6 strategies to redraw the patient care map
For rural healthcare organizations, access has become the central organizing principle behind nearly every strategic decision.
This new operational reality is being shaped by a convergence of pressures. Workforce shortages, rapidly declining independent physician practices, geographic dispersion and aging populations have pushed traditional care models to their limits, widening gaps in access to routine and preventive services. A November 2025 Commonwealth Fund report highlights the consequences: nearly 40% of adults living in rural areas have sought care in emergency departments for conditions that likely could have been treated in primary care settings.
But the challenge, as athenahealth’s research and policy work make clear, runs deeper than geography alone. “I think access is much more nuanced,” Joe Ganley, vice president of government and regulatory affairs at athenahealth, said. “It’s great if I have a doctor’s office in my town. It’s not great if I can’t get an appointment for nine months because they’re totally booked, or I can’t afford it.”
In response, rural leaders are redesigning not just where but how care is delivered — through virtual-first workflows, expanded ambulatory and community-based care sites, stronger data-sharing and new partnerships that ease patients’ access to services while extending scarce clinical capacity.
This article, the first in a four-part series, “Rural healthcare excellence in 2026: 26 lessons in making less do more,” highlights six ways rural providers are expanding access through pragmatic innovation and what it signals for the future of care delivery.
1. Address nonclinical barriers that keep patients from the door
In many rural communities, the biggest barriers to care occur long before a patient enters a clinic. Transportation limitations, language barriers, digital gaps and affordability challenges frequently redirect patients toward emergency departments for care that could have been addressed earlier in primary care settings.
Shelly Soileau, CFO of Opelousas (La.) General Health System, said transportation challenges alone can regularly derail patient care plans. “I think it’s very much going to continue to be an issue in rural Louisiana, because our patients either don’t have transportation or don’t have family available to transport them,” she said during Becker’s “CFO + Revenue Cycle Podcast.” Her organization has pieced together unconventional solutions — coordinating rideshare services and even calling local police departments for help — while pursuing longer-term options with the state.
Digital gaps present a parallel challenge. At MyMichigan Medical Center Alpena, in Michigan’s sparsely populated northeast, limited broadband and the high cost of connectivity infrastructure remain stubborn barriers — not just for patients, but for the health system itself.
“The cost of broadband goes up as the areas are more remote,” Pankaj Jandwani, MD, CIO for MyMichigan Health, told Becker’s.
Even where connectivity exists, digital literacy and patient trust require ongoing attention. Hunter Nostrant, president of MyMichigan Medical Center Alpena, said effective outreach means meeting patients where they are, as some prefer video, others text and others still want in-person contact. Evanston (Wyo.) Regional Hospital is taking a similarly community-rooted approach, relaunching a program for adults over 50 to build confidence and competency with digital health tools that support ongoing engagement in their care.
2. Design virtual-first care models that extend specialty reach
Telehealth has long been viewed as a solution to rural access challenges. Virtual visits can expand provider capacity while improving convenience for patients, often requiring less administrative overhead than traditional office visits and allowing clinicians to see more patients within the same timeframe.
Sioux Falls, S.D.-based Sanford Health has delivered more than 1 million virtual visits across nearly 80 specialties through its virtual care center and hub-and-spoke model. The system’s chief medical officer of virtual care, Dave Newman, MD — the only andrologist in North Dakota — told Becker’s that patients previously drove several hundred miles each way to see him; through virtual care, the average Sanford patient now avoids roughly 176 miles of travel per visit.
Nick Olson, Sanford’s executive vice president and CFO, said the system’s virtual care center has helped extend specialty care access and even expand its clinical trials reach across the region.
Policy support will play a major role in determining how widely these models expand. While telehealth flexibilities for Medicare beneficiaries were extended through 2027, Mr. Ganley said broader reimbursement stability remains essential. “Medicare reimbursement is hugely important when you’re talking about seniors, but in the FQHC world, it’s much more skewed toward Medicaid,” he said. “Medicaid eligibility, telehealth reimbursement and ambulatory physician fee schedule reimbursement are all things that should be on the table.”
3. Deploy mobile and community-based care to close geographic gaps
Expanding access increasingly means moving care beyond the hospital campus. FQHCs and rural health clinics play a central role in that ecosystem — and when they close, patients often have few alternatives beyond the emergency department. With funding shortfalls threatening hundreds of FQHCs nationwide, hospitals are bracing for downstream effects including more avoidable health crises and overcrowded EDs.
Some organizations are stepping in to fill the void, deploying community-based models that bring services closer to where patients live. Mobile health clinics, school-based programs and post-acute services — including partnerships with local health departments and post-discharge coordination — are expanding access to preventive care without requiring lengthy travel.
Pittsburgh-based Allegheny Health Network deployed a mobile MRI unit serving rural Pennsylvania, allowing patients to receive advanced diagnostics at rotating community sites rather than driving hours to urban imaging centers. Essentia Health (Duluth, Minn.) redesigned oncology delivery through a hub-and-spoke network, with central hubs offering surgical care and advanced therapies while smaller community sites provide imaging and infusion services.
“Our patients receive the vast majority of their care in their own communities, where they have the social support critical to navigating their cancer journey,” said Lloyd Ketchum, MD, hematologist, oncologist and division chair of cancer services at Essentia.
4. Recalibrate service lines around what rural hospitals can sustainably deliver
Many rural hospitals are reassessing which services they can realistically sustain. For some, that has meant converting to the rural emergency hospital designation — a model that allows struggling facilities to preserve emergency and outpatient services while discontinuing inpatient care.
Shawn Bright, CEO of Crittenden Community Hospital in Marion, Ky., told Becker’s the transition has created financial stability after years of operating pressure, with the hospital now expecting a positive margin in 2026.
Other rural organizations are taking a different approach: one focused on carefully expanding the services they believe can be sustainably delivered locally. Roosevelt General Hospital in Portales, N.M., recently added surgical subspecialties including orthopedics, urology and cardiology on a limited schedule, while also purchasing a building to expand primary care under a rural health clinic designation — a move CEO Kaye Green said will support local access while generating referrals to the specialty services the hospital is building out.
5. Make health data fluid across rural care networks to enhance coordination
As care expands across hospitals, clinics, mobile services and virtual visits, seamless data exchange has become essential. But many rural providers still lag behind: According to a Black Book Research report,81% cite financial limitations as the primary barrier to IT modernization; 67% face interoperability challenges tied to legacy systems; and only 42% of critical access hospitals are connected to a regional or national health information exchange.
Mr. Ganley said solving that challenge requires a fundamental shift in how healthcare data moves across the system. “If you think about transitioning healthcare to something we do rather than a place we go, that shift requires greater liquidity of health data,” he said.
Federal initiatives are beginning to accelerate progress, as CMS launched a $50 billion Rural Health Transformation Program aimed at upgrading infrastructure. Early planning shows many rural hospitals plan to use these funds to modernize health IT systems, strengthen cybersecurity and expand telehealth and remote monitoring capabilities — investments leaders say are essential to sustaining rural access in the years ahead.
For smaller and independent rural providers, the stakes are especially high. Fragmented data not only complicates care coordination, it widens the gap between well-resourced health systems and the community practices patients depend on most. Mr. Ganley underscored seamless data-sharing as essential.
“Interoperability is a playing-field leveler for ambulatory practices,” he said.
6. Leverage AI and automation to sustain operations under workforce constraints
If interoperability helps rural providers access the right information, automation may help them operate more sustainably.
AI is emerging as a powerful tool for addressing administrative complexity. For small rural teams, time spent on documentation, billing and compliance can consume a significant portion of staff capacity. “If AI and technology can eliminate most of that administrative work, that is wildly advantageous for those practices,” Mr. Ganley said.
Automation tools are already helping rural providers streamline clinical documentation, improve patient outreach and expand behavioral health access. At Avera Health in Sioux Falls, S.D., ambient listening technology has been implemented across its clinics — after one year, 63% of physicians reported higher job satisfaction and the technology reduced their cognitive burden by 51%, president and CEO James Dover told the “Becker’s Healthcare Podcast.”
“I believe AI will do to data and health information what the internet did to how we communicate with each other,” Mr. Dover said.
Do more with less — and a call to action
The pressures facing rural healthcare are unlikely to ease anytime soon. But across the country, rural leaders are responding not by expanding hospital infrastructure, but by redesigning how care is delivered. Virtual-first models, community-based sites, interoperable data systems and AI-driven automation are helping organizations stretch limited resources while keeping care closer to home.
For Mr. Ganley, the path forward requires both strategic and operational discipline. “You’ve got to leverage technology and streamline with AI everywhere you can,” he said. “You’ve got to position yourself as the primary care provider of choice for your community, and you’ve got to think about how you transition into value-based care models that can sustain the practice over time.”
For rural providers, the future may depend less on expanding physical infrastructure and more on building smarter, more connected systems of care that extend high-quality care wherever patients need it.
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