Health Care Matters | September 19
Rural Health Transformation Program Applications Open
The Centers for Medicare & Medicaid Services (CMS) officially opened applications on September 15, 2025, for the $50 billion Rural Health Transformation Program, giving states until November 5 to submit comprehensive proposals for funding that will be distributed at $10 billion annually over five years beginning in fiscal year 2026. Half of the funding will be evenly distributed among all approved states, while the remaining $25 billion will be awarded competitively based on state metrics and applications demonstrating the greatest potential impact on rural community health. CMS has developed a complex 23-factor scoring methodology to allocate the competitive $25 billion, evaluating everything from state policies on SNAP, telehealth, and scope of practice to geographic factors like total square miles. The program aims to address five strategic goals: making rural America healthy again through preventative care, ensuring sustainable access to care, developing the health care workforce, fostering innovative care models, and promoting technology adoption. This opportunity was created as part of the Working Families Tax Cuts Act to help offset the impact of nearly $1 trillion in health care cuts, particularly the $960 billion reduction in Medicaid funding over the next decade. Read here, here, and here.
Why It Matters
This application period represents an inflection point for rural health care transformation, though the financial reality is sobering: the $50 billion fund will only offset roughly one-third of the Medicaid cuts hitting rural providers, and the funding cannot be used to supplant existing payments or cover perpetual operating expenses. Adding complexity to state planning, CMS intends to tie years two through five funding allocations to ongoing program performance against their 23 scoring factors, creating uncertainty around future funding levels that could fluctuate annually based on policy compliance and outcomes achievement.
We're observing states taking markedly different approaches to this opportunity. Some are engaging in extensive stakeholder consultation and issuing requests for information to gather community input, while others are working with external consultants to maximize their competitive funding potential and navigate the intricate scoring methodology. The most promising state strategies are focusing on three key areas: financial sustainability through payment model reforms that move beyond fee-for-service, innovation in care delivery models that leverage technology and community partnerships, and integrated approaches that coordinate across hospitals, clinics, and public health agencies. Given the program's emphasis on sustainable transformation rather than operating expenses, along with CMS Administrator Mehmet Oz's broad discretionary authority over half the funding and the performance-based allocation structure, we anticipate that states demonstrating clear long-term vision, measurable outcomes, and alignment with CMS policy preferences will be most successful in securing maximum allocations. For more detailed analysis on strategic approaches to this funding opportunity, see our comprehensive blog post on the Rural Health Transformation Program.
Innovaccer Acquires Story Health
Fierce Healthcare and Axios report that health care AI company Innovaccer has acquired Story Health, a digital specialty care platform that focuses on transforming episodic specialty care into continuous, AI-powered management for chronic conditions like heart failure, hypertension, and atrial fibrillation. Story Health, founded by Google veterans in 2020, combines AI-driven clinical pathways, remote patient monitoring, medication workflows, and human coaching to deliver care between clinical visits. The acquisition strengthens Innovaccer's Healthcare Intelligence Cloud platform and advances their strategy of building "agentic care augmentation," where AI agents assist specialty care teams with routine tasks while providing continuous patient engagement integrated directly into electronic health records and existing clinical workflows. Read more here and here.
Why It Matters
The deal signals the health care industry's move beyond simple AI dashboards toward comprehensive AI-powered clinical operating systems that can transform how care is delivered at scale. Additionally, this strategy aligns with CMS's specialty care integration goals and 2030 vision for accountable care, positioning health systems using this type of platform for upcoming mandatory models like the Ambulatory Specialty Model that will require specialists to coordinate care with primary care providers through collaborative arrangements.
Look for the Helpers: Integrative Care Grows in Popularity, Despite Payment and Workforce Challenges
Dr. Wayne Jonas and Dr. Darshan Mehta are pioneering advocates for integrative medicine who recognize that true healing requires treating the whole person, not just symptoms. Through their research and leadership, they're working to transform health care from a fragmented, disease-focused system into one that emphasizes prevention, wellness, and the therapeutic relationship between provider and patient. Despite facing significant challenges with reimbursement and training, these physician-leaders continue pushing for a model that combines evidence-based traditional medicine with complementary approaches, ultimately creating more compassionate and effective care for all patients. Read here.
What We Are Writing
CMMI’s GLP-1 Model: Why GLP-1s are a Policy Test Case for High-Cost Drugs
GLP-1 therapies are transforming care and sparking major policy questions. How CMS designs the upcoming CMMI model will set the tone for how high-cost treatments are managed in the future. Read our blog for a clear breakdown of what to watch and what it means for stakeholders across the health care sector. Read here.
3 Key Takeaways from the Heartland Conference on Health Equity & Patient-Centered Care
The Heartland Conference on Health Equity and Patient-Centered Care revealed that sustainable equity work in today's political climate requires distributed leadership that calibrates rather than just raises pressure, trust-building through authentic community partnerships, and a "both/and" approach that simultaneously pursues policy advocacy and direct service delivery to achieve measurable outcomes and financial sustainability. Read here.
What We Are Reading
Improving Payments for Primary Care Physicians
The Commonwealth Fund published an issue brief examining how the Resource-Based Relative Value Scale (RBRVS) system used to set Medicare physician payments undervalues primary care services compared to specialty and procedural care, contributing to a $117,000 annual income gap between specialists and primary care physicians and proposing reforms including CMS-led changes, adjustments to the Relative Value Scale Update Committee process, and legislative solutions. Read here.
How Do We Choose Doctors? Patient, Parent, And Professional Perspectives
Health Affairs Forefront published an article by Coral ally Sai Ma examining the limitations of current physician quality rating systems through a personal experience selecting an orthopedic surgeon for her son's ACL surgery, finding that existing platforms like Medicare's Care Compare provide inadequate, aggregated data and recommending improvements including specialty-specific measures, multidimensional assessments, individual clinician reporting, and AI-powered tools to better serve patient decision-making needs. Read here.
ACO REACH 2023 Performance Results Indicate A Pathway To Sustainable Accountable Care
Health Affairs Forefront published an analysis of ACO REACH 2023 performance results showing that net savings per beneficiary more than tripled from 2021 to 2023, with experienced ACOs driving most savings and High Needs participants accounting for 96% of total program savings, suggesting that program maturation and sustained participation are key to successful accountable care implementation. Read here.
Improving Primary Care Use by Seniors Through Value-Based Care
NEJM Catalyst published a study analyzing data from over 3.2 million Medicare Advantage beneficiaries, finding that patients cared for by senior-focused primary care providers in advanced value-based care arrangements had 20% more primary care visits annually and higher care continuity compared to those in traditional fee-for-service arrangements, suggesting a dose-response relationship between value-based care enablement levels and primary care intensity. Read here.
Breaking News
NCQA Names New Leadership
NCQA announced that Dr. Vivek Garg, MD, MBA, will become its next President and CEO effective January 5, 2026, succeeding founder Margaret E. O'Kane who will retire after over 30 years of leadership. Dr. Garg brings extensive clinical leadership experience from his current role as Chief Medical Officer at CenterWell Senior Primary Care and previous positions at CareMore, Oscar Health, and One Medical Group. Read here.
Pop Health Podcast
Navigating Drug Pricing, Policy, and Access
In this episode, Coral’s Founder Meg Koepke talks with Alison Falb about her journey from CMS to FDA to Coral. We explore current policy trends and challenges in Life Sciences – what they mean for organizations navigating drug pricing reforms, coverage, and access challenges.