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A Playbook for New Rural Healthcare Partnership Models of Investment

  • Douglas P. Jutte, MD, MPH
  • Ruth Thomas-Squance, Ashley Hernandez, Colleen Flynn, Jen Lewis-Walden, Ashauntee Jones, Shante Harding
Rural Farm

Many rural communities across the country face challenges in meeting community needs around health, workforce development, financial stability, infrastructure and more. However there are calls to change the narrative around areas existing outside of urban centers, to recognize the unique assets embedded in these enduring rural communities.

The healthcare industry is a vital player in rural communities, shaping a vision for growth. Often, healthcare organizations are one of the biggest employers in rural areas, impacting communities through their anchor roles and serving an influential role as local conveners able to align groups to address crucial data and build partnerships across sectors.

A Playbook for New Rural Healthcare Partnership Models of Investments, from PHI’s Build Healthy Places Network, is an action-oriented guide designed for healthcare organizations who want to pursue partnerships with rural communities, economic development and other sectors, to create the community conditions that support improved health. It includes case studies from across the country and four core strategies used by healthcare entities as examples for future multi-sector rural partnerships to follow.

See the Playbook

Central Strategies for Collaboration & Partnerships

The report identifies four broad strategies that the healthcare sector can use to collaborate with cross-sector partners for rural health and prosperity:

  1. Strengthening Economic Opportunity and Workforce Support: Economic stability and community health are interdependent: one cannot be sustained without the other. As anchor institutions and major employers, rural healthcare organizations are often significant economic drivers in the communities that surround them. Additionally, lack of economic stability is a major factor in poor health outcomes, so the fate and stability of rural healthcare institutions, both as service providers and as employers and economic drivers, can impact community health. As employers, competitive recruitment and retention of healthcare staff is a challenge for many rural hospitals. In a competitive market, sufficient housing and childcare opportunities can be critical strategies in recruiting great candidates. This strategy deploys economic and workforce development strategies to create stability and increase health outcomes. It includes strengthening local career pathways, healthcare workforce housing for recruitment and retention and access to childcare.
  2. Supporting Local Control: Increasingly, rural healthcare is deploying strategies to support community ownership models that help close the racial wealth and health gap. These models are geared toward supporting collective ownership of land through a land trust, promoting food sovereignty or the right to healthy, culturally appropriate food defined by a community’s own agricultural systems, or advocating for policy change to advance community investment or needed land use changes.
  3.  Strengthening Infrastructure to Support Healthcare Access: This strategy seeks to build and strengthen the infrastructure that supports healthcare delivery and responds to the challenges of physically connecting rural healthcare with those needing services. The work can take several forms, such as collaborating with partners to co-locate services to improve access, supporting community hubs for health, expanding reach through broadband availability, or improving transportation for individuals to access needed services.
  4.  Increasing Resources: A common strategy for healthcare investment in rural development is increasing access to resources. Successful approaches can include diversifying the funding base and finding innovative resources, such as a hospital’s use of general obligation bonds and loans to fund a New Market Tax Credit allocation. Another trend is to donate land to support community-based projects such as affordable or supportive housing. An increasing number of healthcare institutions are reaching out to partners in rural community development that have expertise in creatively deploying capital in support of housing, workforce development, and other issues central to rural healthcare’s impact on community health.
Central Strats

Case Study: Wagner Community Memorial Hospital Avera & Yankton Sioux Tribe (South Dakota)

Wagner is a community of about 1,500 people located in Charles Mix County in south central South Dakota. It is adjacent to the Yankton Sioux Reservation and is 120 miles from the closest major tertiary hospital, in Sioux Falls, South Dakota. Almost a quarter of the population in Charles Mix County is living in poverty, double the rate for South Dakota.

Wagner Community Memorial Hospital Avera (WCMH-A) serves the community through a mix of public pay services, Medicare, Medicaid, and the Indian Health Service, providing over half of its services to Native Americans and members of the Yankton Sioux Tribe. This mix of diverse cultures, where healthcare practices and local politics play an intricate role, affects how healthcare is managed and delivered.

One part of this effort was the revival of the dormant Wagner Area Growth, a nonprofit economic development corporation. WCMH-A helped Wagner Area Growth hire an economic development director and recruited a major store chain in the community to adopt a sales tax rebate through the City of Wagner. As a result of the improved product quality and selection, WCMH-A’s revival of this economic development corporation ultimately led to the doubling of retail sales, increased jobs, and better economic stability.


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