The Blueprint outlines what sustainable healthcare services look like in 22 rural regions across the state.
Raleigh, NC – (August 27, 2025) – In 2023, the North Carolina General Assembly charged independent nonprofit, the Rural Healthcare Initiative (RHI), with creating “effective models of sustainable healthcare for North Carolina rural communities.” RHI recently delivered on its promise with the completion of the Rural Healthcare Sustainability Project, a comprehensive analysis of and blueprint for what healthcare services and facilities are sustainable under local market conditions in rural regions across the state of North Carolina.
“The delivery of the blueprint is just one step in the journey to strengthen and preserve healthcare delivery in North Carolina and unlocks the possibility of transforming healthcare in rural communities across the nation,” said RHI co-founder Bob Wilson. “This project represents thoughtful collaboration and consistent engagement from our many partners. I am proud of the value we’ve brought to the state of North Carolina and the way this work will create new opportunities for rural healthcare nationwide.”
To create the blueprint, RHI conducted extensive primary and secondary research, including large-scale data analysis, quantitative surveys and listening sessions with North Carolinians in rural communities, and ongoing collaboration with healthcare leaders throughout the state. The process was designed to obtain a comprehensive view of current rural healthcare utilization and to forecast future healthcare demand. The culmination of these efforts led to the unique and extensive nature of this report—tailored to meet the actual needs of rural patients and communities now in a way that is sustainable in the future.
The blueprint included eight key findings, some of which challenge common assumptions about rural healthcare and point toward more nuanced, sustainable approaches for the future. For example, RHI found that rural counties with the worst health outcomes actually have the highest levels of acute care and ED beds per capita as well as the highest rates of preventable hospitalizations – meaning bigger hospitals and more beds are not in themselves a guarantee of better health. To read more on the report’s findings, click here.
The intentionality behind the research and findings laid the foundation for the output – a statewide blueprint with potential sustainable models for care in each of North Carolina’s 22 rural regions. Each regional model considers local population characteristics, existing resources, and realistic market conditions. Ultimately, the models are designed to match services to community needs by balancing proximity (the most utilized or most urgent services are located where residents can reach them most easily); complexity (more complex services can be found at a reasonable distance, based on regional needs); and stability (healthcare providers have the financial wherewithal to provide the services needed in their community). To read more about the blueprint and regional models, click here.
The delivery of the blueprint coincides with the signing of the One Big Beautiful Bill Act, which includes a new $50 billion Rural Health Transformation Program established to support rural healthcare delivery. Based on the foresight in commissioning the Rural Sustainability Blueprint, North Carolina is uniquely well-positioned to pursue discretionary funding to support the execution of the report.
“We are humbled and honored to have been given the opportunity to complete and share this important project in North Carolina – but we know the work does not stop here,” said Dawn Carter, co-founder of RHI. “We look forward to discussing potential next steps in North Carolina and seeking new opportunities to bring RHI’s unique, data-backed approach to make rural healthcare more accessible and sustainable to other states.”
To read more and/or request the full Rural Healthcare Sustainability Project Report, please visit: https://ruralhealthcareproject.com/.