As States Apply, Vendors Form Coalition Around Rural Transformation Program

Nov. 5 is the deadline for states to submit applications for the $50 billion Rural Health Transformation (RHT) Program. CMS is expected to announce awardees for the five-year program by the end of 2025. The RHT Program focuses on promoting innovation, strategic partnerships, infrastructure development, and workforce investment.

Five vendors have come 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 

The CHRA members said they will work together to deliver an AI-enabled interoperable operating platform that accelerates state RHT participants’ abilities to realize their visions. The platform will connect patients and clinicians—bringing national economies of scale to the local delivery of care in rural communities. 

The CHRA members broke down what each organization is bringing to the coalition. 

Lumeris — Primary Care as a Service Platform. Through its AI-enabled Tom platform, Lumeris provides the backbone technology, workflows, and population-health visibility that make primary care function as a utility for rural America. Google Cloud’s AI models and infrastructure power AI-enabled Tom. 

Teladoc Health — High-Quality Virtual Care Delivery. With the largest nationwide network of virtual care providers including licensed clinicians, therapists and health coaches, Teladoc Health delivers and orchestrates primary care, 24/7 urgent care, mental health, and chronic care services to expand access and improve outcomes in rural communities.

Nuna — Daily Virtual Coach for Chronic Disease. Nuna’s platform includes an AI-native mobile app, a daily “coach” to support patients to follow their physicians’ care plans. 
Nuna’s app notifies clinical care teams for support or intervention when necessary.

Deloitte — Data Systems Interoperability & Program Operations. Deloitte provides systems interoperability and data integration across IT platforms, using analytics and population data, to drive and measure program outcomes. Deloitte provides program execution and supports alignment of state efforts with the CMS RHT Program guidelines.

Unite Us — Human Services Coordination & Community Network Integration. Unite Us' Self Sufficiency Score establishes a benchmark and measures the ongoing effectiveness of human service interventions, connecting rural residents to medical, behavioral, and community support services via an integrated care coordination and payment platform.

While the recently passed H.R. 1 law included an estimated $1 trillion in cuts to Medicaid, it also features $50 billion for the RTP program, but states had only a few months to prepare applications. 

Critics have argued that the RTP program's short timeline and discretionary funding undermine its potential to effectively address rural healthcare crises.

A Health Affairs article recently noted, “the relatively short implementation timeframe—with state submission of applications and CMS approval determinations happening within a few short months—compounds the underlying program limitations.” The  article notes that “rather than dealing with the crisis at hand, solving the major blow to healthcare spending and resulting coverage declines that OBBBA represents, the program instead positions itself as a multi-year effort to strengthen rural healthcare systems through strategic plannings. Put another way, there appears to be a total mismatch between the actual program contours and the problem it purports to solve.”

Michael Baker, director of healthcare policy for the center-right American Action Forum, wrote in an Aug. 8 blog post: “While masquerading as an innovative government program, the RHTP is little more than a slush fund. There is no transparent formula for funding determinations, and instead the CMS administrator has immense discretion in determining state eligibility and allowable program expenditures, setting the stage for funding decisions based on personal taste rather than well-reasoned formulas with defined variables.”

Baker added that “even the most well-intentioned innovation can’t patch over the kind of shortfalls rural patients face.”

Here are the components each rural health transformation plan is expected to address:
• Improve access to hospitals or other healthcare providers and services for rural residents;
• Improve healthcare outcomes of rural residents;
• Prioritize the use of new and emerging technologies, emphasizing the prevention and management of chronic disease;
• Initiate and strengthen local and regional strategic partnerships between rural hospitals and other healthcare providers to promote quality improvement, financial stability and share best practices;
• Enhance economic opportunity and supply of healthcare providers through enhanced recruitment and training;
• Prioritize data and technology-driven solutions that help rural hospitals and providers deliver high-quality services, as close to a patient’s home;
• Outline strategies to manage long-term financial solvency and operating models of rural hospitals; and
• Identify causes driving the accelerating rate of stand-alone rural hospitals becoming at risk of closure, service reduction or conversion.