Leaders at Gundersen Health System, La Crosse, Wis., presented at AHA’s 2019 Rural Health Care Leadership Conference on how affiliations between health systems and critical access hospitals can benefit both. Gundersen currently has formal affiliations with five CAHs in the region. 

By 2010, Gundersen Health System in La Crosse, Wis., had developed good relationships with several critical access hospitals in the area. They were informal relationships, but in 2011, Gundersen leaders proposed creating a more formal, legal relationship with the CAHs. 

“We thought about how the affiliation would be a stabilizing influence for the critical access hospital but also would help the [health] system as a whole better understand what resources we needed to be able to provide for the critical access hospitals,” said Marilu Bintz, M.D., senior vice president of population health strategy at Gundersen.  

In 2011, Gundersen developed formal affiliations with St. Joseph’s Hospital and Clinics in Hillsboro, Wis., and Tri-County Hospital in Whitehall, Wis., and has since formally affiliated with three more CAHs.

At the time the organizations affiliated, all but one of the CAHs had negative operating margins; today, four out of the five have rectified that and now have positive operating margins. The fifth one is still early in the affiliation process. 

By reducing their operating costs, the hospitals are able to reduce the cost of care to patients, said Garith Steiner, vice president of affiliated CAHs and clinics at Gundersen. 

Bintz underscored how the affiliations have helped make Gundersen a teaching facility where all types of medical students can come and thrive in a high-quality rural health care environment. “We want to let them see how much fun a rural practice can really be,” Bintz said. “And hopefully, we can keep some of those young people in our system as great providers of outstanding rural care.” 

Among other benefits, Gundersen installs its electronic health record at the affiliated hospital or clinic. 

“As a clinician, I can tell you there is a huge advantage in patient care by having us all on the same electronic health care record,” said Bintz. “Taking care of those patients over the continuum of care is much more integrated, coordinated and less expensive, than if you don’t have that interoperability.”  

Overall, Bintz and Steiner are pleased with the impact Gundersen’s model has had on both the health system and its key stakeholders, including the communities served. 

“If you talk to the clinicians, they would look at it as a win in terms of patient care and educational resources that they didn’t really have before,” Bintz said. “And whether you are talking about clinicians or non-clinicians, I would say it’s been a win for the system because the affiliations have given people a better appreciation of what rural health care is all about and what rural health care brings to rural communities.” 

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