ROLLA, N.D. — A three-year-old network for collaboration between rural hospitals in North Dakota is winning accolades and giving other states a template to follow that cuts costs, improves patient outcomes and protects the hospitals’ independence.
“I think if you talk about rural health transformation, this is the most transformative thing that’s going on in rural health in North Dakota,” said Chris Albertson, CEO of SMP Health – St. Kateri in Rolla. “It’s what other states are starting to follow, the same model.”
Albertson is talking about the impact of the Rough Rider High Value Network (RRHVN), formed in 2023 among 23 independent rural and critical access hospitals that collectively serve around 65% of North Dakota’s rural population.
St. Kateri, a 25-bed critical access hospital in Rolla, was among the first chosen to pilot in the network.
“I said I want to see it work, and I want to see it work in probably the hardest subset of the patient population we have,” said Alfred Sams, president and CEO of the RRHVN, who came to the position with more than a decade of rural healthcare experience in North Dakota.
Sams said the Rolette County population the hospital serves, with many dual-enrolled on tribal insurance and Medicaid, has one of the highest numbers of traditional Medicaid patients.
So far, St. Kateri has been able to reduce hospital readmission rates from around 16.5% down to around 5% by being part of the network.
The integration also reduced the number of emergency room visits by 536 over a nine-month period, saving approximately $1.13 million in healthcare spending. Integration has also helped the hospital avoid around $500,000 in Medicare spending in that span.
Part of the rollout was a partnership between the network and Caret Health on improving outcomes for patients on Medicaid, said Albertson.
It’s had a significant impact, he said, in reaching patients who can sometimes be difficult to connect with to ensure they’re getting to appointments, with some of those cases already saving lives and costs.
“We had a lady who we were able to have her come in for a clinic appointment and got her set up for a mammogram, and they found breast cancer, she didn’t show any signs,” Albertson said.
“So that’s saved that person’s life, potentially, but also saved the Medicaid system a significant amount because if you catch these things earlier it costs less.”
Albertson said cancer care navigation has improved significantly as well, so when there’s a diagnosis, the patient is turned over to a care navigator that helps them through the entire process.
Artist Bennet Brien painted this mural inside SMP Health – St. Kateri in Rolla, North Dakota. Brien also designed the University of North Dakota’s Fighting Sioux logo in 1999.
Michael Standaert / North Dakota News Cooperative
“It’s to make sure no one is falling through the cracks,” Albertson said. “So if you have lung cancer, it’s making sure they’re seeing an oncologist on time, making those follow-ups and referrals and making sure those aren’t getting dropped. Making sure they’re able to make the care appointments.”
Lori Martinson, cancer care coordinator at St. Kateri, said integration into the network has helped greatly with troubleshooting when it comes to care.
“The main thing with Rough Rider is the proactive primary care and engagement,” she said. “That’s huge.”
Having that one point of contact personalizes the process as well, so the patient isn’t getting calls from all the different specialists, potentially missing calls or creating confusion.
At the network level, across those 23 hospitals, the RRHVN has increased colorectal cancer screenings by around 12%, cervical cancer screenings by around 11%, and breast cancer screenings by 10%.
Sams said the idea started to develop back in 2020 when rural hospital directors in North Dakota started talking about how to meaningfully transform rural health for hospitals and providers so they didn’t get gobbled up in the system.
Just a few years in now, the network was highlighted in a recent report by the Centers for Medicare and Medicaid Services (CMS) as the kind of collaborative venture that something like the federal Rural Health Transformation Program should support and that other states could emulate.
Sams said CMS had him come out to Washington, D.C., at least four times to talk about what the network has been doing and its positive outcomes.
The North Dakota Legislature appropriated $3.5 million to help the initiative get off the ground in 2023.
By aggregating patients across the network, the network of hospitals can also jointly take on risks that individual hospitals might not be able to, Sams said.
Overall adult preventive visits have also doubled, and there have been measurable improvements on both blood pressure and diabetes control across the network.
Part of that is through the improved outreach a network like this can provide.
Kali Luecke, a physician assistant at St. Kateri, said the monthly clinical integration meetings she has with others in the network are another aspect that’s helped and not something readily available to an individual hospital going it alone.
“It’s like what are you doing that’s working, what’s not working, and being able to pull from everybody and use everyone’s ideas has been really helpful,” Luecke said.
Other Rough Rider High Value Network participants
Ashley Medical Center; St Andrews Hospital, Bottineau; Southwest Healthcare Services, Bowman; Towner County Med Center, Cando; Pembina County Mem Hospital, Cavalier); Cooperstown Med Center; St. Luke’s Hospital, Crosby; Jacobson Mem Hospital, Elgin; St. Aloisius Hospital, Harvey; Unity Medical Center, Grafton; Linton Hospital; First Care Health Center, Park River; Heart of America, Rugby; Northwood Deaconess; Altru Health System, Grand Forks; Altru Devils Lake; Tioga Medical Center; South Central Health, Wishek; Langdon Prairie Health; McKenzie County Health System, Watford City; Jamestown Regional; Nelson County Health System, McVille.
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This story was originally published on NewsCoopND.org.
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