The ACR continues to respond to requests for information (RFIs) as states across the country seek guidance on applications for the Rural Health Transformation Program. The ACR has offered expert guidance on policies designed to improve healthcare delivery, strengthen the workforce and ensure patient access to rheumatology care.
To date, the ACR has submitted detailed RFI responses in Alaska, Arizona, Arkansas, Connecticut, Maine, Massachusetts, Michigan, Missouri, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Virginia and Washington, highlighting solutions to address the growing challenges facing patients with rheumatic diseases.
Addressing Workforce Shortages in Rural & Underserved Areas
Each response has underscored the nation’s severe shortage of rheumatology professionals—particularly in rural regions and in pediatrics. Eight states currently lack a single pediatric rheumatologist.
Such workforce gaps severely limit access to care and delay diagnoses. The ACR urges states to prioritize rheumatology workforce expansion as part of its rural health redesign efforts. Recommendations include:
- Loan forgiveness and tax credits for cognitive specialists who commit to rural practice for at least five years;
- Expanded pediatric specialty repayment programs to recruit the next generation of pediatric rheumatologists; and
- Partnerships between universities and community practices to train fellows in rural settings.
In addition to these recommendations, the ACR’s RFI submissions emphasized that addressing the workforce shortage is essential to preventing long-term disability and reducing avoidable healthcare costs.
Building Smarter, Patient-Centered Care Models
Some state RFIs sought input on value-based care models and payment reform. The ACR encourages states to design specialty-specific alternative payment models (APMs) that measure value by disease control, functional improvement and reduced hospitalizations—not by short-term cost savings.
Here, the ACR’s recommendations include:
- Piloting specialty-focused APMs within Medicaid and state-regulated plans;
- Technical assistance and data infrastructure grants for small or rural practices;
- Funding the further integration of telehealth and remote monitoring into chronic disease management; and
- Developing and funding shared-service models where multiple rural facilities pool resources to sustain access to specialty and post-acute care.
These models, the ACR notes, can both improve outcomes and control costs if designed to account for the unique complexities of autoimmune and musculoskeletal diseases.
Leveraging Data to Improve Quality & Reduce Costs
In every response, the ACR highlighted the importance of data-driven quality improvement through its national registry, the Rheumatology Informatics System for Effectiveness (RISE).
RISE currently supports nearly 1,000 providers in 39 states and enables practices to benchmark performance on 27 quality measures, including six rheumatology-specific measures. The ACR urges states to:
- Incentivize qualified clinical data registry (QCDR) participation through grants or enhanced reimbursement;
- Align value-based programs with specialty registries like RISE; and
- Invest in patient-reported outcome (PRO) measures and tools that connect directly with registries.
These strategies, the ACR argues, help states lower costs, close care gaps and ensure that policy decisions are grounded in real-world clinical data.
Expanding Access Through Telemedicine & Team-Based Care
The ACR has stressed the need for team-based models that empower primary care providers (PCPs) to manage stable, lower-complexity patients while maintaining consultation access to specialists.
The ACR recommends:
- Telementorship programs, such as Project ECHO and the ACR’s Rheumatology Access Expansion (RAE) initiative, to train PCPs and physician extenders;
- Funding for nurse and physician assistant onboarding to rheumatology practices; and
- Reimbursement for specialist consultations that support collaborative care.
These models, the ACR notes, can improve access and continuity of care without sacrificing quality, especially in rural regions.
Looking Ahead
Through these responses, the ACR continues to demonstrate its value as a key stakeholder in shaping evidence-based, patient-focused health policies across the states. By engaging early in the policymaking process, the ACR helps ensure that initiatives intended to transform care—whether through payment reform, workforce investment or affordability programs—truly improve outcomes for people living with rheumatic diseases.
The College will continue to work collaboratively with state officials, provider organizations and patient advocates through the implementation of the Rural Health Transformation Program. Throughout the process, the ACR will pursue policies to improve access to rheumatology care to better meet the needs of patients.
Joseph Cantrell, JD, is the ACR’s director of state affairs and community relations.