How rural hospital networks are cutting costs, boosting care

North Dakota rural hospitals are showing they don’t need the help of a large health system to provide more primary care while driving down costs.

In 2023, more than 20 critical access hospitals formed the Rough Rider High-Value Network, seeking to share data and collective resources to standardize care and improve financial performance. 

It’s been less than three years, but the network’s early results are a good sign for the concept given the pressure on margins at all hospitals, and especially those in far-flung communities. Rural providers in five other states have since banded together in similar coalitions of independent hospitals while many of their peers join larger health systems. 

Related: Rural Wisconsin hospitals join clinically integrated network boom

Rural hospitals in North Dakota have leveraged their network to bring more patients in for wellness visits and screenings. As a result, providers are identifying diseases earlier while keeping costs in check through a centralized care coordination program coordinated by rural health-focused advisory firm Cibolo Health. 

Participating hospitals have guided employees and patients through a new workflow and scheduling process to achieve those results. The program’s administrative support has allowed clinicians to spend more time at the bedside.

“We don’t have the manpower to contact over 1,000 patients multiple times to tell them to come in for screenings,” said Gabby Wilkie, finance director of the 25-bed SMP Health – St. Kateri hospital in Rolla, North Dakota. “But the Cibolo centralized care coordination program has closed care gaps and helped us financially while we work toward hitting quality measures that can lead to shared savings.”

St. Kateri was the first hospital to roll out the care coordination initiative, which has expanded to 15 North Dakota hospitals over the past year and a half. 

Artificial intelligence-backed technology identifies high-risk patients based on their care history and location, said Brittany Sachdeva, Cibolo chief operating officer. The data analysis also helps determine when patients are most likely to respond to texts or calls. 

A centralized administrative team, equipped with patient histories and call scripts created by clinicians, reaches out to patients multiple times to schedule care, Sachdeva said. For particularly hard-to-reach Medicaid patients, administrators must contact them an average of 11 times. 

“Hospitals benefit from economies of scale and can keep nurses at the bedside instead of spending time tracking down patients,” she said. 

North Dakota hospitals have increased productivity, lowered labor costs and increased revenue after revamping care coordination efforts. Those facilities generate $418,000 per 1,000 patients a year in average savings and revenue improvements, Sachdeva said. Visits for pediatric checkups, breast cancer screening and colorectal screening have increased 120%, 32% and 17%, respectively, she said. 

In one case, St. Kateri treated a 42-year-old Medicaid patient who never had a mammogram. The scan came back positive, and doctors determined the tumor wasn’t cancerous. Since that visit, the patient comes in regularly for checkups and screenings, Wilkie said.

Maintaining routine care has helped keep patients out of the emergency department while streamlining operations and lowering care costs, she said.

“The program has allowed us to keep more care local,” Wilkie said. 

Providing preventative care such as cancer screenings and wellness visits at community hospitals is a key component of value-based care arrangements. Insurers may not want to participate in an outcomes-based contract with a provider that doesn’t maintain high levels of preventive care. 

St. Kateri has needed to reconcile data discrepancies with commercial insurers it has value-based contracts with as part of the care coordination improvement process, Wilkie said. For instance, an insurance company may not have logged a patient’s colonoscopy, and St. Kateri had to provide the corresponding documentation.

The critical access hospital in Rolla – a town of about 1,100 people – is one of many rural hospitals in Cibolo-backed clinically integrated networks that have expanded value-based contracts, such as Medicare shared savings, Cibolo CEO Nathan White said. The advisory firm handles the paperwork and negotiates on behalf of dozens of rural hospitals, he said. 

Those types of arrangements continue to drive interest in clinically integrated networks, White said. Cibolo, which has set up rural hospital networks in Minnesota, Montana, Nebraska, North Dakota, Ohio and Wisconsin, is talking with providers in six other states about setting similar networks, he said.
 

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