Arkansas has made significant investments to strengthen its primary care physician workforce over the past decade. New medical schools have opened in the state, residency program slots have increased, and loan forgiveness programs have been established to incentivize residency graduates to remain in the state to practice. Despite these efforts, access to a usual source of care (i.e., a place where one goes for routine healthcare needs) remains a challenge for many Arkansans, according to a new report.

Published February 12 by the Milbank Memorial Fund, the report, “Investing in Primary Care: The Missing Strategy in America’s Fight Against Chronic Disease,” evaluates states’ primary care performance. Among its findings is that 18% of Arkansas adults report not having a usual source of care, which is comparable to the national estimate of 17%. That means that nearly 1 in 5 Arkansans do not have a consistent way of interacting with the state’s healthcare system.

Access to a Usual Source of Care

Nationwide, the report finds that among adults with chronic disease, having a usual source of care is associated with lower odds of hospitalization and lower total spending on health care. These findings are particularly relevant for Arkansas, where chronic disease prevalence remains high. The most recent America’s Health Rankings report from the United Health Foundation ranked Arkansas 44th among all 50 states and the District Columbia for its percentage (15%) of adults with three or more chronic conditions — such as arthritis, diabetes, or cancer — in 2023, with the top-ranked state having the lowest percentage.

The Arkansas Primary Care Payment Improvement Working Group, established under Act 483 of 2025, is currently examining primary care investment in the state. The group, which includes a representative from ACHI, is tasked with measuring current primary care spending, evaluating the adequacy of the primary care delivery system, and recommending spending targets for Medicaid and commercial insurers. These efforts align with national recommendations to track and increase primary care investment, an issue we highlighted in a previous post.

Arkansas’s Primary Care Workforce

The country’s primary care workforce supply is another focus of the Milbank report. The report estimates that Arkansas had 58 primary care physicians per 100,000 residents in 2023, below the national average of 68 per 100,000 residents. The Milbank report also finds that 29% of Arkansas physicians were working in primary care in 2023, compared to 27% nationally.

The state’s higher-than-average share of physicians choosing primary care is encouraging, but long-term retention and geographic distribution remain challenges. ACHI developed the Arkansas Primary Care Physician Workforce Dashboard, an interactive tool that allows users to view data on primary care physicians practicing in Arkansas. The dashboard — which uses a broader definition of “primary care physician” than the Milbank report’s — shows that per capita rates of primary care physicians vary widely between urban and rural counties, and that two counties, Montgomery and Newton, had no active full-time primary care physician in 2022. The dashboard also shows that 26% of fill-time primary care physicians in the state were 60 or older in 2022, raising concerns about future supply as many approach retirement.

The Milbank report finds that in communities with higher levels of social deprivation — measured by the social deprivation index, a composite indicator of socioeconomic hardship — primary care physician availability in Arkansas is lower on average than in similarly deprived communities nationwide. Given the high burden of chronic disease among Arkansans, this is a concerning finding.

Recommendations

States that invest in primary care, as highlighted in the Milbank report, experience downstream improvements in population health and lower healthcare costs. Arkansas has established the infrastructure to evaluate and potentially increase those investments. ACHI will continue to track physician supply, distribution, and access to help inform primary care policy discussions.

Find more information about Arkansas’s healthcare workforce on our topic page.

DOVER – Leaders from the Delaware Department of Health and Social Services (DHSS), behavioral health providers, and health care partners gathered Thursday at Dover Behavioral Health System to highlight DTRN360, an innovative care coordination platform designed to strengthen collaboration across Delaware’s behavioral health system and improve care for individuals living with mental health conditions and substance use disorder.

Developed by DHSS’ Division of Substance Abuse and Mental Health (DSAMH), DTRN360 connects behavioral health providers across the state and gives them access to real-time information to better coordinate care as individuals move between crisis services, hospitals, outpatient treatment, and community-based supports.

The system is the first of its kind nationally and currently supports more than 14,000 client care journeys with nearly 600 registered staff users across Delaware’s behavioral health system. Participating organizations include DSAMH programs such as Mobile Crisis and PROMISE teams, as well as contracted providers including Dover Behavioral Health System, Rockford Center, Sun Behavioral Health, Recovery Innovation crisis stabilization centers, Northeast Treatment Centers, Conexio Care, Horizon House, and Resources for Human Development.

By bringing critical information together in one place, DTRN360 helps providers close long-standing gaps in behavioral health coordination, improving communication across organizations, strengthening care transitions, and ensuring individuals receive the right support at the right time.

“Delawareans living with mental health conditions, substance use disorder, and complex social needs depend on a system that is coordinated, responsive, and prepared to meet them where they are,” said DHSS Cabinet Secretary Christen Linke Young. “DTRN360 represents the kind of innovation that strengthens connections across our behavioral health system and equips providers with better tools and information to build a more responsive, connected system of care.”

DTRN360 was built by DSAMH with strategic design and implementation support from HEALTHe Insights. The platform incorporates technology from Bamboo Health and FindHelp to unify treatment referrals and connect individuals to community-based services that address social determinants of health.

The platform was developed through more than 200 stakeholder interviews with frontline clinicians, crisis responders, emergency department staff, justice partners, and community organizations across Delaware.

Today, DTRN360 integrates multiple data sources into a single workflow, including hospital admission and discharge alerts, crisis response information, prescription monitoring data, treatment referrals, and social services connections. Through integration with the Delaware Health Information Network (DHIN), providers can view a more comprehensive picture of an individual’s care history and coordinate next steps in real time.

Michelle Singletary-Twyman, RN, Director of Operations for DSAMH, said the platform represents a major step forward in addressing fragmentation that has historically existed across the behavioral health system.

“Fragmentation in behavioral health is more than inconvenient, it can be dangerous,” Singletary-Twyman said. “DTRN360 was designed to close those gaps by bringing critical information together in one place so providers can see the full picture of a person’s care journey and intervene earlier when support is needed.”

For providers delivering care on the front lines, access to better information helps improve coordination and discharge planning from the very beginning of treatment.

“One of the challenges in inpatient behavioral health is understanding the care someone may already be receiving when they arrive during a crisis,” said Lindsey Huttie, Dover Behavioral Health Director of Business Development. “DTRN360 gives us clearer insight into a person’s care across the system and helps us coordinate more effectively with community partners to support safer transitions and better outcomes.”

To help address behavioral health needs of Delawareans, DHSS has several ways for individuals or their family members to connect:

• Call the 24/7 Delaware Hope Line at 1-833-9-HOPEDE or 1-833-946-7333 – a single point of contact where callers can connect to a variety of resources and information, including support from clinicians and peer specialists plus crisis assistance.
• Stop by one of DHSS’ Bridge Clinics for an in-person assessment.
• Visit com to find out which treatment providers are located near you.
• Visit com, DHSS’ one-stop website where Delawareans can search for treatment services and resources in Delaware or nearby states.
• Call 988 if the individual is in crisis and needs immediate support.
• Call 911 if someone has overdosed and needs emergency medical attention.
• Learn where to find Narcan training, get the medication through the mail, and download the OpiRescueDE App

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It only took three weeks for a group chat for conservative students at Florida International University (FIU) to become a place where participants eagerly used racist slurs, prompting widespread condemnation from community leaders.

Abel Alexander Carvajal, secretary of Miami-Dade county’s Republican party and a student at FIU’s College of Law, reportedly started the chat after the killing of Charlie Kirk, the founder of Turning Point USA, in September 2025.

But on Wednesday, the Miami Herald published leaked WhatsApp conversations in which the college Republicans made racist, sexist, antisemitic and homophobic comments, including variations of the N-word used more than 400 times. Knowledge of the chat’s existence was revealed on the same day that Republican lawmakers in Florida pushed forward a bill to rename a one-mile stretch of road alongside FIU in honor of Kirk.

William Bejerano, who the Herald noted once tried to start an anti-abortion group at Miami Dade College, was the most prolific user of the N-word. Using the slur, Bejerano called for dozens of acts of extreme violence against Black people, including crucifying, beheading and dissecting.

Dariel Gonzalez, then the College Republicans’ recruitment chair, who has recently applied to become a GOP committee member, responded to the calls for violence by saying: “How edgy.” He repeatedly used “colored” to describe Black people, including writing: “Ew you had colored professors?!” and “Avoid the coloreds like the plague,” according to the Herald.

Carvajal, who was appointed to a two-year role on the city of Hialeah’s planning and zoning board earlier this year, confirmed to the paper that the group chat was his doing, but he denied knowledge of the problematic comments until the publication contacted him about its logs last week.

“It’s been five months since this was sent and this is the first time I’ve seen this message,” Carvajal told the Herald.

“I guess to an extent, I bear some responsibility, cause I created a chat. But if I had seen this at the moment, I would have removed [Bejerano] from the chat. I probably would have even blocked his number.”

The Herald found that Carvajal had deleted 14 messages sent by other participants in the chat and 42 of his own messages before the publication obtained the chat’s logs.

He also participated in some of the racist discussions. While referring to a Black student who allegedly left FIU’s College Republicans after a member of the group “called her a [N-word]”, the Floridian reported that Carvajal wrote: “Why didn’t miggress leave?” Elsewhere in the chat, the publication reported that Carvajal used “Miggress”, “Migglet” and “Migger” to refer to Black women, Black children and Black people, in general.

At one point, Gonzalez wrote: “You can fuck all the [K-word, a slur for Jewish people] you want. Just don’t marry them and procreate.”

Ian Valdes, the Turning Point USA FIU chapter president, responded, “I would def not marry a Jew,” before changing the group chat’s name from “Uber [R-word slur for disabled people] Yapping” to “Gooning in Agartha”. “Gooning” is a gen-Z slang term for male masturbation, while “Agartha” is a mythical white civilization promoted by Heinrich Himmler, one of the most powerful leaders in Nazi Germany next to Hitler.

Gonzalez reportedly described Agartha to the group chat as “Nazi heaven sort of”.

Kevin Cooper, the first Jewish chair of the Miami Dade Republican party, condemned the group chat in a statement published to X and called for Carvajal’s resignation.

“The majority of our board voted to request Carvajal’s resignation. We have commenced removal proceedings and look forward to resolution from the Republican Party of Florida,” he wrote.

That call was echoed by Juan Porras, a Republican state representative and Miami-Dade GOP state committee member, who said in a statement: “Leadership carries responsibility. When someone in a leadership role engages in this kind of behavior, it damages the trust placed in our party by voters across Florida. For that reason, I am asking the Miami Dade Republican party secretary to step down from this position.”

In a joint statement, Florida Republican state senators Alexis Calatayud, Ileana Garcia and Ana Maria Rodriguez denounced the chats and called for the expulsion from party leadership of its participants.

“The individuals in the group chat have exposed how profoundly misaligned their beliefs are to the views of the Republican party of Florida,” their statement said. “We call for the immediate expulsion of the individuals disseminating from any level of leadership of the Miami-Dade Republican Party … We will not tolerate bigotry or discrimination.”

Multiple leaked group chats from young Republicans have created controversy in recent years.

Last year, Politico published messages from a group chat of more than 100 conservatives across the country in which users also made racist and antisemitic comments. In 2022, a Young Republican group chat from North Dakota was revealed as a cesspool of homophobic and antisemitic rhetoric.