Most healthcare payers offer alternative payment models (APMs) that incentivize quality of care and health outcomes while reducing costs. The Centers for Medicare & Medicaid Services set a goal of having all Medicare Fee-for-Service (FFS) beneficiaries and a majority of Medicaid enrollees in accountable care relationships by 2030. Commercial payers, including Medicare Advantage plans and Medicaid Managed Care Organizations, also offer APMs often with financial incentives for meeting quality metrics. However, rural provider participation in APMs has lagged behind that of urban providers. Barriers to rural participation include low volumes, lack of financial resources to invest in upfront costs, and limited capacity to analyze data to optimize participation.
The Texas Organization of Rural & Community Hospitals (TORCH) was established in 1991 as a membership organization of rural hospitals and partners with the goal of addressing the needs, interests, and issues affecting rural healthcare in Texas. Recognizing the need for independent rural hospitals in Texas to prepare for APMs in Medicare and Medicaid, TORCH launched the TORCH Clinically Integrated Network (TORCH CIN) in 2021. A CIN is a group of providers, hospitals, or healthcare entities that join together to deliver coordinated care, increase efficiency, and manage costs. CINs contract with payers on behalf of their provider networks, aligning payment incentives with the goal of improved health outcomes and cost savings through APMs.
The TORCH CIN is one of the only rural hospital-focused CINs in the country, bringing together independent rural hospitals and their affiliated primary care providers. Since its initial launch with nine participants, the TORCH CIN has grown to 32 participating hospitals—rural acute care hospitals and critical access hospitals (CAHs)—and their affiliated rural health clinics (RHCs) and primary care practices as of spring 2024.
We conducted 29 key informant interviews with 33 individuals between January and March 2024 to gather insights on strengths and opportunities for the TORCH CIN to facilitate success for rural providers in value-based care arrangements. Interviews included a sample of five key informant types: participating hospital administrators (n=13), non-participating hospital administrators (n=1), CIN leadership (n=4), and payers/payer partners (n=5). We also conducted interviews with subject matter experts involved with rural-relevant APMs outside of Texas (n=6). Additional information about the evaluation methods is included in Appendix B.
