Bethany Pellegrino<\/b><\/strong><\/p>\n<\/div>\nHowever, for some, the issue is not the platforms themselves but how they will work in practice. Many experts who spoke with Healio voiced concerns that the MAHA initiatives, as stated, are not enough to provide people the resources they need to be healthy.<\/p>\n
\u201cThe MAHA initiative suggests that people should eat good food, but they can\u2019t get it because they can\u2019t afford it,\u201d Lindsey said. \u201cWe need to reach these populations with healthy alternatives at affordable prices. I do not see a lot of action on that front. I hear a lot of rhetoric. It is good rhetoric, but it is still just rhetoric.\u201d<\/p>\n
According to Schmidt, failure to generate material improvements among these communities through concrete action could result in further declines in health and outcomes.<\/p>\n
\u201cThe need for improvement is illustrated by the density of chronic illness found among rural residents, a sector of the population who face unique barriers to accessing health care,\u201d she said. \u201cHigher rates of chronic diseases and preventable conditions are common in rural regions, with rural residents being older and at higher risk for poor health outcomes, including a higher risk for death from heart disease, cancer, unintentional injury, chronic lower lung disease and stroke than their urban counterparts.\u201d<\/p>\n
According to Pellegrino, geographic and socioeconomic barriers for patients living in rural areas can be \u201cdire.\u201d <\/p>\n
\u201cRural residents often travel long distances for basic health care and may face poverty and inadequate resources making it difficult to travel,\u201d she said. \u201cBringing more care within reach is key to addressing these challenges.\u201d<\/p>\n
One way to address this barrier would be to expand the rural health care workforce.<\/p>\n
Workforce investments \u2018critical\u2019<\/h2>\n
Training, residencies, recruitment and retention incentives are encouraged in the Health Transformation Program, according to HHS. Emerging professionals may have pathways to remain in practice in their own rural communities, while states are urged to invest in programs that will keep health care professionals local. <\/p>\n
\u201cWorkforce investments are critical, given long-standing challenges with recruitment and retention of clinicians in rural areas,\u201d Jolly said. \u201cNew funding and training opportunities would create a pathway for clinicians living in rural communities to access health care workforce training and help fill these roles, and also make these communities more attractive to outside health professionals.\u201d<\/p>\n
General practitioners and specialists alike are needed in rural communities, according to Pellegrino. <\/p>\n
\u201cThe clinical workforce is tenuous in rural and medically underserved regions, which often lack a sufficient cadre of primary care and specialty providers, making access to even essential services difficult and the receipt of preventive care all but impossible, leading to delayed diagnoses and worse health outcomes,\u201d she said.<\/p>\n
All of the experts who spoke with Healio agreed that a workforce shortage exists in rural areas. What is not so clear, however, is how specifically to address the shortage and improve workforce figures in these areas.<\/p>\n
That said, a recent program for training rheumatology fellows at Louisiana State University, which Lindsey helped create, may offer a new way forward.<\/p>\n
\u201cWhen you put a new program in a larger area, and when you train people there, they tend to stay in that area,\u201d he said. <\/p>\n
As part of the LSU program, the university has written contracts with rural hospital systems in the United States and abroad, wherein the hospitals provide financial support for the fellow. In return, the fellow commits to return and practice in a sponsoring institution for a prespecified period.<\/p>\n
LSU has also implemented a similar program with an internal medicine student in an area of rural Idaho where there is not a rheumatologist within a 200-mile radius, according to Lindsey.<\/p>\n
However, in the face of approximately 30 million people with osteoarthritis, 2 million with rheumatoid arthritis, millions more with fibromyalgia, gout and lupus, such initiatives on their own are insufficient, according to Lindsey.<\/p>\n
\u201cWe have to spend a lot more time and effort on rheumatology,\u201d he said. <\/p>\n
Whether the MAHA initiative will generate enough practitioners to treat these patients across the vast rural areas across the United States is uncertain. As states develop their own workforce development programs, another possible solution to the same problem may be found in technology.<\/p>\n
\u2018Difficult to implement\u2019<\/h2>\n
The Rural Health Transformation Program aims to modernize facilities and equipment, bolster cybersecurity and interoperability, and expand access to telehealth, remote patient monitoring and digital tools. Efforts focusing on the use of AI to improve workflow for overworked clinicians are also recommended. <\/p>\n
\u201cModernizing infrastructure and technology is likely needed in all rural areas,\u201d Schmidt said. <\/p>\n
These efforts will not be easy, according to Pellegrino. <\/p>\n
\u201cNew and emerging technologies such as remote monitoring, artificial intelligence, robotics, and consumerfacing digital tools for chronic disease management may be difficult to implement,\u201d she said. \u201cIn West Virginia, where broadband and digital literacy are not uniform across the state, it could be difficult to reach [chronic kidney disease] patients in remotely populated areas of the state who struggle with transportation to clinic visits or labs for blood draws.\u201d<\/p>\n
Although Jolly described the emphasis on technology as \u201cencouraging,\u201d she pointed to recent history \u2014 specifically the height of the COVID-19 pandemic \u2014 as an example of how uptake remains imperfect. <\/p>\n
\u201cTelehealth and remote patient monitoring expanded during COVID-19, but may still not always be fully integrated into routine care,\u201d Jolly said. \u201cThe Rural Health Transformation Program creates an opportunity to more intentionally use these tools to close gaps in chronic disease care.\u201d<\/p>\n
For Moore, the rocky history of telehealth technology in rheumatology may signify ongoing challenges in the specialty. <\/p>\n
\u201cIt is difficult to do virtual telehealth visits for many rheumatology patients,\u201d he said. \u201cIt can be difficult to assess swelling in the joints and other components of the physical exam.\u201d<\/p>\n
That said, Moore added that routine visits for updating prescriptions, or for patients in stable condition, could be conducted virtually. <\/p>\n
Alongside new and expanded technologies, the Rural Health Transformation Program also broaches payment reform and increased efficiency as ways to help improve chronic disease care in rural areas. <\/p>\n
\u2018Transformative\u2019 payment models<\/h2>\n
According to Jolly, flexibility in payment models \u2014 like the ability to use value-based care approaches \u2014 could be \u201ctransformative\u201d for rural health clinics, independent providers, and small health systems.<\/p>\n
\u201cThis kind of flexibility supports collaboration and allows care delivery models that better reflect the realities of rural communities,\u201d she said.<\/p>\n
Jolly additionally described sustainable Medicaid reimbursement for lifestyle interventions, chronic disease remission programs, and care models that support medication deprescribing as \u201cessential.\u201d<\/p>\n
\u201cMedicaid, in particular, plays a critical role in rural America,\u201d she said.<\/p>\n
Regarding structural efficiency, the HHS statement lists \u201cstreamlining operations,\u201d \u201cempowering providers to enhance coordination of care and resources,\u201d and building partnerships across individual states, with the goal of keeping care local, as priorities.<\/p>\n
\u201cThis includes establishing specialized hub-and-spoke models, rural regional centers of excellence, comprehensive data-sharing platforms, and rural clinically integrated networks,\u201d the statement said.<\/p>\n
According to Schmidt, empowering community providers with innovative care models \u201cshould improve efficiency and coordination of care for rural patients whose providers may be located far away.\u201d<\/p>\n
Schmidt and Pellegrino cited their own work developing a network of 17 rural outreach care sites dedicated to kidney care in north central West Virginia as one way to address the structural barriers confounding rural access to health care. <\/p>\n
To improve rural health care, policymakers must tailor their proposals to the people who live in these communities and their unique challenges, Schmidt said.<\/p>\n
\u201cStructural barriers that uniquely affect rural nephrology \u2014 distance to dialysis, few nearby transplant centers, a small nephrology workforce \u2014 are more than just details,\u201d Schmidt added. \u201cThese issues will require specific attention and recommendations that rural residents, many of whom have socioeconomic challenges, can realistically follow. Additionally, resources may be lacking in some rural regions, thus recommendations and potential solutions need to be tailored to local availability.\u201d<\/p>\n
The key question, then, is how these programs ultimately take shape once they ultimately make contact with rural communities across the country, and what material impacts will result.<\/p>\n
\u2018It\u2019s still early\u2019<\/h2>\n
According to Jolly, it remains too soon to judge the program\u2019s effectiveness. <\/p>\n
\u201cIt is still early,\u201d she said. \u201cFunding was awarded only recently, and many states are still in the planning phase, issuing requests for applications and preparing for implementation.<\/p>\n
\u201cStates appear engaged and creative in how they are approaching the program,\u201d she added. \u201cNo two states are taking exactly the same approach, and many are tailoring strategies to meet their specific rural needs \u2014 whether that is workforce development, infrastructure and technology for critical access hospitals, or statewide chronic disease prevention efforts.\u201d<\/p>\n
In June 2025, Louisiana Gov. Jeff Landry signed a bill to coincide with the MAHA initiative, Senate Bill 14, banning multiple dyes, artificial sweeteners and other ingredients from school meals. Kennedy attended the bill signing ceremony at Pennington Biomedical Research Center in Baton Rouge.<\/p>\n
\u201cThe bill contained sweeping changes in school nutrition, banning dyes and updating labels,\u201d Lindsey said. \u201cIt made nutrition mandatory to get a teaching license for K-12 in Louisiana.\u201d<\/p>\n
Although Lindsey said he applauds such efforts, he added that they may be \u201ctoo narrow\u201d to tackle some of the state\u2019s larger health care challenges, including the growing consolidation of local hospitals under larger health systems.<\/p>\n
Other experts have expressed similar concerns. <\/p>\n
\u201cUnfortunately, the One Big Beautiful Bill seems to have hurt the state of Missouri,\u201d Moore said. \u201cAlready, we have seen 12 small hospitals close in the last 2 years. The HHS statement says that Missouri will receive $216 million, but we have yet to see any movement on that.\u201d<\/p>\n
Dollar amounts aside, Jolly said she hopes everyone involved in enacting these programs considers the \u201cupstream drivers of health\u201d in rural communities.<\/p>\n
\u201cRural residents face challenges related to housing, employment, transportation, education, access to healthy food, and safe spaces for physical activity,\u201d she said. \u201cWithout considering these factors, even well-designed clinical interventions can fall short.\u201d<\/p>\n
Caring for patients across all specialties should also be considered as these programs are instituted, according to Moore. <\/p>\n
\u201cThe initiatives may help the major subspecialties, like oncology, cardiology, pulmonology and GI,\u201d he said. \u201cI wonder how much they will help smaller ones like rheumatology, infectious diseases and immunology.\u201d<\/p>\n
According to Jolly, ensuring primary care and specialty clinicians are trained in evidence-based lifestyle interventions could improve outcomes as well as clinician and patient satisfaction, as would community outreach.<\/p>\n
\u201cGroup medical visits or shared medical appointments, in particular, are well-suited to rural settings because they build community, reduce costs, and improve clinical outcomes,\u201d she said. \u201cCollaborations with schools, community colleges, YMCAs, farms, libraries, parks, and faith-based organizations can extend the reach of health interventions beyond clinic walls. Integrating healthy lifestyle behavior principles into schools, especially K through 12, is a powerful way to support long-term change in communities with limited resources.\u201d<\/p>\n
The final consideration is how long the funding, and the will to support rural communities, will last. <\/p>\n
\u201cThe initial infusion of funding is an important first step, but payment and incentive structures need to support effective care models beyond the life of these grants,\u201d Jolly said. \u201cSustainability matters.\u201d<\/p>\n
For more information:<\/h2>\n
Jessica Jolly<\/b> can be reached at jjolly@lifestylemedicine.org. <\/p>\n
Stephen <\/b>M. <\/b>Lindsey, MD, MACR<\/b>,<\/b> can be reached at slinds@lsuhsc.edu. <\/p>\n
Terry L. Moore, MD, FACP, FAAP, MACR<\/b>,<\/b> can be reached at terry.moore@health.slu.edu. <\/p>\n
Bethany Pellegrino, MD,<\/b> can be reached at bpellegrino@hsc.wvu.edu. <\/p>\n
Rebecca J. Schmidt, DO, FACP, FASN<\/b>,<\/b> can be reached at rschmidt@hsc.wvu.edu. <\/p>\n\n
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