States Ready RFPs to Allocate Rural Health Transformation Funds

Just as states hurried to complete applications for the $50 billion federal Rural Health Transformation (RHT) Program in a few short months, they are now working furiously to develop Requests for Proposals (RFPs) to allocate funds for the program, and the pressure is on to get the funds out the door as quickly as possible. To help them do so, vendors are forming consortia to help with implementation, as well as with measuring performance across cost, quality, access, and sustainability.

For instance, RFPs are now open in Delaware, which received a $157 million federal award for the first year of the program. Delaware’s RFPs involve school-based health centers, food-as-medicine infrastructure, and rural community health hubs. The plan prioritizes mobile health units and telehealth innovations to bring care directly to residents who face transportation barriers or live in remote areas. Mobile health pods and clinics will visit schools, libraries, churches, and town centers, while expanded telehealth access and remote monitoring programs are expected to make it easier for patients to connect with healthcare providers anytime, anywhere.

“These initiatives are designed to build lasting capacity, not short-term fixes,” said Delaware Department of Health and Social Services Cabinet Secretary Christen Linke Young, in a statement. “By aligning workforce development, prevention, and access strategies, Delaware is creating a healthcare system that can meet rural residents’ needs today and into the future.”

Moving even faster than Delaware is Iowa, whose Department of Health and Human Services has already announced awards of $78.6 million in funding through two competitive RFPs. The first grants awarded support the Hometown Connections initiative, part of Iowa’s Healthy Hometowns Project, which focuses on building partnerships to restructure healthcare delivery options for rural communities. The grants will fund medical equipment procurement and installation, and support healthcare workforce recruitment.

Speaking at a recent Duke-Margolis Institute for Health Policy webinar, Kody Kinsley, former Secretary of Health and Human Services in North Carolina and now a senior policy advisor to Institute for Policy Solutions at the Johns Hopkins School of Nursing, said states are working to finalize the cooperative budget agreements with CMS on the Rural Health Transformation Program. He stressed that states are going to need to have funds from year one obligated by the end of September. “We’ve heard clearly that CMS wants to see this money out the door aggressively in shovel-ready projects and in strategies that are tested and proven, and that are making a difference.”

Kinsley noted that states have five years to build toward something that's sustainable. “Disrupting how healthcare is delivered in rural communities is a longtime challenge and also a tall order,” he said, “so when we think about the key tools that we know are in the vast majority of all states’ applications — multi-payer payment reform strategies and different technology innovations and implementations — we can't afford to have something tested in year one that doesn't change until year three. We have to have things that are being tested in quarter one of year one and change, if not working, in quarter three or earlier. States are in a period of design, trying to learn from each other, and they're going to want to get that work on the ground as quickly as possible, because they understand that their success in year one will likely inform how many resources they can make investments in year two. So the pressure is on.”

Vendors are coming together to offer states assistance with implementation and measurement. For instance, Science Applications International Corp. (NASDAQ: SAIC), has launched the Alliance for Advancing Rural Healthcare (AARH) to bring together healthcare organizations to help state governments rapidly and successfully execute the program. The alliance includes SAIC, Arcadia, Castlight Health, Covista, Mission Mobile Medical, Telemedicine.com, TruBridge, and Walgreens 

The partners say they can bring the capabilities, coordination, and execution needed to deliver durable gains in access to care, modernized systems, and expanded workforce capacity. 
  
"State governments face unique challenges in transforming rural healthcare and need partners who understand public sector accountability, the complexities of healthcare operations, and the need for scalable, results-driven solutions," said Suresh Soundararajan, former Virginia Department of Health CIO and current SAIC RHT Program Lead, in a statement. "AARH helps states overcome these hurdles, delivering sustainable, people-centered solutions that address the critical needs of rural communities.”

Earlier, five vendors came together to form a collaborative to help state leaders accelerate their efforts in the RHT Program. The Collaborative for Healthy Rural America (CHRA) includes Lumeris, Teladoc Health, Nuna, Deloitte, and Unite Us.  

The Collaborative said its goals are to share the benefits of national economies of scale to serve rural community needs and to track sustainability metrics such as reduced preventable hospitalizations, higher patient satisfaction, higher patient self-sufficiency, stabilized provider finances and reduced administrative burden.