44 EXECUTIVE BRIEFING
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EXECUTIVE BRIEFING
For rural healthcare organizations, access has become the central
organizing principle behind nearly every strategic decision.
This new operational reality is being shaped by a convergence of
pressures. Workforce shortages, rapidly declining independent
physician practices, geographic dispersion and aging populations
have pushed traditional care models to their limits, widening gaps
in access to routine and preventive services. A November 2025
Commonwealth Fund report highlights the consequences: nearly
40% of adults living in rural areas have sought care in emergency
departments for conditions that likely could have been treated in
primary care settings.
But the challenge, as athenahealth's research and policy work make
clear, runs deeper than geography alone. "I think access is much
more nuanced," Joe Ganley, vice president of government and
regulatory affairs at athenahealth, said. "It's great if I have a doctor's
office in my town. It's not great if I can't get an appointment for nine
months because they're totally booked, or I can't afford it."
In response, rural leaders are redesigning not just where but
how care is delivered — through virtual-first workflows, expanded
ambulatory and community-based care sites, stronger data-sharing
and new partnerships that ease patients' access to services while
extending scarce clinical capacity.
This article, the first in a four-part series, "Rural healthcare
excellence in 2026: 26 lessons in making less do more," highlights
six ways rural providers are expanding access through pragmatic
innovation and what it signals for the future of care delivery.
1. Address nonclinical barriers that keep
patients from the door
In many rural communities, the biggest barriers to care occur long
before a patient enters a clinic. Transportation limitations, language
barriers, digital gaps and affordability challenges frequently
redirect patients toward emergency departments for care that
could have been addressed earlier in primary care settings.
Shelly Soileau, CFO of Opelousas (La.) General Health System, said
transportation challenges alone can regularly derail patient care
plans. "I think it's very much going to continue to be an issue in rural
Louisiana, because our patients either don't have transportation
or don't have family available to transport them," she said during
Becker's "CFO + Revenue Cycle Podcast." Her organization has
pieced together unconventional solutions — coordinating rideshare
services and even calling local police departments for help — while
pursuing longer-term options with the state.
Digital gaps present a parallel challenge. At MyMichigan Medical
Center Alpena, in Michigan's sparsely populated northeast,
limited broadband and the high cost of connectivity infrastructure
remain stubborn barriers — not just for patients, but for the health
system itself.
"The cost of broadband goes up as the areas are more remote,"
Pankaj Jandwani, MD, CIO for MyMichigan Health, told Becker's.
Even where connectivity exists, digital literacy and patient
trust require ongoing attention. Hunter Nostrant, president of
MyMichigan Medical Center Alpena, said effective outreach
means meeting patients where they are, as some prefer video,
others text and others still want in-person contact. Evanston (Wyo.)
Regional Hospital is taking a similarly community-rooted approach,
relaunching a program for adults over 50 to build confidence
and competency with digital health tools that support ongoing
engagement in their care.
2. Design virtual-first care models that extend
specialty reach
Telehealth has long been viewed as a solution to rural access
challenges. Virtual visits can expand provider capacity while
improving convenience for patients, often requiring less
administrative overhead than traditional office visits and allowing
clinicians to see more patients within the same timeframe.
Sioux Falls, S.D.-based Sanford Health has delivered more than
1 million virtual visits across nearly 80 specialties through its virtual
care center and hub-and-spoke model. The system's chief medical
officer of virtual care, Dave Newman, MD — the only andrologist
in North Dakota — told Becker's that patients previously drove
several hundred miles each way to see him; through virtual care,
the average Sanford patient now avoids roughly 176 miles of
travel per visit.
Nick Olson, Sanford's executive vice president and CFO, said the
system's virtual care center has helped extend specialty care access
and even expand its clinical trials reach across the region.
Policy support will play a major role in determining how widely
these models expand. While telehealth flexibilities for Medicare
beneficiaries were extended through 2027, Mr. Ganley said
broader reimbursement stability remains essential. "Medicare
reimbursement is hugely important when you're talking about
seniors, but in the FQHC world, it's much more skewed toward
Medicaid," he said. "Medicaid eligibility, telehealth reimbursement
and ambulatory physician fee schedule reimbursement are all
things that should be on the table."
3. Deploy mobile and community-based care to
close geographic gaps
Expanding access increasingly means moving care beyond the
hospital campus. FQHCs and rural health clinics play a central role
in that ecosystem — and when they close, patients often have few
alternatives beyond the emergency department. With funding
shortfalls threatening hundreds of FQHCs nationwide, hospitals
are bracing for downstream effects including more avoidable
health crises and overcrowded EDs.
Closing the Access Gap
6 strategies to redraw the patient care map
Rural Healthcare Excellence in 2026
