Healthcare in rural areas like North Carolina faces serious challenges. The Rural Health Transformation Program (RHTP) aims to help, especially as Medicaid cuts loom. In North Carolina, nearly 80 rural counties struggle under one of the highest Medicaid burdens in the nation. Federal funding covers 73% of the state’s Medicaid costs, putting a spotlight on the obstacles rural healthcare systems face, according to UNC Health CFO William Bryant.
While UNC Health operates across all 100 counties with 17 hospitals and over 900 clinics, the impact of federal funding is questionable. Bryant believes that funding, averaging $2 million per county yearly, won’t significantly change the rural healthcare landscape. He points out that anticipated Medicaid cuts are much larger than the relief offered by the RHTP. Some of these federal dollars may even go to organizations outside direct patient care, limiting their potential impact.
“It’s helpful but not transformative,” Bryant states. He remains hopeful that improvements will unfold over the next few years, despite current concerns.
In the past few years, UNC Health has proactively considered the fragility of rural healthcare in its planning. While the financial health of rural hospitals has improved, largely due to Medicaid expansions, Bryant warns that these gains might be short-lived. The healthcare system has now taken steps to strengthen its finances and focus on long-term rural support.
“We’ve seen significant investments to stabilize rural providers in North Carolina,” he said. The present situation shows some improvement, but challenges remain, especially with upcoming reimbursement cuts and program expirations.
As turbulence looms, UNC Health is deepening partnerships with rural providers and exploring durable care models to help offset future shortfalls. Bryant foresees an increasing responsibility for UNC Health to stabilize access to care in rural communities, especially with some independent providers expected to struggle. This involves capital planning, infrastructure investments, and collaborations with the state and other healthcare systems.
The organization’s strategies sharpened following Hurricane Helene, which highlighted vulnerabilities in rural healthcare. After the storm, demand surged while services became harder to access. The experience reinforced the need for long-term investments in infrastructure and informed future planning for facilities.
Virtual care has become crucial in bridging these gaps in rural healthcare. UNC Health has expanded telehealth services to help connect rural patients with specialized care and reduce pressures on urban facilities. “Telehealth can help break down barriers that disrupt continuity of care,” Bryant explains.
However, uncertainties regarding Medicare repayment complicate long-term strategies, even as telehealth usage rises. During Hurricane Helene, these services proved essential, and their importance has continued to grow. The aim now is to improve care coordination through partnerships that reduce unnecessary migration of patients to urban centers.
Workforce shortages are another pressing issue. Bryant emphasizes the need for training programs to cultivate local healthcare providers. Collaborations with community colleges aim to strengthen the rural workforce. For instance, Wake Tech is working with WakeMed to create simulation hospitals, providing hands-on training opportunities.
These combined efforts are crucial for stabilizing healthcare in North Carolina, reflecting broader issues facing rural areas nationwide. Aging infrastructure, tight budgets, and workforce gaps are challenges shared across the country, driving healthcare systems to rely more on virtual and integrated care.
Looking ahead, Bryant warns that simply investing in parts of the system won’t solve systemic issues. Many rural hospitals, originally built with government funding decades ago, now struggle under outdated frameworks. To sustain rural healthcare, a comprehensive rethinking of insurance markets and payment structures is essential. Technology and AI might offer efficiency, but reform must address the core issues affecting access to care.
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