Transforming Rural Health Through Innovation and Evidence

The Centers for Medicare & Medicaid Services’ Rural Health Transformation Program (RHTP) offers state leaders an opportunity to secure federal funding to redesign care delivery, strengthen access, and improve outcomes for rural communities.

For states that want to apply for the program, Mathematica—backed by decades of experience working closely with CMS—partners with the Rural Health Redesign Center to provide comprehensive support throughout every stage of the transformation process. From developing applications and strategies to delivering technical assistance and program design expertise, we work hand in hand with states to navigate program requirements, forge partnerships, and build scalable solutions grounded in data, evidence, and local needs and priorities.

Rural hospitals and providers are lifelines for their communities, but thin margins and workforce shortages threaten their future. To address these challenges, state leaders are designing new strategies for sustainable rural health care delivery and pursuing support for these efforts through the Rural Health Transformation Program.

Mathematica’s new data tool can strengthen states’ application planning process by showing how rural factors—such as population size and uncompensated care—will shape award amounts. This information can help state leaders sharpen their strategies and ground planning and policy conversations in evidence.

With Mathematica’s expertise in rural health policy and data analytics, we equip states to move from uncertainty to sustainability.

Rising healthcare costs make it critical for policymakers and program administrators to understand what’s driving spending growth and where to target improvements. Mathematica provides clarity through pricing and utilization data that bring performance metrics into clearer focus and make them easier to act on.

Our Rural Health Potentially Avoidable Utilization (PAU) Dashboard gives more than 2,000 rural hospitals nationwide insight into how PAU in emergency departments and inpatient settings impacts Medicare revenue—helping them identify where to invest to reduce their PAU.

We’ve also been a partner in developing resources such as a hospital cost tool and a health systems dashboard that provide policymakers and researchers with accessible data on hospital pricing, quality, and outcomes.

Hospital closures continue to challenge rural communities, creating a shortage of accessible providers and forcing residents to travel long distances for essential care. To help sustain access, policymakers and CMS created the Rural Emergency Hospital (REH) designation—allowing communities that can’t support a full-service hospital to maintain 24-hour emergency, observation, and outpatient services.

Mathematica helps small rural hospitals, critical access hospitals, and rural community partners assess the feasibility and benefits of REH conversion. Through the REH Technical Assistance Center, we provide advisory services, financial modeling, virtual learning opportunities, and educational resources to guide hospitals through the transition process.

To curb rising costs and sustain rural healthcare, CMS and other payers are testing new approaches that reward care coordination, preventive care, and community health partnerships. These alternative payment models—including hospital global budgets—aim to stabilize financing while improving services for rural residents.

Mathematica supports states, federal agencies, payers, and providers in designing and implementing these models in rural settings with multi-payer participation, such as through our work on initiatives like the Vermont All-Payer ACO Model and the Pennsylvania Rural Health Model. We’ve partnered with the Pennsylvania Rural Health Redesign Center and the CMS Innovation Center to provide technical, financial, and data support that turns innovative payment models into practice.

Rural communities face unique challenges that heighten behavioral health needs—from provider shortages and geographic isolation to economic stress and limited access to broadband and transportation.

Mathematica works with governments, health systems, and community organizations to strengthen behavioral healthcare by identifying gaps in services, evaluating what works, and translating evidence into practical strategies for states and providers.

We analyzed a large health system in the Dakotas and rural Minnesota that integrated behavioral health into primary care—leading to improved quality-of-care processes and reduced emergency department use. We’ve also studied programs that support parents with substance use challenges who are involved in the child welfare system, helping identify strategies to promote recovery and family reunification. These insights guide the development of scalable, evidence-based solutions tailored to rural realities.