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. 

Why transform rural health care?

Rural health care providers and systems are often the backbone of their regions’ economies, with staff and providers who are embedded in and care deeply about their communities. They also face complex challenges, including:

  • Aging and, in some areas, sicker populations.
  • Unique challenges in provider recruitment and retention.
  • Unreliable or unavailable broadband and cell service in some areas.
  • Fewer resources to invest in practice transformation and innovation models.  

These challenges have magnified over the last few years, jeopardizing access to essential care for those in rural communities.

The CHART Model

In 2021 and 2022 Washington State, along with the states of Alabama, South Dakota, and Texas, was part of the Community Health Access and Rural Transformation (CHART) Model, through the Centers for Medicare & Medicaid Innovation (CMMI).

The CHART Model was promising as it offered both a Medicare and a Medicaid Alternative Payment Model (APM) for hospitals in rural areas. Unfortunately, none of the four states or Washington’s rural hospitals were able to participate in the Medicare APM.

In March of 2023, CMMI announced the end of the CHART Model. HCA and CMMI continue to work to address payment structures for rural health that can support greater health and well-being along with ensuring sustainability and continuity of care in rural communities. 


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