From 2003 to 2025, 146 rural hospitals closed or stopped providing the type of general, acute-care, inpatient services which we view as the core service of hospitals. And most of that is because these rural hospitals are hemorrhaging money, especially for Medicaid patients with whom most rural hospitals lose money.
And this rural health crisis extends beyond hospital services: whether it is lack of behavioral health services (where more than half of rural counties lack a single psychiatrist or psychologist), lack of primary care physicians (again, with 65% of rural areas with a shortage of primary care physicians), and more than 22,000 preventable early deaths amongst rural residents because of that lack in available care.
Luckily, this summer’s One Big Beautiful Bill Act (H.R. 1) provides a $50 billion investment fund in rural health care through the Rural Health Transformation Program (IRHTP) where every State will receive at least $100 million per year over the next five years, and potentially much more. One of the key programs within the RHTP include an initiative to “…foster and strengthen local and regional strategic partnerships between rural hospitals and other health care providers to promote measurable quality improvement, increase financial stability,…and share best practices in care delivery.”
Likely to capitalize on this once in a decade opportunity, Dr. Mehmet Oz (the current Administrator of the Center for Medicare and Medicaid Services (CMS)) has brought on Dan Brillman to lead the Center for Medicaid and Children’s Health Insurance Program (CHIP) Services; and Dan happens to know how to optimize this opportunity as the co-founder of Unite Us, a tech company transforming rural health outcomes.
The National Defense Committee believes Dan Brillman is exactly the type of executive CMS needs to help reform rural health care delivery systems, and believe it’s especially important someone like Dan Brillman lead this effort for rural veteran health care delivery; by integrating community-based resources to supplement health care delivery, using predictive analytics to analyze trends in community health , and taking the same care coordination systems used to support veterans and applying them across all health and human services, Dan Brillman helped lead Unite Us to reduce health care costs and seamlessly integrate whole patient health.
Unite Us’ experience, especially with rural health care delivery improvements, shows us what a new coordinated system can deliver better results for the entire health care delivery system, and especially for veterans, who live disproportionately in rural areas, are generally older and suffer more complex medical conditions than their non-veteran rural neighbors, and are much more likely to suffer inadequate access to health care.
Unite Us’ co-founders Brillman and Taylor Justice are both veterans who saw firsthand the unique veteran challenges found in getting assistance upon their return to civilian life, including a fragmented health and delivery system. Unite Us found its beginnings in assisting the veteran and military population but then has since expanded to serve many, many others, seeing success in states like Missouri, Virginia, and North Carolina where they built digital infrastructures to overcome physical distance issues. Most importantly for integrating Veterans Health Administration and Medicaid medical services, the Unite Us platform has made 295,000 referrals for more than 112,000 military-affiliated individuals.
Brillman's appointment is another positive step for improving veteran health care delivery during the Trump Administration, and underscores how the private sector can supplement government health care programs without replacing them, contrary to the specious argument that any integration of private sector providers will lead to the privatization of veteran health care.
Now is the time to tap the private sector to reform and integrate health care programs with government services, and let's reform Medicaid as well, especially for rural veterans.
Captain Bob “Shoebob” Carey, US Navy (Ret) is Executive Director of the National Defense Committee, a veterans organization dedicated to military and veterans civil and legal rights. He previously served as Executive Vice President, Advocacy and Strategy for The Independence Fund, a veterans organization serving catastrophically disabled veterans, their caregivers and their families, and a member of the Senior Executive Service of both the Departments of Energy and Defense, and veterans affairs advisor to two U.S. Senators.
