Q&A: Office of Rural Health director discusses the workforce pipeline and access challenges for rural communities

Ashley Moretz is the director of the Office of Primary Care & Rural Health at the Utah Department of Health. He has been the director since Feb. 2020 and aims to improve health care access to rural, underserved communities in Utah. 

In this Q&A, Moretz discusses the challenge of workforce shortages in rural clinics and hospitals, improving the health care professional pipeline, and the financial health of rural clinics and hospitals.

 

 

Patrick Jones: What are some of your biggest concerns for rural health primary care clinics and hospitals in Utah right now?

Ashley Moretz: “I’d really start with the workforce. Our health care providers, whether it’s doctors, nurses, or other support staff, are just really stretched thin. Before COVID-19, we already had workforce shortages in Utah. More appropriately, these are maldistributions and how the providers that we have are spread out across the state. But, COVID only made that worse. We’re seeing some attrition among the staff, whether that’s through early retirement or other reasons that people are leaving the workforce. The morale is a bigger problem, though.

This strain on the health care workforce is considerable, and it’s grinding, day in and day out. Anecdotally, we’ve heard about nurses, for example, advising students not to go into healthcare. That’s really, really troubling for us because it’s already hard enough to build that pipeline of future healthcare workers, but if we’re going to have any gap in that, that’s going to create longer term challenges for us to keep that pipeline full.”

PJ: What are some measures that have been put in place to try to encourage newer generations of the health care workforce to enter the profession and into rural centers?

AM: “There are a number of programs that existed already before COVID to help build the pipeline. So there are programs like the AHEC program, which is the Area Health Education Centers. They have a number of programs that look to encourage people to choose and pursue health care careers. Once you’ve already taken that step to enter into school, our office administers a number of programs — with both state and federal funds — that offer incentives for educational loan repayment. For example, [we are] trying to incentivize providers to work in rural and underserved areas. If you’re a behavioral healthcare worker, working in a publicly funded facility, you can get very attractive, state funding to help repay that educational debt. We have another program that supports not just behavioral health specialists, but a broader-based health care workforce to incentivize providers to work in rural and underserved areas.”

PJ: Have there been any impacts from these programs in this new COVID world yet or is this more of an investment towards the future of the rural workforce in Utah?

AM: “I think they’re really still more of an investment in the future. The program that I mentioned for the behavioral health workforce was actually funded during the legislative session in 2020, so we just started making our first awards in October of last year.  We got a very generous $2 million appropriation from the Utah State Legislature, and we’ve already been able to make awards totaling over a million dollars to behavioral health providers working in these rural and underserved areas. These programs actually have not just a recruitment element to them, but also a retention element. [We are] trying to keep people in their jobs, especially for the behavioral health specialists working in publicly funded facilities who might be relatively lower paid than others in the private sector. So, if we can help with their educational loans, that can serve as an incentive that may help them stay in that job where they’re serving patients that really need that care.”

PJ: What have some of these rural facilities been doing to stay afloat financially during this pandemic?

AM: “I can speak a little bit from some of the experiences of the programs that our office administers. For example, rural hospitals have gotten direct funding through a federal program called the Small Hospital Improvement Program (SHIP), and that funding was provided through the CARES Act. Then, another round through the American Rescue Plan Act (ARPA) funding. The funding that’s gone to the rural hospitals, has allowed them to make some changes and improvements to keep their staff safe, mitigate the spread of COVID, expand testing capabilities, and many of them have used those funds.

Telehealth also has helped. They’ve been able to use telehealth for virtual visits there and the change in Centers for Medicare and Medicaid Services (CMS) rules that allow for telehealth visits to be reimbursable has really helped them. They have reached parity for that.

There’s been additional ARPA funding that’s come in to help with lost revenues and costs associated with COVID-19. Just recently, a number of health centers in Utah got over $7 billion in funding through ARPA that’s going to help them with getting freezers if they need to store to vaccines, mobile vans to get out and reach out to underserved communities, help with some of the equipment for telehealth, and also facility needs.”

PJ: What are some of the main problems with access for rural patients in this COVID environment? What is your biggest barrier to providing care?

AM: “As we look to move to telehealth, access to broadband has been uneven across the state. It’s good that that’s been one of the priorities in Governor Cox’s One Utah roadmap. There has been a real focus on rural issues, including the infrastructure for rural areas. That’ll still take time. I just read an article where someone said that, in rural communities, “medicine moves at the speed of trust.” So, the adoption of telehealth will still take time. But getting that infrastructure in place is critical to it so that people can have the time to adapt and increase their trust in new ways of getting their healthcare.

Every few years, [our office] does a primary care needs assessment. A couple barriers were identified, like the geographic isolation and transportation to be able to get care. If you don’t have transportation, you’re not going to be able to access care.

Another barrier is [around] health insurance coverage and the ability to afford care. We have higher uninsured rates in the rural communities. Some of that infrastructure for low cost or other subsidized health care isn’t there in the rural communities in the [same] way [as] urban settings, including free clinics. So, that lack of coverage can hinder people’s access to care.”

PJ: What gives you hope for the future?

AM: “One thing I’d point to is the way the Navajo Nation started during the pandemic. They had really serious challenges with COVID-19. They [were] already dealing with health disparities. So, the effect of the pandemic was much more severe. At one point, the Navajo Nation had the highest COVID-19 infection rates in the entire country, if I understand correctly. So, they turned things around. They put strict protocols in place, were consistent with health messaging, how to address it, what they could do, and Navajo Nation leaders worked with the health care providers and systems to promote a successful vaccine campaign. They came together to protect each other, protect their community, and look after each other. As a result of that, they’ve seen really positive outcomes. That shows me that there is a way forward from here, and we can learn from that, by coming together and focusing on the health and well-being of our entire community.”

This interview was edited for clarity and length.