Deploying technology is vital to expand rural healthcare access, but ensuring follow-up care, supporting local providers, and creating sustainable services are equally critical, according to a panel at the Verizon Healthcare on Air Summit in Los Angeles last week.
Dr. Rafid Fadul, chief medical officer at the Advanced Research Projects Agency for Health (ARPA-H), highlighted the agency’s focus on closing these gaps through mobile care delivery, clinical trial redesign, and agentic AI.
AI as a Gap Filler, Not a Replacement
Fadul emphasized that technology, particularly AI, can extend clinical expertise to communities lacking specialists. He pointed to ARPA-H’s ADVOCATE program, a federal research initiative developing an FDA-authorized autonomous AI system for cardiovascular care.
“The reality is that the technology is getting better and better every day, and they’re not here to replace doctors. They’re here to fill the gaps where we don’t exist,” Fadul said.
He stressed that discussions about care delivery should prioritize patients with the fewest resources and limited access to existing services. “The conversation is how can we do right by the person with the least resources, because that is what we are judged by as a health system, not by who’s got the most resources,” he said.
Fadul also called for humility among doctors regarding AI’s capabilities. “We should not be arrogant about the fact that technology is getting better and better, and we as doctors should have some humility around the fact these tools are, in fact, very, very good, and data shows better than us in certain capacities, and so we have to have some openness to it.”
Sustainability Beyond Funding
For health systems, the challenge is creating operating models that ensure consistent access to care through technology. Jarrod McDonald, chief of staff at UC San Diego Health, described his organization’s regional hub-and-spoke approach to support local care delivery.
Despite expanded hospital capacity, UC San Diego Health faces ongoing demand exceeding bed availability. The health system plans to initially focus on maternity and prenatal care in rural areas through virtual care and regional partnerships, with potential expansion to specialties like gastroenterology.
McDonald stressed that true transformation goes beyond spending the $50 billion in federal funding from the Rural Health Transformation Program (RHTP). “True transformation is setting up models where we don’t need this money anymore, and it’s financially sustainable after five years,” he said.
Andrew Stepp, founder of AscendRural, agreed, emphasizing the need for long-term affordability of technology after federal funding ends. “You might get a new software platform, whatever it might be, but then how are you going to afford it once that funding cuts off in five years? So, I think sustainability is a huge aspect that needs to be considered as part of this,” Stepp said. He identified broadband connectivity, interoperability, and sustainability as critical for long-term return on investment.
Dr. Mark Feng, health commissioner for Arcadia, highlighted the role of community health fairs in reaching people outside traditional healthcare settings. Community events can provide a more approachable entry point to care, Feng said. He emphasized the importance of screening and early intervention alongside chronic disease management, especially for people who may not know they have common conditions such as diabetes or raised cholesterol.
“One thing to think about is also not just focusing on chronic disease management or reactive management. Think about screening and early intervention, and that’s the key,” Feng said. “These things, if you can capture early on and intervene early, and set up these non-traditional hubs to continue follow-up and make sure they’re referred to the proper sources for care, are huge.”
Dan Desmond, president of The Simi Group, emphasized the need for screening, stating patients must be connected with follow-up services while keeping their primary care providers informed.
Fadul acknowledged concerns about patient security and cybersecurity. “Yeah, a million things make me nervous about it,” Fadul said. He likened AI use to a ventilator, stating, “I taught my fellows how to manage ventilators. What I would tell them is that in the right hands, with the right training, this is a tool for good. In the wrong hands, with suboptimal training, this is a weapon, right? And the same thing actually applies to our AI tools.”
Despite the risks, Fadul remains optimistic. He noted that the U.S. healthcare system lags behind other first-world nations, and addressing healthcare deserts requires urgent action. “I don’t think we have the luxury right now with the laggard way that our healthcare system is as compared to other first-world nations, and when we look at these healthcare deserts, we don’t have the luxury to turn up our nose and be arrogant about it. We have to be very diligent. The burden is on us to craft these tools in the way that they actually are optimized. But absolutely, this is the future.”
