Shao-Chee Sim | EHF
Jana Eubank | TACHC
John Henderson | TORCH
Texas has a once-in-a-generation opportunity to transform rural health care. Through the federal Rural Health Transformation Program, the Texas Health and Human Services Commission (HHSC) is implementing Rural Texas Strong, a multi-year effort to strengthen rural health access, improve outcomes, advance technology adoption, support workforce development, and improve the long-term sustainability of rural providers.
As HHSC begins investing in rural transformation, one policy question deserves special attention: What is the most effective way to strengthen rural health systems: funding individual provider-payer partnerships one organization at a time, or investing in shared infrastructure that can support entire networks of providers simultaneously?
Two recent evaluations funded by the Episcopal Health Foundation, one focused on the Texas Association of Community Health Centers’ (TACHCH) My Texas My Health clinically integrated network and the other on the Texas Organization of Rural and Community Hospitals (TORCH) Clinically Integrated Network, suggest a compelling answer: clinically integrated networks, or CINs, may be one of the strongest vehicles Texas has for turning Rural Texas Strong into lasting rural health infrastructure.
The central argument is simple: instead of building multiple separate solutions, public investment can support one shared platform that helps dozens of rural and safety-net providers access data, quality management and improvement support, care management tools, technical assistance, and value-based contracting expertise.
EHF Helped Build the Foundation Before Rural Texas Strong Existed
Years ago, EHF recognized that rural hospitals, community health centers, and other safety-net providers could not thrive by themselves in an increasingly value-based health care environment. These providers lacked the scale, data systems, analytic capacity, care management resources, and contracting expertise needed to participate successfully in alternative payment models (APMs). Rather than funding individual provider projects, EHF made strategic investments to help create and support a statewide CIN infrastructure.
Over the years, EHF has invested more than $2 million in feasibility planning, grants, and evaluation support for the TACHC and TORCH CIN efforts. Those investments helped launch and develop My Texas My Health, a statewide CIN established by TACHC to support federally qualified health centers, and helped create the TORCH CIN as it brought together independent rural hospitals and affiliated rural health clinics to improve readiness for value-based payment arrangements and strengthen rural provider sustainability.
Together, these investments created some of the first Texas-specific evidence on how CINs function in practice and what types of infrastructure rural providers need to succeed in value-based care. As Texas implements the Rural Texas Strong plan, there is real-world, Texas-based experience with operating large-scale provider collaboratives that have already tested approaches to data sharing, quality improvement, workforce support, and value-based contracting.
Why CINs: A Better Public Investment Than One-Off Provider-Payer Arrangements
Texas has traditionally pursued value-based care through contracts between individual providers and managed care organizations. These partnerships can generate local successes, but they often require each provider to independently develop data systems, quality reporting processes, care management capabilities, and payer expertise. This approach can create duplication, inefficiency, and uneven performance. One provider may succeed, while another nearby provider is left to start from scratch. In rural communities, where capacity is already limited, that kind of fragmentation can slow system-wide transformation.
CINs offer a different approach. Instead of building fifty separate solutions, public investment can support one shared platform serving dozens of providers and hundreds of thousands of patients. CINs can provide shared data analytics, population health infrastructure, quality management and improvement tools, care management resources, training, technical assistance, value-based contracting expertise, and peer-learning networks.
From a public policy perspective, this creates a multiplier effect. Funding an individual provider-MCO partnership can improve one organization. Funding a CIN can improve an entire ecosystem. Supporting an individual provider-MCO arrangement is similar to helping one business purchase equipment. Supporting a CIN is more like building roads, broadband networks, or water systems that benefit entire communities.
About the Two Statewide CINs
My Texas My Health: A Statewide Platform for FQHC Transformation
My Texas My Health rapidly established itself as a statewide infrastructure platform for Texas health centers. The network grew to 62 participating health centers, representing approximately 78 percent of Texas FQHCs and covering roughly one million patients. The CIN also established a Medicare accountable care organization (ACO), launched Medicaid value-based contracts with UnitedHealthcare and Aetna, implemented a statewide population health and analytics platform, and helped align performance reporting requirements across multiple payers.
Participating health centers consistently highlighted the value of shared analytics, technical assistance, data integration support, and collective negotiating power. For many smaller or rural health centers, these capabilities would be difficult to build alone.
TORCH CIN: Helping Rural Hospitals Prepare for Value-Based Care
The TORCH CIN network includes 46 participating rural hospitals, providing members with training, technical assistance, shared learning opportunities, value-based care expertise, contracting support, and a platform for rural advocacy and collaboration.
What the Evaluations Found
Although the TACHC and TORCH CINs serve different provider populations, both evaluations reached a similar conclusion: rural providers cannot successfully transform care alone.
The evaluations consistently identified several drivers for successful CINs, including shared data infrastructure, technical assistance and training, quality measurement and performance improvement support, peer learning and collaboration, collective contracting expertise, strong governance, trusted leadership, and economies of scale that reduce costs for participating providers. Four notable evaluation themes include:
- CINs are not just planning vehicles. They help safety-net providers move into real APM contracts and arrangements by giving rural hospitals and health centers the shared infrastructure needed to reach the contracting table, align around common measures, and build the internal systems required to perform under value-based payment.
- CINs create a practical pathway for providers to move into value-based payment without requiring each center to negotiate, build data systems, and manage contract performance alone.
- CINs support the data infrastructure. One of the evaluation’s strongest findings was that rural hospitals need better access to timely, actionable data. The report recommended further investment in shared data infrastructure and analytics capacity to help rural providers succeed in future APMs.
- CIN can prepare providers to take on more risk. Many rural hospitals remain reluctant to accept downside risk because they operate with low patient volumes, thin margins, limited analytic capacity, and little room for financial volatility. CINs can help providers move gradually, from readiness and pay-for-performance arrangements toward shared savings and more advanced risk-based models only when the data, governance, reserves, and care management infrastructure are in place.
Why CINs Matter for Rural Texas Strong
Rural Texas Strong identifies several priorities, and the learnings from EHF’s CIN evaluations and investments suggest that these goals are interconnected and that CINs can help advance them. For example, Driver 2 of Rural Texas Strong, Rural Texas Patients in the Driver’s Seat, appears at first to focus primarily on technology such as patient portals and information exchange tools. Both evaluations suggest that effective patient engagement depends on a broader infrastructure: before patients can access useful information, schedule appointments, manage chronic conditions, or engage digitally with providers, health care organizations must first have reliable data systems, integrated reporting capabilities, population health tools, care management workflows, and staff trained to use information effectively. In that sense, CINs function as the engine behind many of the patient-facing technologies that Rural Texas Strong hopes to expand.
Here is a detailed description of how CINs can advance the priorities of Rural Texas Strong:
CINs Make Value-Based Payment More Practical
CINs help make value-based payment more practical for rural and safety-net providers. HHSC’s value-based care strategy asks Medicaid Managed Care Organizations to move away from paying only for volume and toward payment models tied to quality, outcomes, efficiency, and accountability. The evaluations of My Texas My Health and the TORCH CIN show why network-level infrastructure is critical: providers need data, care management capacity, quality management and improvement support, attribution and reporting systems, and contracting expertise before they can succeed in value-based arrangements.
The key takeaway: CINs help provider-MCO partnerships succeed by giving rural and safety-net providers the shared infrastructure needed to participate effectively, improve performance, and sustain value-based care over time.
A Strategic Opportunity for HHSC
Texas is not starting from scratch. Years before Rural Texas Strong emerged, EHF invested in building the kinds of provider networks, data systems, governance structures, and learning collaboratives that Rural Texas Strong now seeks to scale. Those early investments created real-world laboratories that demonstrated how shared infrastructure can help independent providers improve care, strengthen financial sustainability, and prepare for value-based payment arrangements.
As HHSC implements Rural Texas Strong, it has an opportunity to leverage these existing assets rather than recreate them. The evidence from both evaluations suggests that CINs are strategic infrastructure organizations capable of advancing multiple Rural Texas Strong priorities simultaneously, including patient engagement, data exchange, workforce development, technology adoption, quality improvement, provider capacity, value-based payment, and rural provider sustainability.
If Rural Texas Strong seeks lasting transformation rather than a collection of isolated projects, CINs may represent one of Texas’s strongest vehicles for achieving that vision. EHF’s early investments helped build the foundation. Rural Texas Strong now has an opportunity to build upon it.
Bottom Line
EHF’s early CIN investments helped Texas build tested infrastructure before Rural Texas Strong arrived. HHSC can now use Rural Texas Strong resources to scale what has already been learned: shared provider networks, shared data systems, shared expertise, shared accountability, and shared financing pathways are more likely to produce statewide rural transformation than one-off provider-payer arrangements.
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