With 92 rural hospitals, Kansas is second only to Texas in the number of rural hospitals. In June, the seven-hospital Kansas High Value Network (KS-HVN) became the seventh rural hospital-owned network to partner with Cibolo Health, which launched its first high-value network in North Dakota in October 2023 and its most recent network in Wisconsin in September 2025. It also has networks in Minnesota, Nebraska, and Ohio.

Healthcare Innovation recently spoke with Ben Bucher, executive vice president, network operations at Cibolo Health, and Edward (Eddie) Herrman, president and CEO of HaysMed in Hays, Kan., and chair of the KS-HVN board, about the value these networks of rural hospitals are creating.

Healthcare Innovation: Before we talk about Kansas, Ben, could you talk about the initial launch in North Dakota and the creation of Cibolo Health?  How did it come together and how have you been able to replicate that success in other states?

Bucher: I was a hospital CEO in North Dakota for 10 years, and about five years ago there were roughly five of us CEOs who wanted to find a way to start working together. We could see the writing on the wall. Larger healthcare systems kept getting larger. A lot of us wanted to remain independent, because a lot of us are rural and we wanted to keep our care local.

We started talking about how we could work together and still abide by the rules of the FTC and make sure that we're not violating any anti-competitive practices. We thought maybe a clinically integrated network would be the way to do that, because the FTC does recognize clinically integrated networks as a good use of resources to come together to accomplish the Triple Aim. Our goal is healthier patients, healthier communities, and lowering the cost of healthcare. We can do that by coming together to create scale, which allows us to enter into value-based care arrangements together, care for a larger number of patients, and also work with other vendors and organizations to exchange volume for discounts.

HCI: When you did that in North Dakota, was there a thought that this could spread to other states, or was that not on your mind initially?

Bucher: It wasn't on our mind initially. We just wanted to get this started in North Dakota to preserve our independence. We knew we needed some help. Clinically integrated networks aren't new, but when they're expected to be run solely by CEOs, it's very difficult because you're also trying to run a hospital. So I called up a good friend of mine, Nate White, and I said, "Nate, can you help us out here in North Dakota and help us get the CIN up and running?" He is a lawyer by trade and he also used to work for a large healthcare system, so he had really good input on large system ideology and rural independent ideology, being a South Dakota farm kid growing up. It took us a good 18 months to get the network up and running. I was the board chair of the network at the time, and I told Nate that we still needed him around,. We needed someone to help run this network, because they're so fragile when they start.

We also knew that we needed to grow. Five wasn't enough, but it was a good starting point. So Nate was actually our first president of the Rough Rider Network in North Dakota, and what happened is similar to what we're doing in Kansas. There was a media launch, both regionally in North Dakota and nationally, and as other executives around the country started reading up on what we were doing, we started getting phone calls from other states saying, "Hey, we really like what you're doing in North Dakota, could you help us in our state?”

After about six months we realized that there are a lot of states that need help, so basically out of that first network grew Cibolo. We did realize that this model is able to be replicated. The Rough Rider Network grew from five to 23 hospitals. Now we're working in 10 states, helping them start their networks, get them up and running, and then helping manage the networks.

HCI: Eddie, how did you hear about Cibolo, and had you and other small-hospital execs in Kansas already started working together on an idea like this?

Herrman: We were already looking at how we could come together and gain some efficiencies, improve care coordination, and keep costs down. We heard of the Rough Rider Network and started inquiring. At a meeting in Washington, D.C., I met one of the leaders of the Headwaters High-Value Network in Minnesota, and that’s what led us to the initial conversations with Nate and Ben.

HCI: Do hospitals like yours face a lot of pressure to merge with larger health systems or challenges in keeping certain service lines open?

Herrman: Yes. I think everybody feels the pressure from the financial landscape in healthcare right now. When you look at inflation of products we use in the hospital, it's much higher. If inflation was 7% last year, it was probably 20% on products within the industry, and then you get a 2% increase from CMS and a 2% increase from the commercial insurers — that doesn't add up. We’ve seen 4% to 5% increases in physician salaries, year over year. You can't keep up and you can't cut yourself to success either. We’ve got to figure out how to do it cheaper, but also drive more services and revenue for the facilities, and that means keeping care local.

HCI: Ben, does Cibolo come in with a formula for the governance of this, but also which things to try to address first?

Bucher: Not surprisingly, the networks have a lot of synergies across state lines, but each network is also independent, and they have their own needs. What makes this model unique is that each state owns their own network. It’s member-owned and member-driven, and we help guide the strategy of the network. 

The first conversations that we tackle usually revolve around two things: No. 1, now that we have economies of scale, how can we drive discounts to the members that we serve? We do that by working with local organizations, but also national organizations. No. 2, this is a clinical solution to the patients that we serve. We want to look at getting into a value-based care arrangement with any payer that's willing to work with our network. That’s really important because the foundation of the network is better quality at a lower cost, and we need partners to help us accomplish that. We want make sure that we can pool our lives together, because when you enter into value-based care, you want a large number of patient lives, and a lot of the hospitals don't have those numbers on their own. By coming together, we can pool those patient lives together and have much more success in value-based care.

For a lot of facilities, that initial investment is already a non-starter. They just don't have the capital. To Eddie's point, there's not excess money sitting around, and there are tools and resources that you need to invest in to perform well in value-based care.

HCI: Eddie, are there some payers in Kansas that might be interested in partnering with you in that kind of value-based care arrangement?

Herrman: Well, we would hope that all of them would be, but for many of them, it's really a national company that you're talking with, especially with United Healthcare or others like that vs. Blue Cross/Blue Shield. That's where Cibolo has been such a great partner. We don't have to reinvent the wheel. It’s already been invented, and they help sharpen that learning curve to get to the point where you know that you have a product and a value proposition that you can set down because it's win/win for us and for the insurance companies, too, because they're getting value for their consumers.

HCI: I understand that you're going to set up a committee to determine a set of clinical metrics for the network to measure performance and also oversee implementation of a clinical data-sharing platform. Is all of that a being set up for value-based care participation?

Herrman: Yes, that’s definitely a piece of it. As Ben said, it's expensive to stand these things up. We're a much larger facility than a critical access hospital, and we don’t have the ability to spend the capital dollars it would take to have a population health platform. Until you have that, and you can get the data into that pop health platform, a lot of these facilities don't know everything that's going on with their patients from an outcomes perspective, because you can't see that long-term view. It’s hard to see the trend. When we can see those trends, it allows us to understand the top five to eight areas that we need to focus on that are going to improve the outcomes for patients, and we know that it will decrease the cost, because we now are focused on improving outcomes and treating the issues that exist.

HCI: We're starting to see Kansas and other states develop these grant funding specifics for the federally funded rural health transformation programs. Is there any way that the work of this network can take advantage of that funding?

Bucher: When the notice of funding opportunity came out from CMS, several of our networks were mentioned as a good use of RHTP funds. We have infrastructure that each network needs. One of those is you have to have a population health platform. A couple decades ago it was very difficult for networks to be efficient and to drive change, because it usually meant you all had to be on the same electronic health record, which is really impossible to do. It’s expensive and it's disruptive to your staff. So now with these population health platforms, they lay over the top of everyone's EHR, and they're EHR-agnostic. That tool allows you to input your data into the central source of truth. Payers input data; state HIEs input data. Now you've got real-time data that allows you to recognize if you have care gaps for your patients and how to close those care gaps to make sure that they're getting the care that they need.

The other thing is we want to make sure that we can do chronic care coordination well. We need to coordinate the care of our patients, and a lot of that involves contacting the patients where they are, which can take up a lot of staff time, so we need to get more innovative on how we do that. 

The other thing would be expanding our telehealth capabilities to make sure that we can keep care close to home, but still have our patients get the specialty care that they need. Remote patient monitoring is another big thing coming out of RHTP. If we can monitor our patients, especially after they've been discharged, we can reduce readmissions and reduce unnecessary ER visits. So all of those infrastructure tools have been listed under CMS in the Rural Health Transformation Program as a good use of funds. If the network receives those funds, everyone in the network gets to benefit from that. So we like to think it's a really good bang for your buck, because if you fund one single network, you're touching 25 rural independent hospitals that are getting access to those tools and resources that they normally would not be able to afford. So whatever size the network is, one funding source affects all of those hospitals the same way.

HCI: Ben, do you expect Cibolo Health to expand to even more states? 

Bucher: We do expect it to grow organically. It grows out of necessity. It doesn't grow because we are out on the road and contacting states. It grows when someone like Eddie calls me up or e-mails me wanting to learn more. Then we set up meetings, and before you know it we've got six or seven hospitals wanting to get started. That’s how it grows.