Beyond Borders: Using RHTP to Build Regional Capacity That Actually Improves Outcomes

Healthcare does not respect state lines—yet much of our infrastructure still assumes it does.

Patients in rural and frontier communities routinely travel for hours to access specialty care. EMS agencies cross borders every day to reach the nearest appropriate destination. Health systems operate across multiple states. And during surges—whether driven by respiratory illness, wildfires, extreme heat, or mass-casualty events—the closest available bed is often not in the patient’s home state.

Despite this reality, most investments in capacity, data, and preparedness continue to be made on a state-by-state basis. That gap—between how care actually flows and how systems are funded and designed—is where the next generation of improvement must occur.

Why is this moment different?

States now have a rare opportunity to rethink how they invest in healthcare infrastructure—particularly for rural and safety-net settings—through the Rural Health Transformation Program (RHTP).

RHTP is often discussed as a tool for rural hospital stabilization. And it is. But it also represents something more consequential: a chance to modernize the operational data and coordination backbone that rural systems depend on—if states are willing to think beyond borders.

Used strategically, RHTP dollars can do more than shore up individual facilities. They can help states collaborate to:

• Extend the impact of each dollar across regional care networks

• Improve access to timely, appropriate care for patients who already cross state lines

• Seed durable data and coordination infrastructure where it is needed most

  
  

This is not about creating new bureaucracies. It is about making smarter, shared investments that reflect how patients move and how care is delivered.

The limitation of state-only investment

Many states are planning RHTP investments around internal needs, including hospital finances, workforce pressures, service line stabilization, and reporting requirements. These are all valid. But for rural and frontier regions, state-only solutions often leave the most complex problems untouched.

For a patient needing behavioral health placement, high-risk obstetrics, pediatric specialty care, or trauma services, the “right” bed may be hours away—and frequently across state lines. When each state invests independently, the result is fragmented visibility, slower transfers, and continued reliance on manual coordination.

A regional lens changes the equation.

For rural patients, access is regional by necessity. Investment should be regional by design.

Making RHTP investments go further—together

The real opportunity is not for states to pool funding in a single pot, but to align investments around shared regional capabilities.

When states coordinate RHTP strategies, they can collectively support:

• Shared situational awareness across natural referral regions

• Faster, more reliable transfer pathways for high-acuity and specialty care

• Reduced boarding and offload delays that disproportionately affect rural facilities

• Stronger surge response without duplicative systems

  
  

Most importantly, collaboration allows states to seed data modernization in the most challenged settings—rural hospitals, small EMS agencies, and overstretched public health teams—without requiring each to build and maintain standalone solutions.

This is how investment scaling impacts without scaling costs.

Data modernization as a means, not an end

RHTP creates space to modernize operational data—but the goal is not better reporting for its own sake. The goal is better decisions at the point of care.

When rural providers, EMS leaders, and public health officials can see regional capacity and constraints in near-real time, decisions change. Transfers accelerate. Surge response becomes coordinated. Rural hospitals gain relief earlier rather than later.

But none of this happens automatically.

Data only improves outcomes when governance, trust, and operating models are designed alongside the technology.

This is where many initiatives stall: technology is procured, but the regional operating model is never fully defined.

Governance: the quiet determinant of success

Cross-state collaboration raises legitimate questions—especially when federal funding is involved. Who governs shared assets? How is data used? How are providers protected from punitive interpretation? How are vendors aligned without locking regions into rigid platforms?

Regions that succeed treat governance as an enabling function, not a compliance exercise. They design it intentionally, with input from states, providers, and responders—before the first dollar is spent.

This is not easy work. But it is essential if RHTP investments are to produce lasting value rather than short-term projects.

A narrow but meaningful window

RHTP provides more than funding—it gives permission. Permission for states to experiment, collaborate, and build infrastructure that would otherwise be difficult to justify.

But windows like this close quickly.

States that move early can shape regional models that endure beyond a single funding cycle. Those who move slowly may find themselves constrained by solutions that optimize for compliance rather than outcomes.

The leadership question for states

The question is no longer whether states can collaborate to make their investments go further. The question is whether they will.

Who will help design a regional approach that allows RHTP dollars to reach more patients, support the most challenged settings, and leave behind a durable capability—not just a completed project?

That is not a vendor decision. It is not a procurement exercise. It is a leadership decision.

If you’re considering how to use RHTP funding to collaborate regionally, modernize critical data infrastructure, and improve patient outcomes—especially in rural and frontier settings—I welcome the conversation.