the same way each and every time.

Common Components of an Evaluation Report  

When you have identified your method/s and collected data, you will then need to communicate your findings. There are many ways to structure the evaluation, and organization and content will depend on your process and methodology, but the following is a common structure of an evaluation:

  1. Title page
  2. Table of contents
  3. Executive summary
  4. Purpose of the evaluation
  5. Organization and program background
  6. Overall evaluation goals
  7. Methods used
  8. Interpretations and conclusions
  9. Recommendations
  10. Appendices

For more detail on the above, see Contents of an Evaluation Plan. As you embark on your program evaluation and tie it into your network assessment, keep in mind that the most important element in the evaluation process is that you start early in the process of implementation and that you are consistent in your collection methods.

Additional Reading

Basic Guide to Outcomes-Based Evaluation for Nonprofit Organizations with Very Limited Resources (Free Management Library)

Basic Guide to Program Evaluation (Including Outcomes Evaluation) (Free Management Library)

Critical Components of Evaluation by Alana Knudson, Ph.D., National Rural Health Resource Center Evaluation Workshop (August 6, 2014)

Designing Evaluations (GAO/PEMD-10.1.4, United States General Accounting Office - Program Evaluation and Methodology Division, 1991)

Evaluation for Nonprofits (Nonprofit Answer Guide)

Tools and Resources for Assessing Social Impact (TRASI) (Foundation Center)

Tools and Strategies for Managing Health Networks: Network Evaluation (NCHN)


NCHN Member
Mar 6, 2015 11:08 AM

This article was written by Toniann Richard, Executive Director, Healthcare Collaborative of Rural Missouri, for the “Networking News” monthly newsletter. The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.

At the Health Care Collaborative of Rural Missouri (HCC), having encountered both challenges and successes, we unequivocally say Friend!

The HCC is a rural health network, committed to improving the health status of underserved populations in a three county area. HCC was formally established in 2006 following a three year period of working informally together to address area health care needs. The purpose was to ensure that the health care needs of all citizens in our service area were met, particularly the needs of the under- and uninsured. Since forming, our focus has been to develop and implement programs that are responsive to the documented health needs of county residents, with specific health status indicators as benchmarks for progress on addressing those needs. Of course, this was how we embarked on our telehealth journey in 2011.

HCC applied for and received a USDA Distance Learning and Technology grant with network partner Lafayette Regional Health Center (a Critical Access Hospital).  We purchased several telehealth units for the rural health clinics as well as one for the emergency department and outpatient clinic.  The initial project was focused on integration of mental health services with HCC’s network partner Pathways Community Health, a Community Mental Health Center. 

Initially we had several bumps in the road. Let’s start with the obvious…high speed internet.  Our network is located in a very rural part of Missouri - think dial-up connectivity.  So, step one was finding a connection that was both fast enough and affordable enough for all of our partners.  We began by partnering with an information technology vendor who understood the value of purchasing connectivity in rural Missouri.  We then applied for Universal Service Administrative Company funding and were granted reduced cost connectivity.

With the connectivity problem overcome, we developed another problem…firewalls.  The point to point connection from A to B was a much bigger hurdle than we could imagine.  There were two firewalls, along with the bridge firewall at the HCC office.  It took three information technology consultants, a technology vendor and multiple staff from the network and network members to get the problem started and solved, multiple times.  Each time the firewall changed for the members, we had to bring the consultant team back together to troubleshoot the problem yet again.  It is an ongoing challenge for us, but we have learned how to work together to meet the requirements for connectivity.

The next phase of our project was even more interesting.  HCC had made a decision in 2012 to apply for a new access point (Community Health Center) funding for our network.  HCC was awarded this designation in late 2013 and one of our first orders of business was to launch our own telehealth project, which focused on behavioral health.  We were so excited to launch this program because there is a major lack of mental health providers in our area and psychiatry is definitely a major shortage. We partnered with long-term friend of HCC, Pathways Community Mental Health, for a behavioral health consultant (face to face) and a psychiatrist (telehealth).  As a result, Pathways is paving the way for telehealth statewide. On average, they currently do 3000 telehealth visits per month with over 30 of those visits being for HCC. 

You must be asking yourself, “But what do the patients think?”  Well, I am glad you asked!  Pathways conducts annual patient satisfaction surveys with their telehealth patients.  We were proud to learn that their overall satisfaction was over 90% and over 20% would choose telehealth as their form of treatment.  As healthcare leadership, this tells us that telehealth is being accepted more and more across rural America.

Last but never least, during implementation we were also working on policy.  Senate Bill 262 was introduced in 2012 and passed in 2013.  Senate Bill 262 prohibits health carriers from denying coverage for a health care service on the basis that the service was provided through telemedicine if the same service would be covered when delivered in person.  This was a major hurdle for rural Missouri and it is one of the areas where Missouri set the tone for the rest of the Midwest. 

We look forward to our next step in Telehealth, which will be the addition of a new unit at our second health center and plans to develop a comprehensive, vertical telehealth network with our partners.

About HCC

The Health Care Collaborative of Rural Missouri (HCC) has a mission to "Cultivate partnerships and deliver quality health care to strengthen rural communities." Since its inception, the HCC has developed into a comprehensive rural health network, with a wide variety of health, social services and community partners that provide health and wellness prevention and treatment programs for all citizens in our service area, and focused on the health care needs of low-income, under- and uninsured residents. The HCC's strength lies in developing collaborative relationships, utilizing the strengths of individual organizations to develop programs and services that are larger than any one organization. HCC is the first rural health network to receive HRSA's Bureau of Primary Health Care 330 funding to operate a community health center. HCC has been an active member of NCHN (National Cooperative of Health Networks) since 2010.  

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Strategic Planning-Aligning Resources and Capabilities for Competitiveness

Mar 6, 2015 10:58 AM

This article was written by Brendan L. Ashby, MBA, MPH, MCHES, FACHE, Dean of Health Sciences and Service Programs, Saint Paul College, for the “Networking News” monthly newsletter. The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.

            Having been involved in the development and leadership of rural based healthcare networks in Minnesota and health workforce training in post-secondary academic institutions has shown me the importance of strategic planning.  As network leaders, our charge is to assess the viability of the current or emerging network, gauge if the network is tactically positioned to meet its goals and objectives, and identify which strategic concerns and challenges warrant immediate leadership attention (Ashby, 2014). However, as important as strategic planning is, I have found it useful to adopt a mindset of strategic process that involves strategic thinking, acting, and learning that are just as important if not more important than any approach to strategic planning (Ashby, 2014).  To help foster that mindset of strategic process, I want to share two of the tools that have helped my stakeholders and me-the Business Model Canvas and Strategy Change Cycle.   

Business Model Canvas

When I was preparing for strategic planning sessions with my network, I wanted a novel approach and a colleague of mine suggested I try to develop business model canvases that she had effectively incorporated into her strategy sessions.  The Business Model Canvas is a strategic tool developed by Alexander Osterwalder and Yves Pigneur as a way to visually capture and describe a network’s business model.  I have had great success when using the business model canvas, especially when engaging reticent stakeholders that might have limited experience in any type of strategy planning or experts who appreciate the pragmatic framework.  This unpretentious but powerful tool can demonstrate what is happening within a network and its value proposition in nine key areas:

  • Key activities: What are the most important activities that your network does or is planning to do?
  • Key resources: What resources are necessary for the network and its stakeholders to experience success?
  • Key partners: Identify all of your network’s critical partners such as hospitals, clinics, vendors, community-based organizations, academic partners, insurance companies, and other stakeholder groups.
  • Value proposition:  What makes your network the best value for your stakeholders?  Why would a patient, customer, or partner organization participate in your network’s services?
  • Costs: How many resources and types of resources does your network need to be sustainable and successful?
  • Customer relationships:  How does your network establish and maintain relationships with your customer segments?  On a one-to-one relationship, mass market, or niche?  What are the costs of those relationships?
  • Customers:  Who are your customers?  Think beyond the healthcare partners, funders, or health consumers. 
  • Revenue:  How do you bring money into your network?  Through grants, training, services, shared savings?   What else?
  • Channels:  How do you communicate with your stakeholders?  Face to face meetings? Social media?  Web conferencing? Printed materials?  Think about all of the channels that your network currently uses or could use. 

Using the business model canvas helps network participants to discover areas of strength, minimize network weaknesses, and potentially discover opportunities for additional funding and increasing services (  For example, the business model canvas was an instrumental tool used in my former palliative care network to develop new relationships with other likeminded rural based healthcare systems across nine counties in northern Minnesota that resulted in increasing interdisciplinary training for health providers involved in palliative care, growing patient participation, and improving patient education.  The business model canvas is an effective, interesting, and enjoyable method for network participants to begin to review their efforts from diverse perspectives.      

Strategy Change Cycle                     

            The Strategy Change Cycle developed by John M. Bryson can assist network leaders to figure out what the challenges are and provides ten steps to work through the strategic planning process. The strategy cycle will help network leaders think about your stakeholders and who needs to be part of the discussion; what details does the network leadership need and if you are missing any information; how you are going to implement this strategy process; if this is realistic; and lastly how can we create the highest enduring value for the people that your network serves (Ashby 2014). 

The ten steps are as follows:

  • First your network leaders have to agree on the strategic planning process
  • Identify the network’s mandates
  • Review and gain understanding on the network’s mission and vision
  • Conduct a SWOT analysis
  • Discover the strategic issues facing the network
  • Frame tactics to address the challenges
  • Review and approve the strategic plan
  • Reaffirm alignment with the network’s vision
  • Foster a successful implementation process
  • Revaluate strategies and the strategic planning process

(Ashby, 2014).

     The final steps of using both the Business Model Canvas and Strategy Change Cycle will occur when your network reassess your identified strategies and remember to be agile, change when necessary, and make corrections as needed.  You need to constantly be thinking strategically.  Remember, this is a process and not a one-time project.  If you keep that in mind then you will be successful.



Ashby, B.L. (2014).  Topic Based Essay.  Creighton University, Omaha, NE.
Bryson, J. M. (2011). Strategic planning for public and nonprofit organizations. San Francisco, CA, USA: Jossey-Bass.
Osterwalder, A., & Pigneur, Y. (2010). Business model generation. Hoboken, NJ, USA: John Wiley & Sons.
Thompson, A. A., Peteraf, M. A., Gamble, J. E., & Strickland III, A. J. (2014). Crafting and executing strategy: Concepts and readings (Vol. 19th ed.). New York, NY, USA: McGraw-Hill Irwin.

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Michigan Rural EMS Network: Ten Rural Communities Receive MiResCu Community Awards, To Be Presented at EMS Summit

NCHN Member
Mar 2, 2015 10:37 AM

Ten Rural Communities Receive MiResCu Community Awards, To Be Presented at EMS Summit  

Frankenmuth, MI – February 6, 2015

Emergency Medical Services (EMS) face numerous challenges in responding to the needs of rural communities.  The Michigan Rural EMS Network was formed to help rural EMS professionals address these challenges in Michigan. 

In September 2014 Michigan Rural EMS Network received two federal grants from the Office of Rural Health Policy for its cardiac arrest initiative, the Michigan Resuscitation Consortium (MiResCu).  From there, the MiResCu Community Award program was established.  In its first cycle, the MiResCu Community Award program will provide support for 10 organizations representing residents in 21 rural counties across Michigan.   These communities will receive assistance to implement strategies that have been proven to increase cardiac arrest survival.  The MiResCu Community model is based on the system that was developed by the Resuscitation Academy, and first initiated in Seattle/King County Washington.  Today, someone who suffers cardiac arrest in King County is 4 to 5 times more likely to survive.  In 2013, Seattle/King County achieved a 62% survival rate for cardiac arrest in witnessed ventricular fibrillation, among the highest reported survival rates in the world.  Most cities experience rates in the single digits.  Through MiResCu Community awards, the Michigan Rural EMS Network will provide the support needed to help rural communities increase their survival rates from cardiac arrest. 

In January 2015, the Michigan Rural EMS Network received fifteen eligible applications for assistance.  An objective review panel assessed community need, readiness, and available resources to determine awards.  Awards will benefit approximately 510,000 rural residents.  The following communities will be presented with their awards at a luncheon on February 27, 2015 at the EMS Summit held at the Bavarian Inn Lodge in Frankenmuth, MI. 

  • Oceana County, Oceana County EMS
  • Menominee County, MidCounty Rescue 114, Inc.
  • Northern Michigan MCA
  • Alger County
  • Northwest Regional MCA
  • Tuscola County, Mobile Medical Response (MMR)
  • Plainfield Township, Plainfield Township Fire Department
  • Gladwin County, MidMichigan EMS
  • Northeast MI MCA
  • Missaukee County, Missaukee County EMS

The support provided through the awards will include High-Performance CPR (HP-CPR) Trainer Certification, HP-CPR provider courses, AED placement and registries, training for dispatch and law enforcement, and support for community education and events.  A variety of technical assistance in developing a community team, implementing system change, establishing a cardiac registry, and evaluating the impact on cardiac arrest survival rates will also be provided.   Communities will kick off their initiative through training at the first annual Michigan Resuscitation Academy to be held on March 20, 2015 in Mt. Pleasant.  Two additional award cycles are planned.  For information about this initiative contact Mark Becmer, MiResCu Community Outreach Coordinator at and (231) 350-3447 or Vincent Schwartz, MiResCu Training Coordinator at and (810) 844-1446.  For information about other rural EMS programs and initiatives, contact

HRSA Rural AED Grant: Federal funding provides 100% of program costs, or $150,000 per year.
HRSA Network Development Grant: Federal funding provides 80% of total program costs, or $300,000 per year.

Contact:  Leslie Hall, Executive Director, Michigan Rural EMS Network
Phone:  989-284-5345

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From the Executive Director (February 2015)

Rebecca Davis
Feb 17, 2015 07:53 AM

Rebecca Davis

Welcome to winter. Wait, this is mid-February and we should be thinking about spring! But for most of the country as well, as here in Hardinsburg, Kentucky, we are in the middle of record snow falls, unusually low temperatures, forecast for even lower temperatures for the reminder of the week, and lots of shoveling in our future!  Kind of reminds me of the network world – we think we are moving along and things are going smoothly and suddenly things change. Sometimes we have planned and are prepared for changes, but sometimes they catch us by surprise. 

Last week on the ER Call for Network Leaders, Dr. Mary Kay Chess discussed Creativity & Innovation in new and growing networks,a very timely topic for the changing roles of health networks in today’s health care delivery system.  Do you have the creativity and innovative spirit to refocus your network if faced with major changes? Have you thought about “innovation” and what it may mean to your organization?  According to Dr. Chess and Oxford Dictionary, innovation is to make changes in something established, especially by introducing new methods, ideas, or products. 

You will have the opportunity to participate in an exciting time for NCHN, as 2015 is an important milestone for your Association! NCHN will be celebrating its 20th birthday this year!  I am happy to have been a part of such a growing, creative, and innovative organization since July 2006! I wonder if the founding members of NCHN, thought about what the Association would look like in 20 years? If they thought about what changes the organization would face and how creative and innovative the Directors and Officers, along with the membership would be to ensure the continuation of the Association?

During the recent move from Colorado to Kentucky, I had the opportunity to review files and rediscovered a folder that contained historical documents of the Association. Also, I looked for and found a slide presentation, “Celebrating 10 Years of Success with a Lot of Hard Work and Total Commitment!,”  that Steve Ward, NCHN’s first president had prepared and sent me in the fall of 2006. Steve wanted to capture and share the history of the Association, but more importantly, he wanted the network leaders meeting in Nashville that fall to celebrate 10 years of working together to improve healthcare delivery in rural America.

According to Steve’s presentation, “Once upon a time … in the late 1980s hospital groups such as HCA, VHA, Quorum, and LHS were forming consolidated spheres of influence in the marketplace. Smaller hospitals such as community hospitals, rural health districts, private hospitals found themselves on the outside looking in.”  Survival instinct takes over and Jan Bastian, Montana Health Network was featured as the leader of the pack! 

As Steve continues to tell the NCHN story, “A new species forms! They are islands in the middle of somewhere!”  Independent hospital networks begin to form – (and as you read the listing of those 10 hospital networks that were forming or were already formed in the 1980s, I know that you will be pleasantly surprised and glad to see some names you recognize that have given and continue to give so much to your Association over the years!) :

  • Great Plains Health Alliance, NY, John Osse;
  • Health Community Alliance, NY, Patricia Kota;
  • *Health Future, OR, John Meenahan;
  • **Montana Health Network, MT, Jan Bastian;
  • Northern Lake Health Consortium, MN, Terry Hill;  
  • **Northland Healthcare Alliance, ND, Tim Cox;
  • **Rural Wisconsin Health Cooperative, WI, Tim Size;
  • *Sunflower Health Network, KS, Sheryl Dority;
  • *Synernet, Inc., ME,  Bus Davis; and
  • *Western Healthcare Alliance, CO, Steve Ward.

*Continual NCHN membership; **Founding NCHN leader and still serving as network leader to their organizations! 

The Beginnings of NCHN (according to Steve Ward’s presentation):

  • Those brave pioneers had never met each other and I still don’t know how they found each other! (Amazing, but also shows the creativity and innovation of health network leaders!)
  • The fact is, we needed support as we were the new breed of hospital network directors. We  had to turn inward.
  • We met informally the first time in Minnesota in a Hilton Suite for two days behind locked doors.
  • The only rules, No Board Members allowed.
  • After all… we were going to speak about them behind their backs.
  • These directors continued to meet in concurrence with the NRHA (National Rural Health Association) meetings. There was much discussions of becoming a sub-group of NRHA.
  • Additional Directors of Health Alliances met in Chicago in 1995. At that meeting the decision was made that we should not be confused with or thought of as a political lobbying group.
  • In the Summer of 1995 By-laws for the organization were developed by a group of network Executive Directors led by Steve Ward.
  • On December 4, 1995, thirteen (13) network leaders met for the first official meeting of the National Cooperative of Health Networks (NCHN).
  • On December 5, 1995 the following network leaders signed the Certificate of Incorporation of the National Cooperative of Health Networks Association:
    • Janet Bastian, MT
    • Timothy C. Cox, ND
    • Sheryl Dority, KS
    • Lynn Edmonds, NY
    • Cecil Gray, MO
    • Jeff Houck, OH
    • Patricia Kota, NY
    • John Osse, SD  
  • The first officers were also elected and were as follows:
    • President – Stephen Ward, Western Healthcare Alliance, CO
    • Vice-President – Scott Parisella, Coastal Carolinas Health Alliance, NC
    • Secretary/Treasurer – Janet Bastian, Montana Health Network, MT
    • Officer-at-Large – Paul (Buzz) Davis, Synernet, Inc., ME

Twenty years later it is so very humbling, as well as exciting to see that all five organizations that provided the first leaders of NCHN are still organizational members of the Association! These founding members have continued to be creative, visionary leaders of the Association! 

So now we ask you, as members, to give to NCHN!  We are beginning to plan for a huge birthday celebration at our 2015 Annual Educational Conference, which will be held September 1-2 in Portland, OR. We are looking for members to volunteer to serve on both the Conference Planning Committee and a special 20 Years Celebration Committee.  If you are interested in helping plan, coordinate, and provide on-site assistance at the 2015 Conference, please let me know. 

History of NCHN will continue in March’s column. Until then, if you have any early documents, pictures, and/or members of early NCHN events, please share them with us.  Christy will be collecting member stories of their involvement with NCHN over the past 20 years.  We encourage you to share yours today!  

Rebecca J. Davis, Ph.D.
Executive Director

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