This is an op/ed by Dr. Shannon Dowler, former chief medical officer of N.C. Medicaid, and Dr. Toyin Ajayi, CEO and co-founder of New York-based Cityblock Health.
North Carolina, like other states, is facing a severe physician shortage, with the largest rural deficit in the country — requiring an estimated 642 additional primary care physicians to close the gap between rural and urban access.
For rural residents, the lack of access to nearby healthcare services means disease often remains untreated. For example, 53% more residents have heart disease, 29% have diabetes, and 16% experience chronic disease. In the most innovative country in the world, we still can’t get it right for the people who need it most. Urgent action is required to instill lasting transformation for the residents of rural North Carolina to get the quality care they need and deserve.
Across the nation, nearly one in four individuals residing in rural areas receive care through Medicaid. For these communities, Medicaid serves as a crucial safety net for those with disabilities, low-income families, and older adults requiring long-term care, particularly in regions marked by high poverty rates and limited access to healthcare resources. For over a third of North Carolina residents eligible for expansion from rural areas, the Rural Health Transformation (RHT) Program presents a significant opportunity to foster innovative approaches and support organizations dedicated to developing new solutions to enhance health outcomes for rural America.
For most industries, technology, more specifically AI, has contributed to solving problems. In healthcare, it can offer powerful tools and solutions that have the opportunity to ease pressure on deeper issues by reducing clinician burden, triaging care, and expanding access while also providing a more seamless, always on care experience for members. But some of the most innovative AI applications have yet to make an impact for those in lower socioeconomic communities—and it’s high time for a change. If states partner with the right innovators, Medicaid can be the proving ground for effective and responsible AI in healthcare.
For AI to truly make an impact, it’s critical to acknowledge the inherent concerns that surround it. Healthcare is first and foremost personal and hesitancy toward AI in healthcare is not simply a fear of new technology, it’s rooted in a long history of inequities and under-resourced care. Without thoughtful integration around how these technologies are developed and deployed, we risk losing trust with the people we care for. But how do we know when it’s done correctly?
AI to improve access and engagement in rural North Carolina
The RHT program can support rural North Carolina through investment to accelerate clinically-led development of new AI capabilities, and their expansion into rural areas.
AI provides a transformative opportunity to address challenges faced by those vulnerable members of rural communities like clinician shortages, inadequate access to care, and increased burden of chronic disease. By involving clinicians in the process and directly investing in them to drive innovation by identifying solutions they face is the first step. Envisioning what it feels like on the ground for the human being using technology and identifying potential challenges and opportunities is a superpower for those of us who get the privilege of being physicians and leaders. Being involved means that trust is maintained, there is greater clinical accuracy, and integration into workflows is more seamless. Tools that provide 24/7 member support can be a lifeline for individuals who live hours from the nearest clinic. Clinicians can help develop tools like these that support human decision-making, instead of replacing it.
Tools and technology that will make the difference
By layering in AI-powered clinical productivity tools — such as automated pre-visit research summaries and AI-assisted care planning — organizations are using technology as a force multiplier for all clinicians, especially strained rural clinicians. These tools will reduce their administrative burden, allowing them to focus on patient care and allowing all clinicians to operate at the top of their license.
The successful implementation of these tools, coupled with investment in clinical research and development to ensure the creation of technologies that seamlessly integrate into clinical workflows and achieve lasting impact, will be a critical demonstration of the state’s capacity to utilize complex, AI-driven projects to solve real-world problems for underserved communities.
We’re at a pivotal moment. Through the RHT program, states like North Carolina, with substantial rural populations, are uniquely situated to collaborate with clinicians, technology vendors, and other healthcare professionals to develop the next generation of AI tools that will ultimately deliver equitable, sustainable healthcare to rural America, and, more specifically, over 3.4 million rural North Carolinians.
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