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Becker’s Healthcare Podcast
Krista Drobac of Health Policy Futures Lab on the Rural Health Transformation Program
00:13:49
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- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.
- [00:32]
B
Hello and welcome to the Becker's Healthcare Podcast. My name is Chanel Bunger. Today I have the pleasure of speaking with Krista Drobeck, partner at Sirona Strategies and co founder of Health Policy Futures Lab, who joins the podcast today to discuss how the Rural Health Transformation Program is reshaping support for rural health care, its core components and timeline, and a bit more. Krista, thank you so much for joining me.
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C
Thank you for having me.
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B
Perfect. Well, before we dive in, can you talk a bit about your background and your journey from the Senate and CMS to the work you're doing now in rural health?
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C
Yes, I have been in D.C. most of the last 30 years. I did have a stint as the Deputy Director of the Illinois Department of Healthcare and Family Services, and I also ran the Health division at the National Governors association, specifically the center for Best Practices. So even though I'm in Washington and work a lot on federal issues, I have a state experience and I really enjoy working on issues with states because they're on the ground and very solvable.
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B
Thank you so much for the introduction. And now diving into our topic, can you give us a broad outline of what the Rural Health Transformation Program is and how does it differ from past efforts to support rural healthcare?
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C
In the Big beautiful bill, there were changes and cuts to Medicaid that made it difficult for rural hospitals. So the Rural Health Transformation Fund was a $50 billion program set up to transform rural health care. The idea was to make investments that would make long term rural health care sustainable and accessible. It is administered by cms, but the money goes to state government and it is, as I mentioned, a five year program. There is a one time application and then $10 billion is distributed every year for five years.
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B
Got it, got it. And building on that, what are the core components of this program? And you kind of gave us a timeframe with five years, but can you dive a little bit deeper into that?
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C
So there are 11 buckets for the uses of funds, and states in the application had to choose at least three eligible uses of these funds. So I'm going to run through the buckets very quickly. Rural workforce and training clinical services and those are non billable clinical services. So you can't duplicate services that are in Medicare and Medicaid partnerships, state policy actions, Medicaid incentives, technology and data prevention and population health, EMS services, consumer engagement, capital infrastructure and then other innovations. Like you could use the money to set up a, like an initiative whereby you get matching funds from the private sector and you distribute funds that way. So just to go back and hit a couple points on these 11 buckets, the clinical services, as I mentioned, cannot duplicate what is already covered in Medicare and Medicaid. So there had to be a lot of creativity on clinical services because anything that has a CPT code can't be included in clinical services partnerships. That's like strategic collaborations and provider networks. We saw a lot of partnerships through a hub and spoke type model in applications and then things like EMS services. Really interesting new ideas around community paramedicine and treat in place. So each one of these buckets had states that came up with ideas in their applications that were somewhat novel.
- [04:33]
B
That's really helpful context. Now a lot of our listenership are hospital and health system leaders. So I'm sure they're curious about what their role is in this program or I guess like what is the role of hospitals in this program.
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C
The legislation was clear that states could not formulaically distribute this fund to hospitals. There is a cap on the amount of money that can actually go to providers. But hospitals are at the core of this program. The reason is because they are the ones that are working with the state on how to deploy some of the new technologies and infrastructure that the state wants to spend this money on. There was a meeting in Alaska, for example, whereby Alaska brought in tech providers and folks that really can stimulate innovation in rural healthcare. And they told them, you have to have provider partners in Alaska. We're not just going to buy a tech tool, we want you to work with providers. That is one model where hospitals are working closely with the states and they're part of applying for it and also partnering with vendors. Then there's the other side, which is also a prominent strategy among states, which is to have the state buy licenses for rural hospitals. So instead of each hospital contracting with a separate tech provider, this is where the state can say, you know, we know that you're extremely busy keeping the doors of your hospital open and working on operational issues and we want to invest some infrastructure for you. And so we're going to buy a tool and then provide the licenses to you if you meet these criteria. And in that case, the hospitals can be the beneficiary of infrastructure investments. And in those states there is a lot of hospital input. So I would say every single state has had lots of stakeholder engagement road shows to hear what hospitals need for the future and what kinds of investments are needed that are not under. Typically what we have is our funding streams today, like Medicaid, for example. So I'd say heavy engagement. And if you're not already engaged with your state, you should be. And certainly your trade association at the state level is engaged with the state. I know that in every state the hospital associations have been very active.
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B
Absolutely. And now can you talk about the different kinds of innovations or care models that you are seeing emerge from this program?
- [07:20]
C
Yeah. So I was interested to see what would come up because of this prohibition on duplication of services, if you can't duplicate what's already has a CPT code. You know, you've got to be creative. And one of the things that I found really interesting was the mobile units. More than 25 states have put mobile units in their applications. And those are all the way from prevention, which is something, you know, like a breast cancer screening bus, for example, all the way to interventions. So having a fully equipped vehicle that can do procedures in a community. So I thought mobile units was a really interesting innovation. That is not duplicative innovation. We also saw treat in place ideas. So can EMS services, instead of picking you up and taking you to a provider location, can they do more to treat in place because the scope of practice of EMTs and paramedics is higher than you would think. They can maybe do more on site. Remote patient monitoring was throughout applications. How do we transmit biometric data from patients with chronic disease to a health system or provider so that we can better monitor people with chronic disease and potentially keep them from having to drive 25 to 100 miles to a hospital? I will say there are a lot of hub and spoke models that are parts of these applications and that is really how do you create a clinically integrated network where you have these like tertiary institutions at the center that are a higher capability facility that then have smaller distributed care sites like rural clinics or primary care clinics in rural areas that then can connect in with that central location. So those are some of the innovations. And of course there are many more. Nutrition value based care, lots of prevention. So if anybody's interested, the Health Policy Futures Lab definitely has a compilation of all the applications and would be happy to share.
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B
Got it. Got it. Thank you so much. And now as you think about the future, would you say that this model is financially sustainable long term for both hospitals and the government?
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C
Oh yes, absolutely. The whole entire idea of the Rural Health Transformation Program is to create longer term sustainable future for healthcare in rural areas. All the states are focused on not just creating one off pilots or programs but are how do we invest in a way that can become sustainably over time. So our effort, and I think those of the states and CMS is to always look five years down the road and not just year by year investments. So I think most of the folks who are engaged in this at all levels, even the vendors know that this money is finite and that the investments have to be self sustaining over time and have to be evaluated on an ongoing basis because if they're not working then we need some rapid cycle changes because again the money is just not going to be there in perpetuity.
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B
Absolutely. And now looking ahead and to bring it all home, what should hospitals expect to see in 2026 from this program?
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C
So in 2026 CMS has already announced the awards. So it's about 200 million, you know, but around 200 million per state. And they are currently in the process of signing cooperative agreements with states. Some states are required to get legislative approval to spend money and the those states are going to take a little longer to send out their requests for proposals. But, but we expect to see those in, you know, March, April, May and some have already come out and essentially the request for proposals are fulfilling what the obligations that the state said they were going to fulfill in their application process. And states have to start reporting in to CMS this fall. So everyone is in a big hurry to get those RFPs out and get some of this money obligated because they have to start telling CMS what they're doing with, with these funds. So I would expect to see in Fairly rapid succession RFPs coming out in all, in all states. And I'm imagining that many hospitals are probably getting incoming calls from, you know, vendors and AI companies who are want to work with them to fulfill some of the obligations of the states in their application. So it's going to be 2026 is going to be a very busy year in the Rural Health Transformation program.
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B
Absolutely. Well Krista, I want to thank you for your time today. But before I let you go, for hospital and health system leaders or just anyone that's interested in this program, where.
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C
Can they learn more health policyfutureslab.org we have a resource page. We have webinars. We're having one tomorrow. We have events. We're having a big event June 9th in Washington, D.C. it's open to all. The registration is on our website. And we will be talking to state leaders and CMS and those hospitals who are already working in RHTP in June. So I would welcome everyone to come to Washington for that event on June 9th.
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B
Got it. Well, Krista, I want to thank you once again for your time today and for sharing your insights on the Baker's Healthcare podcast. Thank you so much.
- [13:45]
C
Great. Thank you.