GRAND FORKS – An organization dedicated to supporting independent small-town hospitals has helped facilities in North Dakota and Minnesota build their own rural health networks. Personal experiences working in the field and the changing landscape of health care drive the team behind Cibolo Rural Health Networks.

Nathan White, president and CEO of Cibolo, said the organization is committed to ensuring small-town hospitals can remain open and independent.

“How do we make sure that these rural hospitals not only survive but thrive?” he asked. “I think that’s the fundamental challenge that really motivates us, and seeing their energy in developing new opportunities is also tremendously positive. So that’s why we’re doing this.”

Cibolo partners with independent rural hospitals to create clinically integrated networks – groups of health care providers that work together to improve the quality of care and reduce costs. Cibolo has created two networks so far since its inception. One is the Rough Rider High Value Network in North Dakota, a collaboration of 23 hospitals and 41 clinics. The other is the Headwaters Network in Minnesota, which includes more than 50 clinics and 19 hospitals, with the latter expecting to grow.

The networks work with insurance companies to create value-based care contracts that are different from what is common across the country, according to Clint MacKinney, Cibolo’s chief medical officer. Many health care providers are paid based on the services they provide, even if those services don’t help the patient, which they don’t like.

“It sounds a little cynical, and maybe it is, but I would tell people that as a doctor, the more I do for you as a patient, the more I get paid, whether it helped you or not,” he said. “And I think that is fundamentally, if not morally, wrong.”

Value-based care, on the other hand, rewards doctors and hospitals for continually improving the quality of care and services they provide to their patients and for using health care resources responsibly, he said.

Cibolo was born with the creation of the Rough Rider network. Three and a half years ago, some of the state’s hospital CEOs began conversations about how they could work together to share best practices and resources, improve clinical performance and make the investments that would make those goals possible. This was uncharted territory, White said, and the group wasn’t sure what the collaboration would look like. For months before Rough Rider and Cibolo officially formed, there were numerous conversations with the CEOs about what was important to them and how the group might be structured. The hospitals’ main goal was to remain independent. Some in the state had to merge with larger health systems to stay afloat, and that wasn’t the direction Rough Rider wanted to take.

“The mantra was ‘independence through interdependence,'” White said.

Cibolo was founded as a hybrid of a consulting and management company, he said, and helped Rough Rider members figure out how to structure and operate the network. CEOs of rural, independent hospitals in Minnesota took notice and reached out, leading to the recent creation of Headwaters. Cibolo’s goal right now is to prove that the concept of these networks works and that it provides better care to communities from a clinical perspective, White said.

MacKinney added that Cibolo is working on the “triple aim,” a term commonly used in health care that refers to the three main goals that health systems should pursue: improving patient care, improving population health and making wise use of resources.

“And that is exactly what we want to deliver,” he said.

Otto is the Grand Forks Herald’s regional reporter.