The Flex Monitoring Team (FMT) released a new product, Improving the Value Proposition of Critical Access Hospitals (CAHs) – Lessons from Federal and State Initiatives. This brief describes the lessons learned from federal and state models to improve the value proposition of CAHs.

The concept of transformation has been the foundation for recent efforts to reform health care, including those focused on rural hospitals. We reviewed the Centers for Medicare & Medicaid Services Innovation Center’s (CMMI) initiatives, including the Pennsylvania Rural Health Model, the Community Health Access and Rural Transformation model, the Vermont All Payer Accountable Care Organization model, and the Accountable Health Communities model. We also reviewed state initiatives including the Georgia Rural Hospital Stabilization Program, the Arkansas Clinical Transformation Collaborative, the Colorado Hospital Transformation Program, and the Oregon Hospital Transformation Performance Program.

The lessons learned from these initiatives can be directly applied by State Flex Programs (SFPs) to improve the value proposition and patient centeredness of their CAHs and support their participation in value-based payment models.

New research from Georgetown’s Center on Health Insurance Reforms examines how federal and state policy has shaped the expansion of mobile health care, and what policymakers can do to transform mobile models into a durable part of the health care system that reaches rural and other hard-to-reach communities.

Mobile health can deliver in-person care directly to communities facing persistent access barriers, including provider shortages, transportation challenges, and structural inequities. While evidence shows mobile models can improve access across a wide range of services and populations, policy infrastructure has not kept pace.

Key findings include:

• Mobile health has largely been promoted as a piece of the broader response to specific policy priorities, such as crisis response, expanding opioid use disorder treatment, and improving rural access. However, it is a uniquely effective delivery platform that needs its own coherent policy framework.
• This approach has produced uneven progress across models. Some models of mobile health care, such as mobile crisis response and community paramedicine services are more likely to have standardized insurance coverage and tailored reimbursement, while other critical models, such as mobile primary care, remain dependent on short-term grants and fragmented reimbursement.

The report outlines policy recommendations to:

• Use Medicaid, insurance regulation, and state and federal grant-making to normalize and sustain mobile delivery;
• Align federal policy levers to support state infrastructure development and long-term sustainability; and
• Build platform-level regulatory frameworks across mobile health.

The report finds that the key policy question is no longer whether mobile health can improve access to care, but whether policymakers will build the durable frameworks needed to sustain and scale it.

Read the executive summary and full report here.

Penn State faculty member Dr. Charleen Hsuan, Associate Professor of Health Policy and Administration, published an article in Health Affairs Scholar describing which hospitals and races report detailed race and ethnicity information. Only using broader race categories (e.g., Asian, Black or African American, Native Hawaiian or Pacific Islander (NHPI), and White) can hide patterns within race groups. For example, Asian patients altogether are healthier than White patients, but Filipino patients are more likely to have worse health compared to White patients.

In their analysis of hospital discharge data from 2016 to 2022 in New York State, Dr Hsuan and her collaborators found that:

1. Hospitals and patients were more likely to report detailed race and ethnicity for Hispanic, NHPI, and Asian patients, which is consistent with state recommendations.
2. Hospitals collecting detailed race and ethnicity information were larger, located in more urban areas, and served less disadvantaged counties.

With the federal government revising their rules to make detailed race and ethnicity collection the default for all major race groups, this study shows that hospitals and patients would collect these data when encouraged, but hospitals with less resources may need more support to manage labor-intensive transition in data collection.

A link to the full text of the article is here.

Citation: Hsuan C, Miller D, Zebrowski AM, Rogowski JA, Wei EK, Mahmud Y, Yeung A, Ponce NA. Provision of disaggregated race and ethnicity information in hospital visits. Health Affairs Scholar. 2025. doi: 10.1093/haschl/qxaf047.

Around 486,000 Pennsylvanians enrolled in Pennie coverage during the 2026 Open Enrollment period compared to 496,000 enrollees for 2025. Enrollment in 2026 went from being 11% higher at the start of Open Enrollment to being 2% lower by the end when compared to 2025.

Roughly 79,500 Pennsylvanians enrolled in coverage through Pennie for the first time, but it was clear that costs remained a barrier with new enrollment being 12% lower than last year. Nearly 18% of enrollees dropped coverage altogether. Terminations were highest among older and rural Pennsylvanians and those with incomes just above Medicaid or above the new income cliff. Fifteen of the top 20 counties, based on proportional disenrollment, were rural counties. Many in these areas relied on the enhanced premium tax credits (EPTCs), which Congress did not extend by the December 31 deadline, to afford higher premiums.

The expiration of EPTCs raised costs, leading to 85,000 people leaving Pennie coverage. Around 33,000 more Pennsylvanians enrolled in bronze plans this year compared to last year, a 30% increase. While the numbers do not seem stark in contrast at this point, typically enrollment drops after the first three months of the year due to consumers not being able to afford the plan they chose.

Check out Pennie by the numbers.