The Rural Health Gap: Why We Need More Than Just a "Transformation Fund"

The recent NPR report by Juana Summers highlights a high-stakes debate over the "Rural Health Transformation Fund." Sarah Jane Tribble of KFF Health News recently noted that while a $25 billion fund sounds substantial, experts at the National Rural Health Association (NRHA) estimate it may only cover about 43% of what is actually needed to offset coming cuts.

For states like Montana, the stakes aren't theoretical. We are seeing a convergence between rising chronic diseases and a shrinking care map. Since the 1990s, diabetes rates in Montana have tripled, particularly among American Indian and Alaskan Native adults. Yet over 100 rural hospitals closed between 2013 and 2020, and others are forced to shutter vital services like obstetrics.

When traditional infrastructure stalls, we have to ask: how do we deliver care to a population that hasn't changed location, even if their hospital has?

Beyond the Four Walls: A Blueprint for Transformation

The "Rural Health Transformation" isn’t just about the financial survival of buildings; it is about the financial sustainability of care delivery. Our work in Montana provides a real-world look at how the pillars of the Rural Health Transformation Program (RHTP) can be implemented today.

• Workforce Extension: In the NPR report, Tribble mentions that when a hospital closes, providers often leave the area. By using digital health, 11 Diabetes Care and Education Specialists (DCES) in Montana were able to maintain a continuous connection with 198 patients, regardless of their proximity to a physical clinic.

• Consumer-Facing Technology: Access remains the primary barrier in "frontier" communities. Digital tools fill the gap between episodic doctor visits, which often require long commutes, by providing on-demand support for the daily self-care behaviors that actually drive outcomes.

• Outcomes & Program Measurement: For any transformation to be sustainable, it must prove it works. In Montana, two-thirds of users who tracked their glucose improved their control. Among the most engaged users, the average improvement in estimated average glucose (eAG) was -47 mg/dL¹. Those who achieved weight loss saw an average reduction of 7%¹ from their baseline.

• Inclusive Engagement: Digital health is often criticized as being only for the tech-savvy, but the Montana study showed that 30% of participants were aged 65 or older. This suggests that when the need for care is high, the "digital divide" can be bridged with the right tools.

The Strategic Path Forward

If we only focus on the size of the fund, we are missing the opportunity to modernize the model. Digital health platforms allow systems to expand their capacity by automating routine monitoring and freeing up clinicians to focus on the most complex cases.

The goal of a true Transformation Fund should be to move rural health from a state of crisis to a state of resilience. As Sarah Jane Tribble noted, rural America needs new ways of thinking about care delivery. Montana has shown that when we integrate technology into the existing care team, we don't just bridge a gap, we build a more sustainable future for the 20% of Americans living in rural communities.

How is your organization approaching the RHTP pillars for underserved populations?

Book a partnership briefing or download the Montana Case Study for real-world results.

1 Welldoc Data on File. Results may vary based on BlueStar App adherence.  

The Welldoc® App includes Welldoc Diabetes and Welldoc Diabetes Rx, which is Software as a Medical Device (SaMD) intended to be used by healthcare providers (HCPs) and their patients – aged 18 years and older – who have type 1 or type 2 diabetes. Welldoc Diabetes and Welldoc Diabetes Rx is intended to assist patients in managing their diabetes with guidance from their providers. Welldoc Diabetes Rx requires a prescription. Welldoc Diabetes and Welldoc Diabetes Rx should not be used by patients with gestational diabetes or patients using an insulin pump. Improper use of Welldoc Diabetes and Welldoc Diabetes Rx may result in unsafe recommendations that could result in hyperglycemia or hypoglycemia.