Rural Health
Resources by Topic: Reimbursement and payment models
Community Health Centers Are Increasingly Important to Medicare Beneficiaries
Presents data on health center Medicare patient characteristics, service utilization, and revenue between 2019-2023. Compares sociodemographic and health characteristics of health center patients with those of the general Medicare population. Discusses the impact of managed care plans on health center finances.
Author(s): Elizabeth Dutta, Marsha Regenstein, Feygele Jacobs
Date: 05/2025
Sponsoring organization: Geiger Gibson Program in Community Health
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Presents data on health center Medicare patient characteristics, service utilization, and revenue between 2019-2023. Compares sociodemographic and health characteristics of health center patients with those of the general Medicare population. Discusses the impact of managed care plans on health center finances.
Author(s): Elizabeth Dutta, Marsha Regenstein, Feygele Jacobs
Date: 05/2025
Sponsoring organization: Geiger Gibson Program in Community Health
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Negotiated Prices for Care at Independent and System-Affiliated Rural Hospitals
Compares negotiated prices for procedural and imaging services at independent rural hospitals versus system-affiliated rural hospitals. Analyzes commercially negotiated price data with their associated hospital and evaluates number of negotiated prices for services. Discusses policies for rural hospital financial sustainability.
Author(s): Cody Lendon Mullens, Mitchell Mead, James D Lee, et al.
Citation: JAMA Network Open, 8(5)
Date: 05/2025
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Compares negotiated prices for procedural and imaging services at independent rural hospitals versus system-affiliated rural hospitals. Analyzes commercially negotiated price data with their associated hospital and evaluates number of negotiated prices for services. Discusses policies for rural hospital financial sustainability.
Author(s): Cody Lendon Mullens, Mitchell Mead, James D Lee, et al.
Citation: JAMA Network Open, 8(5)
Date: 05/2025
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Environmental Scan on Reducing Barriers to Participation in Population-Based Total Cost of Care (PB-TCOC) Models and Supporting Primary and Specialty Care Transformation
Presents results of an environmental scan on reducing barriers to participation in population-based total cost of care (PB-TCOC) models and supporting primary and specialty care transformation. Discusses identifying pathways for maximizing participation of different kinds of organizations in PB-TCOC models; an assessment of and approaches to reducing organization-level barriers; approaches to support primary and specialty care transformation; an assessment of factors that influence the ability of PB-TCOC models to be competitive; and a summary of relevant features in previously submitted Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references throughout.
Date: 05/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Presents results of an environmental scan on reducing barriers to participation in population-based total cost of care (PB-TCOC) models and supporting primary and specialty care transformation. Discusses identifying pathways for maximizing participation of different kinds of organizations in PB-TCOC models; an assessment of and approaches to reducing organization-level barriers; approaches to support primary and specialty care transformation; an assessment of factors that influence the ability of PB-TCOC models to be competitive; and a summary of relevant features in previously submitted Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references throughout.
Date: 05/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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CMS Innovation Center Strategic Direction
Describes the vision and strategic objectives for the Center for Medicare and Medicaid Innovation (CMS Innovation Center). Strategic objectives include promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition.
Additional links: Frequently Asked Questions, White Paper: The CMS Innovation Center's Strategy to Make America Healthy Again
Date: 05/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Describes the vision and strategic objectives for the Center for Medicare and Medicaid Innovation (CMS Innovation Center). Strategic objectives include promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition.
Additional links: Frequently Asked Questions, White Paper: The CMS Innovation Center's Strategy to Make America Healthy Again
Date: 05/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Rural Healthcare Provider Transition Project (RHPTP) Webinar: Quality Improvement (QI) Alignment Across the Hospital and Clinics is Key to Value-Based Payment (VBP) Success
A recorded webinar that discusses strategies to align quality improvement (QI) projects with value-based payment (VBP) across organizational settings. Discusses clinical quality measures and sustainability of QI. Transcript available below description.
Additional links: Slides
Author(s): Lisa Olson, Candy Hanson
Date: 05/2025
Sponsoring organizations: National Rural Health Resource Center, Stratis Health
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A recorded webinar that discusses strategies to align quality improvement (QI) projects with value-based payment (VBP) across organizational settings. Discusses clinical quality measures and sustainability of QI. Transcript available below description.
Additional links: Slides
Author(s): Lisa Olson, Candy Hanson
Date: 05/2025
Sponsoring organizations: National Rural Health Resource Center, Stratis Health
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Evaluation of the Primary Care First Model: Third Annual Report
Provides an overview of the Primary Care First (PCF) model, which aims to enhance primary care and move primary care practitioners toward value-based payment. Describes the PCF model implementation experiences for Cohort 1 and Cohort 2 practices through 2023. Explores the characteristics of practices and payers that continued to participate in the PCF model compared to those who left. Examines the role that the PCF Model's incentives and supports played in the strategies and practices adopted to improve care delivery and how the trajectory of these strategies and activities practices have transformed over time. Estimates the impact of the PCF Model on Medicare fee-for-service (FFS) expenditures and service use, including acute hospitalizations. Estimates the impacts of the model on a set of seven leading indicators to provide an early assessment of whether care delivery changes are resulting in meaningful early outcome changes.
Additional links: Executive Summary, Findings at a Glance
Date: 05/2025
Sponsoring organizations: Centers for Medicare & Medicaid Services, Mathematica
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Provides an overview of the Primary Care First (PCF) model, which aims to enhance primary care and move primary care practitioners toward value-based payment. Describes the PCF model implementation experiences for Cohort 1 and Cohort 2 practices through 2023. Explores the characteristics of practices and payers that continued to participate in the PCF model compared to those who left. Examines the role that the PCF Model's incentives and supports played in the strategies and practices adopted to improve care delivery and how the trajectory of these strategies and activities practices have transformed over time. Estimates the impact of the PCF Model on Medicare fee-for-service (FFS) expenditures and service use, including acute hospitalizations. Estimates the impacts of the model on a set of seven leading indicators to provide an early assessment of whether care delivery changes are resulting in meaningful early outcome changes.
Additional links: Executive Summary, Findings at a Glance
Date: 05/2025
Sponsoring organizations: Centers for Medicare & Medicaid Services, Mathematica
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Medicare Shared Savings Program: Rule Changes and Implications for Rural Health Care Organizations
Summarizes changes to the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (SSP) that take effect in January 2023 for current participants, and in January 2024 for organizations applying for a January 1, 2024 start. Discusses the potential impact of these changes on rural health and participation considerations.
Date: 05/2025
Sponsoring organization: Rural Health Value
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Summarizes changes to the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (SSP) that take effect in January 2023 for current participants, and in January 2024 for organizations applying for a January 1, 2024 start. Discusses the potential impact of these changes on rural health and participation considerations.
Date: 05/2025
Sponsoring organization: Rural Health Value
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10 Things to Know About Rural Hospitals
Presents information and data on rural hospitals and rural hospital finances. Compares insurance coverage of discharges and births, margins, and the impact of Medicaid expansion by hospitals' rural and urban location. Includes information on rural hospital closures and Medicare special payment designations for rural hospitals. Discusses the potential impacts of recent federal spending proposals on rural hospitals.
Author(s): Scott Hulver, Zachary Levinson, Jamie Godwin, Tricia Neuman
Date: 04/2025
Sponsoring organization: KFF
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Presents information and data on rural hospitals and rural hospital finances. Compares insurance coverage of discharges and births, margins, and the impact of Medicaid expansion by hospitals' rural and urban location. Includes information on rural hospital closures and Medicare special payment designations for rural hospitals. Discusses the potential impacts of recent federal spending proposals on rural hospitals.
Author(s): Scott Hulver, Zachary Levinson, Jamie Godwin, Tricia Neuman
Date: 04/2025
Sponsoring organization: KFF
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Strategies for Sustaining Emergency Care in the United States
Assesses the value of emergency care in the United States, evaluates challenges to sustaining emergency care, measures trends in emergency care payment, and identifies alternate funding strategies for emergency care. Features a case study of a hospital-based emergency department closure in a rural community, and mentions rural throughout.
Author(s): Mahshid Abir, Brian Briscombe, Carl T. Berdahl, et al.
Date: 04/2025
Sponsoring organization: RAND Corporation
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Assesses the value of emergency care in the United States, evaluates challenges to sustaining emergency care, measures trends in emergency care payment, and identifies alternate funding strategies for emergency care. Features a case study of a hospital-based emergency department closure in a rural community, and mentions rural throughout.
Author(s): Mahshid Abir, Brian Briscombe, Carl T. Berdahl, et al.
Date: 04/2025
Sponsoring organization: RAND Corporation
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Sustaining Rural Hospital Access: Adjustments to Medicare Rural Hospital Designations
Describes the history of Medicare rural hospital designations. Discusses how traditional Medicare, Medicare Advantage, and Medicaid impact hospital finances. Outlines policy recommendations to the Secretary of Health and Human Services (HHS) and Congress regarding rural hospitals designations, payment adjustments, Medicare Advantage, and rural ambulance and emergency services.
Author(s): Emma Sheffert, Maya Sandalow
Date: 04/2025
Sponsoring organization: Bipartisan Policy Center
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Describes the history of Medicare rural hospital designations. Discusses how traditional Medicare, Medicare Advantage, and Medicaid impact hospital finances. Outlines policy recommendations to the Secretary of Health and Human Services (HHS) and Congress regarding rural hospitals designations, payment adjustments, Medicare Advantage, and rural ambulance and emergency services.
Author(s): Emma Sheffert, Maya Sandalow
Date: 04/2025
Sponsoring organization: Bipartisan Policy Center
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