Aspire Rural Health System + Covenant HealthCare (Michigan “Thumb” region)
Before: Multiple small rural hospitals had limited local access to specialty care and cancer services.
What they did: Renewed and deepened a multi-hospital affiliation (CRTN/“CRTN Health”) to coordinate specialty coverage (e.g., cardiology 5 days/week) and operate a regional cancer center at Aspire Marlette.
Result: Expanded specialty access closer to home with a formalized regional network and service consolidation under a shared brand. https://aspirerhs.org/2025/01/15/aspire-rural-health-system-and-covenant-healthcare-announce-deeper-affiliation-to-enhance-care-in-the-thumb/ Aspire Rural Health System | https://www.covenanthealthcare.com/ch/crtn-health covenanthealthcare.com | https://www.michigansthumb.com/news/article/aspire-covenant-healthcare-partnership-20054390.php Huron Daily TribuneProject ECHO (University of New Mexico) + Rural Primary Care Clinics
Before: Rural clinicians lacked specialist support; patients with hepatitis C faced long travel/wait times.
What they did: Hub-and-spoke tele-mentoring—weekly videoconference case reviews linking specialists with rural PCPs.
Result: Cure rates and safety comparable to an academic clinic; large access gains statewide. https://www.nejm.org/doi/full/10.1056/NEJMoa1009370 New England Journal of Medicine | https://pmc.ncbi.nlm.nih.gov/articles/PMC1831800/ PMCHospital + Preferred Skilled Nursing Facility (SNF) Networks
Before: High variation in post-acute performance and elevated 30-day readmissions from SNFs.
What they did: Hospitals built formal “preferred” SNF networks with data sharing, clinical standards, and tighter transitions.
Result: Hospitals using preferred networks cut readmissions from SNFs ~6.1 percentage points (vs. 1.6 points without networks) over 2009–2013. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0211 Health Affairs | https://www.publichealth.columbia.edu/news/readmission-rates-decline-when-hospitals-develop-skilled-nursing-facility-networks Mailman School of Public HealthCleveland Clinic + Local SNFs (“Connected Care” model)
Before: Elevated 30-day readmissions among patients discharged to area SNFs.
What they did: Deployed hospital-employed physicians/APPs for frequent on-site visits across selected SNFs with shared protocols.
Result: Adjusted 30-day readmissions fell from 28.1% to 21.7% at intervention SNFs; no improvement at controls. https://shmpublications.onlinelibrary.wiley.com/doi/10.12788/jhm.2710 shmpublications.onlinelibrary.wiley.com | https://pubmed.ncbi.nlm.nih.gov/28411287/ PubMedRegionalized Trauma Networks (multi-hospital systems & transfer protocols)
Before: Fragmented trauma response, variable transfer patterns, and preventable delays—especially for rural/severely injured patients.
What they did: Organized statewide/regional trauma networks with tiered centers, EMS triage criteria, and standardized interfacility transfers.
Result: Multiple studies show reduced mortality and faster time to definitive care after regionalization. https://pubmed.ncbi.nlm.nih.gov/28005711/ PubMed | https://wjes.biomedcentral.com/articles/10.1186/s13017-021-00381-0 BioMed Central | https://jamanetwork.com/journals/jamasurgery/fullarticle/1351847 JAMA NetworkCommunity Care Partnership of Maine (Hospitals + FQHCs ACO)
Before: Rural Maine patients had access gaps and uncoordinated care across community hospitals and health centers.
What they did: Formed an ACO joining hospitals with FQHCs to standardize care management and negotiate shared-savings contracts.
Result: ACO now serves ~120,000 patients and participates in MSSP and MA contracts, expanding coordinated rural access. https://www.ruralhealthinfo.org/project-examples/944 Rural Health Information Hub | https://www.cms.gov/newsroom/press-releases/participation-continues-grow-cms-accountable-care-organization-initiatives-2024 CMSBellin Health + Employers (Direct-to-Employer/On-site & Near-site Primary Care)
Before: Rising employer medical spend; fragmented access to preventive and chronic care in a mixed rural/urban market.
What they did: Built employer partnerships with on-/near-site clinics, care management, and value-based contracts.
Result: Reported $6.4M savings for employer partners in 2023 and an 11% reduction in Bellin employee medical spend; long-run spend “bent” >$25M. https://bellin.org/press-releases/112-employers-save-66-million-through-emplify-health-by-bellin-direct-partnerships Bellin Health | https://www.healthleadersmedia.com/finance/bellin-health-costs-down-market-share Health Leaders Media | https://www.advisory.com/topics/value-based-care/bellin-health-vbc Advisory BoardTelehealth Hub-and-Spoke for Specialty Access (Critical Access + Regional Hubs)
Before: CAHs and rural clinics struggled to provide specialty consults; preventable transfers and leakage.
What they did: Deployed hub-and-spoke tele-specialty (e.g., ECHO-style, specialty e-consults) to support PCPs and keep care local.
Result: Evidence and toolkits show improved access and capability at rural spokes, with lower travel burden and better chronic disease management. https://www.ruralhealthinfo.org/toolkits/telehealth/2/care-delivery/specialty-care Rural Health Information Hub | https://www.ruralhealthinfo.org/toolkits/telehealthSt. Cloud ENT + ASC Partnership (Minnesota)
Before: Sleep apnea surgical service was fragmented; patients had to navigate between ENT clinics, hospital ORs, and ASCs without unified care pathways.
What they did: Partnered with an ASC to streamline sleep apnea surgery services, aligning protocols, workflows, and referral patterns.
Result: Improved surgical outcomes, better patient satisfaction, and growth in surgical volume. https://www.advisory.com/content/dam/advisory/en/public/sponsored/inspire/st-cloud-ent-sleep-apnea-outcomes-case-study.pdf.coredownload.pdf (advisory.com) Advisory BoardCCSC (Capital City Surgery Center, NC) + NAPA / WakeMed
Before: Total joint procedures were being done in hospital settings; variation in pre-/post-operative protocols and inefficiencies.
What they did: Hospital-physician/ASC partnership with standardized pathways, shifting certain total joint procedures from hospital to the ASC; integrating anesthesia‐team protocols.
Result: Increased surgical volume, higher efficiency, improved outcomes, high patient satisfaction, recognized with awards (“Best ASC”) in NC.https://napaanesthesia.com/news-and-insights/how-napa-protocols-helped-an-asc-earn-national-recognition-for-clinical-outcomes-improve-efficiency-achieve-100-patient-satisfaction-and-add-value-for-its-hospital-partner/?utm_source=chatgpt.comTexas Rural Accountable Care Organization (TRACO)
Before: Rural Texas region had high chronic disease, persistent manual communication fragmentation, low integration among hospitals/physicians, underused HIE (Health Information Exchange), payer contracting weak.
What they did: Formed a rural-focused ACO (TRACO) that strengthened care coordination, built out HIE, expanded self-management programs for diabetes, etc., and created referral systems / payer contracting.
Result: Improved coordination of care, better targeting of high-cost/high-need patients, improved alignment with CMS "triple aim" (better health, lower cost, better care) plus better financial viability for safety net providers. https://www.ruralcenter.org/sites/default/files/Case%20Study-Final.pdf (ruralcenter.org) National Rural Health Resource CenterPrimary Care Practice Transformation / Team-Based Care (Multiple States, US)
Before: Rural/underserved outpatient clinics suffering from PCP shortages, burnout, inability to accept Medicaid or uninsured patients, limited patient access.
What they did: Team-based care (PCPs+APPs+NPs/ PAs + care coordinators), performance-based bonuses, relaxed scope of practice / regulatory support, improved clinic workflows, some states doing PCP support programs.
Result: Reduced provider burnout, increased provider participation in Medicaid, improved patient access, more sustainable outpatient clinics. https://www.nihcr.org/wp-content/uploads/CaseStudy-AccessPrimaryCare_final_compressed.pdf (nihcr.org) nihcr.orgRegional Partnership among Rural Hospitals (“How Regional Partnerships Bolster Rural Hospitals”, Commonwealth Fund)
Before: Many rural hospitals operating in isolation; staff shortages; inability to participate in value-based payment models; financial instability.
What they did: Created regional networks to share staff & resources, pool purchasing, standardize care, join in shared value-based contracts, share expertise & data across hospitals.
Result: Improved efficiencies, ability to participate in value-based payments, enhanced sustainability; better negotiation power; some cost savings & quality improvements. https://www.commonwealthfund.org/publications/2023/may/how-regional-partnerships-bolster-rural-hospitals (commonwealthfund.org) Commonwealth Fund+1Hannibal Regional Healthcare System (Missouri) Workforce & Outreach
Before: Acute workforce shortages and difficulty recruiting/retaining health service and clinical staff in a rural multi-county area.
What they did: Built partnerships with area schools, colleges, universities to establish local training programs, internships, residencies; training pipelines.
Result: Dozens of health service/professional careers launched locally; more stable workforce; enhanced capacity of HRHS to provide more specialties, services across multiple counties. https://www.aha.org/2023-11-02-case-study-adapting-new-workforce-environment-hannibal-regional-healthcare-system-outreach (aha.org) American Hospital Association“Hospital as Convener” (Trinity Health + Carilion Clinic as examples)
Before: Health systems/hospitals treated mainly as service providers; weak coordination with social services, public health, non-profits; preventive health and SDOH (social determinants of health) addressed patchily.
What they did: Hospitals acting as conveners: bringing together local partners (public health, social service orgs, transportation, housing, food access etc.), planning collaboratively, co-designing community health goals.
Result: In these communities, better alignment of services, more efficient use of hospital/community resources, improved population health planning and response capacity. https://www.aha.org/system/files/media/file/2021/04/rural-case-study-the-hospital-as-convener-in-rural-communities-april-2021.pdf (aha.org) American Hospital AssociationNorthwest New Mexico Trauma / ED / Hospital Access Mixed Methods
Before: Rural trauma care resources sparse; long distances to definitive care; limited resources in rural EDs; uncertain mappings of access.
What they did: Mixed-methods study to map trauma access, identify resource gaps, engage local hospitals & EDs, improve transfer agreements, etc. (though less full implementation reported).
Result: Identified priority areas for investment; better awareness of trauma access gaps that could drive policy or hospital collaboration. https://www.cureus.com/articles/41135-making-it-work-a-preliminary-mixed-methods-study-of-rural-trauma-care-access-and-resources-in-new-mexico (cureus.com)
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