The Atrómitos Way

#055: Rural Health Transformation in Washington State and Beyond

• Atrómitos, LLC • Season 5 • Episode 55

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The Rural Health Transformation Program (RHTP) is the largest federal investment in rural health in a generation: $50 billion over five years, distributed to all 50 states. Washington State received $181 million in year-one funding, with $5.43 million designated for The Rural Collaborative. 

In this conversation, Michealle Gady sits down with The Rural Collaborative Executive Director, Elya Prystowsky, to cut through the noise about one of the most consequential rural health investments in years. They cover the stakes, the strategy and what comes next: 

How has The Rural Collaborative helped Washington hold on to its rural hospital footprint while hospitals elsewhere have closed at alarming rates? What are Washington state’s specific goals for these funds, and how were they chosen? What do rural providers need to do before the 2030 deadline to ensure lasting impact?

Elya Prystowsky has led The Rural Collaborative — a nonprofit serving 31 rural, independent hospitals in Washington State — for seven years. She brings 11 years of applied epidemiology and biostatistics and 15 years in healthcare, with a track record of translating research into practice.

Key Takeaways

Shared ownership over maintaining access. The RHTP’s $50 billion does not offset the loss of $137 billion in Medicaid funding — but organizations like The Rural Collaborative are pursuing every available avenue to help people maintain coverage and get the care they need. In Elya’s own words, “If one rural hospital closes in Washington, then we all collectively fail.”

Collaboration takes energy and effort. Washington’s rural hospitals are already making strides: leveraging shared services, strengthening networks, and focusing on sustainability. Their principle— “Independence Through Interdependence” — is both the method and the proof of concept.


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Narrator

Welcome to the Atrómitos Way podcast, where we candidly discuss the everyday challenges facing health and human service providers, including government agencies, philanthropies, and advocates. With the tagline Independence through interdependence, the Rural Health Collaborative is a network of 31 rural hospitals across 23 counties, all with the goal of ensuring rural Washingtonians receive the same high-level access to high-quality care as their urban counterparts. The Rural Health Transformation Program is the largest federal investment in rural health in a generation. $50 billion over five years distributed to all 50 states. Washington State received $181 million in year one funding with $5.43 million designated for the Rural Collaborative. In this conversation, Michealle Gady sits down with the Rural Collaborative Executive Director, Elya Prystowsky, to cut through the noise about one of the most consequential rural health investments in years.

Michealle Gady

Welcome back to the Atrómitos Way. I'm Michelle Gady, and today I'm joined by Elya Prystowsky, Executive Director of the Rural Collaborative, a statewide network of independent rural hospitals in Washington State. Elya is an epidemiologist by training with a doctorate from the University of Washington and a master's from Harvard University. We're talking today about the Rural Health Transformation Program, $50 billion, five years, all 50 states. It's the largest federal investment in rural health in a generation, and it landed in the same legislation that slashed more than $900 billion from Medicaid over the next day, decade, with roughly $137 billion affecting rural communities nationwide. So the promise is real, but so is the tension. Unfortunately, this isn't an abstract policy conversation. Rural hospitals are closing, rural patients are driving further for care. State agencies and health systems are making decisions right now about how to use these federal dollars. And the choices made over the next 12 months could shape rural health outcomes for the next decade. Washington is worth paying close attention to. So your training is in epidemiology and population health. So tell us about the path that led you from that work into leading a statewide network of rural hospitals. What drew you to the rural health and to the rural collaborative specifically?

Elya Prystowsky

Oh, well, thank you so much, Michelle. And I'm so happy to be here. And I love that I get to represent the state of Washington. So a little bit about me that helps you understand my journey. I actually was born on the Presidio in San Francisco during the HIV epidemic. And at that time, my dad was a dermatologist at the University of California, San Francisco. And he was one of the researchers that helped make the connection between Capacity sarcoma and gay men in San Francisco. And he, I got really interested in it and grew up kind of listening to him talk about it and trying to understand why some people get sick and other people don't. Because as a kid, it just didn't seem to make much sense. Then as I progressed through my career, I really found myself drawn to the fact that the biggest driver of your health is where you live. It's your zip code. And of course, that led me straight to the rural health pack. And I have had the honor of being hired to be the executive director of the rural collaborative in October 2019, just six months before the COVID travel ban was announced. And so being an epidemiologist and then also working with rural hospitals, I have never been so proud to be surrounded by people with just a tremendous amount of integrity, people who really serve the community and are committed, they're resourceful, they don't ask for trophies or parades at the end of the day to celebrate their good deeds. They just do the right thing. And I've never looked back.

Michealle Gady

That's really great. So for listeners that are unfamiliar with the rural collaborative, can you explain what it is and the problem it was created to solve?

Elya Prystowsky

Well, yeah. So the rural collaborative was created by rural hospital CEOs back in 2003 so they could have a space to think together and to build strategies together. Now it started as a pretty loose alliance of only five hospitals. In fact, the original name was the Western Washington Rural Health Care Collaborative. And they formed around a health information technology grant back in the early 2000s. Did not get the grant. To this day, we still have five different EHRs, but they found tremendous value in the networking and the CEO-to-CEO engagement. Fast forward to 2015, TRC Incorporated as a nonprofit, this time with 15 rural hospitals. Now 2026, we are 31 rural hospitals covering 23 counties and taking care of around 800,000 Washingtans each year with a net patient revenue of 2.5 billion. So you asked what was the problem that we were created to solve. I don't think they realized it at the time, but because they just liked each other and they liked being around each other. But really, the reason we exist is to make sure rural Washingtans receive the same high-level access to care, the same high-quality care that urban Washingtonians receive. And for more than two decades now, these rural leaders have connected with purpose and turned that collaboration into very real operational, financial, and clinical gains.

Michealle Gady

That's great. So let's talk about how this works. So the organization's tagline, so the rural collaboratives tagline is independence through interdependence. So what does that mean in practice for a network of member hospitals that, you know, at least on paper, um can compete for workforce and contracts and patients. How do how does that all work together?

Elya Prystowsky

Yeah, I mean, sure, there's always going to be some competition, but you you get a lot less competition when you get out into rural health systems. And that's really what makes this work. And it's simple. So these rural hospitals are independent and they could either hang together or hang alone. And they have to stick together. And that stickiness is so important that we've used the uh the term that this is a coalition of the wanting. It's not a coalition of the willing. Collaboration takes energy, it takes effort. You have to commit, you have to show up, you have to be present, you have to respond, you have to follow through. So the see the CEOs have formed this engine for shared strategy, network-level performance, and payer leverage, all while staying independent. And this has helped each of them operate stronger, negotiate smarter, deliver better outcomes. And on paper, if you look at it just, you know, quantifiably, the average return on investment for our members is 10 to one, which is pretty astronomical. Um and just our, you know, just the work we've done with GPOs and revenue cycle and some other other big programs and initiatives has really ended up turning into real green dollars for these rural hospitals.

Michealle Gady

And that's really important, particularly as we're seeing rural hospitals across the country closing at really an alarming rate. Um, you know, in Washington, though, the rural hospital footprint um is really held on. So after two decades of the rural collaborative's work, what do you see as the organization's biggest contributions? And given what it has made possible here in Washington, what do you think it would take for other states to build something similar?

Elya Prystowsky

Well, I don't think the collaborative can take all the credit. Everything you're saying is true, and I could not be happier. The truth is, our state did expand Medicaid in 2012. Our state's insurance exchange worked the first time and has worked for the last 15 years pretty much seamlessly. Washington state has public rural hospitals. So, by the nature of being public, they benefit from tax levies and bonds that private hospitals or non-public hospitals wouldn't be able to avail themselves of. We have a found fantastic state office of rural health in our Department of Health. We have a strong hospital association and association in Washington Public Hospitals. Washington still is one of the, I think just slightly half of the states in the country use cost-based reimbursement for Medicaid. This is huge in helping hospitals stay open. So these are like tectonic factors that I have no control over. But I think, you know, I like to think um that the rural collaborative is part of the solution. Our return on investment is great, our peer-to-peer networking and shared learning is vital. And we have a saying that if one rural hospital closes in Washington, then we all collectively fail. So there's a shared ownership over maintaining access, even if that's not your own community.

Michealle Gady

That shared accountability is really important.

Elya Prystowsky

Super important.

Michealle Gady

So let's take a step back in a bigger picture. Um, so the rural health transformation program is as, you know, as we started, $50 billion over five years. Um, it is the largest rural health commitment in a very long time. Um, but it is connected with the significant reduction in Medicaid dollars, uh, in particular, about 137 billion in rural areas across the country lost Medicaid dollars. So how do you hold kind of those two realities together when you talk about the rural health transformation program with your rural hospital leaders?

Elya Prystowsky

Well, uh it's it's a math problem, Michelle. It's just basic math. Uh, and and the rural hospital leaders are are they're astute. Um rural hospitals will see a decrease in Medicaid enrollment. Plain and simple. More uninsured means more bad debt. It means more charity care. You add on top of this the provider tax reductions that uh restricts how states fund Medicaid, that's gonna impact Washington. We will see revenue losses and potentially service line closures or reductions. I think we're already seeing this in OB and these maternity deserts that are popping up around the country. There's there's really no way around this. It's simple math. And I mean, it makes me sad, but I am proud of how Washington State is really trying to tackle this, looking for every possible way to help people maintain their coverage. But we are not gonna going to be immune. I would not be surprised if we saw some changes to the Washington landscape. We had we had one hospital just transitioned to a rural emergency hospital this year. That was our first one. We'll do everything we can to soften the blow. And I know that our rural leaders across the network of the collaborative are looking at every line of data that they have to see where they could streamline and um and or expand to get through the worst of what's to come.

Michealle Gady

So, you know, one of the points I've made in my own writing around the rural health transformation program is that if states and stakeholders view this program as a Medicaid revenue replacement, that is going to be a problem. So if they see it as an opportunity to prop up current operations, that's not really going to work. And so I'm curious how you see it from where you sit. Are you close enough to see how providers are thinking about this? Where is the field landing in terms of a realistic place? Or are you starting to see patterns emerging that are worrying you about how hospitals and other stakeholders are viewing the rural health transformation program?

Elya Prystowsky

I think everybody got the memo that this does not replace lost Medicaid revenue. It does not. It cannot. I mean, math problem, first and foremost. And there are a lot of restrictions around the dollars. And the other piece of this that I really struggle with is the word transformation. And it I just find it it's overused and people don't really understand what it means anymore. And every they want to transform everything. I actually, uh in preparation for this, I looked up the definition of transformation because it's been a minute since I've looked at it. And it means a thorough or dramatic change in the form, appearance, nature, or character in something or someone, often resulting in improvement or a completely new state. It represents an irreversible fundamental shift rather than a temporary change. Now, here's the problem. I mean, there's a lot of problems. So I would posit that rural hospitals are the last-standing bastions of good health care in this country. You get the care you need, you get it faster. It's personal, it's close, it's culturally relevant, and rural people love their hospital. They do not complain, they really like their hospital. And to think we would want to reverse this is troubling. And secondarily, transformation is unachievable with the money on the table. Like if they wanted to transform, they could have done something like say, we will pay all rural hospitals to go on epic. That would have transformed rural healthcare. But it's not enough money in the conditions that we're facing. I don't think we're gonna see a lot of transformation. And while I'm on my little diatribe, uh about this word transforming, uh, we've been transforming healthcare for 60 years. I mean, if you go back 60 years, rural healthcare looks completely different. Hilburton Act of 1946 to build the hospitals, swing beds in 1980, 340B in 1992, critical access hospitals weren't established until 1997. To think that you can give us $50 billion to replace $137 billion and tell us to transform, it's insulting. And if you define transformation as doing less with more, which is I think what it's starting to mean? What it's starting to mean. I'm sorry, doing more with less, which is what I think it's starting to mean. It means to be creative, to be resourceful, maybe be a little bit scrappy. And to that end, I think I'm very optimistic about what we're gonna do with our allotment in Washington State. You know, work smarter, not harder, leverage where we can, maintain access to care, get hospitals paid for essential services, go toe-to-toe with payers that continually make it harder and harder for us to get paid, roll out technology that makes sense for rurals in the clinical, administrative, and operational space, and train and recruit the next generation of rural healthcare workforce. We could do all of this. I don't know if it's gonna meet their definition of transformation. It certainly doesn't meet mine, but it's the right work.

Michealle Gady

So, you know, kind of building on that, the rural health transformation program, it's structured as really a performance-based cooperative agreement rather than kind of a block grant to the states. And so CMS will re-score half of the funding annually. And then the CMS administrator has a lot of broad discretion in terms of what awards look like going forward. And so Washington's first year budget was approved in February, and then you know, Montana followed shortly after thereafter. But there are other states that are still waiting for their budgets to be approved, including California, which is kind of the largest democratic state in the country. And this is well past the 45-day review period. So, what does this start to tell you about how CMS is managing the program so far? And what does it potentially mean for political risk down the road?

Elya Prystowsky

You know, I I'm not a very politic, I'm not very politically savvy. I'm more of an operator. I also am from California, so I really hope they get their money. I think they deserve it. I focusing on Washington, you know, Washington's a blue state, and we got our money. I think they already have it. I do think it's a testament to our state's governor's office, the healthcare authority, department of health, department of social health services. They really came together and just they made they made it work. I understand that CMS is hiring project officers. I hear that Washington's project officer is exceptional. I don't think this is a people problem. I think looking at this program is one thing. I think the folks at CMS are working hard and I I don't envy their jobs right now. But I think it's a values problem that we even are here right now. If we need our lawmakers to value rural Americans, and until they do, you know, I'm not gonna blame CMS. I'm going straight to the folks who voted for HR1. It's created unrealistic timelines and a lot of fear. I'm optimistic, as I said, about Washington State. Um I know the players here, it's a fantastic team. And if you want to get world motivated, just tell them they can't do something because they will just say, hold my beer. Best and climb down and show you how to get it done. I wish the best for California. They need it just as badly as the rest of us. Yeah. But I can't, it's just too much for me to process.

Michealle Gady

So, what do you think state leaders and rural providers watching from outside of Washington need to understand about how the program, you know, actually works?

Elya Prystowsky

You know, I don't think most people actually understand how it works. Uh truth, truth be told, it's very confusing in the the parameters they put around it and the 50% goes here and 50% goes there, and here's a rubric, and oh, you can't use it for this. And we like tech, but we're still gonna cap it. It makes it really hard to wrap your head around. I I just tell people if you think this will save rural, it will not. It won't. Only rural can save rural with the support of our representatives in in the other Washington in the Washington DC. This program is not a this is not a ladder that will help us get out of a hole. It's an opportunity, and we're gonna take full advantage of that opportunity, but it's gonna require a lot of really smart people.

Michealle Gady

So let's get into more of the details about what Washington um has proposed to do. So the state um asked for close to a billion dollars in funding, and it got 181 million. So that's not a small shortfall. That's kind of a fundamental question about what the program can actually deliver. So um, what do you think can be done with the 181 million dollars?

Elya Prystowsky

Well, fortunately, so long as we spend this $180 million correctly, we will get another $180 million next year. So it's not quite that big of a shortfall. You know, we we didn't get 19 million. Um, I do think that the way that they came up with the scoring rubric for the states, those states with a lot more rurality and a lot more geographic spread could get more. In fact, some states did get more than 200 million.

Michealle Gady

They did.

Elya Prystowsky

I was so excited that we got 181. million just because the way in Washington State is shaped and with the water and we have the peninsula, we got kind of docked because we didn't fit this kind of mold of like Nebraska or Kentucky or Texas, these other states that are very, I mean, along the same issues, but a lot more rural hospitals and a lot more rurality than we had. So I am I'm I think 181 million is is there's nothing to sneeze at. I mean I'm pretty excited about it actually. And I I am I mean I know there's a lot of doom and gloom out there but I I think I mean I think our state's gonna knock this one out of the park, at least according to the parameters that CMS sets out for us.

Michealle Gady

That's great. So with that 181 million the state is you know at least in this first year the state is looking at over potentially the five year period six initiatives so hospital innovation focused on AI, cybersecurity and revenue cycle a community-based chronic disease prevention 10% set aside for tribal governments, the technology and data solutions, rural workforce development, and then really importantly a rural behavioral health expansion. So that includes the mobile crisis support and school-based services. So how and and why did the state choose these specific initiatives kind of from your perspective?

Elya Prystowsky

So how did the state choose these initiatives? Well I mean I think they're obvious I mean these are the right things. I don't think anybody would argue with any of these they did a significant amount of stakeholder engagement and listening sessions, request for ideas, transparency. They spoke to me they spoke to the hospital association they spoke to a bunch of other kind of segments of the rural healthcare delivery system. I think these are great great categories I mean we are the home of Microsoft it absolutely makes sense that we should focus on cybersecurity and AI and you know that should not have been a surprise to anyone there there's nothing in the application I'm not in favor of I just wish we had more time to implement. Yeah because these are big. They're they're big and they will take they will take a long time like some of our hospitals still aren't on an EHR that is you know the bare minimum so to even think about stuff like remote patient monitoring or um ambient listening these technologies it's a stretch.

Michealle Gady

We need time yeah yeah so one of those particular areas the 10% tribal set aside you know that was a a clearly a deliberate uh policy decision made in Washington because it it wasn't a CMS requirement and you know it's grounded in treaty law and of course acknowledges the the role of Indian healthcare in rural Washington do you have a sense of how that commitment came together and what do you think it says to other states in terms of what they need to be thinking about when it comes to advancing equity I have very strong opinions about this and I will say this unequivocally unequivocally that this should have been a CMS requirement.

Elya Prystowsky

I did not know that until you just said that I think that's just I don't know I have I'm kind of speechless I I know the people who kind of wrote this in I know the uh tribal liaisons with the healthcare authority and the governor's office and I know all of the stuff they did a bunch of sessions with the tribes government to government sessions they do it they do it well it's in our DNA here we have I think almost 30 tribes in Washington a lot of um coastal sandbag fishing tribes out near the water and I thought it would be more to be quite honest. I think when I saw this number I thought that seems a little bit low and I think that I'm not alone in that I think there is it's a well established truth at least in the state of Washington that um tribal healthcare is their right as written in their treaties and we we have to be able to deliver. So I yeah our state did a good job I guess I don't know about the others I'm kind of disappointed to hear that it might not be part of the other states applications.

Michealle Gady

Yeah so let's talk about the work of the Royal Collaborative as this rolls out. So you know you're identified the organization is identified as an important partner in this work. And so to the extent that you can because I think you may have procurements out now. Yeah. How do you how are you thinking about using the dollars and um how do you think that will impact your members over the next 12 to 18 months?

Elya Prystowsky

So how we will use the dollars is to strengthen the network. I mean at the end of the day you know I said if one hospital fails then we've all failed in our network. So we have two guiding principles to how we use our 5.43 million. The first is to focus on building a stronger network which means things that we could do jointly through shared services shared contracts shared learning opportunities to really operate as a unified network without being a system is really around equity which is not all the hospitals are in the same have the same challenges if you will and so it might be that some hospitals need something now or they need more than others need right now. So it's about raising the average so you do that by taking the hospitals that are struggling and making sure they get the support they need to be able to thrive. So those are two really important principles that guide our work I think I think they're really cool. I'm proud of our board for choosing this path to that end we have decided to focus on areas that are mission critical to operations for our hospitals so that would be revenue cycle management, shared services and contracts, workforce development, health information technology, and payer contracting and you are correct we are doing all of the legwork we're getting ready for the money to come in so we're choosing our vendors we're involving our members in the selection of the vendors so that they are working with consultants firms technologies that they help select and then we're ready to we're ready to go I mean we have contracts that we're just waiting to sign and start as soon as that money lands and I think it's gonna start pretty soon. And for some of your more savvy listeners that are kind of leaning in and wondering what exactly we're gonna do how exactly do you spend five and a half million dollars and let's be honest we're gonna have to spend that by probably October just because of these timelines. You spend it on revenue cycle root cause analysis you spend it on payer contract compliance and auditing shared positions like a shared senior director of purchasing or shared employment lawyer rural nurse leadership training HR compliance and efficiency audits IT cyber security hub payer scorecard these are just some examples of of how we're going to spend that money I look forward to seeing all of that work.

Michealle Gady

That's going to be really exciting I mean right now it's bossing but I I think it will be we are it is a great problem to have uh you know one of the things I have some concerns about are the opportunities that are available and some of the smaller entities kind of getting missed or left out just because they don't have the infrastructure or uh the experience capacity et cetera to apply for state grants that might be available or you know they'll end up getting kind of crowded out by larger, better resourced entities. How real do you see that as a risk in in Washington and and what's your organization doing to kind of prevent some of that?

Elya Prystowsky

Well it's a real issue rural hospitals often the same person who's you know your compliance officer is also your facilities manager and you're you know they may also do credentialing on the side you know people wear so many hats and sometimes they're also grant writers and it is a real problem. We along with I want to just call out the Washington State Hospital association um we're doing as much of this legwork in advance. So we're doing all of the procurement identifying the vendors negotiating the contracts and then we are paying the vendors directly so that the dollars don't actually hit the hospital's books and they only need to indicate which things that they want and then we pay for that for them. Okay and just try to hit the easy button as much as possible for rural hospitals. I think as the rest of so we're only section 1.2 and the hospital association is section 1.3 there I think five other sections that all do have grants so I don't know how those are going to rule out and whether or not we need to hire a shared grant writer or what to do to be able to leverage those dollars. There's only so much we could take on though at once yeah yeah absolutely um and so to that the aggressive timeline uh you know it's states have I think less than six weeks to apply uh year one funds have to be spent I think by September 30th uh 2027 so what is the um the biggest implementation risk that you see you know the thing that might be keeping you up at night I think uh you know I the timeline is aggressive the clock has started but we haven't gotten the money yet I would say that we're nervous I am nervous and I am also reassured that we have been working tirelessly since January to line up all of the ducks so that once the money comes we could we could move these projects forward and spend on that money I am a little bit more concerned just based on what you've said about some of the other states that may not have they may not be as far along as us so what happens to them if they don't meet those deadlines and what does that mean for the program you know at the end at the end of the day yeah I I I care about Washington I care about Washington rural but this is a federal program and and it it could take a couple of states or that could really impact the whole program and I really hope that CMS has some grace for us in trying to roll this out under these conditions.

Michealle Gady

So as we look forward the program is legislative for five years. So you know the as of right now the program you know formally concludes in September of 2031 with any unspent funds needing to be returned you know within the year by 2032. And so that creates essentially kind of a funding cliff that we're looking forward to five years from now. How is the Royal Collaborative thinking about that funding cliff?

Elya Prystowsky

And what does a kind of a well-planned exit from the program look like uh that's a great question I think we were given very clear instructions by our members at the start that what we choose to invest our $5.4 million in are those projects, activities, services, infrastructure, et cetera, that result in a swift and sustainable return on investment. So you won't see us using these dollars to to run programs that won't be sustainable in the long term. And in fact for some of these programs and activities the ROI is so substantial that we may only pay for it for one year. And after that the program will pay for itself.

Speaker 3

That's good.

Elya Prystowsky

So you know we were really intentional about this because you know as I said's been transforming for 80 years. This is five years it's kind of a blip in the frying pan. It's important it's a huge opportunity we're gonna make it work as best we can but we're planning on being here for 20 years after this is is you know we were here for 20 years before and another 20 years after I mean I might not be in this position. I hope we're but I I think I think we'll see a sustainable impact.

Michealle Gady

So what would you say to uh rural hospital CEOs from other states what is the one action that they should take this month right now to position themselves well for the transformation program.

Elya Prystowsky

Okay so if you're in Washington no so if you're out of Washington state if you're in if you're in a rural health system and you're not part of a rural health network they're almost in every single state and I would try to see about joining a network because that's how you hear about everything and it's just there's so much information and it's it's nice to have have it synthesized for you. It could really be your lifeline. All of the grant funding activities in Washington are um if you sign up for a newsletter you get all of the the information so go online like in Oregon I think it's I think it's the Oregon Care Authority and different states has a different nexus for information. It's either going to be your governor's office your state Medicaid agency your state department of health or maybe your state social services health agency and find out just get get the information because it's coming out really rapidly and finally I I don't want us to like each state had six weeks to write their application. It was not a long time at all they did their best but if you if you have big feelings about what made it into your state's application I know it's they can't change it but it's still it's not too late to provide that feedback because there this may open again like there may be this was a a good first try but CMS may say look we really didn't do a good job we're gonna try again and you want to get in with those folks that are writing the application become a trusted advisor for them to make sure that they use you much time.

Michealle Gady

And there's also the opportunity to inform the state in terms of how they go about doing this the way doing the things they said they were going to do. All right so in five years how would you what what would you hope the program brings to Washington?

Elya Prystowsky

What would help you say that that was a success for us specifically about the program what gives me hope is that Washington did its homework our state agencies listened our tribal partners are at the table our hospitals are lined up like they have signed up for things and they're just ready to start um I think this is rare and I think it matters. Yep the other thing that gives me hope is that the rural collaborative isn't starting from zero we have 23 years of trust infrastructure shared strategy and the rural health transformation program is an accelerant to do the work that we probably were going to do anyways it's just all happening at once. Specifically in five years 2030 oh 2031 um so success all 31 of the hospitals are still open every single one uh the rural communities have more access to healthcare not less hospitals are getting paid fairly and on time by payers and the peer-to-peer network is stronger not weaker than it is today and if we can get to 2030 and say no rural hospital in Washington closed on our watch and the ones we have are stronger that's the whole ball game right there. That's success.

Michealle Gady

So where can listeners learn more about the rural collaborative and and follow your work?

Elya Prystowsky

So we have a website it's called uh ruralcollaborative.com and you could sign up for our newsletter we put out information from time to time we're pretty small so the website's probably the best way we're also on LinkedIn but I don't I don't know how often we update that so final question what does leading fearlessly look like in rural health right now leading fearlessly okay leading fearlessly I think my opinion right now in today's climate leading fearl fearlessly means telling the truth even when the truth is unwelcome it means saying out loud to anybody who will listen that $50 billion not replace $137 billion it means not hiding but behind a word like transformation it means going toe to toe with payers and not backing down just because you are small or rural or tired. It means sitting across from policymakers and saying if one rural hospital in Washington closes, if one closes, we all fail. And actually meaning it showing up because you're committed not because you're comfortable and doing the right thing when nobody's watching and rural folks have been doing this for a long time and nobody gets a parade you know nobody shows up for the ribbon cutting you know nobody nobody cares what you do you just do it. And it's what rural healthcare leaders have been doing for the last 80 years. And they don't need me to teach them to be fearless. I think they are fearless and so I have one job only one I would say it's making sure that every one of the 31 hospitals in my network have what they need to get her done. And that's it. That's the whole thing.

Michealle Gady

Well thank you Elia I'm this is exactly the conversation I hoped we would have an honest conversation about the risks and the clear opportunities that's grounded in the actual work of rural hospitals and the communities that they serve. So a few things that I'm taking away from today's conversation first um the rural health transformation program is an investment it's not a rescue anyone treating these dollars as Medicaid revenue replacement is going to be disappointed and probably exposed when the funding ends. Second the states doing this well are moving early they're investing in capacity rather than operations and they're refusing to treat equity as optional the you know Washington's 10% set aside for tribal governments is really a model uh worth studying for other states and really holding that that line on on equity and then third the you know the clock is already running so year one funds have to be spent by September by the end of the current fiscal year and the entire program ends in 2031. So organizations that start planning for funding for that funding cliff now and are thinking about sustainability of the things that they put in place will be really in a very different situation than organizations that don't. And so to our listeners if you want to go deeper the website links for the Rural Collaborative and the Washington Healthcare Authority will be in the show notes. And if this conversation was helpful to you please share it with others. I'm Michelle Gady this has been the Atrómitos Way and until next time keep doing the fearless work to create lasting change in your communities.

Narrator

Thank you for listening to this episode of the Atrómitos Way. this podcast is a production of Atrómitos: a woman-owned boutique consulting firm that creates a better way for our health and human services provider clients to achieve their goals by strengthening internal operations enhancing financial stability and evaluating public policies. please follow the show and leave a review. you can find previous episodes and more content on our website Atrómitosconsulting dot com slash Atrómitos dash way that's A-T, R-O, M-I, T-O-S. We'll see you next time.