Challenge
Colorado’s rural health landscape is both vast and complex. With 82% of its land classified as rural or frontier, 52 of 64 counties fall outside the Denver metro corridor. Approximately 800,000 people rely on Rural Health Clinics (RHCs) for primary care, chronic disease management, and preventive services.
However, financial pressures have jeopardized the stability of these access points. Out of the 32 Critical Access Hospitals (CAHs) in the state, 21 are operating at a loss. Contributing factors include staffing shortages, uncompensated care, and reliance on public insurance reimbursements. For rural communities—many of which already encounter barriers to healthcare—this results in reduced service lines and limited capacity to broaden their services.
To address these challenges, the Colorado Rural Health Center partnered with Stroudwater Associates to answer a key question: could publicly available cost report data be transformed into a benchmarking and strategy tool to guide the state’s RHCs toward stability and growth?
Process
Together, the team designed the Rural Health Clinic Dashboard—a data-driven platform that translates Medicare cost report data into actionable insights.
Key steps included:
- Defining Measures of Success: Initial focus areas included the all-inclusive rate (AIR) compared to the statutory limit, cost per visit, physician productivity (tracked for operational—not reimbursement—purposes), and overhead costs as a percentage of total.
- Building a Multi-Level Dashboard:
- Individual RHC Reports with three-year trending and benchmarking against 25th/50th/75th percentiles.
- Hospital Network Reports for systems with multiple RHCs, allowing comparison across clinics and against state/national medians.
- Statewide Reports providing blinded, aggregate benchmarks to inform system and policy-level decisions.
- Guided Reviews: Stroudwater consultants conducted live walkthroughs of the dashboards, helping leaders interpret the data, identify strengths, and prioritize opportunities for improvement.
The approach bridged two essential domains: cost report preparation and interpretation, as well as operational performance, equipping clinics to act on insights rather than only collect them.
Results
The dashboard illuminated critical trends and sparked meaningful change across Colorado’s RHCs:
- Medicare Bad Debt Education: Several clinics reported zero bad debt reimbursement—prompting clarification and training on qualifying expenses.
- AIR Fluctuations Identified: Year-over-year swings in payment rates highlighted potential data entry issues, underscoring the need for cost report accuracy.
- Operational Productivity Insights: Reported visits per FTE revealed both performance gaps and categorization inconsistencies, enabling more informed staffing decisions.
- Charge and Revenue Trends: Shifts in average charges per visit helped clinics connect operational decisions (like chargemaster reviews or EHR transitions) with financial outcomes.
Perhaps most importantly, the dashboard provided Colorado RHCs with their first unified view of state and national benchmarks, allowing leaders to tailor support, identify inefficiencies, and share best practices across clinics.
Impact
For Colorado’s State Office of Rural Health, the dashboard has become more than a reporting tool; it is a strategic framework for improvement. By blending reimbursement data with operational realities, the project has:
- Enabled clinics to move from reactive, day-to-day problem solving to proactive, long-term planning.
- Strengthened constructive conversations between hospital systems and their RHCs.
- Provided policymakers and state leaders with clearer visibility into the financial health of rural clinics, guiding resource allocation and support strategies.
“This is the first time many of our Rural Health Clinics can see their performance alongside state and national peers in one place. Having that level of visibility has been transformative. It’s not just about numbers on a report—it’s about giving clinics the confidence and context to make informed decisions, strengthen their financial footing, and ultimately improve access to care for the communities they serve across Colorado.”
— Kristin Morris, Quality Improvement Specialist, Colorado Rural Health Center
Conclusion
The Colorado Rural Health Center’s partnership with Stroudwater demonstrates how public data, when transformed into actionable insight, can drive measurable change. By equipping clinics with the Rural Health Clinic Dashboard, Colorado has laid the foundation for stronger, more stable RHCs—and healthier communities across the state.
To learn more about how Stroudwater’s Rural Health Clinic Dashboard could improve efficiency and strengthen RHC performance, please click here.
