Embracing an innovation mindset in rural health transformation

While the RHTP grant opportunity is a welcome federal investment to address gaps in rural health access, the grant’s “stage-gate” funding model introduces significant program design and delivery risks for state government leaders. Specifically, this stage-gate funding model differs from traditional block grants or formula-based funding approaches by linking a state’s annual funding to the progress achieved onrural health initiatives and milestone-based performance measures outlined in each state’s rural health transformation plan and application. If defined progress goals or outcomes are not delivered by milestone dates, states face potential claw-back provisions and/or reductions in future funding allocations.2 The first evaluation period is less than two years, suggesting a need for a fast and effective program launch.

In this way, the RHTP stage-gate funding approach shifts the state's role from simply distributing grant funds and facilitating required reporting to actively managing a portfolio of initiatives to deliver results. This will require establishing a dedicated, experienced team and a structured approach for engaging rural health stakeholders in detailed initiative planning and ongoing evaluation. Transforming rural health also will require public and private sector collaboration to reimagine care delivery models and help implement technologies such as telehealth and remote monitoring, artificial intelligence (AI)-enabled mobile apps, closed-loop referral platforms, and data standards to enable secure, bidirectional data sharing. The pace, magnitude, and complexity of change necessary to achieve RHTP progress goals requires that state agency leaders embrace an innovation mindset by defining an integrated, outcomes-focused strategic roadmap of RHTP initiatives and establishing a dedicated team with sufficient staff capacity to actively manage the ebbs and flows of implementation with rural health community stakeholders.