As part of the Rural Health Transformation Program, 42 states are expanding or establishing new alternative payment models, a recent analysis shows.
The analysis (PDF) was conducted by nonpartisan think tank USofCare and was based on state summaries compiled by the Centers for Medicare & Medicaid Services (CMS). All states included proposals to boost the workforce through scope of practice changes, expanded roles and new incentives.
The $50 billion program ($10 billion per year over five years) was established as part of President Donald Trump and his party’s H.R. 1 bill with the goal of improving rural healthcare nationwide and to partially offset the legislation's broader cuts to healthcare funding.
Most states are focused on payment models that promote “patient-first care,” per the analysis, which is what USofCare calls value-based care. These models can provide hospitals with financial stability, improve health outcomes and lower costs.
“We know this resonates with people. We know people want care coordination, we know people want whole-person care,” Eric Waskowicz, senior state policy manager at USofCare, told Fierce Healthcare. “We see an investment as a way to kind of move the ball forward there.”
Some states, like Georgia, are planning to leverage the CMS’ Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model to shift to value-based care. Georgia plans to use funding to allow more providers to participate in AHEAD by covering startup costs and offering technical support. Rhode Island, which already participates in AHEAD, will use new rural funding to support the transition to hospital global budgets through incentive payments and technical support. North Carolina plans to invest in supporting the shift toward hospital global budgets and primary care capitation payments. USofCare has published a resource (PDF) outlining the latest changes to the model.
The vast majority of states are, unsurprisingly, prioritizing investments in telehealth and digital health. “Telehealth plays a really important role in connecting these people to care they deserve,” Waskowicz said. “This is reflective of people’s needs.” Twenty states are also proposing initiatives promoting access to mobile and emergency medical services.
Further, nearly all states placed an emphasis on chronic disease prevention and management via preventive care and care coordination efforts.
Under the statute, half of the $10 billion-per-year distribution is split between the states evenly. The remaining half is determined by the CMS based on how well the states’ pitches met goals of strengthening rural health prevention, standing up sustainable access, developing a rural workforce and introducing innovative care delivery and technology.
States are currently still negotiating with the CMS and finalizing their budgets. Funding is expected to be dispersed starting in October, the start of the federal fiscal year. The first reporting metrics as part of the program need to be addressed in the next six to eight months, Waskowicz said, so states need to be thoughtful about implementation.
“Something like this, it can’t just be a plug-the-hole solution. This needs to be a long-term, durable solution,” Waskowicz said of value-based care. “For so long, there’s been this kind of nibbling on the edges, and we want to make sure the money being used as part of this program is effective, is stabilizing rural healthcare and infrastructure and ensuring long term stability.”
States with larger rural populations like Texas and California generally received larger state awards compared to smaller, more urban states, like New Jersey and Connecticut, the analysis found. At the same time, the amount of funding per rural resident varied, with Rhode Island receiving significantly more ($6,305) per rural resident than Texas ($66), for instance.