Beyond the RHTP Buzz: Is Your Rural Community Ready to Scale What Works?
ASTHO's Dr. Susan Kansagra joins Metopio's Angie Grover to unpack state implementation models, rural benchmarks, and what it takes to be ready to scale.
The Rural Health Transformation Program (RHTP) is a five-year, $50 billion investment — and unlike most CMS funding (which flows directly to providers) this money goes to states first, who then decide how to invest it in their communities. That structure gives states enormous latitude, and a year into the program, the picture of how they're using it is starting to come into focus.
In partnership with the Association of State and Territorial Health Officials (ASTHO), we recently hosted a webinar on exactly that: how to make the most of RHTP investments, featuring Dr. Susan Kansagra, Chief Medical Officer (ASTHO), and Angie Grover, co-founder and COO (Metopio). Susan brings a national vantage point from ASTHO, plus firsthand experience leading public health at both the state and local level in North Carolina and New York City. Here's what they shared.
RHTP Isn't Asking You to Reinvent Your Work
RHTP doesn't require a brand-new way of working. Most health systems, public health agencies, and community organizations are already assessing community needs, building strategic and improvement plans, tracking performance, and doing quality improvement to adjust what isn't working.
What RHTP creates is an opportunity to connect those existing activities around a shared set of rural health priorities — assessment tells you where the priorities are, planning tells you what you're going to do about them, and performance management tells you whether you're making progress. The real question isn't "what new process do we need?" It's "how do we connect the work we're already doing into a shared strategy we can measure and sustain over time?"
Five Pillars, One Set of Goals
CMS has five core priorities for the program: prevention (chronic disease, maternal health, family health, and behavioral health, under the broader "Make Rural America Healthy Again" banner), access to care, workforce — including community health workers, peer support specialists, doulas, and telehealth as ways to extend the provider base — innovative care models and financing, and technology, including telehealth infrastructure that supports long-term sustainability.
The framing and vocabulary differ a bit between health systems and public health departments, but the underlying goals are largely the same. The overlap is useful: it means the priorities organizations are already tracking in their community health needs assessments are very likely to map onto what states are trying to accomplish with RHTP.
States Are Taking Different Paths to Get Money Out the Door
Because states have so much latitude in how they implement RHTP, there are a range of models taking shape:
Statewide models, where the state identifies needs and issues an RFI directly — Alaska is one example.
Region-centered models, where funding flows to regional entities (often chosen through an application process) who then identify local needs and distribute funding to community partners. North Carolina has taken this approach.
Hybrid models that blend both.
States also vary in how they're building in community input — through state-level advisory bodies or newly formed regional councils that are actively recruiting members.
““Keep a close eye on how your state is structuring execution, because that will tell you a lot about where to show up. First, understand who’s making the decisions, then learn where regional and community voices fit into that process, and finally, pay attention to how the money flows to implementation. That determines where your organization needs a seat at the table.””
Why Rural Benchmarks Matter as Much as the Raw Number
Comparing a rural county only to its statewide average can be misleading, because that average can hide a lot of variation — especially in states with large urban centers.
Metopio builds rural benchmarks into the platform using HRSA's definitions as a consistent federal baseline, but states often define "rural" differently for their own RHTP purposes — North Carolina, for instance, considers an entire county rural if it contains even one rural census tract. Knowing how your state defines rural, and being explicit about the populations you're comparing, matters for how convincingly you can tell your community's story.
From Spreadsheets to Collective Measurement
Improving rural health is rarely the work of one organization — it's a health department, a behavioral health provider, a school, a community organization, and a state agency all pulling in the same direction. That makes reporting notoriously hard: five partners producing five different reports that someone then has to stitch together by hand.
Metopio recommends an approach with three connected pieces: shared insight (a common understanding of the problem and the population), collective measurement (connecting multiple partners' work to the same set of measures so you can roll results up to a community-level outcome), and a collaborative workspace for tracking it all in one place. For RHTP specifically, the goal isn't just to show that money was spent or activities occurred, it's to show whether the outcomes you expected to move are actually moving. That's what makes the case for what deserves to scale!
Are You Ready to Scale? Four Things to Check
When investment becomes available for something that is working, can your organization absorb it? Here's how you can prepare:
Know your state's RHTP plan inside and out. All state plans are now posted on the CMS website — understand the connection points before you try to engage.
Find the tables worth sitting at. New advisory bodies and regional organizations are actively forming and recruiting right now.
Assess your own organizational readiness. Can you point to where your data shows you're already making a difference, and connect that to the state's broader plan?
Understand state processes — procurement, reporting, and compliance requirements. States are accountable to CMS, and they'll pass much of that accountability down to the organizations they fund.
Reflections on Year One
This past year, states had to build the plane while flying it — there wasn't much time to plan before funding needed to go out the door. Where possible, states are trying to concentrate investment in shared, sustainable infrastructure (provider pipelines, technology upgrades) rather than one-off projects, and regional governance structures look different from state to state, which makes it worth revisiting your specific state's plan directly.
One notable pressure point: states that aren't spending their allocation by the end of year one risk having those funds reallocated to states that are. Also good to note: "access" is being interpreted more broadly than just providers — it includes access via new technology, access to different types of providers, and access into the future through workforce pipelines. This broader lens is opening the door to investments in things like non-emergency transportation and childcare — the non-medical drivers of health that shape whether people can get to care or stay in the rural workforce at all.
Keep the Conversation Going
RHTP is a multi-year commitment, and both Metopio and ASTHO will be involved in this work for years to come. If you missed this live session, you can access the recording right here!