Each state's approach to rural health transformation is slightly different, and that is why it is fascinating to read the planning documents and RFPs coming from state governments this summer. One thing they tend to have in common is a goal of bolstering statewide health information exchange infrastructure. Another common thread is taking a regional hub approach. For instance, in its rural health transformation effort, the Commonwealth of Pennsylvania plans to leverage already established regional entities that coordinate economic development activities. 

As the project narrative about the Pennsylvania Rural Health Transformation Plan (RHTP) explains, these eight Partnerships for Regional Economic Performance (PREP) organizations are long-standing, quasi-governmental organizations that convene regional stakeholders, administer federal and state grants, collect local data, report outcomes, and catalyze public and private partnerships for regional economic development. They bring established governance structures, convening power, and a track record of successful cross-sector collaboration. 

The PREPs will convene regional stakeholders to create Rural Care Collaboratives (RCCs) to align initiatives with regional economic planning and development, with the goal of making the RHTP investments sustainable and promoting long-term partnerships.

RCCs will include healthcare providers directly delivering care in that region alongside other local stakeholders such as local officials, business leaders, patients, educational institutions, foundations, and community-based organizations (CBOs). 

Local hospital leadership will participate in the RCC, even if that hospital is part of a larger system, to maximize local impact. RCCs will have a statewide steering committee to allow for collaboration and learning communities across regions and coordination of cross-regional projects. With statewide support and access to technical experts, RCCs will be charged with identifying and implementing key initiatives and prioritizing investments and activities based on meeting their local rural health needs. 

The Commonwealth noted that as RCCs mature, they will take the lead in setting priorities and guiding implementation of statewide initiatives in their regions. The RHTP Office states that this dual structure — statewide vision with regional implementation — ensures Pennsylvania can move quickly to stabilize access in the near term, while building local, collaborative, sustainable systems in rural regions to accomplish key goals.

RCCs will Invest in tailored, sustainable community telehealth infrastructure, digital solutions to improve primary and specialty care access, and technology-enabled prevention and chronic disease management strategies.

In addition, RCCs in each of the eight PREP regions will build and sustain regional partnerships. A funding allocation formula will be used for regions based on the size of the rural population in HRSA-defined rural census tracts and other regional measures.

In a hub-and-spoke model, Regional Hubs will be anchored by health systems, health information exchanges, or other organizations positioned to lead regional digital technology and AI adoption. The hubs will provide direct support to local hospitals and providers, including technical assistance, workflow redesign, staff training, and mentoring. Each RCC will designate a regional hub entity to lead planning, engage stakeholders, and prioritize resources, while a central state team assists with technology standards, compliance, workforce training, and data reporting.

Spoke facilities (rural hospitals, CHCs, clinics, and long-term care providers) will gain access to vetted digital tools, implementation support, and virtual care models and in collaboration with the hub, determine the suitability of technology solutions for rural facilities.

Shared statewide technical assistance resources will provide centralized vendor vetting, training, and evaluation.

Modernizing statewide health data infrastructure

Meanwhile, Pennsylvania will seek to modernize its statewide health data infrastructure in alignment with the CMS Health Technology Ecosystem (HTE) model, a national framework designed to enable secure, consent-based, API-driven data exchange across payers, providers, and patients. Pennsylvania’s initiative will transform its existing health information exchange network, the P3N, into a CMS-Aligned Network, ensuring compliance with federal interoperability mandates and creating a foundation for all future health transformation efforts.

Under the HTE model, Pennsylvania will expand and build three core statewide services:
 (1) an Identity and Trust Service that extends Keystone Login to a CMS-approved IAL2/AAL2 level, ensuring verified digital identities for all Fast Healthcare Interoperability Resources (FHIR)- based exchanges; 
(2) a FHIR Endpoint Directory synchronized with CMS’s National Directory of Healthcare, enabling real-time discovery and connection between payers, providers, and digital health applications; and
(3) an Authorization and Audit Utility, modeled after CMS’s Developer Portal, to issue secure access tokens, manage consent, and maintain auditable transaction logs.

By modernizing the P3N framework to fully participate in the CMS HTE, Pennsylvania will seek to enhance accountability for value-based outcomes and position itself as a national leader in AI-ready health interoperability.

The Commonwealth said it will begin with a Discovery & Current State Assessment to inventory provider systems, electronic health records (EHRs), HIOs, payer platforms, and digital applications across the state for FHIR readiness, data models such as United States Core Data for Interoperability (USCDI v3) or beyond, consent frameworks, identity management, and connectivity gaps.