By Patrick Quinlan, MD

$50 billion in RHTP funding won’t save rural healthcare if we keep investing in more of the same. For years, everyone involved in rural healthcare has known what the problems are. Now we need to fix them by investing in solutions that can be deployed in weeks – not years – and deliver measurable improvements in patient volume, hospital margins, and quality of care.

Hospitals operate on extraordinarily thin margins. Clinicians are increasingly difficult to recruit and retain. Specialist access is disappearing from many communities. Rural populations tend to be older, have higher rates of chronic disease and face greater barriers to preventive and specialty care.

The latest numbers underline just how precarious the situation has become. According to Advisory Board, the average rural hospital margin is around 2%, compared with an industry average of 8%, and nearly 14% of rural hospitals are now considered at immediate risk of closure. And, 41% are operating in the red. The solution must return volume, revenue and effective care to rural hospitals, not just automate to cut costs.

Against that backdrop, the Rural Health Transformation Program (RHTP) represents a once-in-a-generation opportunity.

States now have access to billions of dollars specifically intended to stabilize and transform rural healthcare through 2030. The first funding decisions are being made. RFPs are appearing. Projects are moving forward.

We are about to find out what “transformation” actually means.

And that is where things get interesting.

A lot can hide behind the word “transformation”

The healthcare research firm, Advisory Board recently examined early RHTP activity across the country. Its May 2026 report identifies six areas attracting investment: workforce recruitment and retention; workforce education and pipelines; access and care delivery; infrastructure and capital; technology and data; and system coordination and technical assistance.

There is plenty to like in that list. Rural communities desperately need investment in all six.

The concern is what happens when hundreds of individual funding decisions accumulate into a five-year, multibillion-dollar program.

It is entirely possible to spend an extraordinary amount of money improving pieces of the current system while leaving its underlying limitations largely intact.

A hospital can upgrade its technology and still struggle to provide specialty care. A state can invest heavily in recruitment while shortages continue to grow. New facilities can improve access locally while the clinicians required to staff them remain scarce. Digital health investments can expand rapidly without materially changing clinical workflows.

Each project may be perfectly defensible on its own. By 2030, however, we should expect something considerably more ambitious than a collection of individually defensible projects.

The workforce problem requires a different equation

Workforce is understandably receiving significant attention.

Iowa, Nevada, Texas and West Virginia are among the states investing in recruitment and retention. Hawaii, Georgia and New Hampshire are investing in education and workforce pipelines.

These investments matter. Healthcare workforce shortages are national. Rural America needs more clinicians. But there is also a demographic reality that no grant program can wish away.

Specialists are particularly scarce. Rural communities are competing for the same limited pool of clinicians as large health systems and growing metropolitan markets, frequently without the salaries, professional opportunities or infrastructure those markets can offer.

Recruitment will remain part of the solution. Building an entire rural health strategy around recruitment is much harder to justify.

RHTP gives states the chance to change the workforce equation itself. Imagine measuring success partly by how much additional clinical capacity each investment creates from the workforce already available.

A specialist who can effectively support several rural communities has greater reach. A nurse, medical assistant or community health worker who can collaborate directly with remote specialists becomes capable of supporting more sophisticated care locally. A rural hospital that can access clinical expertise remotely may be able to manage patients who previously required referral or transfer.

That changes how we think about workforce investment, with clinical capacity becoming just as important a measure as headcount.

Geography shouldn’t dictate the level of care

One of the more encouraging findings in the Advisory Board report is the emphasis some states are placing on access and new care-delivery models.

North Carolina, Pennsylvania and Wisconsin are cited for investments including mobile units, satellite clinics, mobile integrated health and hub-and-spoke models.

Meanwhile, Minnesota, South Carolina and Washington are pursuing technology and data initiatives including remote patient monitoring, interoperability and digital health infrastructure.

There is a powerful opportunity where these priorities intersect.

For most of modern healthcare, expertise and location have been tightly connected. If a patient needed a specialist, the patient travelled to wherever the specialist happened to be. Usually a regional facility many miles away.

That model becomes increasingly difficult to sustain when patients are spread across large geographic areas and specialists are concentrated in regional and metropolitan centers.

Virtual care can change that equation, particularly when it moves beyond the familiar video visit. A clinician or community health worker can remain physically alongside the patient while collaborating with a remote physician or specialist. Clinical expertise can reach a rural clinic, nursing facility, community setting or patient’s home. Local healthcare workers gain support from colleagues who may be hundreds of miles away.

The scarce resource – specialist expertise – can suddenly reach much further. For rural healthcare, that is a profound shift.

Technology should earn its place

RHTP will inevitably fund a lot of technology. Some of it will deliver tremendous value. Some of it will end up underused.

Healthcare has seen this movie before.

New platforms arrive with impressive capabilities, yet adoption stalls because they don’t fit clinical workflows. Equipment gets purchased through capital budgets and never reaches meaningful utilization. Digital tools create another screen or another task for clinicians already overwhelmed by both.

Rural providers have little capacity for that kind of experimentation.

Every technology investment should therefore face a fairly unforgiving set of questions:

How much additional clinical capacity does it create?

How many more patients can access specialty expertise?

How much more effectively can existing clinicians work?

What care can now be delivered locally that previously required travel or transfer?

Which services become sustainable that weren’t sustainable before?

What happens when the grant funding ends?

Those questions force the conversation toward measurable capability and long-term value.

Beware the usual suspects

There is another risk as billions of dollars begin moving through the states: too much of it may gravitate toward the usual suspects.

Large government programs naturally favor organizations that know the procurement system, have established relationships and can navigate complex state funding processes. Political relationships inevitably add another dimension.

Those concerns surfaced even before the money began flowing. Reporting carried by Georgia Public Broadcasting quoted one digital health expert worrying about unclear approval criteria and the risk, in the current political climate, of decision-makers starting to “pick and choose our favorites.”

Established vendors will inevitably play an important role, and many bring valuable experience. The bigger concern is whether procurement processes leave enough room for organizations with genuinely different approaches to rural care.

RHTP was created with transformation in its name. If most of the money flows through familiar channels to fund familiar approaches, the results are likely to feel familiar too.

States should be actively creating room for new models, new entrants and ideas that challenge the status quo – particularly around where care happens, who can deliver it and how scarce clinical expertise is deployed. Real transformation carries some risk. So does spending $50 billion and discovering that rural healthcare still works much as it did before.

Some states are already moving. Others are still getting organized.

The Advisory Board analysis reveals striking differences in implementation.

Iowa and Hawaii have moved quickly with targeted early deployments. Delaware, Nevada and South Carolina are using multiple competitive funding opportunities. Minnesota, Montana and Washington have concentrated initially on infrastructure and system enablement. Michigan, Maryland and Massachusetts have taken a more deliberate approach centered around planning and governance. Texas and Florida are using larger, bundled solicitations covering multiple priorities.

Interestingly, the pace doesn’t appear to correlate neatly with award size. Administrative readiness and implementation strategy are proving just as important.

That matters because RHTP funding is awarded year by year. States need to demonstrate progress to continue receiving support through 2030.

The coming months will reveal a great deal about which states have developed a genuine transformation strategy and which are still assembling one.

Speed alone tells us little. Direction matters enormously.

What will be left behind?

At Hippo, this is the question we keep coming back to.

Our work in rural health is built around extending the reach of clinicians. Through Coactive Care™, a local clinician or other healthcare worker can collaborate with a remote physician or specialist at the patient’s point of care, helping scarce expertise reach communities where maintaining that expertise locally may never be economically or practically feasible.

The technology enables the model. The value of the model ultimately lies in the additional clinical capability it creates. That same test can be applied far more broadly across RHTP.

By 2030, has specialist access expanded? Can rural clinicians manage more patients locally? Are fewer patients travelling long distances for care that could be delivered in their community? Can scarce specialists effectively serve larger populations? Have new points of care become viable? Are rural hospitals able to provide services that were previously beyond their workforce or economic capacity?

Those outcomes would represent meaningful change. And they would endure beyond the funding cycle.

2030 will arrive quickly

RHTP has created something rural healthcare rarely gets: substantial resources, national attention and permission to think differently.

That combination won’t come around often.

Five years from now, the number of RFPs issued and grants awarded will be largely forgotten. The important question will be whether rural healthcare gained capabilities it didn’t have when this program began.

If specialist access remains determined largely by ZIP code, we won’t have gone far enough.

If rural hospitals remain dependent on recruiting clinicians who simply aren’t available, we won’t have gone far enough.

And billions invested in digital health will mean little if clinical capacity remains essentially unchanged.

The opportunity reaches well beyond keeping today’s rural healthcare system running for another five years. We have the resources to build the rural healthcare system the next twenty years will require.

What states do next will determine whether we build a rural healthcare model for the future – or simply bandage the old one and extend its life for a few more years.

To learn more about how Hippo Virtual Care is helping rural hospitals expand workforce capacity, improve access to specialist expertise, and strengthen care delivery without adding headcount, contact me at: pat@myhippo.life