Rural health systems are contending with eroding margins, persistent workforce shortages and shrinking access as service lines close. CMS’ $50 billion Rural Health Transformation (RHT) Program offers a rare chance to redesign care delivery rather than simply stabilize it — but converting a one-time funding opportunity into lasting value is the harder problem.
During a June webinar hosted by Becker’s Healthcare and sponsored by Premier, two rural health system leaders joined moderator Caroline Brazeel, senior director of advisory services at Premier, to discuss how they are translating policy into execution. The panelists were:
- Kevin Post, DO, chief medical officer at Avera Health (Sioux Falls, S.D.)
- David Wilson, chief operating officer at North Mississippi Health Services (Tupelo, Miss.)
Below are four takeaways from their conversation.
Note: Quotes have been edited lightly for length and clarity.
1. A narrow window rewards clear strategy over fast spending
The RHT Program delivers $50 billion over five years in $10 billion annual increments, with states given two fiscal years to spend each tranche and a first CMS reporting deadline in August. Allowable uses are broad, which puts the burden on systems to define where investments will drive durable impact. Avera Health built guiding principles to keep the money in service of its existing strategy.
“Never get the plan ahead of the planning,” Dr. Post said, adding that the aim was to ensure “the funding doesn’t drive strategy, but it enables strategy.”
2. Cross-functional collaboration is doing the heavy lifting
With state guidance arriving late, North Mississippi Health Services began work in February, drafting a mock application and making the effort a standing item in its weekly systemwide meetings. The list of candidate projects grew from roughly 10 items to nearly 50 ahead of a June 15 to July 15 application window.
Avera Health ran open brainstorming sessions where no idea could be shut down, while reminding regional leaders to keep a system hat on so investments serve the whole organization.
3. Workforce and access models top the investment list
Both systems are prioritizing care-redesign and workforce projects. Avera Health is training rural obstetrics teams to counter growing OB deserts — where some mothers travel more than two hours for maternal care — and is using community health workers and advanced practice providers to extend specialty care such as oncology.
North Mississippi is expanding graduate medical education, including new pulmonology critical care and cardiology fellowships. “We know how difficult recruitment to rural areas can be,” Mr. Wilson said.
Both systems are also investing in workforce housing: Avera Health partnered with local contractors and its city to build affordable employee housing in one South Dakota community, while North Mississippi Health Services is working with a developer on walkable units near its Tupelo hub.
4. Virtual care is the connective tissue
Hub-and-spoke virtual models anchor both systems’ strategies. North Mississippi Health Services runs a patient logistics center it calls mission control, alongside a virtual nursing program, born from COVID-era equipment, that handles admissions, discharges and new-nurse mentorship.
Avera Health is pairing systemwide teletracking with virtual nursing, virtual sitters and asynchronous e-visits. Both systems have also seen ambient AI documentation spread quickly among clinicians and patients alike.
What will separate the systems that thrive
The leaders pointed to implementation and adaptability — not strategy on paper — as the differentiator over the next five years. That means fostering a culture where teams can move quickly and recover from missteps. “Try something different,” Mr. Wilson said. “If it doesn’t work, fail fast, let’s move on.”
Pairing that urgency with shared accountability, the panelists agreed, is what will turn a once-in-a-generation funding moment into durable rural care.
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