“Healthcare is broken.” We hear that all time, don’t we? And magic bullet solutions don’t exist anywhere except in someone’s imagination. So it’s understandable that there’s been a lot of excitement about the $50 billion Rural Health Transformation Program – a new source of federal funding for rural healthcare. States applied last fall for a significant windfall to improve outcomes, adopt telehealth, and solve workforce challenges. The program is also intended to offset the impact of the roughly $1 trillion in cuts to Medicaid and Obamacare passed by Congress last year.
Funding awards were announced a few weeks ago. While each state will get at least $100 million a year over the next five years, other factors determine the remaining allocation – such as rural population percentages and program proposals.
Here’s a look at the RHTP – and how it will impact Native and rural health.
The geography of care
If you live in a remote community – maybe it’s a rural town or a reservation – you know that healthcare insurance isn’t the only key to accessing decent care. Location factors in too. Your access to specialty care, modern technology, and other resources can swing from one end of the spectrum to the other based on where you live. If your rural county depends on one Critical Access Hospital (CAH) and its MRI machine breaks down, you can’t simply drive to the next hospital 15 minutes away.
Urban and suburban healthcare is just such a different ballgame. Beautifully equipped medical centers with a surplus of specialists, moderate wait times for appointments, access to the latest robotic surgery systems or advanced PET scans, even access to clinical trials – here, when critical equipment breaks down or an infectious disease expert is on vacation, it’s easy and natural to bring in reinforcements.
Compare that to rural hospital closures and underfunded IHS clinics, or communities where getting a skin cancer screening means a three-hour drive and a nine-month wait.
Why is the difference so stark?
Rural health is a complex landscape and it’s not as simple as pointing at one villain. As with everything in healthcare, funding, technology, social determinants of health, and other factors coalesce into a barrier that’s not easily dismantled. Consider these dynamics:
- Hospital Closures: More than 700 rural hospitals—about one‑third of all rural hospitals—are currently at risk of closure due to serious financial problems. Those that remain often operate at a loss, largely because a higher percentage of their patients rely on Medicare and Medicaid, which reimburse at lower rates than private insurance.
- Provider Shortages: Clinician shortages are most severe in rural and Tribal communities – something that often leads to long hours and burned-out staff and higher turnover.
- Security Vulnerabilities: Because rural hospitals often lack the budget for sophisticated cybersecurity defenses, they can be a ripe target for cybercriminals. About 84% of ransomware attacks on rural hospitals caused operational disruptions, including system downtime in 81% of cases. This can be life or death in a hospital.
- Privacy Fears: In a small town, many patients know front-desk staff, nurses, medical assistants, and other staff on a social basis. Fear of gossip can stop patients from seeking behavioral healthcare, treatment for certain chronic conditions, or other sensitive issues.
- Broadband Limitations: About 53% of rural Americans lack high-speed bandwidth necessary for seamless, high-definition telehealth – further limiting their ability to access the specialty care that isn’t available in their communities.
- High-Risk Populations: Seniors, veterans, and Native Americans are all more likely to live in rural areas – and they all experience greater need for medical care, from service-related disabilities to chronic conditions like diabetes and cardiovascular disease to cognitive decline and mobility issues. More than half of all rural counties have no hospital obstetric services – with expectant mothers skipping prenatal care in these “maternity care deserts” or giving birth in Emergency Departments not equipped for complex delivery complications.
- Transportation and Travel Times: In trauma medicine, the first 60 minutes after an event are critical. That can be a determining – even fatal – factor in patient outcomes when you consider how long it takes a medical emergency to reach the right hands. An ambulance can reach you in 10 minutes in a city, but might take 30 minutes or longer in a remote area.
The RHTP addresses these disparities through a multi-pronged strategy.
Given the multifactorial roots of rural health problems, the RHTP takes a multifactorial approach to dismantling those barriers. The overall goal is simple: improve rural health outcomes. How we get there is a bit more complicated.
Stronger preventive care and education, expanded access to behavioral healthcare, smarter chronic disease management – you’d expect all of those, and they are indeed central to the RHTP. However, the program addresses the entire healthcare ecosystem such as improving the financial viability of rural hospitals, building regional networks, and promoting care coordination and community-based resources. Technology innovation is another key aspect, from expanding telehealth to better data sharing to improving cybersecurity.
Also critical: strengthening workforce development. That means recruiting and retaining clinicians in rural areas (something that’s long been a challenge), building strong talent pipelines, and providing training and education. This is something we have first-hand experience with, and it’s the impetus for our Critical Care Response Training (CCRT) program we launched during the pandemic. Rural hospitals struggle to cover the gaps left when staff go offsite for training; we bring training to the hospital. From simulations to elbow-to-elbow training, teams learn new skills right as they’re working.
RHTP Impact on Native and Rural Areas
The program has the right idea when it comes to strengthening infrastructure and digital modalities. Simply pouring cash into an underserved area isn’t going to solve much. If a Tribal nation lacks broadband access, funding can be used to bridge the Digital Divide. If a rural hospital is struggling to stay open, a regional or statewide network can help connect patients to care while keeping revenue in that hospital’s coffers. Remote Patient Monitoring can change everything for Native elders dealing with diabetes or hypertension, while workforce development can upskill staff and improve critical care.
Tribal Health has always been active in rural communities, from Native reservations to agricultural counties that struggle with staffing their local hospitals. Our expertise lies in improving healthcare in underserved areas – so the RHTP is right in our wheelhouse. Over the coming months, we will share more of our involvement, from new mobile clinics to telehealth services.
And of course, we’ll extend our top-tier provider network to support RHTP workforce initiatives, such as solving staffing gaps, connecting patients to experienced specialists, and expanding access to behavioral health professionals – all through a culturally responsive lens.
Ultimately, the Rural Health Transformation Program is about keeping hospitals open and patients connected to care. The potential for transformation is vast. Will it build a new paradigm of care that reaches every corner of the country? Probably not overnight. But it’s a step in the right direction – and we look forward to aligning our versatile services and deep expertise in remote communities to make this vision a reality.
