The Rural Health Transformation Program (RHTP) is a landmark opportunity, offering significant funding to address the persistent challenges in rural healthcare. But states that view this as just another funding stream will miss the point. The RHTP is a mandate for sustainable change, demanding bold vision and a clear-eyed strategy for execution. Success won’t come from simply checking boxes; it will be forged through data-driven action, strong leadership, and a new way of thinking about healthcare delivery.
States that succeed will be those that build their programs on a foundation of robust data infrastructure, recognizing that you cannot improve what you cannot measure.
Medicaid Must Play a Leading Role
Medicaid agencies are natural leaders for this transformation. As a ubiquitous payer and states’ chief policy instrument for rural healthcare, they possess the infrastructure, experience, and scale required to orchestrate a program as complex as the RHTP, which rivals an 1115 waiver in its scope.
However, leading doesn’t mean working in isolation. True transformation requires building a powerful coalition. This means engaging community stakeholders in honest conversations about difficult choices, like the future role of local hospitals. It also involves partnering with specialized vendors who can deliver innovative solutions—from mobile health to remote patient monitoring—directly to the communities that need them most.
Effective governance isn’t about creating new bureaucracy; it’s about fostering an inclusive process where the best ideas can rise to the surface.
Data is the Bedrock of Sustainable Change
The RHTP’s requirement for sustainability is its most defining feature. This is where data moves from a supporting role to the main event. To prove sustainability and demonstrate progress to CMS, states must have a sophisticated data strategy from day one.
A “check-the-box” approach to the application will fail. Instead, leaders must present a detailed blueprint for their data ecosystem. This includes:
- Mapping the Current State: Understand what data you have, where it lives, and what barriers prevent it from being shared and utilized effectively across HIEs, providers, and community organizations.
- Designing the Future: Create an enterprise architecture that integrates disparate data sources—clinical records, claims, workforce data, and crucial social determinants of health (SDoH) like broadband access.
- Enabling Targeted Action: Use this integrated data to power advanced risk stratification. By identifying high-need individuals who are underutilizing services before a crisis, we can shift from reactive, high-cost care to proactive, coordinated interventions. California’s Medi-Cal program provides a powerful model for how this can be done at scale.
A technology partner can’t magically solve these challenges. The foundational work of mapping data and defining a clear analytics strategy is essential. This groundwork informs how initiatives are designed and ensures that progress is measurable and demonstrable.
From Vision to Action: A Parallel Path
With tight deadlines, states cannot afford a sequential planning process. The design of the program, its implementation plan, and its evaluation framework must all happen in parallel. You must begin with the end in mind. If your evaluation requires new data points, your implementation plan must include the mechanisms—like a health screener—to collect them from the start.
This parallel approach requires confronting tough policy questions head-on. Debates around scope of practice, payment reform, and provider structures can’t be pushed down the road. Laying these issues on the table early builds the alignment and momentum needed for real change.
The RHTP is more than funding; it’s a call to action. By anchoring a bold vision in a sophisticated, data-driven strategy, state leaders can seize this opportunity. To achieve success, state leaders should seek out their state Medicaid agency as well as committed partners that can help their state navigate this complexity, turning ambitious plans into a sustainable reality for millions in rural communities.
Author: Andy Allison, Senior Medicaid Advisor at Gainwell Technologies
Bio: Andy Allison, PhD, is a health policy leader and Medicaid expert with deep experience guiding state and national reform initiatives. A former state Medicaid director and founding board member of the National Association of Medicaid Directors, Dr. Allison brings a unique combination of policy insight, economic analysis, and operational perspective to advancing more effective, efficient, and equitable public health programs. He currently advises states and partners through his role at Gainwell Technologies.
