December 2025/January 2026

Applications were required to be focused around interventions relating to access, workforce development, innovative care, and technology.  The deadline for applications was November 4rth and CMS will review them and respond to applying states by December 31st.

Michigan’s application is publicly available and offers a good look at how Michigan proposes to use funding to optimize outcomes for Michiganders if CMS approves the proposal as submitted. As you read through the summary, you will see that MDHHS did a very nice and balanced job of leveraging and strengthening existing key efforts as well as introducing exciting new initiatives that will indeed transform rural health and improve outcomes. We will continue to watch the RHTF application and report on updates and additional details as they are available. In the interim, here is a peak at what’s inside the application submitted by the Great Lakes state. The Michigan application has four main components:  1) Partnerships Initiatives; 2) Workforce Initiatives; 3) Interoperability Initiatives; and 4) the Closer to Home Blueprint. Here is a glimpse at the highlights of each of the areas:

1. Workforce for Wellness Initiative including:
   • A Rural Health Workforce Pipeline and Education Fund with:
     • A High School to Health Care Pipeline Grant Program
     • A BSW to MSW Stipend Program
   • A Rural Provider Recruitment and Capacity Fund
     • Rural Health Provider Recruitment and Retention Fund
       • Maternal Health Provider Training Program
       • EMS Retention and Recruitment Program
       • Limited Licensed MSW Supervision Stipend Program
       • CHW and community paramedic trainings and certifications
       • Creating initiatives for new workforce entrants and incentivizing and supporting the existing workforce
   • A Rural Provider Recruitment, Retention, and Capacity Program
2. An Interoperability Initiatives Program aimed at reducing duplicative care and improving health outcomes that features:
   • Remote technologies for high-need patients
   • Pilots to link EMS data with hospital EHRs and integrate community-based social service data via Community Information Exchanges to improve the timeliness and coordination of care
   • Data integration pilot projects with EMS, rural clinics, rural hospitals, FQHCs, and community-based organizations
   • EHR, Health Information Exchange, and Community Information Exchange capability
   • Expanding data-sharing capabilities between rural providers and HIE networks
   • Strengthening statewide coordination of care
3. A Closer to Home Blueprint that will bring health services closer to rural residents and connect health and social sector providers, reduce transportation barriers, and expand opportunities for older adults to age in place through:
   • A new behavioral health model to reduce costs by diverting avoidable inpatient admissions and minimizing reliance on law enforcement interventions
   • Behavioral health urgent care via telehealth or in-person options for same-day, urgent access.
   • Promoting healthy aging through expanded community-based care for older adults
   • Proactive discharge planning to ease the path to independence for elders, including accessible housing support, transportation to primary care appointments, medication management, follow-up, and support.
   • Supporting rural PACE (Program for All Inclusive Care) alternative care settings that provide adult day services and clinical care with a more flexible model than full PACE centers.
   • Providing Home and Community-Based Service clients with medical needs with emergency preparedness kits, battery-operated generators for power outages

It’s also worth noting that five percent of the award will be set aside for projects with tribal government partners for programs that fit their unique needs. If you would like to keep apprised of developments related to Michigan’s Rural Health Transformation application, subscribe to the updates at: Michigan RHT Application ListServ.

It’s a quandary. As a nation, it is well-recognized that primary care is essential to a well-functioning, efficient, effective patient-centered healthcare system. Over time, primary care moderates increases in healthcare trend and improves patient outcomes (Starfield, 2005).  In fact, a classic 2004 analysis by Baicker and Chandra demonstrated a linear decrease in Medicare spending along with an increase in the supply of primary care physicians in addition to better quality of care.

Paradoxically, though, nationally, and in Michigan, though primary care is desirable, we spend the least on it of any component of medical spending. Although primary care receives at least 35% of all office visits (National Center on Health Statistics, 2025, the share of the healthcare dollar that goes to primary care services is estimated at only 5% of total medical expenditures. Other developed countries with better health outcomes and lower overall health expenditures spend a much larger portion, from 12 to 15% of healthcare spending on primary care. 

Primary care is overlooked as a lever to obtain better value for our health care dollars.  It is the underpinning of our system and the first point of contact for many patients, but we have chronically underfunded it and have overburdened it with excessive administrative expectations. It is time to change course and redistribute spending so that primary care is better positioned to function effectively in this important role.

The National Academy of Science, Engineering, and Medicine’s (NASEM’s) Implementing High Quality Primary Care report underscored the importance of resourcing primary care. Its recommendations feature a minimum spend threshold for primary care, calling for more states and the federal government to increase investment to 10%-12% of total health care spend. It is a national imperative and as the nation ages and the population grows sicker, it is more important than ever to make progress toward reaching the goal of increased investment in primary care.

One way of doing this is to mandate that insurers spend a larger share of total medical spending on primary care. Setting a minimum percentage of total healthcare spending that should be spent on primary care does not increase insurance or healthcare costs. Instead, it underscores the importance of primary care and provides important resources to support practices to fund practice teams to support their patient panels.

There are a number of states that have already taken action to increase investment in primary care as they work to make healthcare more affordable and people healthier. Some states have paired with affordability or health cost growth containment efforts. Eleven states have passed legislation or taken state action to increase spending on primary care as a portion of total medical costs. Among them: 

• California 
  • A goal of increasing primary care investment to 15% of overall medical spending by 2034 has been set by the California Office of Health Care Affordability.  Their expectation is that spending on primary care as a share of total medical expenses increases each year in the interim by .5 to 1%. In addition, the state’s Medicaid program, Medi-Cal, increased rates for primary care providers to 87.5% of Medicare rates, effective January 1, 2024.
• Delaware 
  • Delaware has set a primary care target of 11.5% of total medical spending by 2025 for private insurers and a requirement to match Medicare reimbursement rates for primary care. 
• Oregon
  • Oregon requires both Medicaid Coordinated Care Organizations (CCOs) and state plans to spend at least 12% of total medical expenditures on primary care. The state also has public-facing dashboards that have demonstrated success in reaching their targets. Their 2023 report showed a commercial plan average spend of 13.3% of total medical expenditures.
• Oklahoma 
  • Oklahoma requires reporting of the percentage of health care expenses by each contracted entity on primary care services, with 11% devoted to primary care no later than the fourth year of a contract with the Medicaid program. 
• Rhode Island 
  • Rhode Island was the first state to establish a target requirement for commercial insurers to invest at least 10.7% of their total medical expenses in primary care.
• Washington
  • The state of Washington charges the state’s Health Care Cost Transparency Board with measuring and reporting on primary care expenditures and progress toward increasing primary care spending to 12% of total healthcare expenditures.
• Connecticut
  • Connecticut requires progressively increased spending on primary care to reach a target of 10% by 2025.

In addition to these state legislative efforts, the Center for Medicare and Medicaid Innovation (CMMI) is operating a total cost of care demonstration model called AHEAD (Achieving Healthcare Efficiency through Accountable Design) with several state partners. The AHEAD model features increased investment in primary care, hospital global budgets, geographic ACO entities, multi-payer alignment and shared cost and quality targets to stabilize funding, expand primary care services, and improve population health. The AHEAD model requires a set of hospital partners willing to participate as well as the participation of Medicaid in the applying state as well as a set of primary care practices and at least one additional payer. It has not to date been a fit for Michigan but is operational in six other states.  

Together we face many tough tradeoffs, but strengthening primary care should not be one of them. To stem the erosion of primary care in Michigan we must both pay primary care providers more and pay primary care services differently as emphasized in the NASEM Implementing High Quality Care report.

New Medicaid Managed Care Comparative Payer Policy Table Now Available

The latest update of the Medicaid Managed Care comparative payer policy coding table is now available here.  The table outlines how each of the nine Medicaid Managed Care Plans approach requirements and policies for care management. The table displays the way (e.g., PMPM or fee for service) the plans pay for care management services, whether there is a percentage of patients reached required to earn an incentive, and whether there is a cap or maximum on care management payments. We hope it is helpful in your work to coordinate care for Medicaid patients.

New Payment Basics Series from MedPAC

The Medicare Payment Advisory Commission (MedPAC) does more than advise congress about Medicare policy reform. They also issue an excellent set of reports in their Payment Basics series and it has just been updated. They offer great overviews about the basics of Medicare payment structure. From inpatient rehabilitation to ambulance services, the series explains what Medicare pays for, as well as how payment rates are set and updated for each type of provider.  The series includes helpful overviews of the basics of payment for:

• Physician Services
• Accountable Care Organizations
• Federally Qualified Health Centers and Rural Health Centers
• Medicare Advantage+

The series was originally intended to be a resource for policymakers to better understand how Medicare pays for health care services, but it is also a great learning tool to include in orientation for positions related to administration, billing, and reimbursement.

Wonderful and Broken: The Complex Reality of Primary Care in the United States

Troyen Brennan’s newest book explores primary care’s struggles and emerging solutions to improve its viability. He takes a tour across the nation to share their stories of promising models that have produced on performance.

He also talks about what he learned from talking with practices to better understand the problems and struggles that they face. He finds hope in value-based care models that enable flexible care and incentivize whole-person care approaches that are built on Primary Care Medical Home chassis with extended care teams and integrated mental health services. It’s a great read and provides food for thought about how primary care can deliver with the right resources.

Combining Medicare Wellness Visits with Problem-Based Visits Reduces No-Show Rates and Improves Completion of Quality Measures

Annual Wellness Visits (AWVs) are an important, but underused Medicare benefit.  It is estimated that half of Medicare beneficiaries don’t receive them. Research has shown that AWVs were associated with significantly reduced spending on hospital acute care and outpatient services. Patients who received an AWV in the index month experienced a 5.7% reduction in adjusted total healthcare costs over the ensuing 11 months.

There are many reasons that AWVs are underused, one of which is the additional complexity encountered when patients introduce issues that are beyond the scope of AWV design.  A new article by Wellman, et. al., describes a process to improve AWV utilization which involves scheduling combined AWV and problem-based forty-minute visits with the provider that the patient most often sees. These combined appointments allow patients to complete the Medicare annual wellness visit and, if needed, have regular medical issues handled in the same visit with their regularly seen physician.  Clinician education and targeted scheduling to focus on those at greatest need were also a part of the approach. When combined, the techniques markedly increased the volume of AWVs and decreased the volume of no-shows.  The article offers some instructive ideas for those who are working to make AWVs a priority in their practice.     

Health Policy 101:  Health Care Costs and Affordability

The Kaiser Family Foundation (KFF) is a wonderful source for well-reasoned critiques and analyses about important healthcare issues of the day. Affordability has been much in the news, with healthcare premium rates increasing and the underlying cost of care on what seems to be a runaway train.

KFF has just published a piece on healthcare costs and affordability that looks at changes in healthcare spending over time, explains the tie between healthcare spending, costs, and affordability, the concerns about financial vulnerability, and provides a look at future estimated trends. It is required reading for those who want to better understand the issue of affordability and work toward constructive solutions that make care more affordable and accessible to all.      

Health Net of West Michigan

Michigan Community Health Worker Alliance (MiCHWA)

Practice Transformation Institute (PTI)

Michigan Center for Clinical Systems Improvement (Mi-CCSI)

My Michigan Health

Michigan Institute for Care Management and Transformation (MICMT)

Integrated Health Partners (IHP)