The rural shift health plans can’t afford to ignore

From shrinking provider networks to higher rates of chronic conditions, rural communities face severe access challenges. As a lifelong Tennessean, I’ve seen this first-hand as Tennessee has faced more rural hospital closures per capita than any state. These gaps affect health plan performance and costs.

The Centers for Medicare & Medicaid Services (CMS) developed the Rural Health Transformation (RHT) program to inject billions into modernizing healthcare in rural America. In my years of experience, there’s nothing that compares to the opportunity RHT presents to bridge gaps in rural healthcare.

This federal investment is only a jump start. It will be health plans that determine the long-term impact.

Why health plan participation in RHT matters

Through RHT, CMS will distribute $50 billion to states through 2030. States will work with local partners, such as hospitals and provider groups, to carry out their plans to improve rural health.

While not generally recipients of RHT funding, health plan participation is critical. Health plans can help RHT-funded programs scale and ensure sustainability by leveraging their core functions of benefit design and coverage expansion. It’s an opportunity to help maximize the impact of this federal investment during and beyond the five-year funding period.

By supporting providers who receive RHT awards, health plans can do more than help those initiatives succeed. Plans can help drive down spending, improve outcomes and promote healthy behavior changes for rural members, ensuring people in rural areas have access to innovations and sustained improvements for years to come.

The realities of rural care, and the health plan role in maximizing impact

Since RHT was announced, it’s been clear that states are counting on virtual care. There’s a misconception that people in rural areas won’t engage virtually, but state priorities and Teladoc Health member data tell us that’s not the case.

As technology and digital infrastructure improve through RHT investment, the impact of virtual care will grow even further. This will help health plans meet their members’ needs and achieve better health outcomes.

Virtual care is a proven equalizer

An analysis of Teladoc Health members through 2024 shows that engagement in virtual chronic condition management support programs—from device monitoring to coaching visits—is similarly high across urban and rural communities over a 90-day period. For example, in our diabetes prevention program, 97% of rural members regularly engaged compared to 95% of those in urban areas.

For hypertension support, engagement rates were 94% for both rural members and urban members. This reinforces that rural residents will use digital health tools just as much as people in urban areas when accessible.

Rural members report strong satisfaction with an NPS of 59 compared to 65 for members in urban areas. With new multi-carrier-enabled devices improving connectivity, especially in rural communities, we expect the member experience to improve.

What it means for health plans: Plans must align strategically with RHT awardees to ensure virtual care programs translate into the key performance indicators (KPIs) CMS is monitoring.

By updating benefits, reimbursement structures and member support models, plans can help RHT-funded providers secure performance-based payments and meet sustainability requirements. This approach also prepares plans to carry these programs forward long-term, especially as rural members increasingly rely on and expect virtual support.

Chronic care outcomes are about removing barriers to access

Cardiometabolic challenges, including hypertension, diabetes and obesity, sit at the center of RHT strategies because these conditions drive disproportionate cost and quality gaps in rural communities.

Among rural members receiving Teladoc Health diabetes prevention and weight management support for at least six months, 42% achieved target weight loss based on starting BMI compared to 44% for people in urban areas. Hypertension support showed similar parity.

Rural markets can become some of the strongest chronic care performers in a health plan’s portfolio. RHT helps remove the access barriers, such as infrastructure, workforce, connectivity and referral workflows, so plan-covered services can reach rural members. When those barriers come down and covered benefits are easier to use, rural outcomes can match urban performance.

What it means for health plans: When rural members can access chronic care programs, they engage and improve at rates comparable to urban members. RHT can introduce and enable access, but it’s up to health plans to streamline and sustain that access (benefits, reimbursement, referrals) to realize long-term outcomes and ROI.

A pivotal moment to boost rural health

Health plans have an opportunity to help fulfill the promise of RHT for sustainable rural health improvement by taking the following actions:

• Strengthen provider proposals with rural population analytics that project impact and a clear sustainability plan tied to RHT KPIs and post-RHT coverage so programs endure.
• Scale virtual care programs to align with RHT-funded services including telehealth, remote patient monitoring and virtual chronic care support to create a lasting infrastructure and smooth transitions of care over time for rural residents.
• Align your plan’s care provider incentives with state RHT key performance indicator measurements to streamline provider workflows and create operational efficiencies.

No single entity can transform rural healthcare alone. Collaboration across the industry, from plans to providers to health services organizations, can drive meaningful change for rural health.

With experience across rural Medicaid markets and partnerships like Collaborative for Healthy Rural America, Teladoc Health can help health plans turn short-term investments into lasting change.