The rural hospital collaborative in North Dakota has secured two value-based contracts with commercial insurers and more are expected this year, building momentum for those considering similar alliances.
Cibolo Health in October created the Rough Rider High-Value Network comprised of 23 critical access hospitals in North Dakota. The rural hospital advisory firm has since helped launch a similar venture in Minnesota and is in early talks to expand the model in several other states, CEO Nathan White said.
Related: Rural Minnesota hospitals to form clinically integrated network
The Rough Rider network inked a Medicare shared savings contract with CVS Health and a contract with Blue Cross Blue Shield of North Dakota that includes quality-based payments and shared savings, White said. Other payers are interested in Medicare Advantage and accountable care organization contracts, he added.
Alternative payment models are a primary focus of these rural hospital clinically integrated networks, which are designed to leverage a network’s scale to coordinate care, boost reimbursement, reduce costs and improve treatment.
The Rough Rider network will be able to pursue more types of value-based contracts once it gets its data analytics software up and running, which is expected by the end of the year, said Ben Bucher, CEO of Towner County Medical Center in Cando, North Dakota, and chair of the Rough Rider network.
A lack of data and low patient volume prevent many independent rural hospitals from even talking with insurers about alternative payment models.
“You can’t survive in the value-based world without access to data,” Bucher said. “Because of this network, we are able to look at data-sharing platforms and what would work best for us. We wouldn’t even have looked prior because it was out of our grasp.”
Hospitals without an in-house analytics system would have to rely on insurance companies to provide patient data, which was often at least six-months old, Bucher said. In addition, the data typically isn’t tailored for rural hospitals, he said.
One of the network’s goals is to supply care navigation services and infrastructure usually available to health system-affiliated hospitals. For instance, the Rough Rider network plans to hire care navigators who tell clinicians if patients are ready for an annual wellness check, are due for a screening or need a physical, White said.
“If we’re doing background work for a physician, we can markedly improve the metrics for an organization,” he said. “Rural hospitals, unless they have a large health system doing some of these tasks for them, are on an island.”
Many rural hospitals struggle with staffing, given that it is hard to recruit specialists to rural communities that do not do as many procedures as urban areas. A mobile imaging semitrailer, provided by the Rough Rider network, helps alleviate some of those staffing issues by traveling to hospitals several days a month to provide ultrasounds, CT scans, mammograms, bone scans and other nuclear imaging tests, White said.
The mobile imaging truck has helped save Rough Rider hospitals a little money, but more importantly, service levels have increased tremendously, he said.
“A significant amount of care leaves rural communities,” White said. “We hope to change that, and redefine our relationship with larger health systems.”
Communication among Rough Rider hospitals has vastly improved, which has also boosted care continuity, Bucher said.
After talking with other hospitals in the clinically integrated network, Towner County Medical Center changed its scheduling processes, he said. Instead of asking patients to come in six months after a physical for a wellness check, physicians are telling them to return in two weeks. Patients are doing a better a job of keeping those appointments as a result, Bucher said.
“If we are catching more things earlier, that can considerably lower the cost of care and improve health outcomes,” Bucher said.
