The Rural Health Transformation (RHT) program represents one of the most consequential opportunities in decades to reshape how care is delivered in rural America. Administered by the Centers for Medicare & Medicaid Services, the program commits $50 billion over five years to help states modernize rural care delivery through Medicaid-focused reform.
Rural Health Transformation: A Performance-Driven Program
The program places a clear emphasis on speed to deployment, speed to value, and the use of technology innovation to deliver measurable improvements in access, quality, and cost. Importantly, CMS has also emphasized strong stewardship of federal dollars, with expectations that states demonstrate transparency, accountability, and protection against fraud, waste, and abuse as RHT funds are deployed.
The intent is explicit. RHT is a performance-driven program, not a grant program designed to fund isolated pilots. It is a time-limited execution-focused investment meant to catalyze durable system change: expanding access, modernizing infrastructure, and using technology innovation to deliver quantifiable improvements in outcomes and cost. States are expected to demonstrate tangible progress against defined goals to retain and unlock future RHT funding, making rapid execution and measurable outcomes essential.
States must not only execute quickly, but also track, report, and validate outcomes to retain funding – making measurement, auditability, and responsible stewardship of funds aligned with core program requirements.
All 50 states received initial RHT awards at the end of last year, generally ranging from approximately $150 million to more than $280 million for the first year of implementation, with additional funding tied to performance and execution over time.
From Plans Execution: The Role of CHRA
To help states move quickly from planning to action, the Collaborative for Healthy Rural America (CHRA) launched as a national coalition purpose-built for rapid deployment, measurable impact, and long-term sustainability.
CHRA brings together Lumeris, Teladoc Health, Nuna, Deloitte, and Unite Us to provide proven, immediately deployable infrastructure that states can activate now – leveraging existing data platforms or initiatives, enabling real-time performance monitoring, auditability, and proactive identification of potential fraud, waste, or misuse of RHT-funded services, while keeping patients and local providers at the center of care.
The Top 10 Challenges States Must Solve
Based on CHRA’s engagement with rural health leaders in more than 30 states, the following challenges consistently emerge as the primary barriers to realizing the full promise of Rural Health Transformation – particularly when speed to value and accountability for outcomes are required.
These challenges reflect not just structural barriers, but the operational realities states must address to deliver results within CMS’s performance and accountability framework. These challenges are especially acute as states are required to demonstrate measurable progress on clinical outcomes, equity, and cost while maintaining rigorous oversight of RHT investments.
Access & Execution Challenges
1. Fragmented access and navigation
Challenge: Rural care is delivered across clinics, hospitals, EMS, telehealth platforms, schools and community organizations, often without coordination. Patients face multiple entry points and no clear front door.
How CHRA Helps: Delivers unified access models that connect disparate entry points into a single, navigable system anchored in local providers and designed to expand access quickly without disrupting existing care relationships.
2. Geography-driven barriers to care
Challenge: Distance, travel time and weather continue to dictate access to care, even as states invest in new programs.
How CHRA Helps: CHRA blends local care teams with virtual care, mobile services, and intelligent routing so geography no longer determines access or outcomes.
3. Moving from planning to execution at scale
Challenge: Many states have strong Rural Health Transformation plans but face challenges translating them into consistent, statewide execution.
How CHRA Helps: CHRA delivers immediately deployable, deployment-tested models that allow states to move from plan approval to execution quickly and scale statewide while producing early, measurable results tied to RHT goals.
Data, Technology, & Accountability Challenges
4. Siloed investments that fail to connect
Challenge: Investments in technology or programs often stand alone and fail to integrate into day-to-day care delivery.
How CHRA Helps: Provides shared infrastructure that connects RHT-funded investments into a single operating model centered on patients and local providers.
5. Data without day-to-day insight
Challenge: States have data but often lack real-time, actionable insights that support frontline decisions and performance accountability. This gap also limits states’ ability to detect anomalies, monitor utilization patterns, and ensure appropriate use of RHT-funded services.
How CHRA Helps: CHRA turns existing data into actionable intelligence that supports care delivery, performance monitoring, CMS-aligned reporting and proactive identification of anomalies and patterns associated with potential fraud, waste, or misuse of program resources through transparent, auditable workflows.
6. Technology fragmentation and infrastructure risk
Challenge: States cannot mandate EHR changes, yet interoperability gaps and uneven IT readiness persist.
How CHRA Helps: CHRA overlays existing systems to promote interoperability, within a secure infrastructure – avoiding rip-and-replace while accelerating value.
Sustainability, Workforce & Outcome Challenges
7. Unsustainable primary care economics
Challenge: Fee-for-service models often fails to support primary care in rural markets, threatening long-term access.
How CHRA Helps: CHRA enables primary-care-led models, including Primary Care as a Service, that align payment, access, and outcomes and generate quantifiable return on investment to support sustainability beyond the RHT funding period.
These models are explicitly designed to improve performance on rural-relevant clinical metrics, including maternal health, chronic disease management for COPD and CHF, preventive care, and longitudinal primary care access.
8. Avoidable emergency department use and transfers
Challenge: Emergency departments are frequently used as substitutes for primary care, driving cost and unnecessary transfers.
How CHRA Hhelps: CHRA integrates triage, EMS treat-in-place, and virtual specialty support to keep care local whenever appropriate.
These capabilities support measurable reductions in avoidable ED utilization and readmissions, particularly for patients with chronic conditions such as CHF and COPD.
9. Gaps in maternal and behavioral health continuity
Challenge: Loss of obstetric services and fragmented behavioral health follow-up create critical gaps in care.
How CHRA Helps: CHRA supports coordinated maternal and behavioral health pathways that combine local care teams with virtual specialty support and closed-loop follow-up, enabling measurable improvements in maternal health outcomes, postpartum follow-up, and behavioral health continuity in rural communities.
10. Workforce strain and unmet social needs
Challenge: Rural systems face staffing shortages, burnout, and limited visibility into social needs outcomes.
How CHRA Helps: CHRA enables team-based care, workflow automation, and closed-loop social services integration, extending capacity without replacing local providers.
Why Execution and Integration Matter
As John Fryer, chief growth and corporate development officer and one of the leaders organizing CHRA noted, “Rural Health Transformation is not about funding more programs. It is about delivering results quickly and building systems that work together. States that succeed will be the ones that turn RHT investment into measurable access, value, and sustainability—while keeping patients and local providers at the center of care.”
Rural Health Transformation is not about funding more programs. It is about delivering results quickly and building systems that work together. States that succeed will be the ones that turn RHT investment into measurable access, value, and sustainability—while keeping patients and local providers at the center of care.
From Transformation to Sustainability
CHRA’s approach is intentionally designed to help states demonstrate progress early, measure results continuously, and sustain expanded access long after initial RHT dollars are deployed. This includes a commitment to tracking the metrics that matter most in rural communities: maternal health, chronic disease outcomes (including COPD and CHF), avoidable utilization, access, and equity—while maintaining transparency and accountability for every RHT dollar invested.
RHT gives states both the resources and the responsibility to rethink rural care delivery. The challenge is execution. The opportunity is to deploy proven infrastructure that delivers expanded access, measurable outcomes, responsible stewardship of public funds, and sustainable return on investment – well beyond the RHT funding window .
Learn More
Learn more about the Collaborative for Healthy Rural America and how it is supporting states’ Rural Health Transformation efforts at https://www.lumeris.com/chra/, or contact us at connect@lumeris.com
