Arkansas Hospitals, Summer 2023

2023 STATISTICS ISSUE

Arkansas Hospitals is published by The Arkansas Hospital Association

419 Natural Resources Drive | Little Rock, AR 72205

To advertise, please contact Brooke Wallace magazine@arkhospitals.org

Ashley Warren, Editor in Chief

Nancy Robertson, Senior Editor & Contributing Writer

Mike Spain, Graphic Designer

Roland R. Gladden, Advertising Traffic Manager

BOARD OF DIRECTORS

Ron Peterson, Mountain Home / Chairman

Larry Shackelford, Fayetteville / Chairman-Elect

Peggy Abbott, Camden / Treasurer

Chris Barber, Jonesboro / Past-Chairman

Ryan Gehrig, Fort Smith / Director, At-Large

Greg Crain, Little Rock

Barry Davis, Paragould

David Deaton, Clinton

Phil Gilmore, Crossett

James Magee, Piggott

Guy Patteson, Jonesboro

Gary Paxson, Batesville

Eric Pianalto, Rogers

Robert Rupp, Mena

Judy Shaffer, Mountain Home

Brian Thomas, Pine Bluff

Debra Wright, Nashville

EXECUTIVE TEAM

Robert “Bo” Ryall / President and CEO

Jodiane Tritt / Executive Vice President

Tina Creel / President of AHA Services, Inc.

Pam Brown / Vice President of Quality and Patient Safety

Lyndsey Dumas / Vice President of Education

Debbie Love / CFO

DISTRIBUTION:

Plus, enjoy earning on your business checking account!

Determination

In late April, hospital leaders from across the state joined the AHA staff at the 2023 Annual Membership Meeting of the American Hospital Association with the mission of carrying the concerns of Arkansas’s hospitals directly to Washington, D.C.

In meetings with Senator John Boozman and Representative French Hill – and staff members from the offices of Senator Tom Cotton and Representatives Rick Crawford, Steve Womack, and Bruce Westerman –our group provided a clear-eyed assessment of Arkansas hospital finances and other issues, including ways to grow the health care workforce and evidence of the detrimental impact of delayed Medicare Managed Care payments on our hospitals.

Our congressmen and their staffers listened carefully to and showed an understanding of Arkansas hospitals’ issues, and we appreciated their acknowledgement of the difficulties hospitals everywhere are facing.

We would particularly like to thank Senator Boozman for co-sponsoring the Physicians for Underserved Areas Act, legislation that would update the Graduate Medical Education (GME) distribution process to allow medical residency programs in areas with physician shortages a greater chance of gaining available residency slots following a hospital closure elsewhere in the country. We also appreciate his sponsorship of the the Resident Education Deferred Interest (REDI) Act that would allow medical and dental students to pause student loan interest accrual and principal loan payment while serving in their residencies or internships.

Hospitals in Arkansas faced workforce challenges even before the COVID-19 pandemic, but the situation is now alarming. Projected shortfalls in the numbers of health care professionals pose a significant threat to the health and wellness of our communities and, frankly, to the

stability of our state. We must not take our excellent health care workforce for granted. This problem will not be solved quickly or by hospitals alone, but we owe it to the coming generations to take aggressive action to meet this challenge. Updating the GME distribution process is a first step on this journey.

Also at the Annual Meeting, Michael Stewart, CEO of Saline Health System, did an excellent job representing the state of Arkansas during his panel presentation titled “Pressure Points: The Financial Future of the Field and Impact on Patients.” He and other panel members discussed policyrelevant research on the financial pressures facing hospitals as they fight to care for their communities, and they pinpointed policy and regulatory burdens that add to these pressures. The panel explored key considerations related to short-term reforms and long-term strategies that address the financial sustainability of the health care field. Thank you, Michael, for a job well done!

I'd also invite you to join me in raising awareness around what's involved in the current Medicaid Redetermination and what it could mean for the hospitals and patients of Arkansas. As you know, the end of the COVID-19 Public Health Emergency brought with it the end of the continuous enrollment provision,

which prevented states from disenrolling people from Medicaid coverage during the pandemic. We have concerns that, as the unwinding of the Medicaid continuous coverage protection continues, more and more patients who believe they are still covered by Arkansas Medicaid will be surprised to find out they have been dropped from the rolls.

Hospitals certainly know this is coming, and they pledge to help eligible patients get re-enrolled in the Medicaid program. Patients may first discover that they are no longer enrolled when they try to pick up prescriptions that typically have been covered at their local pharmacies. We thank pharmacies throughout the state for helping this first wave of patients reconnect to the marketplace through the Renew Arkansas program. The AHA will continue working with provider groups and insurers to help all eligible Medicaid recipients reconnect if they find they’ve lost access to their coverage.

To be clear, the number of affected patients is already staggering. More than 54,000 children have at present been disenrolled, and we have grave concerns that these numbers – in addition to the numbers of adults who are also being dropped – will only continue to rise.

Our concerns surrounding Medicaid Redetermination and our mission to speak hospitals’ truth in Washington spring from the same source: We are determined to protect Arkansans’ access to quality health care and to support Arkansas’s hospitals as they advance the health and well-being of their communities.

Bo Ryall President and CEO Arkansas Hospital Association

No matter how many beds you oversee, we make sure you sleep well in your own.

Leading with Heart

This morning I sat, amid a joyful commotion in the “cafetorium” of my son’s public elementary school in the moments just before his fifth-grade promotion ceremony, doing my best to still my mind and be fully present. It requires a concerted effort for me – task-oriented thinker that I am – to leave behind the scramble it took to get everyone out the door wearing the correct attire, with all the necessary and/or required paraphernalia in-tow, with all the heads combed, all the bellies full, and all the teeth brushed. I took a few deep breaths and watched the families around me gather to cross this threshold together.

It’s easy to pooh-pooh an event like this with a, “What’s all the fuss?” or an, “In my day, we didn’t make a big deal of simply completing every single year of school.” In fact, I’m guilty of downplaying it myself for fear of being misunderstood as a rahrah-everyone-gets-a-participationtrophy type of Millennial mom. But mere minutes before I found myself sitting and waiting for the ceremony to begin, I had my attitude adjusted by a whole bunch of little kids.

Before the fifth (almost sixth!) graders left their classrooms to single-file their way to the assembly, the kindergarten-through-fourthgrade students sat, lining the halls of the school, shaking pom poms and cheering, as the fifth ( soon to be sixth!) graders strode through with big smiles and chins held high. It was then I realized – shocked to be blinking back tears – that all the pomp and circumstance wasn’t only about celebrating the fifth (basically sixth!) graders’ achievements – it was also

about inspiring the younger students and reminding the fifth (very nearly sixth!) graders that they are role models playing an important role within a larger community.

As the crowd settled in and the chaos dulled to a gentle rumble, students took turns offering personal reflections on all the fun they had and the learning they did during their time at the school. They sang songs, accepted diplomas, and listened (or mostly listened) as their teachers urged them to go forward with confidence, humility, joy, and a deep awareness that they are moving through the world as junior representatives of their families, their friends, and all the teachers who have poured their hearts into guiding them along the way. This event marks the transition not only from elementary into middle school but also from childhood into adolescence – an era of greater freedom and responsibility. And the resounding message, though it was never said in these words, was that our connections, context,

and community all matter. And they matter deeply.

The focus of this issue’s featured articles is social determinants of health and the persistence of longstanding disparities and inequities in health and health care. The data don’t lie, and the story they tell is not about politics. The disparities that exist result in disproportionate health outcomes across different patient populations. As leaders in our state’s health care system, hospitals play a pivotal role in our communities. Just like the fifth (can’t we just go ahead and say SIXTH already?!) graders I applauded this morning, it behooves us to understand a) how far we’ve come and how far we have yet to go, b) the deep responsibility we have to our communities, and c) that it takes innovation and collaboration from all parties to provide the best possible outcomes.

As Arkansas's hospitals lead us toward a healthier future, they will strive to do so with an awareness of the profound influence that context, connections, and community have on our patients. Together we must continue to develop better and more equitable solutions to address the barriers some Arkansans face to highquality care and improved health outcomes, wherever their paths may lead.

Ashley Warren Editor in Chief

2023 Summer Calendar

JULY

July 13

AHAA Board Meeting

AHA Board Room

July 18

340B Quarterly Meeting

Virtual event

July 19

AHA Services Webinar

Qualivis CorHire Webinar

July 20

AHA Quality Forum

Patient and Family Engagement

Virtual event

AUGUST

August 11

AHA Board Meeting

AHA Board Room

August 15-17

20th Annual Mid-South CAH Conference

The Grand Hotel Golf Resort and Spa

Point Clear, Alabama

August 16

AHA Services Webinar

Voyce Webinar

August 17

AHA Quality Forum

Blood Culture Contamination

Virtual event

August 25

Arkansas Society for Directors of Volunteer Services (ASDVS)

Summer Conference

AHA Classroom

SEPTEMBER

September 8

AHA Board Meeting

AHA Board Room

September 14

AHAA Board Meeting

AHA Board Room

September 20

AHA Services Webinar

Vizient’s Managed Care Webinar

September 21

Arkansas Hospital Association

Worker’s Compensation Self-Insured Trust (AHAWCSIT)

Annual Education Conference and Board Meeting

AHA Building

Little Rock

September 21-22

Arkansas Healthcare Human Resources Association (AHHRA)

2023 Fall Conference

Capital Hotel, Little Rock

September 21-22

Arkansas Association for Healthcare Engineering, Inc. (AAHE)

2023 Fall Conference

Washington Regional Medical Center, Fayetteville

September 24

AHA Quality Forum

Sepsis

Virtual event

COMING IN OCTOBER

October 6

Arkansas Association for Medical Staff Services (AAMSS)

2023 Fall Conference

AHA Classroom

HOSPITAL NEWSMAKERS

Michael Stewart, CEO of Saline Health System in Benton, joined Cathy Jacobson, president and CEO of Froedtert Health in Milwaukee, Wisconsin, April 24 in a panel discussion at the 2023 Annual Meeting of the American Hospital Association. Led by AHA Chair-Elect Joanne Conroy, MD, the discussion was titled “Pressure Points: The Financial Future of the Field and Impact on Patients.” Stewart and Jacobson discussed adapting to a post-COVID business model. Stewart noted that the pandemic reaffirmed the importance of community partnerships in the delivery of health care.

Arkansas hospital leaders recently joined AHA staff at the 2023 Annual Meeting of the American Hospital Association. The group met with Senator John Boozman and Representative French Hill, as well as staff members from the offices of Senator Tom Cotton and Representatives Rick Crawford, Steve Womack, and Bruce Westerman.

Results of the compensation portion of the AHA’s 2023 Salary Survey are ready. Results are available to all members who responded to the survey, and contacts at participating facilities have received information on accessing the information. Results include information for the state overall, as well as detailed data cuts for the state and the wider Lower Midwest/South Central region of the U.S. (Missouri, Kansas, Arkansas, Oklahoma). Results of the benefits portion of the survey will be distributed soon.

Izard Regional Hospital, located in Calico Rock, is the new name of the former Izard County Medical Center.

From left, Joanne Conroy, MD, Michael Stewart, and Cathy Jacobson. Their panel discussion took place at the Annual Meeting of the American Hospital Association in Washington, D.C. April 24.

Board members from Conway Regional Health System (left), CEO Matt Troup (behind), AHA Executive Vice President Jodiane Tritt (right) and congressional staff members share a light moment with Representative French Hill and Senator John Boozman. This meeting with Arkansas's congressional delegation occurred concurrently with the 2023 Annual Meeting of the American Hospital Association.

Chris Blair, MBA, BSN, is the new CEO of Northwest Medical Center-Bentonville. Blair, who also serves as Chief Administrative Officer at Siloam Springs Regional Hospital, served as Interim CEO at Northwest Medical Center-Bentonville beginning in March.

Arkansas Children’s recently announced an eight-year, system-wide expansion plan that will increase bed capacity, transform inpatient and outpatient surgical approaches, add an ambulatory surgery center, redesign clinical spaces to promote multidisciplinary care, and create an inviting and accessible campus experience. The $318 million investment includes construction at the Arkansas Children’s campus in Little Rock and the Arkansas Children’s Northwest campus in Springdale. The plan includes recruiting more than 100 new providers and 400 new team members.

Samuel Pieh, DPT, MBA, FACHE, has been named CEO/Administrator for Baptist Memorial Hospital-Crittenden . He most recently served as COO at Baptist Memorial Hospital-Memphis, and he has held leadership roles at Baptist Memorial Hospital-Tipton as well as hospitals in Virginia and Michigan. He earned his Bachelor of Science degree at the University of Memphis, his Master of Business Administration degree from Union University, his Master of Physical Therapy degree from the University of Memphis, and his Doctor of Physical Therapy degree from Temple University.

The University of Arkansas for Medical Sciences recently received a $5.5 million supplemental award from the U.S. Department of Health and Human Services to fund training and outreach programs in rural and underserved areas of the state. The supplemental funding is added to $1.1 million awarded earlier this year, and it brings the total grant award to more than $19.5 million over four years. The funding is designated for projects that will increase the number of primary care physicians practicing in rural and medically underserved communities in Arkansas.

AHA Diamond Awards: Call for Entries

The Arkansas Hospital Association (AHA) is now accepting entries for this year’s Diamond Awards. The open nominations are co-sponsored by the AHA and the Arkansas Society for Healthcare Marketing and Public Relations. This year’s recipients will receive their awards during the November 2, 2023 Awards Luncheon at the Little Rock Marriott.

The 2023 Diamond Awards recognize excellence and encourage improvement in the quality, effectiveness, and impact of health care marketing and public relations in the state of Arkansas. Awards will be presented in several categories, including advertising, annual report, foundation, publications, and writing.

Divisions include hospitals with 0-25 beds (CAHs), 26-99 beds, 100-249 beds, and 250 or more beds. Emphasis will be placed on the budget for each entry within each division.

Nominations and entries, accompanied by appropriate documentation, must arrive at AHA headquarters no later than July 7, 2023, by 4:00 p.m.

A brochure providing details of the awards competition was distributed to hospital CEOs and marketing and public relations directors. The brochure can also be found on the AHA website .

Call for Nominations: AHA Awards

Each year, the Arkansas Hospital Association (AHA) conducts an awards program to recognize individuals whose service represents a significant contribution toward achieving the goals either of the association or one or more of its institutional members.

Nominations for the A. Allen Weintraub and Distinguished Service awards (due this year on or before August 4) are evaluated by the AHA Board of Directors, after which they select the winners. This year, the awards will be presented on Thursday, November 2, during the AHA Annual Meeting Awards Lunch held at the Little Rock Marriott. Learn more by scanning the QR code.

Scan this QR Code to get the Award Program Booklet

of

THEY INCLUDE:

• Health Care Access and Quality (physical and mental health needs).

• Social and Community Contexts (food and nutrition, housing adequacy, transportation access, availability of and access to social services).

• Economic Conditions and Barriers (access to employment, economic mobility, income stability).

• Education Access and Quality.

• Environmental and Neighborhood Factors (water quality, air quality, noise pollution, proximity to hazardous waste sites, weather, climate change).

Social Determinants

Health are the NON-MEDICAL FACTORS that influence health outcomes.

ADDRESSING SOCIAL DETERMINANTS OF HEALTH

Why Are U.S. Health Outcomes Worse Than Those of Other Developed Countries?

By Cliff Fullerton, MD and Jasmin Sumrall, MPH

Study upon study proves it: A person’s overall health is determined not just by their physical and mental status but also by the complex set of environmental and living conditions unique to each individual.

Known as Social Determinants of Health (SDoH), these conditions are defined by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) as

the non-medical factors that influence health outcomes. They include the locales and environments where people are born, grow up, work, live, and age.

AN EXAMPLE: LONDON

In London, life expectancy can change drastically from one small area of the city to another – even one Underground stop to another.

A famous 2012 study, “Lives on

James Cheshire’s mapping of life expectancy and child poverty in London used the well-known and -utilized Tube map to clearly illustrate how disparities in social condition affect health.

2012. Lives on the Line: Mapping Life Expectancy Along the London Tube Network.

(7). Doi: 10.1068/a45341.

the Line,” by Dr. James Cheshire, University College London, used the London Tube Network (LTN) map to illustrate how life expectancy (at birth) and child poverty can change drastically within just a few blocks or a few miles – or a few Tube stops. Cheshire’s “map” dramatically illustrates the high variability of life expectancy in London from ward to ward and borough to borough.

On the surface, explaining these disparities isn’t hard – life expectancy correlates closely with wealth, and the wealthier boroughs show an unsurprisingly

years within just a few Tube stops. This, in turn, causes a negative gradient in health and life expectancy, even though the health care system does not materially change between the various areas of London. [Marmot notes that the same factors and life expectancy variances occur in other communities, large and small, across the world. He cites Baltimore, Maryland, as another city where life expectancies between neighborhoods can vary as much as 20 years, dependent on SDoH.]

Exercise, healthy eating, and stress management are vital components of our health, but, as the London Tube example indicates, the reality is that there are additional environmental factors, often longstanding, that influence health and well-being.

“We have to put reduction of health inequalities at the center of our public health strategy, and that will require action on the social determinants of health,” Marmot notes.

FORCES AND SYSTEMS

higher life expectancy rate than do boroughs of more modest means.

However, Sir Michael Marmot, a Professor of Epidemiology at University College London, and long an expert in the field of SDoH, believes that differences in life expectancy are affected even more by the complex conditions – the SDoH – of one’s environment. “It’s social conditions that determine health,” he says, “not health that determines social circumstances … and it is not just about the money. Health inequalities and the social determinants of health are not a footnote to the determinants of health. They are the main issue.”

In London, social and environmental conditions vary widely and can deteriorate from borough to borough. Indeed, life expectancies can differ by as much as 20

Also key in any examination of health are the wider set of forces and systems shaping the conditions of daily life in any neighborhood, community, region, or nation.

The CDC suggests that besides an individual’s genetic characteristics and personal behaviors, both the physical environment and the social and economic environments affect overall health.

We see these forces and systems play out as economic policies, agendas for development, neighborhood and regional social norms and social policies, cultural harmony (or disharmony), and even existing political systems. Other factors influencing health include racism, misogyny, climate change, ready access to medical care, and access to education.

Regional studies completed in the U.S. suggest that clinical care accounts for

Health inequalities and the social determinants of health are not a footnote to the determinants of health. They are the main issue.

about 20% of health outcomes, while SDoH account for the additional 80% of health outcomes.

These statistics generally apply to all countries across the world. In both poor and rich nations, health status closely correlates to socioeconomic position. The more economic, environmental, and personal resources an individual can access, the more likely they are to have good health.

HEALTH SYSTEM INVOLVEMENT IN SD o H

When determining an individual’s overall health, SDoH are obvious components of each person’s health status. Intuitively, we understand that insufficient access to financial and educational resources – and lacking basic needs like clean air and water, food, safe shelter, and transportation –makes maintaining personal physical and mental health difficult.

However obvious to “good health” these elements appear, health care systems all over the world have, in the past (notably, pre-pandemic), largely taken a handsoff approach when acknowledging and addressing social contributors to health.

But a new era in health care is dawning. Recognizing, understanding, and addressing SDoH is becoming a priority for many health care systems and networks. For example, a patient who is taking medications to control diabetes and has insufficient funds for purchasing both groceries and medicine faces a dilemma each time they must purchase either. As health care providers, we want to recognize, examine, and address such challenges with our patients and do what we can to help them overcome barriers to improved health.

But the U.S. health care system’s feefor-service payment model complicates physicians’ and health systems’ efforts to meaningfully address SDoH. The fee-forservice payment model pays for office visits, procedures, tests, and other traditional, volume-related services. There is no ready avenue for addressing environmental or economic barriers within this current model.

Not all countries have these same constraints. Countries with less structured

health care models can, oftentimes, be quite nimble in addressing individuals’ health. They can more easily apply limited resources in ways that best benefit individuals.

Take the treatment of asthma: The U.S. health care system pays for an asthmatic child to be evaluated by a physician, and it pays for treating that child’s asthma with medications, but it does not generally pay to assess and improve air quality in the home, though the latter can be less expensive and even more effective than options available through fee-for-service. (There’s more on this below.)

Developing maps of barrios around each clinic helps health workers identify homes where health risks exist.

AN EXAMPLE: HONDURAS

Predisan is a not-for-profit health care system operating in Honduras. Its resources include access to physicians, nurses, dentists, pharmacists, physical therapists, and psychologists, and services such as inpatient care, surgical care, radiology, and pharmacy access that all provide fee-for-service care similar to that supplied in the U.S.

However, Predisan can also use donated resources and governmental funding to manage social determinants. One example is a simple tactic that they use to manage childhood asthma in some poor areas.

Many people in rural Honduras cook their food over open fires inside their homes with

no ventilation. This can, of course, lead to patients acquiring and suffering from asthma and emphysema. Predisan will use its resources to build chimneys in these homes. Cleaning up the home’s air is a simple and inexpensive treatment that often cures the asthma of the children living there.

In its Healthy Communities Program, Predisan addresses SDoH directly and encourages healthy lifestyle choices. It offers both counseling and education, such as nutrition and cooking classes, gardening and environmental education, and DIY instruction on how to improve sanitary conditions (like putting in latrines to manage water-borne infections).

Its Healthy Schools Program offers traditional health care within the school itself, providing vitamins, physical exams, and medications to combat parasites. It also offers healthy meals for students and family education courses about nutrition and food preparation. Healthy Schools adds a preventive approach by educating students about the risks of drug use and what to do in cases of home violence. Knowing that education is an important social determinant of health outcomes, Predisan also provides scholarships that allow poor children to finish school.

Some Predisan clinic staffs create home-specific maps of their surrounding neighborhoods. Each citation on the map includes the health specifics being addressed in that home, e.g., tuberculosis, hypertension, malaria, etc. Clinical staff members use this information to organize logistical support for the needs in that home. (For example, a certain patient may need home delivery of medications, transportation to the clinic, or home checks for safety or sanitation. Patients’ health care needs –including those offered in the clinic and those related to SDoH – are addressed on individual bases.)

Funding for Predisan mostly comes from its fee-for-service payments and funding from the Honduran government. The organization also relies on donations, which adds to its flexibility in addressing health issues at the most effective and efficient points of contact. It has created a holistic blend providing both traditional

For those without access to transportation, Predisan provides patient transportation and medication delivery services with vehicles like these.

health care strategies and customized management of local SDoH. The scope of disease management options provided under one health care system allows maximum coordination, resourcefulness, and prioritization.

SD o H IN ARKANSAS

Just as they shape the health of everyone across the world, it is not surprising that SDoH factors shape the health of all Arkansans.

Arkansas ranks among the 10 U.S. states with the highest rates of diabetes, heart disease, kidney disease, and chronic lower respiratory disease.

Recent analysis of U.S. Department of Agriculture data by the Arkansas Center for Health Improvement showed that in more than a quarter of all Arkansas census tracts, at least 50% of the population lives in food deserts, or areas without ready access to grocery stores and healthy foods. In turn, people living in these areas are less likely to attain adequate nutrition which can increase their risk of acquiring diseases such as diabetes, heart disease, and obesity. Living in a food desert is one of the most common determinants of health in our state.

A wide variety of organizations, both governmental and non-governmental, work to address SDoH challenges faced by Arkansans. For instance, the Arkansas Department of Health has multiple avenues for addressing SDoH. The Department identifies points of access to education, and it identifies food deserts and seeks to bring healthy food into these areas. It identifies adverse childhood events, stigma, and lack of access to behavioral health resources so that remedies and resources can be made available where needed. The Department identifies areas with a lack of readily accessible public transportation, and it shines a light on the lack of access to broadband internet as pertinent SDoH for Arkansans.

ADVANCING SOLUTIONS

While health care solutions regarding SDoH are still being researched and developed, there are promising strategies being put in place that identify patients’ needs and

connect them to resources.

For example, Community Health Workers (CHWs) are a strategic tool for addressing SDoH challenges in both the U.S. and abroad.

CHWs are nonclinical health care professionals who have a shared identity with and an intimate knowledge of the community they serve. Some CHWs share the same health conditions and socioeconomic status as their clients. We can think of CHWs as trusted peers that provide a cultural translation of the patient’s care plan.

CHWs use their unique connection with patients to help them navigate complex health care systems and connect patients to resources for overcoming barriers to improved health. In health care, CHWs

for patients

families in immediate need.

are most effective when they’re viewed as complementary members of a care team who can help patients overcome barriers that may undermine the care plan.

In one successful example, Hispanic diabetic patients with Spanish as their first language showed a significant improvement in their diabetes control when Hispanic

Baptist Health's Food Rx Program provides non-perishable foods

and

CHWs with Spanish as their first language helped patients understand their care plans. No change in medications, diet, or physician visitation was needed. Patients just needed a better understanding of their medical care plan, and that was provided based on the bonds of trust and common language.

BAPTIST HEALTH’S FOOD RX PROGRAM

At Baptist Health, we recognize the financial constraints that many of our patients face, and, in response, we have developed the Food Rx Program that provides nonperishable food items to patients who have an immediate need.

Arkansas provide food to those in need. The Baptist Health Food Rx Program provides health-needs specific bags of food to patients in our primary care clinics. Diabetes-focused bags offer lower carbohydrate and higher protein food items, while hypertension- and congestive heart failure-focused bags provide lower sodium foods.

While the Food Rx Program provides an immediate, though short-term, solution, Baptist Health recognizes the need for connecting patients to longer-term solutions. Baptist Health partners with findhelp – a search engine for national and local social services providers. Baptist Health and findhelp are working together to build partnerships with community-based organizations that offer social services to which patients can be referred.

Using the example of food insecurity, patients who receive a bag of food through Food Rx can also be referred to the SNAPARK Call Center – an offering of the Arkansas Hunger Relief Alliance. The call center helps people check their eligibility for the Supplemental Nutrition Assistance Program (SNAP) and helps people apply for the program if they’re eligible. SNAP provides a monthly allowance to supplement food budgets of families in need so they can purchase healthy foods and move toward self-sufficiency. The combination of Food Rx and a referral to SNAP-ARK provides both short- and long-term solutions for patients who are experiencing food insecurity.

MOVING FORWARD

Patients are asked two questions using the Hunger Vital Sign TM Screening Tool, and when they indicate that having additional food would be beneficial to them and their household, they are provided with a bag of nonperishable food.

Our partner in food acquisition is the Arkansas Foodbank, which helps more than 400 agencies across Central and South-Central

The United States, when compared with other developed nations, has both a lower life expectancy and higher rates of chronic disease. These statistics are puzzling when we consider that, though the U.S. spends more on health care than these same countries, we have poorer results and outcomes.

One explanation for this disparity may be that U.S. spending on social services lags behind that of other nations. The U.S. has traditionally under-invested in preventive and social care, and, instead, has prioritized sick care, which does not provide the best financial return on investment.

However, in recent years, spurred by the

Baptist Health keeps a well-stocked pantry for its Food Rx Program. Meeting patients' immediate needs for food is a priority.

COVID-19 pandemic, health care providers and payers are beginning to prioritize identification of patients’ social needs and their navigation to social services. A Harvard University analysis by Robert H. Shmerling, M.D. puts it this way: “The social determinants of health likely explain a lot of these disparities. For example, those with the shortest life expectancies in the U.S.

tend to have the most poverty, face the most food insecurity, and have less or no access to health care, all factors that contribute to lower life expectancy.”

As the nation and its health care systems seek to improve health outcomes and life expectancy, we must focus on improving our understanding of and spending on solutions that address SDoH.

Health and Social Care Spending as a Percent of GDP, 2016 or Latest Available Year

Cliff Fullerton, MD, MS, serves as Senior Vice President for Baptist Health and as its Chief Value-Based Care Officer. Jasmin Sumrall, MPH, serves as Operations Manager for Baptist Health's Population H ealth Services Office.

HEALTHY PEOPLE 2030 and Social Determinants of Health

Healthy People is a project of the U.S. Department of Health and Human Services that provides useful tools and objectives for those seeking to improve the health and well-being of their communities.

The project began in 1990, and at the beginning of each decade it refines and launches 10-year, measurable public health objectives designed to improve the health of every American. The current program, Healthy People 2030, includes new tools to help measure and track progress of program objectives.

The program identifies pressing public health priorities and presents objectives for achieving

being of their populations. Healthy People 2030 includes a multifaceted resource section defining, providing research and statistical information, and connecting those interested in specifically addressing social determinants of health in their everyday work.

A WEALTH OF INFORMATION

Healthy People 2030 includes a resource area, “Social Determinants of Health Literature Summaries,” that provides snapshots of the latest research related to specific social determinants of health: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhoods and the Built Environment, and Social and Community Contexts.

Is your workgroup looking for ways to improve the economic stability of your region? You might want to access literature summaries in the areas of employment, food insecurity, housing instability, and/or poverty.

Are you working on local improvements to educational access and quality? Specific literature summaries are available in the areas of Early Childhood Development and Education, Enrollment in Higher Education, High School Graduation, and Language and Literacy.

improvement in public health. Healthy People 2030 connects users to dozens of data sources and hundreds of evidence-based resources that can be used to set (and track progress of) national, regional, and local public health improvement targets.

Health care organizations, non-governmental helping organizations, and communities have long made use of the toolkits included in Healthy People to improve the health and well-

If health care access and quality is your main focus, you can explore summaries on the topics of Access to Health Services, Access to Primary Care, and Health Literacy.

Summaries in the area of Neighborhood and Built Environment include Quality of Housing, Crime and Violence, Environmental Conditions, and Access to Foods that Support Healthy Dietary Patterns.

And in the area of Social and Community Context, summaries addressing Civic Participation, Discrimination, Incarceration, and Social Cohesion are now available.

Healthy People 2030, a project of the U.S. Department of Health and Human Services, sets data-driven national objectives to improve health and well-being over the next decade.

HOW DOES HEALTHY PEOPLE 2030 ADDRESS SOCIAL DETERMINANTS OF HEALTH?

One of the project’s five overarching goals specifically relates to social determinants of health: “Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.”

More than a dozen workgroups made up of subject matter experts with differing backgrounds and areas of expertise developed the Healthy People 2030 objectives for improving health and reducing health disparities. One of these workgroups is dedicated to the social determinants of health.

Healthy People first introduced social determinants of health objectives in 2010. Addressing social determinants of health means focusing on resources needed to maintain health and quality of life. Healthy People 2030 highlights resources for achieving safe and affordable housing, high-quality education, access to healthy foods, local health and emergency services, and environments free of life-threatening toxins that provide opportunities for safe physical activity.

Lead federal agencies involved in the Healthy People 2030 Social Determinants of Health Workgroup include the Office of Disease Prevention and Health Promotion, the National Institutes of Health, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the National Center for Health Statistics. Other agencies and groups engaged with this workgroup include the Robert Woods Johnson Foundation and the World Health Organization, among others.

• Increase the proportion of children living with at least one parent who works full time.

• Reduce the proportion of families that spend more than 30% of income on housing.

• Increase the proportion of high school graduates in college the October after graduating.

• Increase the proportion of federal data sources that include country of birth.

• Increase the proportion of the voting-age citizens who vote.

Representatives of the National Center for Health Statistics involved with this workgroup regularly summarize data on these objectives and track progress toward achieving them.

For more information on Healthy People 2030 and how your organization can utilize its resources as you address social determinants of health in your area, scan the QR code below or visit healthypeople.gov.

USEFUL INFOGRAPHICS

Do you need infographics to support your work on the social determinants of health? You’ll find reproducible infographics on the Healthy People 2030 website that illustrate how social determinants of health can influence health outcomes. Look for infographics in the areas of employment, early childhood development and education, access to health services, healthy foods, and civic participation, among others.

There are eight objectives identified by the Social Determinants of Health Workgroup. These are:

• Reduce the proportion of children with a parent or guardian who has served time in jail.

• Reduce the proportion of people living in poverty.

• Increase employment in working-age people.

DR. MICHELLE KRAUSE

By Nancy Robertson

Some people cite a defining moment when their career choice is crystallized. Some say they feel pulled toward one field or another. And others just know. They know, with a certainty inside themselves, what their work in this world is to be. Dr. Michelle Krause, Senior Vice Chancellor for UAMS Health and Chief Executive Officer for UAMS Medical Center, says she always knew that she would be a physician. From the time as a youngster when she accompanied her father on rounds at the hospital, she knew. When she saw that care delivery is not always equal, she knew. And when she worked with a mentor who encouraged serving the underserved, she knew.

She. Just. Knew.

Michelle Whittier lost her mother, Joan, a nurse, to ovarian cancer when she was five years old. She and her older sister and two younger brothers learned to depend upon one another and on their dad, Dr. Fred Whittier, as they grew up in the Midwest.

Dr. Whittier told his kids he would pay for their college tuition as long as they stayed in their home state of Ohio. “I wanted to go to school as far away from my hometown of Canton as possible,” she grins, “so I applied to the University of Cincinnati.” There was already a piece of “home” there –Michelle’s sister also attended the University of Cincinnati where she pursued nursing as a career.

“After graduation, I knew that paying for med school was up to me, so, being practical, I chose to stay in Cincinnati to attend the University of Cincinnati College of Medicine,” she says. While in medical school, Michelle encountered a faculty member who would become a beloved mentor. “She was an Internist who taught me that serving patients in underserved areas was one of the most important things we could do as physicians.”

This often meant providing care in clinics and settings that lacked sufficient supplies and resources – but finding ways to provide equal care to every patient, no matter their circumstances or means, became a driving force.

“When it was time to match for medical residency, I applied to the University of North Carolina at Chapel Hill,” she says. “While I was growing up, we sometimes vacationed in North Carolina, and it felt like a friendly and familiar place to me.”

She was accepted for the UNC residency program and began her internship, then residency in internal medicine. Decisions on what direction to follow gripped her. Should she go into private practice? Community medicine? Academic medicine? Research?

“Along the way, I learned that I was drawn to caring for the very sickest of patients and at the same time was drawn to medical research, so an academic setting made sense. I decided to pursue fellowships in nephrology and nephrology research, because this work put me where I wanted to be – in a position to care for patients who are extremely ill while pursuing ways to improve their care.”

Concurrent with her fellowship training, Michelle attended the university’s Gillings School of Global Public Health, where she earned her Master of Public Health degree in epidemiology.

SEEKING TO SERVE

“As I neared the end of my nephrology training, it was time to find where I would ultimately practice,” she recalls. “It made sense to me that to care for the sickest of patients, I should look at serving in one of the larger cities in the country. I was determined to serve the underserved, so I decided to interview in several of America’s big cities.” Interview after interview occurred. But nowhere did she find people who seemed

excited with their work, nor did she find people who seemed happy to support one another in the medical workplace. “I struggled for months,” she says. “I needed to find a job, but it needed to feel ‘right.’ I reluctantly decided to go with my sister’s urging and settle somewhere near her on the east coast.”

While attending a national meeting for physicians practicing nephrology, she got a call from her old boss at UNC. “I think I have a job for you,” he said, “but I’m not going to tell you where it is.” While still at the conference, a breakfast interview with the “mystery” organization was arranged, and she was introduced to Dr. Sudhir Shah, a division chief at the University of Arkansas for Medical Sciences.

“Dr. Shah was so dynamic, and so excited about the possibility of my joining the UAMS team,” she remembers. “He asked me to come to Little Rock to see what UAMS was all about.”

She was frustrated, she says, with not being able to research much about UAMS before coming to Little Rock. “There was no internet, no way to find out much before I made the trip.”

But when she came to the UAMS campus, she felt like it could become “home.”

“People’s doors were open, they were friendly, they seemed to support one another and UAMS’s work, which was so important,” she says. “Though I knew no one in Arkansas, I felt I could come here and not feel alone.”

life taken root, but so had her family and personal life.

Now Dr. Michelle Whittier Krause, she began her work combining research, patient care, and an academic career.

Dr. Krause’s gift of organization led to an offer in Administrative Oversight. This position allowed her to work with others in organizing UAMS’s entire clinical umbrella, bringing needed structure to the massive educational and clinical enterprise that is the teaching hospital.

Michelle’s sister and aunt were very concerned about her impending decision. “They made me feel that I should locate closer to family and to my support system,” she says. “What they said made sense.”

But when she called Dr. Shah in 2002, ready to decline his offer of employment, she surprised herself by instead saying, “Yes, I’ll accept your offer and come to Little Rock.”

AT HOME IN LITTLE ROCK

“At the age of 32, I moved into a 1920s-era home in Hillcrest with a yard of my own,” she smiles. “It was all new to me, and I loved it.”

Across the street lived a single lawyer who came to visit shortly after her move to the neighborhood. “Within several months we were married, and shortly thereafter came three kids in four years.” So not only had her professional

“Roxanne Townsend was our first female CEO, and at the time of her leadership there was a new, national focus on clinical efficiencies and quality of care,” she says. “I was asked to oversee our medical specialties service line, which gave me the opportunity to both concentrate on quality and, at the same time, expand our service to the medically underserved throughout the state. The attention we placed on quality of care got UAMS noticed, and as time went on, we were able to put our attention where it most needed to be – on the patient’s experience when moving from clinic to hospital and back home again. We wanted to build a cohesive experience for our patients, and we believe we’re doing that very well.”

THEN, COVID-19

As COVID hit, all “regular” work at the medical center changed. “Everything we offered, from our medical programming to medical residencies to clinical work in eight locations around the state, became laser-focused on delivery of care to Arkansas patients with COVID,” she says. “Immediately, it became our work to transform care in the communities we served and to make certain every patient had access to the care they needed.”

Dr. Krause was asked to take over UAMS’s COVID response, partly because of her organizational skills, partly because of her dedication to the sickest of the sick, and partly because she could keep a cool head in the midst of the national health crisis.

Dr. Michelle Krause was on the front lines as UAMS set up mobile testing events at the beginning of the COVID-19 pandemic. Here, she and her colleagues conduct individual testing at Shorter College in North Little Rock June 30, 2020.

“Everything evolved quickly,” she recalls. “We had to learn how most safely to take care of our patients in the hospital, how to safely provide care in clinics throughout the state, how to safely operationalize care for non-COVID patients, and how to provide testing when no testing materials or protocols were available.”

Dr. Krause and the COVID team built a plan of care that involved mobile testing – drive-through clinics where people could be tested in their vehicles. They took testing out into Arkansas’s communities, making it available in remote locations of the state.

Working with colleagues in the pathology department and other areas of the campus, her team developed testing protocols, isolation policies, communication tools, and safety procedures for the main campus, then took them to the field and implemented COVID policies that could be adapted anywhere in the state.

“One of the most important things we did was to break down myths,” she says. “We were transparent about what was known about COVID and what we were learning as time went on. When vaccines became available, we developed ways to take them to the people of Arkansas. Local access was put in place, and we also provided a mobile unit that could take vaccine and vaccinations anywhere in the state.”

As COVID wore on and knowledge about COVID care grew, Dr. Krause and her team continually changed protocols and procedures to meet the needs of Arkansans, Arkansas hospitals and physicians, and fellow staff members at UAMS.

“We were and are passionate about the care we offer to every Arkansan,” she explains. “COVID gave us the chance to evaluate what was and wasn’t working for patients and staff,

and we adjusted at every step. That work was some of the most challenging work I have ever experienced. We all worked every day for YEARS. As parents, we adjusted to having kids attend school virtually from home. We adapted and addressed needs as they came up in every corner of our campus. And at the end of the day, I can honestly say that the work during the pandemic was some of the most fulfilling and rewarding of my career.”

A NEW ROLE

With all of the transitions occurring daily and weekly during the COVID crisis, as it neared its end Dr. Krause was offered a new opportunity that grew out of the leadership she presented during the pandemic.

“I really thought I would always keep doing what I had been doing,” she says, “but then I was offered an opportunity to move into administrative leadership of the operation on a permanent basis.”

In January of 2023, she was named Senior Vice Chancellor for UAMS Health and Chief Executive Officer for UAMS Medical Center.

Her personal guiding goal of improving the lives of Arkansans through better health and health care has always been at the center of her 20-year career at UAMS. “No matter a person’s age, race, socioeconomic status – we intended and intend to close existing gaps so that equal care is offered to every person.”

Her reputation for remaining calm in the center of any storm and her determination to keep the patient’s viewpoint at the center of all UAMS programming helps those around her understand the importance of building trust within work groups, in the patient care setting, and in the communities where UAMS offers service.

We must address people’s challenges in order to help them improve and impact their health.

“We must address people’s challenges in order to help them improve and impact their health,” she says. “At the clinic level, at the hospital level, we sort things out patient by patient. We look for ways to connect patients with services. We look for ways to meet people where they are and learn from them about what they need. That gives each of us the opportunity to serve, and it encourages us to develop novel ways of delivering care outside the four walls of the hospital.”

The new Hospital at Home program that encourages home health care for eligible patients, a new collaboration with Hall High School that will prep students to move into health

care careers, the expansion of community clinics to offer innovative services to patients in their hometowns – these are but a few of the projects growing outward from Dr. Krause’s leadership and compassion.

“We can learn from everyone, and everyone can learn from us,” she says.

It’s something she has known, deep down inside since she was a child. Caring for patients is her passion, developing people and programming to make that happen at every level for every person equally is her commitment.

It’s what she set out to do all those years ago when She. Just. Knew.

Leadership Profile Q/A with Dr. Michelle Krause

What is something people don’t know about you?

We bought a home in Ferndale and started a market farm. We are now selling our produce at the Ferndale Farmers Market every Saturday. We also raise chickens for eggs and bees for honey.

What do you like to do in your down time?

I really like being outside, whether that is working in the garden, going to the lake, or taking a walk or going for a run. It helps to clear my mind and gives me inspiration to meet my next challenge.

What’s on your desk right now?

Slides to review for a UAMS town hall meeting on the COVID-19 update and on the impact of the end of the federal Public Health Emergency. I also have slides to review for a presentation at the University of Arkansas Board of Trustees meeting.

Where would you travel if you could go anywhere?

I would like to visit all of our national parks. We traveled to many of them when our children were younger, but I want to get out west and see Yosemite.

What is the most valuable lesson COVID has taught you?

Every single person at UAMS, whether part of the team in clinical areas, research, administration, or education provided input and committed to putting in hard work to face the challenges at the height of the pandemic. No one area was able to work through these challenges alone.

Dr. Michelle Krause

Arkansas Hospitals

ARKANSAS HOSPITAL ASSOCIATION 2023 HOSPITAL STATISTICS

33 Workforce Challenges by the Numbers

34 Arkansas Hospitals 2023 by the Numbers

35 Arkansas Hospital Association Member Organizations by Type, 2023

36 AHA Members by City, Type, Size, and Services

38 Statewide Hospital Financial and Utilization Indicators, 2016-2021

39 Arkansas Hospitals Receiving Local Tax Support, 2023

40 Key Financial Indicators: Arkansas and Surrounding States, 2021

41 Comparative Financial Indicators: U.S. Community Hospitals

42 Hospital Access by County

43 AHA-Member Organizations by Congressional District

44 AHA Members by Control and System Affiliation

46 Inpatient and Emergency Department Discharges by Payer, 2021

Uninsured Inpatient Admissions and Costs, 2011-2021

47 Hospital Uncompensated Care Costs, 2016-2021

Top 20 DRGs, 2021

48 Arkansas Hospitals Locator Map, 2023

Hospital Statistics uses the latest data available, and this year includes utilization and financial data reflecting the impact of the COVID-19 pandemic. Hospitals experienced massive disruptions in 202021, with reductions in revenue due to deferred and delayed care, expenditures related to pandemic preparedness and response, supply chain issues, staffing shortages, and several major surges of COVID-19. At the same time, federal and state COVID-19 relief funding provided some much-needed assistance, though occasionally with future repayment requirements. Financial and utilization measures included are reported based on hospital fiscal year, and not all 2021 data reflect the same 12-month period for each hospital. This year’s edition of Hospital Statistics reflects a full year’s view of hospital operations during the COVID-19 pandemic, and year-over-year changes in measures should be interpreted with caution.

2023 WORKFORCE CHALLENGES BY THE NUMBERS

A 2023 study commissioned by AHA found that Arkansas’s current shortfall of 9,000 registered nurses will not be resolved by 2035 if no interventions are made.

RN SUPPLY ADEQUACY BY REGION, 2021 AND 2035

Note: 100% supply adequacy means supply is sufficient to provide the 2021 national average level of care.

RN SUPPLY ADEQUACY BY COUNTY, ADJUSTED FOR HOSPITAL LOCATION, 2021 (LEFT) AND 2035 (RIGHT)

WORKFORCE CHALLENGES BEYOND RN STAFF

To maintain current Arkansas use patterns, the licensed practical nurse (LPN) workforce would need to grow by an additional 55 LPN full-time employees per year above anticipated status quo growth. By 2035, there will be a shortfall of approximately 240 to 580 respiratory therapists to meet the projected demand.

Other specialties showing shortfalls include:

• Physician assistants.

• Phlebotomists.

• Clinical laboratory technicians.

• Emergency medical technicians.

ARKANSAS HOSPITALS 2023 BY THE NUMBERS

113 Hospitals of all types are located in cities, towns and communities throughout Arkansas.

106 Hospitals and other health care organizations are members of the Arkansas Hospital Association.

55 Community hospitals have fewer than 100 acute care beds.

28 Hospitals are designated by the federal government as Critical Access Hospitals, having no more than 25 acute care beds.

41 Counties are served by a single hospital. Eighteen of those counties are served by a single Critical Access Hospital.

$15.2 BILLION

Is contributed by hospitals toward Arkansas’s economy, through the impacts of well-paid, consistent employment, purchases of goods and services, and construction and capital spending.

11% Of Arkansas workers are employed by hospitals or other health care organizations.

25 Arkansas counties and cities believe their hospitals to be important enough that people in those areas have voted to provide local tax support for the hospital.

20 Arkansas counties – over a quarter of all counties in the state – do not have a local community hospital.

60% Of AHA member organizations are charitable, not-for-profit organizations, while 26% are operated by private, for-profit companies, and 13% are public hospitals owned and operated by a city, county, state, or federal government.

65,655 Hospitalizations due to COVID-19 were reported by Arkansas hospitals during the period of August 2020-May 2023.

18,016 Arkansans sought inpatient or outpatient care from the state’s hospitals each day in 2020, on average, for illnesses, injuries, and other conditions that required medical attention.

35,471 Newborns were delivered in Arkansas hospitals in 2021. Over 40% of those births were covered by Medicaid.

ARKANSAS HOSPITAL ASSOCIATION MEMBER ORGANIZATIONS BY TYPE, 2023

General Med-Surg Hospitals (46)

Arkansas Methodist Medical Center

Baptist Health Medical Center-Conway

Baptist Health Medical Center-Hot

Spring County

Baptist Health Medical Center-Little Rock

Baptist Health Medical Center-N. Little Rock

Baptist Health Medical CenterStuttgart

Baptist Health-Fort Smith

Baptist Health-Fort Smith

Baptist Memorial Hospital-Crittenden

Baxter Health

Chambers Memorial Hospital

CHI St. Vincent Hot Springs

CHI St. Vincent Infirmary

CHI St. Vincent North

Conway Regional Health System

Drew Memorial Health System

Forrest City Medical Center

Great River Medical Center

Helena Regional Medical Center

Jefferson Regional

Johnson Regional Medical Center

Levi Hospital

Magnolia Regional Medical Center

Medical Center of South Arkansas

Mena Regional Health System

Mercy Hospital Fort Smith

Mercy Hospital Northwest Arkansas

National Park Medical Center

NEA Baptist Memorial Hospital

North Arkansas Regional Medical Center

Northwest Health Physicians’ Specialty Hospital

Northwest Medical Center Bentonville

Northwest Medical Center Springdale

Ouachita County Medical Center

Saint Mary’s Regional Medical Center

Saline Memorial Hospital

Sevier County Medical Center

Siloam Springs Regional Hospital

St. Bernards Five Rivers

St. Bernards Medical Center

UAMS Medical Center

Unity Health

Unity Health Jacksonville

Unity Health Newport

Washington Regional Medical System

White River Health

Critical Access Hospitals (28)

Ashley County Medical Center

Baptist Health Medical CenterArkadelphia

Baptist Health Medical Center-Heber Springs

Bradley County Medical Center

CHI St. Vincent Morrilton

Chicot Memorial Medical Center

CrossRidge Community Hospital

Dallas County Medical Center

Dardanelle Regional Medical Center

Delta Memorial Hospital

DeWitt Hospital & Nursing Home

Eureka Springs Hospital

Fulton County Hospital

Howard Memorial Hospital

Izard Regional Hospital

Lawrence Memorial Hospital

Little River Medical Center

McGehee Hospital

Mercy Hospital Berryville

Mercy Hospital Booneville

Mercy Hospital Ozark

Mercy Hospital Paris

Mercy Hospital Waldron

Ozark Health Medical Center

Ozarks Community Hospital

Piggott Health System

SMC Regional Medical Center

Stone County Medical Center

Inpatient Psych Hospitals (11)

Arkansas State Hospital

Conway Behavioral Health

Methodist Behavioral Hospital

Perimeter Behavioral Hospital of W. Memphis

Pinnacle Pointe Behavioral Healthcare System

Rivendell Behavioral Health Services

Riverview Behavioral Health

Springwoods Behavioral Health Hospital

The BridgeWay

Valley Behavioral Health System

Vantage Point of NWA

Inpatient Rehab Hospitals (7)

Baptist Health Rehabilitation Institute

CHI St. Vincent Hot Springs Rehabilitation Hospital

CHI St. Vincent Sherwood Rehabilitation Hospital

Conway Regional Rehabilitation Hospital

Encompass Health Rehabilitation Hospital, a partner of Washington Regional

Mercy Rehabilitation Hospital

Fort Smith

Mercy Rehabilitation ServicesNorthwest Arkansas

Veterans Affairs Hospitals (2)

Central Arkansas Veterans Healthcare System

Veterans Health Care System of the Ozarks

Long Term Care Hospitals (4)

Advanced Care Hospital of White County

Arkansas Continued Care Hospital of Jonesboro

Baptist Health Extended Care Hospital

Cornerstone Speciality Hospitals

Little Rock

Special Focus Hospitals (3)

Arkansas Children’s Hospital

Arkansas Children’s Northwest

Willow Creek Women’s Hospital

Out-of-State Border City Hospitals (2)

CHRISTUS St. Michael Health System

Regional One Health

Non-Hospital Facilities (3)

19th Medical Group

Arkansas Hospice

CARTI

AHA MEMBERS BY CITY, TYPE, SIZE, AND SERVICES

AHA MEMBERS BY CITY, TYPE, SIZE, AND SERVICES

STATEWIDE HOSPITAL FINANCIAL AND UTILIZATION INDICATORS, 2016 - 2021

ARKANSAS HOSPITALS RECEIVING LOCAL TAX SUPPORT, 2023

KEY FINANCIAL INDICATORS ARKANSAS AND SURROUNDING STATES, 2021

Hospitals charged this amount for the inpatient and outpatient care they provided in 2021:

But patients and payer groups didn’t pay the full amount of billed charges for various reasons. Government programs like Medicare and Medicaid, workers’ comp programs and others never pay the full hospital bill. Managed care plans and other insurers typically pay discounted amounts only, and individual patietns often can’t afford to pay some or any of the out-of-pocket costs related to their hospital bills. For those reasons, hospitals had to forfeit this much of their billed charges:

As a result, actual payments to hospitals were:

At the same time, hospitals spent this much providing patient care services…

…to patients needing care for this many adjusted patient days while being served.

So the revenue excess (loss) was:

In other words, hospitals made (or lost) this much on each of the equivalent days of care they provided to inpatients and outpatients:

Yielding a “patient service” margin of:

In addition, hospitals also received revenues from normal, day-today operations from services other than health care provided to patients, such as COVID relief dollars, space rental, cafeteria and gift shop sales, and operating gains:

Which raised total operating income to:

As a result, the “operating margin” rose to:

Hospitals also collected other types of revenue from sources including contributions, tax appropriations, and investments. Those amounted to:

That resulted in total funds available to reinvest in new equipment, update facilities, expand programs and repay debt equalling:

Source: American Hospital Association Hospital Statistics

ARKANSAS

LOUISIANA

MISSISSIPPI

MISSOURI

OKLAHOMA

TENNESSEE

TEXAS

UNITED STATES

COMPARATIVE FINANCIAL INDICATORS U.S. COMMUNITY HOSPITALS

HOSPITAL ACCESS BY COUNTY

AHA-MEMBER ORGANIZATIONS BY CONGRESSIONAL DISTRICT

1ST CONGRESSIONAL DISTRICT

Arkansas Continued Care Hospital of Jonesboro

Arkansas Methodist Medical Center

Baptist Health Medical Center-Stuttgart

Baptist Memorial Hospital-Crittenden

Baxter Regional Medical Center

Chicot Memorial Medical Center

CrossRidge Community Hospital

Delta Memorial Hospital

DeWitt Hospital & Nursing Home

Forrest City Medical Center

Fulton County Hospital

Great River Medical Center

Helena Regional Medical Center

Izard Regional Hospital

Lawrence Memorial Health Foundation, Inc.

McGehee Hospital

NEA Baptist Memorial Hospital

North Arkansas Regional Medical Center

Piggott Community Hospital

SMC Regional Medical Center

St. Bernards Five Rivers

St. Bernards Medical Center

Stone County Medical Center

Unity Health Newport

White River Health System

WoodRidge of West Memphis, LLC

Total = 26

2ND CONGRESSIONAL DISTRICT

19th Medical Group

Advanced Care Hospital of White County

Arkansas Children’s Hospital

Arkansas Hospice

Arkansas State Hospital

Baptist Health Extended Care Hospital

Baptist Health Medical Center-Conway

Baptist Health Medical Center-Heber Springs

Baptist Health Medical Center-Little Rock

Baptist Health Medical Center-North Little Rock

Baptist Health Rehabilitation Institute

CARTI

Central Arkansas Veterans Healthcare System

CHI St. Vincent Infirmary

CHI St. Vincent Morrilton

CHI St. Vincent North

CHI St. Vincent Sherwood Rehabilitation Hospital, a Partner of Encompass Health

Conway Behavioral Health

Conway Regional Health System

Conway Regional Rehabilitation Hospital

Cornerstone Specialty Hospitals Little Rock

Methodist Behavioral Hospital

Ozark Health Medical Center

Pinnacle Pointe Behavioral Healthcare System

Rivendell Behavioral Health Services

Saline Memorial Hospital

The BridgeWay

UAMS Medical Center

Unity Health

Unity Health Jacksonville

Total = 30

3RD

CONGRESSIONAL DISTRICT

Arkansas Children’s Northwest

Baptist Health-Fort Smith

Baptist Health-Van Buren

Encompass Health Rehabilitation Hospital, a Partner of Washington Regional Eureka Springs Hospital

Mercy Hospital Berryville

Mercy Hospital Fort Smith

Mercy Hospital Northwest Arkansas

Mercy Rehabilitation Hospital Fort Smith

Mercy Rehabilitation Services - Northwest Arkansas

Northwest Health Physicians’ Specialty Hospital

Northwest Medical Center Bentonville

Northwest Medical Center Springdale

Ozarks Community Hospital

Siloam Springs Regional Hospital

Springwoods Behavioral Health Hospital

Valley Behavioral Health System

Vantage Point of NWA

Veterans Health Care System of the Ozarks

Washington Regional Medical System

Willow Creek Women’s Hospital

Total = 21

4TH CONGRESSIONAL DISTRICT

Ashley County Medical Center

Baptist Health Medical Center-Arkadelphia

Baptist Health Medical Center-Hot Spring County

Bradley County Medical Center

Chambers Memorial Hospital

CHI St. Vincent Hot Springs

CHI St. Vincent Hot Springs Rehab Hospital, a Partner of Encompass Health

Dallas County Medical Center

Dardanelle Regional Medical Center

Drew Memorial Health System

Howard Memorial Hospital

Jefferson Regional

Johnson Regional Medical Center

Levi Hospital

Little River Medical Center, Inc.

Magnolia Regional Medical Center

Medical Center of South Arkansas

Mena Regional Health System

Mercy Hospital Booneville

Mercy Hospital Ozark

Mercy Hospital Paris

Mercy Hospital Waldron

National Park Medical Center

Ouachita County Medical Center

Riverview Behavioral Health

Saint Mary’s Regional Medical Center

Sevier County Medical Center

Total = 27

ADDITIONAL AHA MEMBER HOSPITALS

INCLUDE:

CHRISTUS St. Michael Health System, Texarkana, TX

Regional One Health, Memphis, TN

AHA MEMBERS BY CONTROL AND SYSTEM AFFILIATION

INPATIENT AND EMERGENCY DEPARTMENT DISCHARGES BY PAYER, 2021

UNINSURED INPATIENT ADMISSIONS AND COSTS, 2011-2021

HOSPITAL UNCOMPENSATED CARE COSTS, 2017-2021 TOP 20 DRGS, 2021

What does it mean to be taken care of?

At Arkansas Blue Cross and Blue Shield, it means providing peace of mind. We’ve been taking care of Arkansans for over 70 years, providing affordable, reliable health insurance … to keep Arkansans healthy and to help them heal. We’re investing in communities to keep this diverse and wonderful state strong. We’re committed to a whole person approach to health, including physical and behavioral well-being. And we recognize that total health is influenced by many factors, including medical history, genetics, lifestyle, environment, nutrition, safety and physical activity. We also realize that it will take all healthcare providers working together to ensure future generations of Arkansans can live their best life their whole life long. Let’s take good care, Arkansas.

PARTNERS WITH AHA SERVICES, Brings Value-Based Care to More Arkansans

From the moment ChartSpan’s leaders began researching AHA Services, Inc. (AHASI), they knew they wanted to partner with the organization.

“After spending time with the AHASI team and a select few of [AHA’s] members, it was abundantly clear that our organizations are aligned,” says Shane Grivich, Chief Strategy Officer for ChartSpan.

A value-based care organization, ChartSpan is committed to creating positive health outcomes for Medicare patients and increased revenue for health care practices, systems, and hospitals. The company’s leaders say they are impressed with AHASI’s commit-

ment to experimenting with new, cost-effective health care strategies that can benefit member hospitals and their patients.

Through the partnership, ChartSpan will offer its services – Chronic Care Management (CCM), Annual Wellness Visits (AWV), Remote Physiological Monitoring (RPM) Enrollment, and Quality Improvement – to the Arkansas Hospital Association's member hospitals across the state.

Here’s a brief overview of ChartSpan solutions from which AHA’s member hospitals can choose to improve outcomes for their Medicare patients.

CHRONIC CARE MANAGEMENT

More than two-thirds – 68% – of Medicare patients have two or more chronic conditions. The Centers for Medicare and Medicaid Services (CMS) created Chronic Care Management to improve care for these patients while reducing their health care costs.

ChartSpan offers full-service Chronic Care Management (CCM), with trained clinical staff who provide CCM services every month. These services include:

Care Coordination: ChartSpan’s clinical staff works closely with patients to create treatment plans, refill medications, schedule appointments, locate community resources, and identify gaps in care.

24/7 Nurse Line: Nurses are available around the clock to answer patient questions and triage patients to urgent care or emergency services, if needed.

Comprehensive Documentation and Compliance: The ChartSpan team documents all patient interactions to ensure each person receives 20 minutes of care a month. All interactions and updates are shared back with the provider.

On average, CCM patients save $240 a year in health care costs and experience 20% fewer hospitalizations. Providers also benefit, with every 300 patients enrolled in CCM generating more than $100,000 in practice revenue.

QUALITY IMPROVEMENT

Continuous Quality Improvement helps health care organizations deliver optimal, cost-effective care to patients. Quality Improvement is especially important for health care systems that embrace value-based care, that are members of ACOs, or that participate in the Merit-based Incentive Payment System (MIPS).

ChartSpan offers complimentary Quality Improvement services for Chronic Care Management clients. Quality Improvement often means lowering the cost of care per patient while ensuring each

patient has positive health outcomes – the exact challenge CCM addresses.

The ChartSpan clinical team identifies patient gaps in care based on monthly CCM interactions and the data contained in the EMR. The staff can then talk to patients about vaccinations, cancer screenings, and other preventive care measures to improve their health and reduce their health care costs. Providers and health care practices can report these improved outcomes to their ACO or to Medicare.

ANNUAL WELLNESS VISITS

Preventive care plays a pivotal role in maintaining patients’ overall health, which is why CMS values Annual Wellness Visits . But patients often skip preventive care.

• Only 24% of Medicare patients receive AWVs.

• Preventive care visits have close to 50% no-show rates

ChartSpan’s AWV software, RapidAWV™, empowers providers to conduct AWVs during alreadyscheduled appointments. This strategy prevents patients from missing their AWVs and gives providers the chance to create preventive care plans, close gaps in care, and increase their revenue.

RapidAWV™ helps with three critical components of Annual Wellness Visits:

Determining Eligibility: RapidAWV™ checks the HIPAA Eligibility Transaction System (HETS) to see which Medicare patients are eligible for an AWV on the day of their visit. Eligible patients are clearly marked

so the clinical staff can hand the patient a Health Risk Assessment (HRA).

Performing the Health Risk Assessment: Patients complete their Health Risk Assessment on a tablet that utilizes a simple, accessible interface. The interface is designed to have one question per page, written in an easily readable font.

Analyzing the HRA Report: ChartSpan’s AWV software automatically generates a report for each patient based on the HRA. The report indicates the areas of greatest concern, from fall prevention to smoking cessation, cognitive impairment, and management of chronic conditions. The provider can then address those concerns and help the patient create a personalized health care plan.

AWVs increase the frequency of vaccinations and preventive screenings and can reduce health care costs by an average of 5.7%, making them a valuable tool in any practice’s preventive care arsenal.

REMOTE PHYSIOLOGICAL MONITORING ENROLLMENT

Remote Physiological Monitoring (RPM), sometimes called Remote Patient Monitoring, allows providers to monitor patients’ vital signs and health data between in-person visits. But many health practices don’t implement RPM because the enrollment process can be complex and time-consuming.

ChartSpan’s RPM Enrollment Service can help. The

ChartSpan team starts by examining patient data to determine which patients are eligible for RPM. They reach out to those patients through voicemail, email, and direct mail to talk about RPM and its benefits.

If the patient chooses to enroll, the ChartSpan team records their consent and archives it so the provider can access it throughout the RPM program.

VALUE-BASED CARE FOR AHASI MEMBERS

ChartSpan’s services, including Chronic Care Management (CCM), Annual Wellness Visits (AWV), Remote Physiological Monitoring (RPM) Enrollment, and Quality Improvement, strive to create positive health outcomes for Medicare patients and increase revenue for health care practices, systems, and hospitals.

If you’re an AHA member and would like to learn about how ChartSpan can help you navigate health care’s evolving landscape, please visit chartspan.com.

THE IMPACT OF THE RURAL SETTING

On Social Determinants of Health

The last time I wrote about the social determinants of health for ArkansasHospitals was in the spring of 2021. Re-reading my column, I realize that though the COVID pandemic vividly illuminated the health inequities and social disparities existing in America, very little has improved along this front in the last two years.

IMPACT ON COMMUNITY HEALTH

Definitions of “social determinants of health” vary by source, but there is general agreement on its components and their impact on community health:

• Health Services Factors include access to physical and mental health care, quality of care, and reliably safe care.

• Social and Economic Factors include nutrition and food access, housing adequacy and

homelessness, access to employment, economic mobility, access to education, transportation access, and availability of community and social services.

• And finally, Environmental Factors, which include water and air quality, noise pollution, proximity to hazardous waste sites, weather, and the effects of climate change on a person’s environment.

SOCIAL DETERMINANTS OF HEALTH IN THE RURAL HEALTH ARENA

Many of the social contributors to health are exacerbated in the rural setting, and with 13.9% of the U.S. population (and approximately 41% of Arkansans) living in rural areas, I’d like to address these from a rural perspective.

Health Services Factors: The Federal Office of Rural Health Policy says that, ideally, rural residents should be able to conveniently and confidently access services such as primary care, dental care, behavioral health, emergency care, and public health services. But we know that access to care, especially in medical specialties, is often limited in rural communities. This requires patients to travel varying distances, perhaps without adequate means of transportation or the ability to take time off from work, for medical services beyond routine health care.

While telehealth – which allows patients and physicians to connect over the internet, sometimes reducing the need for travel – grew exponentially during the COVID crisis, patients living in rural areas may not have access to reliable, affordable high speed internet, thus reducing their ability to connect with remote mental health and medical providers. (Arkansas ranks 49th out of 50 states for availability of high speed internet.)

In addition, the overwhelming shortage of health care workers persists as a challenge in every Arkansas community, particularly the rural areas of the state where hospitals are also at risk of closing. Rural hospitals cannot compete for physicians and clinical staff at wage scales equal to those available in cities. Becker’s Hospital CFO Report (November 2022) reports that, nationally, more than 630 rural hospitals are at risk of closure, including their assessment that 22 rural Arkansas hospitals are among these. What isn’t represented by these already stark numbers is the relative scarcity of rural hospitals already in existence in rural America.

Social and Economic Factors: Again, the Federal Office of Rural Health Policy reports that “Rural residents are more likely [than their urban counterparts] to experience some of the contributing social factors that impact health, such as poverty. The impact of these challenges can be compounded by the barriers already present in rural areas, such as limited public transportation options and fewer choices to acquire healthy food.”

Food insecurity can be a real challenge in rural areas, and the realities of unemployment and low-wage jobs can cause a reliance on safety-net programs. Rural residents are often more limited in individual resources and may have less access to reliable transportation than those in other parts of the country; these factors all correlate with poorer health.

Eighteen counties in Arkansas are ranked as areas of persistent poverty in a report released May 9 of this year by the U.S. Treasury Department. And Arkansas, along with the rest of the country, is facing declining populations in rural counties, which exacerbates many of the other contributing factors to poor community health.

Environmental Factors: Physical environment is one of the most recognized social determinants of health. Environmental basics such as air and water quality, noise pollution, and absence of chemical pollution are often taken for granted, but they affect the health of every person, whether living in rural or urban areas.

The U.S. Environmental Protection Agency in March 2023 announced that nearly $19 million from the new federal infrastructure law is being

With limited available resources, rural hospitals must prioritize their efforts.

made available to Arkansas to address emerging contaminants such as per- and polyfluoroalkyl substances (PFAs) in drinking water – a problem in rural as well as urban areas of the state.

Some of the issues particular to rural Arkansas environmental quality include well water contamination, chemical pollution from farming operations, herbicide usage and its impact on water quality, and the effects of drought and flooding in rural counties.

HOPE FOR RURAL HOSPITALS

The Baldrige Excellence Framework has long placed a focus on societal contributions, but about a decade ago it expanded the health care version of the Criteria to include a responsibility for improving community health. As shown in the sidebar, it is now reflected as one of the Baldrige Core Values and Concepts, meaning that it is a

theme that cuts across various categories and serves as a foundation for the Framework.

This Core Value emphasizes the need for leadership in these efforts: Without your leadership, it will be nearly impossible to have a positive impact on your community’s health. What must you do?

The first step is to publicly commit yourself and your organization to addressing those social determinants of health that are most prevalent/ require the most attention in your community. While rural counties share many common characteristics, they often have unique needs that require leaders’ focused attention.

With limited available resources, rural hospitals must prioritize their efforts. What are the primary causes of a decline in life expectancy and increase in infant mortality in your county? The data sources, while often lagging by a year or two, are

BALDRIGE CORE VALUE AND CONCEPTS: SOCIETAL CONTRIBUTIONS AND COMMUNITY HEALTH

Considering societal well-being and benefit means leading and supporting –within the limits of your resources – the environmental, social, and economic systems in your organization’s sphere of influence. Public health services and the support of the general health of the community are important societal responsibilities of health care organizations. Such leadership and support might include efforts to determine and address social determinants for health and to provide both charity care and investment in your local community and/or beyond, such as by establishing free clinics or affordable health care programs, increasing public health awareness programs, contributing to community organizations, or fostering neighborhood services for the elderly.

It also might involve being a role model for addressing socially important issues, such as diversity, equity, and inclusion; practicing resource conservation; reducing your carbon footprint; performing community service and charity; improving health care industry practices; and sharing non-proprietary information. Increasingly, such societal contributions are a customer or stakeholder requirement.

Leadership in this area may entail influencing other organizations, private and public, to partner for these purposes. Managing societal contributions requires your organization to use appropriate measures and your leaders to assume responsibility for those measures.

plentiful. What other local organizations should you recruit as collaborators in your effort? Is there an already established model for forming such a collaboration?

The “Communities of Excellence 2026” program is a Baldrige-based program that applies Baldrige principles not just to a single organization but to a collaborative of community-based organizations striving to elevate the performance of the community, as a whole.

“Communities of Excellence 2026” (COE 2026) is a 501(c)(3) nonprofit organization that hosts a national learning collaborative of communities across the country, trains communities in the Baldrigebased CommunitiesofExcellenceFrameworkand provides opportunities for communities to work together; to share successes, challenges, ideas, and best practices; and to learn from each other throughout their performance excellence journey.

READER RESOURCES

By definition, the program’s efforts include addressing social determinants of health.

The mission of COE 2026 is to ensure that every person living in America has the opportunity to live their best life in communities that are thriving. In many of these communities, a health care organization serves as a “backbone” organization, recruiting partners, convening meetings, and sharing best practices from other communities of excellence.

To learn more about “Communities of Excellence 2026,” you may contact me or visit the COE 2026 website ( www.coe2026.org ). Specific questions may be addressed to Stephanie Norling, Executive Director, at snorling@ communitiesofexcellence2026.org

These three resources may be particularly useful as you work on social determinants of health in your own organizations.

The Arkansas Department of Health’s Office of Health Equity, Arkansas Minority Health Commission’s Red County Life Expectancy Profile, 2018 (published May, 2020)

The Arkansas Department of Health’s Primary Care Needs Assessment of Arkansas, 2020

Rural Profile of Arkansas, University of Arkansas Division of Agriculture, 2021

The team at BaldrigeCoach would be glad to help guide your hospital’s quest for process improvement. As CEO and Principal of BaldrigeCoach, Kay Kendall coaches organizations on their paths to performance excellence using the Malcolm Baldrige National Quality Award Criteria as a framework. Her team, working with health care and other organizations, has mentored 24 National Quality Award recipients. In each edition of Arkansas Hospitals, Kay offers readers quality improvement tips from her coaching playbook. Contact Kay at 972.489.3611 or Kay@Baldrige-Coach.com.

COMMON CAUSE: Adverse Childhood Experiences and Social Determinants of Health

By Chad T. Rodgers, MD

Screening for Social Determinants of Health (SDoH) in medical practices and hospitals has become increasingly common. We use well-established tools to identify our patients’ needs; this helps us begin to address underlying basic needs with the goal of moving toward improved health.

We commonly screen for anxiety and depression, food insecurity and housing issues, substance abuse, family and community support, and connection.

Too often, we don’t realize that we are also screening for the causes and

results of what is commonly known as Adverse Childhood Experiences (ACEs). And while providers are asking the right questions, do we know what to do with all the answers?

ACE s , DEFINED

Adverse Childhood Experiences (ACEs) are a collection of, sadly, common experiences that occur early in infancy and in early childhood – both of which are crucial developmental periods of the brain and the body. Undergoing these experiences without the safety net of protection from a nurturing

caregiver can cause toxic stress. This type of stress results in a survival response triggering the release of stress hormones that prepare the body and mind to fight or flee from real or perceived danger.

A child’s not being able to remove themselves from this stress results, often repeatedly, in a prolonged and detrimental response.

The original ACEs study, screening tools, and related information can be

EARLY ADVERSITY HAS LASTING IMPACTS

found on the CDC website (https:// www.cdc.gov/violenceprevention/ aces).

Using the ACEs screening, providers can elicit 10 possible experiences that have been identified and studied and are now well known to have detrimental effects on long-term health. They include physical, emotional, and sexual abuse, emotional and physical neglect, and household dysfunction, including a caregiver with a mental illness or substance abuse problem, seeing a caregiver treated violently, and parental separation from divorce or incarceration.

These 10 are not inclusive of all traumas. But we know that the more ACEs you experience, the poorer your mental and physical health, with an overall reduction in quality of life and early death.

An individual with an ACEs score of seven or more is more likely to have a mental illness, use illicit substances and abuse alcohol, have chronic health conditions such as asthma, diabetes, or cancer, and have a significant risk for suicide.

POSITIVES CAN OFFSET NEGATIVES

These traumas are, unfortunately, common. And if you have experienced one, you are more likely to have experienced others. But the important thing to know is that all hope is not lost. Your ACEs score does not commit you to a life of suffering.

Trauma and stress are part of the human experience. However, protective factors such as having consistent and nurturing caregivers who provide support and who both model and help build resilience can

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Jeffrey H. Thomas, Managing Director

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offset these traumatic experiences. The more positive experiences you have, the better chance they have of outweighing the bad.

And, as a medical professional, simply knowing and acknowledging that your patient has experienced trauma enhances and improves the patient’s experience and outcomes, as well.

E.J.’S STORY

When we screen for SDoH, we can also assess for ACEs. Take E.J., a 45-year-old accountant treated for high blood pressure, high cholesterol, and depression/anxiety. He lives alone after a divorce and admits to drinking heavily. You know from his social and family history and the screening that his uncle adopted him after his father was incarcerated for involvement with

drugs (parental separation due to incarceration). His mother completed suicide after a long struggle with depression (mother with mental illness). Growing up in poverty, he moved from house to house and sometimes wasn’t sure where and when he would have his next meal (physical neglect). He wore tattered clothes to school, where he was made fun of by others and never felt like he belonged.

His uncle tried to do his best, but he often called him “stupid,” and E.J. always felt like he was a burden to his uncle (emotional neglect and abuse). E.J., fortunately, had a grandmother, who, despite poor health, often picked him up from school and kept him on the weekends. She provided a safe and loving environment and reminded him of his mother. A schoolteacher observed that E.J. was very smart and encouraged

him to attend college (positive experiences build resilience factors). He was awarded scholarships and found work during college to complete his degree. E.J. has an ACEs score of five or more. But he had two positive factors in his life – his grandmother and an encouraging teacher.

Simply knowing that E.J. has a high ACEs score, we can identify factors contributing to his mental and physical health. Instead of wondering, “What is wrong with E.J.?” we can ask ourselves, “What happened to E.J.?” in order to build a therapeutic and empathetic relationship with him.

IDENTIFYING ACEs: THE IMPACTS

Research tells us that knowing and acknowledging his trauma can improve E.J.’s health outcomes. Looking at

While providers are asking the right questions, do we know what to do with all the answers?

underlying causes, we can address their impact on his social issues. We can address his substance abuse while also addressing his anxiety and depression. Increasing social support for him with his family and community through appropriate referrals will improve his ability to make decisions and make changes that will improve his blood pressure, control his cholesterol, and improve his quality of life.

Improving our own and our staff members’ knowledge of ACEs improves health care. AFMC provides training on ACEs awareness and strategies to better care for our patients and will host the ACEs and Resilience Summit – “The Power of Belonging” – on Thursday, August 3, 2023, at Pulaski Technical College in North Little Rock. We hope you can join us!

ACEs AND RESILIENCE SUMMIT: THE POWER OF BELONGING

Thursday, August 3, 2023 Pulaski Technical College, North Little Rock Cost: $50

for more information

Arkansas Senior Health Insurance Information Program

SHIIP supports Arkansans turning 65, and those already on Medicare and questions about their Medicare options. Our local area certified Medicare counselors are available to offer them the information they will need to make best choices for their healthcare coverage. Topics cover from Part B Deductible, Medicare Supplements (Medigap), Medicare Advantage Plans, and Part D Drug Plans.

AR SHIIP supports Arkansans turning 65, and those already on Medicare and have questions about their Medicare options. Our local area certified Medicare counselors are available to offer them the information they will need to make the best choices for their healthcare coverage. Topics cover from Part B Deductible, Medicare Supplements (Medigap), Medicare Advantage Plans, and Part D Drug Plans.

Call AR SHIIP toll free 1-800-224-6330

AR SHIIP supports Arkansans turning 65, and those already on Medicare and have questions about their Medicare options. Our local area certified Medicare counselors are available to offer them the information they will need to make the best choices for their healthcare coverage. Topics cover from Part B Deductible, Medicare Supplements (Medigap), Medicare Advantage Plans, and Part D Drug Plans.

Call AR SHIIP toll free 1-800-224-6330 let us find a partner in your area today.

let us find a partner in your area today.

publication is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award SAPG0077 with 100 percent funding by ACL/HHS. The contents are those of the author and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.

publication is supported by the Administration for Community Living (ACL), U.S. Department of Health and Services (HHS) as part of a financial assistance award SAPG0077 with 100 percent funding by ACL/HHS. The are those of the author and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.

This publication is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award 90SAPG0077 with 100 percent funding by ACL/ HHS. The contents are those of the author and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.

Chad T. Rodgers, MD, FAAP, serves as Chief Medical Officer at AFMC.

MEDICAID UNWINDING:

The May 11 end of the COVID-19 Public Health Emergency (PHE) brings with it a redetermination of Medicaid beneficiary eligibility. This redetermination is also known as the “unwinding” of PHE extensions, and it creates new obstacles for not only beneficiaries but also for state officials.

During the PHE, Congress enacted the Families First Coronavirus Response Act, which effectively gave special funding to states that agreed to keep Medicaid beneficiaries enrolled continuously through the end of the PHE – meaning that no enrollees would be removed from Medicaid rolls due to income or eligibility while COVID created its many health- and economic-related complications. Beneficiaries could be disenrolled if they moved out of state, died, became incarcerated, or requested their coverage to end; otherwise, their coverage remained intact.

In 2021, the General Assembly enacted legislation that requires the Department of Health and Human Services to conduct and complete the redetermination of eligibility in a short, six-month time frame. This requirement

applies exclusively to “extended” cases that have not been re-evaluated within the past 12 months. Arkansas is the only state in the Union that requires this short time frame. A few other states have 9–12-month requirements, and most states adopted a 12-24-month grace period for the redetermination to be completed.

States that have allowed more time for determinations of eligibility

have the freedom to be more discerning, and they have time to attempt to locate and directly contact beneficiaries for dialogue re: eligibility, rather than relying on what is called “procedural termination” –where beneficiaries are dropped from the Medicaid rolls simply because they did not respond to mailed or emailed eligibility inquiries from state offices.

The Arkansas Department of Health and Human Services has only six months to complete the unwinding process.

Patients, Including Kids, Losing Coverage

ARKANSAS’S RAPID UNWIND

Arkansas began the unwinding process in the earliest month designated by the federal government as possible to do so: February of 2023. Notices that people receiving “extended Medicaid” needed to renew their enrollment in Arkansas Medicaid were mailed immediately, starting that same month.

As of April 1, 2023, the Department of Human Services (which oversees Arkansas Medicaid) could and did begin terminating coverage for those no longer eligible or who did not verify eligibility with the department.

In its February 1, 2023, Arkansas Comprehensive Unwinding Plan, DHS reports that it is unwinding the cases of 422,112 individuals with “extended” coverage, seeking information from these beneficiaries so that their eligibility for Arkansas Medicaid benefits can be redetermined.

These Arkansans may no longer be eligible to receive Medicaid benefits for several reasons:

• They have an income that now exceeds eligibility levels.

• They have not responded to a request for information as part of the renewal process.

• They had a level-of-care or medical change that made them no longer eligible.

• They have aged out of eligibility.

DHS CONCERN: TRYING TO CONTACT BENEFICIARIES

The DHS plan indicates that outdated contact information for beneficiaries is likely to be a problem. “One concern nationwide is that eligible beneficiaries – especially more vulnerable populations like those who are aged, disabled, or who have developmental/intellectual disabilities – will lose coverage during the unwinding because states were not given updated contact information and cannot reach them,” the report says. That is a real concern for Arkansas, and the state is taking steps to mitigate this, including:

• Calling all beneficiaries who have had their coverage extended to verify their contact

information. At least three, and often more, attempts have been or will be made to reach each of these beneficiaries.

• Opening an Address Update Hotline that beneficiaries can easily call to verify and update their contact information. DHS is promoting this through earned, organic, and paid media and social media.

• Requesting that partners across the state share messaging about the importance of updating their addresses and contact information with DHS.

• Receiving approval for an (e)14 waiver from the federal government to allow the State to accept verified beneficiary addresses from managed care organizations, including the Provider-led Arkansas Shared Savings Entities (PASSE), without the need to do additional verification.

The plan indicates that the State also requested approval to accept United States Postal Service/National Change of Address data and verified

Our hospitals have always worked for the ability of every Arkansan to be able to attain health care coverage.

addresses from Qualified Health Plans (QHPs) that provide coverage for Arkansas Health and Opportunity for Me (ARHOME) beneficiaries without the need for additional verification.

PATIENTS’ AND PROVIDERS’ CONCERN: PROCEDURAL TERMINATIONS

Coupling the dilemma of retrieving updated contact information with the legislature’s requirement that “extended” coverage recipient cases be unwound within six months is creating chaos for patients and providers of care. In April, the first month of Medicaid unwinding in Arkansas, 72,802 Medicaid beneficiaries were dropped from the Arkansas Medicaid rolls, including 29,067 children. Income ineligibility caused 5,414 of these terminations. Requests by beneficiaries to discontinue their enrollment numbered 5,791.

Most of the terminations reported from April data – 82% – are due to procedural issues such as failure to return renewal forms, failure to supply other enrollment information, or inability to locate the beneficiary at last known address or contact number. These terminations are called “procedural terminations.”

Procedural terminations of Medicaid coverage – terminations of Medicaid coverage without interaction-based determination of the beneficiary’s income eligibility –cause “churn.” Churn is the process where Medicaid beneficiaries are dropped from the rolls, entering a period of non-coverage while they learn they are no longer covered and seek coverage once again, only to be subsequently re-enrolled.

When individuals who remain income-eligible for Medicaid are dropped from the rolls for procedural reasons, they find themselves without medical coverage and become vulnerable to unnecessarily poor health outcomes. In many cases, these beneficiaries are blindsided as to their status and find out when they go to

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pick up medications at the pharmacy or access care from their provider.

The May Unwinding Report from Arkansas DHS, released just before this magazine’s press date, indicates that 68,838 people were dropped from the Medicaid rolls in the month of May 2023. Of these, 65% were procedural terminations, caused by beneficiaries failing to return renewal forms, failing

to return requested information, or DHS staff being unable to locate them (returned mail).

Once again, the number of children impacted is extremely worrisome. Added to the 29,607 children who lost their Medicaid coverage in April, an additional 25,720 Arkansas children lost coverage in May. That means more than 54,000 Arkansas kids have lost coverage.

“STAGGERING NUMBERS” NATIONWIDE

A June 1 article from Kaiser Health News says that more than 600,000 Americans lost Medicaid coverage in the first month of the unwinding process. The vast majority of these, says author Hannah Recht, “were removed from state rolls for not completing paperwork.”

You are not the darkness you endured You are the light that refused to surrender John Mark Green

More than 54,000 Arkansas children have already lost their Medicaid coverage.

KFF is sounding the alarm that tens of thousands of children are losing coverage. As stated above, more than 54,000 Arkansas children lost coverage in just the first two months of unwinding.

WORKING TOGETHER

Patients (and their advocates), hospitals and care providers (and their advocates), marketplace insurers, and DHS are all working together in the unwinding process,

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seeking to keep all eligible Medicaid beneficiaries enrolled in the program and helping those no longer eligible to access coverage through the Arkansas Health Insurance Marketplace and other sources.

Arkansas Hospital Association Executive Vice President Jodiane Tritt says she is especially grateful

to Amy Webb and the DHS team for their transparency in this endeavor and their willingness to work with the AHA to keep all eligible beneficiaries enrolled without interruption.

“Our hospitals have always worked for the ability of every Arkansan to be able to attain health care coverage,” she says. “It is a given that with today’s

financial constraints, hospitals cannot absorb any additional uncompensated care. We applaud DHS for their efforts to keep all eligible Medicaid beneficiaries covered, and for steering them to the Arkansas Health Insurance Marketplace or employer-based plans if they need to find coverage elsewhere.”

Pulaski Tech, NLR Campus Center Grand Hall A&B

The Power of Belonging Positive Childhood ACEs23

Thursday August 3rd, 2023

Thursday August 3rd, 2023

8 AM - 4 PM

8 AM - 4 PM

Pulaski Tech, NLR

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7TH ANNUAL ACES & RESILIENCE REGISTER AT AFMC.ORG/ ACESUMMIT

The Power of Belonging Positive Childhood ACEs23

7TH ANNUAL ACES & RESILIENCE REGISTER AT AFMC.ORG/ ACESUMMIT