John Barnas is the Executive Director of the Michigan Center for Rural Health and Crystal Barter is the Center’s Director of Programs & Services. They are a private, non-profit office of rural health. Their Board of Directors brings together representatives from state government, the Michigan Department of Health and Human Services, the Michigan Health & Hospital Association, Michigan Association of Local Public Health and more.
In this Q&A, Barnas and Barter discuss how to reduce stigma against substance use disorders, working to incentivize health care workers to work rurally, and training board members on hospital financing.
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Patrick Jones: What do you think are the biggest concerns with rural health in Michigan right now? What are you spending your mental energy on?
John Barnas: “So as we’re talking about issues, we’ll focus on different programs and services that we’re managing in areas, including recruitment of primary care providers in rural Michigan. We’ve expanded that because as we listen to our constituents in clinics and hospitals, there’s a growing need and a trend [of] really needing medical assistants. We’re working with the Department of Labor at the State of Michigan and Northern Michigan University to increase the number of medical assistants in the Upper Peninsula. There’s a training pipeline program that’s been started at Chippewa War Memorial [Hospital] to address and replicate that.
We also need behavioral health workers. That continues to be an issue. We’ve recently, in the last year, put a paramedic on our staff and she’s doing great work and creating Leadership Academy trainings for paramedics across the state. So we’re really a training and education type of center.
Another area of focus that we continue to work on through [federal funding from] HRSA [Health Resources and Services Administration] is our rural community opioid response implementation. Grants that we received [includes] a million dollars for three consecutive years to work in northern lower Michigan, especially centering at the northeast section of the Lower Peninsula. [That] area needs a lot of assistance, prevention, treatment, and recovery for people with OUD [Opioid Use Disorder] and SUD [Substance Use Disorder] issues because it is a disease much like [diabetes]. There is also stigma.
We focus a lot of our time on hospital issues. We’re looking at more training and education for board members. We also manage statewide critical access hospital quality networks and we’re always working to increase the quality inside those hospitals, which then spills over into their communities.”
PJ: What kinds of training are board members receiving?
Crystal Barter: “We teamed up with a longtime partner, Hall, Render, Killian, Heath, & Lyman and they provide board [trainings for] rural hospitals throughout the state of Michigan. The topics are varied depending on the needs of that particular governance structure. The topics [include] ‘Governance 101’, for board members that might be newer to their position on a board or a hospital board. We have sessions focused on the finances making sure that the board members are acutely aware of their roles and responsibilities in terms of the financial operations of the hospital. And then we have education sessions focused on the future of health care. So topics within that might be making sure that the hospital is aligning with primary care physicians in their community and making sure that the hospital is participating in value-based payment appropriately.”
PJ: Can you tell me more about how you guys are working to alleviate stigma among those with OUD and SUD?
JB: “So when HRSA released the rural community opioid response planning [RCORP] grant, we had received information and did some digging and background that the Northeast section of the Lower Peninsula had a very high OUD and SUD rate among its citizens. So, we wrote to the planning grant and we put together a consortium of 36 different organizations representing 14 counties. We met on a monthly basis and we developed a strategy to address prevention, workforce, treatment, and recovery in those communities. Then as we were doing the planning grant, the implementation grant came out, and that’s the three-year million dollar grant. There’s been two more of those that we’ve written to and received so we have this rolling our RCORP funding that’s going across northern lower Michigan to address the issues, including stigma.
What we have is another office site for the Michigan Center for Rural Health in Gaylord, Michigan, [with] Joyce Fetrow as the project director. She is hiring two new project associates and they go and work with the physician community, the pharmacy community, various community based organizations, and also service clubs to do presentations on [the idea] that a person who has an OUD or SUD issue [is suffering from] a disease, like I said earlier. You have to treat [them] much like you would a diabetic patient, and you have to make sure that you treat them with respect. People will have setbacks, and you have to continue to support them as they get through this journey. I think — based on anecdotal evidence — that we are making some [headway] into reducing the stigma of OUD and SUD patient populations in northern Michigan. We work hard to elevate the voices of those with lived experience in everything we do.
[We] created another organization called the Northern Michigan Opioid Response Consortium. There are now 39 organizations that include all of the hospitals up there, all four federally qualified health centers, all of the local public health officials, and community mental health providers and outpatient treatment centers. They get together, they review the work plan, and they [implement] the work plan with Joyce and the project associates. So it’s truly a northern Michigan effort to reduce stigma, increase prevention, get recovery housing out there, [and] get the workforce up to where it should be.”
PJ: So how are you guys addressing this workforce crisis that we’re seeing all around the country? How is it affecting rural communities? What are you guys doing — in terms of future programs — to try to incentivize workers to not only come to rural Michigan, but to stay in rural Michigan?
JB: “We do have a workforce manager on our staff, Rachel Ruddock. She’s also the board chair for the rural recruitment retention network (3RNet). We work with hospitals and clinics to post their jobs on that job site. She also goes to job fairs and residency programs. She’s speaking to first and second year medical students about the need to take a look at this job board.
She’s also the liaison with the state of Michigan for the state and Federal loan repayment programs. So that’s a way to entice and to recruit physicians into rural Michigan, in addition to physician’s assistants and nurse practitioners.”
PJ: What are your plans for the future of your office?
JB: “Let me just add to what we’re doing right now is a lot of downstream work. We are really good at downstream work. But we’re now into our second year of strategic planning and just a few more years down the road we want to start upstream. [We want to focus on] things like food insecurity, housing insecurity, and improving broadband access in rural Michigan. Those are the types of things that are social determinants of health, and we really need to work collectively to address those because that will improve health care and outcomes further down the road. So [when] we work upstream, things will be better downstream.”
This interview was edited for clarity and length.