‘In perpetuity’ – Wyoming officials outline long-term strategy for federal Rural Health Transformation funding

(Cheyenne, WY) – Wyoming’s plan for using its federal Rural Health Transformation Program funding is unique in the nation due to its focus on long-term sustainability, state officials said this week.

“I think Wyoming stands out among the other 50 states … with how we’ve designed the financing on this,” Wyoming Department of Health Director Stefan Johansson said during an RHTP press conference Monday. “(We’re) thinking about 20, 30, 40 years down the line.”

Johansson was referring to the portion of Wyoming’s RHTP application that proposes establishing the Wyoming Health Transformation Perpetuity – an investment vehicle that would allow the state to use some of its federal award “to generate returns … to fund specific health transformation initiatives in perpetuity.”

The application says those specific initiatives include:

• nursing-related, EMS, physician, or behavioral health workforce training
• physician post-graduate medical education
• fixed cost coverage for critical access hospitals
• EMS regionalization

“We’re excited (to) set up that perpetuity account so that when we invest in the hospital incentive programs, our EMS transformations, and our workforce development, we don’t just do that in a rapid fashion … but we accrue those investments and are able to make those investments over a very long period of time,” Johansson said, thanking Wyoming Gov. Mark Gordon for his leadership in that area. 

Johansson also expressed gratitude to the people of Wyoming who weighed in as state officials worked to craft the RHTP proposal last year.

“The public … developed this application with us through a series of town hall meetings, online meetings, (and a) statewide survey,” Johansson said. “We went to rural and frontier places in Wyoming… to hear from the people to get their feedback, to really understand (their) priorities. If they could invest this money, where would they invest it? How would they invest it? And that’s really and literally what developed the priorities and initiatives in our application.”

State officials engaged with Tribal leaders as part of the application process, too, Johansson said, pointing out that the Eastern Shoshone and Northern Arapaho Tribes have made “really impressive” progress in building out their own healthcare infrastructure over the past decade.

“Their experience … was really pivotal in helping us develop some of these applications,” he said. “We’re excited about that partnership. (There are) multiple areas where our Tribal governments and Tribal partners could apply and propose to be part of these investments.”

Public priorities

According to Wyoming’s RHTP application, the ranked priorities that emerged from last year’s public engagement sessions include:

1. Improve the financial viability of small rural hospitals to provide basic services to their communities. 
2. Expand affordable health insurance options. 
3. Recruit and retain primary care physicians, in order to improve access and build longer relationships with patients. 
4. Train and recruit more nurses and related direct care workforce (e.g. nursing assistants) in order to improve staffing at hospitals and long-term care facilities. 
5. Strengthen obstetric/gynecological, labor/delivery and related services so women can deliver babies safely. 
6. Recruit and retain more home health aides, and invest in home- and community-based alternatives to nursing home care. 
7. Expand the integration of behavioral health and primary care, in order to better treat the whole person. 
8. Improve access to specialty medical care in local communities (e.g., orthopedics, pediatrics, geriatrics). 
9. Improve or sustain ambulance availability to ensure timely responses to emergencies.
10. Recruit and retain more medical support staff for the health care industry (e.g. radiology, laboratory, therapies, medical assistants).

“The public who showed up … brought really incredible feedback and ideas,” Johansson said. “We really used that feedback to craft something we think is conservative, practical, innovative, and something that can truly take advantage of this Trump Administration opportunity to transform and sustain rural care.”

Gordon called the proposal a “smart, very conservative, (and) sustainable program for Wyoming going forward.”

“This represents a once-in-a-generation investment to stabilize hospitals, ambulances, doctors, and emergency care, especially in rural communities,” he said. “Wyoming has secured over $200 million in federal funding to address basic healthcare problems that rural families live with every day. The funding for this year, with potential of over $1 billion in five years, is really a remarkable start.” 

Almost half of Wyoming’s RHTP funding will be used to support small rural hospitals and emergency care, Gordon said, while 25 percent will go toward workforce training, 16 percent will be used to fund the Make Wyoming Healthy Again initiative, which “will tackle diabetes, heart disease, and suicide,” and 9 percent will go toward technology investments to support telehealth, transport, billing, and local specialty care options  – “all critical aspects of making sure that our healthcare providers can have a sustainable future.”

One percent of the funding will support the development of a “catastrophic medical plan” in Wyoming, Gordon added, and less than 1 percent of the total will be spent on administration.

“The bottom line is, this program will protect hospitals, strengthen emergency care, grow our rural healthcare workforce, and bring care closer to home,” he said. 

State and federal officials will revise and refine Wyoming’s RHTP proposal over the next couple of months, Johansson said, anticipating that, “if everything goes how we think it will go … as we get into February, March, and April you’ll start to see requests for proposals (and) applications as we implement the various elements that you see within the application.”

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