RUPRI Center for Rural Health Policy Analysis

Current Projects

• Accountable Care Organization (ACO) Market Penetration in Rural Counties
  This project will produce a broad snapshot of the rural Accountable Care Organization (ACO) landscape focusing on the number of assigned beneficiaries, providers, and governance. The project will explore reasons for new rural ACOs, rural ACOs that continue after their initial agreement, and formation of new rural ACOs.
  Topic: Medicare
  
• Affordable Care Act Marketplace Enrollment Shifts in Rural Areas: Implications of Shift to Bronze Plans
  In this project RUPRI will explore the shifts in the Affordable Care Act marketplace in 2026 and consider the implications of these changes for rural people, places and providers.
  Topics: Healthcare access, Private health insurance, Uninsured and underinsured
  
• Causal Effect of Nursing Home Closure on Resident Outcomes in Rural Areas
  We will evaluate the causal impact of nursing home closure on two key outcomes: distance to the transitioned nursing home, and resident physical and mental health outcomes. We will compare the effect of closures on outcomes for rural and urban areas using resident-level data from 2010-2019 and advanced difference-in-differences regression methods.
  Topics: Aging, Health services, Healthcare access, Long-term care, Post-acute care, Quality
  
• Changes in Rural Health Insurance Coverage, 2019-2024
  This project uses secondary data sources to characterize changes in health insurance coverage during 2019-2024 for rural and urban people. The analysis will focus on changes associated with demographic, economic (particularly employment), and geographic characteristics, and will describe how exogenous changes (e.g., the economy, pandemic) as well as changes in federal policies impacted coverage.
  Topics: Healthcare access, Healthcare financing, Medicaid and CHIP, Medicare, Private health insurance, Rural statistics and demographics, Social determinants of health, Uninsured and underinsured, Workforce
  
• Changing Dynamics in Medicare Advantage (MA): Shift From General MA to Special Needs Plans?
  Understanding the rural effects of shifting priorities within Medicare Advantage (MA) organizations and general economic trends on rural access to MA plans.
  Topics: Medicare, Medicare Advantage (MA)
  
• Payer Mix of Rural Health Clinics and Federally Qualified Health Centers
  This project will assess the payer mix of the more than 5,000 Rural Health Clinics and 1,400 Federally Qualified Health Center grantees throughout the country. The analysis will include assessing trends over time and across types and ownership for RHCs and across regions for FQHCs.
  Topics: Federally Qualified Health Centers (FQHCs), Medicaid and CHIP, Medicare, Private health insurance, Rural Health Clinics (RHCs), Uninsured and underinsured
  
• Retention and Expansion of Hospital Services Offered by Rural Hospitals After Enrollment in 340B
  The 340B Federal program is designed to provide hospitals with financial stability through provision of drug discounts which may, in turn, allow hospitals to maintain or expand their service line offerings. Using a series of event study analyses over an 11-year period, this study will examine the impact of enrollment in the 340B program on discontinuing services, maintaining services, and adding new services in eligible rural hospitals.
  Topics: Critical Access Hospitals (CAHs), Health services, Hospitals and clinics, Pharmacy and prescription drugs
  
• Rural-Urban Differences in Prevalence and Predictors of Telehealth Use
  The project will examine rural-urban differences in the use of telehealth as well as differences in reasons for not using telehealth among the adult population as well as specifically for those with chronic conditions.
  Topics: Chronic diseases and conditions, Health information technology, Healthcare access, Telehealth
  
• The Changing Landscape of Medicare Advantage in Rural America
  The recent rapid growth in Medicare Advantage (MA) enrollment, particularly in counties with very little previous activity, has made MA a "hot issue" in rural health policy. This project will provide deeper knowledge of the MA marketplace including the firms offering MA plans and the beneficiaries who are enrolling.
  Topics: Healthcare financing, Medicare, Medicare Advantage (MA)
  
• Variation in Wages and Employment of Administrative Staff in Rural Hospitals and Nursing Homes
  This study examines employment levels and wages for administrative staff such as dietary, housekeeping, and maintenance workers across healthcare and non-healthcare settings in rural and urban areas.
  Topics: Hospitals and clinics, Long-term care, Post-acute care, Rural statistics and demographics, Workforce