Core Competency: Understanding the Current and Future Health Care Environment

Given the goals and role of the Flex Program, the role and services provided by CAHs, RHCs, and EMS, and the population health needs of rural communities, it is imperative that state Flex Programs have a general understanding of the health system. This includes having basic knowledge of: 1) the various roles and classification models of the types of hospitals, clinics, EMS, and long-term care (LTC) facilities prevalent in rural America and 2) the rapidly evolving health care payment models, as payors increasingly pay for value and outcomes rather than for procedures. This understanding enables state Flex Programs to participate in discussions and planning to serve as a rural “voice” to ensure rural needs are met. The COVID-19 pandemic highlighted the need to orchestrate a coordinated response to rural emergencies. The Flex coordinator can be a key partner in rural emergency planning, given the broad scope of their program responsibilities. Pressures are being felt in rural areas as the population ages, costs increase, and payors look for opportunities to decrease health care costs. A broad comprehension of the health care environment is crucial to understanding how various health and social service providers can work together in rural communities to improve the health of populations. 


  • Understand the interconnection of various provider types (i.e., hospitals, clinics, LTC, EMS, behavioral health, etc.)
  • Develop and maintain collaborative relationships with state associations representing various provider types to foster regular communication on new programs, policy and regulatory changes, and opportunities for collaboration
  • Foster CAH participation in local and statewide public health initiatives
  • Engage with public health, rural health care providers, rural community stakeholders, and EMS to prepare for emergencies impacting rural health
  • Encourage rural providers to have up-to-date emergency response plans that are reviewed at least annually and communicated to all local and state partners
  • Describe the future health care environment, drivers for change, and the opportunities for rural providers
  • Understand how quality of care, hospital operations and finances, patient and employee engagement, community collaboration, and health outcomes interrelate to drive the future of rural health care
  • Share new models of care information, resources, and outcomes to rural providers and key stakeholders
  • Help hospitals and rural health clinics understand the need to participate in community-based, comprehensive approaches to emergencies
  • Identify the varying needs of independent and system-affiliated CAHs, and CAHs with provider-based RHCs, LTC, or owned ambulance agencies
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National Rural Health Resource Center



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