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Supporting Rural Healthcare

Rural healthcare is in crisis. In the last decade, more than 130 rural hospitals have closed their doors or ended inpatient services*. The hospitals and clinics that remain serve older populations that suffer from high rates of chronic disease.

 

As a rural health leader, you have experienced the challenges behind these numbers. Rural hospitals struggle to generate enough margin to invest in diagnosis and treatment advances. You also face rising costs of labor and supplies needed to provide care. These headwinds often leave little choice but to cut clinic hours or services, prompting patients to look elsewhere for care. Revenue falls, fixed costs remain, and the cycle begins again.

Why Cibolo Health

Cibolo Health helps independent rural hospitals create networks with their peers to overcome the obstacles rural healthcare providers face. These networks are similar to farmers’ cooperatives, giving member hospitals the scale needed to gain a seat at the table with health plans and large health systems.

Cibolo is a pioneer in enabling independent, rural hospitals to create rural clinically integrated networks. CINs provide the clinical foundation for improving quality, care coordination and access.

The founders of Cibolo Health have been in your shoes. They have run rural hospitals. They have cared for rural communities as either a nurse or a physician, both at the bedside and as clinical leaders. They have faced the same pressure points and developed solutions that took care of patients in that moment of need, and for the long term, too.

 

Most importantly, they share the desire for rural communities to retain local decision making on healthcare. Their work is dedicated to the principle that independent rural hospitals can work together to meet these challenges and emerge stronger while remaining independent.

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* Since 2013, 73 rural hospitals have closed completely, and another 58 rural hospitals have ended inpatient services, according the University of North Carolina.

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Kylie Nissen

Chief of Staff

Kylie Nissen has worked with rural health care systems for over 20 years, with the past 17 being with the State Office of Rural Health in North Dakota. As director of the State Office of Rural Health, Kylie conducted community health needs assessment, strategic planning, grant workshops, administered grants (both as a recipient and a funder), hosted conferences, administered workforce programs and oversaw the health workforce initiative state funding, served on state and national health care committees and boards, and served as a liaison between rural health facilities and the University of North Dakota School of Medicine & Health Sciences. She worked with rural facilities to found the North Dakota Rural Health Association in 2007 and she has served their executive director since that time.

 

Prior to joining CRH, she served as the program/education coordinator for the Office of Continuing Medical Education and Outreach at the UND SMHS. In that capacity, she provided program coordination of continuing medical education activities to physicians and nurses throughout North Dakota, arranged HIPAA certification to North Dakota high schools, community colleges, and health facilities and instructed two undergraduate courses offered online to both college and high school students.

 

Since November 2003, Kylie has been the executive director of the North Dakota Chapter of the American Academy of Pediatrics.

 

Kylie received her bachelor of business administration degree in information systems from the University of North Dakota College of Business & Public Administration, is a certified Health Information Technology Workflow Redesign Specialist, and has her certificate in health administration.

John Naylor

Strategic Advisor

John Naylor was most recently President and Chief Executive Officer (CEO) of Medica. He joined the company in 2010 and served as President and Chief Executive Officer from January 2017 to his retirement in September 2023.

 

Mr. Naylor has more than 30 years of industry experience. As CEO of Medica, he led Medica’s successful expansion to proudly serving 1.5 million members in twelve states (generating more than $6 billion in revenue). Previously he was Senior Vice President, Commercial Markets, Medica’s largest business unit. Under his leadership, Commercial Markets achieved record highs in membership growth and developed a number of industry-first innovations, including accountable care organization products in partnership with a number of health care systems across Medica’s service area.

 

Prior to joining Medica, Mr. Naylor spent more than 20 years at Willis Towers Watson (formerly Towers Perrin). For more than a decade, he served as the market leader for the Towers Perrin Minneapolis office and Managing Director for the U.S. Central Region, with responsibility for all aspects of selling and providing service to clients across the company’s human resources consulting practice.

 

Mr. Naylor is currently the Chair of Itasca Project and previously served on the board of Greater MSP. Both organizations are committed to strengthening the regional economy through programs that promote economic development and regional vitality with a focus on civic engagement and inclusion. He has also previously served on the boards of the Minnesota Council of Health Plans, Medical Alley and HealthEdge.

 

Mr. Naylor is a passionate volunteer at several community organizations, including the YMCA of the North, where he has served on the board for more than a decade.

Brittany Sachdeva, DNP

Chief Clinical Officer

Brittany has worked in health care for over 20 years – the first 10 years as a practicing nurse, largely within the emergency department of an academic medical center. Brittany has held leadership positions within rural integrated health systems in Quality, Accreditation, Regulatory Services and as CNO and COO. 

 

As Chief Nursing Officer she led nursing practice for over 2000 nurses within the system’s largest market, supported the opening of a nearly 500 million dollar new medical center, and achieved accreditation of the nurse residency program. As Chief Operating Officer, she was responsible for a 2 billion dollar P&L, 10,000 employees and service line development. Sachdeva’s interests including advancing rural healthcare’s sustainability, nursing leadership and development, and patient safety. She holds a Doctorate in Nursing with an emphasis in leadership development.

 

Brittany currently serves as Chief Clinical Officer for the Rough Rider High Value Network, a clinically integrated network of 23 North Dakota hospitals, and for Cibolo Health who specializes in rural healthcare network development.

Nathan H. White, JD

President/CEO

Nate White is an expert on healthcare operations and strategy formation with deep domain experience in health system development and leadership. He founded Cibolo Health following a prolific run as Chief Operating Officer of Sanford Health. White’s tenure at Sanford Health saw the organization grow from $350 million in net revenue and a handful of hospitals, to a $6.5 billion national health system with 40 hospitals, 1,500 employed physicians, 200 post-acute facilities, and 250,000 health plan members.

 

More recently, White assisted with the founding—and served as interim Chief Executive Officer—of the Rough Rider High Value Network in North Dakota. This Network includes 23 member hospitals focused on economies of scale through shared services, and improved value-based care arrangements through a clinically integrated network.

 

White offers guidance on organizing principles for major investment decisions designed to expand clinical services across multiple markets. He has helped healthcare executives identify and design affiliation opportunities, including high value networks responsive to new payment models, and partnerships with major payers to align providers towards value-based care.

 

White has been a national speaker on healthcare system development and creating high value networks. He received his BA from Augustana University and JD from the University of Kansas, where he received the highest award given at commencement, recognizing academic excellence, leadership, and community service.

Brett W. Norell, FACHE

Chief Financial Officer

Brett Norell is an innovative, transformational executive with a proven track record of solid operational performance, delivering financial recovery, managed care growth, and strong community engagement.  Brett brings 20+ years of operational and financial leadership experience in a broad range of organizations including pediatric academic, urban multi-hospital system and a small community Catholic hospital.  Most recently, Brett served as President & CEO of Holy Family Memorial in Manitowoc, WI. During his tenure, Brett grew and stabilized the organization while leading partnership discussions and selection of a future partner.  Accomplishments included expense reduction of $11M through implementation of productivity benchmarking and $3.6M in increased revenue through growth in managed care volume.

 

Brett has experience coaching and mentoring leaders at all levels of organizations on the improvement of operational and financial performance. As a coaching professional, trained the Bridges Coaching Method, Brett provides personalized assessment and coaching, guiding leaders to leverage their strengths to effectively lead through any situation. Brett has leveraged his leadership skills to give back to the community and the healthcare profession. Highlights including serving as Chair of the CORE board of directors, Treasurer of the board of directors for a local historical theater, and board member for the Wisconsin Chapter of the American College of Healthcare Executives. He has also coached a variety of youth and high school athletics.

 

Brett received his BS in Bacteriology from the University of Wisconsin and Master of Health Administration and a Master of Public Health from the University of Iowa. He is board certified in healthcare management as a Fellow in the American College of Healthcare Executives.

A. Clinton MacKinney, MD, MS

Chief Medical Officer

Dr. Clint MacKinney has worked in health care for 40 years – the first 14 years as a rural family physician, practicing the full scope of family medicine. He has both owned a private practice and worked with a large healthcare system. Dr. MacKinney then worked as Medical Director for a globally capitated primary care group with 210 employees and a $50 million budget. In addition to clinical duties, Dr. MacKinney worked for eight years as a performance improvement consultant for nearly 50 rural hospitals. Dr. MacKinney completed his clinical career as an emergency department physician in rural Minnesota. Dr. MacKinney then served as the Clinical Design Consultant to the Pennsylvania Rural Health Model (global hospital budgets). Dr, MacKinney currently serves as Chief Medical Officer for the Rough Rider High Value Network, a clinically integrated network of 23 North Dakota hospitals, and for Cibolo, a firm specializing in rural healthcare network development.

 

Dr. MacKinney is a Clinical Associate Professor at the University of Iowa, College of Public Health. His academic and professional interests include rural health system transformation, healthcare value, physician and administration relationships, healthcare financing and payment, and rural health policy. Dr. MacKinney is a member of the Rural Policy Research Institute (RUPRI) Health Panel and has served on national committees for the Institute of Medicine, the Department of Health and Human Services, the American Academy of Family Physicians, and the American Medical Association. Dr. MacKinney received his MD degree from the Medical College of Ohio (now Toledo University), Family Medicine residency from the Mayo Clinic system, and master’s degree in administrative medicine from the University of Wisconsin.

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