North Carolina Rural Health Transformation Program

Background

The North Carolina Rural Health Transformation Program

The North Carolina Rural Health Transformation Program (NCRHTP) is a new statewide initiative implemented by the North Carolina Department of Health and Human Services (NCDHHS) as part of the federal Rural Health Transformation Program (RHTP), a five-year initiative authorized by the U.S. Centers for Medicare & Medicaid Services (CMS) to invest in states to support long-term, community-driven improvements in rural health systems. Duke-Margolis will serve as the neutral convener supporting NCDHHS and NC ROOTS Hubs in implementation of NCRHTP.

North Carolina was awarded over $213 million for its first-year of NCRHTP funding from CMS to strengthen rural communities and improve health outcomes and access across the state through six interconnected initiatives:

NC ROOTs Hubs
Prevention and Chronic Disease Management
Behavioral Health Expansion
Workforce Development
Financial Sustainability
Technology and Innovation

A cornerstone of NCRHTP is the creation of NC ROOTS (Rural Organizations Orchestrating Transformation for Sustainability) Hubs, locally governed regional networks that connect health care, behavioral health, and community-based services to improve care coordination and health outcomes. The role of the NC ROOTS Hubs will be to lead efforts across primary care, behavioral health, workforce development, value-based payment and digital health to support the rural health needs of their regions.

The NC ROOTS Hub Leads are representative of the six North Carolina Medicaid regions. See below for more about each NC ROOTS Hub, their region, and their website detailing their role in NCRHTP.

Impact Health -- Region 1
Trillium Health Resources – Region 2 and 5
Vaya Health – Region 3
UNC Heath -- Region 4
Access East – Region 6

Graphic showing a map of North Carolina broken down by county. Counties are grouped and color coded by each ROOTS Hub region.

How Duke-Margolis Will Support Learning and Implementation of NCRHTP

As the neutral convener, Duke-Margolis' role is to accelerate learning, elevate local perspectives, identify common challenges and opportunities across regions, and translate lessons into actionable guidance for program implementation and sustainability.

Facilitating shared learning across NC ROOTS Hubs and statewide partners by holding quarterly convenings with Hubs as well as hosting an annual statewide public event;
Elevating community and stakeholder voices to inform implementation and continuous improvement;
Synthesizing insights and evidence into actionable recommendations for NCDHHS and regional partners; and
Connecting North Carolina to national innovations and federal opportunities, including CMS resources, best practices, and peer-state learning.

Alignment with Other Duke-Margolis Work

This project builds on Duke-Margolis' broader experience convening diverse stakeholders, generating actionable evidence, and translating research and implementation lessons into practical guidance for policymakers, health care organizations, and community partners:

North Carolina State Transformation Collaborative: This work, which was previously supported in North Carolina by NCDHHS, builds on Duke-Margolis' longstanding role as a trusted, neutral convener across North Carolina's health care ecosystem. Through initiatives such as the North Carolina State Transformation Collaborative (NC STC), Duke-Margolis brings together state partners, health plans, providers, health systems, community organizations, and other stakeholders to advance high-value, whole-person care through shared goals, aligned strategies, and collaborative problem-solving. The NC STC focuses on strengthening primary care, advancing value-based care, improving data sharing, and aligning stakeholders around common health system priorities. NCRHTP builds on this foundation with a specific focus on rural health, creating new opportunities for shared learning, collaboration, and innovation to improve health outcomes across rural North Carolina.

Generating Evidence-Based Recommendations for Advancing Access to High Quality, Whole-Person Care in NC Medicaid This project, funded by the Kate B. Reynolds Charitable Trust, seeks to identify and address disparities in access to health and social care for NC Medicaid members through quantitative analysis, community engagement, and policy-focused research. This work complements and will inform NCRHTP in several important ways. Findings from the project can help NC ROOTS Hubs and NCDHHS better understand where access challenges are most acute, particularly in rural and underserved communities, and inform strategies related to workforce development, behavioral health, primary care, and care coordination. At the same time, insights emerging from NC ROOTS Hubs, community partners, and rural stakeholders through NCRHTP can help shape research priorities, identify emerging access challenges, and provide critical context for interpreting quantitative findings. Together, these efforts create a learning opportunity that combines evidence generation with on-the-ground implementation experience to advance equitable access to whole-person care for North Carolinians.

Convenings

Annual Public Meetings

NC ROOTS Hub Convenings

Hub Meeting Summaries

NCRHTP Case Studies

A key component of Duke-Margolis' role supporting NCRHTP is to generate case studies that provide timely and formative guidance to Hubs, Hub network partners, and NCDHHS on innovative programs, care delivery models, and best practices to inform NCRHTP implementation.

Please check back here for more information as these are released.

Cross-State Learning and Rural Health Transformation Resources

As part of our role supporting NCRHTP, Duke-Margolis will identify and share promising practices, implementation tools, peer-state experiences, and federal resources that can help NC ROOTS Hubs, community partners, providers, and policymakers accelerate rural health transformation efforts across the state. The sections below include a curated selection of resources.

Know of any NCRHTP resources that might be useful to highlight here? Please contact us at RHTP@duke.edu

Federal Resources and Guidance

General Resources for Tracking All State RHTP Programs

Evidence and Best Practices in Support of NCRHTP Initiatives

How Can I Get Involved?

Many organizations, entities, and passionate stakeholders are engaged in this important work to support rural health transformation in North Carolina. Depending on you or your organization’s interest, there are multiple ways to get involved:

Find out more from NC Department of Health and Human Services: NCDHHS has an updated webpage with additional details on the NC Rural Health Transformation Program, including links to NCDHHS-led webinars, information on grant opportunities, and latest NCRHTP news
- NCDHHS publishes a regular NC Rural Health Transformation Program Newsletter with updates on program implementation across the state. Subscribe to the NCDHHS NCRHTP Newsletter
Connect with your NC ROOTS Hub: Each of the NC ROOTS Hub Leads also publish their own NCRHTP focused webpage with more details about the role they play to support NCRHTP in their region:
- Impact Health – Region 1
- Trillium Health Resources – Region 2 and 5
- Vaya Health – Region 3
- UNC Heath — Region 4
- Access East – Region 6

Contact Us

Email us at RHTP@duke.edu

Stevens Amendment Disclosure: This webpage is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $213,008,356.47 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.