In rural towns across the country, hospitals are closing, care providers are stretched thin, finance teams are stressed, and patients often travel hours to see a doctor. Although not all rural healthcare providers experience these challenges equally, the fact remains that low patient volumes, high compliance burdens, and dwindling inpatient revenue streams have resulted in approximately 112 rural hospital closures since 2005.
The Rural Health Transformation Program (RHT Program) gives states a rare chance to stabilize local providers today while designing stronger, more resilient systems for tomorrow. The Centers for Medicare & Medicaid Services (CMS) is leading the way, equipping states with funding and guidance to reimagine how care is delivered.
Since 2021, we’ve partnered with CMS on multiple projects to modernize and design technology that serves health providers and people who rely on their services. Building on that past work with CMS and other health-focused agencies, Coforma is poised to build custom and commercially available off-the-shelf (COTS) solutions designed to meet communities where they are, address their unique challenges, and keep care closer to home.
A Successful Partnership: Building State-Facing Technology for CMS
When CMS set out to improve Medicaid and CHIP data reporting, they needed tools that could scale across 50 states while making life easier for state administrators. As the prime contractor for the Medicaid Data Collection Tools (MDCT) suite, Coforma helped CMS accomplish that goal, modernizing three existing applications and building a new one designed for today’s data demands.
Our work on this project received external accolades, including a Product Delivery Review (PDR) Emmy for Best Tool in 2024 and a Center for Medicaid and CHIP Services (CMCS) Honor Award.
We grounded our approach in a thorough investigation of real-world experiences. Our team conducted 40 research sessions across 18 states, unearthing insights that shaped digital form flows and reporting templates.
Researchers collected and synthesized insights from qualitative interviews, a customer experience survey, and evaluative testing usability studies. Our product design team used that data and a detailed content audit to iterate on designs that met business and user needs while conforming to established design system patterns, reporting requirements, and delivery constraints.
The data and research we synthesized and presented to CMS stakeholders enabled them to make informed decisions about the recommendations our team provided.
We used human-centered design (HCD) to simplify complex data entry while ensuring states met their reporting obligations. On the back end, we rewrote legacy infrastructure for systems like the CHIP Annual Reporting Template System (CARTS) to improve performance, streamline updates, and prepare CMS for future growth.
We also analyzed existing CMS applications and used our observations to inform our approaches to modernizing those applications and building a new tool to achieve the desired functionality. We took inventory of content structures and components from CMS’s design system, conducted a heuristic analysis, and performed accessibility testing to discover items we wanted to replicate going forward, as well as issues to fix.
Iteratively building and evaluating prototypes let us establish interaction patterns and content structures. This knowledge allowed our team to translate data structures defined in Excel into a digital form flow that would facilitate the entry, validation, review, and submission of reporting data.
Accessibility and compliance were priorities at every step. We built custom PDF outputs to minimize manual remediation and achieved full Section 508 compliance, improving usability for administrators using assistive technology.
This combination of human-centered insights and engineering excellence is exactly what the RHT Program calls for. The RHT Program asks states to design technology-driven solutions that improve access, strengthen partnerships, and plan for financial sustainability. Our experience modernizing CMS’s state-facing applications means we’re ready to help states translate federal funding into solutions that fit each state’s unique healthcare landscape.
Read more about our work on MDCT in our case study.
A Human-Centered Approach to Rural Health Technology Investments
For rural communities, access to care is largely influenced by circumstance: reliable transportation, broadband access, staffing shortages, and overextended facilities all affect whether care teams can deliver timely, high-quality services.
When the Department of Health and Human Services (HHS) and the Indian Health Service (IHS) needed to understand the systemic challenges facing American Indian and Alaska Native communities, Coforma led a human-centered research and design effort that informed future health IT modernization.
Our team conducted nearly 150 interviews and workshops with patients, clinicians, administrators, and subject matter experts across the tribal health system. We turned these insights into seven narrative stories, 14 archetypes, and 200 use cases, supported by service blueprints and journey maps, that captured patient experiences, provider pain points, and operational hurdles.
Our human-centered design approach provided insights into the technology needs and goals of American Indian and Alaska Native healthcare facilities IHS then used to inform its future investments in infrastructure and software.
Our work with IHS shows how we partner with providers to gain real-world perspectives and translate them into actionable system improvements. By bringing empathy for patients and an understanding of provider operations, we’ve helped rural tribal hospitals and clinics do what they do best: care for their communities.
Read more about our work with IHS in our case study.
Building Trust Through Patient-Centered Digital Tools
When CMS needed to help the public understand their new protections under the No Surprises Act, they turned to Coforma to design a public-facing digital experience that was clear, inclusive, and actionable.
To satisfy the Act’s requirements, CMS needed to quickly update its systems to receive, store, process, adjudicate, and present information related to cases, complaints, costs, and more. We helped CMS achieve these complex requirements by applying human-centered design (HCD) research methodologies, evaluative research techniques, content design and plain language best practices, bilingual translation, product and systems design, usability testing, and cross-functional development to bridge user needs with the legislation’s unique requirements.
The result was www.cms.gov/medical-bill-rights—a mobile-first, bilingual site that reduced complexity for users while giving CMS a maintainable, future-ready platform.
Just as we helped CMS empower patients with clear rights and action steps, we can work with states to build digital tools that help rural residents navigate available services, understand new care models, and engage with local providers.
By designing solutions that arc across policy, people, and real-world practicalities, we help strengthen public trust in health systems—because the ones we build work. When rural residents can easily find care, understand their options, and feel supported by their providers, health outcomes improve, and communities grow stronger.
Read more about our work on Medical Bill Rights in our case study.
Tailoring Solutions to Meet Rural Health Needs in Your State
The RHT Program offers an extraordinary opportunity to reshape rural healthcare. But dollars alone won’t fix the myriad problems rural healthcare providers and their communities face. Coforma can help. Below is a list of RHT Program goals or directed fund uses and examples of how Coforma could work with you to meet them.
RHT Program Goal / Use of Funds
Coforma's Related Experience
Tech Innovation: Deploy secure, scalable platforms and emerging technologies to improve care delivery and data security.
We rebuilt CARTS’ backend infrastructure using modern, scalable architecture and ensured Section 508 compliance. Our engineering teams can help states deploy secure, future-ready platforms to support telehealth, remote monitoring, and data interoperability.
Consumer-Facing Technology Solutions: Create tools that connect patients with care and information.
On Medical Bill Rights, we launched a bilingual, mobile-first site that empowers patients to understand and act on their rights. We can build similar portals and tools to help rural residents find care, understand benefits, and engage with providers.
Evidence-Based Interventions: Use research and measurable outcomes to guide solutions.
Our 40+ research sessions across 18 states (MDCT) and 150+ interviews for IHS produced insights that drove design decisions and measurable improvements. We bring the same rigor to help states target high-impact interventions.
Right-Sizing Rural Health Systems: Identify gaps and plan investments across the care continuum.
Our IHS service blueprints and journey maps revealed where care delivery broke down and helped leaders prioritize investments. We can help states map their systems to stabilize access points and plan for long-term sustainability.
Training & Technical Assistance: Equip states to sustain and scale new systems.
On MDCT, We provided documentation, design system integration, and playbooks so CMS teams could independently manage and expand tools post-launch. We can do the same for state teams implementing RHTP-funded systems.
Behavioral Health & Substance Use Services: Expand access to treatment and support services.
Our trauma-informed research approach centers the lived experiences of vulnerable populations, helping agencies design services that are accessible, culturally competent, and reduce stigma around treatment.
Every community is different, and so are our solutions. Our approach is tailored, never templated. We work side by side with you to design custom tools and integrate commercially available off-the-shelf (COTS) solutions that fit your state’s program, people, and vision for your state’s future.
Let’s work together to transform rural healthcare from an overburdened system to one that's able to easily meet the needs of every person in your state, regardless of where they live.
Author Bio
Brennan Schloendorn is the Health Programs Lead for Coforma. Prior to joining our team, he served as a Product Lead at the Centers for Medicare and Medicaid Services, shaping the vision and direction for the modernization of the Medicaid Drug Programs (MDP) system. He is passionate about building human-centered technology that simplifies complex problems and supports better health outcomes for everyone.