A Turning Point for Rural Health: How States, Systems, and Digital Health Leaders Are Shaping What Comes Next

Rural America is in the middle of a rare and powerful moment of alignment. For decades, rural hospitals have been fighting a multidimensional battle: shrinking workforces, widening access deserts, aging populations with rising acuity, and tightening financial margins that make every operational decision existential.

This year, that burden meets an unprecedented opportunity.

Through the One Big Beautiful Bill Act, Congress authorized the $50 billion Rural Health Transformation Program (RHTP), a five-year infusion designed to help states rewrite the future of rural care delivery. States submitted their proposals to CMS in early November, and final funding decisions are expected by December 31, despite federal shutdown delays that required HHS to call furloughed reviewers back to keep things moving.

What happens next will determine whether this becomes a once-in-a-generation modernization of rural healthcare or another fleeting cycle of short-term relief.

Rural Health Needs are Urgent and Growing

Rural communities face higher rates of chronic disease, behavioral health needs, maternal health risks, and care access barriers. The workforce picture is equally stark:

About 20% of the US population lives in rural areas, but only 9-11% of the nation’s physicians practice in rural communities. ¹
74% of rural hospital CEOs report needing more RNs. ²
RN staffing density is substantially lower in rural areas versus metro areas, with roughly 65 RNs versus about 100 RNs per 10,000 patients, respectively. ³

Some analyses suggest that a single transferred patient may represent a lost contribution margin of roughly $10,000, a financial reality that compounds the pressure to maintain local access.

Against this backdrop, telehealth stands out as one of the most consistently emphasized modernization levers. In fact, “telehealth” appears 36 times in the RHTP framework, a signal that virtual care is essential to achieving the program’s goals.

Early Signals: How States Plan to Use Funding

Several states have already taken the lead in publicly sharing their RHTP applications, demonstrating an unusual level of transparency for a grant program of this scale. Details from early applications and announcements include:

Maine proposes $200,942,115 over five years to expand telehealth access statewide. ⁴
Washington plans to allocate $15–18 million annually toward a statewide Provider Technology Fund. ⁵
Maryland, one of the first states to publish its proposal, emphasizes broad community engagement and technology-enabled care expansion. ⁶

These early examples show a common thread: states are prioritizing digital infrastructure, care innovation, and workforce sustainability, even though the strategies vary. In a review of 25+ state RHTP announcements, roughly 90% of states included telehealth hub or network language to advance specialist access through programs like tele-stroke, tele-ED, and tele-behavioral health. Workforce reinforcement and mobile telehealth access were also highlighted as key initiatives by many states.

Some may centralize funding through statewide contracts. Others will distribute funds through competitive grants, regional collaboratives, or direct sub-awards to rural facilities. This variation matters and hospitals that prepare early will have the most to gain.

What Rural Leaders Should Be Doing Right Now

During our recent National Rural Health Association (NRHA) webinar, four national thought leaders – Connor Communications Grant Strategist Angela Connor, MA; Caregility CNO Susan Kristiniak, DHA, MSN, RN, NEA-BC, AHN-BC; Health Recovery Solutions CEO Jason Comer, JD; and Equum Medical Chief Marketing Officer Karsten Russell-Wood, MBA, MPH – outlined a clear path forward for rural health organizations preparing for RHTP funding.

Here are the key themes they shared.

1. Prepare: Understand Your State’s Plan and Build Your Own

With RHTP approvals coming soon, Connor underscored the importance of early readiness, encouraging hospitals to:

Review their state’s posted RHTP application to understand priorities, timelines, and distribution models.
Contact their State Office of Rural Health, which will be central to coordinating sub-grants.
Define strategic needs now, rather than waiting for a grant window to open.
Build programs “as if budget weren’t the constraint,” to respond quickly and convincingly.

The takeaway: When states begin awarding funds, hospitals with clear, shovel-ready initiatives will be far ahead of those still brainstorming.

2. Repair: Rebuild Workforce Capacity with Connected Care Tools

Kristiniak brought the inpatient lens to the conversation: rural workforce strain isn’t theoretical. It shows up in fall rates, throughput challenges, safety risks, burnout, and rising overtime.

She emphasized how hybrid care models such as virtual nursing, virtual observation, remote specialist consults, and AI-enabled monitoring relieve both cognitive and physical burden on bedside teams. She highlighted data points rural hospitals can expect when leveraging virtual care:

Faster admissions and discharges
Reduced overtime
Lower fall and hospital-acquired infection rates
Shorter length of stay
Better HCAHPS and discharge readiness scores

These are not abstract possibilities; they’re real outcomes already documented across community and rural hospitals using connected care models.

3. Care: Extend the Continuum Beyond the Hospital Walls

Comer spoke to the reality that modern rural care must extend beyond the inpatient setting. Longitudinal virtual care models such as Transitional Care Management, Remote Patient Monitoring, Chronic Care Management, and Advanced Primary Care Management are essential to the RHTP goals of keeping patients healthier, at home, and connected to their care teams.

He shared emerging success in areas like:

Maternal health: early detection of cardiac complications and reduced postpartum risk
Oncology: fever flagging, renal monitoring, and symptom tracking
Cardiology and endocrinology: continuous, data-driven chronic condition management

These models are reimbursable, scalable, and aligned with RHTP’s emphasis on high-quality care as close to home as possible.

4. Solve the Specialist Gap with Fractional Coverage and Rural Networks

Russell-Wood highlighted a critical reality: many rural hospitals lose patients because they lose specialists. Recruitment cycles stretch 12 months or more, and locums can cost 1.5 to 2X the cost of a permanent hire.

Fractional models for specialties such as neurology, cardiology, pulmonology, and beyond allow hospitals to “subscribe” to the exact specialist time they need. Combined with regional telehealth collaboratives, this creates:

Faster access to expertise
Reduced unnecessary transfers
Higher revenue retention
Stronger local clinical confidence

These models directly support RHTP goals around sustainability, care access, and innovative delivery.

The Bigger Picture: Rural Health Is Entering a New Era

If there is a single takeaway from the NRHA panel, it’s this:

Rural hospitals cannot succeed in isolation. This is a moment for connected strategy, connected technology, and connected care.

For many rural leaders, this is the first time in their careers that strategic vision, federal investment, workforce innovation, and community need have aligned so clearly. The organizations that use RHTP funding to build durable, tech-enabled care models rather than one-off pilots will define what rural care looks like for the next decade.

Ready to Build Your RHTP-Aligned Roadmap?

Caregility partners with rural hospitals and state agencies to design sustainable virtual care programs aligned to the five strategic pillars of RHTP, from regional telehealth hubs to support specialist access to inpatient virtual nursing and AI-assisted observation.

If you’d like to explore how connected care can support your rural hospital’s transformation strategy, set up a discovery call today.

Virtual Care’s Role in Building Health Equity

In a string of years marred by some of the most challenging times in recent healthcare history, one positive trend is the buzz that has been building around health equity. Recognition of health disparity and the push to reduce it is building.

As providers look to build more accessible and inclusive care models for patients, virtual care has an important role to play. Here are a few examples of how telehealth is helping the cause.

Rural Care Access

Telehealth has long been lauded for its ability to reduce rural health disparity by facilitating virtual access to specialist care for patients in medically underserved areas.

Virtual care encounters also reduce barriers to care for patients who reside far from their local providers. Recent research revealed that patients with longer commute times to care sites were more likely to use telemedicine services, and the likelihood of having a telemedicine appointment grew with increasing commute times. Virtual engagement options similarly improve care access for those who have schedule restrictions and those without reliable transportation, many of whom are also economically disadvantaged.

To mitigate the risk of amplifying health inequity for those without access to broadband or enabling technology, many healthcare organizations are dispensing devices to patients to ensure equitable access to virtual care. Local, community-based outlets are increasingly providing device access, as well.

Engaging with Disabled Patients

One area where virtual care and digital health innovation can play a tremendous role in promoting health equity is within the disabled community. Travel arrangements can be particularly difficult and costly for patients with mobility limitations.

More than 60 million adults in the US have a disability, including more than 4.7 million Veterans with a service-related disability. The CDC reports higher rates of obesity, smoking, heart disease, and diabetes among disabled populations, making it imperative that these patients receive proper care. Virtual-first models ensure the most convenient option is the first line of defense in healthcare delivery.

Virtual engagement is ripe for further innovation in disabled care. As advancements in computer vision and precision eye-tracking enter the market, non-verbal patients are empowered to engage with remote clinicians. The incorporation of eye-tracking into virtual care also introduces new possibilities in the field of remote clinical diagnostics for neurodegenerative conditions such as Alzheimer’s, autism, and Parkinson’s, where problems in the brain can typically be detected in eye function.

Language Interpretation Services

For many patients, healthcare can be out of reach due to communication barriers. This can lead to greater health disparity, particularly within healthcare organizations serving culturally diverse patient populations. Patients with limited English proficiency, or LEP, are at a disadvantage to receive equal access to services due to the language barrier.

By integrating virtual remote interpretation capabilities into telehealth programs, health systems are reducing health inequities for deaf, hard of hearing, and LEP patients. This ensures 24/7 access to high-quality remote interpreters trained to provide culturally competent communication to support patient care. Video-enabled virtual engagement additionally supports ASL-based communication and allows providers to pick up on non-verbal patient cues and body language.

Decentralized Clinical Trial Support

Telehealth is also being used to support greater diversity in clinical trials where minorities have traditionally been underrepresented. Some 50% of FDA trials are conducted in one to two percent of all US zip codes. This limits research into the efficacy of care treatments across diverse populations. Through virtually enabled remote clinical trials, medical researchers can cast a broader geographic net to ensure that the patient sample is more reflective of the population.

Each of these virtual care initiatives plays a part in reducing health disparities and advancing patient care. And we’re just beginning to scratch the surface of what’s possible. As hybrid care and digital health innovation continue to ramp up in the coming years, telehealth will continue to redefine how we think about patient engagement and care.