Improving Rural Healthcare by Creating Academic- and Nonacademic-Rural Hospital Partnerships Based on Community Health Needs Assessments and Technological Needs

Abstract

Over the past 14 years, 149 rural hospitals (comprising 6% of all rural hospitals) have closed or no longer provide inpatient services because of financial distress, staff shortages, and resource constraints.¹ In addition, more than 20% of rural hospitals are currently at risk of closing.² Nearly every state has rural hospitals at risk,³ and many rural facilities are cutting services to stay afloat.⁴

These closures and service restrictions reduce access to essential healthcare for underserved communities, many of which already face higher health risks and geographic isolation. Rural hospitals are critical for local economies and provide vital emergency care, making their closures a significant public health and economic concern.⁵

To survive, rural clinics and hospitals need to remain relevant to their service populations, demonstrate value, and remain technologically current. While the White House has recently launched an admirable initiative to support cybersecurity in rural hospitals,⁶ ecosystem transformation could better address the broader challenges needed to create sustainable partnerships between rural and urban healthcare systems.⁷

Without significant changes to reimbursement policies, financial pressures on rural hospitals will persist. Although critical access hospitals have a unique Medicare payment system designed to support their survival,⁸ these financial challenges will continue to hinder their ability to attract and retain an adequate workforce, invest in new technologies, and serve their communities.

Generally, rural hospitals have been standalone facilities with minimal support from larger systems. One solution to the challenges that rural hospitals face would be to create regionally shared resources that allow rural hospitals to collaborate and integrate with larger regional centers in a federal reserve-like model (“Hub and Spoke model”).⁹ Such integration could provide rural hospitals with rotating or virtual staff and modernized technology that could improve patient care and outcomes. The right design could also serve as a philanthropic initiative for partners, allowing them to expand the scope of their impact and services, and for those that are not-for-profit, meet community benefits requirements necessary to maintain a not-for-profit status.

One mechanism that could encourage formalized affiliations between larger academic or nonacademic hospitals and rural hospitals would be to use community health needs assessments (CHNAs) to facilitate the affiliation process between these centers. Using technology to match changing needs identified by CHNAs to resources available at the larger centers, this facilitation process could also provide care coordination, technological access, and clinical consultation between large academic or nonacademic hospitals and rural hospitals.

For example, GE HealthCare has identified six main trends in which technology can facilitate better healthcare outcomes: care team well-being; patient and care team partnership; smart and connected technology; harnessing big data; and predictive, precise, and preventive medicine.¹⁰ By affiliating with larger healthcare systems, rural hospitals might gain easier access to technology that can address these trends, such as acquiring access to quality improvement data to learn how to improve themselves, better leveraging power with payers, obtaining expertise from specialist clinicians, and securing artificial intelligence enhanced electronic medical record analytic tools that use sophisticated diagnostic software and hardware.⁵

Some large academic and nonacademic healthcare centers have initiated programs that provide more resources to rural hospitals. For example, the Rural Health Research Core at Mayo Clinic Care Network,¹¹ which offers consulting services with subject matter experts, helps engage rural communities by including patients and community members as stakeholders alongside providers, faculty, and researchers. Mayo Clinic also runs the Mayo Clinic Laboratories, which offers 3000 lab tests and 24/7 customer service with multilingual agents to their rural community partners, decreasing turnaround time for lab results while providing high-quality results.¹²

Another approach is a coalition-based partnership, wherein several large centers with regional knowledge and expertise can provide extensive and diverse resources to rural hospitals. The Eastern Plains Healthcare Consortium, comprised of ten hospitals in the Colorado Rockies area, has created a staff-sharing program wherein clinical staff can sign up for shifts in rural hospitals and receive funding for opportunities like grants to help lessen the burden of travel costs.¹³ In addition, the Louisiana Independent Hospital Network Coalition has 26 members, with many being critical access hospitals, that share resources such as vaccines, best practices, and current protocols.¹³

To build such affiliations can be a tedious and time-consuming process. Task forces with funding from various departments, grants, donations, and/or philanthropic initiatives identify what their needs are and which entities to partner with, usually incorporating a form of vetting process.¹⁴ However, building these healthcare affiliations will require ongoing effort because rural community needs and larger system resources might change over time: the affiliations themselves should be evaluated to determine the degree to which community needs and those of the respective healthcare systems are being met.¹⁵

To simplify the initial search process, we recommend using existing rural and large healthcare system CHNAs to develop a database that surfaces the expertise and needs of hospitals interested in affiliation. Such a database could benefit all parties by clarifying needs, accelerating the matching process, and ensuring alignment. Rural hospitals might need to align with multiple hospitals for different types of specialty care (Figure 1), and developing these affiliations might require a change in the services that particular hospitals currently offer. In the long run, sustaining these affiliations would help promote health equity and provide stable, long-term resources.

LCMC Health University Medical Center (previously Louisiana Children's Medical Center) and Tulane University School of Medicine are using CHNAs to collaborate with 15 hospitals and community-based organizations to better understand the health needs of their communities¹⁶ and to address health disparities in rural areas throughout Louisiana by affiliating with many rural hospitals and clinics throughout the state.¹⁷ From a report published by the Rural Policy Research Institute Center for Rural Health Policy, Tulane has identified four critical advantages that rural hospitals affiliating with more extensive networks get: improved technology, improved performance and services, greater flexibility in payment models, and better staff recruiting and retention.¹⁸ With regular CHNA reassessment, LCMC Health and Tulane could better understand rural hospitals’ concerns and resources, care access, and provider choice. Using these assessments, the partners can generate recommendations on how the health of rural residents might be improved.

CHNA analysis has allowed LCMC Health to better gauge local population needs across the state and share this information with hospitals serving those populations, empowering them with information needed to improve the well-being of their service communities and build affiliations.

Recently, Microsoft for Startups launched an initiative with the American Medical Association (AMA) Physician Innovation Network (PIN), a match-making tool that connects providers, members of the care team, business liaisons, and entrepreneurs around the country to improve healthcare and outcomes.¹⁹ This tool provides members access to clinical and nonclinical providers and obtains feedback on their processes and innovations. By using the Microsoft for Startups hub that facilitates the interaction of over 20,000 members, PIN has expanded its reach and connected with a broader audience to accomplish a shared mission of improving healthcare and disseminating innovation.

Using a similar approach, a CHNA database could be developed to identify the needs of large academic or nonacademic hospitals and rural hospitals, provide a platform for healthcare systems to communicate new needs and coordinate care and services, and use artificial intelligence to match needs to resources (Figure 2). For some care, such as radiology and ICU monitoring services, geographic proximity would be of less importance than, say, oncology services.

Familiarizing healthcare leadership with ongoing CHNAs and evaluating other hospitals’ assessments to assess strengths and weaknesses will be helpful in finding mutually beneficial partnerships. Sharing this information across systems and making data readily available and searchable will foster new partnerships and create a live, working database. Although affiliations are becoming more popular, such a database could make it easier to find compatible partners and facilitate collaboration between more heavily resourced healthcare systems and underserved ones, matching the appropriate healthcare resources to population needs. Technology and artificial intelligence are increasingly integral to healthcare provision and should be shared in a way that reduces health disparities and improves patient outcomes; we have proposed a process that could help accomplish that goal and facilitate the ecosystem transformation needed to sustain healthcare delivery models that are based on population needs, not financially driven specialty-based care.

Dr. William Weeks, Dr. Juan Lavista Ferres, and Dr. James Weinstein are employed by Microsoft.

The authors declare no conflict of interest.