Author: Scott Andrus, Senior Vice President of Sales, Caregility
At this year’s National Rural Health Association annual conference, transformation funding shared the stage with a much harder question: what happens next?
At this year’s National Rural Health Association (NRHA) annual conference, Rural Health Transformation Program (RHTP) funding came up in nearly every session. But the more interesting story was what the conversations were really about underneath.
Across keynotes, breakouts, and the conversations in hallways and over coffee, a recurring theme surfaced: people are not just thinking about how to win RHTP awards. They’re thinking about what their state, network, and hospital look like five years after the funding cycle closes. RHTP was repeatedly described as a once-in-a-lifetime opportunity, but the room treated it less as a finish line and more as a starting gun.
Six signals from the conference:
1. Rural Health as Economic Infrastructure
The most consistent theme of the conference was that rural health is no longer being discussed solely as a clinical access challenge. Speaker after speaker connected rural hospital viability to jobs, tax revenue, school enrollment, and community stability. The reminder that one in five Americans lives in a rural community came up repeatedly, often alongside the observation that when a hospital closes, the impact extends well beyond patient care.
Leaders framing rural transformation as an economic resilience instead of a one-off initiative are finding it easier to engage state legislatures and community stakeholders who don’t typically sit at the healthcare table. The funding follows the narrative.
2. States are the Strategic Control Point
RHTP is federal money, but the design, prioritization, and distribution decisions are happening at the state level. State Offices of Rural Health, ORHT structures, and state project offices will be the practical decision-makers for the next several years.
There’s no single playbook. The approach varies state-by-state in terms of who owns the plan, which rural associations hold influence, and which rural facilities, FQHCs, EMS agencies, and networks are positioned as priority participants. The states that move first are likely to set patterns that the rest of the country borrows from.
3. EMS is the Crisis No One Can Ignore
One of the most striking data points from the conference was that 47 of 50 states reported active initiatives to address EMS challenges. A speaker from Nevada described ambulance transport distances of up to 160 miles in frontier areas. Rural EMS is not simply a transport issue; it is an access infrastructure question that touches emergency care, transfers, behavioral health response, maternal care, and trauma.
Virtually enabled EMS – including remote triage before transport, specialty consultation during long transport windows, and advanced practice provider support in the field – was repeatedly named as one of the highest-potential use cases for RHTP funding. For organizations that have historically focused on inpatient telehealth, this is a meaningful expansion of where connected care is heading.
4. Cooperative networks are emerging as a sustainability template
One of the more energizing case studies came from North Dakota. The state has 23 Critical Access Hospitals, and several speakers described a cooperative network structure with equal membership, shared services, and aggregated capabilities. Although low-volume rural providers often lack the scale to support modern care delivery individually, they can gain meaningful leverage collectively.
For technology partners, payers, and policy leaders, the implication is significant. Network-level engagement is likely to be more scalable than facility-by-facility relationships. Cooperative and clinically integrated network models also create the scale needed to support shared analytics, workforce strategies, and value-based care participation in ways that individual rural hospitals struggle to do alone.
5. Workforce is the Universal Constraint
Workforce came up in every state-level conversation, and it was rarely framed simply as a recruitment problem. Broader clinical staffing challenges include an aging rural nursing workforce, fragile primary care pipelines, behavioral health shortages, EMS staffing instability, and the persistent challenge of attracting caregivers to communities where there may be limited or no spouse-employment options or specialty schools.
The more interesting conversations were about workforce redesign rather than workforce supply. Virtual nursing, remote specialty coverage, shared staffing across networks, mobile simulation training, and AI-assisted documentation are increasingly being treated as core workforce strategy, not as technology projects that happen to have workforce benefits.
6. Telehealth is Ubiquitous, but the Framing Has Changed
Telehealth came up in nearly every state-level discussion, alongside behavioral health and workforce. But there was also a cautionary signal worth noting. At least one state association suggested telehealth might be deferred to a future phase of RHTP planning in their state, with workforce and EMS prioritized first.
The takeaway is not that telehealth is losing momentum. It is that generic telehealth (“more virtual visits”) is no longer a compelling pitch. The conversations that landed were the ones tied to specific operational outcomes such as keeping fragile service lines viable, supporting maternal and behavioral health access, enabling rural EMS, extending specialty coverage, and supporting value-based care performance. Telehealth as connected care infrastructure resonates. Telehealth as a standalone product category increasingly does not.
Thinking Past RHTP Funding
The NRHA conference reinforced that rural healthcare is at a critical inflection point. RHTP is a once-in-a-lifetime opportunity to stabilize, redesign, and modernize rural healthcare delivery, but the dominant message was clear: rural health transformation cannot simply fund legacy models. It must create sustainable access, strengthen the rural workforce, enable innovative care models, and improve preventive and value-based care.
The months between now and December, when most state award decisions are expected, will establish the foundation for a multi-year redesign of how rural care is delivered, financed, and sustained. The organizations that win in this cycle will not be the ones with the slickest technology implementations. They will be the ones that engage state ecosystems early, partner with cooperative networks, design programs around workforce realities, and build operating models that have a credible path to surviving the end of the grant period.
Contact us to learn how Caregility can support your rural health strategy!
