OPINION:
Decaturville, Tenn., about halfway between Memphis and Nashville, sits 20 miles south of the interstate that connects the state’s two largest cities. The nearest hospital is no closer. That’s because there are no hospitals within the 345 square miles that make up surrounding Decatur County.
The county’s 40-bed hospital shut down six years ago after decades of financial struggle, leaving its 12,000 residents with few good options for care.
When a rural hospital closes, a community loses more than a building. Emergency care is farther away. Local doctors have fewer places to send patients for tests, observation or follow-up. Older adults and people managing chronic conditions often delay care because the trip is too hard, too costly or too far.
Decatur County’s story is hardly unique. More than 20 Tennessee counties do not have a hospital, and many rural hospitals across the country are under similar strain. In late December, an analysis by the Center for Healthcare Quality and Payment Reform found that 756 rural hospitals are at risk of closure. More than 40% of those face immediate risk including 14 in Tennessee.
While UnitedHealthcare is not in the hospital business, we are in the business of helping people get care and that means working with local providers, community partners and policymakers to help address the practical barriers facing rural communities. That work happens in two ways: helping people get care where they live today and helping rural hospitals remain open and stable for the future.
That is why UnitedHealth Group, UnitedHealthcare’s parent company, is working with the University of Tennessee Health Science Center and local partners to bring lessons from neighborhood health hubs in Memphis to rural communities, including Decatur County. These hubs meet people where they live supporting prevention, chronic disease management, health coaching, screenings and referrals before health issues become more serious.
The early results are encouraging. Across West Tennessee, more than half of participants have lowered their blood pressure, helping prevent heart attacks and strokes a practical example of how local partnerships can help close access gaps.
Those gaps do not always fit neatly into program boundaries. What works in one community might not work in another. Rural communities need a more flexible health care ecosystem that supports local providers, reduces administrative friction and helps people get care closer to home.
For UnitedHealthcare, that starts with helping rural hospitals improve cash flow and enhance financial stability before communities lose them. One practical step is helping rural providers receive payment more quickly and predictably. In January, we launched a multistate pilot for Medicare Advantage and dual-eligible patients across Idaho, Minnesota, Missouri and Oklahoma. The initiative has accelerated reimbursement timelines for applicable rural hospitals by nearly 50% on average. Faster payment can help support cash flow, workforce stability and continued access to care.
We have since expanded the program to five additional states: Alabama, Arkansas, Kentucky, Virginia and West Virginia. By fall 2026, we plan to expand to about 1,500 rural hospitals and associated rural practitioners nationally, including all critical access hospitals. The next phase will also include Medicaid and fully insured commercial plans. We will continue applying what we learn as we work toward expanding the program nationwide to every critical access hospital by Jan. 1, 2027.
Payment is only one part of the access challenge. We also need to reduce administrative work that disproportionately affects rural providers. Prior authorization serves an important purpose, helping ensure patients are receiving care that’s safe and consistent with widely accepted clinical guidelines. However, to give rural providers greater flexibility to focus on patient care rather than administrative processes, we’re exempting these 1,500 rural hospitals from most of the prior authorizations that exist today while maintaining safeguards for quality and patient safety through ongoing reviews.
UnitedHealthcare will provide outreach, technical assistance and operational support to help eligible providers transition into the program.
We also need to make care easier to reach. Long drives and long wait times delay treatment, worsen conditions and increase costs. UnitedHealthcare is working with leading health systems on hub-and-spoke care models that connect rural hospitals, clinics and community resources with virtual care, home-based care, data sharing, analytics and clinical decision-support tools more commonly available in urban settings.
The initial focus areas include diabetes, postsurgical care and maternity care areas where earlier support and better coordination can reduce unnecessary travel and help patients and families stay connected to care closer to home.
In Decatur County, the challenge is measured in miles, missed appointments and delayed care. The same is true in rural communities across America, where access often depends on whether care is close enough, timely enough and simple enough to use. The work ahead is to help close those gaps, by supporting local partnerships, helping rural hospitals stay stable and making care easier to reach. UnitedHealthcare is committed to doing its part.
• Bobby Hunter is Chief Executive Officer for Government Programs at UnitedHealthcare.
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