4 opportunities for greatness in rural health’s revolution

In the heart of America something vital is slipping away.   

Since 2010, approximately 190 rural hospitals have closed. Infant mortality is unconscionably high, as 1 in 3 rural counties lack maternity care. And if a life hangs in the balance from a heart attack, stroke or accident, help can be more than an hour away — time victims don’t have to give.

America’s rural health system isn’t broken by accident; it’s simply been left behind. The question today is whether some states will be abandoned on the road to recovery.

Here’s the backstory.  

The Trump administration recently announced a historic, five-year $50 billion infusion to strengthen hospitals, update systems of care and ensure access to health care for every American regardless of where they live.

It’s called the Rural Health Transformation Program. Done right, this program may be the greatest opportunity state leaders have ever had to improve the health of their rural residents. States that do it poorly through improper execution will remember this moment as one of its greatest mistakes.

The Rural Health Transformation Program, designed to reward ambition, integration and results, requires states to submit a plan covering three transformation activities or policy changes to qualify for up to $500 million for the first five years while competing for dozens of activities to merit the second $500 million. 

Further, the state’s plans must implement impactful, measurable and sustainable new programs for patients, providers and taxpayers before the money is gone and Medicaid cuts hit hard in 2030.

States submitting narrow plans will leave millions on the table. Those failing to meet their goals will see future payments clawed back and redistributed to other states.  

For decision makers in Washington, D.C. these days, ideas alone aren’t enough. They want to see execution and results as the only viable ways to build infrastructure for change.  

After conversations I’ve had in the nation’s capital and across the country, I humbly submit a state checklist of four ideas for success:

1. Be prepared to invest in a new frontline workforce — I call it an army of civilian medics — who’d work with patients to promote healthy habits, connect them to care, bridge the gap between innovation and impact and spare over-burdened providers. Specifically, states must provide new funding to recruit, train and pay this workforce before the savings appear. Small, incremental payments won’t create momentum. Large, upfront investments in the workforce will.
2. Every dollar spent will be judged by results. Simple data systems — shareable dashboards, Medicare Shared Savings Program data, etc. — are more effective and auditable than complex integrations. Use existing billing codes, quality metrics and shared savings data to track progress and target interventions. If an initiative can’t be measured, it shouldn’t be in the plan.
3. The most successful plans will center community health hubs — rural hospitals, health centers, local networks — that will manage technology, coordinate payments and workforce, secure IT systems and foster quality improvement for each county. The hub organization must have strong IT and technology capability.
4. States should align incentives across all stakeholders — doctors, hospitals, behavioral health providers, EMS teams, and even patients. The goal is not to simply survive the next five years — it’s to build a financially stable, prevention-focused system that keeps rural communities healthy long after the Rural Health Transformation Program dollars are gone. Providers who create healthier communities must be rewarded with new profit streams to replace lost revenue.

The federal government has done its part. The funding is ready to go, the authority is in place and the rules are clear. It’s now up to the states. Build the workforce. Fund it up front. Measure relentlessly. Focus on technology. Align incentives. Plan for sustainability.  

The (application) clock is ticking, but we’ve never had a better opportunity to show that when it comes to health, America can lead the rest of the world. But we must do things differently. Let’s give health a chance. What do we have to lose, except poor outcomes and high costs?

Seize the day. 

Lynn Barr is the founder of Caravan Health.