Rural Health Reform Initiative

The Rural Health Reform Initiative (RHRI) was formed in 2009 by the Oregon Association of Hospitals and Health Systems to help answer the question: How can the state’s small and rural hospitals stay sustainable and meet the Triple Aim goals of better care, better health and lower cost while maintaining the highest levels of quality care?

Rural hospitals often have more obstacles to overcome than their urban counterparts. These include lower patient volumes and a lack of a balanced source of payer types. This generates insufficient revenue to pay for operating expenses and poses a tremendous challenge.

The RHRI has two primary goals:

  • Sustaining rural hospitals and physician practices: Preserving access to local health care services for rural Oregonians through sustainable state and federal funding for type A/B hospitals and health systems.
  • Preparing for the future: Taking the steps necessary to design and implement new models of care delivery and reimbursement for rural hospitals.

Phase One of RHRI included looking at different reimbursement models for Oregon’s rural hospitals. During the last two years, RHRI’s focus has been to provide Oregon’s rural hospitals with the information and tools they will need to meet the challenges of a changing health care system, namely to identify payment models that are viable and share risk.

RHRI is currently working with the state to develop options for alternative payment models for hospitals that must move off of cost-based reimbursement; and develop a framework to determine financial risk for those hospitals that do move off of cost-based reimbursement by July of this year.

The next phase of RHRI will include delivery reform. This work will focus on meeting the goals of the Triple Aim and partnering with communities on making rural Oregon a healthier place to live. Hospitals must change how they deliver services to communities by partnering with physicians and other health-related entities. Moving forward, RHRI will continue to develop resources to help small and rural hospitals meet the diverse and ever-changing needs of their communities.


  • Build knowledge
  • Technical and research assistance provided through workgroups
  • Performance improvement: creating actionable information and metrics for improvement.
  • Innovation and growth

RHRI Member Resource Library


Katie Harris, MPH
Director of Rural Health and Program Management