Orchestrating success in rural health transformation

How Transformation Management Offices can drive rural health program excellence

The Rural Health Transformation (RHT) Program, with its historic $50 billion investment over five years, offers a unique opportunity for states to address the longstanding healthcare challenges in rural communities. However, the complexity of managing these funds and coordinating across multiple initiatives and stakeholders can be daunting. Traditional project management is no longer sufficient; strategic portfolio discipline, facilitated by a Transformation Management Office (TMO), is crucial for navigating this intricate landscape, making informed prioritization decisions, ensuring Centers for Medicare & Medicaid Services (CMS) compliance, and delivering measurable outcomes that secure continued funding.

The time for action is now. States that establish robust transformation management and portfolio discipline within the first 90 days will be best positioned to maximize their RHT funding and create lasting change for rural communities.

The orchestration imperative in rural health transformation

Four critical factors highlight the necessity for robust program orchestration: 

1

The portfolio rationalization imperative: The temptation to fund everyone and everything—what we call the "peanut butter spread" approach—virtually guarantees mediocrity. States must ruthlessly prioritize and concentrate resources on a few high-impact initiatives. This requires saying "no" to good ideas to say "yes" to great ones, with foundational decisions made in the first 90 days.

2

Complex stakeholder coordination challenges: Rural health transformation requires unprecedented coordination. States must engage multiple agencies while managing relationships with hundreds of rural providers. In rural healthcare settings, where limited resources and complex system constraints prevail, effective stakeholder coordination becomes even more critical.

3

Compliance and performance tracking requirements: The RHT program's structure demands rigorous oversight. States must track at least four quantifiable metrics per initiative, with one requiring county-level granularity. With administrative expenses capped at 10% of funding and workload funding dependent on demonstrated progress, states need sophisticated mechanisms to track performance while maintaining lean operations. Failure to meet commitments can result in funding recovery.

4

The sustainability challenge: RHT funding is designed to catalyze lasting transformation. States must demonstrate how initiatives will persist beyond the funding period, requiring strategic planning that balances immediate needs with long-term sustainability.

A transformation management approach to rural health success

Addressing these challenges requires a comprehensive TMO approach that goes beyond traditional program management:

1

Drive portfolio rationalization and strategic focus: Rigorously assess existing initiatives, identifying overlaps and gaps, and make data-driven decisions about where to concentrate resources.The TMO must have the authority and analytical capability to recommend program consolidation, sunset underperforming initiatives, and redirect resources to high-impact areas.

2

Establish integrated governance and program management: Establish clear governance structures that align stakeholders around a focused set of shared objectives. A TMO provides the framework for enterprise program management and executive level coordination

3

Employ effective tracking and compliance protocols: Establish protocols for compliance tracking, performance measurement, and reporting across the rationalized portfolio. Develop dashboards to improve visibility, reduce administrative burden, and use portfolio information to flag underperforming programs for proactive course correction.

4

Create sustainable transformation frameworks: Embed sustainability from day one through strategic financial planning, business case development, and return on investment (ROI) tracking. Establish clear success metrics and build local capabilities in rural communities, like grants management and data analysis, to ensure lasting value after funding ends.

5

Enable continuous stakeholder engagement: Employ a structured approach for stakeholder management, communications planning, and change management.

How KPMG can help

At KPMG, our Rural Health Transformation Orchestration approach provides states with the framework and experience needed to navigate this complexity. We bring tested experience in large-scale healthcare and state and local government transformations, having supported numerous states in complex program implementations. Our approach—with portfolio rationalization at its core—spanning strategic services, governance, quality assurance, and change management—helps ensure states can deliver on their RHT commitments while building sustainable capabilities for the future. See how a TMO approach can accelerate your rural health transformation journey.

 

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Orchestrating success

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