Arkansas Rural Health Partnership allows hospitals to share resources, provide education and contain costs

Profitability increasingly challenges rural hospitals having a large number of Medicaid and Medicare patients in areas that are economically distressed with an unhealthy patient population. Besides providing life-saving healthcare services, rural hospitals play a significant economic role by being one of the largest, best-paying employers in the area and one of the largest purchasers of supplies.

An organization that is working hard to keep rural hospitals in the Delta healthy is the Arkansas Rural Health Partnership (ARHP) headed by CEO Mellie Bridewell. ARHP is pulling together rural hospitals throughout South Arkansas (mainly the Delta region of the state) to share services and provide better care for the areas served. ARHP is a non-profit partnership of fourteen individually owned rural hospitals that provides support services and programs, cost-saving resources and negotiation, provider training and education, and access to patient education opportunities to enable its partners to provide the best care locally.

Rural hospital closures across the U.S. have become a growing public concern. According to the National Rural Health Association, 107 rural hospitals have closed since 2010, with more than 120 and counting closed since 2005.

"People need to understand, if we don't start doing something to help rural hospitals, they are going to start closing faster than we have seen," Bridewell said. "My job is to fight for survival of these small hospitals. I want to help hospitals in rural Arkansas stay afloat with good-bottom line economics allowed by things like collaborative purchasing, negotiation of contracts, access to healthcare services through telehealth, and quality healthcare services that keep the rural patient at home. Healthcare is rapidly evolving and many rural hospitals, especially those with limited resources, are becoming overburdened as challenges grow. A huge concern is that more changes ahead will create an even more dismal future for these small hospitals."

Bridewell said an important issue to address is the high costs of outsourcing. This outsourcing is necessary for rural hospitals to provide health services in rural communities. The challenges of lack of resources locally causes hospitals to contract out services and staff to support their business office, emergency department, hospital, nursing staff, and in some cases their administrative staff. They become dependent on contractual services that cost more money to the hospital, and the hospital ends up financially worse off. An example would be a nurse employed by the hospital making $40 per hour who quits, but continues working at the hospital under a staffing agency might increase costs to $100 per hour.

Currently, there is focus on healthcare transformation and how to move hospitals toward care coordination. ARHP has been actively supporting quality improvement, care coordination, and healthcare provider training along with education initiatives to better prepare member hospitals and clinics for the upcoming changes.

"With healthcare evolving, small rural hospitals are being forced to look at transitioning to include offering a wider variety of healthcare services and many have gotten into the primary care business. Helping these hospitals with the necessary changes is something we really need to prioritize if we are to continue to keep local healthcare. We must also recognize that quality healthcare services mean making sure every employee in every hospital, clinic and community health center has access to education and compliance training. That has been a focus for the ARHP in 19 Delta counties during the past nine years."

Since 2016, the hospitals have gotten involved in mental and behavioral health. Bridewell said they now have three opioid grants and are working with drug courts and task forces building relationships and helping people addicted to opiates.

ARHP would not be what it is today without its committed board of directors and partners, according to Bridewell. ARHP has five staff members including Bridewell who are employees of the University of Arkansas for Medical Sciences through the UAMS Office of Strategy Management where Bridewell serves as the director.

"UAMS' investment and support in ARHP has provided a valuable connection between a large academic health partner and rural that makes sense," Bridewell said. "This alignment enables our organization to be able to connect seamlessly to quality services and support provided through various departments across the UAMS campus that bring resources to our hospitals and projects."

The ARHP board of directors, which meets every month, consists of the CEOs from all fourteen hospital members.

"What has been most amazing to me is the commitment of my board members who are all hospital CEOs with a lot on their plate," Bridewell said. "Every month we meet together, committed to working together to maintain access to healthcare resources in south Arkansas. This collaboration has allowed these small rural hospitals to have a strong voice together while still maintaining independence. As we continue to move forward, I believe that we will be able to accomplish great things and create a successful model for future rural healthcare. The more I see this collaboration, the more confidence I have that this model can work."

Bridewell, originally from south Louisiana, didn't have a healthcare background prior to moving to Lake Village in 2004. She holds a bachelor's degree in English from Spring Hill College in Mobile, Alabama and a master's in Management Tourism and Recreation. After a couple of years living in Lake Village, she purchased a health club. While loving her work there, she felt the need to get involved in the community around her, recognizing the need to address the health and wellness of all residents in the community.

"I decided to venture out and got involved in the local Hometown Health Coalition," Bridewell said. "I had done some successful writing in the past and felt there was a way I could help bring some funding to the area to address the health issues of the community. After working with the local hospital, I eventually took on the job as the director of the UAMS Delta AHEC in Lake Village, which began my relationship with UAMS. Through this job, I was charged with helping the hospitals in Chicot and Desha counties. It was through this job that I was able to convince five local hospital administrators to help me start up the Greater Delta Alliance for Health (now the ARHP). These original five members have turned to fourteen members and the 'community' I served eventually grew to the south Arkansas region and here I am."

A hospital in Lake Village or Dumas has one voice. However, together the hospitals in ARHP have become one of the largest healthcare entities in the state. Bridewell said this means they have enough patient volume to speak to not only legislators and grant funding agencies, but also with payers.

"We can now negotiate and converse with payers and contractors and we are heard," she said. "That wouldn't happen with one or two hospitals, but it works with 14."

Bridewell and her husband together have two daughters, three sons, three daughters-in-law, and three granddaughters. She credits a lot of her success to her husband, Robert, an attorney in Lake Village, who continues to support her hectic life and is her biggest supporter.

"We are all about family and enjoying our life on the lake and spending time cheering the Hogs on in Fayetteville," Bridewell said. Her greatest accomplishment, she says, has been raising her two daughters, Lillie and Camille.

"One is beginning her career in healthcare next month and the other is pursuing a degree in law and policy (hopefully healthcare policy); imagine that!" she said jokingly.

For more information, go online to: Arkansas Rural Health Organization