Summary
- The Rural Health Transformation (RHT) Program provides a historic opportunity to advance health care in rural America. IHI offers a suite of services aligned with the RHT Program to help states build safer, stronger, and healthier rural communities.
Rural communities across the U.S. face well-documented challenges, including Medicaid funding reductions, hospital closures, provider shortages, limited infrastructure, and health disparities. The $50 billion Rural Health Transformation (RHT) Program represents a historic infusion of federal investment to advance rural health amid these realities. With decades of experience in systems redesign, quality improvement, and collaborative learning, IHI offers a comprehensive suite of services aligned with the RHT Program aims and approved uses of funds.
What is the Rural Health Transformation (RHT) Program?
The Congressional Budget Office estimates that the One Big Beautiful Bill Act (OBBA), which was enacted into law on July 4, 2025, will reduce federal Medicaid spending by over $900 billion over 10 years and increase the ranks of the uninsured by 10 million additional persons. To partially address the effects of these federal spending reductions that will disproportionately impact rural areas — where approximately 60 million Americans reside — the OBBA included $50 billion in federal funding over five years to create the Rural Health Transformation (RHT) Program.
This high-stakes, one-time funding opportunity provides an important catalyst for states to design, implement, and scale high-impact initiatives that sustainably transform health care delivery and caring for millions of people. Vital to the success of state applications is the selection and engagement of partners with proven success in co-designing and scaling high-leverage initiatives that achieve high-yield return on investments and contribute proven results.
IHI: Your RHT Partner
For more than 30 years, the Institute for Healthcare Improvement (IHI) has successfully catalyzed, co-designed, led, and scaled transformative and sustainable improvements in health and health care — including in rural communities — in partnership with state, federal, and national entities. IHI has walked this road with states and systems before, bringing the practical know-how to translate funding into safe, high-quality care, stronger workforces, healthier communities, and sustainable transformation to the very places where care is often hardest to deliver. With decades of experience in system redesign, quality improvement, and collaborative learning, IHI offers a comprehensive suite of services aligned with the RHT Program aims and approved uses of funds. Our core capabilities — world-class education, unrivaled networks, and expert consulting and implementation support — can help states build sustainable, high-performing rural health systems.
Through strategic partnerships with state health departments, rural associations, and affiliated community organizations, IHI can provide customized support across the RHT Program domains. These include (but are not limited to) chronic disease management, workforce development, and technology-enabled care delivery to accelerate innovation, test interventions, share data and lessons in real time, and provide expert facilitation and coaching to support adaptive change cycles and build lasting capabilities.
Select examples of IHI’s contributions to advance rural health and serve as an RHT partner-of-choice for states include:
IHI served as National Improvement Advisor for the CMS Partnership for Patients program, one of the largest patient safety campaigns in U.S. history, which engaged thousands of hospitals, including many rural facilities, and led to more than 2 million fewer harms and saved nearly $20 billion, producing measurable improvement at scale.
Our state-level collaboratives have helped rural- and critical-access hospitals to strengthen safety culture, reduce infections and complications, foster opioid stewardship, and more.
In maternal health, IHI’s work has reduced severe morbidity, including in vulnerable rural communities facing maternity care deserts.
Our leadership and expertise in advancing Age-Friendly Health Systems means that older adults receive evidence-based and age-appropriate care in rural and community hospitals and care settings, including outpatient, primary care, and nursing homes.
Our partnership in the AHRQ ECHO National Nursing Home COVID-19 Action Network reached 9,058 nursing homes in all 50 states, the District of Columbia, and Puerto Rico, many in rural areas, with its 16-week program to provide free training and mentorship to enhance evidence-based infection prevention and safety practices to protect residents and staff.
Our virtual care delivery initiatives and Joy in Work framework have paved the way to meaningfully engage teams in care delivery redesign and innovation to support a thriving workforce — an urgent issue for rural providers.
Our work within and beyond the US has emphasized low-resource innovation, building learning networks, and utilizing community health workers to extend care reach in settings of scarcity.
The $50 billion RHT Program presents a historic opportunity, and its success depends heavily on how states design initiatives and steward resources. IHI understands the urgency of rural health needs and the mechanics of sustainable system redesign, and is the trusted partner that states need to turn RHT funding into lasting gains that persist beyond the five-year funding period for patients, providers, and communities.
To learn more about how IHI can partner with your state to build safer, stronger, and healthier communities, please contact RuralHealth@ihi.org.
Patricia McGaffigan, MS, RN, CPPS, is an IHI Senior Advisor for Safety and President, Certification Board for Professionals in Patient Safety.
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