Arielle Zionts
BOWMAN, N.D. — Retta Jacobi stepped onto a steel platform that lifted her to an entrance on the aspect of a custom-designed semitrailer. Once inside, she lay down on a platform that technicians slid into an MRI machine. Jacobi hoped the scan would assist pinpoint the supply of the ache in her shoulders.
The cell MRI unit visits Southwest Healthcare Services, the hospital in Bowman, North Dakota, every Wednesday. Without it, the neighborhood’s 1,400 residents must drive 40 minutes to get to an MRI machine, an costly piece of medical tools the hospital couldn’t afford by itself.
Southwest Healthcare Services and 21 different impartial, rural North Dakota hospitals are a part of the Rough Rider Network, which used its members’ mixed affected person rolls to barter higher costs for the cell imaging truck.
Independent rural hospitals are more and more becoming a member of what are known as clinically built-in networks, collaborative teams that permit them to keep away from promoting out to bigger well being methods whereas sharing sources to economize and enhance affected person care. Many are motivated by the prospect to mix their affected person rolls for value-based care contracts, a rising reimbursement mannequin by which insurers pay suppliers based mostly on the standard of care they supply and the well being outcomes of their sufferers.
Supporters of the networks are exploring whether or not funding from the $50 billion Rural Health Transformation Program — a part of President Donald Trump’s latest tax and spending invoice — can be utilized to assist begin or broaden such organizations.
For impartial, rural hospitals, the networks are a substitute for shutting down or lowering companies, or to giving up native autonomy and becoming a member of a big hospital system.
“Anything that can help our rural hospitals and add services is awesome,” mentioned Jacobi, who gives speech remedy to youngsters within the native college district.
Since 2010, 153 rural hospitals within the U.S. have shuttered utterly or stopped providing inpatient companies, according to the Sheps Center for Health Services Research on the University of North Carolina. A far bigger quantity, 441, merged with or have been acquired by hospital methods between 2011 and 2021. That’s according to a report commissioned by the Coalition to Strengthen America’s Healthcare, an advocacy group comprising hospitals and well being associations.
The Rough Rider Network gives negotiating leverage to its members, which serve about two-thirds of rural North Dakotans, mentioned Dennis Goebel, CEO of the Bowman hospital.
Health care distributors “probably wouldn’t be talking to us if we’re by ourselves,” he mentioned. “They’re not looking for the little, tiny crumbs. They want a big contract, and they’ll give you better pricing.”
Some rural networks share specialists who aren’t wanted full time at anybody hospital, in line with the Commonwealth Fund, a nonprofit targeted on bettering the well being care system. Some networks additionally spend money on broadband, housing, and different neighborhood improvement tasks that may assist individuals keep wholesome and entry care.
Hospitals can pool staffers for a network-wide worker medical insurance plan, mentioned Nathan White, CEO of Cibolo Health, an organization that helps launch and handle networks in rural areas. He mentioned they’ll additionally enter shared contracts for telehealth, prescription drug packages, and different companies.
White mentioned he began Cibolo Health after a frontrunner from an impartial, rural North Dakota hospital requested him about collaborating with comparable services. The Rough Rider Network launched in late 2023 with help from the corporate and $3.5 million from the North Dakota Legislature.
Since then, Cibolo Health has helped begin networks in Minnesota, Nebraska, Montana, and Ohio. Once a sixth one opens in September, Cibolo-affiliated networks will signify greater than 120 hospitals, with service areas overlaying 4.7 million individuals, White mentioned.
The networks, that are nonprofits owned by the hospitals, pay an annual price to Cibolo Health, a for-profit firm, for administration companies. White mentioned leaders from 10 different states are contemplating becoming a member of this mannequin.
Similar networks have been round for greater than 30 years however turned extra well-liked after the passage of the 2010 Affordable Care Act, according to a report by the Rand Corp., a analysis nonprofit.
Rural well being care suppliers are more and more curious about forming such networks, mentioned Marnell Bradfield, government director of the Community Care Alliance, a community of hospitals and impartial main care workplaces that launched in 2015 in rural western Colorado. About as soon as a month, she mentioned, she will get a name from well being care leaders exploring comparable networks and asking about her expertise.
The Rand Corp. wrote in its 2020 paper that it didn’t discover any educational research that examined whether or not these networks do what its supporters declare — get monetary savings and enhance affected person care.
“In theory, quality should improve with the alignment of health care organizations, but there is no evidence,” the report mentioned. The paper additionally mentioned such networks might find yourself rising costs, one thing that may happen with conventional mergers and acquisitions.
Bradfield and White mentioned they’ve the proof, no less than for his or her organizations.
Community Care Alliance members have diminished their insurance coverage prices whereas bettering affected person outcomes, akin to lowering their want for inpatient and emergency care, Bradfield mentioned.
White mentioned information from a pilot program between Caret Health, a care coordination firm, and SMP Health-St. Kateri, one among Rough Rider’s hospitals, confirmed this system helped a big variety of sufferers meet up with preventive care.
Gabby Wilkie, finance director on the St. Kateri hospital, in Rolla close to the Canadian border, mentioned Caret Health workers known as and texted sufferers who have been behind on annual physicals, most cancers screenings, vaccinations, and different visits. She mentioned staffers defined to sufferers why this preventive care is vital for his or her well being earlier than establishing a three-way name with St. Kateri workers to schedule an appointment. White mentioned it took a mean of 11 outreach makes an attempt earlier than sufferers got here in for any visits.
“To be honest, we didn’t have the resources to reach out,” Wilkie mentioned.
She mentioned St. Kateri would have spent an estimated $300,000 to try this form of outreach for 1,000 sufferers. Meanwhile, she mentioned, the hospital estimates it should earn greater than $100,000 when that many sufferers are available in for his or her preventive care. Cibolo Health and the Rough Rider Network each contribute to the price of the Caret Health service, which is now rolling out to different community hospitals.
Goebel mentioned becoming a member of a community to stay impartial can also be useful for the economic system of rural areas, the place hospitals are sometimes main employers. He mentioned well being methods generally reduce companies and workers at rural hospitals they purchase.
Jacobi is taking remedy and doing bodily remedy after a health care provider examined her MRI outcomes. If that doesn’t work, she might have to make a five-hour spherical journey to Bismarck to get an ultrasound-guided steroid shot. Jacobi was grateful she might get a analysis and remedy recommendation with out having to journey far for the MRI.
“Anytime we can maintain more local control, it’s a good thing for our small towns,” she mentioned.
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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