El Rio taps experienced leader to oversee transition from North Country HealthCare to Elk Ridge

Wednesday marked a major shift in the provision of health care in northern Arizona as El Rio Health, a Tucson-based community health provider, officially acquired most of the assets of the bankrupt North Country HealthCare, hired most of North Country's remaining employees and assumed responsibility for delivering patient care at North Country's 12 remaining clinic locations - including Kingman - which have all been renamed Elk Ridge Community Health.

The closing of the asset sale does not bring an end to current and former employees' attempts to recoup the costs of unanticipated medical bills they accrued after North Country quietly stopped paying its portion of a self-funded health insurance plan. But it does mark the end of one fraught chapter in the messy saga of the nonprofit's collapse -- and the beginning of another, hopefully brighter, chapter.

On Friday, March 27, El Rio announced the new "on-site executive leader" of the Elk Ridge clinics, naming David Rogers, who will serve as an executive vice president of El Rio with a focus entirely on Elk Ridge's operations.

Rogers, born in Eloy, has a bachelor's degree from Grand Canyon University and a master's in business administration with an emphasis on health care management from the University of Phoenix. He spent his entire career in health care administration, beginning at rural hospitals in New Mexico and concluding with a 20-year tenure as CEO of Sunset Community Health Center in Yuma, a federally qualified health center like El Rio and North Country, where he oversaw a fourfold increase in both revenue and employment.

After about two years of what he called semi-retirement, Rogers has spent the last five weeks preparing to take the helm of Elk Ridge.

"It's a pleasure to be here to help El Rio operate these clinics in a manner that's going to sustain Elk Ridge Community Health for many, many years," he said.

Though he readily acknowledged the challenges ahead, he also expressed confidence that financial stability for the clinics -- and with that, a secure work environment for providers and continuity of care for patients -- can be achieved.

"It's realistic. It's doable," Rogers said. "It's something we're going to work really hard to accomplish."

The weeks and months ahead

Rogers said the primary goal of everyone involved in the transition is to avoid major disruptions in the continuity of patient care.

"We recognize they need it for survival, they need it for quality of life," he said.

As part of the process of bankruptcy, North Country shuttered its Bullhead City location.

No additional closures are planned. That leaves 12 clinics in 10 communities: Flagstaff; Grand Canyon; Holbrook; Kingman; Lake Havasu City; Payson; Round Valley/Springerville; Show Low; Williams; and Winslow.

The first week will bring some minor disruptions as all Elk Ridge clinics transition to a new digital records management system. According to Rogers, the change will provide greater efficiency and interoperability in the long run and should be completed relatively quickly -- by Monday, April 6, the clinics should be "off and running."

One area of operations will take longer to reestablish. It will take about "three to four weeks" before all components of pharmacy operations are back to normal, according to Rogers. Elk Ridge's goal is to have "the full complement of inventory on the shelves" at all three pharmacies -- located in the Flagstaff, Kingman and Grand Canyon clinics -- by that time.

"We do need the patience of the community," Rogers said. "We need patients to understand there's going to be some disruption with that part of it."

It will also take a few months for Elk Ridge to complete its licensure under the federal 340B drug pricing program, which allows qualified organizations to buy certain outpatient medications at reduced cost from the manufacturers. That won't affect patients immediately or directly, but the cost savings available through that program are important for the organization's long-term financial health.

Although El Rio offered employment to about 99% of the North Country employees who had endured the bankruptcy process, Rogers admitted that departures ahead of the sale have impacted staffing. (He did not have specific numbers available.)

"The reality is there have been a lot of employees that have left the previous organization," he said. "We're beginning the operation with bare-bones minimal staffing levels, for the most part."

"Where there's a need to replace critical positions, those will happen immediately," he added.

He also said patients will not see any reduction in services or cuts to existing programs as a result of the transition.

"Everything that currently goes on in the Elk Ridge clinics, we'll continue to provide those services," Rogers said. "Our goal and desire is not to get rid of services, it's to expand and grow services. Improve the access to those services."

There will be some consolidation of background organizational functions. Departments such as compliance and risk management, billing and finance and human resources will, for the most part, be integrated with El Rio's existing operations and centralized in Tucson.

Rogers believes that within less than a year, all 12 Elk Ridge clinics will be "operating as well-oiled machines."

"Fortunately, the assets that we're purchasing through this acquisition give us a lot to work with right up front," he said. "It's just a matter of stabilizing the environment. And we'll do that in a relatively short period of time."

Long-term goals

Stabilizing the environment, as Rogers put it, will be the short-term goal. Looking farther ahead, he spoke of the need to evaluate (and re-evaluate) all components of clinic operations, from hours to staffing to resources and technology, in order to ensure that the organization is meeting community needs and also functioning efficiently.

"Will there be challenges? Absolutely," he said. "There'll be staffing challenges. There'll be challenges on the financial side, as we work with Medicaid and Medicare and commercial payers and managed-care organizations in order to demand better reimbursement rates."

Federally qualified health centers generally serve a patient population that is both low-resource and high-complexity, Rogers said. That means administrators need to "work hard with our eligibility programs, working with the patients to qualify them for third-party resources," he explained, and also remain cognizant of the burden on clinicians.

"Communicate, communicate, communicate. Show appreciation. And make sure that the panel sizes for these providers are appropriate, that they're not overloaded with too many patients," Rogers said. "Make sure the minimum requirements of production and productivity and the number of patients they see is appropriate, given the complexities of the health care world that we currently live in. It's not easy; it's extremely difficult for the providers."

Recruiting and retaining clinicians and support staff will be essential to the quality of patient care and the overall stability of the organization. Multiple former employees of North Country HealthCare previously told the Daily Sun that the churn of providers was exhausting and demoralizing. Rogers stressed the importance of open communication with providers, including "a lot of listening," along with competitive compensation and benefits.

He also emphasized the value of residency programs, and said, "We want to be in a position to channel many of those residents and get them to stay at Elk Ridge sites once they complete their residency programs."

Eventually, he believes there could be opportunities for Elk Ridge to expand its offerings beyond current levels. Dental services and behavioral health care are both areas of unmet or underserved need in much of the state.

"We have opportunities to grow and build those programs, and provide more care in those areas," Rogers said.

For the moment, though, the focus will be on the immediate transition of employees and services -- a long-awaited milestone after months of uncertainty for staff and patients alike.

A high-stakes team effort

Though the sale of North Country's assets to El Rio didn't unfold quite as fast as the bankruptcy attorneys originally predicted, Rogers noted that the overall timeline was still relatively quick.

"All of the teams at El Rio have done an amazing job short-cutting many of the processes that historically have taken months to accomplish," he said.

That speed was only possible with the cooperation of the Arizona governor's office, the Centers for Medicare and Medicaid Services and the Health Resources and Services Administration, among others. A bridge loan from Northern Arizona Healthcare and the NARBHA Institute was crucial to keeping North Country operational long enough for the sale to close.

Rogers also praised El Rio CEO Clinton Kuntz for spearheading the acquisition.

"He's never lost sight of pushing this to the end," Rogers said.

With the asset sale officially consummated, El Rio can turn its attention from North Country to Elk Ridge.

"We want this organization to be what it can be and what it should be -- and what it will be in the months ahead," Rogers said.

He acknowledged that the stakes are high for the entire region. North Country served a patient population of about 50,000 people and employed around 500 people. Its role in the health care system and its economic impact -- in relatively small communities -- were both critical.

"Without question, this can't go away. There's nowhere else to put 50,000-plus patients in northern Arizona," Rogers said.

"There's such a rippling effect that would occur if this goes away. And it's not going to go away," he continued. "This is going to work."