RHTP is a Stewardship Moment. Not a Race to Spend

The Rural Hospital Transformation Program arrives at a moment of real urgency. Rural hospitals are under strain, workforce shortages persist, and access gaps continue to widen. States are being asked to move quickly—and for good reason. But speed alone will not determine success.

RHTP represents something far rarer than a funding opportunity. It is a stewardship moment: a chance for states to shape sustainable, people-centered programs that improve outcomes for patients, providers, and communities long after the funding window closes.

The risk is familiar. Without intention, RHTP can become a race to get dollars out the door—well-meaning, fast-moving, and ultimately fragmented. When that happens, projects get funded, but systems don’t change.

Start With Alignment, Not Procurement

The most important work in RHTP happens before the first RFP is released.

States have a unique opportunity to pause just long enough to listen—to rural hospitals, clinicians, behavioral health providers, EMS partners, and community leaders—and to understand what is actually working, what is not, and why. This kind of discovery is not slowing work down; it is acceleration in the right direction.

At its best, early discovery helps states:

• Surface operational and workflow realities that rarely appear in proposals

• Identify governance and trust gaps that technology alone cannot fix

• 
  

  Clarify where coordination breaks down across organizations and regions

• Separate what is needed from what is merely available to buy

  
  

When this alignment happens up front, everything that follows becomes clearer and more effective.

Discovery Is How You Protect the investment.

Too often, funding pushes states toward technology-first solutions. Tools matter—but many of the most critical requirements for success are not technical at all.

What frequently determines whether an RHTP-funded effort succeeds is:

• Who owns the work once implementation begins

• How decisions are made across independent organizations

• Whether workflows fit real clinical environments

• How trust is built and maintained between partners

• What happens when the grant period ends

  
  

When RFPs focus primarily on platforms, features, or integrations, these questions are left unanswered. The result is familiar: systems that look good on paper but struggle in practice.

Using RHTP dollars for structured discovery allows states to design RFPs that are:

• People- and outcomes-focused

• Grounded in operational reality

• Explicit about governance and accountability

• Clear about sustainability expectations

  
  

That clarity helps states identify the right partners—not just capable vendors, but collaborators who can operate, adapt, and scale.

Think Regionally, Not Just Locally

Rural healthcare does not respect jurisdictional boundaries. Patients cross county and state lines for care. Providers collaborate informally across regions. Capacity challenges and workforce shortages are shared realities.

RHTP creates space to ask a bigger question: What would this look like if we designed it together?

States that use RHTP to explore regional or multi-state approaches can:

• Increase the return on limited dollars

• Reduce duplication of effort

• Improve access for rural and frontier communities

• Build models that are more resilient and sustainable

  
  

These conversations do not require immediate commitments—but they do require intention and facilitation.

A Rare Opportunity to Get This Right

RHTP is not just about funding projects. It is about shaping how states partner with rural providers and communities to design programs that last.

The states that see the greatest impact will be those that:

• Act as careful stewards of public dollars

• Lead with listening and alignment

• Invest in discovery before deployment

• Design around people, outcomes, and operations—not tools alone

  
  

This is the work I am leading with states today: helping align stakeholders, structure discovery efforts, and translate real-world insight into sustainable programs and smarter procurements. I’m always glad to connect with state leaders who want to use RHTP as a true transformation opportunity—not simply a spending exercise.