Rural transformation

The Health Care Authority’s (HCA) vision is for all rural residents to achieve greater health and well-being and have access to essential care and social supports when needed. A new rural health care model will ensure sustainable access to care in rural communities.

Why transform rural health care?

Rural health care providers and systems face many challenges in the communities they serve. Critical access hospitals, rural health clinics, federally qualified health centers, and others face overlapping, complex challenges, including:

  • Sicker, aging populations.
  • Provider recruitment and retention or workforce issues, especially with behavioral health and substance use disorder.
  • Fewer resources to invest in practice transformation.  
  • Lack of health information technology and systems to support population health management.

These challenges have magnified over the last few years, jeopardizing access to essential care for those in rural communities. These challenges occur regardless of the type of one’s health insurance and place each community’s economy at risk.

The CHART Model

Washington State, along with the states of Alabama, South Dakota, and Texas, completed the Community Health Access and Rural Transformation (CHART) Model planning year. 

As the lead organization (LO) for Washington State, HCA partnered with several North Central rural hospitals, Department of Health’s Office of Rural Health, and the North Central Accountable Community of Health.

The CHART Model, available through Centers for Medicare & Medicaid Innovation (CMMI), was promising as it offered both a Medicare and a Medicaid Alternative Payment Model (APM). The Medicare APM was slated to go into effect January 1, 2023. Based on the final Capitated Payment Amount (CPA) for this model as well as additional requirements of participation, none of the LOs or rural hospitals in any of the four states were able to participate in the Medicare APM by the deadline of November 1, 2022.

CMMI is now working to revise the original CHART model to better address the rural hospitals’ and LOs’ concerns. As of December 2022, CHART is on hold. CMMI anticipates being able to share more about the revised model in March 2023.


Updated 12/28/2022



Theresa Tamura
Community Health Access and Rural Transformation (CHART) manager