08/11/2026
TCMC is proud to be part of the Rough Rider High Value Network and the work being done to strengthen independent rural healthcare across North Dakota.
We’re sharing the full press release below:
FOR IMMEDIATE RELEASE
North Dakota's Rough Rider Network Becomes National Model for Preserving Rural Healthcare While Improving Quality and Lowering Costs
Bismarck, ND – North Dakota's Rough Rider High Value Network (Rough Rider) is demonstrating that independent rural hospitals can improve quality, lower healthcare costs, and remain locally governed without consolidating into large health systems.
Created by independent rural hospitals across the state, Rough Rider has built a nationally recognized Clinically Integrated Network that enables hospitals to collaborate through shared data, care coordination, quality improvement, and population health management while preserving local ownership, local governance, and local decision-making.
“The Rough Rider Network proves that independence and innovation are not mutually exclusive. Our hospitals have shown that when rural providers collaborate, they can achieve the quality, efficiency, and scale of much larger systems while remaining locally governed and community focused. That's a win for patients, hospitals, taxpayers, and rural North Dakota. It’s ‘independence through interdependence.’" said Jody Nelson, board chair of Rough Rider.
The results demonstrate that collaboration works.
Measurable Improvements in Patient Engagement, Quality and Cost
Since launching the network's clinical integration initiatives, Rough Rider has achieved significant improvements in quality while reducing unnecessary healthcare utilization. From 2024 to 2025, the Rough Rider achieved significant improvements in quality measures for its Medicaid HMO population, demonstrating measurable progress in preventive care and chronic disease management.
RRHVN Medicaid HMO quality improvements from 2024 to 2025:
● Colorectal cancer screening increased from 40.17% to 51.99%
● Cervical cancer screening increased from 27.70% to 38.11%
● Adult annual preventive visits increased from 7.95% to 15.42%
● Breast cancer screening increased from 40.78% to 50.80%
● Blood pressure control improved from 53.37% to 60.87%
● Poor diabetes control (A1c >9%) decreased from 36.92% to 28.28% (reflecting improved diabetes management)
These improvements were supported by a proactive outreach strategy designed to reconnect patients with needed care. Across the network, care teams completed:
● 15,811 outreach calls
● 4,650 total text messages
● 485 inbound calls
The impact of this work is also evident at the individual hospital level. At one RRHVN member hospital quality performance improved substantially across multiple preventive and chronic care measures:
● Blood pressure control improved from 58% to 77%
● Colorectal cancer screening increased from 31% to 62%
● Cervical cancer screening increased from 34% to 60%
● To***co cessation intervention improved from 48% to 81%
● Depression screening increased from 43% to 93%
● Poor diabetes control (A1c >9%) decreased from 42% to 35%
These improvements have translated into better health for rural North Dakotans while reducing avoidable healthcare spending.
An analysis of the initial 9-month period of implementation of the Rough Rider’s Centralized Care Coordination program in SMP Health - St. Kateri in Rolla, saw:
● Hospital readmissions reduced from 16.5% to approximately 5%
● 536 fewer emergency department visits annualized
● Approximately $504,000 in avoided Medicare spending from reduced readmissions
● Approximately $1.13 million in avoided healthcare spending from fewer emergency department visits
These outcomes demonstrate that improving quality and coordinating care lowers the total cost of care by preventing complications before they occur rather than simply paying for more healthcare services.
Preserving Rural Healthcare
Rural hospitals are among the largest employers in their communities and serve as essential economic engines that support local jobs, businesses, and access to healthcare.
For decades, independent rural hospitals often faced two choices: struggle alone or consolidate into a larger health system.
Rough Rider has demonstrated a successful third path - collaboration without consolidation.
By sharing technology, analytics, care coordination, and operational infrastructure, member hospitals have achieved the advantages of scale while maintaining their independence and commitment to serving their local communities.
National Recognition
The success of Rough Rider has gained national recognition. The Centers for Medicare & Medicaid Services (CMS) highlighted Rough Rider as a specific example of the type of innovative rural transformation that should be supported through the $50 billion federal Rural Health Transformation Program Notice of Funding Opportunity, recognizing clinically integrated rural networks as an effective model for improving quality, reducing costs, and preserving rural healthcare.
Thank You to Our Partners
Rough Rider extends its sincere appreciation to the North Dakota Legislative Assembly for its visionary investments during the 2023 and 2025 legislative sessions. Those investments enabled North Dakota's independent rural hospitals to build the shared infrastructure necessary to improve quality, coordinate care, strengthen financial sustainability, and prepare for the future of healthcare.
Rough Rider also gratefully acknowledges Blue Cross Blue Shield of North Dakota for its continued investment in rural healthcare and its commitment to innovative partnerships that improve patient outcomes while lowering healthcare costs.
Together, these investments have positioned North Dakota as a national leader in rural healthcare.
"None of this would have been possible without the vision of North Dakota's rural hospital leaders, the investment of the North Dakota Legislature, and the partnership of Blue Cross Blue Shield of North Dakota. Together, we've built something that is improving healthcare today and creating a stronger future for rural communities across our state." said Alfred Sams, Rough Rider President.
About the Rough Rider High Value Network
The Rough Rider High Value Network is a clinically integrated network of 23 independent North Dakota rural hospitals working together to improve quality, strengthen rural healthcare, reduce the total cost of care, and preserve local access to healthcare while maintaining independent community governance.
