This notice announces the opportunity to apply for funding under the Rural Health Innovation and Transformation Technical Assistance (RHIT-TA) program. The purpose of this program is to provide technical assistance (TA) to support rural health care through innovative payment models and to promote the value-based care landscape in the context of rural health care. For the purposes of this funding opportunity, the term "stakeholders” may include, but is not limited to, different types of rural health care providers, community-based organizations, foundations, third party payers, and public (e.g., state, local, and Federal Government) entities.
In an effort to control health care costs and improve the quality of care, public and private payers have increasingly implemented initiatives to encourage value-based care. Value-based care programs reward health care providers for the quality of care through the realignment of financial incentives towards value over volume. Because of the unique economic factors affecting rural providers, the implementation and effects of value-based care initiatives may look different in rural, low-volume settings. For example, low patient volumes, along with low margins in rural settings can make it more difficult to absorb the financial risks associated with value-based care. Start-up costs for value-based care may seem prohibitive for some, while small volumes may make it more difficult to measure value and may increase the risk of skewed outcomes.
At the same time, value-based care initiatives are evolving towards total cost of care and population-based payment models associated with some level of financial or other risk. Further, considering the ongoing COVID-19 pandemic and its effect on underserved and rural communities, the need for equitable value-based care has become even more evident. Disparities seen before and during this time have shown a need to achieve equitable outcomes through high-quality, affordable, person-centered care through value-based care models, including for rural communities.
Therefore, a major goal of this program is to support the ability of rural providers to participate and succeed in current and emerging payment and delivery system models
designed to provide high-quality care, improve health outcomes and most especially advance health equity. The Centers for Medicare & Medicaid Services (CMS) defines health equity as “the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes”.
Achieving equitable health care through value-based care is a priority of the United States Department of Health and Human Services (HHS). Through the prioritization of value-based care, HHS is working to transform our healthcare system to reduce costs, improve quality of health care services, and ensure access, including strategies to partner with providers to develop payment models and other incentives to expand options for quality care at lower costs. The Center for Medicare and Medicaid Innovation (CMMI), within CMS, is tasked with transitioning our health system to value-based care by developing, testing, and evaluating new payment and service delivery models to reduce health care cost while improving outcomes. In its strategic direction for the next ten years, CMMI is emphasizing equitable value-based care that will improve the health system for all patients and aims to achieve equitable outcomes by focusing on five strategies:
1. Increasing the number of beneficiaries in a care relationship with accountability for quality and total cost of care
2. Advancing health equity by increasing focus on underserved populations
3. Supporting care innovations that enable integrated, person-centered care
4. Improving access by addressing affordability
5. Engaging partners and beneficiaries to achieve system transformation
In alignment with federal priorities with respect to value-based care, this funding opportunity seeks to provide a mechanism for the federal government to support rural health care stakeholders to achieve the following goals:
1. Raise awareness of the unique considerations facing rural providers and communities in implementing equitable value-based care in the current and emerging environments, with a focus on the strategic areas identified above.
2. Enable rural stakeholders to understand value-based care models in both the public and the private sector, the rural relevance of these models, and their options for participation. Help rural providers and other rural stakeholders find and apply strategies to support rural participation in value-based care.
3. Provide resources, analysis, and other TA that is nationwide in scope, meaning that the focus of this award is to reach a broad set of rural stakeholders across the country as opposed to limiting the focus on one particular state, region, provider type, model, or program.
