Welcome to Primary Care for the 21st century

That headline number sounds like a rescue plan for rural America. It is not. Spread across five years and 66 million rural residents, the Rural Health Transformation Program (RHT) amounts to less than $151 per person, per year, not enough to move the needle, let alone transform a system under strain. If this funding is diluted across business-as-usual programs, it will disappear without a trace and accomplish nothing. 

Real transformation will only occur if RHT dollars are concentrated in bold, measurable care pilot programs that deliver integrated, personalized support, use technology and AI to extend scarce clinical capacity, and rebuild the most essential asset in healthcare: a trusted relationship between patient and clinician.

A four-year-old jolts awake with a fever and a throbbing earache and pads into her parents’ room. Her mother knows the options: wait until morning and hope it does not get worse, or start calculating distance, time, and risk in the dark.

Instead, she carries her daughter to the kitchen, opens an FDA-cleared, medical-grade remote diagnostic kit, and within minutes is connected to a physician assistant they both recognize and trust. Guided step-by-step, she uses the device as an otoscope to examine her child’s ear, as if they were in the clinic. The assessment is clear. Treatment is immediate. A prescription is sent to the nearest pharmacy before sunrise.

This is what Rural Health Transformation (RHT) funding is for: turning geography into a detail, not a diagnosis.

Metabolic Syndrome has a nickname: the Killer Cocktail. High blood pressure. High blood sugar. Abnormal cholesterol. Excess waistline. Four warning lights on the dashboard, flashing at the same time. More over 33% of U.S. adults are living with this condition, and the condition is more common in rural communities and older age groups. The danger is cumulative, quiet, and relentless until the day it is not.

You are one of them. Your phone rings.

“Hello, this is Pat from Dr. Smith’s office. How are you doing?”

“I’m fine.”

“I’m calling because your A1C has been above the target you set with Dr. Smith for the last four days. What do you think is driving it?”

You pause, frustrated. “I do not understand. I have never been more careful. I am watching my diet. I am walking more. And it just keeps climbing.”

“Then we are not waiting for the next appointment,” Pat says. “I’m scheduling a blood draw at the county health center today so we can find out what is happening and adjust your plan before this becomes an emergency.”

That is what Rural Health Transformation (RHT) funding can buy when it is used correctly: proactive primary care that moves first, powered by bidirectional digital therapeutics and remote patient monitoring, catching deterioration early and keeping people out of ambulances, emergency rooms, and avoidable hospital beds.

Under H.R. 1 (119th Congress) the One Big Beautiful Bill, Go Direct Care is working with a number of States to deploy an  advanced preventive primary care and digital therapeutics model in rural and medically underserved communities. The model has three tightly integrated components:

1. Go Direct Care’s advanced preventive primary care practice with a detailed staffing, operational, and actuarial framework for a 4,000 adult patient panels in rural areas of America.
2. A virtual proactive primary care solution tailored to rural areas that uses medical grade remote diagnostics, remote patient monitoring, and bidirectional digital therapeutics to deliver care into homes, farms, and state offices.
3. A research spine that connects the University of Illinois supercomputing and artificial intelligence resources and the Carle Illinois College of Medicine with other participating State’s and their designated university research partners to Medicare, Medicaid, commercial claims and electronic health records, turning the care model into a learning health system for the benefit of all rural residents.

The objective is to improve access, outcomes, and health equity for rural residents while reducing total medical expense for payers and the state.

Rural Illinois communities face a persistent combination of limited local primary care capacity, growing chronic disease burden, and inadequate support for adherence and self-management. Key facts include:

• Less than 25 percent of Americans have a personal relationship with a primary care physician, with even lower access in many rural areas.
• Prescription drugs generally need to be taken at least 80 percent of the time to be effective, yet average adherence is about 43 percent.
• Compliance with the broader prescription drug care plan averages roughly 38 percent.
• Standard fee for service payment does not reliably fund remote monitoring, behavioral support, or care navigation, which are crucial for rural patients with transportation and resource barriers.

These gaps translate into higher rates of avoidable hospitalization, uncontrolled chronic disease, and preventable complications for rural residents and contribute to widening disparities in health outcomes across geography and income.

1. Go Direct Care’s advanced preventive primary care clinical core

• Serves a panel of 4,000 adult patients with high prevalence of cardiometabolic, respiratory, and behavioral health conditions in Champaign Urbana.
• Combines in-person care, extended hours, and twenty-four-hour telemedicine with remote monitoring and integrated behavioral health.
• · Uses a multidisciplinary team including physicians, advanced practice clinicians, nurses, behavioral health clinicians, pharmacists, care navigators, data and informatics staff, a remote monitoring technician, and an operations lead.
• · At central assumptions, reduces total medical expense by about 21 percent relative to standard care while operating at an all in cost of 75 dollars per member per month.

2. Virtual proactive primary care for rural communities

• Places medical grade remote diagnostic equipment in rural offices and community sites operated by an attendant with about one day of training.
• Delivers primary care, urgent evaluation, and chronic disease management remotely from regional hubs using video visits combined with in-room diagnostics.
• Adds remote patient monitoring and bidirectional digital therapeutics to maintain contact between visits and identify early signs of deterioration.
• Is organized around eight pillars: physician AI access to standards of care, medical grade remote diagnostics, remote patient monitoring, bidirectional digital therapeutics, virtual primary care, electronic health record integration, AI assisted health equity research, and Smarter Search for cost effective in network referrals.

3. Supercomputing and AI research partnership

• Uses University of Illinois Urbana Champaign supercomputing resources and secure health data platforms to analyze Medicare, Medicaid, and commercial claims with electronic health records and digital therapeutics data.
• Engages Carle Illinois College of Medicine and similar resources from participating states as clinical and research partners for engineering-based medicine and implementation science.
• Transforms Go Direct Care from a static scenario model into a learning health system that continuously refines care pathways and savings estimates for Illinois populations.

The Go Direct Care model provides a quantitatively defined return on investment for payers and the State of Illinois.

• Baseline total medical expense under standard care is 5,800 dollars per patient per year, or 23.2 million dollars per year for a 4,000-patient panel.
• Go Direct Care’s total medical expense at central assumptions is 4,582 dollars per patient per year, or 18.33 million dollars for the panel, corresponding to savings of 1,218 dollars per patient per year and about 4.87 million dollars for the panel.
• All in Go Direct Care’s operating cost is 900 dollars per patient per year, or 3.6 million dollars for the panel, leaving positive net savings in the midpoint scenario.
• Plan savings compared with uncovered model cost are strong: approximately 1,026 dollars in savings versus 225 dollars in uncovered cost for commercial plans, 1,035 dollars versus 135 dollars for Medicare, and 1,181 dollars versus 225 dollars for Medicaid.
• These relationships imply savings to uncovered cost ratios of about 4.6 to 1 for commercial coverage, 7.7 to 1 for Medicare, and 5.3 to 1 for Medicaid.

In practical terms, a modest transformation per member per month payment that covers the unfunded portion of the model cost still leaves substantial net savings for plans and the state.

• For each participating state, the program would:
• Improve access for rural residents through twenty-four-hour virtual primary care supported by medical grade diagnostics and continuous remote monitoring.
• Reduce avoidable emergency department visits and hospitalizations through earlier intervention and better medication adherence.
• Generate meaningful reductions in total medical expense, particularly for Medicaid and dual eligible populations.
• Improve quality of life for patients through better symptom control, integrated behavioral health, reduced travel burden, and stronger relationships with primary care teams.
• Provide a data driven framework for addressing health equity using AI assisted analysis of electronic health records and claims to identify and close gaps in outcomes.

For federal partners such as CMS, the program would:

• Produce high quality evidence on advanced primary care, digital therapeutics, remote monitoring, and hybrid telemedicine for Medicare and Medicaid populations.
• Offer a scalable model for value based primary care that can be replicated across the country.

Recommended actions under the One Big Beautiful Bill are:

• Authorize a rural health transformation per member per month payment that covers the uncovered portion of the Go Direct Care’s model cost for Medicaid, state employee health plans, and other participating lines of business.
• Fund deployment of medical grade remote diagnostic equipment in selected rural state offices and partner community facilities, with training for local attendants.
• Formalize a statewide research and evaluation partnership among the University of Illinois, the National Center for Supercomputing Applications, the Carle Illinois College of Medicine, Carle Health, and 360 to operate the learning health system spine for the program.
• Require transparent reporting on access, utilization, total medical expense, quality, and equity metrics, with results used to refine benefit designs and care pathways over time.

Rural residents continue to experience avoidable morbidity and financial stress from an underperforming system, while structural forces in national healthcare markets make it unlikely that competition alone will deliver affordable care. At the same time, the unique assets of the University of Illinois in supercomputing and AI capabilities and the Carle Illinois College of Medicine can be applied to research all aspects of care and cost.

 The One Big Beautiful Bill is not just legislation. Done right, it is a once-in-a-generation operating mandate. By working with your state to align and deploy these assets with discipline, we can build an advanced, proactive primary care model that finds risk early, intervenes fast, and proves outcomes at scale. This is how you move from incremental reform to measurable transformation: research-grounded, digitally enabled, and fiscally responsible care that can withstand scrutiny, earn trust, and stand as a national exemplar. 

Please email us to start your State's RHT dialogue information@360smartercare.com 

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