The collaboration supports states advancing CMS Rural Health Transformation initiatives with technology-enabled implementation, AI-driven virtual primary care, and integrated access to food and community-based services

WASHINGTON, May 12, 2026 /PRNewswire/ — The Collaborative for Healthy Rural America (CHRA) today announced that Instacart has joined the collaborative, expanding its ability to help states address chronic disease and improve health outcomes by integrating access to nutritious food and essential goods into coordinated care delivery models. The addition of Instacart further enhances the collective approach to longitudinal, AI-enabled primary care and community engagement advanced by Deloitte Consulting LLP, Lumeris, Nuna, Teladoc Health, and Unite Us.

The addition of Instacart comes as states begin implementing new Rural Health Transformation (RHT) initiatives with funding from the Centers for Medicare & Medicaid Services (CMS). State teams are pivoting from outlining five year plans to operationalizing and demonstrating near term progress.

“Expanding access to nutritious food is one of the most powerful things we can do to improve health outcomes,” said Sarah Mastrorocco, Vice President and General Manager of Health at Instacart. “Through Instacart Health, we’re working to use delivery of nutritious groceries as a tool to help Americans prevent and manage chronic conditions. By joining CHRA, we have an opportunity to integrate our capabilities into care delivery models further, helping states address the root causes of disease while improving access, engagement, and outcomes in rural communities.”

With approximately $10 billion in first-year RHT funding awarded nationally, states are advancing implementation within defined timelines while strengthening workforce capacity, governance structures, and performance management capabilities required under CMS cooperative agreements. As Year 2 funding decisions are informed by Year 1’s progress, states are focused on demonstrating early implementation while building durable systems designed to be sustained beyond federal funding.

The CHRA was formed to support state-directed implementation of CMS’s RHT program. CHRA brings together private sector experience and proven, interoperable technology to help states move rapidly from planning to execution. By combining advanced analytics, virtual care, interoperable data platforms, and closed-loop referrals for community-based service integration, CHRA enables states to operationalize complex rural health transformation initiatives at scale, reducing the need for each state to build new capabilities from scratch.

CHRA’s founding collaborators include Deloitte, Lumeris, Nuna, Teladoc Health, and Unite Us. The addition of Instacart to the collaborative helps states expand access to nutritious foods and everyday essentials to address chronic disease and related needs. Together, CHRA represents a comprehensive operating model that is intentionally aligned with CMS expectations, reducing the need for health systems to assemble and manage disparate components independently

Built Around State-Identified Challenges

CHRA conducted a detailed review of publicly available state RHT plans to understand the challenges states themselves have identified as most urgent. While needs vary by geography, four themes consistently emerged across plans.

1. Infrastructure Misalignment in Rural Health Systems

States across the country describe a structural mismatch between legacy rural health infrastructure, declining populations, and fee-for-service payment models. The State of Wyoming notes that rural hospitals face “high fixed costs and low patient volume,” while still needing to maintain emergency capacity. Vermont reports that more than half of hospitals operate at a loss due to low volume, workforce shortages, aging infrastructure, and high fixed operating costs. Illinois highlights large inpatient facilities that are rarely fully occupied, undermining financial viability. Across the country, rural health transformation plans converge on the need for alternative payment models, redesigned delivery systems, flexible workforce strategies, and technology-enabled care to create sustainable models of care.

How CHRA can help states:
CHRA supports states in exploring and operationalizing redesigned care delivery models better suited to low volume, high fixed cost environments such as those intended to be addressed by RHT initiatives. At the core of this approach is the transformation of primary care from episodic, site-based care to continuous, coordinated, and population-driven models that better meet the needs of rural communities.

Through interoperable service models, built to complement existing EHR and HIE systems, CHRA has the opportunity to support beneficiary identification, outreach, virtual and in-person care, care coordination, and outcomes tracking. For instance, CHRA member Lumeris, powered by Tom™, enables primary care teams to operate with greater reach and efficiency—proactively managing patient populations, closing care gaps, and extending care beyond traditional settings.

These supports, alongside virtual care delivery through Teladoc Health’s network of providers and Nuna’s AI-native patient engagement mobile app, introduce a more scalable, prevention-oriented primary care model that aligns payment, workforce capacity, and service delivery with population needs while relieving rural facilities of the burden of sustaining underutilized infrastructure on their own.

2. Gaps in Preventive Care Delivery

States report persistent barriers to preventive services. The State of Iowa cites gaps in early detection and prevention. The State of Maine highlights limited capacity for population-level screening and outreach. Workforce shortages, transportation challenges, and infrastructure constraints limit consistent access to preventive care.

How CHRA can help states:
CHRA leverages population data, predictive analytics, and AI-supported outreach to help states identify priority populations and close preventive care gaps. Unite Us’ Self Sufficiency Score establishes a benchmark, connecting rural residents to medical, behavioral, and community support services via an integrated closed-loop referral and payment platform.

Utilizing the Tom™ platform, CHRA extends prevention beyond episodic care by continuously monitoring patient needs, proactively identifying rising risks, and engaging individuals between visits through timely, personalized outreach. By orchestrating interventions across care teams and community resources, Tom helps ensure preventive actions happen earlier, before conditions escalate, enabling more consistent care, improving health outcomes, and reducing downstream costs associated with avoidable complications.

3. High Burden of Chronic Disease

Chronic disease management is a central concern across state plans. The State of Nevada identifies heart disease, cancer, and chronic lower respiratory disease as leading causes of death. The State of New Jersey emphasizes the need to modernize identification and access to treatment. The State of New Mexico calls for expanded specialty access and evidence-based models, while the Commonwealth of Virginia highlights access to nutrition as a root cause of poor health.

How CHRA can help states:
CHRA helps states more effectively prevent and slow chronic disease by enabling continuous, data-driven management of patient populations. Tom identifies rising-risk individuals, closes care gaps, and proactively engages patients between visits—supporting adherence, surfacing unmet needs, and coordinating timely interventions across care teams. Through CHRA, partners like Teladoc Health that integrate Instacart Health tools, will extend this model by enabling interventions that deliver personalized, clinically aligned nutrition support directly to patients, addressing key drivers of chronic conditions. Using Instacart Health Fresh Funds, stipends for nutritious food, and Care Carts, which allow organizations to order groceries on behalf of others, partners can build programs that address the needs of rural communities. Together, this approach tackles root causes, improves long-term disease management, and reduces avoidable emergency utilization.

4. Workforce Shortages and Provider Access

States consistently cite challenges with recruiting and retaining providers. The State of Ohio reports service lines at risk due to workforce shortages. The State of Nevada ranks near the bottom nationally in physician availability. The State of Georgia reports that most counties are facing a shortage of OBGYNs or pediatricians. Nationally, more than 190 rural hospitals have closed since 2005, with hundreds more at risk, according to the North Carolina Rural Health Research Program.

How CHRA can help states:
CHRA supports Primary Care as a Service (PCaaS) models using solutions like Lumeris’ Tom™ platform, which provides the backbone technology that extends provider capacity through AI-assisted triage, virtual care, and team-based workflows. Deloitte provides cross-platform interoperability and data integration services, grounded in decades of experience supporting states. And Teladoc Health has the largest nationwide network of virtual care providers including licensed clinicians, therapists, and health coaches, and can help patients access care quickly amid shortages or barriers to care. These approaches aim to expand access while keeping local providers at the center of care and reducing burnout. 

Looking Ahead

States will report Year 1 progress to CMS in October 2026. Those that demonstrate measurable improvements in access, utilization, and sustainability will be positioned for continued funding. CHRA’s role is to support states in achieving early momentum while building sustainable rural health systems.

About CHRA

The Collaborative for Healthy Rural America (CHRA) is a coalition of organizations supporting state led rural health transformation initiatives through coordinated, implementation focused support across care delivery, data, community integration, and sustainability.

Learn more: https://healthyruralamerica.org

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SOURCE Lumeris