Altamonte Springs, Fla.-based AdventHealth is investing in rural hospitals, expanding access through clinics and virtual services and restoring care in communities where patients have few alternatives. President and CEO David Banks said sustaining that work will require creativity, local decision-making and a continued focus on costs as federal funding pressures grow.
About 19 of AdventHealth’s 56 hospital sites are considered rural or critical access, a footprint that reflects the system’s sanitarium origins in the late 1800s. Ahead of National Rural Health Day Nov. 19, Mr. Banks told Becker’s that AdventHealth’s size allows it to bring resources into rural communities, but the services offered in each market must reflect local needs and financial realities.
“We work creatively and intentionally to ensure we have viability in those communities, because we’re often the single source of care there,” he said. “Remaining viable in those communities takes different work than it does in metro Denver, Chicago or Orlando.”
In Clay County, Ky., where AdventHealth has operated for more than 50 years, the system has focused much of its work on a rural health clinic attached to its hospital. The clinic serves as the primary source of care for many residents, and AdventHealth has strengthened it with additional providers and access to specialists while extending services into 14 surrounding counties, including through kiosks and virtual behavioral health services inside Walmart stores.
Patients who need more advanced care can travel to Lexington, where AdventHealth has relationships with the University of Kentucky. AdventHealth Manchester also recently joined the UK Markey Cancer Center Affiliate Network.
“So while the hospital is there and available as a backstop, it’s really the network of rural health clinics that creates the network of care for patients in those areas,” Mr. Banks said.
The system is also using virtual services to address specialty care gaps that would be difficult to fill through local recruitment. AdventHealth’s critical care team in Orlando, Fla., provides ICU expertise to the Kentucky hospital, and a virtual behavioral health network supports patients in rural communities. Mr. Banks said the system intends to expand virtual coverage in specialties such as neurology and dermatology.
“They get the same level of ICU expertise in Kentucky that I have in Tampa, Orlando and Daytona, which we would never otherwise be able to have in that remote an area,” he said.
The need for those services is particularly significant in Clay County, which Mr. Banks said regularly ranks among the nation’s poorest counties. Patients sometimes delay seeking care because of cost or limited availability, leaving clinicians to treat conditions they have rarely encountered in recent years.
“If you talked to the internists in our Kentucky clinic, they would tell you they often have to go back to the textbooks because they’re seeing things they haven’t seen in a long time, because people are reluctant to get care,” he said. “It’s expensive, and it’s hard to come by.”
In other rural markets, AdventHealth has determined that expanding access requires investment in physical facilities. The system broke ground in September on a $200 million replacement hospital in Murray County, Ga., where it took over a small hospital about a decade ago. The new campus will replace a 30-bed facility with an emergency department and basic services.
“It’s going to bring a level of care the county hasn’t had,” Mr. Banks said.
In Ottawa, Kan., AdventHealth has focused on restoring obstetric services after the hospital lost labor and delivery care because of physician coverage challenges and other factors. The closure left approximately 300 mothers annually traveling up to an hour to deliver their babies.
As Becker’s reported in March, AdventHealth Ottawa reopened its Family Birth Place in September 2025 after recruiting family practitioners and midwives through its rural health clinic. Mr. Banks said the hospital is on pace to deliver just under 300 babies this year, and surrounding counties have since requested additional OB-GYN support. AdventHealth now operates a mobile health van that brings services into those communities.
“The goal is to ask what the community needs from you and how to organize your resources to best meet that,” he said.
Those decisions are driven by local leadership rather than the system’s corporate office, according to Mr. Banks. AdventHealth operates what he calls a co-operating model, with leadership teams in each community responsible for assessing healthcare needs, developing budgets and determining which services to provide. The larger organization supplies resources such as Epic, supply chain operations, financial systems and remote clinical services.
In Ottawa, CEO Brendan Johnson works with local financial, nursing and clinical leaders to identify service gaps and determine what the hospital can support. Mr. Banks said the decision to restore obstetric care came from that team, illustrating the importance of allowing community leaders to direct investments.
“I would not have known we needed to restore OB services,” Mr. Banks said. “The team said, ‘Here’s the opportunity. Can we go do it?’ Then, with all the resources channeled through the local team, it came alive.”
Maintaining those services could become more difficult as Medicaid changes under HR 1 take effect in 2027 and 2028. Mr. Banks said AdventHealth is looking for ways to reduce the cost of clinical and support services, particularly in communities such as Manchester, Ky., where nearly all patients are covered by Medicare or Medicaid or are uninsured.
The system is also monitoring state supplemental payment programs, including directed payments, while pursuing grants and philanthropy to support rural investments. In Kentucky, a recent philanthropic gift is funding a $2.5 million surgical robot, and Mr. Banks said AdventHealth has received Rural Health Transformation Program support in Kansas, Texas and Kentucky, with different restrictions governing the use of funds in each state.
“I heard a good quote the other day: ‘No new money, less old money,'” he said. “No new money, less old money means we’ve got to sharpen our pencils and get back to work, because we’re not leaving these communities. These people need care, they need us to figure it out, and we’re very committed to doing that.”
Mr. Banks said the financial pressures facing rural providers also complicate the national debate about large nonprofit health systems, which he believes can overlook the resources those organizations devote to communities with limited access to care.
“As nonprofits, we are at the end of the line. All the policy decisions and all the insurance company decisions come to a head where we meet the patient,” he said. “In the national dialogue, people need to understand how complicated this is. It doesn’t lend itself to a simple narrative.”
