Advancing healthcare interoperability is not just about adopting the latest technology. It is about building sustainable systems that serve everyone, especially the communities that have their own unique needs and healthcare dynamics.
UHIN leadership recently returned from the Civitas Networks for Health Annual Fly-In in Washington, D.C., where 20+ leaders from health information exchanges, health data utilities, and regional health improvement collaboratives spent the week in 47 meetings on Capitol Hill. As Utah’s state-designated, nonprofit Health Information Exchange, UHIN was at the center of those conversations. The message Civitas members carried into every office was consistent: locally governed, community-led organizations are the implementation layer that turns federal policy into real-world results.
That message landed at exactly the right moment. The Rural Health Transformation Program (RHTP), a $50 billion, five-year federal investment created by H.R. 1 (the One Big Beautiful Bill Act), is moving from announcement to execution. Utah received $195.7 million in first-year funding, with up to $500 million expected over the life of the program. How states deploy those dollars between now and 2030 will shape rural healthcare for a generation.
Here is what stood out from our time on the Hill, and what it means for Utah.
1. Rural Providers Need to Be at the Center
The ongoing debate over the Rural Health Transformation Program (RHTP) funding centers on a critical question: who is best equipped to help alleviate the struggles of medicine?
While the $50 billion investment has drawn a surge of venture-backed firms, there is growing concern that these entities prioritize a five-year revenue “exit” over the generational stabilization required to fix medical deserts and workforce shortages.
The Civitas perspective argues that the most effective stewards of this capital are the local, mission-driven organizations already embedded in these communities. The rationale for prioritizing nonprofit HIEs, local providers, and public health agencies is rooted in the specific challenges they are uniquely qualified to address:
Why Local Stewardship Matters for Rural Challenges:
- With 50% of rural hospitals operating at a loss, venture-backed models often cherry-pick profitable services. Local providers, however, focus on maintaining “unprofitable” but essential lifelines like maternity care, preventing the expansion of maternity deserts.
- Private firms often rely on temporary “locum tenens” or remote-only solutions. In contrast, local agencies invest in the “grow your own” strategy, which is 5.4 times more likely to result in long-term physician retention in areas where 70% of the population faces primary care shortages.
- Technology-only solutions from external contractors often fail because they ignore the low health literacy and poor broadband infrastructure prevalent in rural zones. Local HIEs and public health offices have the “boots on the ground” track record necessary to help an aging population navigate these digital hurdles.
2. Don’t Reinvent the Wheel
A consistent thread across every conversation: state and federal dollars have already built much of the interoperability infrastructure RHTP now depends on. Health Information Exchanges, Health Data Utilities, All-Payer Claims Databases, and Quality Improvement Organizations are the connective tissue of community health data. They are already in place, they are governed by the people they serve, and they have decades of investment behind them.
The temptation with $50 billion of new federal money is to spin up something new and shiny. That impulse carries a real cost. Every dollar spent rebuilding what already works is a dollar not spent improving care in rural communities. Civitas members made the case repeatedly: the smart move is to strengthen and extend infrastructure that has been earned and tested over years, not to start over from zero.
This is the work UHIN has been doing in Utah for 30 years. The CHIE already moves clinical data securely across providers, payers, and public health partners. Our recently modernized, FHIR-aligned platform is ready to scale to meet the use cases RHTP is asking states to solve.
3. The Reality of RHTP, Honestly
There was real candor in these meetings about how the program came to be. RHTP was created by the same legislation that carried significant Medicaid changes. Several Civitas members and Congressional staff spoke about deep regret tied to those cuts. To be clear, many in the room do not view RHTP as a win. They view it as the reality we now have to work with, and they were honest that the program, on its own, will not offset what rural hospitals stand to lose when the funding window closes in 2030.
That said, this is the world we are operating in. RHTP is the tool in front of us, and Utah received $195.7 million in first-year funding to put it to work. The question is not whether to engage. It is whether we engage thoughtfully enough that, five years from now, rural Utah is in a stronger position than it is today, not facing a steeper cliff.
That requires honesty about the math. It also requires the kind of long-game thinking that nonprofit, community-governed organizations are built for.
4. Sustainability Is the Whole Game
If there was one word that came up in nearly every meeting, on both sides of the aisle, it was sustainability.
Some rural organizations cannot even absorb the funding being offered. They do not have the bandwidth, the technical staff, or the procurement infrastructure to take a fire hose of federal dollars in a 12-month window and turn it into durable change. That is not a failure on their part. It is a structural reality of rural health that this program has to plan around.
The harder problem is what happens in 2030. Programs stood up on five years of grant money have a way of collapsing the moment the money stops. The work that will outlast RHTP is the work that fits inside infrastructure that was already going to be here, supported by sustainable funding models, governed by people accountable to the communities they serve.
What This Means for Utah
UHIN exists for a simple reason: Interoperability for all. Better costs. Better care. That mission predates RHTP, and it will outlast it.
With 25 of Utah’s 29 counties designated rural, and many rural Utahns traveling more than an hour for hospital care and four to six hours one way to see a specialist, the case for a connected, statewide data foundation is hard to argue against. Rural providers need clinical, claims, and public health information harmonized in a way that is computable, real-time, and actually useful at the point of care. That is the foundation that makes everything else possible, from analytics and clinical decision support to the AI applications coming next.
UHIN has spent three decades building toward that picture. We operate a FHIR-aligned, statewide exchange. We coordinate data every day across hospitals, EHR vendors, payers, and public health agencies. We know rural Utah, because we have been showing up there for a long time.
If RHTP is going to deliver what rural Utah needs, the infrastructure to do it does not need to be invented. It needs to be invested in.
Get Involved
If your organization serves rural Utah and you want to talk about how the CHIE can support RHTP-related initiatives, or about what a sustainable, trusted, connected data foundation looks like in practice, reach out to us here. We are ready to roll up our sleeves.
References
Borders, T. F., Youngen, K., & Cecil, J. (2026). The social determinants of health—Rurality and pregnancy. PMC – NIH. https://pmc.ncbi.nlm.nih.gov/articles/PMC13095225/ Cited by: 5
CDC. (2026). Geographic and sociodemographic patterns in prevalence of diagnosed diabetes, US, 2021–2024. Preventing Chronic Disease. https://www.cdc.gov/PCD/issues/2026/25_0288.htm
Frontiers. (2026). Digital twin virtual hospitals and rural health disparities: a six-country comparative study (2018–2024). Frontiers in Public Health, 14. https://doi.org/10.3389/fpubh.2026.1741438
Orimaye, S. O. (2026). Roadblocks to rural health: State transportation policies’ impact on health care access in Virginia’s rural communities. American Journal of Public Health, 116(2), 175–179. https://doi.org/10.2105/AJPH.2025.308285
Youngen, K., Cecil, J., & Borders, T. F. (2026). How 2026–2030 digital health policies impact access & patient engagement. Rural & Underserved Health Research Center Publications. https://digitalcommons.liberty.edu/cgi/viewcontent.cgi?article=3008&context=research_symp
