What Rural Healthcare Providers Really Need to Know to Succeed in the Rural Health Transformation Program

Hard Truth

The One Big Beautiful Bill Act (OBBBA), approved by signed into law by Trump on July 4, 2025, is on track to effectively cut federal Medicaid spending by approximately $1 trillion over a decade. The specific impact on rural healthcare, including Community Health Centers and Rural Hospitals, is hardest. Community Health Centers are projected to lose up to $32 Billion in revenue, and one in three rural hospitals at risk of imminent closing.[1][2]

Rural health systems must be willing to do honest self-audits to identify and address all opportunities of reducing waste and improving efficiency. No system nor process is immune. No more saying, “This is how we’ve always done it.”

Rural healthcare workers are the lifeline for millions of Americans. Improving effective care includes listening to your teams as they know first-hand where challenges and inefficiencies hide. Addressing waste and low-performing processes improves staff morale as well as patient satisfaction and confidence.

Value Based Payment Reform

The Centers for Medicaid and Medicare Services (CMS) are also on track to have all Medicaid and Medicare payments moved to a value-based care (VBC) model and away from fee for service. Payments from private insurance organizations are also on the hook to produce outcomes.

Value-based care outcomes include key performance measures identified by CMS and individual State data sets. Most measures are from national resources, such as the National Association for Healthcare Quality’s HEDIS data sets.

The VBC key performance indicators cover all areas of performance, including clinical quality, operations, cost, patient satisfaction, adaptation of VBC contracts, provider collaboration, and more. Organizations conducting their self-audits must be willing to look at all VBC outcomes and processes, collaborate with internal and external teams, and think creatively to address all inefficiencies.

Revenue Cycle Management

Honest self-audits also require a complete review of current revenue cycle processes and outcomes. Analyzing each individual payer’s outcomes will bring a clear understanding of waste as well as potential solutions.

Examine all the usual suspects, such as coding accuracy and compliance, as well as review the complete cycle, from enrollment to discharge, to claims submission, payment posting, and collections. You will discover opportunities to improve from both human and technology processes.

Integrated Physical and Mental Healthcare

The Rural Health Transformation Program (RHTP) is a change in thinking to the entire rural healthcare system. This program includes community-based integrated health system requirements for payment. Specifically, RHTP provides money to States (not individual providers) with the task of creating rural integrated systems that leverage technology, integrate systems between providers, and increase skills within provider groups to increase access and coordination of care of all community patients. No silos. No individual free-standing care.

The RHTP finding cannot supplement provider payments. The funds may subsidize provider housing and education costs. Providers serving physical and mental health are eligible.

Investigate your individual State’s RHTP proposal to identify how you can best approach integrating your practice with your community system and maximize longevity of your staff and organization.

We Are Here to Help

SunHawk provides expertise in readiness reviews and assists rural healthcare providers in successful grant and program development.

Partner with SunHawk to:

• Evaluate value-based care readiness for Medicare, Medicaid, HRSA, and insurance
• Design infrastructure and business/clinical processes to excel in value-based care
• Analyze revenue cycles, including identifying leakage, waste, and all opportunities to improve efficiency
• Assess Electronic Health Record (EHR) compliance and improvement plans
• Identify high-volume patients for CMS benchmarking categories and increased patient quality and clinical revenue capture
• Detect missed coding opportunities
• Identify and engage unattached patients

[1] The Commonwealth Fund. Nearly 5.6 Million Community Health Center Patients Could Lose Medicaid Coverage Under New Work Requirements, with Revenue Losses Up to $32 Billion. May 30, 2025. https://www.commonwealthfund.org/blog/2025/community-health-center-patients-medicaid-coverage-work-requirements

[2] Center for Healthcare Quality and Payment Reform. RURAL HOSPITALS AT RISK OF CLOSING. May 2026. https://ruralhospitals.chqpr.org/downloads/Rural_Hospitals_at_Risk_of_Closing.pdf

Brigita Landstrom, MHS, CPHQ, CAS
Director
SunHawk Consulting

Brigita Fody Landstrom has 25 years of Medicare/Medicaid managed care, Community Health Center Quality, and large hospital and healthcare systems experience. Passionate about population health, Brigita has dedicated her career to serving the health of communities, with extra attention on traditionally marginalized populations. Brigita has worked with leaders and regulators within multiple market segments on data-driven systems improvement, large-scale health program implementation, grant writing, risk contracting, budget development, policy development, and staff training and support.

Sailaja Prakriya
Director
SunHawk Consulting

Sailaja Prakriya is a healthcare analytics and transformation leader with more than 20 years of experience helping payer, provider, and government healthcare organizations improve operational performance, financial outcomes, and population health through data-driven strategies. She specializes in healthcare analytics strategy, revenue cycle performance analytics, and value-based care transformation, helping organizations translate complex healthcare data into actionable insights that drive measurable improvement.