By Laura Young, Co-Founder & Managing Director, Converge Health
LinkedIn: Laura Young
LinkedIn: Converge Health
Why interoperability, community information exchange, and behavioral health sit at the center of CMS’s $50 billion bet
The recent establishment of the Office of Rural Health Transformation by the Centers for Medicare & Medicaid Services marked a quiet but consequential shift in federal rural health policy. Combined with the release of state award amounts and project abstracts under the $50 billion Rural Health Transformation (RHT) Program, the message is clear: rural health transformation is no longer framed as a collection of pilots. It is being treated as an infrastructure challenge.
That framing matters.
A review of the state-submitted RHT abstracts shows that while workforce, telehealth, and hospital sustainability remain prominent, the most consistent throughline across states is the need to fix how information moves at the last mile. States may not always use the same vocabulary, but interoperability, cross-sector data sharing, and integrated systems appear repeatedly as prerequisites for success.
Just as importantly, states are no longer limiting “interoperability” to hospitals and clinics. Community information exchange and behavioral health integration are embedded throughout these proposals, signaling a broader understanding of what whole-person care actually requires in rural settings.
From Access Expansion to System Design
Historically, rural health funding has focused on access points: keeping hospitals open, expanding telehealth, recruiting clinicians. The RHT abstracts suggest a shift toward system design.
States are proposing hub-and-spoke models, regional care networks, shared services, and community-based delivery models that depend on reliable information flow. In these designs, care does not live in a single building or system. Patients move. Providers collaborate across organizations. Community partners play active roles.
In that context, interoperability becomes less about technical compliance and more about operational viability. If data does not follow the patient across settings, the model breaks down.
This is the essence of last mile interoperability.
Iowa: Health Hubs Built on Exchange
Iowa’s RHT abstract is one of the most explicit in treating interoperability as foundational infrastructure. The state’s strategy centers on community-based Health Hubs and coordinated rural networks designed to support new care pathways.
Critically, Iowa links these hubs to a Health Information Exchange initiative that ensures records are accessible as patients move across providers and geographies. This is not abstract interoperability. It is a recognition that rural patients often receive care from multiple systems, and continuity depends on shared data.
Iowa’s framing reflects a mature understanding of last mile challenges: care redesign without interoperable records simply shifts burden to clinicians and patients. With it, coordinated models become feasible.
Rhode Island: Whole-Person Care Requires Whole-Person Data
Rhode Island’s abstract approaches rural transformation through the lens of connected, community-based systems. While its rural geography is limited, the state emphasizes technology innovation and digital infrastructure as essential enablers of integrated care.
Rhode Island explicitly ties interoperable technology to community health workers, behavioral health integration, and coordinated service delivery. The state’s vision depends on information flowing across clinical, behavioral health, and community settings.
Rather than positioning HIE as a standalone solution, Rhode Island implicitly embraces community information exchange concepts, where data supports navigation, follow-up, and whole-person care.
Alaska: Interoperability as a Survival Requirement
Alaska’s abstract underscores the realities of frontier care. Vast distances, limited workforce, and heavy reliance on remote services make connectivity essential.
The state emphasizes telehealth, data sharing, and cybersecurity as part of its technology and innovation strategy. In Alaska’s case, last mile interoperability is not an efficiency play. It is necessary for continuity, safety, and access.
Alaska’s proposal highlights a broader truth reflected across many rural states: when care is distributed, data must be even more mobile than providers.
California and Connecticut: Interoperability as Participation Infrastructure
California and Connecticut both articulate interoperability as a means of enabling participation, particularly for rural and smaller providers.
California emphasizes modernizing IT infrastructure, improving data sharing, and providing technical assistance so rural providers can meaningfully engage in digital care and exchange. The focus is not just on connectivity, but on usability and sustainability.
Connecticut is more explicit, calling out expanded interoperability, health information exchange participation, telehealth infrastructure, and analytics. By pairing exchange with analytics, Connecticut signals an expectation that shared data will drive performance improvement and policy insight, not simply move between systems.
Florida, Delaware, and Hawaii: Exchange in Practice
Several states offer particularly concrete examples of exchange-aligned investments.
Florida highlights health information exchange and encounter notification systems as tools to improve care coordination and continuity. Encounter notifications represent a classic last mile use case. Their value depends entirely on governance, workflow integration, and adoption.
Delaware explicitly names health information exchange as a fundable investment category, including illustrative dollar amounts. That specificity suggests readiness to move quickly from planning to implementation.
Hawaii proposes a Rural Health Information Network, effectively naming a statewide digital backbone designed to connect rural providers across islands. In a geographically fragmented state, this network approach reflects a deep understanding of how data connectivity supports system cohesion.
Community Information Exchange: The Unspoken Backbone
While not always labeled as such, community information exchange (CIE) concepts run throughout the RHT abstracts.
States describe care coordination across community partners, community-based hubs, navigation services, and integration with social supports. These models implicitly require systems that can share information beyond traditional healthcare entities.
States like Oklahoma, Montana, Rhode Island, and California emphasize community-centered models that rely on data flowing between clinical providers, behavioral health organizations, EMS, public health, and community-based organizations.
This is where last mile interoperability becomes most complex and most impactful. CIE requires governance, consent, trust, and workflows that reflect how care actually happens on the ground.
Behavioral Health Moves From Add-On to Infrastructure
Behavioral health appears across the RHT abstracts not as a separate program, but as an integrated component of rural care models.
States cite shortages in mental health and substance use services, the need for crisis response, and the importance of coordinated follow-up. Increasingly, they embed behavioral health within telehealth expansion, care coordination teams, and community hubs.
This integration has significant interoperability implications. Sharing behavioral health information responsibly requires thoughtful consent models, clear governance, and systems designed to support collaboration without compromising privacy or trust.
The abstracts suggest states understand this complexity. Many leave room for phased implementation and stakeholder engagement, signaling an awareness that behavioral health integration is as much an operational challenge as a technical one.
Whole-Person Care Lives at the Last Mile
Taken together, the RHT abstracts reveal a national shift in how rural health systems are being designed.
States are not simply trying to connect hospitals. They are trying to connect people, services, and supports across rural communities. That is whole-person care in practice.
Health information exchange, community information exchange, and behavioral health integration converge at the last mile, where policies meet workflows and technology meets reality. This is where investments either translate into impact or stall.
Why This Moment Is Different
The scale of RHT funding allows states to think beyond pilots. The creation of a dedicated federal office creates continuity and accountability. And the substance of the state abstracts shows that lessons from past efforts have been absorbed.
Interoperability is no longer framed as a technical aspiration. It is being treated as operational infrastructure for rural health sustainability.
If the RHT program succeeds, it will not be because of any single platform or model. It will be because states use this opportunity to build trusted, interoperable ecosystems that support clinical care, behavioral health, and community services together.
The next phase of rural health transformation begins now.
With funding awarded and plans on the table, the focus must turn to how care is actually coordinated across rural communities. Interoperability, community information exchange, and behavioral health integration are no longer optional. They are the mechanisms through which whole-person care becomes real. The states and partners who lean into this work now will define what rural health looks like for the next decade.
This article was originally published on Converge Health and is republished here with permission.