Latest / Becker’s Healthcare Podcast / Krista Drobac of Health Policy Futures Lab on the Rural Health Transformation Program

Transcript

Krista Drobac of Health Policy Futures Lab on the Rural Health Transformation Program · Becker’s Healthcare Podcast

• 0:02
  This is where health care leadership comes together.
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  Becker's sixteenth annual meeting brings more than 3,500
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  hospital and health system executives and nearly 800
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  speakers to Chicago
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  April.
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  This year's event includes keynote conversations with Dallas
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  Cowboys legend Troy Aikman and former president George
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  w Bush. For the agenda and event details,
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  visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right. We're looking forward to hosting you
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  in Chicago.
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  Hello, and welcome to the Becker's Healthcare podcast.
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  My name is Chanel Banger. Today, I have
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  the pleasure of speaking with Krista Drobac, partner
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  at Sirona Strategies and cofounder of Health Policy
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  Futures Lab,
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  who joins the podcast today to discuss how
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  the rural health transformation program
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  is reshaping support for rural health care, its
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  core components and timeline, and a bit more.
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  Krista, thank you so much for joining me.
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  Thank you for having me. Perfect. Well, before
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  we dive in, can you talk a bit
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  about your background and your journey from the
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  senate and CMS to the work you're doing
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  in now in rural health?
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  Yes.
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  I have been in DC
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  most of the last thirty years.
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  I did have a stint as the
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  deputy director of the Illinois Department of Health
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  Care and Family Services.
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  And I also ran the health division at
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  the National Governors Association,
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  specifically the Center for Best Practices.
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  So even though I'm in Washington and work
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  a lot on federal issues, I have a
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  state experience and I I really enjoy working
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  on issues with states because it's
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  they they're on the ground and very solvable.
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  Thank you so much for the introduction. And
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  now diving into our topic, can you give
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  us a broad outline of what the rural
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  health transformation program is, and how does it
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  differ from past efforts to support rural health
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  care?
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  In the big beautiful bill,
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  there were
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  changes and cuts to Medicaid that made it
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  difficult for rural hospitals.
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  So the rural health transformation fund was a
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  $50,000,000,000
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  program set up to transform rural health care.
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  The idea was
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  to make investments
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  that would make
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  long term
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  rural health care sustainable and accessible.
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  It, is administered
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  by CMS, but the money goes to state
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  government.
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  And it is, as I mentioned, a five
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  year program.
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  There is a one time application,
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  and then $10,000,000,000
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  is distributed every year for five years.
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  Got it. Got it. And building on that,
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  what are the core components of this program?
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  And you kinda gave us a time frame
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  of five years, but can you dive a
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  little bit deeper into that?
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  So there are 11 buckets
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  for the uses of funds,
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  and states in the application
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  had to choose at at least three eligible
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  uses of these funds.
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  So I'm gonna run through the buckets very
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  quickly.
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  Rural workforce and training,
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  clinical services,
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  and those are non billable clinical services. So
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  you can't duplicate services that are Medicare and
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  Medicaid,
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  partnerships,
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  state policy actions,
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  Medicaid incentives,
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  technology and data,
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  prevention
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  and population health,
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  EMS services,
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  consumer engagement,
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  capital infrastructure,
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  and then other innovations. Like, you could use
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  the money to set up a
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  a like, an initiative whereby you get matching
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  funds from the private sector and you distribute
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  funds that way. So just to go back
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  and hit a couple points on these 11
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  buckets,
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  the clinical services, as I mentioned, cannot
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  duplicate
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  what is already covered in Medicare and Medicaid.
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  So there had to be a lot of
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  creativity
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  on clinical services
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  because anything that has a CPT code,
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  can't be included in clinical services.
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  Partnerships,
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  that's like strategic collaborations
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  and provider networks. We saw a lot of
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  partnerships
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  through a a hub and spoke type model
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  in applications.
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  And then things like EMS services,
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  really interesting,
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  new ideas around community paramedicine and treat in
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  place. So each one of these buckets had
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  states that came up with ideas in their
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  applications
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  that were somewhat novel.
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  That's really helpful context.
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  And, now a lot of our listenership
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  are hospital and health system leaders, so I'm
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  sure they're curious
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  about what their role in is in this
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  program, or I guess, like, what is the
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  role of hospitals in this program?
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  The legislation was clear that states could not
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  formulaically
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  distribute
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  this fund to hospitals.
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  There is a cap on the amount of
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  money that can actually go to providers,
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  but hospitals are at the core of this
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  program. And the reason is because
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  they are the ones that are
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  working with the state on how to deploy
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  some of the new technologies and infrastructure that
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  the state wants to,
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  spend this money on. So there was a
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  a meeting in Alaska, for example,
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  whereby,
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  Alaska brought in tech providers and
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  folks that really can stimulate innovation
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  in rural health care, and they told them
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  you have to have
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  provider partners in Alaska.
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  So we're not just gonna buy a, you
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  know, a tech tool.
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  We want you to work with providers.
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  And so there that is one model where
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  hospitals are working closely with the states, and
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  they're part of,
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  you know, applying for it and also partnering
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  with vendors. And then there's the other side,
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  which is also a prominent strategy among states,
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  which is to have the state buy licenses
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  for rural hospitals. So instead of each hospital
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  contracting with a separate,
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  tech provider,
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  This is where the state can say, you
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  know, we know that you're extremely busy keeping
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  the doors of your hospital open and working
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  on operational issues, and we wanna invest some
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  infrastructure for you. And so we're gonna buy
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  a tool and then provide the licenses
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  to you if you meet these criteria.
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  And in that case, the hospitals can be
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  the beneficiary of infrastructure investments. And in those
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  states, there is a lot of hospital input.
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  So I would say every single state has
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  had
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  lots of stakeholder engagement,
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  roadshows
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  to hear what hospitals need
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  for the future and what kinds of investments
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  are needed that are not under typically
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  what we have as our funding streams today,
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  like Medicaid, for example. So I'd say heavy
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  engagement,
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  and if you're not already engaged with your
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  state, you should be, and certainly your trade
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  association at the state level,
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  is engaged with the state. I know that
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  in every state, the hospital associations have been
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  very active.
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  Absolutely.
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  And now can you talk about the different
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  kinds of innovations or care models that you
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  are seeing emerge from this program?
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  Yeah.
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  So I was interested to see
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  what would
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  come up because of this prohibition
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  on duplication
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  of services.
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  If you can't
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  duplicate
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  what's already has a CPT code, you know,
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  you've gotta be creative. And,
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  one of the things that I found really
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  interesting
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  was the mobile units.
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  More than 25 states have put mobile units
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  in their
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  applications, and those are all the way from
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  prevention, which is,
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  something, you know, like a breast cancer screening
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  bus, for example,
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  all the way to
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  interventions.
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  So having a fully equipped,
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  vehicle that can do,
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  procedures,
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  in a community.
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  So I thought mobile units was a really
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  interesting
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  innovation
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  that is not
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  duplicative,
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  innovation.
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  We also saw treat in place ideas. So
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  can EMS services, instead of picking you up
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  and taking you
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  to a provider location, can they, do more
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  to treat in place? Because the scope of
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  practice of,
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  EMTs and paramedics is is higher than you
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  would think.
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  They can maybe do more on-site.
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  Remote patient monitoring
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  was throughout applications.
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  How do we per you know,
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  transmit biometric data from patients with chronic disease,
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  to a a health system or or provider
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  so that we can better monitor people with
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  chronic disease and potentially keep them from having
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  to, you know, drive 25 to a 100
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  miles to to a hospital.
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  I will say, there are a lot of
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  hub and spoke models that are parts of
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  of these applications.
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  And and that is really, you know, how
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  do you
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  create a clinically integrated network
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  where you have these, like, tertiary institutions at
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  the center
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  that are a higher capability facility that then
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  have smaller distributed care sites
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  like rural clinics or
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  primary care clinics,
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  in rural areas that then can connect in,
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  with that central location.
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  So those are some of the innovations.
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  And, of course, there are many more nutrition,
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  value based care, lots of prevention.
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  So if anybody's interested,
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  the health policy futures lab definitely has
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  a a compilation of all the applications and,
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  would be happy to share.
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  Got it. Got it. Thank you so much.
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  And now as you think about the future,
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  would you say that this model is financially
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  sustainable long term for both hospitals and the
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  government?
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  Oh, yes. Absolutely.
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  The whole entire idea of the rural health
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  transformation program is to create
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  a long term
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  sustainable
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  future for health care in rural areas.
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  All the states are focused on not just
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  creating one off pilots or programs,
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  but our
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  how do we
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  invest in a way that can become sustainably
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  over time.
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  So
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  our effort, and I think those of the
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  states and CMS,
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  is
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  to always look five years down the road
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  and not just year by year investments.
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  So I think most of the folks who
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  are engaged in this in at all levels,
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  even the vendors, know that this money is
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  finite
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  and that the investments have to be self
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  sustaining over time and have to be evaluated
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  on an ongoing basis. Because if they're not
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  working,
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  then we need some rapid cycle changes
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  because, again, the money is just not gonna
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  be there in perpetuity.
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  Absolutely. And now looking ahead and to bring
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  it all home, what should hospitals expect to
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  see in 2026 from this program?
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  So in 2026,
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  CMS
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  has already announced the awards. So it's about
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  200,000,000, you know, but around 200,000,000
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  per state,
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  and they
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  are currently in the process of signing cooperative
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  agreements with states.
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  Some states are required to get legislative approval
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  to spend money,
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  and
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  the those states are gonna take a little
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  longer to send out their requests for proposals.
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  But but
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  we'd expect to see those in, you know,
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  March, April, May,
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  and some have already come out.
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  And essentially, the request for proposals are fulfilling
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  what the
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  obligations that the state said they were gonna
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  fulfill
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  in their application process.
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  And states have to start reporting in
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  to CMS
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  this fall, so everyone is in a big
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  hurry,
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  to
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  get those RFPs out and get some of
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  this money obligated,
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  because
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  they have to start telling CMS what they're
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  doing with with these funds. So I would
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  expect to see in fairly rapid succession
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  RFPs coming out,
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  in all in all states.
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  And I'm imagining that many hospitals are probably
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  getting incoming calls from,
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  you know, vendors and AI companies,
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  who are wanna work with them,
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  to fulfill some of the obligations of the
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  states in their application. So it's gonna be
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  2026 is gonna be a very busy year,
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  in the rural health transformation program.
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  Absolutely. Well, Krista, I wanna thank you for
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  your time today. But before I let you
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  go,
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  for, hospital and health system leaders or just
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  anyone that's interested in this program, where can
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  they learn more?
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  Healthpolicyfutureslab.org.
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  We have a resource page. We have webinars.
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  We're having one,
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  tomorrow. We,
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  have events. We're having a big event June
• 13:17
  9 in Washington, DC.
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  It's open to all. The registration is on
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  our website,
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  and we will be, talking to state leaders
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  and,
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  CMS and,
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  and those hospitals who are already working in
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  RHTP,
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  in June. So I would welcome everyone to,
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  come to Washington for that event on June
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  9.
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  Got it. Well, Krista, I wanna thank you
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  once again for your time today and for
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  sharing your insights on the Becker's Healthcare podcast.
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  Thank you so much.
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  Great. Thank you.