Georgia's Application: Rural Health Transformation - Goals and Strategies

Rural Health Transformation: Goals and Strategies

The GREAT Health Program is the result of connecting, listening, and strategizing with rural communities to build a strong foundation of transformed health in rural Georgia that is aligned with the needs of rural populations, in rural places, for rural progress. Given that 126 of Georgia’s 159 counties/portions of counties are designated as rural by HRSA, transforming the health of rural Georgians will make an impact that reaches far across the state. By knitting together the vital assets, strengths, and unique knowledge from rural communities, with the expertise and support of health providers, academic institutions, state agencies, and other partners, GREAT Health is driving toward a new value-based, risk-bearing model of care under the AHEAD model. Achieving this vision means:

Rural populations are healthier, live longer, have an improved quality of life, and can both live and work in the communities they love.
Rural places have healthcare that is high quality, more abundant, and more effective.
Rural progress creates systems-level change that leverages technology, drives innovation, and improves quality, while maintaining a patient focus and embracing patient voice.

The GREAT Health Program will move the state toward this vision by focusing on five goals that reflect the five RHT Program strategic goals with a Georgia lens, tracking five objectives that direct manageable steps to progress and outcomes, and implementing five project initiatives that organize multiple, synergistic strategies for each initiative. To advance this vision of health aligned with needs of rural Georgians, the GREAT Health Program goals, objectives, initiatives, and associated strategies are further described in the section titled "Proposed Initiatives and Use of Funds."

Strategic Goal 1: Innovative Care

GREAT Health Goal 1: Use Evidence-Based Models for Value-Based Care to Innovate and Strengthen the Healthcare Delivery System in Rural Georgia

Objective 1: Implement innovations in health care delivery that improve health outcomes and quality of life.

Initiative 1: Transforming for a Sustainable Health System in Rural Georgia

Under this initiative, the state will prepare rural healthcare facilities and Georgia to succeed in the CMS-driven AHEAD Model for hospitals and AHEAD primary care programs to align with the vision of rural progress. Many of the initiatives that are related to sustainable access, workforce, and technology innovation are focused on providing opportunities, resources, technology, and system-level shifts to increase the readiness of providers, hospitals, RHCs, and FQHCs to shift to value-based care contracting and global payments. As part of this initiative, the state’s strategy is to dedicate resources to work collaboratively with healthcare facilities and leaders to assess readiness, identify gaps, provide technical assistance, and mitigate fiscal risk, particularly for already vulnerable hospitals and small rural clinics.

Strategic Goal 2: Make Rural America Healthy Again

GREAT Health Goal 2: Make Rural Georgia Healthy Again

Objective 2: Focus on root causes of disease to prevent illness and coordinate care for enhanced chronic disease management.

Initiative 2: Strengthening the Continuum of Care in Rural Georgia

Initiative 2 includes nine strategies, which focus on improving behavioral health programs; enhancing infrastructure related to emergency response to mitigate trauma risks; improving public health initiatives related to inter-hospital transportation and strengthening newborn screenings; expanding support for acquired brain injury survivors; creating a nutrition and weight management eligibility category to Georgia’s Planning for Healthy Babies demonstration program; and increasing access to nutrition services for children with autism spectrum disorder (ASD).

Strategic Goal 3: Sustainable Access

GREAT Health Goal 3: Increase and Sustain Access to Healthcare in Rural Georgia

Objective 3: Provide sustainable access to healthcare.

Initiative 3: Connecting to Care to Improve Healthcare Access in Rural Georgia

Initiative 3 includes six strategies that align with the vision of increasing access in rural places to ensure residents have more opportunities for primary, specialty, dental, and behavioral healthcare.

Several strategies use technology to expand access to care, including deploying mobile health units; integrating telehealth point-of-care pods; implementing and expanding telehealth for specialty care access; expanding access to provider-to-provider consultations through telehealth for pediatric psychiatry and postpartum behavioral health; and enhancing public health telehealth infrastructure. Georgia is also proposing to improve access to maternal care by placing obstetric carts in rural, non-delivering emergency departments and implementing patient bundles to improve quality outcomes. Furthermore, Georgia is enhancing the state’s legislatively established Rural Hospital Stabilization Grant Program to create a track specifically aligned to the RHT Program goal of increasing access. Grantees for this program will be asked to commit to aligning with innovative care strategies that are focused on improving health outcomes and transitioning providers to participate in value-based care contracts.

Strategic Goal 4: Workforce

GREAT Health Goal 4: Build and Sustain a Highly-Skilled Rural Healthcare Workforce

Objective 4: Recruit and retain a healthcare workforce that is empowered to make decisions that engage patients for improved outcomes.

Initiative 4: Growing a Highly Skilled Healthcare Workforce in Rural Georgia

Initiative 4 has five strategies that are grounded in increasing and incentivizing healthcare providers to work in rural Georgia and directly associated with the GREAT Health vision for rural populations in rural places. Implementation of Georgia’s graduate medical education (GME) strategy includes incentives for physicians, doctoral-level providers, and GME programs to strengthen the primary care workforce. The state is also focused on increasing access to paramedics through an emergency medical services (EMS) scholarship program. Additionally, a partnership with the Area Health Education Centers (AHECs) will allow GREAT Health to engage with future doctors and nurses, and telehealth technology will be utilized to train and mentor all provider types in dementia care best practices. The proposal also includes several strategies to address critical nursing shortages, focusing on improvements in clinical faculty recruitment and retention, enhancing clinical training, and identifying and motivating the next generation of nurses.

Strategic Goal 5: Technology Innovation

GREAT Health Goal 5: Use Technology Resources to Improve Healthcare Access, Delivery, and Information in Rural Georgia

Objective 5: Integrate technology that improves care delivery and gives providers and patients real time, secure access to health data information.

Initiative 5: Leveraging Technology for Healthcare Innovations in Rural Georgia

Georgia is committed to scaling up innovation with a focus on improving care delivery in alignment with the vision of advancing rural progress. There are eight technology-based strategies incorporated into the GREAT Health Program. The state will partner with the Advancing Access to Robust Care and Health in Rural Georgia (ARCHER) Tech Catalyst Fund to invest in the development of rural technology. This collaborative effort will focus on four components: rural healthcare needs delivery, company scouting and validation, investment in rural deployment, and long-term monitoring and impact assessment of deployed technology. Additionally, under this initiative Georgia will dedicate resources to improving cybersecurity, enhancing electronic medical record (EMR) systems to ensure rural hospitals, clinics, and facilities use data to drive population health initiatives, streamlining the Medicaid eligibility system, and deploying a consumer facing product that engages patients in wellness and preventive health actions. Funds are also dedicated to integrating robotic technology in rural places to increase access to surgical services and contribute to surgeon recruitment and retention. Georgia will also engage in a behavioral health technology assessment that can inform future behavioral health innovations.

Statutory Elements

Improving Access: One of the GREAT Health Program pillars is a focus on improving access to care in rural places. Initiative 3 of the project will create access points in rural, underserved communities by collaborating with local rural healthcare providers to place telehealth point-of-service primary care pods where a brick-and-mortar clinic is not feasible. The state will work with hospitals and clinics to deploy mobile units focused on expanding access to primary care, specialty care, dental care, behavioral care, and preventive health screenings. The state is also providing financial support for hospitals and rural clinics to ensure financial solvency by developing strategies to improve quality care and foster collaboration to enhance available services through the rural stabilization grants. GREAT Health will also use telehealth technology to improve access to specialty care services and increase provider-to-provider consultations for pediatric and postpartum psychiatry, allowing patients to receive needed behavioral health care from primary care providers in their communities. Telehealth strategies also include infrastructure improvements to increase public health departments’ telehealth capacity. The GREAT Health Program also aims to strengthen perinatal systems of care by integrating obstetric carts into rural non-delivering emergency departments to address emergent delivery needs.
Improving Outcomes: Targeted outcomes in the GREAT Health Program include increased compliance with preventive health screenings related to chronic conditions, improved chronic disease control, and decreased chronic disease prevalence rates. These target outcomes will be realized by enacting strategies such as using mobile units to increase preventive health screening access, engaging primary care clinics in quality improvement strategies (e.g., care management to improve preventive screening compliance), increasing access to care and reach rates through telehealth programs, and increasing the workforce capacity for preventive healthcare.

Additionally, maximizing participation in and success under the AHEAD program will improve the quality of chronic disease care. Medical providers will engage in enhanced communication, better care coordination, and data-driven approaches to population health management that will improve patient-level health outcomes and clinical quality metrics. The above strategies will contribute to overall declines in rural Georgia’s all-cause mortality rate.

Technology Use: One pillar of the GREAT Health vision is rural progress through the use of technology, and multiple strategies support innovation and integration of technology. The ARCHER fund is solely focused on supporting innovation, including those that incorporate artificial intelligence, to improve healthcare efficiencies. Another strategy includes a consumer-facing technology that prompts patients to engage in preventive health care and provides education focused on wellness initiatives, such as nutrition and weight loss strategies. Other technological innovations in the GREAT Health Program include streamlining the eligibility process for Medicaid enrollment, improving rural hospitals cybersecurity, and installing telehealth capabilities into EMS units to implement a treat versus transport approach to care. Additionally, the program provides an opportunity for rural hospitals to enhance surgical services recruitment through the purchase of robotic surgical instruments.

The state will evaluate the suitability for new technologies for rural providers and patients through stakeholder, provider, and patient feedback; technology assessments; and competitive grant application processes. Healthcare entities and providers will apply for funding for innovative technology. As part of that process, the applicants will need to address the readiness of the organization to adopt new technology, the ability of providers to integrate the new technology into practice, steps for change management, and the will of the community or patients to engage in the use of new services available. Additionally, Georgia will offer technical assistance and training in conjunction with planning and implementation to ensure the successful adoption and integration into practice.

The seed-funding and initial costs of equipment and technology are integrated into the GREAT Health Program budget. However, fund recipients will need to focus on implementation practices and develop strategies for long-term sustainability. Part of the grant application process will require applicants to address sustainability needs such as upgrades, maintenance, data security, long-term support and vendor reliability, energy consumption, and future cost considerations.

Partnerships: The GREAT Health Program is comprehensive in scope and provides opportunities for partnership engagement at the local, state, and regional levels. A key stakeholder advisory council that consists of at least 60% rural representation will ensure a focus on rural health and provide opportunities for information sharing, data reviews and reflections, and discussion of lessons learned during implementation. This advisory council is discussed in greater detail in the key stakeholder section of the proposal. Georgia will also strive to form AHEAD hospital and AHEAD primary care networks with all participating entities. These networks will have separate and combined meetings that will encourage hospitals and primary care providers to collaborate to move the work forward. Participating healthcare organizations will promote measurable quality improvement, discuss strategies for financial stability, and share best practices. Bringing these entities together will provide the opportunity for a more robust discussion around developing a more formal structure, such as a clinically aligned network.

Georgia will leverage current structures such as its public health districts, hospital associations, and primary care associations to engage hospitals, primary care clinics, public health partners, and FQHCs. Regional partner engagement will include opportunities to share best practices, discuss quality initiatives, provide training, and explore how to formalize regional approaches to consortia and networks. Most of the initiatives include strategies for grant opportunities at the local level. In the grant proposal phase, local healthcare organizations and partners will be encouraged or required to demonstrate a consortium or network approach to the work with at least two additional partner agencies or organizations. At the local, regional, and state levels, the partners will focus on ensuring clinical shifts, engaging in cross-sector planning, providing training, developing data accountability systems, and sharing outcomes.

Workforce: The GREAT Health Program has an initiative entirely dedicated to recruiting, training, and developing a pipeline for clinicians with a focus on doctoral-level providers, nurses, and paramedics as well as programs for current practitioners in the workforce to advance their skills and training. Georgia will work in collaboration with academic institutions to develop and implement both new and enhanced GME and incentive programs to recruit health professionals to practice in rural areas. Additionally, the state will engage the regional AHECs to create a high school and college healthcare workforce pipeline with a focus on the Preceptor Tax Incentive Program. Nursing strategies seek to increase faculty capacity at the academic level in order to train additional nurses. Funds will also be used to provide tuition assistance, purchase simulation equipment, and develop toolkits for nurse faculty orientation.
Data-driven Solutions: Data-driven solutions are at the core of the GREAT Health Program. Most of the program initiative strategies are focused on increasing the capacity of rural hospitals and clinics for the AHEAD program, which is a data-driven program. The state is investing in multiple assessments to gather state-level data on gaps in behavioral workforce, AHEAD readiness, and for the deployment of telehealth and mobile service expansions based on data indications. At the hospital and clinic levels, the GREAT Health Program will provide resources to enhance EMR systems specifically focused on building capacity around population health reporting and development of data-driven solutions to improve care metrics, enhance case management, and improve overall population health outcomes. Additionally, growing the population with access to a consumer engagement platform through participation in the AHEAD model will allow patients to engage with their own health metrics and provide greater insights to providers on individual health and risk factors, allowing health professionals and payers to utilize AI technology to stratify risk and identify patients who need care ahead of major health events. The GREAT Health Program will bring technology into rural communities to expand access to services through telehealth, point-of-care pods, the ability for paramedics to treat in the field with telehealth equipped ambulances, and for expansion of behavioral health services.
Financial Solvency Strategies: The GREAT Health Program's strategies are aimed at building capacity and financial solvency of both hospitals and rural clinics, including FQHCs, by investing in innovation, technology, and workforce development. The GREAT Health Program will drive down costs using technology, focusing on primary care, expanding access to care (which will increase market share), and increasing revenue through value-based quality care initiatives. The primary metric for financial solvency is successfully creating a fiscally sound value proposition for rural entities to participate in AHEAD and transitioning to a value-based model of care that maximizes financial success and improves patient outcomes.
Cause Identification: Standalone rural hospitals are at risk of service reduction or closure due to a combination of financial, demographic, and systemic challenges. Some key reasons include low patient volume due to isolated or aging populations in Georgia’s rural communities, relatively high rates of uninsured patients contributing to high levels of uncompensated care, a patient mix with low commercial payer coverage and heavy reliance on Medicaid and Medicare, workforce shortages that impact the ability to expand services, and facility infrastructure needs (e.g., updates and upgrades in equipment and buildings). Overall, standalone rural hospitals operate on thin margins, serve high-need populations, and face structural and fiscal challenges that urban hospitals can more easily manage. The GREAT Health Program addresses these challenges by encouraging regional collaboration, strengthening workforce, increasing revenue by increasing access to services, and working towards value-based care models to change the traditional paradigm away from fee-for-service care.
Program Key Performance Objectives: The overarching GREAT Health Program rural outcome metrics demonstrate the program vision of healthier populations, access to care in rural places, and leveraging technology to drive progress in the following metrics by FY31.
- Increased access to 10% of rural residents measured by increased use of telehealth services and reduced travel time and distance to services
- Decrease in all-cause mortality in rural areas by 15%
- Decrease in readmissions in 75% of rural hospitals
- 20% increase in the ratio of rural primary care providers to rural population
- 0% increase in the number of patients in participating rural counties with preventative screenings at evidence-based intervals

Initiative-specific metrics can be found in the metrics and evaluation section of this proposal.

Strategic Goals Alignment: The GREAT Health Program’s strategic goals, initiatives, and strategies are directly aligned to the five RHT Program strategic goals and the above statutory elements. The five GREAT Health Program Goals mimic the RHT Program strategic goals but reflect a focus on Georgia. The program design is intentionally focused, as discussed above, on increasing access, achieving health outcomes, using technology, enhancing partnerships, developing workforce, implementing data-driven solutions, and addressing financial solvency and causes for hospital closures. This alignment is further illustrated in the evaluation plan.

Legislative or Regulatory Action

B.4. Nutrition Continuing Medical Education: While Georgia does not presently have nutrition as a mandated factor for Continuing Medical Education (CME), Georgia is committed to exploring opportunities for nutrition related CME for all providers. As displayed in the strategies laid out for the GREAT Health Program, Georgia is actively pursuing more avenues for increased medical education on this topic. Regulatory change through the Composite Medical Board to encourage provider CME will be explored in the upcoming year. This will demonstrate to providers the commitment the state has to health and encourage providers to educate their patients on the value of healthy lifestyle and nutrition. Ensuring medical providers have this education will provide a new lens of wellness to Georgia’s medical community to improve outcomes for rural residents. This change will take place before the final Board meeting of 2028.
F.1. Remote Care Services: Improving maternal outcomes in Georgia is a policy arena that stretches across branches of government and party lines. Informed by the successes of a pilot program which began as a result of legislation passed in 2023, DCH is pursuing a regulatory change to institute statewide benefits for these services. Services include remote blood pressure, glucose, and weight monitoring during pregnancy and up to 90 days postpartum and eligibility is determined by diagnoses and at provider discretion. This additional remote monitoring benefit connects rural mothers to more targeted care and promotes prevention-driven interventions for those with the most high-risk pregnancies. This change will be pursued ahead of the final Board meeting in 2027.

Other Required Information: State Policies

B.2. Health and Lifestyle: Georgia currently has a state-specific Presidential Physical Fitness Test in place called Fit Georgia. Under State Board Rule 160-4-2-.12, each local board of education is required to use a fitness assessment approved by Georgia Department of Education (DOE). Students in grades 4-12 are required to complete all five assessment components. Additionally, O.C.G.A. § 20-2-777 codifies the Student Health and Physical Education Act (SHAPE Act) which requires annual fitness testing in public schools and that school systems report results to parents and aggregate data to the state.
C.3. Certificate of Need (CON): The Cicero Institute report from 2024 lists a total CON score of 95/100 for Georgia. However, it is important to note that Georgia’s CON law was amended in the 2024 legislative session of the Georgia General Assembly by House Bill 1339, which was signed into law by Governor Kemp on April 19, 2024. The regulations for these changes were adopted by the Board of Community Health in December of 2024 and June of 2025; thus, these changes are not reflected in the Cicero score. The updated CON law provides several new exemptions targeted at rural communities, including an exemption for new or expanded perinatal services in rural counties, new general acute hospitals in rural counties and new acute care hospitals in rural counties where a short stay hospital has been closed for more than one year without the opening of a replacement. The law also adds an exemption for new or expanded psychiatric or substance use inpatient programs and an exemption for new or expanded birthing centers. Finally, the law raises the total limit on tax credits for donations to rural hospital organizations to $100 million. These new flexibilities demonstrate Georgia’s continued focus on rural access to care.
D.3. Scope of Practice: Dental Hygienists: In the 2025 legislative session, House Bill 567 expanded scope of practice for teledentistry functions for dental hygienists, and House Bill 322 allowed foreign-trained dentists and hygienists to apply for a license to teach. Rule 150-5-.08 of the Georgia Board of Dentistry also became effective on December 24, 2024 and allows dental hygienists to utilize a dental diode laser, which expanded the permissible scope of practice. Further amendments to this rule and Rule 150-5-.03, which authorizes the use of general supervision of dental hygienists, are under review and will broaden permissible procedures. Nurse Practitioners and Physician Assistants: The 2024 and 2025 legislative sessions both included law changes that increased the scope of practice for nurse practitioners and physician assistants. House Bill 36 in 2025 included both professions as signatories in guardianship and conservatorship proceedings. House Bill 557 in 2024 allows Schedule II prescribing abilities to both professions in emergency situations, and House Bill 1046 in 2024 gave both professions the authority to sign death certificates.
E.3. Short-term, limited duration insurance (STLDI): State policies on STLDI mirror current administration policy and can be found in O.C.G.A. § 33-24-21.1.
Factor A. 2: As of application submission, there are no CCBHCs operational in Georgia. However, three CCBHCs will open in January 2026 to serve patients, with two located in rural areas and more to come.
Factor A. 7: 112 hospitals received DSH payments in 2025. The total number of hospitals eligible for DSH is 131 (85% receive); however, including psychiatric and inpatient rehab facilities, Georgia has 189 hospitals. The percentage of all hospitals that receive DSH is 59%.