Closing Rural Health Care Gaps: Why At-Home Testing Is Becoming Health Plans' Best Tool

More than 61 million Americans live in rural, Tribal, and geographically isolated communities, and by most measures, they're older and sicker than the rest of the country, even as the care they'd need to close that gap keeps getting harder to reach. Rural hospitals have been closing or scaling back services for two decades. Since 2005, 181 rural hospitals have shut their doors entirely, and the pace hasn't slowed. At the same time, CMS just put $50 billion behind reversing the trend. For health plans trying to close HEDIS gaps in rural markets, that combination of shrinking infrastructure and new federal urgency makes this the year to rethink what access actually requires.

The Rural Health Access Problem Is Getting Worse

Rural residents are older, sicker, and less likely to have insurance than their urban counterparts. They face higher rates of smoking, high blood pressure, and obesity, and higher death rates from the top five leading causes of death in the U.S.: heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke. Drug overdose and suicide deaths have also climbed faster in rural areas than in cities over the past two decades.

Layer hospital closures on top of that, and the picture gets worse. More than 100 rural hospitals have closed or converted to a different provider type in the last decade, and industry analysis puts another 429 at high financial risk. Those closures disproportionately eliminate obstetric units, too — one recent analysis found 36% of U.S. counties now qualify as maternity care deserts, with no hospital offering obstetric services and no OB-GYN or midwife nearby. Researchers studying the resulting "healthcare deserts" — areas with insufficient access to medical services — estimate that up to a third of Americans now live in one, with rural communities disproportionately represented.

For a health plan member in one of these areas, a closed hospital doesn't just mean a longer drive for emergency care. It means the nearest lab draw, the nearest OB-GYN, or the nearest specialist who can order a screening, might now be an hour or more away. That distance shows up directly in HEDIS performance: measures like Colorectal Cancer Screening (COL), Cervical Cancer Screening (CCS), and Kidney Health Evaluation for Patients with Diabetes (KED) all depend on a member being able to physically get to a point of care.

CMS Is Betting $50 Billion on Rural Health Transformation

This is the backdrop for the Rural Health Transformation (RHT) Program, the $50 billion, five-year initiative CMS launched to rebuild rural health infrastructure. HHS Secretary Robert F. Kennedy Jr. called it "the largest investment ever made to improve health care for rural Americans" when the program was announced. States can use the funding, distributed at $10 billion a year through fiscal year 2030, for a defined set of priorities: chronic disease prevention, workforce recruitment and retention, and — notably for health plans — "consumer-facing, technology-driven solutions for the prevention and management of chronic diseases" and technology that improves care delivery in rural hospitals, including remote monitoring.

The Center For Medicare and Medicaid Services rural health equity framework makes a similar point: closing rural health gaps requires meeting people where they are, not just building more brick-and-mortar access points in places where the economics of running a hospital or clinic don't hold up. The CDC's Office of Rural Health has been making this case for years — rural health improvement depends as much on reaching people outside clinical settings as it does on the settings themselves.

That's the opening for at-home testing.

At-Home Testing Closes the Distance

Closing a care gap in a rural market usually isn't a matter of convincing a member that a screening matters. It's a matter of removing the physical distance between the member and the test. That's a different problem than the one most outreach campaigns are built to solve, and it's why plans that lean only on reminder calls and mailers tend to see the smallest gains in the ZIP codes that need the most help.

At-home testing turns the access equation around: instead of asking the member to travel to care, the kit travels to the member. Ash's at-home testing programs ship directly to a member's home under the health plan's own brand, with bilingual instructions and support built in, and route results back through clinical review without requiring a clinic visit at all. For a rural member, that removes the drive, the missed shift, and the dependency on a facility that may no longer exist in their county.

The measures this affects most are the same ones rural counties tend to underperform on:

• Colorectal Cancer Screening (COL). Rural members skip colonoscopy referrals for the same reason they skip everything else: the specialist is too far away. Mailed FIT kits paired with navigation nearly tripled six-month screening completion among rural Medicaid enrollees, from 4.5% to 11.8%, with no clinic visit required.
• Cervical Cancer Screening (CCS). Distance isn't the only barrier here — so is the exam room itself. Mailing HPV self-collection kits nearly doubled screening uptake among under-screened women, to 72% compared with 37% for scheduling assistance alone.
• Kidney Health Evaluation for Patients with Diabetes (KED). This measure requires both a blood and a urine test, which is a lot to ask of a member managing diabetes and a long drive. Only 40% of Americans with diabetes get the recommended annual kidney evaluation nationally, and rural access gaps widen that shortfall further.
• HbA1c Screening for Patients with Diabetes (GSD). HbA1c testing rates among diabetic Medicare beneficiaries range from 71.0% in the lowest-testing ZIP codes to 93.1% in the highest, a spread that tracks closely with how far a member lives from a lab.
• Controlling High Blood Pressure (CBP). A federally qualified health center in rural southern West Virginia saw a 44% increase in patients reaching controlled blood pressure after moving to at-home monitoring, in a service area with the same transportation and broadband gaps common to rural markets nationally.
• Chlamydia Screening in Women (CHL). This measure depends on a member seeking out a test many are reluctant to ask for in person. A meta-analysis of 19 studies found chlamydia and gonorrhea test completion was 2.61 times higher when testing happened at home instead of in a clinic.

Ash supports all six with a lab network available in all 50 states and more than 100 biomarkers, which matters in rural health specifically because it means coverage doesn't depend on whether a given county still has an in-network lab.

CMS built "tech innovation" and "sustainable access" into the RHT Program's core goals for a reason: they know facility-based care alone won't close the rural health gap in the timeline they're working toward. Closing care gaps in rural markets increasingly means building a program that doesn't rely on the member reaching a building at all.

What This Means for Health Plans

For Medicare, Medicaid, and Medicare Advantage Plans alike, plans with meaningful rural membership, this isn't a peripheral concern. Quality metrics are built substantially on HEDIS performance, and members in healthcare deserts are disproportionately likely to be the ones dragging a measure down, not because they don't want care, but because the path to getting it has gotten longer. As we've written before, the gap between access and completion is rarely about awareness. In rural markets, it's rarely about willingness either. It's almost always about distance.

With federal dollars now flowing specifically toward technology-enabled, consumer-facing rural health solutions, plans that build at-home testing into their rural gap closure strategy now are positioning themselves ahead of where CMS itself expects the field to go over the next five years.

If your plan has rural membership and gaps that outreach alone hasn't closed, let's talk about what an at-home testing program could look like in those markets.

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