CONTINUING THE TRANSFORMATION

Northwest
Arkansas
Health Care Vision 2030

DATA PREPARED BY

2024
 TABLE OF CONTENTS
3 The Road Traveled & the Road Ahead

4 Introduction & Executive Summary

5 Accomplishments

8 Section I: Progress Since 2018

8 Finding 1: Northwest Arkansas has Expanded its Health Care Industry Since 2018, but Work
Remains

11 Finding 2: More Patients are Staying in Northwest Arkansas for Care

12 Finding 3: Graduate Medical Education has Expanded in the Region

14 Finding 4: Medical and Health Science Education Must Expand to Meet Demand

15 Finding 5: Biomedical and Health Care Research has Expanded, but More Collaboration is
Needed to Accelerate an Innovation-Based Economy

15 Section II: Current Challenges

16 Challenge 1: Payment Rates for Health Care Services Remain Among the Lowest in the United
States

20 Challenge 2: Research Comparisons with Flagship Universities

22 Challenge 3: Need for an Expanded Health Care Workforce

25 Challenge 4: Expanding Specialty Care Must Continue

27 Challenge 5: Level 1 Trauma Service

28 Section III: Roadmap for 2030

29 Health Care Specialty Service Expansion

31 Expand Regional Workforce to Meet Health Care Needs of Growing Region

32 Expand a More Collaborative Health Care Research and Innovation Ecosystem

33 Advancing Health Policy and Payment Reform Efforts in Support Of Value-Based Care

36 Appendix A: Profiles of Growth in Health Care Institutions (2018-2023)

38 Appendix B: Profiles of Growth in Education Institutions (2018-2023)

39 Appendix C: Profiles of Growth in Research and Innovation (2018-2023)

41 Appendix D: Stakeholders

42 Appendix E: Tripp Umbach Experience

Novem b er 1 3 , 2 0 2 4
Foreword: Building a Healthier Future Together
The Northwest Arkansas Council’s Health Care Transformation Division and Heartland Whole Health Institute are
pleased to present this update on the region’s health care initiatives.

The past few years have marked significant progress in elevating health care services, education, and research in
Northwest Arkansas. Collaboration among health care providers, community organizations, and educational
institutions has fueled meaningful advancements, creating a strong foundation for Northwest Arkansas to emerge
as a model for health care innovation and delivery.

Since the 2018 report, the region came together during one of the most challenging periods in history—the
COVID-19 pandemic—and collectively helped protect the Northwest Arkansas community. The lessons learned and
partnerships forged during this crisis continue to guide efforts to build a resilient and responsive health care system
for the future.

The launch of Heartland Whole Health Institute and Alice L. Walton School of Medicine are pivotal milestones in the
region’s efforts to create a holistic and proactive health care model. This work is guided by whole health principles
that emphasize a comprehensive approach to well-being, integrating physical, mental, emotional, and social
health. These organizations will catalyze new delivery models that drive the region’s efforts to lower costs, improve
quality, and broaden access to health care in the Heartland.

Additionally, the region is working together to strengthen and expand graduate medical education to build a
robust pipeline of locally trained health care providers who are committed to serving Arkansas. With new residency
and fellowship programs on the horizon, the goal is to retain talented medical professionals, reducing the need for
external recruitment and retaining more health care dollars within the community.

Through these efforts and the ongoing and consistent investments by regional providers, Northwest Arkansas is
poised to become a national leader in health care innovation and delivery. Investments in education and research
will drive breakthroughs, expand specialty services, and prepare our workforce to meet the needs of our diverse
and growing population.

The success of these initiatives is a testament to the spirit of partnership that defines the region. Health care
providers, community organizations, educators, and industry leaders are united by a shared vision of excellence,
making the region an attractive destination for top medical talent, researchers, and educators—all dedicated to
improving health outcomes for our community.

Looking forward, much work remains. To build on our achievements, we must further integrate whole health
principles, focus on value-based care, and enhance our health care workforce. Continued innovation and service
development are vital to improving the overall health and well-being of our residents. Achieving these goals will
necessitate renewed commitment, ongoing collaboration, and strategic investment from all stakeholders.

The roadmap to 2030 outlines a bold vision to create a health care system that is second to none. Together, the
region is shaping a future where everyone has access to high-quality care, innovative research, and comprehensive
health services that support lifelong well-being.

The Northwest Arkansas Council’s Health Care Transformation Division and Heartland Whole Health Institute invite
all stakeholders to join this journey in building a healthier, more vibrant Northwest Arkansas—one that stands as a
model for health care excellence and collaboration.

Sincerely,

Nelson Peacock, President and CEO, Northwest Arkansas Council

Walter Harris, CEO, Heartland Whole Health Institute

 THE ROAD TRAVELED:
Coordinated COVID Ongoing health
response—vaccine care infrastructure
distribution and public investment
health response

Outmigration I3R Reduced

in 2018: established outmigration by
$950M Heartland $255M since 2018
Whole
Health
Institute Alice L.
established Walton Graduate medical education
Established the
School of positions increased from 55 to 74,
Health Care
Medicine a 35% increase
Transformation
established
Division

The road ahead:

Advance health
policy and
payment reform
efforts in support of
value-based care

Expand service
offerings to attract
more patients Reduce
Expand health from outside the costs and
care specialty region than it improve access
services loses through and health
outmigration outcomes
Strengthen Expand the
health care health care
research and workforce/
innovation workforce Change health
training and care paradigm:
Expand data simulation Collaborate to
capabilities to center build a nationally
measure recognized value-
outmigration based care
and support environment
opportunity Address
analysis for reimbursement
growing health rate disparities
care services

3
Tripp Umbach was invited by the Northwest Arkansas Council, Heartland Whole Health Institute, and key
regional stakeholders to update a landmark report initially completed in 2018. The original report, “Northwest
Arkansas Health Care: Assessment, Economic Impact, and Vision for the Future,” provided strategies to
expand the region’s $2.7 billion health care sector and laid the groundwork for future growth. The 2024
update focuses on changes in the health care economy from 2018 to 2023 and outlines a vision and roadmap
for regional growth by 2030. Building on the 2018 strategies, the updated report emphasizes expanding
undergraduate and graduate medical education, increasing collaboration on research and increasing
fellowships in needed medical specialties.

The initial vision of creating connected, cohesive communities to support regional health care transformation
and community health improvement remains central. The 2018 report, released in 2019, also identified
challenges and opportunities, stressing the need for a regional strategy to prevent underperformance in
the health care sector, which could otherwise harm future health outcomes, economic development, and
population growth.

This report highlights progress over the five years, addresses current challenges, and sets goals for continued
growth through 2030. To accomplish this task, the Northwest Arkansas Council’s Health Care Transformation
Division and Heartland Whole Health Institute worked closely with Tripp Umbach to steer the report and
recommendations over a 10-month process. Tripp Umbach revised data from the original report, including peer
benchmarking, and assessed the economic and social impacts outlined in the previous report. This report
provides an updated list of regional priorities to leverage the significant accomplishments over the past five
years as it sets the stage for actions to be accomplished by 2030.

EXECUTIVE SUMMARY
Northwest Arkansas has made progress in expanding its health care industry from 2018 to 2023, with investments
in infrastructure, services, and workforce development fueling economic growth. Northwest Arkansas’ health
care economy outpaced overall economic growth during this period, demonstrating its increasing importance
to the region. This expansion has resulted in new facilities, greater access to specialized care, and more
residency training programs, and is poised to launch a new private medical school. Compared with peer
regions, Northwest Arkansas witnessed the most significant positive change in health care employment as a
percentage of total regional employment in 2018-2023. However, while the region has achieved milestones,
more work is needed to meet the health care demands of a population projected to exceed 1 million by mid-
century.

Rapid population growth and shifting demographics are straining the region’s health care capacity.
Compounding these challenges, the national health care industry has undergone significant changes,
including the impact of the COVID-19 pandemic. This disruption highlights the urgent need for a more
coordinated regional care system, as patients with complex medical conditions who see multiple specialists
face higher costs and poorer outcomes. Addressing shortages of health care professionals at all levels is critical
to ensuring effective care delivery to the growing population.

Furthermore, policy changes in reimbursement must accelerate to shift the focus from sickness to health,
emphasizing preventive care and focusing on value-based care. The next five years are crucial, and a clear
roadmap for 2030 is essential to ensure continued regional health care growth and economic development.

Tripp Umbach conducted over 20 interviews with regional and statewide stakeholders to better understand
the region’s progress and future opportunities (see Appendix D) and facilitated four on-site work sessions in
Northwest Arkansas, where steering committee members provided direction and feedback. Stakeholders
recommended the 2024 report focus on the following areas:

Expand health care Establish a best-in-class Drive a more Advance health

specialty service regional workforce for collaborative health policy and payment
the health care needs of care research and reform efforts in
a growing region innovation ecosystem reimbursement and
value-based care
4
 ACCOMPLISHMENTS
Transformation Division Established
As recommended in the 2018 report, the Northwest Arkansas Council formed the Health Care Transformation
Division in July 2019, marking a vital first step in aligning the region’s economic development efforts toward a
cohesive health care strategy. Few communities in the United States have a separate division of an economic
development organization dedicated to the health care economy. The new division was pivotal in establishing
improved connectivity among employers, community health initiatives, and health care providers, which has
been essential in achieving long-term economic and social outcomes for the region. Fortunately, the
Transformation Division was already in place to coordinate regional providers during the COVID-19 pandemic.
Bringing together hospitals, physician practices, the Department of Health, and the business community helped
save lives by encouraging public safety measures and coordinating vaccines. The work of the Health Care
Transformation Division during this time demonstrates the importance of continuing to support and
expand the Division in the future to ensure the infrastructure for community response is in place for future
unexpected events.

DIVISION PARTICIPANTS INCLUDE:

Arkansas Children’s Northwest Northwest Health
Community Clinic University of Arkansas for Medical
Sciences Northwest Regional Campus
Heartland Whole Health Institute
University of Arkansas
Highlands Oncology
Washington Regional Medical Center
Mercy

Institute for Integrative and Innovative Research (I³R)

Since the 2018 report, the University of Arkansas established I³R, an interdisciplinary research institute, to support
and promote the excellence and relevance of research to respond to expressed needs and to achieve
tangible impacts. The Institute plays a significant role in bolstering the economy of Northwest Arkansas by
fostering interdisciplinary research in fields such as biotechnology, nanotechnology, health, and data science.
I³R is poised to attract substantial research funding, supporting high-paying jobs in the region. The Institute’s
cutting-edge work promotes collaborations between academia, industry, and government, fueling the growth
of local startups and innovative enterprises. This innovation ecosystem drives economic diversification and
strengthens Northwest Arkansas’ reputation as a scientific research and technology development hub. The
Institute’s research initiatives also support workforce development by training highly skilled professionals in
critical industries, thus contributing to the region’s economic competitiveness. By anchoring a research-driven
economy, I³R not only stimulates direct employment but also spurs secondary economic benefits through
increased demand for services, housing, and infrastructure, thereby enhancing the overall economic vitality of
Northwest Arkansas.

Alice L. Walton School of Medicine; Heartland Whole

Health Institute Established
The Alice L. Walton School of Medicine represents a transformational
project mentioned first in the 2018 report. Opening the Alice L. Walton
School of Medicine in 2025 provides the region with a
transformational springboard to drive the region’s physician
workforce. The medical school will grow and attract medical talent
and foster research, innovation, and advancements in health care
technology. In addition, Heartland Whole Health Institute is poised to
drive Northwest Arkansas in the transformation of the delivery of health
care by elevating a whole-person model of care that prioritizes the
patient experience, supports team-based primary and specialty care
models, and incorporates data and analytics.

5
Graduate Medical Education Expanded
Addressing the identified gap in graduate medical education (GME), the region made progress in
adding new residency programs and established a plan to expand physician training programs more
significantly by 2030. This expansion has been crucial in supporting the health care sector’s growth by
attracting and retaining medical professionals in Northwest Arkansas, thereby enhancing the region’s capacity
to meet the health care needs of its growing population. The expansion of GME has laid the groundwork for
further development in medical education, aligning with the long-term goal of establishing a medical school in
the region. However, more work is needed to achieve the goal of training 200 residents by 2040.

Washington Regional Medical Center (WRMC) working with the University of Arkansas for Medical Sciences
(UAMS) took a significant step forward for the state and region when WRMC elected to undertake a
geographic wage reclassification with the Center for Medicare and Medicaid Services that would allow it to
adjust its federally subsidized residency cap. The Arkansas Legislative Council approved $12.5 million in funding
in 2020 to support WRMC’s effort and has committed to additional funding to expand residencies and
fellowships across the state. This effort, once complete, will add 76 new residency positions at WRMC and keep
more Arkansas medical graduates in the state for their postgraduate training. However, the state still ranks No.
49 in the nation for active physicians per 100,000 people and No. 37 for active primary care physicians, so much
more work is needed.

Health Research and Innovation Expanded

As highlighted in the 2018 report, progress has been made toward expanding biomedical and health
improvement research and innovation at the University of Arkansas, UAMS Northwest, Highlands Oncology,
Arkansas Children’s Northwest, and hospitals. This initiative inspires collaboration across various fields of study,
driving innovation and research that can directly contribute to the health care sector’s growth. While progress
was made, much work remains to position Northwest Arkansas as a hub for health care innovation, improving
health care outcomes, and strengthening the local economy. These initiatives have collectively contributed to
a more robust health care sector in Northwest Arkansas. The progress has expanded the health care industry’s
economic impact and enhanced the region’s capacity to provide high-quality health care services in response
to its changing demographics and population growth. Continuing to grow the health care sector through
implementing recommendations outlined in this report is critical to keeping the region on a trajectory to
becoming a national leader in health care innovation and delivery, further solidifying its economic and social
prosperity.

Transformational Investment in Specialty Care

The Alice L. Walton Foundation, Mercy, Heartland Whole Health Institute, and Cleveland Clinic recently
announced a transformative 30-year, $700 million partnership to expand specialty care, improve
resident training, and drive economic development in Northwest Arkansas. This initiative will focus on
bringing world-class cardiovascular care and comprehensive health services to the region, anchored by a new
cardiac care center at Mercy’s campus in Rogers and a specialty outpatient center in Bentonville. Mercy’s
$350 million investment and the Alice L. Walton Foundation’s matching investment will also support physician
recruitment and retention, enhancing the region’s medical workforce.

Cleveland Clinic will provide cardiovascular expertise, helping

establish a leading cardiovascular center. The collaboration will
reduce health care costs through value-based care, leveraging
technology and telehealth to improve health outcomes. This
effort will transform Northwest Arkansas into a premier health
care destination. The initiative will attract hundreds of new
physicians, offering advanced training opportunities and
positioning the region as a model for preventative, whole-
person health care. Additionally, it will support the Alice L.
Walton School of Medicine in training future health care
professionals, with Mercy serving as a critical educational
partner. This strategic collaboration aims to create a sustainable
health care model that enhances quality, reduces costs, and
improves health outcomes for the Heartland.

6
 Health Care Infrastructure Investment
Investments in health care-related facilities from 2018-2023 can be seen driving along the I-49 corridor and
throughout the region. These investments, totaling more than $529.5 million, include:

$247 million expansion of Mercy Hospital Northwest Arkansas.

$217 million expansion at Washington Regional Medical Center.

$19.5 million expansion of Arkansas Children’s Northwest.

$40 million Cancer Center at Highlands Oncology.

$6 million to expand the UAMS Institute for Community Health Innovation (ICHI).

Projects Underway
Transformational projects valued at $1.3 billion are planned by 2030 in Northwest Arkansas. Building on $529.5
million developed from 2018 to 2024, total health care facility investment is estimated at nearly $2 billion from
2018 through 2030 (See Appendix A).

Construction of the Alice L. Walton School of Medicine (AWSOM), a 154,000-square-foot medical

school.

Construction of Heartland Whole Health Institute’s 75,000-square-foot facility will be complete in

2025.

Expansion of Community Clinic, adding 16 locations to support the growing needs of Northwest
Arkansas (and Eastern Oklahoma).

$120 million for the Institute for Integrative and Innovative Research (I³R) at the University of
Arkansas.

$83 million for the expansion of Arkansas Children’s Northwest.

$109 million Orthopedic Surgery and Sports Medicine Center at UAMS Northwest.

$4.5 million to expand Northwest Health’s behavioral health unit in Springdale.

$700 million partnership among the AWSOM, Mercy, Heartland Whole Health Institute, and
Cleveland Clinic to expand specialty care, improve resident training, and drive
economic development in Northwest Arkansas.

$7.5 million Highlands Oncology cancer center planned for Rogers to expand service to patients
in Benton County.

7
 Progress Since 2018
SEC. 1

Northwest Arkansas has Expanded its Health Care Industry Since

FINDING 1:

2018, but Work Remains

Peer Market Comparisons

Aligning with the 2018 report methodology, Tripp Umbach benchmarked Northwest Arkansas with seven peer
regions: Austin, TX; Boise, ID; Des Moines, IA; Durham-Chapel Hill, NC; Evansville, IN; Madison, WI; and Spokane,
WA (see Figure 1).

FIGURE 1: FIGURE 2:

Peer Regions for Benchmarking Growth in Health Care Employment 2015

(2015-2022) 2022

Compared with peer regions, Northwest

Arkansas witnessed the most significant
positive change in health care
employment as a percentage of total
regional employment from 2015 to 2022.
While health care employment has grown in
Northwest Arkansas, only Austin, TX, has fewer
jobs per capita in the health care sector. The
Spokane, WA, region has 46% more health
care employment than Northwest Arkansas
(see Figure 2).

Source: Data USA

8
 Growth in the Northwest Arkansas Health Care Industry Since 2018
Northwest Arkansas’ health care economy has outpaced overall regional economic growth, demonstrating its
increasing importance to the region. From 2018 to 2023, the total Gross Regional Product (GRP) increased by
37%, from $27.5 billion to $37.7 billion. Importantly, the region’s health care sector grew by 80% during the
same period, from $2.5 billion to $4.5 billion, reflecting a growth rate twice as fast as the overall
economy. Projections indicate that the health care sector could reach $6.1 billion by 2030, reflecting a 144%
growth rate between 2018 and 2030 (see Figure 3).

Additionally, progress has been made in addressing the region’s health care employment gap. From 2018 to
2023, Northwest Arkansas added 4,096 health care jobs.2

This means that two-thirds of the 2018 report’s goal of creating 6,000 jobs by 2040 has been achieved. This
increase in jobs is a significant achievement, showing the region’s commitment to expanding its health care
services and reducing the economic losses caused by outmigration (see Figure 4).

Health care employment gains in the region accelerated from 2022 to 2023, especially in Benton County,
indicating recovery from COVID-19 (see Figure 6).

FIGURE 3: FIGURE 4:
Health Care Gross Regional Product Health Care Employment in 2018 & 2023

FIGURE 5: FIGURE 6:
Total Health Care Jobs Created Private Sector Employment –
(2018-2023) Compared with Education & Health
Goal for 2030

2018 - 2023

Remaining Jobs

1
Source: US Bureau of Economic Analysis, fred.stlouisfed.org
2
According to the U.S. Bureau of Labor Statistics, the total change from 2018 to 2023
equals 5,462 jobs gained in health care and social services (based on Tripp Umbach’s
assumption that 75% of employment in this broad sector is health care providers and
support staff, the total health care job gain in the period is 4,096).
9
According to Tripp Umbach’s 2018 report, Northwest Arkansas’ health care economy was $950 million lower
annually than expected based on national standards. This difference is mainly attributable to the high
outmigration of patients seeking advanced medical services elsewhere and the region’s inability to attract
patients from outside the area. This economic loss was attributed mainly to the region’s underdeveloped
subspecialty service lines in advanced cardiology and oncology areas. However, since 2018, Northwest
Arkansas has seen improvement in keeping health care spending in the region, with more patients opting to
stay within the region to receive care.

Tripp Umbach’s analysis shows that this economic disparity has improved by $255 million since 2018 as
more health care dollars remain in the region. As a result, the economic inequity in the region’s health care
industry fell from $950 million to $695 million in 2023, reflecting progress toward a goal of attracting more health
care dollars than leaks from the economy.

Regarding peer community benchmarks, Northwest FIGURE 7:

Arkansas had the most improvement in health Change in Economic Disparity in Health
care location quotient score among peer markets, Care in Northwest Arkansas
rising from 0.74 in 2018, reflecting $950 million in
economic disparity from the nation, to 0.86 in 2023.
This 16% increase in location quotient underscores
real growth in the health care industry in Northwest
Arkansas compared with the peer markets and the
nation. (see Figure 8).

While the region still trails behind peers, such

as Durham Chapel Hill, NC, and Spokane, WA,
which has location quotients of 1.86 and 1.67,
recent progress is a step toward narrowing the
gap and retaining more health care dollars
within the local economy.

With continued investment in subspecialty services

and advanced health care infrastructure, Northwest
Arkansas can eliminate the remaining $695 million
in outmigration and capture the full potential of the
health care sector by 2040. (see Figure 7).

FIGURE 8:
Health Care Location Quotients for Peer
Markets, 2018-2023
2018
2023

This figure represents the difference in the size of the health care economy in Northwest Arkansas compared with the U.S. average of all markets, represented by location quotient
3

analysis. While this number is impacted by outmigration of patients and low levels of immigration of patients, the calculation is broader than the flow of health care spending that leaves
or comes into the region.

10
 FINDING 2: More Patients are Staying in Northwest Arkansas for Care
The Arkansas Center for Health Improvement (ACHI) partnered with Tripp Umbach to analyze medical
spending on the health care of Northwest Arkansas residents from 2018 to 2023. Data used in the analysis is from
the Arkansas Health Care Transparency Initiative, administered by ACHI, and includes the Arkansas All-Payer
Claims Database.5

Medicare Market
The percentage of Medicare spending for medical services
for Northwest Arkansas patients occurring out of state has
consistently declined, from 8.2% in 2018 to 6.7% in 2021.
Spending on medical care in Northwest Arkansas
for Medicare recipients who remained in the region
increased from $1.37 billion in 2018 to $1.62 billion in
2021, representing an increase of $254.8 million. This
trend indicates a growing tendency for residents to seek
medical care within the region, attributed to health care
infrastructure expansion. It must be noted that while the
percentage of health care spending leaking out of state
declined over the period, out-of-state health care spending
resulted in a modest change in actual dollars leaving the
region, from $136 million in 2018 to $129.9 million in 2021
(see Table 1).

TABLE 1: Commercial Insurance Market

Percentage and Dollar Change in Out-of-State Based on the available ACHI data, the
Medicare Spending (2018 - 2023) SOURCE: ACHI percentage of medical-only spending by
commercial payers directed out-of-state
TOTA L SP E N DI N G % O F TOTA L O U T O F S TATE
for Northwest Arkansas residents has also
ON NWA SP E NDI N G L EAK AG E ( $ )
RESID ENTS O UT- O F - S TAT E F R O M N WA shown a downward trend. However, these
YE AR
data do not include self-insured large
companies, which comprise approximately
2018 $1.658B 8.2% $ 1 36 . 0 M 25 percent of Northwest Arkansas’ health
insurance market. In 2018, 12.1% of the
2019 $1.775B 8.3% $ 1 47 . 3 M
total spending in the commercial
2020 $1.790B 7.2% $ 1 28 . 9 M insurance market was out of state, which
decreased to 6.3% in 2022. This represents
2021 $1.940B 6.7% $ 1 29 . 9 M a reduction of $18.3 million in out-of-state
spending from 2018 ($59.9 million) to 2022
($41.6 million) within the commercial
TABLE 2: market. This decrease suggests an
Commercial Payers Medical-Only Spending increasing reliance on local health care
SOURCE: ACHI
providers, indicating improvements in the
TOTA L SP E N DI N G % O F TOTA L O U T O F S TATE region’s availability and quality of medical
ON NWA SP E NDI N G L EAK AG E ( $) services (see Table 2).
YE AR RESID ENTS O UT- O F - S TAT E F R O M N WA

2018 $495M 12.1% $59.9M

2019 $614M 11.4% $69.9M

2020 $607M 8.2% $49.8M

*All data presented do not include large company sponsored health
5

2021 $697M 6.6% $46.0M plans; i.e., Walmart, J.B. Hunt, Tyson Foods. Therefore, the Northwest
Arkansas Council needs to work with large employers to develop a
data-sharing platform where all data on outmigration can be viewed
2022 $661M 6.3% $41.6M and used for planning purposes.

11
FINDING 3: Graduate Medical Education has Expanded in the Region
The state of Arkansas faces significant physician shortages, and this problem is likely to grow given that 35% of
Arkansas physicians are over 60 years of age. At the same time, many graduates of Arkansas medical schools
are forced to work elsewhere due to a shortage of postgraduate medical residencies. The state has become
a net exporter of medical talent, and because most physicians practice within 60 miles of their residency,
the state will likely lose this talent. Arkansas has an impressive record for retaining medical residents after their
training is complete, ranking No. 4 in the nation for retention. However, there are simply not enough positions
available to accommodate the number of graduates seeking to complete their residency in Arkansas.

Washington Regional Medical Center (WRMC), acting with the support of University of Arkansas for Medical
Sciences and other regional hospitals, helped the region take a significant step forward when it applied for
a geographic wage reclassification with the Center for Medicare and Medicaid Services (CMS). This process
allows eligible institutions to increase the number of federally subsidized residency positions beyond its current
limit or cap. The process is not without risk. Any institution undertaking this process faces significant startup costs
and a lower reimbursement period until the process is complete. The State of Arkansas supported Washington
Regional effort with a commitment of $12.5 million in 2020 and has committed to additional funding to help
the WRMC - and other similarly situated hospitals - to undertake this process. Once implemented, the wage
reclassification process must be completed within five years. To date, WRMC has established 50 residency
positions and will apply to the Accreditation Council of Graduate Medical Education once funding is made
available for the 26 additional residency slots under federal rules.

While the region is off to a good start, more work is needed to expand residency programs as more Arkansas
medical students graduate each year than available residency spots. Increasing the number of residencies will
help retain medical graduates in Northwest Arkansas, expand the local health care workforce, and prepare
for the region’s population growth. Each residency position generates $715k in economic impact annually. The
WRMC program, once fully implemented, will generate over $54M in annual economic impact to the state.
Each new physician in the state will create, on average, 17.1 jobs and add $2.4 million to the local economy.

Finally, robust residency programs also help foster a culture of research and innovation within the hospitals
and the community. Community-based teaching hospitals such as Mercy and WRMC serve as hubs for
medical research, attracting grants, contracts, and other external funding sources. This not only contributes
to economic growth but also leads to increased quality and positive health outcomes. Expanding graduate
medical education (GME) also helps reduce health care costs. By increasing the number of primary care
physicians and specialists in the region, patients can receive timely and preventive care, reducing the need for
more expensive emergency department visits and hospitalizations. Studies show that areas with greater access
to primary care physicians see lower overall health care costs, as early interventions and regular care help
prevent chronic conditions from worsening.

12
 Since 2018, Northwest Arkansas has seen growth in GME (physician residency training), beginning with the
launch of an internal medicine residency program through the University of Arkansas for Medical Sciences
Regional Centers sponsoring institution, based at UAMS Northwest Regional Campus and WRMC. This program,
which added eight residency slots per year or 24 positions total, marks the first step in a larger plan to expand
residency training in the region by adding approximately 92 more positions by 2030. Internal medicine was
chosen as the initial program for this GME expansion because an internal medicine residency program is
required to have fellowships in the internal medicine subspecialties like cardiology.

GME grew from 55 residents and fellows in training in the region in 2018 to 74 in 2023, a 35% increase.
Plans are underway in the area to significantly increase residency programs, bringing the total number
of residents in training to 155, representing an increase of 182% over 12 years (see Table 3).

TABLE 3:
Residency Growth in Northwest Arkansas (2018-2030)
SOURCE: UAMS AND WASHINGTON REGIONAL

NUMBER OF NUMBER OF PR O JE C T ED # OF
R E S I D E N TS R E S I D E N TS I N RESIDENTS/
PR OG RAM I N 20 1 8 2023 F E L LOWS BY 2 0 3 0

Fa m i ly Medic ine Res id ency ( Was hi n g t o n R eg i ona l/Nor thwes t) 30 30 27

In ter na l Medic ine R es id ency ( Mercy/ VA) 24 32 30

Spor ts Medic ine Fellows hi p 1 2 4

In ter na l Medic ine R es id ency ( Was hi n g t o n R eg iona l) 0 8 24

Emergency Medicine R es idency ( Was hi n g t o n Re giona l) 0 0 24

Ne urology Residency ( Was hi n g t o n R eg i o n a l ) 0 0 8

Fa m i ly Medic ine Res id ency – R ura l P rog ram 0 2 12

( Wa s h i n gt o n R e gi o n a l / Mercy Ber r yv i l l e)

Genera l Surger y Res idency ( Was hi n g t o n R eg i ona l) 0 0 2

Tra nsi tiona l Year R es id ency ( Was hi n g t o n R eg i ona l) 0 0 10

C a rdiovasc u lar D is eas e Fellows hi p ( Was hi n g ton Re giona l) 0 0 6

Rh eum a tology Fellows hi p ( Was hi n g t o n R eg i o n a l) 0 0 4

En do c r inology Fellows hi p ( Was hi n g t o n R eg i o n a l) 0 0 4

TOTA L 55 74 15 5

While impressive, more efforts are needed to FIGURE 9:

ensure the region reaches its goal of 200 Residency Growth in Northwest Arkansas
additional residency positions by 2040. (2018-2030)
WRMC completed a geographic wage
reclassification, allowing fresh federal dollars
for residency programs to flow into the
hospital over five years. However, since Mercy
and Northwest Health Springdale are both
currently capped, it will be imperative that a
state/regional funding source be identified
to continue investing in GME expansion
to meet the 200-resident goal. Additional
strategies may include resetting low CMS caps,
changing rural payment designation, and
ensuring that all future hospitals have a unique
provider number (see Figure 9).

13
 Medical and Health Science Education Must Expand to Meet
FINDING 4:

Demand
Since 2018, Northwest Arkansas has seen modest growth in medical, nursing, and health science education
(see Appendix B for Profiles of Area Medical and Health Science programs). The region has not kept pace
with the need to grow medical and health science employment through transitioning graduates into
needed jobs. For example, the number of health care-related bachelor’s degrees awarded grew by only 5%,
compared with 50% in Austin (see Figure 10).

FIGURE 10:
Bachelor’s Degree Concentration in Nursing & Public Health

2018
2022

It is important to note that the University of Arkansas awarded 220 degrees in psychology and 52 bachelor’s
degrees in biomedical engineering over the period and is not included in Figure 10 above8.

While bachelor’s degree graduation was flat over the period, a more significant concern is the decrease in the
number of graduates in health science degrees at the master’s level awarded over the period. At just the time
when the region needed more health care providers, the number of master’s level graduates declined by 20%
(see Figure 11).

It is important to note that the University of Arkansas introduced new public health and occupational therapy
programs during this period, which are included in these numbers. Also, master’s and doctoral-level biomedical
degrees awarded by the University of Arkansas are not included in these data.

FIGURE 11:
Master’s Degree Concentration in Health

2018
2022

University of Arkansas, Office of Strategic Analytics and Insights

8

14
 Biomedical and Health Care Research has Expanded, but More
FINDING 5:

Collaboration is Needed to Accelerate an Innovation-Based Economy

From 2018 to 2023, Northwest Arkansas experienced modest growth in biomedical research, health care
innovation, and technology development. The University of Arkansas reached a record $184 million in total
research expenditures in 2023, driven by its 150 Forward Strategic Plan. The creation of the Institute for
Integrative and Innovative Research (I³R), among other capital projects, enhances its research capabilities,
particularly in health sciences and technology commercialization. I³R provides a regional framework for
enhancing health care research through multiple collaborations within the University of Arkansas, with UAMS,
Children’s, and support for the research component of the medical education of incoming AWSOM students.

Highlands Oncology advanced cancer treatment through clinical trials, offering innovative therapies, including
early-stage experimental medications. The Heartland Whole Health Institute, although not a traditional research
entity, influenced patient care models by promoting efforts to reduce the cost of care, improve quality, and
expand access to care. Collaborative initiatives, such as the Women’s Health Research Collaboration and the
Arkansas Integrative Metabolic Research Center (AIMRC), further strengthened Northwest Arkansas’ position as
a growing center for health-related research. These partnerships, supported by funding from federal initiatives
and regional foundations, have advanced the commercialization of health care technologies and innovations,
positioning the region as an emerging hub for biomedical research and health care solutions. Growing
health care markets with robust medical education, research, and advanced clinical practices are magnets
for companies to gain advantage from locating near biomedical-based research institutions and hospitals
where advances are brought to the bedside (see Appendix C).

CURRENT CHALLENGES
SEC. 2

The health care economy in Northwest Arkansas faces

challenges and opportunities over the next five years
as it navigates rapid population growth and workforce
constraints. With an annual influx of 15,000 new
residents, health care providers grapple with the strain of
meeting increasing health care demands. Staffing
shortages, worsened by pandemic-related burnout, present
a critical issue as the region struggles to recruit and retain
doctors, nurses, and other health care professionals. Rising
labor and supply costs—some increasing as much as 60%
since the pandemic—compound these workforce
shortages.

The cost of health care insurance also continues to rise.

According to the Kaiser Family Foundation’s 2023
Employer Health Benefits Survey, the average premium
for single and family coverage has grown 22% since 2018.
At $24,000, the average premium for family coverage in
2023 is 22% higher than in 2018. At the same time, insurer
reimbursement rates have remained relatively stagnant,
creating financial stress across the health care system. The
sustainability of the current health care model is
increasingly questioned, with regional stakeholders
pushing for collaborative efforts to mitigate these issues.

15
 Payment Rates for Health Care Services Remain Among the
CHALLENGE 1:

Lowest in the United States

As payments to health care providers move from the volume of care provided to the outcome of such care,
the cost of health care in the region will be unsustainable for individuals and employers. The financial burden
of an unhealthy population results in massive losses to the overall health care sector. Northwest Arkansas is
caught in the middle of an economic design shift in health care. New payment models have not fully
developed to compensate for being behind the curve with chronically low reimbursement. Additional
collaboration is needed to support the shift towards value-based care. Health care providers in peer markets
with higher reimbursement are in a stronger financial position to invest in new programs and thereby lowering
their financial risk as they move from fee-for-service to value-based care.

Arkansas is at a significant disadvantage as a result of national reimbursement methodologies. Payment

formulas for Medicare are based on 60-year-old cost data when the entire state of Arkansas, including
Northwest Arkansas, was severely disadvantaged in most all measures compared to the nation. Because
commercial insurers base their reimbursement rates on the amount of money providers receive from Medicare,
Northwest Arkansas is burdened with the lowest government and private reimbursement rates. This
accumulating impact has been a monumental challenge for the growth and development of health care
services. Unfortunately, historical payment formulas for government payment levels drive payment formulas
for private insurers. Currently, reimbursement methodologies are limited for innovative care models, inhibiting
emerging strategies such as growth in virtual care.

FIGURE 12: FIGURE 13:

Office Visit, Established Patient - Office Visit, Established Patient -
Low Complexity High Complexity

Source: Health Prices | Price Comparison Tool • Health Care Prices

16
 Medicare Geographic Payment Discrepancies
Medicare, the federal health insurance program for persons over 65 years old, exhibits significant geographic
variation in spending and reimbursement across the United States. The differences in Medicare spending per
beneficiary arise from various factors, including health care utilization patterns, costs, and quality disparities.
While some regions in the United States spend more on health care, others offer services at lower costs, raising
concerns about fairness and efficiency. Policymakers have debated whether lower-spending regions like
Northwest Arkansas are unfairly penalized for their efficient care delivery. At the same time, higher-spending
areas, often characterized by inefficient academic medical centers and economically disadvantaged
populations, face challenges that drive up their costs.

Within larger MSAs, smaller subdivisions called Metropolitan Divisions account for regional health care costs and
wage differences. Wage index payments, the adjusted rates that Medicare pays health care providers, often
reflect these geographic distinctions. However, disparities arise when wage indexes fail to account for the
actual costs of delivering care, leading to dramatically lower provider payments in places like Northwest
Arkansas.

One example of this discrepancy is in the Medicare wage index system, which adjusts payments based on
local wage levels. These wage indexes can vary significantly even within the same state or region. For instance,
Northwest Arkansas counties may receive a Medicare wage index of 0.83, whereas nearby places such as
Oklahoma City (0.87) or Kansas City (0.93) receive higher indexes. Such discrepancies greatly impact the
financial sustainability of health care providers and make it harder for regions like Northwest Arkansas to
attract and retain qualified health care professionals.

Arkansas has among the lowest payment rates, only slightly higher than the neighboring states of Louisiana and
Mississippi (see Figure 14).

FIGURE 14:
Median Area Wage Index by State, FY 2022

SOURCE: Centers for Medicare and Medicaid Services

17
Making matters worse, states like Arkansas that receive the lowest level of federal reimbursement also have the
poorest health status and sickest patient population. Figure 15 illustrates how states in the lower Mississippi Delta
such as Arkansas, Mississippi, and Louisiana have the greatest health needs.

FIGURE 15:
Overall Health Rankings by State
Rank Based On: Sum of weighted z-scores of all Annual Report ranking measures

SOURCE: America’s Health Rankings analysis of America’s Health Rankings composite measure, 2023,
United Health Foundation, AmericasHealthRankings.org, accessed 2024.

As shown in Figure 16 on the right, Arkansas FIGURE 16:

had the lowest payments to providers Prices for Hospitals’ and Physicians’ Services,
among all states in 2018 based on Medicare 2018 SOURCE: Congressional Budget Office, January 2022
fee-for-service rates. This results in
Arkansas having 31% less reimbursement
than the national average.

As a result, providers in Northwest Arkansas

are at a competitive disadvantage
compared with neighboring states in terms
of the amount of money they receive per
patient. For example, a hospital in nearby
Oklahoma treating the same patient with
the same medical condition would make
$5,725 more. This illustrates how money for
reinvestment and growth is unavailable to
hospitals in Northwest Arkansas compared to
a state only a few miles away (see Figure 17 on
the following page).

18
 FIGURE 17:
Average Reimbursement per Patient
for Arkansas and Neighboring States,
February 2024
MO
$11,767.40

TN
$13,681.60
OK AR
$14,567.20 $8,842.50

MS
$12,517.20

TX
$17,346.60

LA
$11,988.80

19
CHALLENGE 2: Research Comparisons with Flagship Universities
Northwest Arkansas has historically been disadvantaged in biomedical research compared to peer markets
with large academic medical centers. NIH Research funding awarded in 2024 to the University of Arkansas
Fayetteville ($12.3 million) is second lowest among peer flagship universities (see Figure 19a).

FIGURE 19a:
TOTAL NIH FUNDING OCTOBER 2O24
UAMS Compared with Peer
State Health Science
Universities

Research Comparisons with Health Science Centers in Neighboring States

NIH Research funding awarded in 2024 to UAMS ($70.8 million) is comparable with neighboring health science
centers but far below UAB ($334.3) (see Figure 19b).

FIGURE 19b:
UAMS Compared with Peer
Health Science Universities TOTAL FUNDING AS AT OCTOBER 2024

SOURCE: NIH Reporter

20
 In 2024, UAMS secured over $70 million in grants for precision medicine, rural health care, and telemedicine
research. These efforts will focus on reducing regional health disparities and fostering health equity initiatives.
For example, the NIH awarded the UAMS Translational Research Institute (TRI) $31.7 million in federal funding
to continue advancing research in Arkansas and across the United States. This funding, part of the prestigious
Clinical and Translational Science Award (CTSA), places UAMS among approximately 60 research institutions
nationwide. The primary grant, totaling $26.9 million over seven years, and two additional grants worth $4.73
million will support critical areas such as clinical trials, researcher training, community engagement, and data
analytics. The funding also supports early-career researcher development and collaboration with institutions
such as Arkansas Children’s Research Institute and Central Arkansas Veterans Health Care System. The CTSA
enhances UAMS’ research capabilities, attracts talent, and expands opportunities for groundbreaking research,
benefiting Arkansas and similar states nationwide. For example, only the second person in the world recently
received an innovative prosthetic hand developed by researchers at the Institute for Integrative and Innovative
Research (I³R), which restores a meaningful sense of touch and grip force following surgery9.

NIH Funding in Peer Communities

Compared with peer regions, Chapel Hill, NC, and Madison, WI, have nationally recognized academic medical
centers that receive significant funding from the NIH. Peer regions with high levels of biomedical research have
substantial infrastructure, such as advanced laboratories, research institutes, and clinical trial centers, supported
by decades of investment. Regions with a long history of conducting clinical research attract and retain top
researchers and institutions. In contrast, Northwest Arkansas, without a legacy of large-scale medical and
clinical research, lacks the deep talent pool and established relationships with pharmaceutical companies,
research universities, and biotech firms that often drive biomedical innovation in other areas (see Figure 20).

FIGURE 20:
NIH Research Awarded
by Regions (2023) -
Based on
Congressional
Districts (2024)

However, Northwest Arkansas

has expanded biomedical
research and investment in
facilities since 2018. It has
received more NIH funding in
2024 than Boise, Austin, Des
Moines, and Evansville (see
Figure 21).

FIGURE 21:
NIH by Region
Excluding Chapel
Hill, NC, and
Madison, WI

9
University of Arkansas: Innovative Prosthetic Hand System Developed by I³R Researchers Implanted in First Arkansan Source: NIH Reporter

21
Stronger collaborations among health care institutions such as Highlands Oncology, UAMS Northwest, Alice
L. Walton School of Medicine and Heartland Whole Health Institute are still in their early stages. While these
institutions are laying the groundwork for future research capacity, developing the critical mass of expertise,
funding, and projects needed to become a biomedical research hub will take time.

Research grants are a significant driver of economic development as peer markets with higher funding have
significantly stronger health care economies, greater job growth, higher wages, and more outside investment in
capital and construction. Therefore, Northwest Arkansas must develop a regional strategy to provide support to
research faculty from universities as they develop NIH and other grant applications.

CHALLENGE 3: Need for an Expanded Health Care Workforce

Northwest Arkansas is experiencing rapid population growth, with Washington and Benton counties surpassing
560,000 residents in 2022 and projections suggesting the population could exceed 1 million by 2050. This
demand for health care services places considerable pressure on regional providers, including Washington
Regional, Mercy, Northwest Health, Highlands Oncology, UAMS and Arkansas Children’s. Persistent staffing
shortages exacerbate health care workforce challenges, with more than 1,200 open positions for health
care practitioners—such as physicians, nurses, and technicians—and an additional 1,500 openings
in health care support roles. Particularly acute is the need for nurses, as evidenced by 352 openings for
registered nurses and 152 for licensed practical nurses, highlighting the region’s health care workforce shortage
in the face of rapid population growth (see Figure 22).

FIGURE 22:
Health Care Practitioners

Source: U.S. Bureau of Labor Statistics, May 2023 Metropolitan and Nonmetropolitan Area Occupational Employment and Wage Estimates

22
 Although some initiatives are underway to expand the health care workforce, much more work is required at
all levels, with broader collaboration across multiple institutions. For example, Northwest Arkansas Community
College (NWACC) and Northwest Technical Institute have expanded nursing and health science programs to
accommodate more students annually, addressing a critical gap in health professions education. Likewise,
efforts to expand graduate medical education are progressing, with WRMC, UAMS Northwest, and Mercy
planning to add up to 92 new residency slots. In partnership with WRMC, the Eleanor Mann School of Nursing at
the University of Arkansas recently received a $1.19 million grant through the Arkansas Linking Industry to Grow
Nurses (ALIGN) program to further grow the number of highly skilled nurses in the region. Washington Regional
Medical Center provided additional support. The grant will allow 100 RNs at WRMC to earn their Bachelor of
Science in Nursing degree at the University of Arkansas, increasing their wage potential and advancement
opportunities while improving patient outcomes. However, these initiatives alone are insufficient to meet the
region’s growing health care needs, and they will take time to produce measurable impacts. It is evident that
a more comprehensive approach, including significant growth in medical and health science education, is
urgently needed to address current and future demands.

Recruiting physicians and other health care professionals in Northwest Arkansas faces significant challenges,
especially in a region without robust health science education programs and pipelines. Historically, the division
in higher education between Little Rock-centric UAMS, with a public medical school and a strong focus on
health science education, and UA Fayetteville, with limited health science programs, has placed Northwest
Arkansas in a lower relative position compared with peer regions. The UAMS Northwest regional campus has
managed to grow in recent years, but the historical decisions to concentrate health-related education in Little
Rock continue to hold Northwest Arkansas back.

Hospitals and clinics have made progress—such as Mercy Hospital in Rogers, which recently added more than
50 physicians and 75 nurse practitioners—but critical specialties such as neurology and rheumatology remain
particularly difficult to staff. This shortage raises concerns about the health care system’s capacity to serve a
rapidly growing population. The absence of a local, independent medical school currently limits the
development of homegrown talent, making the region heavily reliant on external recruitment, which is costly
and competitive. This is why the development of Alice L. Walton School of Medicine is a game changer for the
region’s economic development and health status.

The need for a more comprehensive approach to workforce development is clear. Collaborative efforts, such
as those led by the Northwest Arkansas Council and regional health care providers, are critical in addressing
these shortages. Strategic initiatives, including the development of Alice L. Walton School of Medicine and
Heartland Whole Health Institute, are expected to play a transformative role in attracting top medical talent
and fostering innovation in health care education. Establishing such programs is essential for positioning
Northwest Arkansas as a health care hub that can effectively meet its residents’ growing and evolving needs.

23
Communities where few undergraduates pursue health care professions often face significant shortages of
health care professionals, as this creates a weak workforce development pipeline. Studies have shown that
regions with low enrollment in health care-related undergraduate programs, such as nursing, allied health, or
pre-medical studies, tend to struggle with filling essential health care positions. The key to addressing this issue
lies in strengthening local education opportunities. For instance, areas with limited health care education
pathways may have 30-40% fewer practicing physicians, nurses, and technicians compared to regions with
strong undergraduate programs. This shortfall is further exacerbated by the fact that health care professionals
who train locally are more likely to remain in the region after graduation.

Without a robust pipeline, communities are forced to rely on costly recruitment

from other regions, often competing with larger cities and established medical
centers, which deepens the health care access gap for local residents.

This cycle of low enrollment and inadequate local training perpetuates long-term shortages and impacts the
community’s ability to provide adequate health care services. Compared with peer markets, health care
professions are not among the top three degree choices (see Table 4).

TABLE 4:
Most Popular Undergraduate Majors in Peer Markets
SOURCE: DATA USA

LOCATIO N M O ST P O P U L A R M AJO R S E C O N D M O S T P O PU L AR TH I R D M O S T P OP U L A R
M AJO R M AJO R

AUSTIN, TX G E NE R A L S T UDI E S G E N E R AL B U S I N E S S AD M I N G E N E R AL PYS C HOLOGY

& MGMT

BOISE, ID G E NE R A L S T UDI E S R E G I S TE R E D N U R S I N G G E N E R AL B U S I NES S A DMI N

& MGMT

DE S MOINES , IA L I B E R A L A RT S & SC I E N C E S R E G I S TE R E D N U R S I N G H O M E L AN D S EC U RI T Y

C H AP EL HILL , NC G E NE R A L B U S I N E S S AD M I N C O M PU TE R S C I E N C E G E N E R AL B I O LOGI CA L
& MGMT SCIENCES

EVANSVILLE, IN G E NE R A L B U S I N E S S AD M I N R E G I S TE R E D N U R S I N G H E ALTH CAR E A DMI N &

& MGMT MGMT

M ADISON, WI G E NE R A L CO M P U T ER & R E G I S TE R E D N U R S I N G G E N E R AL E C ONOMI C S

IN F O S CIE N CE S

SP OKA NE, WA L I B E R A L A RT S & SC I E N C E S G E N E R AL B U S I N E S S AD M I N G E N E R AL B I O LOGI CA L

& MGMT SCIENCES

NORTHWEST L I B E R A L A RT S & SC I E N C E S G E N E R AL B U S I N E S S AD M I N ENGINEERING &

AR KANSAS & MGMT I N D U S TR I AL MGMT

24
 CHALLENGE 4: Expanding Specialty Care Must Continue

Northwest Arkansas continues to experience a growing need for specialty care services. Heart disease is a
particular focus because it is the leading cause of death among Arkansans and because cardiology is one of
the most in-demand types of specialty care. For example, Arkansas ranks No. 42 in the nation in terms of the
number of cardiologists per capita. Compared with states containing peer regions, Arkansas’ location quotient
for cardiology (.88) is lower than Wisconsin’s (.91) and Iowa’s (1.83) Source: US Bureau of Labor Statistics.

The recently announced strategic collaboration between AWSOM, Heartland Whole Health Institute, Mercy,
and the Cleveland Clinic is a significant step toward addressing these needs. This partnership is poised
to enhance cardiac care by expanding service lines focusing on advanced diagnostics, interventional
cardiology, and cardiac surgery. With Cleveland Clinic’s expertise in cardiovascular care, ranked top in the
nation, Northwest Arkansas will gain access to leading-edge treatment protocols and technology that will
benefit the local community directly.

The collaboration emphasizes the development of residencies, especially in cardiology and related
subspecialties, to help alleviate the region’s shortage of specialized medical professionals. By training the next
generation of physicians within Northwest Arkansas, this initiative helps ensure a steady pipeline of heart care
specialists familiar with the community’s unique needs and challenges.

Cardiology Procedures for NWA Medicare Enrollees, 2019

Of the more than 75,000 cardiology procedures performed on Medicare enrollees
who lived in Northwest Arkansas in 2019, 11%, or about 9,000, were provided outside
the region. The percentages were higher for specific procedures: 14% of coronary
artery bypass grafting surgeries and 20% of heart valve replacements were provided
outside the area.

FIGURE 26:
Cardiology Procedures for NWA Medicare Enrollees, 2019
SOURCE: ACHI

2 .6 %
1 .7 % 1 .3 % UNIQUE PATIENTS: 29,849
5.6%
LO CATI O N O F S E RV I C E

N O RTH W E S T AR K AN S AS 71 , 2 4 9

L I T TL E R O C K / N O RTH L I T TL E R O C K 1, 0 4 4

AR K AN S AS (EXCLU D I N G N WA / LR/ N LR) 1, 3 9 1

M I S S O U R I /O K L AH O M A 2, 0 8 5

OTH E R O U T- O F - S TATE 4, 4 6 9
8 8 .8 %

25
Coronary Artery Bypass Grafting (CABG) Procedure
Utilization & Location for NWA Medicare Enrollees, 2019

This graphic displays coronary artery bypass grafting (CABG) procedure utilization
and location of service for Northwest Arkansas Medicare enrollees.

FIGURE 27:
Coronary Artery Bypass Grafting (CABG) Procedure Utilization &
Location for NWA Medicare Enrollees, 2019
SOURCE: ACHI

6 .9 %
2 .6 % UNIQUE PATIENTS: 188
4.8%
LO CATI O N O F S E RV I C E

N O RTH W E S T AR K AN S AS 162

AR K AN S AS (EXCLU D I N G N WA ) 5

M I S S O U R I /O K L AH O M A 13

OTH E R O U T- O F - S TATE 9

8 5 .7 %

Valve Replacement Procedure Utilization and Location

for NWA Medicare Enrollees, 2019

This graphic displays heart valve replacement procedure utilization and location of
service for Northwest Arkansas Medicare enrollees.

FIGURE 28:
Valve Replacement Procedure Utilization and Location for NWA
Medicare Enrollees, 2019
SOURCE: ACHI

3 .8 % UNIQUE PATIENTS: 178

7 .0 %
LO CATI O N O F S E RV I C E
8.6%

N O RTH W E S T AR K AN S AS 149

AR K AN S AS (EXCLU D I N G N WA ) 7

M I S S O U R I /O K L AH O M A 13

OTH E R O U T- O F - S TATE 16

8 0 .5 %

26
 CHALLENGE 5: Level 1 Trauma Service

As Northwest Arkansas anticipates a population growth of 1 million residents by 2050, establishing a Level
I trauma hospital becomes critical for several reasons. A Level I trauma center is equipped to provide
comprehensive emergency care for the most severe and life-threatening injuries, ensuring that residents have
immediate access to specialized medical attention when needed. This capability is essential in a rapidly
growing region, where increased population density often correlates with higher rates of accidents and
emergencies. Moreover, a Level I trauma hospital enhances public safety. It significantly improves health
outcomes by offering advanced surgical and critical care services that can save lives and reduce trauma-
related complications.

Beyond health benefits to citizens, the presence of a Level I trauma center can stimulate economic
development in the region. Such facilities attract top-tier medical professionals, fostering a robust health care
workforce and contributing to the local economy. A Level I trauma center will draw patients from neighboring
areas and states, generating revenue and supporting local businesses. Furthermore, having a state-of-the-art
trauma facility positions Northwest Arkansas as a health care hub, which can attract research and innovation
initiatives, leading to further investment in health care technology and education. Ultimately, establishing a
Level I trauma hospital will meet the urgent health care needs of a growing population and catalyze economic
growth and quality of life in Northwest Arkansas. For example, as Northwest Arkansas becomes a national
destination for mountain biking and outdoor recreation, a trauma center for injuries to athletes is critical to
continuing to attract events.

Geography also plays a role in receiving Level I trauma designation. Figure 24 shows the location of
Level I trauma centers in the multi-state region. The closest Level I trauma center areas are in Oklahoma
City, OK (221miles), Springfield, MO (130 miles); Little Rock, AR (180 miles); and Wichita, KS (250 miles).

FIGURE 23:
Location of Level I Trauma Centers in the Multi-State Region

27
 ROADMAP FOR 2030
SEC. 3

The vision of regional health care transformation that began in Northwest Arkansas in 2018 must expand
to grow subspecialty and trauma care, health science education, and post-graduate physician training in
needed subspecialties. At the same time, a collaborative strategy for research and innovation must be in place
to fuel continued growth. All these initiatives must be rooted in policy changes focused on increasing health
care reimbursement and accelerating the movement from fee-for-service payments to value-based care with
employer buy-in. Successfully implementing the four strategies below between 2025-2030 will require greater
collaboration and collective effort, as no single institution can accomplish these priorities alone. Through the
co-leadership of the Northwest Arkansas Council and Heartland Whole Health Institute, an implementation
strategy with these goals will focus on the following areas:

Health Care Specialty Service Expansion

By 2040, the goal is to attract more patients from outside the region than it loses through
outmigration. This includes increasing research-based physicians and subspecialty fellowships
to enhance quality scores and develop the area as a destination for high-quality health care.
Hospital systems and medical schools will invest in centers of excellence, potentially partnering
with national health care centers. An important outcome of expanding medical education and
specialty care will be the development of a Level I trauma program in the region.

Expanding the Health Care Workforce

By 2030, the region will have Alice L. Walton School of Medicine and additional students at
the University of Arkansas and UAMS Northwest, driving physician workforce development,
biomedical research, and specialized care. Growth in graduate medical education will be
supported by funding for subspecialty programs. The goal is to have the size of the medical and
health science programs match the median of peer markets by 2040.

Expanding a More Collaborative Research and Innovation Ecosystem

Increase biomedical research funding, development, and commercialization in Northwest

Arkansas to the median of peer markets by 2040. Reaching this goal will require facilities,
infrastructure, and faculty to raise the region’s biomedical research profile.

Advancing Health Policy and Payment Reform Efforts in Support of Value-Based Care

By 2030, with a single voice, the region will advocate for state and federal policy changes to
raise provider reimbursement to the level of peer markets and neighboring states. By 2040, the
regional health care ecosystem will be a nationally recognized value-based care model
integrating a whole-person system to manage health care costs while improving outcomes.
Critical to success will be coordination among company-sponsored health plans to reduce
costs, improve quality, and increase access.

28
 HEALTH CARE SPECIALTY SERVICE EXPANSION
To advance subspecialty care and trauma services in Northwest Arkansas, a multi-faceted approach is
essential to meet the region’s growing health care needs by training and retaining more physicians in Northwest
Arkansas. Key to this effort is the attraction and retention of research-based subspecialty physicians,
particularly in surgical fields, which will enhance the quality of care and reduce the number of patients leaving
the region for specialized treatments. This will position Northwest Arkansas as a destination for patients outside
the region seeking advanced care. By continuing to forge state and national partnerships, Northwest Arkansas
can expand subspecialty services, further retaining patients while increasing out-of-state referrals and driving
significant economic and health care growth.

Level I Trauma Services

A regional strategy to evaluate and develop Level I trauma services for adults and children should be as highly
prioritized within the region as expanding commercial air service and highway construction was in past
decades. Establishing comprehensive trauma care will ensure timely and life-saving interventions, reinforcing
the region’s capacity to handle complex medical emergencies. To address trauma services, the development
of Level I trauma services for adults and children is necessary. A gap analysis of the region’s current trauma
infrastructure should be completed within six months, followed by a strategy to secure funding and support
within two years.

With secured partnerships and resources, the region will focus on program development and facility renovation
to achieve Level I Trauma Center designation by 2030. A robust Level I Trauma Center will also be a magnet
for highly specialized clinicians and researchers. Expanding GME is required to achieve Level I trauma status,
as surgery and emergency medicine residencies must be in place. To qualify, WRMC, the only Level 2 trauma
center in the region, must continue its transformation from a community hospital to an academic medical
center to meet the following requirements:

1,200 trauma admissions per year.

An average of 35 major trauma patients per surgeon.

Residency training in trauma surgery.

10 peer-reviewed journal submissions every three years.

Tripp Umbach recommends that

WRMC, the only Level 2 trauma program
in the region, and the Northwest
Arkansas health care community join
forces in early 2025, working through
the Northwest Arkansas Council to bring
Level I trauma service to Northwest
Arkansas by 2030, led by WRMC and
UAMS.

29
Physician Recruitment Strategy
A strategic action plan focusing on physician recruitment, partnership development, trauma services
expansion, and patient attraction is essential to growing health care specialty services in Northwest Arkansas
over the next six years.

Attracting and retaining research-based subspecialty physicians is a key priority, particularly in neurosurgery,
cardiovascular surgery, and pediatric specialties. A targeted recruitment campaign in the region is
recommended in 2025 among hospital systems, universities, medical schools, and residency programs to attract
top-tier subspecialty physicians. Offering competitive salaries, research opportunities, and academic
appointments will further enhance the region’s attractiveness to specialists.

Tripp Umbach recommends establishing a regional clinical service expansion task force to serve as a forum for
ongoing regional recruitment and retention in areas where appropriate and within legal guidelines. An initial
step should involve the development of a detailed updated inventory of all health care services to serve as
a baseline for identifying gaps in services and areas where patients are less likely to receive their health care
locally.

The success of this initiative can be measured by the increase in subspecialty physicians recruited and retained
by 2030. Greater collaboration among regional hospitals is imperative to fill specialty service gaps, especially in
areas that do not have high reimbursement, such as oncology or heart service lines.

National Partnership Development

Partnering with national health care providers, such
as Cleveland Clinic, to train and retain specialty
providers represents an emerging part of the regional
strategy. The region’s hospitals, health systems, and
large physician groups should continue evaluating
and engaging in formal service expansion
partnerships with regional, state, and national health
care systems, universities, and research institutions.
These partnerships will enable joint research projects,
clinical trials, and referral programs to attract
patients from outside the region. Such partnerships
are essential to growing the number of persons from
the area served by regional health care providers
and increasing the degree of patient inflow by 2030.

Expand Data System to Include Private Self-Pay Companies

While the Arkansas Center for Health Improvement (ACHI) provided Medicare, Medicaid, and commercial
insurance data to Tripp Umbach during this process, they cannot access claims data from self-insured
companies. Data from companies must be shared with an independent data platform managed by ACHI to
provide a complete picture for planning. This is not a significant issue in most markets, as self-insured company
plans comprise approximately 5% of the health care insurance market. However, because of the high
concentration of large companies in Northwest Arkansas, approximately one in every four working adults have
employee insurance, leaving a large hole in the data required to accurately measure regional outmigration of
health care dollars and opportunity analysis for growing health care services.

Tripp Umbach recommends creating a regional health care data-sharing system to support the expansion of
the Northwest Arkansas health care economy. By integrating claims data from the ACHI and data provided by
local employers, health care providers can more effectively plan and develop subspecialty services tailored to
community needs. This approach will allow Northwest Arkansas to build a comprehensive, cutting-edge health
care infrastructure capable of serving residents and attracting patients nationwide.

By creating a HIPAA-compliant data-sharing platform in collaboration with ACHI, health care providers,
employers, and technology partners can aggregate real-time data on patient demographics and care gaps.
This system should be designed and implemented in partnership with ACHI and fully used to guide subspecialty
recruitment by 2027.

30
 EXPAND REGIONAL WORKFORCE TO MEET HEALTH CARE NEEDS OF
GROWING REGION
The health care provider workforce in Northwest Arkansas is vital for the region’s continued economic growth
and for improving the health status of its rapidly expanding population. Unfortunately, the region’s health care
education ecosystem is not keeping up with workforce demands. The Northwest Arkansas Council’s Health
Care Transformation Division is ideally positioned to coordinate efforts around health care education,
attraction, and retention, helping to ensure the region can meet the rising demand for medical services. One
key aspect of this strategy is the ongoing expansion of graduate medical education, including residency
programs and subspecialty fellowships, which will bolster the availability of highly trained medical professionals.
By attracting and retaining health care providers locally, Northwest Arkansas can meet its health care needs
and become a destination for patients from other regions, further enhancing its reputation and health care
infrastructure.

In addition to expanding GME, there is a growing need to support existing workforce development efforts and
create a robust pipeline for future health care professionals. This can be achieved by exploring the
development of a health science high school in close proximity of a regional health care workforce training
and simulation center. Such a high school and training facility would provide state-of-the-art education and
hands-on training opportunities for physicians, nurses, and other health care professionals. Additionally, the
center could serve as a hub for data collection and grant-writing services, supporting health care organizations
in securing funding for growth and innovation.

Strategic partnerships with school districts, higher educational institutions, health care systems, and public
agencies will be crucial in sustaining these efforts, enabling Northwest Arkansas to cultivate a health care
workforce that is highly skilled and deeply embedded in the community. This approach will not only improve
patient care but also drive economic development by creating jobs, attracting investment, and improving the
overall health outcomes of the region.

31
To address the growing health care workforce needs in Northwest Arkansas, a multi-faceted strategy can be
developed with the following key components:

1 Create a Regional Health Care Workforce Task Force

The first step is to form a Regional Health Care Workforce Task Force led by the Northwest Arkansas
Council’s Health Care Transformation Division. This task force will include key stakeholders such as
health care providers, educational institutions (University of Arkansas, UAMS Northwest, AWSOM),
school districts, government agencies, and business leaders. The objective of this group will be
to assess regional needs, coordinate efforts, and establish a comprehensive plan for health care
workforce growth. The task force will aim to meet within three months of formation, creating short-
and long-term goals to guide health care workforce expansion in the region.

Continue to Expand Graduate Medical Education Programs

2
To address critical physician shortages, regional hospitals and medical schools should collaborate to
increase residency and fellowship programs, focusing on underrepresented specialties in Northwest
Arkansas. Over the next 18 months, at least three new residency or fellowship programs should be
developed to train 100 new specialists over the next five years. This will ensure a sustainable pipeline
of physicians, which is crucial for meeting the health care demands of a growing population.

Develop a Regional Health Science High School and Health Care

3
Workforce Training and Simulation Center
A state-of-the-art simulation center would enhance the skills of current health care professionals and
new entrants into the field. This center would offer hands-on training for medical professionals,
continuing education opportunities, certifications, and specialized training for nurses, technicians,
and allied health professionals. By launching the center within five years and serving health care
professionals annually, Northwest Arkansas would create a hub for health care training, improving
workforce readiness and patient care. Efforts to develop a health science high school can build from
the CHAMPS (Community Health Applied in Medical Public Service) program at UAMS, allowing
middle and high school students to learn about health professions and attend workshops that
enhance their experience in the health care field.

Grant Writing and Data Support

4
To ensure continued financial support for these initiatives, a grant writing and data services unit
should be created within the workforce training center. This unit will help local health care
organizations secure federal, state, and private funding for workforce expansion and infrastructure
improvements.

EXPAND A MORE COLLABORATIVE HEALTH CARE RESEARCH AND

INNOVATION ECOSYSTEM
The Northwest Arkansas Council can leverage collaborative research efforts by aligning regional, state,
and federal entities in a unified economic development plan. A central strategy is to identify, and support
coordinated research activities that engage key stakeholders, including the University of Arkansas, UAMS
Northwest’s Institute for Community Health Innovation, Arkansas Children’s Research Institute, AWSOM,
Heartland Whole Health Institute, and Institute for Integrative and Innovative Research (I³R). The region
can strengthen its health care research and innovation ecosystem by fostering collaboration among these
institutions, accelerating medical sciences and health care delivery breakthroughs. The Council can play
a pivotal role in identifying gaps in the region’s research and innovation ecosystem, such as underfunded
areas or emerging fields where the region lacks expertise. This will help shape a strategic agenda for future
collaborative research projects, focusing on securing federal funding opportunities through NIH, NSF, and
other federal grant programs. Ultimately, these efforts can position Northwest Arkansas as a hub for health

32
 care innovation and economic growth, drawing on its rich academic and medical resources to spur new
opportunities for jobs, startups, and investment in the health care sector.

Research Ecosystem Assessment and Action Agenda

Establishing a health innovation steering committee with representatives from key institutions such as the
University of Arkansas, UAMS Northwest, Highlands Oncology, Arkansas Children’s Northwest, the AWSOM, and
Heartland Whole Health Institute represents a first step toward the goal of exceeding the amount of research
funding of peer communities by 2040. This committee will coordinate efforts, set goals, and ensure alignment
across research initiatives. This group will guide an in-depth analysis of the region’s existing research capabilities,
identifying strengths, gaps, and opportunities for collaboration and using the findings to shape the regional
research strategy.

Based on the innovation ecosystem assessment, key research priorities aligning with regional health care needs
and national trends will be developed. Such an agenda will focus on interdisciplinary projects that leverage
the strengths of multiple institutions. By actively targeting funding from agencies such as NIH, NSF, HRSA, the
Department of Defense, and the Veterans Administration, the committee can bring fresh dollars into the region
from public and private sources. The committee can establish dedicated grant writing teams to prepare
competitive proposals, aiming for significant funding for high-priority projects through expanded public-private
partnerships with health care, pharmaceuticals, and biotechnology industry leaders. Finally, the regional
research agenda would identify critical infrastructure needs, such as lab space and advanced equipment, to
position the region and secure funding for new or upgraded research facilities to support cutting-edge scientific
work.

Promote Research Commercialization and Startups

Health-related startups in Northwest Arkansas can benefit from existing university programs that support
research and innovation. The University of Arkansas’ Office of Tech Ventures and UAMS’ Bioventures offer IP
protection, tech licensing, and startup support. At the same time, the Office of Entrepreneurship and Innovation
Ventures and the Arkansas Small Business and Technology Development Center provide additional resources
for entrepreneurs. Leveraging and expanding these collaborations will enhance support for startups, fostering
economic development and growth in the region’s innovation economy.

ADVANCING HEALTH POLICY AND PAYMENT REFORM EFFORTS IN

SUPPORT OF VALUE-BASED CARE
A strategic approach centered on targeted advocacy for state and federal policy reforms is crucial to
effectively transform and advance the health care economy in Northwest Arkansas over the next five years.
In partnership with Heartland Whole Health Institute, Northwest Arkansas Council’s Health Care Transformation
Division should co-lead advocating for transformative health policy changes to enhance the region’s health
care sector.

Increasing Reimbursement Rates

A key policy initiative is to advocate for increased reimbursement of state and federal rates for health care
providers and facilities. Competitive reimbursement rates are vital for ensuring that health care providers and
facilities are adequately compensated for their services. These funding increases are essential for retaining
health care professionals and attracting top talent to the region. By pushing for higher reimbursements at both
state and federal levels, Northwest Arkansas can build a more sustainable health care workforce, improve
patient outcomes, and reduce provider burnout. Working with the Council and Heartland Whole Health
Institute, a coalition of health care providers, local hospitals, and specialty care practices should develop a
unified advocacy message and campaigns aimed at legislators and policy makers, emphasizing the urgent
need to increase Medicaid and Medicare reimbursement rates.

This coordinated advocacy initiative must develop targeted campaigns directed at state legislators and
federal representatives, emphasizing the urgent need to increase Medicaid and Medicare reimbursement

33
rates. By partnering with professional organizations such as state medical societies, hospital and nursing
associations, the Council and Heartland Whole Health Institute can amplify its message regarding the
importance of competitive reimbursement rates. Public awareness campaigns can also educate communities
about the direct benefits of increased reimbursement rates, such as improved health care access and better
patient outcomes.

Transitioning to Value-Based Care

An equally critical step in transforming health care in Northwest Arkansas is transitioning from a fee-for-service
model to a value-based care system. This approach emphasizes patient outcomes and the quality of services
rather than the volume of procedures performed. To facilitate this shift, Northwest Arkansas Council along with
Heartland Whole Health Institute should convene employers, payers, and providers, and facilitate the initiation
of pilot programs and alternative payment models to support whole-person care delivery. A regional coalition
focused on these models can demonstrate the effectiveness of value-based care, and promote successful
case studies and expand their reach to improve patient outcomes and support the financial sustainability of
health systems.

Engaging with private insurers and government payers to create new payment structures that incentivize high-
quality, cost-effective care will be critical. Legislative advocacy should focus on state policies that support
the adoption of value-based care, including bonuses for high-quality outcomes or penalties for unnecessary
procedures. Collaborating with the Arkansas Department of Human Services and others to explore state-led
initiatives that align with federal models, such as Accountable Care Organizations (ACOs), will further enhance
this transition.

Over the next five years, Northwest Arkansas can implement value-based care tools and models that focus on
improving primary care, addressing social determinants of health, and fostering innovation. One example of
a value-based payment model is Primary Care First (PCF), which empowers providers (PCPs) to innovate care
delivery and receive capitation payments, incentivizing improved patient outcomes and reducing emergency
department and inpatient hospital use. This model also incorporates behavioral health and social determinants
of health, ensuring a holistic approach to patient care.

Programs such as eConsults, introduced by Arkansas BlueCross and BlueShield, allow PCPs to collaborate
electronically with specialists, improving care efficiency while easing access to specialist care. The PCF program
has shown promising results, with higher compensation for high-performing providers and better utilization of
low-cost primary care settings. Arkansas BlueCross and BlueShield also collaborates with health care analytics
companies like Embold to measure provider performance and help patients access top-performing physicians,
which can reduce care costs and improve outcomes. A Northwest Arkansas value-based health care coalition
should be further developed with multiple insurers to leverage these insights to refine provider performance.
Innovation is driven through multi-stakeholder groups and summits such as these, which connect health care
startups with regional stakeholders to address challenges with emerging technologies and scale innovative
solutions for affordable and accessible care in Northwest Arkansas.

Engaging Large Employers

Engaging large employers in Northwest Arkansas is vital for creating a powerful coalition to advocate for
health care transformation. Major employers like Walmart, Tyson Foods, University of Arkansas and J.B. Hunt
have an interest in reducing health care costs while improving the health and well-being of their workforce.
Tripp Umbach recommends organizing a coalition of these employers to build support for and advocate for
value-based care. These employers can also grow workplace wellness programs that prioritize preventive care
and employee well-being, demonstrating the benefits of a value-based care approach in reducing long-term
health care costs.

By developing employer-led initiatives, the region can position these programs as case studies to promote the
advantages of health care policy reform. Furthermore, engaging business leaders in direct conversations with
policymakers can strengthen advocacy efforts and amplify the coalition’s voice in state and national policy
discussions.

The key to success is developing a robust data system that includes health care spending and utilization data
from employees working at large self-insured companies. As recommended earlier in this report, the facilitation
of a working group of large employers is a high priority in early 2025. Tripp Umbach also recommends a data
partnership with ACHI, as ACHI already has the data infrastructure and can create a customized product for

34
 Northwest Arkansas institutions to use in their strategic decision-making. By having a complete picture of all
medical claims from the region, Northwest Arkansas Council Health Care Transformation Division and Heartland
Whole Health Institute will be able to target the growth in specific specialty areas where providers are needed.

Leveraging Federal Funding and Expanding Health Care Access

Northwest Arkansas can explore opportunities to leverage federal funding to support the push for increased
regional wage index. Medicaid expansion, demonstration projects, and other federal initiatives can provide
states with enhanced matching funds that can be utilized to supplement reimbursement rates for specific
services or populations. Addressing challenges related to Medicaid enrollment and eligibility is also crucial for
ensuring that more individuals access these benefits, ultimately increasing the volume of services provided and
enhancing the financial stability of health care providers.

Expanding access to health care services is another critical strategy. Efforts should focus on increasing the
number of health care providers in the region, enhancing transportation infrastructure, and implementing
telemedicine initiatives to serve remote and underserved populations. By addressing these barriers, the region
can improve health care access and reimbursement rates for providers.

Other states have successfully implemented strategies to increase Medicare and Medicaid reimbursements.
Minnesota, for example, has emphasized value-based care models like ACOs and Medicaid managed care
programs. These initiatives have improved care coordination, reduced costs, and improved health outcomes.
Similarly, Oregon’s Coordinated Care Organizations (CCOs) have integrated physical, behavioral, and dental
health services to improve patient care and reduce health care costs, leading to higher reimbursement rates.

Massachusetts has also led in payment reform, adopting alternative payment models and value-based
purchasing programs. The state has invested in health care workforce development and expanded access
to primary care services, which has helped improve care quality and reduce unnecessary health care
spending. Other states have implemented similar programs aimed at improving care coordination, chronic
disease management, and overall health care delivery. These initiatives have resulted in higher Medicare and
Medicaid reimbursements for participating providers and have contributed to better patient outcomes.

Addressing wage index disparities is another critical policy action to ensure that health care providers in
Northwest Arkansas receive fair compensation. Policymakers and health care advocates can propose various
approaches to align wage index rates with the actual costs of care in rapidly growing regions. For instance,
examining successful strategies implemented in states, where local wage indices are adjusted to reflect
health care costs better, can provide valuable insights. Tripp Umbach recommends retaining legal and CMS
accounting experts nationally to develop and implement a strategy to address wage index disparities.

Building Grassroots Support

Building grassroots support for health care reform
is essential. The Northwest Arkansas Council should
engage community leaders, health care advocates,
and patients in a grassroots effort to promote health
care transformation and value-based care. Hosting
town halls, public forums, and community discussions
will build widespread support for policy changes.
Collaborating with patient advocacy organizations
can help elevate the voices of those most affected by
current reimbursement and payment models.

A multi-pronged action strategy, leveraging regional

partnerships and targeted advocacy, should be
implemented to advance health care payment reform
policy in Northwest Arkansas.

35
Appendix A: Profiles of Growth in Health Care Institutions (2018-2023)
Washington Regional Medical Center: From 2018 to 2023, Washington Regional Medical Center experienced significant growth
and development, solidifying its position as a leading health care provider in Northwest Arkansas. The hospital expanded its physical
infrastructure and medical capabilities during this period to meet the region’s growing health care needs. Washington Regional
strengthened its role as the region’s only Comprehensive Stroke Center, treating 663 stroke patients in 2021, many transferred from
neighboring states, while excelling in spine care through its J.B. Hunt Neuroscience Institute. The hospital earned the Gold Seal of
Approval® for Spine Surgery and introduced advanced technologies such as the robotic ROSA® Hip System for precision hip
surgeries.

Washington Regional also addressed critical regional health care needs by adding more than 100 providers from 2018 to 2023,
expanding its cardiology, neurology, and other specialties. The opening of a 16-bed Cardiac Progressive Unit further underscored its
commitment to advanced cardiovascular care.

Collaborations with the University of Arkansas for Medical Sciences (UAMS) bolstered the hospital’s educational and service
capacities. These partnerships led to the creation of an accredited internal medicine residency program, the arrival of new medical
residents to the area, and the launch of the Maternal Fetal Medicine Clinic for high-risk pregnancies. Additionally, Washington
Regional expanded its support for cancer patients by opening the J.B. Hunt Transport Services Cancer Support Home.

Mercy Health: A significant component of this growth was the expansion of inpatient services. Mercy added new patient rooms and
expanded its emergency department to accommodate increasing emergency visits. The upgraded emergency facilities allowed Mercy
to offer more efficient, lifesaving care to patients throughout the region, serving thousands of patients annually.

From 2018 to 2023, Mercy Health in Northwest Arkansas significantly grew, enhancing its services, facilities, and workforce to meet
the region’s expanding health care demands. The hospital introduced cutting-edge technology, notably in its surgical services, with a
significant investment in robotics to offer minimally invasive procedures in areas including orthopedics, general surgery, and urology.
These innovations improved patient outcomes, reduced recovery times, and solidified Mercy’s position as a leader in advanced health
care.

Mercy Health also expanded its specialty care, recruiting numerous physicians in cardiology, orthopedics, and other critical areas. The
hospital bolstered maternity services and pediatric care to meet the growing needs of women’s and children’s health. By opening new
clinics and outpatient facilities, Mercy decentralized its services, ensuring broader access to primary and specialized care for patients
in surrounding communities.

Workforce development was another key focus for Mercy during this period. Creating new programs to support nursing and medical
staff, residency programs, and partnerships with local universities helped attract and retain top medical talent. Mercy’s workforce
expansion included recruiting more than 50 physicians and 75 nurse practitioners.

Mercy’s $247 million expansion plan further enhanced the region’s health care infrastructure, addressing the needs of a rapidly
growing population. Despite successes, challenges remain, particularly in recruiting high-demand specialists such as neurologists and
rheumatologists. Mercy strives for accessible, high-quality care while reducing outmigration for medical services.

Arkansas Children’s Northwest: Since opening in 2018, Arkansas Children’s Northwest has experienced significant growth,
investing more than $100 million in expansion of facilities. The current expansion underway is a four-story addition that will
seamlessly connect to the existing structure and increase the number of available beds from 24 to up to 40. This expansion focuses
on critical specialties, including orthopedics, urology, gastroenterology, and ear, nose, and throat services. It allows the hospital to
manage more complex surgeries and expand its infusion center for patients with cancer, gastrointestinal disorders, rheumatology
concerns, and genetic conditions.

Over the next six years, Arkansas Children’s Northwest will invest considerable resources to grow the number of physicians and staff
members, including nurses, to meet the region’s growing health care needs. This investment will further expand the campus’ ability to
provide care locally with physicians based in Northwest Arkansas that work collaboratively with the state’s pediatric health system,
which is now the leading system in the region and nationally ranked in seven specialties.

The hospital’s growth has also attracted patients from neighboring states, most notably Oklahoma and Missouri, generating a net
increase in health care-related economic activity for Northwest Arkansas. The expansion reflects Arkansas Children’s Northwest’s
commitment to providing nationally reputable, comprehensive pediatric care locally, benefiting the region’s health care system and
economy.

36
 Northwest Health: Northwest Health improved access to medical services, reporting more than 565,000 patient encounters in 2023
alone. Its network of hospitals and outpatient clinics has expanded considerably, handling more than 86,000 annual emergency
department visits and providing more than $181 million in uncompensated care. This reflects Northwest Health’s commitment to
supporting the community’s most vulnerable members while continuously advancing its medical services. Investments in cutting-edge
technologies, such as minimally invasive lung biopsy equipment and advanced MRI systems, have enhanced diagnostic and surgical
capabilities. Workforce development remains a key focus, with initiatives such as an RN residency program and partnerships with
local nursing schools helping to strengthen the region’s health care labor force.

Besides these advancements, Northwest Health has prioritized the development of specialized care programs, including cardiology,
orthopedics, and behavioral health services, to address the community’s diverse needs. The introduction of telehealth services has also
broadened access, enabling patients to receive care from the comfort of their homes. Moreover, community engagement initiatives,
such as health fairs and educational workshops, promote wellness and preventive care. This comprehensive approach not only elevates
the standard of health care in the region but also fosters a culture of health awareness among residents, paving the way for a healthier
Northwest Arkansas.

Highlands Oncology: Highlands Oncology has significantly expanded its role in specialized cancer treatment, becoming a key
contributor to the health care infrastructure in Northwest Arkansas. Over recent years, its growth has enabled the region’s residents
to access advanced cancer care close to home, reducing the need for patients to travel out of state for treatment. This expansion has
improved patient convenience and ensured that local cancer patients receive cutting-edge therapies and treatments without leaving
their community.

Highlands Oncology’s investment in advanced oncology research and services, including state-of-the-art radiation therapy,
chemotherapy, and immunotherapy, positions it as a leader in cancer care. By offering access to highly specialized oncologists and
multidisciplinary care teams, the facility has become a trusted center for comprehensive cancer care, addressing a range of needs from
diagnostics to long-term treatment plans. Highlands Oncology’s expansion has bolstered the local health care economy by attracting
top medical talent to the region, enhancing the workforce, and establishing Northwest Arkansas as a destination for high-quality
research-based cancer treatment.

The combined efforts of these health care institutions have transformed the region into a burgeoning health care hub. As the population
is expected to approach one million by 2050, continued investment in facilities, workforce development, and advanced medical
technologies will be critical to ensuring that the health care system can meet the needs of Northwest Arkansas’ rapidly expanding
population.

Community Clinic: For more than a quarter of a century, Community Clinic has been dedicated to delivering high-quality and easily
accessible health care services to the residents of Washington and Benton counties. It offers multilingual services in English, Spanish,
Marshallese and more. It accepts most commercial insurance as well as Medicare and Medicaid. Through the years, Community
Clinic has grown to become Northwest Arkansas’ largest safety-net health care provider, serving more than 41,000 patients in 2022.

As a Community Health Center, it operates under the highest standards of accountability in the medical field and regularly assess
outcomes to enhance patient experience and improve health outcomes.

Dedicated clinical teams tirelessly address a wide range of medical conditions. In cases where a specialist outside of our network is
needed, they guide patients through the referral process and collaborate closely with the referred specialist to ensure treatment is well-
coordinated and tailored to meet each patient’s needs. Specialty referrals enable the organization to enhance the expertise of its clinical
teams when it’s in the patient’s best interest. Community Clinic is also recognized as a Patient-Centered Medical Home (PCMH).

VA Medical Center: The Veterans Health Care System of the Ozarks (VHSO) in Fayetteville, Arkansas, is a key health care provider
for veterans in northwest Arkansas, southwest Missouri, and eastern Oklahoma. It offers a wide range of medical services to a
predominantly rural veteran population. In addition to its main campus in Fayetteville, the VHSO operates several outpatient clinics
and community-based outreach centers in areas such as Fort Smith, Harrison, and Branson, Missouri.

The hospital provides comprehensive healthcare services, including primary care, mental health services, rehabilitation, specialty
medical care, women’s health, and long-term care. Its mental health programs focus on PTSD and substance abuse treatment, while
rehabilitation services offer physical and occupational therapy. Specialty services cover a broad spectrum, including cardiology,
oncology, and orthopedics. For female veterans, the hospital offers reproductive health services, breast cancer screenings, and
specialized mental health care.

37
VHSO has partnerships with the University of Arkansas for Medical Sciences (UAMS) and the University of Arkansas, making it
a training site for healthcare professionals. The hospital is also engaged in clinical research, particularly in veterans’ mental health,
PTSD, and chronic disease management.

The facility actively reaches out to veterans through mobile clinics and community programs, including services for homeless
veterans. Modernization efforts have expanded telehealth infrastructure and improved healthcare delivery, ensuring the hospital
remains a vital resource for the region’s veterans.

Appendix B: Profiles of Growth in Education Institutions (2018-2023)

UAMS Northwest: Established in 2007 UAMS Northwest, plays a pivotal role in addressing the growing demand for health care
professionals and enhancing the economic landscape of Northwest Arkansas. Serving over 330 students, more than 82 residents and
fellows, and employing over 500 staff members, UAMS Northwest is integral to the region’s health and economic growth, evidenced
by its 64,000+ annual patient visits. UAMS Northwest’s clinics have notably alleviated pressure on local emergency departments,
resulting in an annual cost avoidance of $27 million. Additionally, managing chronic diseases through these clinics yields more than
$100 million in cost savings, further emphasizing the economic benefits of preventive health care services. In the fiscal year 2022, the
research activities undertaken by UAMS Northwest contributed an economic impact of $25.4 million, sustaining 218 jobs within the
region.

UAMS Northwest is strengthening the health care workforce, with the education of 93 residents and fellows in FY25 projected to
generate an economic impact of $46.5 million. Each graduating class of physicians from UAMS Northwest is estimated to bring about
$114.4 million in economic impact and $63.3 million in annual cost savings, primarily through their roles as primary care providers.
Collectively, these contributions position UAMS Northwest as a cornerstone of economic stability and growth in the Northwest
Arkansas health care economy, fostering improved health outcomes and robust economic development.

University of Arkansas: Over the past five years, the University of Arkansas Fayetteville has experienced significant growth in
its health-related programs, driven by new educational offerings and expanded partnerships. A key development is introducing a new
Master of Public Health (MPH) degree, reflecting the university’s commitment to addressing public health needs. The occupational
health program has also grown, particularly in its communication disorders and occupational therapy departments, which have gained
strong leadership and enhanced academic offerings. Additionally, the RN to BSN program has expanded through a partnership with
Washington Regional Medical Center (Washington Regional) in addition to a $1.19 million ALIGN grant from the State of Arkansas
aimed at improving nursing education. The nationally ranked Office of Entrepreneurship and Innovation has further contributed to
this growth by successfully running the BioDesign Sprints program, which fosters innovation in health-related startups. The program,
coordinated with the College of Education and Health Professions (COEHP), has led to three provisional patents, highlighting its
success. These efforts have positioned the University of Arkansas Fayetteville as a leader in advancing health education, research, and
innovation, contributing to the state’s health care workforce and economic development.

Alice L. Walton School of Medicine: Founded in 2021, AWSOM will welcome its first class of 48 students in July 2025 into
a four-year MD program that will enhance traditional medical education with the arts, humanities, and whole health principles.
The School’s unique curriculum, ARCHES, features six elements longitudinally integrated into courses, clerkships, and electives
throughout four years of instruction to proactively support a patient’s whole health. The evidence-based curriculum takes inclusive and
collaborative approaches to care designed to promote resilience, prevent disease, and restore health. AWSOM has secured preliminary
accreditation status by the Liaison Committee on Medical Education, its program accrediting body.

The 154,000 square-foot School of Medicine building on the Crystal Bridges campus will foster a culture of student well-being,
empowering future physicians to care for their patients and themselves. It features four stories and will include learning halls, a
public gallery, library, clinical teaching spaces, administrative offices, a student lounge, covered bicycle parking, and recreation and
wellness areas. Designed by Polk Stanley Wilcox Architects with rooftop park and landscape design by NYC-based design studio
Office of Strategy + Design, the building is scheduled for completion in summer 2025 by Crossland Construction, Inc. Additionally,
the architects designed a campus housing complex on an 11-acre site adjacent to the School. Construction will begin in early 2025 and
will include student apartments in a park-like setting with nature trails and easy access to the downtown Bentonville community.

The Alice L. Walton School of Medicine will play a crucial role in addressing the region’s shortage of physicians by producing the
next generation of physician leaders. AWSOM will work with Mercy as a primary education partner in a new affiliation announced
recently between the Alice L. Walton Foundation, Heartland Whole Health Institute, and Mercy. Together, they have committed to a
30-year, $700 million affiliation agreement to expand access to health care, reduce costs, and improve health outcomes in the region.
This investment includes a collaboration with Cleveland Clinic to enhance cardiovascular care in the Heartland.

38
 Heartland Whole Health Institute : Heartland Whole Health Institute’s purpose is to lower costs, improve quality, and broaden
access to health care in the Heartland by catalyzing new delivery models, using whole health principles, that can be replicated to
disrupt the national health care system.

Founded in 2019 by philanthropist Alice Walton, Heartland Whole Health Institute puts a whole health approach at the center of the
broader health care system to address the current health care crisis. The Institute was driven by its founder’s health care experience,
and furthered by research revealing that the United States has one of the highest levels of health care spending worldwide yet
relatively low rankings in overall health. In conjunction with Alice L. Walton School of Medicine, the Institute will transform health
care by improving outcomes, reducing costs, and expanding access, beginning in the Heartland and scaling nationally.

Collaborations with renowned institutions like the Cleveland Clinic will help bring much-needed specialty care to the area, reducing
the economic loss from residents seeking care outside the region. Through research, commercialization, and value-based care models,
the Heartland Whole Health Institute and Alice L. Walton School of Medicine are poised to improve the health and well-being of the
population, train more physicians, and significantly boost the economy, setting Northwest Arkansas on a path to becoming a national
leader in health care, research, and innovation.

Economically, these initiatives are projected to have a profound impact on Northwest Arkansas, potentially generating $2 billion in
economic gains by 2040. This growth stems from the expansion of specialty services, innovative health care delivery models, and the
establishment of the region as a health care hub.

Appendix c: Profiles of Growth in Research and Innovation (2018-2023)

University of Arkansas: In 2023, the University of Arkansas achieved record-high research expenditures of $184 million, guided
by the university’s 150 Forward Strategic Plan, which emphasizes research excellence. Since 2021, the university has directed more
than $136 million toward applied research facilities. Three new key capital projects—the Institute for Integrative and Innovative
Research (I³R), the Multi-User Silicon Carbide Research and Fabrication Facility (MUSiC), and the Anthony Timberlands Center for
Design and Materials Innovation—are expected to transform the U of A’s research capabilities.

The University of Arkansas has played a critical role in advancing biomedical research by investing in life sciences and health-related
research programs. The university’s Institute for Integrative and Innovative Research (I³R) fosters interdisciplinary collaboration to
address health challenges, with a particular focus on developing technologies and health solutions that can be commercialized and
deployed. Medical devices, virtual reality applications, nanotechnology, biosensing, and data-driven health interventions are being
researched for their potential applications in medicine, device and drug development, rehabilitation services and diagnostic tools. The
university’s tech commercialization office also helps bridge the gap between academic research and the private sector by supporting
startups and intellectual property development.

UAMS Northwest: The University of Arkansas for Medical Sciences (UAMS) Northwest Regional Campus has been a driving force
in expanding the region’s research-driven economy. UAMS collaborates with local hospitals and research institutions to conduct
translational research on improving patient outcomes. This includes studies in precision medicine, telemedicine, and rural health care
innovations. UAMS Northwest has developed partnerships to help bring these innovations to market, leveraging its connections with
larger medical systems and industry partners.

UAMS Northwest has made a significant economic and social impact on Northwest Arkansas through its research programs. Since
2012, UAMS Northwest secured more than $70 million in grant funding from the NIH, CDC, and private foundations including
Walton Family Foundation and Walmart. These funds have fueled more than 75 projects aimed at reducing health disparities locally
and globally, making the office a leader in health equity research. With a team of more than 150 multidisciplinary faculty and staff,
the office brings together diverse cultural and academic perspectives to address complex health challenges. Additionally, the office has
conducted more than 20 program evaluations to ensure effectiveness and guide future initiatives. Over the next five years, the UAMS
Office of Community Health and Research aims to strengthen its role as a leader in community-engaged research, expanding its
influence on regional, national, and global health outcomes. Its ongoing efforts are poised to continue driving economic growth in the
region while improving population health.

Highlands Oncology: Highlands Oncology has been pivotal in advancing cancer treatment through its extensive expansion in
clinical trials over the past five years. The center conducts trials in oncology and hematology, focusing on experimental
medications and innovative uses of existing therapies. Highlands Oncology is unique as the only community-based Phase I oncology
clinical trial center in Arkansas. These early-stage trials assess the safety and appropriate dosing of novel medications, offering
patients access to cutting-edge treatments before they are widely available. Highlands Oncology is at the forefront of oncology

39
advancements through its commitment to research, benefiting the regional population and the broader cancer treatment landscape.

E-Health Transformation Cluster (UAMS Lead Initiative): This initiative, funded by the Build Back Better Regional Challenge,
aims to grow an e-health cluster focusing on health care technology, workforce development, and job creation in underserved
communities. Major projects include accelerated Bachelor of Nursing degrees in e-health, simulations for workforce training, and
advancing BioDesign for health care entrepreneurship.

Women’s Health Research Collaboration: A partnership among the University of Arkansas for Medical Sciences (UAMS), the
University of Arkansas (U of A), and the Arkansas Children’s Research Institute (ACRI) led to a $310,000 grant from the NIH to
digitize and enhance a comprehensive maternal health data set. This project uses AI and machine learning tools to improve maternal
and child health, making this data more accessible to researchers and clinicians.

Northwest Arkansas BioDesign Sprints (NABS): Inspired by Stanford Mussallem Center for BioDesign, this program, launched
by the U of A in collaboration with major regional health care systems, focuses on addressing health care challenges by harnessing
innovation and entrepreneurship. Funded by a $685,330 grant from the Walton Family Foundation, it empowers clinicians and
engineers to develop health care solutions, resulting in market-ready innovations and intellectual property.

Arkansas Integrative Metabolic Research Center (AIMRC): Established as a COBRE at the U of A, AIMRC advances research
in cell and tissue metabolism using AI-driven data science approaches. This center supports collaborations among UAMS, Arkansas
Children’s, and other regional institutions to improve health care outcomes, particularly in areas such as precision health, nutrition,
and metabolic diseases.

Biomedical research and innovation in Northwest Arkansas have experienced significant growth in recent years, driven by
collaborations among key institutions such as the University of Arkansas, UAMS Northwest, hospitals, medical practices, the Whole
Health Institute, and the Alice L. Walton School of Medicine. These efforts are positioning the region as a hub for translating research
into commercial products, particularly in health sciences, biotechnology, and patient-centered care.

Center for Public Health and Technology: The Center for Public Health and Technology at the University of Arkansas was
established in 2020 as an interdisciplinary health research hub to support public health surveillance, intervention, and evaluation
and advance health literacy, communication, and outcomes. The NIH-funded research in the Center spans from studying the use of
gabapentin for non-medical reasons to inform treatment practices for opioid use disorder and aid in the development of prevention and
intervention strategies to examining policy loopholes, key challenges related to enforcement, and tobacco industry interference among
emerging youth access laws (e.g., Tobacco 21, Flavor restriction policies, a maximum nicotine level law).

Exercise Science Research Center: The Exercise Science Research Center has significantly expanded its externally funded
research capacity with the addition of top muscle physiologists. Multiple NIH funded projects are currently underway in the Center
focused on examining and preventing muscle mass decline across the lifespan. These projects focus on uncovering fundamental
information on what keeps skeletal muscle molecular youthful by exploring the extent to which exercise plays a central role during
aging and can be leveraged to improve muscle health throughout the lifespan; developing new techniques to isolate skeletal muscle
nuclei to determine the role of muscle-specific miRNA in the context of exercise and aging to provide foundational insight for
combatting age-mediated skeletal muscle mass loss and dysfunction; providing cutting-edge insights into preventing cancer cachexia,
a wasting syndrome that largely affects the muscles, along with other body tissues, and is present in up to 80% of cancer patients; and
developing a nonsurgical strategy of restoring the muscle function from volumetric muscle loss occurring from significant traumas,
including battlefield injuries, car accidents, and some tumor removals.

Institute for Integrative and Innovative Research (I3R) at University of Arkansas (UA): The Institute for Integrative and
Innovative Research (I3R) at University of Arkansas has been established to advance research at UA that will not only contribute to
the health and well-being of Arkansans, but also contribute to economic development in the region. I³R is pursuing this mission by
pioneering solutions to grand challenges through convergence research across academic, industry, government, and nonprofit sectors
to make a positive societal impact by creating and deploying innovations at scale. The Institute has embraced Integrative Health as a
human-centered design model that seeks to improve human health by influencing a broad set of physiological, societal, and structural
factors. Current projects support development and deployment of implantable medical devices to address neurotrauma through
first-in-human clinical trials, wearable technologies to support rehabilitation of sensorimotor function in at-home settings, augmented
reality systems to enable advanced medical care, brain imaging to develop and evaluate clinical interventions, medical robotics to
enhance surgical and clinical capabilities, and AI driven platforms to support access to health care and nutritious food.

40
 Appendix D: STAKEHOLDERS

NAME INSTITUTION

Alicia Ber kemeyer Ar kansas BlueCross and BlueShield

Chancellor Char les F. Robinson Univer si ty of Ar kansas

Ei leen Hyde Wa lmar t Founda tion

Er ic Piana lto Mercy

Jeff Hunnicu tt Highlands Oncology

Joe Thompson Ar kansas Center for Hea lth Improvement

Judd S emingson Communi ty Clinic NWA

Ka te Mamiseishvi li Univer si ty of Ar kansas, College o f Educa tio n & Hea l t h P rofessi on s

Lar r y Shackelford Washington Reg iona l Medica l System

Laura Jacobs Univer si ty of Ar kansas

Marcy Doderer Ar kansas Chi ldren’s

Mar sha ll S avier s Cushman & Wa kefield | S age Par tner s

Mar tine Pollard Ar kansas BlueCross and BlueShield

Mi ke Ma lone Univer si ty of Ar kansas

Nelson Peacock Nor thwest Ar kansas Counci l

Pete Kohler OurPhar ma

Ranu Jung Univer si ty of Ar kansas

Rick George J.B. Hunt

Stefanie Paw lu k Hear tland Whole Hea lth Insti tu te

Todd Simmons Simmons Foods

Wa lter Har r is Hear tland Whole Hea lth Insti tu te,

Alice L . Wa lton S chool of Medicine

Yee -Lin Lai Wa lton Fami ly Founda tion

41
Appendix E: Tripp Umbach Experience

Tripp Umbach is among the most established and respected private

consulting firms in the United States. Tripp Umbach is a force in
economic and community development, working with our health care,
education, government, and corporate clients to improve communities’
economic, social, and physical well-being worldwide. Founded in 1990
in Pittsburgh, PA and presently headquartered in Kansas City, MO, Tripp
Umbach has a rich history of working with more than 1,000 organizations
providing community assessment, economic impact assessment, and
economic development. Tripp Umbach has completed health science
education and bioscience economic development strategies in more
than 50 other metro regions throughout the United States.

42
C O N T I N U I N G T H E T R A N S F O R M A T I O N : n o r t h w e s t a r k a n s a s h e a lt h c a r e v i s i o n 2 0 3 0

DATA prepared by

pUBLISHED by