We have to stop pretending that a “perfect” clinic visit can fix a broken zip code.

I call Texas home, and my family has deep roots in our rural towns. My mother grew up on a farm that we visited every summer, and I can still remember the distinct worry of being so far away from everything. What if something happened? The nearest house was miles away, and the nearest hospital was even further.

My grandmother actually worked in the Emergency Room of our local hospital until it closed, forcing my family and an entire community of farmers to seek care that was effectively out of reach. For me, the struggle to get to a doctor isn’t a “social driver” I read about in a report — it’s a conversation at my kitchen table. It is a reality that millions of Americans face every day.

I recently spent time at a partner clinic that reminded me of those summers. In this Mississippi Delta town, the local hospital closed in 1991. The nearest specialist is two hours away. There is a beautiful eight-acre garden and a greenhouse on-site, built by the clinic because the nearest grocery store is ten miles away. Instead of fresh produce, the local landscape is dominated by convenience stores filled with ultra-processed foods — items that are inexpensive, shelf-stable, and convenient.

In places like this, distance is just as dangerous as high blood pressure.

The Reality on the Ground

We have to be honest: our current healthcare systems weren’t built to support the clinicians who choose to stay in these communities. I meet so many doctors and nurses who went away to school specifically to come back and care for the neighbors who raised them. They stay because of roots, history, and a dedication to service.

But they are often working against the grain. Healthcare is a business, and until we truly align incentives to provide high-quality, affordable, and accessible care that accounts for where that care is delivered, these communities — and the clinicians who serve them — will continue to struggle.

The “Deprivation Penalty”

Tools like the Community Deprivation Index let us see, block by block, what a patient is actually up against — whether it’s a lack of internet for a telehealth visit or a lack of transportation to a pharmacy. Teams in these areas are checking the boxes and following the protocols. But their patients’ health outcomes still face a “deprivation penalty” because of the environment. You can’t protocol your way out of a town with no pharmacy, or a multigenerational family with no car. When we measure success without accounting for these barriers, we aren’t seeing the full picture of the care being delivered.

The Tools We’re Watching

CMS recently released two new programs, ACCESS and LEAD — ten-year plans designed to change how we pay for care. Are they perfect? No. But as leaders shaping new health frameworks, we need to stay at the table and advocate for better where they fall short.

There are specific guardrails here worth watching and pushing to improve:

  • The Ten-Year Runway: LEAD is scheduled to run for a decade without rebasing ACOs. My hope is that if this works, we see these same stable policies extend into MSSP.
  • Support for Rural Teams: LEAD carries forward favorable assignment rules for Nurse Practitioners and PAs. In rural areas, these clinicians are often the only source of care; we have to ensure the system captures their full impact.
  • Investing in Transformation: For higher-spending areas, a 1.5% Administrative Benchmark Add-On provides the capital needed for initial care transformation.
  • Outcome-Aligned Payments: The ACCESS model moves us away from paying for activities and toward rewarding measurable results through technology-supported care, like cellular-enabled blood pressure cuffs.

We have to keep advocating for better. We have to demand incentives that actually recognize the complexity of rural care. And we have to use every tool we have — from new CMS models to better data — until high-quality care is a reality for every community, not just the fortunate ones.

Healthcare is a team sport. If we don’t advocate for these communities, the failure eventually affects us all.