Tri County Rural Health Network

What started as a letter of inquiry from Dr. Heidi Behforouz to Rx Foundation Executive Director Jennie Riley led to a six-year grantmaking commitment of more than $1 million to the Tri County Rural Health Network (TCRHN) in Arkansas and its partners at the University of Arkansas for Medical Sciences (UAMS). It also led to Dr. Behforouz being elected, five years later, to the Rx Foundation’s Board of Directors.

The Rx Foundation had previously worked with Dr. Behforouz when she led the PACT Project – an initiative serving HIV patients in Boston, MA, and providing technical assistance to other health care organizations, that the Rx Foundation funded from 2003 to 2009. Dr. Behforouz later provided technical assistance to another Rx Foundation-funded initiative with Community Solutions in Hartford, CT, in 2013 and 2014. When she sent the letter of inquiry, she was running a small consulting firm helping community-based organizations and was pursuing funding for a large-scale, sustainable, demonstration project embedding community health workers in primary care practices in rural Arkansas.

As discussions unfolded, the Rx Foundation’s Board of Directors approved in 2014 a planning grant of $249,337 to the Delta Health Partners Initiative, which consisted of the Tri County Rural Health Network and two implementing partners. The Initiative was led by Ms. Naomi Cottoms, Executive Director of TCRHN, and Dr. Behforouz. The grant addressed the needs of high-risk patients in five rural counties in Arkansas’s Mississippi Delta.

Subsequent grants to the Delta Health Partners Initiative over the next five years supported the following activities: implementation of a community health worker pilot in three medical practices; the expansion of PATH (Patients Advancing Their Health), the project that evolved from the pilot and integrated community health workers into complex care management teams in primary care medical practices serving high-need/high-cost Medicaid and Dual Eligible beneficiaries; and capacity-building for TCRHN to serve as a center of excellence for community health worker training and technical assistance in Arkansas.

The grantmaking demonstrated the impact of embedding community health workers in primary care settings, in three respects: providing needed and timely health care, improving patient outcomes, and lowering medical expenditures. But it had another ripple effect. It resulted in thousands of Arkansans being enrolled in health insurance, as the expansion of the Affordable Care Act unfolded. The value of that benefit to Arkansas and the nation far exceeds the more than $1 million in grantmaking. The insured people could now have regular access to needed care; health care providers would be compensated, and medical crises that often result from lack of care, especially in complex cases, would be avoided. In addition, the health care coverage is ongoing, generating health benefits and financial savings that continue to accrue.

The Rx Foundation’s Board of Directors continues to benefit as well from the extraordinary advice and guidance of Dr. Behforouz, who has become a leading expert on caring for populations who are overlooked or excluded by traditional care models, and the growing role of community health workers in supporting health and health care in America.