Partners in Rural Health Transformation: From Framework to Function

Rural health systems continue to face structural challenges that are unlikely to be solved by any single program or funding stream. Workforce shortages, fragile provider finances, limited infrastructure, and geographic barriers remain persistent realities. The CMS Rural Health Transformation (RHT) Program reflects a federal effort to support states as they address these issues, but its success ultimately depends on how well the framework is adapted to local conditions and operationalized over time. 

As states move from planning into implementation, the focus is shifting from program design to execution – where tradeoffs, capacity limits, and sustainability considerations become more visible. 

State Leadership Within Real-World Constraints 

The RHT Program places states in a central coordinating role, asking them to translate broad federal objectives into strategies that fit diverse rural contexts. In practice, this means navigating differences across regions, aligning multiple stakeholders, and making decisions with incomplete data and limited administrative capacity. 

Early state experiences point to the importance of pacing and prioritization. Engagement with rural providers and communities is essential, but it requires time, trust, and consistent communication. States are also confronting the challenge of designing initiatives that can be maintained once RHT funding sunsets – often requiring difficult conversations about scale, scope, and long-term financing. 

Rather than sweeping transformation, many states are focusing on incremental improvements that can realistically be supported within existing systems. 

Health Plans as Implementation Partners 

Health plans are a key part of how RHT efforts move from policy to practice. Their role extends beyond reimbursement to include data sharing, care coordination, and provider support. However, alignment between state RHT goals and managed care operations is not automatic. 

Rural markets often lack the volume, infrastructure, and staffing that many value-based models assume. As a result, states and plans are working through how to adapt payment approaches, provide technical assistance, and reduce administrative burden on rural providers. Early lessons suggest that progress depends less on novel contracting models and more on practical coordination, clear expectations, and sustained collaboration. 

“Pilots that cannot transition into routine operations are unlikely to have lasting impact, regardless of their technical promise.”

Innovation With a Narrower Margin for Error 

The RHT Program encourages innovation, but rural environments leave little room for solutions that require extensive customization or ongoing external support. States are becoming more selective in how they engage startups and technology vendors, emphasizing reliability, integration with existing workflows, and demonstrated value in similar settings. 

For innovators, success increasingly depends on understanding state procurement processes, rural provider capacity, and the realities of implementation at small scale. Pilots that cannot transition into routine operations are unlikely to have lasting impact, regardless of their technical promise. 

AscendRural’s Role as an Intermediary 

Across these dynamics, AscendRural functions as an intermediary rather than a driver—helping states, plans, and innovators interpret the RHT framework, share implementation lessons, and identify approaches that are feasible in rural contexts. By convening stakeholders across sectors and states, AscendRural supports learning that is grounded in practice rather than theory. 

This role becomes particularly important as states compare notes on what is working, what is not, and where adjustments are needed. 

Moving Carefully, but Forward 

The RHT Program does not offer a comprehensive solution to rural health challenges, nor was it designed to. Its value lies in providing structure and resources that states can use selectively and pragmatically. Progress will likely be uneven, incremental, and shaped by local capacity. 

What matters most is not the pace of change, but whether the changes that are made can be sustained. That outcome will depend less on ambition and more on coordination, realism, and long-term commitment from the partners involved. 

Want to explore how rural health transformation is being implemented on the ground? Join us for a three-part webinar series to explore the roles of startups, health plans, and state leadership. Register now >