Kirk Mathews, chief transformation officer at the Missouri Medicaid Transformation Office of the MO HealthNet Division of the Department of Social Services
Photo: Kirk Mathews
Ensuring rural residents can access quality care is a top priority of the healthcare industry and a focus of the government.
With more individuals losing insurance due to the drop in Obamacare subsidies and thus fewer patients who can reimburse rural hospitals and clinics that already face steep financial challenges – not to mention the further $1 trillion Medicaid reductions in the One Big Beautiful Bill Act – rural healthcare is in trouble.
Rural case management
Kirk Mathews, chief transformation officer at the Missouri Medicaid Transformation Office of the MO HealthNet Division of the Department of Social Services, will be addressing the subject in a session titled "Rural Case Management: Lowering Utilization and Healthcare Costs" at the 2026 HIMSS Global Health Conference & Exhibition in March in Las Vegas.
"Rural healthcare is in trouble – real trouble," Mathews said. "And this is not a surprise to anyone. As long as I can remember, people have been talking about how to save rural healthcare – with very little actually being done successfully.
"Historic reimbursement models for hospitals make it nearly impossible for rural hospitals to compete," he continued. "Complex care delivery has long since left rural America and with it the volume – both patients and dollars – needed to sustain the local facility."
The focus of the session will be on a pilot program in Missouri called the Transformation of Rural Community Health, or ToRCH.
Passing the ToRCH
"Born in the mind of a Washington University rural health economist named Abigail Barker, and nurtured in the Transformation Office of Missouri Medicaid, ToRCH provides the resources for a rural hospital to impact population health at the county level by addressing the upstream causes of poor health," Mathews explained.
"By serving as the health hub in their county, the local hospital convenes all the providers, stakeholders and community-based organizations in their local community to identify those in their community who struggle with non-clinical contributors to poor health and help them get assistance," he added.
It all is held together by a social care referral platform.
"As population health in the county improves, the cost of care for the Medicaid population comes down," Mathews explained. "And the resultant savings are shared with the hospital to sustain the model.
"One of our ToRCH sites is a critical access hospital in a county that, last year, had 20 low-birthweight Medicaid babies requiring NICU stays at urban hospitals," he noted. "Our Medicaid data shows every low-birthweight Medicaid baby costs the system an average of $90,000 more than a healthy birthweight baby."
How to save a million bucks
If the hospital can cut that number in half by addressing social needs like transportation to pre-natal care, adequate nutrition and smoking cessation counseling, the system saves nearly $1 million. Up to 75% of that is shared back with the hospital. To a rural Missouri critical access hospital, that shared savings might just be the difference between survival and closing their doors, Mathews said.
One of the various takeaways HIMSS26 attendees will get from Mathews' session is for healthcare organizations to be creative.
"Consider how serious collaboration among stakeholders – added with a few dollars and wrapped in some amazing technology – might transform rural health," he concluded.
Kirk Mathews' session, "Rural Case Management: Lowering Utilization and Healthcare Costs," is scheduled for Tuesday, March 10, from 2:15-3:15 p.m. in Palazzo C/Level 5 at HIMSS26 in Las Vegas.
Follow Bill's health IT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.
WATCH NOW: Wisdom on nurses and IT from a health system's nurse CIO
