Alright. I'm gonna go ahead and kick us off. My name is Tom Curtis. Good afternoon or good morning. I am director of state affairs here at NCQA, and I am gonna talk with you all a little bit about the rural health transformation program that I'm assuming you're all, intimately familiar with and propose some options for you all to think about as you move forward in implementing your programs for, working with NCQA to leverage your, your goals, pursuing your goals. I did see a number of names on the registration list that were not, as familiar to us all. And so I'm hoping it's partly because you're in the rural health area of your state, and you're working on this program. So before I get into it, I just wanna do a very quick introduction of NCQA in case anyone is less familiar with with NCQA. NCQA, first of all, stands for National Committee for Quality Assurance. The organization is a nonprofit. We've been around for over thirty years, and we are headquartered in Washington DC. We are committed to, as our name states, quality in health care. And so we create standards that are associated with best and promising and evidence based practices for delivering high quality health care, and we are in the business of measuring the extent to which providers and health plans are pursuing the highest levels of quality in their, populations that they serve or that they're responsible for serving. So it's an evaluation. It's a measurement and performance management, and it's a standard based compliance oriented, level of how we target high quality health care the United States, and we've been doing that for over thirty years. You can go to the next slide. So we, I, in particular, really encourage engagement from the audience. So as you are listening, you may, type a question in the q and a box. You may raise your hand, and, we absolutely welcome you to email us or contact us afterwards. I also think the chat, chats function is available for folks to utilize, this today as well. So, please, please, this really works and works well for you all when you are asking questions or talking amongst yourselves or talking with NCQA. So we we definitely want that, as much as you're willing to offer. Next slide. So I'm gonna do a very quick over overview of rural health and, really to get at the the, moment that we're at is really, really important and could be, a level of success for our rural communities that we really haven't had a huge opportunity in the United States to achieve or pursue, historically. And so we'll talk a bit about the fund itself. And then I wanna leave you with an idea of if you have initiatives that are already underway or are being planned, options for how NCQA could support, what you're pursuing in your state. Next slide. So very quickly, rural health. Next slide. You're all gonna probably know all of these things, but I want, one thing I like to do is just center everybody's thinking around some common key ideas before we get into the the conversation. So this here is a map of the percentage of individuals living in rural areas by state. So it does vary across states, but the key is there is rural communities in every state. And rural folks represent one in five Americans and roughly sixty five million individuals. Many of them rely on Medicaid and or Medicare. So it that represents a public health, opportunity as well as a public purchaser opportunity in improving health. Next slide. Here, we have two maps, next to each other. And thinking about those states that you just saw that high had higher percentages of rural communities in their jurisdictions, you can relate that to the primary care shortage areas that you see on the left and the mental health shortage areas that you see on the right with the the darker, excuse me, the darker, areas being higher levels of shortage as it health professionals. So, one fifth of the population experiencing professional shortage areas. And if we go to the next slide, that pretty clearly translates into higher proportion of cancer, heart disease, unintentional injury, respiratory disease, and stroke. So if you look at these bars here, we're really saying the the the two darker brown bars on the far right of each category are noncore and micropolitan, which is another way of, distinguishing rural areas in states. So one fifth of the population, chronic professional shortage areas, and higher proportion of those one fifth of people experiencing a higher burden of disease and injury. Next slide. So herein lies the opportunity we have in front of us, everybody. The federal gov you can go to the next slide. The federal government has authorized billions of dollars in investment in states over the next five years focusing on these five strategic areas, making rural America healthy again, which is this administration's version of wellness, disease prevention, and disease management to mitigate the risk of exacerbating existing chronic conditions and and the state in which those those conditions are currently in. Innovative care, which is getting into behavioral health integration, but also leveraging technology and digital tools to advance virtual care. Tech innovation, it also has to do with virtual care. But there were a number of other state real health transformation programs that talked about digital quality measurement, data exchange, data standardization. So using tech to inform, more timely medical decisions, shared decision supports, and, ultimately, quality measurement that is associated with those data that are also used to drive care decisions. Workforce development was another prominent, component of the rural health transformation program. That might include community health workers, but also graduate medical, assistance and really getting ways to attract professionals to those shortage areas. And lastly, sustainable access, which speaks directly to those shortage areas we just spoke about. This might mean telehealth. It might mean workforce related efforts, but also team based care in existing facilities or expanding the footprint of FQHCs and other types of safety net providers. Next slide. Now before I get into the sort of nuts and bolts of how NCQA has been thinking about how we can offer ourselves as supportive partners in rural health transformation, I wanted to remind or or make it known, depending on on who you are and your and your history in in state, health care programming, that we've been through this before as a country, as a partnership of states and NCQA, or even as states states themselves. In twenty thirteen between twenty thirteen and twenty twenty, there were investments made in health care transformation known as the state innovation model or SIM. These amounts equated to around six hundred and fifty million for eleven states over five years. So not nearly the scope and scale of rural health transformation, but conceptually, that investment was still committed to value based payment, quality improvement, and leveraging the purchasing power and policy power of states to increase access, improve quality, and and at least, maintain the cost containment, trajectory. What we found and this is just as a way to get you all thinking about the flexibilities you may wanna look into or ask about in the context of rural health transformation. What we saw in the evaluation is that every state, nearly every state, requested a no at least one no cost extension over the five year program period. And so for that is one reason why you see twenty thirteen to twenty twenty when it was a five year program initially. Many states, received no cost extensions. And part of that's because it was a a sizable level of investment investment that needed more thinking and more time and more deliberation to really make sure that it was being spent in a responsible way that would ultimately improve the outcomes for for the the residents of the state. Sometimes that just takes a little more time than is is realized. So no cost extensions were utilized in SIM. And if if they are available for rural health transformation, then that is a tool you will have available. And when I think about hundred and fifty, two hundred million dollars coming to a state, no cost extensions become, an attractive option for making sure that money gets spent in your state for your people, which is another thing we found in the evaluation. Almost all states had to send back some of the money that was received in SIM. So even the considerable lower level of investment in SIM, states were either unable or unwilling to spend it all. So that's another thing to think about in the context of rural health transformation, given the the amount is so much higher than what states were looking at with the SIM investment. And lastly, sustainability was a key component of SIM, and states used Medicaid waivers and state plan amendments and managed care contracting to continue the work they had put into place. One thing that was also utilized were, NCQA programs, PCMH actually being one of the prominent programs that states used to promote health care transformation and value based payment and quality improvement in the context of this, overall state, health care improvement and and payment reform initiative. So, just to look back in the past, a lot of states in their SIM programs also talked about rural health care transformation. So, some of you may actually be looking back at the things you learned and tried and and were able to achieve and building on those successes, with this opportunity. Next slide. So when I think about states in the SIM, process, many of them pivoted and adjusted their priorities over their grant period. Many of them had to extend the the timeline beyond the five year period, and many of them struggle to really find ways to expend all the money in alignment with the goals in the program. And what we wanna do at NCQA is acknowledge those realities that you're all probably experiencing or about to experience, that, you had a program in place. Now you're trying to figure out how to operationalize it, how to be able to tell your residents and your leaders and your political leaders how you went about spending this public investment to improve care, improve quality, improve outcomes for your rural communities. And we just want you all to know that we're here, and we're available. Even if we weren't written in initially into the program, that's okay. If we become something that might help you achieve your goals, we want you to know about it. We're an affordable option for that. So go ahead and go to the next slide, and I'm gonna talk a little bit about some of our programs and how they relate back to each of these categories. Now keep in mind, many of our programs actually fit in multiple categories, but just for simplicity's sake, we wanted to just go one at a time. And so the first bucket we have here is make rural America healthy again. That's the wellness and prevention category of this administration. And we have a new wellness and condition management accreditation program. It's focused on supporting prevention. It's focused on early intervention and targeting patients and members and engaging them, and potentially even using digital health app applications and vendors for doing so. And we want you all to be aware of this app, this accreditation in case you have plans in, in your rural health transformation program that are related to digital health vendors or use of these digital enablement tools to promote access to care and prevention and wellness for your rural communities. The other program, that fits well under this because it's more of a disease management, approach is the diabetes recognition program. This is, somewhat of a level of excellence recognition program. So it takes measures and evaluates providers based on their performance in the context of those diabetes management, measures and bestows the accreditation to providers who are performing well enough to be considered as a recognized provider of excellence in the context of, diabetes management. So we wanted to make you guys aware of those, programs. If diabetes is something in your rural communities, that you really wanna focus on in your program, this is a provider level recognition. So the other thing when we we're thinking about these programs is how do we make sure states can logically tie back the investment to honing in on their rural communities? And so, provider level recognitions can get you that tangible connection between these providers and these areas received these standard standardized, recognition or accreditation programs, and this is how their behavior changed and improved, relative to patient care. If you have, like, a statewide program, it's harder to make that connection between the investment and how it impacted the the target population. So, you can go to the next slide. The next, category I'll I'll highlight here is innovative care. And so we've got a couple programs here I'm gonna speak a little about. The first one is certified Community Behavioral Health Center or CCBHC accreditation. So, I'm sure nearly all of you or all of you have, existing CCBHCs in your state. Some may be SAMHSA demonstration grant funded. Some may be Medicaid funded. Some may be grant funded in in some other ways. Excuse me. In order to, receive the Medicaid applied payment, which is kind of the sustainability plan for CCBHCs, they have to be certified by the state. And so NCQA created an an accreditation that essentially reviews CCBHCs against the SAMHSA criteria. However, we've structured their criteria so that they're, easier to operationalize. And we've also created tools like the community needs assessment tool to help CCBHCs really tie back to what the community needs and make all of those staffing, care delivery, care model, payment model decisions based on what the community needs and what sort of care and community partnerships that caring for that population would really need in in that in that community. This is something that's a three year accreditation. And, if you have CCBHCs or wanna expand CCBHCs, which is really looking at team based care for behavioral health. Team based care is another evidence based way to increase access. So instead of having that psychiatrist psychologist or counselor talking about, social needs with their patients, there might be a CHW in that CCBHC that's that's attending to those needs so that psychiatrist or psychologist can really work at the highest level of their license and provide access to more patients in the context of of what their license allows them to practice. So that's a a sort of reason why CCBHC is an innovative access to care team based approach. The next program I'll highlight here is advanced primary care. This is right now being piloted, in a number of areas, and it's expected to launch later this year. So NCQA sort of, began to recognize that patient centered medical home has been around for over a decade. It has advanced primary care practices in a considerable way over that last ten plus years, and there there was an appetite for a next step in how to move, further up the, upstream with practice transformation and system level change. So it emphasizes, again, team based care, behavioral health integration, population health management. There are standards associated with data sharing and data exchange. Right now, we're partnering with health systems in piloting this. If you're interested in learning about those pilots and where they are, if there are some of them in some of your states, please get ahold of us, and we can talk to you about what we're seeing in those in those health system pilots. The last one I will talk about in innovative care is a new accreditation, called community focused care accreditation. This, program actually used to be known known as Health Equity Accreditation Plus. We have since, as of last December, separated Health Equity Accreditation and Health Equity Accreditation Plus to where an organization can pursue community focused care accreditation without having to pursue the the former accreditation. This is really about community based organization connectivity, requiring organizations to look at community risk, community need, and creating that are attending to those social risks, those community based risks by partnering with communities, by assessing for need among their their membership, and tracking referrals, tracking those, receipt of intervention within within the the population. Go to the next slide. And I want to take a pause for a moment because I feel like I've been talking and talking very fast, and see if there are some questions that people are thinking and would be willing to write in the chat or in the q and a. It can be related to rural health transformation in general. It can be a question for the states themselves that are here. It can be a question for NCQA or just to talk about a challenge that you all are, experiencing and could use some assistance with, in the context of your program. So I'm gonna take a minute and and create some some silence, and I would really like to see, if folks have questions. Alright. I'm not seeing any, but I would like to see some. So I'm gonna keep going. Looks like the next topic here is tech innovation. So the state affairs team at NCQA, we we actually reviewed every single rural health transformation program narrative, and we were looking for, ways to support states with affordable options in doing so that that we know are sustainable, that we know have a built in evaluation program, with them, and that we know have a foundation in states that allow them to build upon that in the context of rural health. We also saw some states making some ambitious, strides in pursuing, what what I'll call digital transformation in their state. So there were references to data exchange standards, measure calculation standards, and data validation, processes as well as artificial intelligence. And so we wanted to let you all know, that if the Rural Health Transformation Fund is looking to your state, like, an opportunity to invest in this technical transformation and has created the policy will to do so, and the investment opportunity to do so, that NCQA has some programs out there that are being used by states right now to move in the direction of using more clinical data for measurement, transferring more clinical data that we know are valid, and trying to put into place standards for use of artificial intelligence. One of those programs we call data aggregator validation or DAV, that is a program that essentially looks at a a pod of clinical data and determines whether it's usable by any health plan for reporting HEDIS measurement. And so it's a simpler way to, to validate and verify that that data are are correct, back to the source and can be used for reliable, measurement, which also means that it is reliable and can be used for care decision making. The other program we have is called digital content services or DCS. This is getting into more of calculating digital quality measures or DQMs. And so it's a package of resources that states can consider using for taking their data that they have available after structuring it in FHIR and using DCS to really start leveraging those data to identify care gaps and calculate performance measures. We also have in our, upcoming health plan accreditation updates and other accreditation programs, standards focused on artificial intelligence and responsible use of those tools in identifying and addressing quality improvement needs. So if any of these digital tools, or artificial intelligence standards are something that you're wanting to know more about in the context of your rural health program, then I, I would hope you contact us, or simply ask start asking some questions right now during this this conversation. Next slide. Workforce development is, one that NCQA is a little less involved in. A lot of those have to do, in some ways, if we look at, similar types of federal investments like ARPA, have to do with, wages or, educational incentives or incentives to move to certain areas and and commit to staying there and and providing care to patients for a set amount of time. One thing we have done, however, that when we so when we looked at a lot of state rural health transformation narratives, a lot of, several states were, talking about community health workers as a a solution to some of the access to care issues and rightfully so. Alaska is actually a great example of having leveraged community health workers for a number of years now, to improve access to care in one of the most rural, states in the country. We have recently worked with Tennessee Medicaid and the, Tennessee Community Health Worker Association to create community health worker program standards. Now very important to understand these are not we did not create an accreditation or a licensure for a community health worker themselves. We see that as not the NCQA role. Should states choose to do that, that should probably be more of a a regulatory, function of a public entity, not a private creditor. However, we worked to create program standards, and so these are best practices that a program or an employer that's looking at leveraging community health workers to improve access or increase quality, to adopt. So their training, supervision, continuing education, things of that nature, community collaboration that are essentially, best practices in surrounding the community health workers with a supportive infrastructure instead of putting the onus of, improving social service delivery on the shoulders of individuals like community health workers. They have they absolutely have value in the system in creating trusting relationships where where that is already a challenge of the existing system. But these individuals need support and assistance and guidance from the broader program that's that's employing them or the employer that's employing them. And so that's what these standards are really focused on on doing. And lastly, measuring the effectiveness and evaluating the effectiveness of particular programs that are employing community health workers. So if you're interested or have that in part of your plan, you are welcome to talk to us and learn more about, what we've been able to fashion with in partnership with Tennessee. Next slide. And last, the last, category here is sustainable access, and there are a number of programs that I'll I'll briefly mention here. The first one is virtual care. So this was rolled out, about a year or so ago, and it was in recognition that a lot of organizations, were proposing that they provided virtual care, and access to care, but there was there has been limited oversight, of those organizations. And it's been referred to by some as the Wild West, and we wanted to put some standardization and some some quality controls around those organizations and what they were offering folks. So we came up with these virtual, care accreditation standards. They are now being adopted across the country, probably in many of your states. If you're interested in finding out if there's any organizations currently going through accreditation or have achieved accreditation in your state, you may you may, get ahold of us after this after this webinar, and we'd be happy to meet with you. The the standards really look at quality and patient safety, provider and patient experience, ensuring equitable access, care coordination, and data sharing and exchange. So we one thing we really wanted to make sure of is that when an individual receives virtual care, that that virtual care is coordinated properly with their primary care provider, or with their primary care provider office, or as, as, other providers in their care team deem necessary. And that was, one thing that we heard a lot of organizations and stakeholders talk about was not happening like it needed to. And so that's one of the sort of critical elements of our virtual care accreditation that we survey programs and ensure is happening on an ongoing basis. The next, this is sort of two programs, and one here is Patient Center Medical Home along with Patient Center Medical Home behavioral health integration. So this has been one of the most successful, I would I would argue, movements of practice transformation in the US health care system probably in the last several years. It, the program focuses on team based care, care transitions, implementing clinical practice guidelines, flexible scheduling, medication management, developmental screening, all of the CPGs that we really want every single, resident to receive in addition to innovations to increase access to care, are part of this program. We already know that New York State, is going to be leveraging and building upon their foundation of PCMH as part of their rural health transformation program. And we know that there's over ten thousand practices right now, recognized as PCMH. And we also know that there's about twenty states over twenty states that are incentivizing, in some way, the adoption of PCMH. So there's enough foundation out there for you all to think about building on. Should this be something that you want to build into your, rural health transformation program. If you're not sure if your state has an incentive or you wanna know how many practices are currently in your state, please get ahold of us. We can provide that information to you. There's a a module within PCMH, and that is focused on behavioral health integration. We're already talking with a state currently about considering adding behavioral health integration to support rural practices. This state in particular has a sort of regional hub infrastructure that proposes to support these rural practices with behavioral health activities and functions so that these rural practices don't necessarily have to hire a social worker or a psychiatrist. They can leverage these resources in the shared regional hub. But in the context of that, still align with best practices and evidence based practices for behavioral health integration into primary care. And we know right now that, HRSA is supporting NCQA and FQHC adoption of behavioral health integration. So that is, one of my favorite programs, PCMH, and some of the things that are already going on there. And the last program I'm going to talk about is CMS I'm so sorry. My my dog sees somebody outside, I think, is CMLTSS. This is a program that's focused on working with community based organizations that are providing LTSS services. And so we often think of, like, AAA agencies, area agencies on aging, that are implementing person centered planning, coordination services for, individuals needing home and community based services, organizations that are community embedded and still committed to providing, the proper level of care for individuals who would otherwise, receive care in a nursing home. So this program has a level of flexibility that I think would be of interest for states to learn more about. It allows these organizations to align with national or state requirements or standards when it comes to what the LTSS, waiver in particular or or waiver population that you might all be, providing care to, while also holding true to to national best practices for LTSS. And, ultimately, adoption of this program leads to auto credit for any health plan that also has, our LTSS distinction for health plan accreditation. So those are the access programs that I wanted to talk about, and we can go to the next slide. Before I stop and also, again, try to open it up to some questions, which I would really, welcome from you all. I want to also leave you with the idea that NCQA does work with states on tailored solutions. And so this can be customized training or education. It can be dedicated technical assistance support. We create dashboards and reports and evaluation, methods, analytics, and produce findings and recommendations. We also can access program discounts for states who may be interested in adopting some of these trainings or programs in your in your, rural health transformation initiative, and we can provide those kinds of discounts as well as others, what I'll call customized content development. So this might be, program standards. If there's a particular provider type or program type that you're really looking for some input feedback or support developing, then we've done that. The CHW program standards are an example of that. And, also, measure content development is something that NCQA has engaged with states previously. And so we want to make you all aware that this sort of customized, support can be offered. Let me go to the next slide, and then I do wanna pause, and I want to see about some questions that the audience may have. Looks like I do see some names that I'm familiar with, so I don't wanna have to call on anybody. Well, that, my bluff didn't work, so I don't see any questions still. So I'm gonna go ahead and and oh, hey. It looks like we did get a question and a chat. Alright. Okay. I'm gonna go with the question first, and then I'll go back to the chat. So Tanya asks, how do you see states balancing innovation with scalability, especially when pilot programs often don't translate well across diverse rural settings? That's a really good question. I will make an attempt at giving you my two cents on it. I would actually be really curious, though, if there are others in the audience, like Laura Pennington or David Reichert or Dan Dania McDonald, just to name some names, Linda Shaughnessy. If you all are thinking about the same question, at least let let Tanya know that you're still you're in the same the same group as as her. And, if you have any thoughts on that, I think Tanya would welcome them, or anyone else. Those are just the names I saw that I recognized. I think, Tanya, one thing I I think about in the context of this is it goes back to what I said earlier about no cost extensions and balancing innovation with scalability in especially in rural settings requires time and a rigorous methodical approach. And so five years may not be enough, and states may want to think of a longer term timeline in taking their their experiments, piloting them out, and then spreading them gradually across the different rule settings and and tailoring them, right, to those diverse settings. But that just that takes time and probably more than five years. And so no cost extensions if those are going to be allowed here. Might be a really good opportunity to take something that's more innovative and then scaling it and attending to the diversity that that you're talking about here. So that's sort of my my initial option there or thought there. But let me see if others just have a reaction to what I shared or have a reaction to your question or a comment to make. I would take a a raised hand. Even if you wanna raise your hand and say, we are struggling with that same question. Okay. Tanya agrees with me a hundred percent. There's probably more to it. Thank you, Tanya. There's probably more to it, to really make it effective. But, again, five years is not very long. Especially this first year is probably going to be, just trying to get your group together, get your governance together, get your stakeholder engagement together. Go ahead, Laura. Oh. Sorry. Don't Now you can talk. There you go. Yeah. Okay. Yeah. Everything you just said, I think, is where we're at in our state as well. It's still early days. You know, we offered our support to our our, rural health transformation grant team to help them, you know, identify appropriate measures, and they just said, yeah. But we're way off from that. So they're still just trying to figure out what they're doing first, before they can really get at the idea of sustainability. So and the quality piece that's built into that. So we do know that our rural we work closely with our rural health communities on, you know, quality areas, and, it's just, I think, a struggle all around. So I guess what I would say is more to come. Yeah. Laura, if you don't mind, are there historically, have there been, rural health associated requirements, like, in your managed care contracts in the past, or or not? Or did oh, go ahead. That's a great question. I don't believe so because, we have convened, our rural health partners, to talk about how their work aligns with our Washington State Common Measure Set. And, we've heard from several of them that there's not a lot of consistency across the health plans, especially the managed care organizations in what they're requiring, the like, the rural access hospitals and some of the rural providers to to do. So that leads me to believe that, no. We don't have anything in there, but don't quote me on that. That is Yeah. No. It's person makes sense. I used to work for a state. Laura knows this. And Yeah. I don't I don't I don't recall us having anything particularly associated to rural health and ours either. But when I think about sustainability and I think about attending to diversity while also being scalable, which are sort of contrary to one another, the managed care plans are sort of already doing something associated with this that may be helpful or not. And so there's that's sort of one way, at least for a portion of the rural population, to get at some some alignment and coordination and, ultimately, scalability. Right? The plans can can scale things and sustainability. So that was just that was the the point of my question. I didn't wasn't trying to catch anybody. If any if anybody does have rural health specific requirements in a managed care contract, I would welcome, hearing about that. Alright. Let thank you, Laura, for for jumping in. And so I'm gonna go to the chat. It's, Cynthia. Having CHWs has been a great help to patients in our organization. I love to read that. Cynthia, I'm, would you be willing to come off mute and just say a little bit more about what the CHWs so I'm assuming, first of all, you're from a rural a rural area serving organization. And would you be willing to say a little bit more about the CHWs and what they do? And and Yes. Currently can you all hear me okay? Yeah. Absolutely. Great. Good afternoon, everybody. Currently, we use CHWs for our family program, a family planning program, and we also have a community health clinic. We have several three community health clinics and a UniMobile that goes around to different colonials. And so they what they do is they do the registration of the patients and identify the needs and find the services and funding and grants for the patients to be able to receive the services that they need. And it's been a great help because they have the knowledge, training, the resources to help our community. And these are in in rural rural communities. Yeah. Cynthia, do you mind, how how many years have you all been how many years have you seen CHWs to be sort of part of the fabric of the health care system? I've been here seven years, and the organization has been around since twenty fifteen. And so, actually, twenty twelve. So they they've always worked with the Promotoras Association, which is, they're the ones that are certifying community health workers in our state, Texas. And so, they're highly utilized here in the valley. Yeah. Where I'm I'm at, which is South Texas. Yep. Okay. Thank you. I I thought you said Colonials, which I which could have been in a number of different states down there. But Texas. Alright. Do you know, Cynthia, if the state is looking at community health workers as a as a solution, in their rural health transformation to, like, expand and promote the use of They they are. I'm very involved, you know, in the transformation. And, yes, they are looking at utilizing them. A lot of we have one rural health hospital that utilizes community health workers currently. None of the private, you know, clinics that are in the rural area utilize them. But I think once this initiative is implemented, there's gonna be opportunity to for physicians to start, you know, tapping into those resources. Fantastic. Do you have a sense sorry. Do you have a sense if, the state is thinking about, like, a like, a IT platform for connecting physicians and and CHWs? They just started their meetings. Actually, they kicked off their first meeting, I think, once when we were awarded the funding in January, they they did, like, a little news flash, and now they're organizing their committees. They're they're putting those together. And I think the first kickoff meeting is gonna occur in May. And so they're working very quickly to get that going. Yeah. Thanks. Thank you so much. So I just wanna thank everybody who's chiming in here. It's this is really what makes this conversation the best for you all, is is hearing from each other, and and asking questions and and sharing ideas. So I just wanna first of all, that's also something that just makes our state affairs job very fulfilling is when you all are are working with each other to help your people. Cynthia, I got a question for you from Tanya in the chat asking if you would share with them your CHW accreditation program. So I don't know if you guys wanna we could probably connect I don't know. Amy, do we have email addresses we could connect Tanya and and Cynthia? Yes. Definitely. They've been around for a while, and, I used to work for the state Medicaid program, years ago for several years. I'm very familiar with how the process began and where it's at now. So, definitely, Tanya, I would be more than happy to assist you. Awesome. Thank you, guys. Well, that's the most fun I've had on this webinar. So I wanna stall a little bit and see if I can if we can get a little bit more. Otherwise, I I've got some slides that I've got. To say say one more thing. If y'all are wanting to look at what, you know, states are doing, I encourage you to go to the different states and see what their platform looks like in this rural health transformation program. Health and Human Service Commission for Texas already has their project narrative, their materials. A lot of information is already out there for there's, like, f q FAQs, fact sheets that you can look at for reference. That's how I learn. I learn just I look at other states of what they're doing and see if something they're doing can work in our state. Yeah. Absolutely. Thank you, Cynthia. We also, rely on on, those narratives and other things that states are are publishing. Thank you again. I've got a couple, slides, I think, to round us out. I wanna go back to, some of the things we mentioned when we were talking about SIM and the and the state experiences that were shown in the evaluation there for that transformation investment. And just let you all know why we why we felt it was important to let you all know that we have programs that we think could help you. Part of it is timing. Many of our recognition and accreditation programs have been adopted already or we built with heavy stakeholder engagement and input and pilot processes on the front end. And so we're confident they can be, pursued and achieved successfully within a roughly twelve to eighteen month timeline. So in the context of a five plus year grant, thinking about, effective standards that will change provider behavior or access to care for residents, we do think we have programs that can achieve that and pursue that in a reasonable amount of time. The other thing that really compelled us to do this with you all is because our programs are very reasonably priced. And, usually, a credit or recognize a provider organization or a plan for a three year period. So you you may be paying a thousand or two thousand dollars per practice or upwards of ten thousand dollars for a CCBHC accreditation, but they last multiple years. And that is still affordable in the context of the amount of investment, that you're that you're receiving. So a pivot to support your existing goals using an NCQA program can be done and can be done, in an affordable way. The flexibility I talked about, we we do have the ability to do tailored types of support for for states. It is not, super well known to states that we do that, but we have a lot of examples that we'd be happy to share with you about our work in Tennessee and North Carolina and and other states. So if that's something you want to hear more about, please let us know. And sustainability, we I already mentioned New York State, has a PCMH foundation in place already. They will be leveraging that foundation moving forward to expand on it in their real health transformation program. So these standards are, a way of sustainably assuring access to care and provider behaviors and patient care continues to happen, beyond the grant period. And I saw, oh, yes. Thank you, Cynthia. Thank you for coming, and we'll be sure to share, Tanya's, contact information with you. Alright. Next slide. Alright. I got a couple cool polling questions for you, and then I'm gonna round it out with a a thank you and a little heads up on some some things we have coming up. This first one is, whether you would like to connect with us. So as I mentioned, we would like to hear from you. We'd like to meet with you if any of this resonated with you. So please I think it's all, select all that apply. Yep. So please take a second. Select this if you wanna hear from us, or if you want to ask us some questions about anything we shared, the this afternoon, please, pick your option. And I think once we hear from enough of you, we will close this. So Alright. Maralena or Amy, did we get enough? Yeah. Let's move on to the next. Alright. So coming up, we have, for anyone who hasn't heard of this, we have a fireside chat series where we invite a leader to speak with our either our president or somebody from our our executive level of the organization. And in May, we have assemblywoman Tracy Brown May from the Nevada State Assembly coming to speak with us, and they're gonna focus a a fair amount on some of the data exchange efforts that are going on as well as disability care efforts that are going on in Nevada. So please take time take a moment to register either, in any of the public policy note emails you receive or any of the announcements for this, and we'd love to see you there. Next slide. As I mentioned, we have an a newsletter called public policy notes, and so I would encourage you to take a take a second to subscribe to that if you don't already receive that. It is how we keep in touch with our public policy partners. Next slide. We're gonna be, some of us are gonna be in Denver at the National Council for Mental Health Well-being. So please find us there if you're if you're gonna be at NACCON. And we're also going to be at the National Association of State Mental Health Program Directors Conference in Washington DC in July. So if you're gonna be there, please look for us there. You can also schedule a time to talk to us at that public policy at NCQA dot org email. Next slide. And, look at that. One fifty nine on the dot. I wanna thank you all for taking some time out of your day and coming and sharing with us and listening. And we really, we really hope that you, found something useful out of this time and that we hear from you soon. Thank you.