Research on Health Care Policy and Practices

The Center for Governmental Studies has partnered with state associations and communities in the Midwest through the Critical Access Hospital Program to study the long-term trends and issues of the health care industry, including  cost, efficiency, and delivery of services. Areas of focus have included: 

  • Analysis of the economic impact of hospitals and other healthcare institutions in Illinois.
  • Quality of care considerations in rural critical access hospitals.
  • Hospitals’ adaptation to technology, organizational and personnel changes, and related trends.
  • Collaboration between healthcare providers as way to maintain viability and provide cost-effective access to care and quality services in rural areas.
  • Innovative approaches to Population Health management practices in rural areas.
  • Potential impacts of the Patient Protection and Affordable Care Act and ways to insure the long-term sustainability of rural providers. 

The final reports for the Critical Access Hospital Program can be found below. 

Critical Access Hospital Program:

Issue 4: Illinois Critical Access Hospital Program: Learning from the Past, Building the Future

Newly Released

Executive Summary  |  Full Report

Critical access hospitals (CAHs) are important in rural areas not only in terms of access to health care, but also as local sources of employment, often representing one of the largest employers in a region. The CAH designation was created by Congress through the Medicare Rural Hospital Flexibility Program (Flex Program) in 1997, allowing small rural hospitals to be licensed as CAHs and offers grants to state governments to strengthen rural health care infrastructure. Since the Flex Program’s inception in 1999, Illinois CAHs have been able to improve services and are more financially stable. The 15-year CAH program milestone is a chance to reflect on the program, explore current and emerging issues and challenges in rural health care, and look ahead to the future of CAHs and the CAH program in Illinois.

The Illinois Critical Access Hospital Network (ICAHN) has proactively addressed the emerging issues of health system change through research and collaboration. Since 2006, ICAHN and Northern Illinois University’s Center for Governmental Studies (CGS) have partnered on several issue papers to highlight the economic impact, quality of care, collaboration, and community wellness efforts of CAHs, and new delivery systems.
ICAHN, along with financial partners Lancaster Pollard, Murray Company, Eide Bailly LLP, Nixon Peabody (formerly Ungaretti & Harris LLP), and Shive-Hattery, collaborated with CGS to gain a better understanding of major demographic, economic, and policy changes affecting rural health care and how CAH designation has benefited CAHs in Illinois.

Issue 3: Managing Healthy Communities in Rural Illinois | October 2013

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The Illinois Critical Access Hospital Network (ICAHN), working with the Center for Governmental Studies (CGS) at Northern Illinois University recently released, “Illinois Critical Access Hospitals: Managing Healthy Communities in Rural Illinois,” the third in a series of white papers focused on rural health care issues. The ICAHN and CGS worked with hospital administrators across rural Illinois to examine PHM challenges, alternative revenue models, and promising practices that can help small hospitals respond to the new health care environment.

The report identifies population health management approaches currently underway in Illinois critical access hospitals (CAHs) and other health care organizations. It also examines factors affecting hospital outreach activities to help them have the most impact on their clients and communities. Many rural hospitals and health care organizations are using new approaches to make local populations healthier. Some of these innovative approaches are summarized in the report to guide similar activities in other hospitals.

Issue 2:  Collaborating for Effective Rural Health Care | January 2013 

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As health care budgets tighten and professional resources become more limited, critical access hospitals (CAHs) may need to consider collaboration as an option to maintain local viability, allowing CAHs to continue providing access to care and quality services for their rural residents. Collaborative health care models are becoming commonplace in today's health care vocabulary, and already several

Midwest CAHs in six states are participating in these types of models. This paper will describe the experiences of these CAHs through survey findings and highlight effective approaches taken to achieve successful rural collaboration. The paper will also identify issues that precipitate discussions about collaborative partnerships and explain what may or may not change as collaborations become more formalized. In addition, implementation of the Patient Protection and Affordable Care Act is accelerating discussions about collaboration among providers in an effort to move to a quality, outcome-based care system as opposed to a volume-driven payment system. CAHs will need to determine which collaborative initiatives are the best match for their organizations and recognize that important unique challenges exist in addressing the long-term sustainability of rural providers.

Issue 1:  Enhancing Quality of Care in Rural Illinois | April 2012 

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Critical access hospitals (CAHs) are essential to rural health care and play an important role in its delivery as a safety net for rural patients. While CAHs operate in a challenging environment, this report focuses on the Illinois Critical Access Hospital Network (ICAHN) and Illinois CAHs commitment to provide high quality health care despite limited resources, both financial and personnel. Illinois CAHs rank high on several nationally measured patient outcomes, patient satisfaction indicators, and provide a high value, affordable option for rural patients. They are also exploring "rural relevant" measures that consider the distinct characteristics of rural health care delivery, while continuing efforts to increase the number of CAHs reporting on all national measures, and prepare for upcoming required reporting. ICAHN and Illinois CAHs recognize that the effort to accomplish meaningful quality of care outcomes is major, but delivering effective care will benefit patients, hospitals, and the community as a whole.

Economic and Community Impact in Illinois | May 2011 

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The Illinois Critical Access Network (ICAHN) is a not-for-profit entity that works with member critical access hospitals to share resources, provide education opportunities, promote operational efficiency and improve health services in their respective communities. In 2006, ICAHN partnered with the Center for Governmental Studies (CGS) at Northern Illinois University (NIU) to analyze the economic impact critical access hospitals (CAHs) generate in Illinois. This project builds on that work.The current project updates information on the effects of CAH designation on various aspects of CAH operations, including revenues and expenditures. This report examines four additional areas: the current economic condition of CAHs and services provided; the impact of the current recession and CAH responses; the economic impact of CAHs on their communities, regions, and statewide; and CAHs adaptation to technology, organizational and personnel changes, and related trends.




For more information about research on healthcare policy and practices, please contact: 

Melissa Henriksen
Research Associate
815-753-0323 or