Okay, so today's agenda we're going to describe the National Organization of State Offices in rural health and role of state offices of rural health. We're going to list approaches and methods considered in designing a state rural health plan. Iify potential stakeholders to develop and or advance a rural state health plan. And discuss challenges and successes in the development of a state rural health land. So I want to introduce today's speakers. It is my pleasure to have with us Tammy Norville
, Lisa Davis, and Heather Anderson. Miss Tammy Norville is Chief Executive Officer of the National Organization of State Offices of Royal Hill. She's has nearly 20 years of experience working with and 4 state offices of Royal Health and providing hands-on technical assistance in rural communities with the focus on operations and administrative efficiency. She is a North Carolina native and a graduate of UNC Chapel Hill. And Tammy is committed to finding innovative and straightforward ways to hel
p state offices of rural health, role providers, patients, neighbors, and communities become. Oh, become and remain more will comprehensively while moving the power of role forward. Next, we have Miss Heather Anderson who serves as the director of the Division of Primary and Rural Health at the Virginia Department of Health. In this role, she directs Virginia State Office of Rural Health to address and rectify health disparities affecting the state's rural residents. She accomplished this throug
h establishing and growing partnerships and collaborations throughout the Commonwealth. And we also have with us Miss Lisa Davis, who is the director of outreach for the Pennsylvania Office of Royal Health and its associate professor of health policy and administration in the College of Health and Human Development at Penn State University. She serves on a wide range of boards of directors. Advisory committees and task force for national, state, and university level focused on rural health polic
y, rural health research, economic development, outreach and education, vulnerable populations, and specific health issues such as oral health and cancer. Additionally, she is the recipient of the Distinguished Award from the National Organization of State Offices for Rural Health, an outstanding leadership award from the Pennsylvania Rural Health Association and an award for individual contributions to the public health from Pennsylvania Public Health Association. Welcome Tammy Heather and Lisa
. Hey y'all, I'm Tammy. And I'm sorry, Saman. I mean, in a rep. Just let me know when you want me to advance. You can just say next slide and I'll move forward. Thank you. I sure will. I shall will. Thanks. So hey y'all, I'm Tammy Norville, CEO of the National Organization of State Offices of Rural Health. We're the member association of the 50 state offices of rural health across the country providing capacity building and support to all state offices and the stakeholders in rural communities t
hey serve. Thanks to faith for the opportunity and I'm delighted to help kick off this amazing gathering. Next slide. So a question get us started. Why? Why do you do what you do in the way that you do it? This single question is the heart and soul of the rural health business, but also how we go about articulating or telling the story of services provided. It's our approach to engagement. And partnership development. So I assume your why is similar to ours. Our why is to help state offices of r
ural health or sore. Rural providers, patients, communities, and neighbors become and remain more well. You might ask yourself. How state offices of rural health might help meet your need. Lisa Davis of Pennsylvania and Heather Anderson of Virginia 2 of our innovative state office overall health directors are gonna walk us through how they use their rural health plans to do just that. As an aside, if you don't know your why, if you know Simon Sinek, he's a leadership development guru YouTube aut
hor kind of TED Talk guy. He talks about getting to the why of your business. That's how you make impact. Being able to convey that why you can Google him and find out all about it. Next slide, please. So you might be asking yourself, Tammy, what is no sore and I am so glad you asked. As I mentioned, the National Organization of State Offices of Rural Health or NOSE or is the member association of the 50 state offices of rural health across the country. And our mission is to provide capacity bui
lding and support for state offices. Their stakeholders and partners. So no sore was established way back in the mid ninetys to assist sore in their efforts to improve access to and the quality of health care for approximately 61 million rural Americans. We promote the capacity building of and land support to state offices to improve health care in rural America through leadership. Development, advocacy, education, and partnerships. Next slide. It's simple terms, no sort connects, leverages, and
resources partnerships in communities to improve rural health. Saying it another way, we help state offices help their rural providers, patients, communities and neighbors become and remain more well. Are you picking up a theme? That's why we do what we do. We provide this capacity building and support through many means. Education, collaboration, innovation, and communication. We called that moving the power of rural forward. We're all about connection. How do we make the pieces fit? So one th
ing to remember. Is rural health as a family. And I use that word intentionally. So for all the good, the bad, and the ugly that might be associated with the construct of family. So is rural help. For all its differences. Like you've seen one rural community, you've seen one. To all its similarities. One thing is for certain. Find in ways for providers. And I don't just mean physicians or physician assistants or nurse practitioners. All kinds of providers. Whether in a multi-provider practice or
a single provider practice, ensuring providers as the head caregivers. Have connection and support. That is so imperative for long-term success. But also for the success of the practice, the business, whether it's inpatient or outpatient. Next slide. No sort of education brings attention and in-depth understanding to key rural issues. Capacities, connecting state offices and their stakeholders with trusted partners that we rely on to help with these efforts. Speaking of connections, interesting
ly, Even though our educational resources are mostly targeted at state offices of rural health, about 40% of our participants are non-sour. So y'all need to come and participate. Being the member organization for the 50 state offices, we develop and provide education tools and resources of a wide range of topics. You can check out our website. Knowsore. Org to take a look. If you can't find what you're looking for, drop me an email. My contact information is on a later slide. The capacity buildi
ng and support provided to all or helps them build their skills to help everyone they work with be successful long-term and to help them help rural providers become and remain more well. As natural connectors, collaboration is in the DNA of state offices, of NOSEOR, and rural health care providers in general. We do it with the intention of enhancing understanding of rural and providing resources to improve rule. We refer to this as moving the power of rule forward. And right alongside collaborat
ion and connection is communication because it's hard to collaborate and connect without communicating. Association, No SORE communicates policy and program changes regularly and then state offices communicate with rural providers and communities. On another communication front, National Rural Health Day was created more than a decade ago. To shine a light on all the positively unique aspects of rural health. It's an opportunity for rural communities and state offices of rural health to help us
shout out about rural health efforts and to honor rural rock stars through the community stars program. These rock stars are celebrated. Dear National Rural Helps a Week. Combinating on the day. The third Thursday of November each year and then throughout the year via social media from no sore and the sore for the star state. Next slide. So as I said, we said aside the third Thursday of November to celebrate the power of rural National Rural Health Day as an opportunity to bring attention to and
honor the incredible effort of rural health care providers, communities, organizations, state offices of rural health, and other stakeholders dedicated to addressing the unique health care needs of rural America. So. This year, National Rural Health Day is Thursday, November, 20 first. Check out Powervorl. Dot org. And find free resources and community star stories as well as key messages. Remember, we set aside the third Thursday of November to celebrate the power of rural on National Rural He
alth Day as an opportunity to bring attention. To and honor the incredible efforts of rural health care providers, communities, organizations, state offices of rural health and other stakeholders dedicated. To addressing the unique health care needs of rural America. But all of Nosaur's work is accomplished with trusted partners. The State Office of Royal Health, their stakeholders folks like NRHA, the National Rural Health Association in AREHC, the folks like faith, none of us can do this work
alone. And fortunately, we don't have to. It takes all of us, each in our own way, connecting to establish relations, to collaborate. Contributing to the power of rule movement, helping our rural providers, patients, communities, and neighbors become and remain more well. Next slide. As I mentioned, each state has a state officer rural health. The one-stop shop in your state for all things rural health. So are come in 3 organizational types. State offices living in state government. Some in acad
emic institutions and 3 that are independent nonprofits. Check out our website if you need contact information. It's noswer.org. Since state offices are that one stop shop of all things rural health within each state, they work closely or house the primary care office. Which is where all designations happen. Health professional shortage areas, medically underserved areas, medically underserved populations, etc. Most Hersa grants require some designation for funding eligibility. In addition, HRSA
houses the Bureau of Primary Healthcare, where National Health Service Corps is located and the loan repayment programs are housed. See how all those things connect? Sore statewide organizations designed to work at the local level linking federal and state resources to rural and frontier community need. They do that in 3 core areas, information dissemination, coordination being key conveyors and they reduce duplication when needed and providing technical assistance. Last year, about 20,000 TA c
lients and participants were helped. Stay offices are the connection to state and federal resources for hospitals, clinics, and thousands of rural health partners across the United States and work to improve access to health care and resources in rural and underserved areas. Next slide. No matter the organizational structure, No source, state offices, and y'all, we're all working towards the same goal. Despite our rural communities, generally having older, sicker and poorer populations, We're al
l dedicated to making our rural neighbors and communities more well. It really is about connections. Connecting y'all to information, services, assistance, either directly or connections that state offices might have within the state and beyond depending on what the need is. State offices meet folks where they are. So I like to say, let's help state offices help you all. They are the conduit that might help you meet your wife. And as I mentioned before, all of Nassau's work is accomplished with
trusted partners. So remember, none of us can do this work alone. And we don't have to. It takes all of us contributing to the power rural movement. Next slide. So let's go back to our. Question of why. Why do you do what you do in the way that you do it? Remember, this is the heart and soul of the rural health business, but also how we go about articulating or telling the story of services provided to patients we serve. You have to understand the why in order to get to the what and how of servi
ces provided. So I hope you can kind of see how value fits into rural health. What we do and how we do it, if you know about CPT codes. Tales the story of the why or ICD 10 the diagnosis codes that include medical necessity That's the crux of value. Finding and embracing your wide will help in your day-to-day operations no matter what you do. Development of outreach efforts and framing how we respond to challenges and change. More importantly, If you really embrace your why, you're so deep motiv
ation for the work you're doing, it strengthens resilience and job satisfaction. Exponentially. Next slide. I appreciate y'all allowing me to take a few minutes to talk about no sore and state offices of rural health. Thanks again to Fate Steel for allowing me to be part of this amazing webinar. Special thanks to Lisa Davis and Heather Anderson for including me. And thanks to y'all for having interest in helping your rural communities and neighbors. But come and remain more well. Moving the powe
r of rule forward every day. Again, I'm Tammy Norville, CEO of the National Organization of State Offices of Rural Health or No SOR, the member association of the 50 state offices. Overall health across the country. Let me know if you have questions or if we may be of assistance. That's why we're here. Thank you so much. Thank you, Tammy. We, so appreciate you making time for us today. I think next up is I'm gonna pass it over to Heather. Thank you. Good afternoon, everyone. I'm delighted to be
a part of this presentation and tell you a little bit about Virginia's experience and updating our state rural health plan. It's our why to continue with Tammy's theme. I direct the State Office of Rural Health in Virginia and I also direct the primary care office. Next slide, please. This just tells you how we're funded. We're a partnership between the Virginia State Office of Rural Health and the Virginia Department of Health and our federal funders at the Federal Office of Rural Health Policy
. Next slide, please. So we have several items I want to share with you today about our state rural health plan. I'll tell you about our approach in developing the plan. Why we chose the topics we did. The challenges we faced, who wrote the plan, who we wrote the plan for, and who we hope will use the plan, and some successes of our plans so far. Next slide, please. In Virginia, the last state rural health plan was produced in 2,013. The purpose of the state role health plans at that time were t
o establish critical access hospitals. Our previous plan was very hospital focused. In 2,019 our team decided we needed a new plan to prioritize the work of the State Office of World Health. Virginia has the plan for well-being and we have state health improvement plans, but nothing that was specifically rural focused. Rural Virginia covers 46% of the state's landmass and 12% of our population live in rural areas. Next slide, please. So I love this quote and it's true for our process. This rural
health plan would not have been done without the right place, right team in the right place at the right time. There were 9 of us, some were behind the seams. Some wrote the plan, some interviewed stakeholders, some provided the vision. We painstakingly combed through pictures and themes and look for model programs to highlight. But boil down to the fact that we were a cohesive team with different perspectives and talents. We balanced each other out and trusted each other and it worked. Next sl
ide, please. So a little bit about Virginia. It's a fairly large state not as large as Pennsylvania, but most Virginians live closer to another state capital than they do to Richmond. It takes 5 h to drive from the very tip of Virginia to Richmond. Virginia has some of the wealthiest populations in our state and those are significantly, in the Metro DC area. But Virginia is also home to some of the poorest counties in the area. In the country. If we were to lop off the top of Virginia, the state
would look very different. Economically, culturally, and health-wise. The area known as the Blue Ridge is part of Appalachia, an area known for chronic poverty and poor health. The eastern shore of Virginia is separated from the rest of the state by the Chesapeake Bay and a 17 mile bridge and tunnel. Next slide, please. So this is what we did in August, 2,019. We gathered our subject matter experts in a room and brainstormed about how we wanted to go about updating the plan. We ended up with ou
r core team and as I said, everyone had different strengths and perspectives. We desired to hear from people who were beneficiaries of our programs, not necessarily the people working in healthcare. Are research involved focus groups, subject matter expert interviews, site visits, and key informant interviews with funders and community leaders. Prior to our community meetings, we reviewed all the community health assessments done by our local health districts, governments, or hospitals. To devel
op targeted interview questions that were in addition to the standardized ones we asked every community. Next slide, please. Our first step was to figure out where to go. We looked at data from the Wood Johnson Foundation, the county health rankings, the Appalachian Regional Commission's economic distress index, and our own health opportunity index. We utilized our own lived experience as well. Most of us in the room grew up in rural areas or still lived in them. Early on we knew we wanted to us
e grassroots community-focused approach to validate our assumptions and research. We wanted to hear the community's perspective that's often missing in the in the data. The SOAR team embraced unconventional methods to bring community members who don't traditionally participate in the updating of health plan to the table. In order to do this, we took the national information and then said, what else do we want to know? At that time, we knew quite a bit about the counties identified as distressed.
But we wanted to find out what was missing that could be part of the story. This was not to cast the national expert information aside, but instead to look underneath the national level reports that sometimes leave us with broad categories. We decided we wanted to go to distressed areas in areas that are in the shadow of urban areas like Scott County, which is near Abingdon in southwest Virginia. We're a million, which is close to Richmond. We wanted to include people not normally asked. We rea
lly wanted to listen to people who use healthcare services who sometimes struggled trying to get work. We wanted to speak to Civic and business leaders, teachers, law enforcement, and EMTs because they often see the effects of health care gaps. This map shows where we went. We went to Bluefield, Pennington Gap, Stuart, these places are pretty remote and then we went to Amelia and to Danville. In Dando, we had a program at one of the high schools that was a youth leadership program. We talked to
those students. It was really eye-opening. They were very forthcoming about the violence experienced in that community and the shortcomings of some of the solutions that were offered. We started in the fall in Southwest Virginia in 2,019 to get ahead of winter weather. We took a break during the holidays for obvious reasons and to determine if we were on the right track before proceeding again in March. You're planning on hitting the Blue Ridge in March and ending up on the eastern shore ahead o
f the tourists in May. We had identified 11 locations that we wanted to physically go to for conversations. Next slide, please. Our approach was, you know, innovative and unique at the time. We decided to keep it local. Our tagline was come for supper and stay for the conversation. What's more rural than a cover dish supper? We did our own version. We engaged our community experts to help us identify locations people were used to going into. Places like the VFW or theater. Or a library. We didn'
t want the building to be a barrier to people walking in the door. Ahead of the conversations we did site visits and held key informant interviews with community leaders, stakeholders and business owners for their perspectives. We even hung out in a coffee shop in Stuart and talked with folks. We know people easily engage in a conversation over a meal. We worked with the Rural Health Association to find a mom and pop place to provide the food for the evening. We knew that if people bothered to c
ome to our meeting, we wanted to get their perspective. The biggest rule was no PowerPoint. We wanted to really listen. We stood in the background and listen to conversations during supper and took notes. After supper, we had a local facilitator who knew the people in the room and the issues raised to guide the conversations. The facilitator served as a local translator for LANGO about places or organizations. At the table, we used a model called World Cafe Style where there were index cards wit
h questions on them at each table for people to respond to. There were big pads and pens on the table also. After 30 min, the facilitator brought the group together to hear what everyone talked about. Everyone answered the following questions. What are the good things about your community? Name one or 2 things that you wouldn't that would improve the health of your community. And what is wellness and what does it look like here? The conversations led to themes within the plan along with the oppo
rtunity to learn about community or regional best practices. Next slide, please. We were on our way to Page County in March, 2020 when the entire world set down. So we took a break, a break between March and August and then got back to work. Next slide, please. So during COVID, we spent a lot of time explaining to contractors and others about rural populations. We also spend a lot of time talking to many about messaging to a population that's known for not trusting outsiders. We had to rethink h
ow to connect with people who were bombarded with information. We had to figure out how to keep the trust of some very fragile communities. Virtual discussions were a challenge for a number of reasons, primarily connectivity. Instead, we decided to conduct subject matter interviews and added redcap surveys for anyone to respond to. We ramped up our newsletter and social media efforts and we used partners to get the word out about the surveys. Fortunately, we had had enough face-to-face conversat
ions in the beginning that we were able to identify themes heard nearly in nearly every conversation. The conversations led to the topics within the plan along with community and regional best practices. During our conversations, we learned about community resilience and tenacity. We learned about abandonment and isolation. We learned about grandparents raising grandchildren. We learned about the beauty of rural Virginia and the pride people have in their communities. And we learned how importan
t faith-based organizations are to small communities. Next slide, please. In retrospect, our ability to work virtually became a blessing for this process. Our team worked on this document from the fall of 2020 until it was completed at the end of 2,021. Our team was large enough to support one another when COVID duties called and members had to step away or if there was another interruption. For many, this work was a welcome break from our COVID duties. Most of us had personal challenges along t
he way. Name a challenge and we experienced it. We had 2 babies during in our team during this time frame and had to work around maternity leave. That was a challenge. We also unfortunately experienced illness. But we also experienced graduations and most importantly, we adjusted to working from home, from our couches, with our dogs by our side. Next slide. Another part of the process was before we began writing, we trained ourselves to use a new asset-based language when speaking about rural. W
hen one of us would say diseases of despair or distressed communities and another team member would gently correct that person. When we would hear about it gap, we would look for an antidote somewhere. We began to look for champions. And solutions and started to speak in encouraging language. This was not easy. Negative language was everywhere. It's how we're educated, right? As public health providers, we're trained to look for gaps and challenges. We also began talking about how we wanted to p
resent the information along with the look of the plan. We decided early on that this document was not going to be an academic looking, but instead of Use pictures of local areas and highlight champions and present a positive tone. During our conversations in spite of talking about serious long-term challenges, Our rural communities told us they were very proud of the beauty of their area and the assets their communities have. We wanted to capture and honor that feeling as well. Next slide, plea
se. Another part of our approach we took was to define rural Virginia. We get asked to define rural all the time. And the problem is it's not easy. Within the rural health plan we try and explain world Virginia as best we can. Depending on which lens you use, it gives different results. For instance, in 2,01788% of Virginians thought they lived in a rural area. Another way to look at rule is simply by the numbers. The Office of Management and Budget defines a micropolitan area as a population of
at least 10,000 but fewer than 50,000 people. So using this definition, 46% of Virginia's landmass and 12% of the population and 8% of the economy are considered rural. That seems pretty good, but there's still some areas left out with that definition. The state of rural health understands that there are areas in Virginia that are rural and yet because of their proximity to an urban center they don't qualify for rural resources. Most for unions associate role with open spaces. Slower pace and a
small town lifestyle. At the end of reading this plan we want everyone to understand that rule is a culture you'll see in clinics. It's an economy that often struggles to compete and it's most certainly a geography. Next slide, please. So the plan is centered around these 13 themes which were identified with the question, what would a healthy community look like? People spoke about the good things and the missing elements within their communities. This list, with the exception of a few, was nam
ed by most everyone we spoke with. A topic that surprised us a bit was the need for financial literacy. People everywhere struggle with understanding an insurance statement or how to use credit wisely. Even though this is not specific to health, if you consider the role poverty plays in health. We could not ignore the topic of financial literacy. You can see where we turn talking about a gap into a goal. Lack of affordability, affordable housing became healthy housing. Chronic diseases became he
althy minds and bodies and so on. Next slide, please. So we're hoping this role plan will really come to life. We want people to use this plan as much as possible. Internally, we use it to amplify and focus our 5 priority areas and to provide information about rural areas, regions, and communities in a unique way. As the sore we're focusing on food insecurity, behavioral health, telehealth workforce, and substance use disorder. And we're working to develop partnerships throughout Virginia, which
focus on each of these areas. We hope that many audiences are able to use this plan to guide their works. Next slide, please. The list of potential stakeholders for implementing this plan is endless. We don't want this plans usage to be limited to healthcare providers. We learned that a healthy community with healthy people requires all sectors to work together. We've cobbled together a list of agency types that are the low hanging fruit for partnerships in a community. Don't rule out an agency
just because they don't work in health care. For instance, Chambers of Commerce or Board of Supervisors may not know that by adding a sidewalk and a down town area. Would increase access to businesses or the walkability of a location. And of course, you all know that libraries are great places for community resources of all kinds. Don't forget churches, small businesses, pharmacies, and schools. Next slide. Please. So I'm happy to say that there's been many successes from the updated state rura
l health plan. Many partners use it to target their programmatic work at their individual agencies. The sword took the opportunity to write and publish a series of policy briefing. Each policy brief took a gap. In a rural community. Identified a local resource to interview and made policy recommendations. And we published about 7 of these. So as Tammy said, I really want to encourage you all to support the power of rural. Yes, first of all, I just want to say thank you very much Tammy Heather an
d Lisa for this. This is something I heard Heather give a presentation at the VCOM rule conference and I just thought it was so compelling to listen to her story about how she developed it. And then when I reached out to her, she, reached out to Tammy and Lisa who, were gracious enough to. Also participate in this webinar. So I just wanna thank you all for this and for your time today because I know you're all very busy in doing things. So the chat is open for questions. I'll kick it off. I do h
ave a question. Something you kind of alluded to earlier Lisa which would be rural and urban. I would assume most people on this call are here because they have an interest in rule. However, I don't want to rule out that they're play on words, that there are people that are urban as well and that why these things matter to urban people as well, are people also residing in urban communities. Well, rural and urban are very much connected. And I think that especially when we are looking at health c
are delivery systems in Pennsylvania just like much of the country we are seeing a consolidation of health care delivery systems and I think having a strong rural and healthy rural population is quite important because of not only the food that is grown, most of that is grown in rural areas, but also if you look around your individual state you will see that the much of the economic development activity, especially when it's related to tourism. Occurs out in rural areas. So it is a very strong e
conomic driver. But also we are looking at the fact that all of us are connected to a system of some kind. And it's not one versus the other. It is all of us together. So I think that that is one reason why urban needs to be thinking about rural. I can also say that using these rural health plans is absolutely vital. Our state, like many states, also has a state health improvement plan, which is a plan for the entire state in there and in that plan and in our plan. Are lots of terrific data. Tha
t can be used. When developing, evaluations, developing proposals and so on, and bringing in rural voices is important when we are starting to think about diversity, equity, and inclusion. So wanting to make sure that we are representing the needs of all of the members of our state. And It I think it provides a richer type of perspective. Great. Thank you so much. I do have a question for Tammy as well, Tammy, you mentioned that. Anybody, maybe anybody can join as a member of the organization an
d I just wanted you to briefly kind of talk about non rule offices that you have that are members so that people might kind of understand you know the benefits of membership or just you know other things that how they can tap in. Partnership. So it's not really membership, it's partnership and collaboration. We do a lot of partnership and partnerships and collaborations and we look for mutually beneficial arrangements. That's pretty easy, right? It's, it's, it never ceases to amaze me how if you
just kind of talk to folks. How soon and how quickly and how easily A lot of work that folks do on an everyday. Basis work together to improve. The help and wellness comprehensively of the folks around them. And that's kind of a universal thing. It's not just urban. It's not just rural. If I may back to the urban rural. Connection for a second. A lot of urban communities have health care centers called community health centers are federally qualified health centers. These folks are federally qu
alified health centers are funded through the Bureau of Primary Healthcare that I mentioned earlier that's associated with the primary care. So sometimes the primary care office and the state off several health are co-located. They definitely work together on a regular basis to help establish these special designations. Medically underserved populations, medically underserved areas, health professional shortage areas. So even if you're in Europe, if you're in a rural community, you may actually
have a closer tied to the State Office of Rural Health than you realize. So I hope you'll take a minute and if you don't know folks in your state office of rural health that you'll go to nosaur. Dot org and look up your state and find that connection. I think that you will, A, find someone who has connections. Everywhere and in places that are Not necessarily what you might consider traditional. Health care because we do spend a lot of time talking about influencers of help or social determinant
s of health depending on who you talk to. So thinking about those things happy to make those connections if we can. Wonderful, thank you. And I have a question, a final question that kind of will roll up and feel free to answer too, Lisa. I mean, Tammy as you see fit, but it's a little geared towards Lisa and Heather. As far as. How this goes to rolling up to your larger state health plan, for example, because I'm sure there's a big Pennsylvania or big Virginia health plan and then this is a com
ponent of that so you know in developing this does it also you know potentially go to the governor or other people you know how this kind of works in continuum with your larger health plans if that makes sense what I'm asking. Yeah, it does. So I'll jump in quickly. Obviously our health plan has been identified by the General Assembly because they're using it to inform their work that they're going to do to study rural health. Our governor has copies of the rural health plan and and uses it to a
lign a lot of his priorities. And we are really grateful that he's picked that up and does that. As far as the agency, the agency is in the process of updating their state health improvement plan. And they looked at our rural health plan and they said. We've done, you've done rural and it's been recent, so we're going to use that to actually inform and so we will actually end up in Virginia with 2 separate documents, but they're gonna complement each other and work side by side. For the populati
on. So we're very grateful that that it's being used so thoroughly in Virginia. And we're different here in Pennsylvania. The Pennsylvania Department of Health leads the development and implementation of the state health assessment and the state health improvement plan. It took me a about 20 years. To get approval from the Department of Health to do a stand-alone rural health plan. We like Heather had done one many years ago back in 2,000 to satisfy some federal grant requirements. But I also se
rve on the overall state health improvement plan committee and on multiple subcommittees and on the state health assessment. So there's lots of overlap and with our advisory committee and with those who are working at the state level. They are on our committee as well. So even though they will be 2 standalone plans. Ours is quite comprehensive because it's the first one in 20, well, in what will be 24 years. So we wanted to make it very comprehensive and then we will be doing probably updates ev
ery 3 to 5 years that will be much shorter and much more easy to digest. But they will also reference the state health improvement plan because it is so important that all of us are working together. And also our governor's office is starting to focus on rural health, which is fantastic. First time ever. At least in my history in the state that our governor is planning on doing that and the state health improvement plan will inform some of that. Wonderful. And I asked that question because kind
of when Tammy was talking earlier about, you know, this being a partnership between different types. We have a lot of areas I would think in all of the states that have even a blend of both, like there might be a county that's not 100% rule. It's not 100% urban, but it kind of contains both of those. And so that particular county would have or areas that it may apply to would have an interest in this because they've kind of got a blend of both of those and we're seeing this too as people start t
o move out. Heather, you mentioned earlier Northern Virginia. I remember when Northern Virginia was the affordable place to go for DC and now not so much. Now you're moving out to like Manassas and Spotsylvan and like, you know, farther places than they were before. And I'm assuming all of those communities that you guys live in are experiencing some of that as we get into some affordability challenges for housing and what have you. So. And I would also say that, one reason to like for here in P
ennsylvania, we have 67 counties. We have 48 predominantly rural counties. But out of our 67, only one of our counties has no rural percentage in it. And that's Philadelphia County. So I think you're absolutely right. Every single county has rural communities. And that is another reason to want to invest in here in our state, 26% of our population. Lives in areas that are designated as rural. The other reason is, and I'll say this really quickly, because I know we're running out of time, but we
saw this especially during the pandemic. That when when urban dwellers were needing a place to go where they felt more safe. They were going to rural communities. They were going after hunting camps. They were going to vacation homes. They were going out and making and and working and living in those communities. And some of them have not returned. Back to their back to their urban areas. So it's really important that rural health care delivery systems. Be strong and vibrant so that they can add
ress the needs of new residents but also residents who are coming through. Well, again, thank you all so much for presenting today. Thank you all for your interest and attending this webinar. I will send out a link to the recording. It will have the corrected link to the evaluation in it. I'm also have a separate instructions for a CE credit for MLACE Credit as well. Again, thank you all so much for agreeing to be on this. I hope to see you all again soon in the future webinar. And again, thank
you so much for just your work in doing this and helping us to understand how we can support the power of rule. OkayThank you, Faye
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