Seize the Day: Four Strategies States Must Use to Rescue Rural Health

Something essential is slipping away in rural America.

Since 2010, roughly 190 rural hospitals have closed. Infant mortality remains unacceptably high and one in three rural counties lacks maternity services. When a heart attack, stroke or serious injury occurs, emergency help can be more than an hour away—time many patients cannot afford to lose.

The erosion of rural health care is not accidental; it is the result of long-term neglect and underinvestment. A newly announced five-year, $50 billion initiative—the Rural Health Transformation Program—offers a once-in-a-generation opportunity to reverse that trend. Whether states seize it will determine the future of health care for millions of Americans who live outside urban centers.

Why this moment matters

The program rewards ambition, integration and measurable improvement. To qualify for initial funding, states must submit plans that include at least three transformation activities or policy changes to compete for up to $500 million during the first five years. Additional funding is available to states that present a broader slate of activities and demonstrate strong outcomes.

Plans must deliver meaningful, measurable and sustainable programs for patients, providers and taxpayers before the funding window closes and expected Medicaid changes take effect in 2030. States that submit narrow proposals risk leaving federal dollars unused; states that fail to meet goals may see funds reallocated to better-performing jurisdictions.

Four practical priorities for state leaders

Based on conversations with policymakers and health leaders nationwide, states should build applications and strategies around these four priorities:

1. Build a new frontline workforce

Create an "army of civilian medics"—community-based health workers who coach patients on healthy behaviors, connect people to services, translate innovations into impact and relieve overburdened clinicians. States should invest up front in recruitment, training and pay for this workforce; small, staggered payments won’t create the momentum needed to change utilization and outcomes.

2. Measure every dollar by results

Use simple, auditable data systems—shareable dashboards, Medicare Shared Savings Program metrics and established quality measures—rather than complex, hard-to-audit integrations. Leverage existing billing codes and shared-savings data to track progress and target interventions. If an initiative cannot be measured, it should not be part of the plan.

3. Organize care around community health hubs

Center regional delivery systems on community health hubs—rural hospitals, federally qualified health centers and local networks—that manage technology, coordinate payments and workforce, secure IT infrastructure and drive local quality improvement. Each hub must demonstrate strong IT capacity and the ability to support neighboring counties.

4. Align incentives for long-term sustainability

Align payments and incentives across physicians, hospitals, behavioral health providers, EMS teams and patients so that prevention and community health generate stable revenue streams to replace declining fee-for-service income. The goal is not merely to survive the next five years but to build financially sustainable, prevention-focused systems that keep rural communities healthy long after federal dollars subside.

Next steps and a call to action

The federal funding and program authority are in place; the responsibility now falls to states. Successful applications will combine bold initial investments in workforce and technology, clear measurement and reporting, strong local hubs and aligned incentives that prioritize population health.

This is an unparalleled opportunity to show that the United States can deliver equitable, high-quality care to all communities. States should act decisively: build the workforce, fund it up front, measure relentlessly, invest in technology, align incentives and plan for sustainability. Seize the day.

Lynn Barr is the founder of Caravan Health.