A decade on the road: NRHA’s Brock Slabach on rural health
After a decade speaking across the country on behalf of the National Rural Health Association, Brock Slabach, MPH, FACHE, NRHA senior vice president of member services, has a deep understanding of health policy and what it means for rural America. Over the years, Slabach has delivered more than 200 presentations and logged thousands of travel miles covering every corner of the U.S., from New England to Nevada, Alaska to the Florida panhandle, sometimes even internationally. Reaching out to health professionals and decision-makers helps build momentum for important rural health initiatives, and in his efforts Slabach has connected with countless people who share his passion for building a stronger future for rural health care. To better understand his 10+ years of work presenting and advocating for NRHA’s policy directives, we sat down with Slabach for a Q&A session.
Q: How do you prepare for presentations?
A: It’s important to tailor the presentation so it fits with the theme and topic for the event. I always propel the main messages and priorities for NRHA within the context of the presentation and in ways that will resonate with the audience. My presentations are structured in a way that allows me the flexibility to build in and swap out slides depending on the topic.
Q: Who asks you to speak?
A: I’m invited to speak for hospital associations, health networks, state rural health associations, regional gatherings, and conferences. In addition to speaking engagements, I also facilitate planning sessions and participate in meetings addressing health policy issues.
Q: What types of responses do you receive from audiences?
A: Audiences are always different. Some audiences have lots of questions. Other times people hesitate to ask questions, especially when there are a lot of people in the room. Small groups have a different dynamic though – when I presented for an Osteopathic Association Fellows group of 10 or 12 people, for example, they started asking questions on the third slide of around 30 or 40, and the rest of the time was devoted to Q&A. One question led to another, and I really enjoyed that.
Q: What’s one of the toughest questions you’ve had to answer?
A: At one of my first speaking gigs in Illinois in 2008, a gentleman in the front row raised his hand and asked, “Would you ruminate on the definition of rural?” It’s a good thing I knew what the word “ruminate” meant! It’s funny how something that seems so simple on the surface can have so many layers. I was glad to get that question out of the way – at the time, it felt like a graduate-level thesis defense question.
Q: What’s the most common misconception about rural health?
A: One misconception we’re constantly fighting against is the notion that rural health facilities are miniature versions of urban facilities, and that policymakers can just scale things down for rural programs. Unfortunately, some policies were never tested or shown to work in a low-volume environment, and as a result, we have to deal with the harmful effects of well-intentioned federal policies that don’t work for rural America. That’s where we find a lot of our work at the advocacy level – educating stakeholders at the local, state, and federal levels so they understand what makes rural health different and recognize that those differences are meaningful.
Q: What were some of the milestones for rural health in the past 10 years?
A: In 2009, the American Recovery and Reinvestment Act was the first major piece of legislation Congress passed for health care. In that was born the meaningful use and health information technology programs for hospitals, which ushered in a big opportunity for rural hospitals to purchase or expand their information technology.
Then in 2010, the Affordable Care Act (ACA) ushered in a new era of health policy that impacted all Americans – and for rural Americans, it had special and unique consequences. ACArelated topics dominated most of our meetings and presentations in those years. We had to balance the pressures of people’s opinions about the bill itself while also educating providers on what to expect and how to help rural patients and community members understand health insurance and how to get covered.
Q: What are some of the biggest challenges in health policy?
A: Reimbursement models and the workforce shortage continue to be the two areas of greatest concern that we’re working on. This is our focus today; I would say the same thing 20 years ago, 10 years ago, and five years ago. We’re always striving for better reimbursement solutions, and there’s a growing need for more people to work in rural health. You can’t have one without the other, and that’s why these two issues are intricately intertwined in our policy work.
Q: What trends do you see on the horizon?
A: The most exciting change since I’ve come to work with NRHA – and the most gratifying in terms of a sense of hopefulness for the future – is the transformation of our system toward appreciating the role of population health. This includes how social determinants of health can play such a large role in the delivery of health services in rural communities. This probably is one of the most promising developments to reduce the burden of disease for everyone – not just rural, but urban too – and hopefully learn techniques to better manage care for populations that will keep them healthy longer.
Addressing the root of the problem will require reforming the payment system in a way that fully appreciates the role of population health versus the fee-for-service systems that dominate our payment structures. Innovation in this area is promising for the future of rural health, and we’re seeing programs take shape at the state level.
One example is the Pennsylvania Rural Health Model, which is designed so that participating rural hospitals receive payments based on all-payer global budgets. With this model, the insurance companies are aligned around the same payment structure that’s guaranteed in the global budget. It provides a distinct opportunity to improve rural access to high-quality care and incentives to implement population health activities. I’m really impressed with the cooperation and synergy Pennsylvania’s leaders have created in regard to this project, and we’re hoping similar solutions can be implemented in other states.
Q: Do you ever get stage fright as a public speaker?
A: No, not really. I feel as though when I’m well versed on the topic, I have nothing to worry about. I actually have a thumb drive that contains the slides from every NRHA presentation I’ve ever given. I speak in PowerPoint.