DON GONYEA, HOST:
Health care in America's rural communities faced challenges even before last year's massive cuts to Medicaid. Think tight budgets, aging infrastructure, staffing shortages and long commutes for patients to get care. The Trump administration's fix is called the Rural Health Transformation Program, $50 billion over the next five years and, among other things, exploiting artificial intelligence, including AI nurses. But this comes at the same time Medicaid is facing cuts that could amount to nearly a trillion dollars over the next decade, according to KFF Health News. We're joined now by Dr. Mark Holmes, director of UNC Chapel Hill's Cecil G. Sheps Center for Health Services Research. Welcome to the program.
MARK HOLMES: Thanks, Don. I'm excited to be here.
GONYEA: Let's start with the money. What can this $50 billion influx do over the next five?
HOLMES: Some states, for example, are leaning into creating more rural residencies for physicians or dentists and trying to train more people in rural areas, which we know works. We also have programs that are looking at community health workers and trying to take non-health professionals and train them so that they can help people navigate the health care system. There's recruitment and retention, physician training on nutrition. So a lot of different ideas are out there, and we're going to see them get in the field and learn a lot about solutions that work in rural America.
GONYEA: OK. And once states do have this money in hand, how is it actually flowing to hospitals and to providers?
HOLMES: In some states, they are active RFAs and contract bids that are open there. In other states, they're doing this through an appropriation process and involving a legislature. But we're in this space now of the critically important but mostly invisible bureaucracy of getting the money out, getting the initiatives launched and starting to put this money to work.
GONYEA: OK. So it can be a complicated process just following the money from the federal government to the states into the hands of the people who actually use it.
HOLMES: One thing we've seen in the past with other circumstances like this, for example, during the ARRA money in the Recovery Act, for example, back in 2008 and 2009, and the COVID funds, both of those programs have some similarity to RHTP in that there's a lot of money that's trying to get into the field very quickly. And most states have learned some lessons from those previous two and are thinking about, how can we spend this money in a way that is appropriate and with the proper oversight and getting it out as quick as possible because money that's sitting in the state capital is not being put to work and getting it out in the field is of critical importance.
GONYEA: Let's turn to the AI, the artificial intelligence piece of this. Health Secretary Robert F. Kennedy and Medicare and Medicaid chief Mehmet Oz have spoken approvingly about using AI to address the challenges facing rural health care. First off, your thoughts on how would that work in practice?
HOLMES: There's a lot of promise for AI in all of health care, including rural. If you think about remote monitoring - if I have heart failure and I live in a rural community and I'm not getting out of the house much, think about the promise of stepping on the scale every day, having that scale talk to my physician and having an algorithm that runs and say, hey, this guy's, you know, put on a couple pounds the last couple of days, we should check him out and make sure that his heart failure meds are titrated appropriately. There's two items in particular that we need to be cautious of. One is digital literacy and broadband access. And any tool that requires people to have high-speed fiber is not going to work as well in rural as it is in urban and the ability of people to understand what - how these things work.
The second is AI models get trained on data. And if we're training AI models on people living in urban settings, getting their treatment at academic medical centers, that again is going to be harder translation to rural communities where there may be different practice patterns and there may be different resources available to rural residents than there are in urban.
GONYEA: And I want to ask you specifically about something I mentioned at the top, AI nurses. I understand they don't actually exist yet. What are your thoughts about a health secretary kind of floating that idea, even promoting it at this stage?
HOLMES: I appreciate the creativity and thinking about what can work, and let's try it and see what options may address some of these challenges that rural America and their residents have been facing for decades in terms of being healthy.
GONYEA: Mark Holmes heads up the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. Doctor, thanks for speaking with us.
HOLMES: I appreciate the time. Transcript provided by NPR, Copyright NPR.
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