Network Spotlight: Northwest Rural Health Network

April 2017
Organization: 
Northwest Rural Health Network

Care coordinators participate in a recent class held by the Northwest Rural Health Network.

Network Name Northwest Rural Health Network
Location Spokane, WA
Key Contact Jac Davies, Executive Director
Mission To share resources and collectively support rural health systems to develop integrated models of care.
Vision The Northwest Rural Health Network collectively contracts for and supports cost-effective, high-quality population health services in rural communities through the development of individual community capacity and innovative partnerships.
Jac Davies, executive director of the Northwest Rural Health Network, was interviewed by the Network TA Team to share information on the network’s characteristics, key learnings, accomplishments, and challenges.

Q: In a “nutshell,” how would you describe your network?

A: We are a peer-based network of 15 rural health systems, 14 of which are critical access hospitals and one of which is not, that serve communities all across the eastern third of Washington State. Our members vary in size from serving a community as small as 3,700 to communities of over 80,000, but they all have in common a strong dedication to rural communities and rural populations. 

Our original name was the Critical Access Hospital Network. Our board felt that the emphasis on the critical access hospital element was less important than it used to be, because all of our members are in fact rural health systems. They're much more than hospitals. They operate clinics; they are working on a variety of population health measures in their communities. We felt it was time to start recognizing them as such, and we’ve been known as the Northwest Rural Health Network since September of 2016. 

Q: What benefits do network members receive?

A: Because we are all located in a relatively common geography, our members face many of the same challenges. Part of the reason they're members and part of the benefits they receive is facilitated collaboration and sharing of information, as well as looking for ways to share resources across members to help them be more effective at serving their populations. A major part of it is recognizing that our members have so many commonalities. Many of them are in a common referral region, with patients traveling to the same urban centers for advanced care, so it makes sense for them to collaborate and coordinate their efforts. We also do quite a bit with facilitated planning. We have committees that are working on some joint projects to see how we can, at the very least, share information so that they can each make more informed decisions. Also, we're working on some specific projects where we might be able to reduce some of their costs and improve their access to services.

Q: What other types of organizations do you partner with?

A: There are larger organizations, integrated health systems, that are more urban-based but with which our members interact regularly because patients may end up in the urban centers for specialty care or long-term hospitalization. While it's very important to our members to have this network be dedicated to rural interests, particularly rural health systems, we certainly want to make sure that we have good relationships and are able to work effectively with the urban systems. 

Q: What challenges do you face working in rural health care?

A: The speed and overwhelming complexity of change that is happening now in health care, particularly here in Washington State, is a challenge. It’s not necessarily unique to rural health care, but I think it's exacerbated by the nature of rural health care. There is a lot of work being driven by the Washington State Health Care Authority, which is our Medicaid agency, around Medicaid transformation. The state was actually just granted a waiver and is kicking off a large-scale project. It's a program to try and move Medicaid and the delivery system entirely to value-based payments. Of course, that's also happening on the Medicare side. 

Because the State Health Care Authority is also the largest purchaser of private insurance for state employees, they're using their purchasing power to drive the commercial sector as well. So there's a huge amount of pressure to move in this value-based purchasing direction, and there's all kinds of support and tools, such as the TCPI, the Transforming Clinical Practice Initiative, for example, and the ACO movement that CMS is promoting. The Health Care Authority has put out a huge number of resources to help practices with this transformation.

On the one hand, while it's great that there are all those resources available, in a small rural health system there are only so many people who can access them. We’re now trying to see if we can coordinate all of these programs, or at least coordinate some of the resources, so that they’re easier for our members to take advantage of and they aren't overwhelmed by all these different groups—the state hospital association, the state Department of Health, the State Health Care Authority, the quality improvement organization, our network, etc.—everybody coming to them and saying, "We know you need to make this change. Here are some things that can be done. How can we help?" 

Q: On the flip side, what are the advantages of working in your rural environment?

A: I think that one of the big advantages of rural in general is that because these are smaller systems and, in our case, they're all independent, they have the ability to make decisions and act very quickly. They are very closely tied into their communities, and they have the ability to really engage their communities as part of that decision-making process. I think that's a stronger connection than many urban health systems see. By and large, our members have a strong history of working together, and so there are good relationships already in place. They all understand the challenges that they each are facing. That's very helpful in trying to run an effective network.

Q: Tell us about a challenging situation your network is facing. How are you working to overcome it?

A: About three years ago, we experienced a period of rapid growth, when our network membership almost doubled. So, there are a number of new members in the network who were not there from the beginning. Our members are accustomed to sharing information, or at least some of them, and subsets are used to working together. However, we’re actively trying to develop some common business requirements across all members and actually going out together to try and develop specific resources. This is new for our group. It’s been a challenge developing the processes and beginning to develop the culture of collectively identifying and sharing resources in a very concrete way.

Through a strategic planning process last year, we tried to identify common needs across the network. The one that rose to the top universally was behavioral health services. That need was there regardless of the size of member. So we elected to focus on that specifically as a group and have been working through a process to both qualify and quantify what our members mean by behavioral health services.

When you start drilling down, behavioral health services, of course, have got a lot of complexity. We're working through some processes now to very specifically understand what that means in terms of the types of patients. Are we talking pediatric, or are we talking adults? What does it mean in terms of care settings? Is it for critical cases in the emergency department? Is it for long-term chronic behavioral health issues in primary care? What does it mean in terms of volume? How many patients are we talking about?

We've set up a structured process to answer all of those questions. Once we've characterized the problem, then we’ll work together to identify some solutions. Some of our members do have behavioral health staff. Is it looking at how we might share those staff via telehealth? Or is it contracting together to some outside telehealth-based behavioral health service vendors? It's been a challenge because it's the first time this group has very concretely pursued the idea of collectively looking at a problem and identifying some solutions. 

They're beginning to see the power of a network through this process. It goes from being the theoretical, "Yeah, we're in a network because we can do things together," to "Here's something that we are doing together, and here's how we're doing it."

Q: What keeps your network members engaged throughout this process?

A: With so much other stuff going on, it's difficult for people to take the time. We're running data reports now on behavioral health encounters. Each member's running some reports to get a sense of what their volume is. All those things take time. There's just so much other stuff going on. I think patience and persistence are the two keys. It's also working to understand what the barriers are for individual members. Some of them have the IT staff and the types of information systems that basically allow them to generate a report the next day. Some of them have much more difficult processes and have to work with outside vendors. It's seeing, can we help with funding to develop a report? Can we connect them with a peer in another organization that has the same information system who can help them walk through it? It’s trying to be persistent without being obnoxious, and that's a hard balance.

Q: Based on your experiences as a network leader, what advice would you give to a developing rural health network?

A: Partly I'm just by nature a pragmatist, but I think it's really important to find something concrete that the members are interested in and want to work on, something that they're going to see value from. Behavioral health services are an example, which is why we're working so much on that. They all recognize it is an area of need. They all recognize the value of being able to do something together because it's concrete. The only way you can make the hard transition from the theoretical to the specific is to identify whatever those pain points are for your members and focus on those to get things moving.

 

<< View More Network Spotlights

Network Spotlight

Network Spotlight: Illinois Telehealth Network

November 2017

ITN promotes the capacity of members to improve access to health care in rural, underserved and disadvantaged communities, through the application of telehealth and telemedicine solutions.

Network Spotlight

Network Spotlight: Indiana Rural Workforce Innovation Network

September 2017

IRWIN strives to become a sustainable, rural-focused workforce network that recruits motivated students, delivers allied health professions’ education and training, facilitates meaningful clinical rotations, and places graduates in rural allied health professions’ jobs.

Network Spotlight

Network Spotlight: Southeast Texas Health System

July 2017

SETHS integrates health care locally and regionally in responding to the growth of managed care in a way that preserves local control and maintains the independence of member institutions.

Network Spotlight

Network Spotlight: Northeast Oregon Network

May 2017

NEON increases access to and quality of integrated health care for Northeast Oregon residents by identifying system gaps, facilitating community-developed solutions and advocating for health policy change.

Network Spotlight

Network Spotlight: Northwest Rural Health Network

April 2017

The Northwest Rural Health Network shares resources and collectively supports rural health systems to develop integrated models of care throughout eastern Washington State.

Network Spotlight

Network Spotlight: Affiliated Service Providers of Indiana

March 2017

ASPIN provides educational programs, resource management, program development and network management in collaboration with health care entities to address health disparities and whole health management throughout the state of Indiana.

Network Spotlight

Network Spotlight: Foothills Health Network

January 2017

Foothills Health Network improves the health of people living in Polk County, NC, and neighboring communities by increasing access to coordinated, quality care and cultivating community engagement.

Network Spotlight

Network Spotlight: Community Care Alliance

December 2016

Based in Colorado, the Community Care Alliance prepares healthcare organizations for success in the future, where medical communities will be rewarded for achieving better care, healthier people and smarter spending.

Network Spotlight

Network Spotlight: Palmetto Care Connections

November 2016

Palmetto Care Connections facilitates health care access across South Carolina through the utilization of innovative technology to promote the provision of qualified medical professionals of various disciplines.

Network Spotlight

Network Spotlight: North Coast Clinics Network

October 2016

The North Coast Clinics Networks is comprised of three FQHCs in northwest California that collaborate to ensure health care workforce readiness, improve the quality of care and shape health care policy.

Network Spotlight

Network Spotlight: Safetyweb Network

September 2016

The Safetyweb Network works throughout Polk County, WI to increase health care coverage access and retention among the uninsured and underinsured.

Network Spotlight

Network Spotlight: North Country Health Consortium

August 2016

The NCHC is a rural health network, created in 1997, as a vehicle for addressing common issues through collaboration among health and human service providers serving Northern New Hampshire.

Network Spotlight

Network Spotlight: Mountain Health Alliance

June 2016

The Mountain Health Alliance is a regional network dedicated to advancing a culture of health through collaboration and community engagement.

Network Spotlight

Network Spotlight: Prairie Health Information Technology Network

May 2016

The Prairie Health Information Technology Network improves patient outcomes and the quality of care for the medically underserved, including the uninsured and underinsured patients of South Dakota, through the meaningful use and adoption by both provider and patient of health information technology and the electronic health record.

Network Spotlight

Network Spotlight: Tri-County Health Network

April 2016

The Tri-County Health Network is a nonprofit organization committed to improving the overall health and quality of health care in rural southwest Colorado by identifying, developing, and operating programs and initiatives that will reform the health care delivery system and payment methodology in rural communities.

Network Spotlight

Network Spotlight: Illinois Rural Health Network

March 2016

The Illinois Rural Health Network strives to be an accessible system of care that promotes early identification of and provides resources and services for children at risk for developmental, medical, emotional, social and/or behavioral difficulties.