{{item.videoDuration}}
{{item.title}}
{{item.text}}
{{item.videoDuration}}
{{item.text}}
Glenn Hunzinger, PwC’s Health Industries Leader, speaks with Thom Bales, PwC’s US Health Services Advisory Leader, and Jill Olmstead, a Principal in PwC’s Health Services practice, about the $50 billion Rural Health Transformation Program, how states are deploying funds, and what sustainable change could mean for rural communities.
Prefer to read instead of listen?
We’ve summarized the discussion in a short Q&A so you can get the highlights in minutes.
What makes the Rural Health Transformation Program different?
Q. Glenn Hunzinger
Why is this moment different from prior rural funding efforts?
A. Jill Olmstead
This is a once in a generation opportunity. Past funding focused on stabilization. This program is designed for systemic change and long-term sustainability.
It also engages the full ecosystem, not just hospitals, and ties funding to measurable outcomes. Future dollars depend on performance.
Where are states concentrating their investments?
Q. Glenn Hunzinger
What priorities are emerging?
A. Jill Olmstead
Workforce remains a central focus, but states are approaching it through a sustainability lens. Many are expanding care teams and encouraging providers to practice at the top of their license to increase access in rural communities.
States are also advancing value-based care models and regional partnerships that connect rural providers with broader health systems and resources to improve access, quality, and long-term stability.
How is technology supporting transformation?
Q. Glenn Hunzinger
Where does digital innovation play a role?
A. Jill Olmstead
States are investing in virtual care, remote monitoring, and shared data infrastructure.
Modern systems and AI enabled tools can lower costs, strengthen collaboration, and support participation in new reimbursement models.
What does successful execution require?
Q. Glenn Hunzinger
What should providers prioritize as funding begins to flow?
A. Thom Bales
We are in year one of a five-year program. Providers must stay aligned with state strategies and coordinate internally across technology, footprint, and partnerships.
Strong governance, milestone tracking, and outcome reporting will be essential given the oversight attached to these dollars.
Where is the greatest execution risk?
Q. Glenn Hunzinger
What adds complexity?
A. Jill Olmstead
States are managing shared performance measures across broad ecosystems. Sub awardees must align with those expectations.
For multi-state providers, differing requirements increase reporting and compliance complexity.
If this succeeds, what could rural transformation look like in three to five years?
Q. Glenn Hunzinger
What changes might communities see?
A. Thom Bales
The goal is durable sustainability, not short-term relief. That could mean modernized infrastructure, digitally enabled care models, and redesigned workforce strategies.
Done well, these investments become embedded in long term financial structures that improve access and stability.
What should leaders be doing now?
Q. Glenn Hunzinger
What is your advice for healthcare organizations?
A. Jill Olmstead
Engage your state’s strategy and identify where you can contribute. Prepare for compliance and reporting requirements.
Most importantly, focus on initiatives that will deliver measurable impact and long-term value for rural communities.
What gives you optimism about this moment?
Q. Glenn Hunzinger
What excites you most?
A. Thom Bales
Strengthening clinician presence and equipping providers with better tools is meaningful. This program creates the opportunity for more personalized, locally relevant care supported by sustainable funding models.
Speakers
< Back
< Back
[+] Read More
Episode transcript
Find episode transcript below.
Welcome to PwC’s Next in Health. I'm Glenn Hunzinger, PwC’s U.S. Health Industry Leader. Today we're talking about rural health care and not in the abstract. Over the past decade, we've seen mounting pressures, hospital closures, workforce shortages, aging infrastructure and razor thin margins. Now, with the Rural Health Transformation Program or RHTP, there's $50 billion of federal investment that's pouring in.
00:00:31:11
So the real question is, are we at a real inflection point? Is this just another round of temporary stabilization, or is this really a once-in-a-generation opportunity to truly redesign and transform rural health? Joining me today are Thom Bales, our U.S. Health Services Advisory Leader, and Jill Olmstead, a Principal in PwC’s health services practice and one of our leading voices on rural health and rural-health transformation.
00:00:58:01
Thom and Jill, welcome.
THOM BALES:
00:00:59:10
Yeah. Thank you, Glenn, happy to be here.
JILL OLMSTEAD:
00:01:01:08
Thanks for having us.
GLENN HUNZINGER:
00:01:03:08 Let's jump right in. We got some fundamental questions here as we think about this topic. How is this program different? What are the states prioritizing? What does it take to execute? What does that transformation look like and what should leaders be doing?
00:01:18:16
So as we think about the program, Jill, maybe let's start with you. We've seen relief funding before. What makes the Rural Health Transformation program different and why is now a different time?
JILL OLMSTEAD:
00:01:30:03
Yeah. Glenn, thank you for asking that. I really do feel like this is a once-in-a-generation opportunity. So, while we've seen relief funding like what came with COVID and we've also seen block grants that have really subsidized the facilities and the clinicians working in rural health,
00:01:51:01
this is really fundamentally a different program, because what we're looking to see happen here is transformation within the system and transformation that leads to sustainability in rural health. And while previously rural health efforts have been targeted just to the rural hospitals, this is engaging the entire ecosystem to create more sustainability and health in general.
00:02:17:09
And so I'm excited about those opportunities. Another thing that's different is really the accountability here. So, block grants historically have not had a lot of teeth. But this is really where CMS taking the lead on this effort and tying it to its financial programs, along with the structure as a cooperative agreement, gives the federal government a larger role.
00:02:41:11
And they've already shown in terms of how they've reviewed applications and working with the states to set their budgets, that they're going to lean in and require results. Future funding is going to rely on that. And so, it's really exciting to see the push towards results in rural health.
GLENN HUNZINGER:
00:02:59:03
Yeah, it certainly seems like outcomes and accountability for those outcomes are super critical right now. So, with that, like what are states doing and how are they actually prioritizing the idea of funding and what they're going to do with it?
JILL OLMSTEAD:
00:03:12:00
Yeah. So, the way the program is structured is around a set of goals to achieve and a set of initiatives. And each of the states applied, making sure that they're covering those areas, not all of them, but doing the things that are right for their states. I think there are a number of things that we've seen, though, that are common themes across the states.
00:03:33:04
So, certainly workforce, which has historically been an initiative for rural health, has been one thing that they've looked at, but from a different lens. So, from a sustainability perspective, it's not just funding the workforce and creating new positions. It's also creating greater access to care, not just for the patients, but making sure we have more providers positioned and available for rural health and that definition of those providers is evolving.
00:04:02:10
And so the states have been asked to expand what it means to work at top-of-license and expand who really is involved in delivering care. So, we've all talked about nurses working at top-of-license in the past. This is really expanding that pool and getting creative. So that we're talking about pharmacists now. We're talking about dental hygienist.
00:04:24:01
We're talking about community health workers. Beyond the workforce, I think we've seen a number of other initiatives that are common across the board. Value-based care and making that sustainable for rural hospitals. Traditionally, that hasn't been the case, but what are the new models that we can use and the financial support for those to make that sustainable in rural hospitals?
00:04:48:00
The other things that we're seeing are partnerships. Typically, on a regional basis, many states are taking a regional approach to link folks in rural areas, really to likely the closest other resources in healthcare that can help get access and improve quality by working with them.
GLENN HUNZINGER:
00:05:05:08
Jill, that's interesting as far as thinking about workforce and everything else. Obviously, there's a tremendous amount of push when we think about technology, robotics, all the digital capabilities, telehealth. How are all the states thinking about that when we think about rural health?
JILL OLMSTEAD:
00:05:21:05
That's a great question, because technology not only plays a major role in innovating and modernization, but also with the opportunity to increase accessibility and potentially to bring down the cost of care. So, we've seen that in most state plans that they do have innovation funds in a number of states.
00:05:41:02
But the role that technology will play definitely hits on the areas that you've touched on. So, remote patient monitoring, virtual care, all sorts of other services. We're also seeing state-wide infrastructure when it comes to augmenting the health-information exchange with other capabilities in using shared platforms, whether it's HIEs or something different to make AI tools accessible to folks in rural health.
00:06:09:06
So, all sorts of different uses. And then at a facility level, potentially sharing technologies is a cost-saving measure, creating access to more modern electronic health records for rural hospitals that really enable them to participate and collaborate with others in a different way.
GLENN HUNZINGER:
00:06:27:20
Yeah. And certainly, we've spoken at great length about the fact of just the capital that's needed to sort of modernize everything. I think this certainly gives the added bolster that hopefully we can move rural health really to that next level of transformation that we've been speaking about as far as what's needed in the world of health and certainly technology as a huge enabler.
00:06:49:02
So thank you for that, Jill. And when we think about the execution on it, maybe I'll kick it over to you, Thom, when you think about from a provider perspective, obviously, a lot that the states are trying to do, a lot of federal funding is trying to get after was rural health. What does this actually take to execute on it in your mind?
THOM BALES:
00:07:06:06
Thanks, Glenn and Jill. So, just a few things to think about. So first of all, start with — we’re in year one of what’s five years of funding. And so, every year, there'll be $10 billion that gets released. And so, in year one you have to imagine that literally hundreds if not thousands of points of input were provided to the states are on how to use these dollars.
00:07:27:01
They have each put forward their plans for what they think the most effective use is to drive value-based care sustainability in rural health. And then they're going to start to get into no kidding, design efforts, really understanding their technology landscape, who the partners are and how they play out. As a provider and or as a payer or as a community service organization in this space,
00:07:51:06
many of you have already provided some of that input. It is more important now that as the dollars start to come in to be alert, tapped in, understand what your communication strategy is with your state and local government on that. And to think about how is it that information is coming back to your organization and being passed on to those individuals that may be making footprint decisions,
00:08:15:10
those people that may be making technology decisions? And how are you going to manage that information as it comes in? And that's just simply to understand how do you think about what you need to do, and how is it that you get the most out of the dollars that are coming into the states that you are engaged in?
00:08:29:13
Then as that comes through state funding and federal funding comes with a fair amount of oversight. And so, there's the monitoring of the dollars. There's the controlling of it. There's the reporting against that, all on sort of the controls and governance side. And then on the operations side, there are obligations around how is it that you participate,
00:08:50:20
ensuring that you meet the milestone deliveries, that you understand what those requirements are that may be coming from the state for your systems or from their alliance partners, that they may be working with their technology partners. And then lastly, you have to imagine this as being a federal and then subsequently a state program,
00:09:08:07
that there have been a lot of interest around the outcomes that are produced from this. And how is it that you track and report against those for your consumers, for state-interested parties, and just for the community that you're a part in? It is a lot. And at the same time, it has really just tremendous, tremendous upside for our rural health communities.
GLENN HUNZINGER:
00:09:28:03
So, Jill, with everything Thom just said, where do you see the greatest execution risk here? Obviously, there's a ton of complexity at the state level and compliance requirements. But then, we just talked a little bit about this because obviously it's great that we're talking about $50 billion, $10 billion a year.
00:09:44:19
But what does it mean to be able to make sure you're executing on that, to accomplish obviously the outcomes and transparency that everybody wants?
JILL OLMSTEAD:
00:09:52:06
Yes, I think it's really a couple different layers of complexity, Glenn. So, I think if your state, states are used to managing grants, but this is one that really requires engaging in ecosystem and creating sub awards and subcontracts to that. And while there will be multiple parties, they have one set of performance measures that they're putting up to the federal government that they've had approved.
00:10:19:06
That will be the expectations that they set really around this whole community. So, depending on how they do their awards to subsequent organizations or how they manage their grant money themselves, there's going to be a certain level of complexity there based on the number of players at hand and the different roles that they have.
00:10:38:02
I think if you go to that next level and let's say you're an organization that is a sub awardee to this overall grant program — one, you're going to have expectations that flow down from the state that you're in, but you also have circumstances where certain organizations and I'll say, for example, providers that are operating in multiple states, you're going to have that complexity of multiple-state requirements.
00:11:07:03
So, when we see how systems that are operating in maybe five, ten more states, you've got to manage the requirements against those states and their plans, the initiatives that you may want to coordinate across your enterprise as well as within the individual states. And then you've got to reconcile all the compliance and performance reporting that goes with that.
00:11:32:02
So, things that we might normally run as strategic initiatives out of the enterprise and do one set of reporting may wind up varying significantly based on the number of states that you have. And so that will drive both state-level and enterprise-level reporting. So, you can see there's kind of a couple layers here where it can get a little tricky in terms of how it's managed.
GLENN HUNZINGER:
00:11:55:10
Lots of nuances to sort of work with, some of which I imagine that's probably not the exciting part of this. Thom, if you think about the excitement of what true transformation looks like, maybe talk a little bit about what would that look like in 3 to 5 years when we think about the rural markets?
THOM BALES:
00:12:13:10
Sure, Glenn, and it's a great question because there's been debate around how does this $50 billion really get used? And the intent of it is in the title of the program and it is transformation. And so, where the debate has been is today, there are gaps in care in the rural community, access to care in the rural community, lack of clinicians in the rural community and then reimbursement and in some cases where the need is very great —
00:12:36:18
this has been thought of, is this just a sort of a shot in the arm? And I don't think anybody wants it to be just a shot in the arm. What they're looking for is sustainability. And so, where we have aged infrastructure to shut that down and replace that with modern architectures, footprints, sites of care that can be sustained, perhaps at a lower cost, more digitally and technically enabled.
00:13:00:03
We're looking at labor models that, it's certainly about telehealth, but it's about telehealth and digital in ways that maybe allow for clinicians to travel into communities from time to time and provide that access to care. And so that's both the people and the technology component that come together.
00:13:16:07
It's looking at ways around how do you sustain that workforce by providing the education both within those communities, having a strategy for it for your state specifically to ensure that the clinicians match the population needs of your residents. It's looking at how do you establish regional partnerships? Healthcare extends, and we've talked about this for years as well, beyond the four walls of a hospital.
00:13:40:05
And so what are those community-service organizations that are out there? What are those organizations that may be, perhaps in the space of education that help us with those clinician shortages that are out there and then technology and many other kinds of institutions and organizations that will need to come together,
00:13:56:07
so that when we're through the $50 billion, what we have here is actually a durable, long-term financial structure that can persist over the course of time. And so those costs that are associated with us now are embedded as a part of the cost of delivery of care in those states. And then some of the costs that we have today that may be a little bit higher than where they need to be have been reduced. And so that net is sustainable and can be persistent.
GLENN HUNZINGER:
00:14:25:03
Yeah. It's tremendous. The idea of being able to really transform, I think, is super exciting. And Jill, with that excitement, what conversations are you having with healthcare leaders right now and what are you advising them as far as what they should be doing?
JILL OLMSTEAD:
00:14:40:03
Really it starts with getting engaged, Glenn. So, for folks who haven't been at the table with their state, encourage them to really go out to that state website, make sure you understand what they're asking for and look at how you can engage. So, many of the states are offering webinars and other forums to really help folks understand what their requirements are
00:15:04:03
and how they can contribute, because these states want to drive performance. So, understanding that state strategy and being out there with your organization is really key right now. We think the other thing is understanding internally how your organization can contribute. And it's not just what you can do on your own as an entity.
00:15:24:03
But as Thom mentioned, there are lots of players in this ecosystem. And because we're talking about systemic change, bringing those partners to the table for the things that you want to accomplish as a part of this program is part of that as well. So, we are encouraging looking internally for what you want to do strategically if you have something to offer as part of the program, or if you're a rural hospital that really needs strategic help in some key areas.
00:15:52:01
We're definitely encouraging that. There are organizations who are participating who have and have not dealt with federal grant money before, and for those that may have less experience or maybe haven't dealt with that, really understanding the compliance and reporting requirements is something that we want to make sure folks are focused on.
00:16:13:09
The last thing we want is folks not being able to execute, demonstrate their performance and to be compliant, because we know this has implications for this program. Some of the teeth I talked about means that this money can be pulled back. It's not guaranteed for future years. So, this is really something to pay attention to.
00:16:34:09
More so than even past efforts. And then really, we want to think about impact. What are the things that you want to do that will make the most impact? Because we know there's a lot going on. There's a reason there will be multiple stakeholders in each state and even as folks begin to collaborate more beyond a single state.
00:16:55:30
So we want to make sure that folks are really looking at what's going to maximize that impact. How are you really going to focus your time knowing you can't do everything, but what are the right things for your organization and the right things to achieve the goals of this program?
GLENN HUNZINGER:
00:17:09:00
Yeah, that's super helpful. And obviously, when we think about where the funding goes and your comments on workforce stabilization, using technology to sort of modernize changing models. Thom, leaving our listeners with a lasting thought, what's the most exciting thing to you? What are you seeing from the states?
00:17:29:02
Obviously, there's a lot of just shoring up where rural health is, but what kind of innovations or ideas are coming from the states right now? Knowing that some of this and their ideas is all public sort of information.
THOM BALES:
00:17:39:12 So there are a few things that are coming out of this that are really exciting. So first of all, let's just remember every state is slightly different in this. And so what rural means in their state, how far away is it that they're from the access that they need varies. And in many cases, as much as we like to think about digital and telehealth and technology
00:17:59:04
and what's going on, the most urgent need is actually around ensuring that there are clinicians available in the rural community, whether that be present on foot or present via telehealth, that are available to the members and the patients that are in those communities. And so, there's a part here which is around shoring that up that I think is incredibly exciting.
00:18:19:05
And then I think it's very much about giving the tools for those providers, those health systems to better address the actual care problems, very, very specific to what may be different in a state that's in the North versus a state that's in the South, in a way that over the course of time will look like more personalized care better suited for the rural consumer that is a resident in that state.
00:18:44:04
So from that aspect of shoring up the clinicians and better personalizing the care that the rural members and patients get, I think it's incredibly exciting.
GLENN HUNZINGER:
00:18:53:00
Yeah. And I think that visual of the rural patient and what we've sort of outlined in some of our future of health, I think it ties right with that. So, super exciting. There's no doubt that rural health care has sort of been under this strain for years. But you're right, this moment does feel different. The opportunity is substantial.
00:19:12:01
Clearly, the timeline is fast and escalating and organizations that collaborate, innovate and scale thoughtfully here will really help define this next chapter of rural health. Jill and Thom, thank you so much for your insights here. Hopefully, our listeners find it interesting as well. And thank you all for tuning in to PwC’s Next in Health.
00:19:32:08
For more on these topics and other insights across the health industries, please subscribe to our podcast at pwc.com/U.S./Next in Health podcast. Until next time, this has been Next in Health.
FEMALE VOICEOVER:
00:19:54:00
This podcast is brought to you by PwC. All rights reserved. PwC refers to the US member firm or one of its subsidiaries or affiliates and may sometimes refer to the PwC network. Each member firm is a separate legal entity. Please see www.pwc.com/structure for further details.
00:20:13:06
This podcast is for general information purposes only and should not be used as a substitute for consultation with professional advisors.
{{filterContent.facetedTitle}}
{{contentList.loadingText}}
{{contentList.loadingText}}
Contact us
Follow us
