{"id":11159,"date":"2026-01-05T12:59:40","date_gmt":"2026-01-05T17:59:40","guid":{"rendered":"https:\/\/uniteustailstg.wpengine.com\/?p=11159"},"modified":"2026-04-30T16:24:30","modified_gmt":"2026-04-30T20:24:30","slug":"lighting-the-torch-transforming-rural-health-in-missouri","status":"publish","type":"post","link":"https:\/\/uniteus.com\/case-study\/lighting-the-torch-transforming-rural-health-in-missouri\/","title":{"rendered":"Lighting the ToRCH: Powering Rural Health Transformation through a Hospital-Led Hub Approach"},"content":{"rendered":"

Missouri\u2019s<\/span> Transformation of Rural Community Health (ToRCH) program<\/span><\/a> provides rural communities with the infrastructure and network they need to successfully coordinate care. Through Unite Us\u2019 closed-loop referral system, participating providers can connect patients to community resources, streamline reimbursement, improve health outcomes, and minimize costs.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Missouri\u2019s Transformation of Rural Community Health (ToRCH) program provides rural communities with the infrastructure and network they need to successfully coordinate care. Through Unite Us\u2019 closed-loop referral system, participating providers can connect patients to community resources, streamline reimbursement, improve health outcomes, and minimize costs.<\/p>\n","protected":false},"author":5,"featured_media":11326,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[108],"states":[55],"topic":[89,130,79],"industry":[97],"series_name":[],"class_list":["post-11159","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-case-study","states-missouri","topic-medicaid-innovation","topic-roi","topic-rural-health","industry-all"],"acf":{"layout":"report","gated_page":{"":null,"title":"","featured_image":null,"description":"","form_title":"Fill out the form to download the white paper.","code_editor":"","title_2":"","description_2":"","embeds":null,"display_cta_button":true,"button_text":"Download the White Paper"},"columns":null,"download_page":{"document":""},"reports_component":{"components":[{"acf_fc_layout":"buttons","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"action_buttons":[{"name":"Read the Case Study","style":"button-solid","link_type":"external","page_link":null,"link":"#background","icon":"down-caret","is_blank":false,"background_color":"","text_color":"","background_color_hover":"","text_color_hover":""}]},{"acf_fc_layout":"key_takeaways","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"","menu_label":"","header":"

Key Takeaways<\/h2>\r\n

In this case study, you\u2019ll learn how:<\/h3>\r\n\"\"Rural communities, anchored by local hospitals, use a hub-and-spoke model to coordinate 900+ community services.\r\n\r\n\"\"Centralized technology reduces administrative burden and drives thousands in cost savings.\r\n\r\n\"\"Data-driven collaboration strengthens community capacity and readiness, especially in rural areas\r\n.<\/span>","takeaways":null,"text":"

<\/h3>\r\n\r\n
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<\/h3>\r\n

Key Results<\/h3>","tiles":[{"header":"$27K","text":"in administrative cost savings"},{"header":"99%","text":"invoices accepted"},{"header":"92%","text":"reported improvement in community capacity"},{"header":"18%","text":"increase in timely behavioral-health follow-up after ED visits"},{"header":"19.6%","text":"increase in individuals with controlled blood pressure "},{"header":"17 mins","text":"in time saved per referred case"}]},{"acf_fc_layout":"wysiwyg","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"background","wysiwyg":".<\/span>\r\n

The Background: Laying the Groundwork for Integrated Rural Care<\/h2>\r\n\"\"The <\/span>Transformation of Rural Community Health (ToRCH) program<\/span><\/a>\u2014supported by Missouri Medicaid\u2014channels critical resources into rural communities to address the underlying social and economic factors that contribute to poor health outcomes. By embedding community-based care services within traditional clinical workflows, ToRCH strives to improve patient wellbeing, strengthen the financial sustainability of rural hospitals, and enhance chronic condition management. ToRCH focuses on optimizing existing funding streams while creating lasting, community-centered models of care in a fiscally responsible manner.<\/span>\r\n\r\n
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The Challenge: Closing Critical Gaps in Rural Health<\/h2>\r\nThe Rural Health Transformation Program\u00b9<\/span> offers a timely opportunity to tackle challenges unique to rural America. Rural communities face limited access to care due to distance, transportation barriers, and provider shortages\u00b2<\/span>\u00a0\u2014alongside higher rates of poverty and fewer economic opportunities\u00b3.<\/span> These factors heighten vulnerability to <\/span>non-medical drivers of health,<\/span><\/a> such as food, housing, and transportation insecurity, which can worsen health outcomes. But at the same time, rural communities possess unique strengths: they often have a strong sense of community and a resilient mindset. By partnering with community organizations, rural providers can leverage these strengths to help address health-related needs and improve population health, backed by secure data-sharing technology infrastructure. <\/span>"},{"acf_fc_layout":"wysiwyg","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"","wysiwyg":" \r\n\r\n
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The Solution: A Unite Us-Powered Model for Rural Transformation<\/h2>\r\nMissouri\u2019s <\/span>ToRCH<\/b> initiative\u2014funded through a unique application of the <\/span>1915(b) waiver authority<\/b>\u2014was designed to directly confront the interconnected challenges of rural health.<\/span>\r\n\r\nWith <\/span>Unite Us<\/b> as the technology backbone, hospitals connect seamlessly with community-based organizations through a <\/span>Community Information Exchange (CIE)<\/b> that enables <\/span>secure, closed-loop referrals<\/span><\/a> and <\/span>Medicaid reimbursement<\/span><\/a> for certain care services delivered.<\/span>\r\n\r\nSince July 2024, six participating hospitals have acted as <\/span>ToRCH Hub leads<\/b>. These hub leads serve as central access points for coordinated care across their communities and are incentivized through outcome-based payments beginning in 2026 and shared savings beginning in 2028.<\/span>"},{"acf_fc_layout":"spotlight","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"","background_image":11357,"disable_overlay":false,"pill_text":"","button":"","text":"

\"\"<\/a>\u201cThe power of ToRCH is the convening power of bringing together these entities.\u201d<\/h3>\r\n
\r\n
- Kirk Mathews,<\/strong> Chief Transformation Officer, MO HealthNet<\/div>\r\n \r\n\r\n<\/div>\r\n
See Kirk\u2019s Full Testimonial<\/a><\/div>"},{"acf_fc_layout":"wysiwyg","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"","wysiwyg":"
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How It Works<\/h2>\r\nThrough <\/span>Unite Us\u2019 closed-loop referral platform<\/span><\/a>, clinical staff at participating organizations within ToRCH Hubs refer patients to community-based organizations to address their non-medical needs. The ToRCH model of care not only enables patients to access both the health and community care they need, but also reimburses community service organizations addressing transportation, food assistance, home modifications, and environmental services when documented as a health-related need.<\/span>\r\n\r\n[caption id=\"attachment_11258\" align=\"aligncenter\" width=\"960\"]\"\" Figure 2:<\/strong> ToRCH Referral and Reimbursement Workflow[\/caption]\r\n\r\n \r\n\r\n
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The Impact: Technology-Driven Transformation in Rural Missouri<\/h2>\r\nAcross the six participating Missouri ToRCH counties\u2014Dent, Henry, Pettis, Phelps, Polk, and Ray\u2014 referrals have been sent on behalf of 2,789 individuals for over 900 community services,\u2075<\/span> with 66% of all referral activity initiated by ToRCH Hubs. <\/span>\r\n\r\n[caption id=\"attachment_11262\" align=\"aligncenter\" width=\"1650\"]\"\" Figure 3:<\/strong> Population and Referral Characteristics[\/caption]\r\n\r\n "},{"acf_fc_layout":"blockquote","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"","text":"\u201cPrior to ToRCH, we did not have consistent case management efforts. This model has enabled us to put social risk screenings in place and a way in which to follow up on them.\u201d\r\n\r\nTabitha Stanfast, BSN, RN, LSSYB,<\/strong><\/span>\u00a0Salem Memorial Hospital"},{"acf_fc_layout":"wysiwyg","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"impact","wysiwyg":"
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ToRCH Hub Results<\/h2>\r\nToRCH demonstrated that locally governed, data-driven collaboration can improve both outcomes and financial stability. Participating hospitals and clinics achieved measurable results, including a 19.6% increase in individuals with controlled blood pressure and an 18% increase in behavioral-health follow-up after ED visits. These are critical Healthcare Effectiveness Data and Information Set (HEDIS) measures, given evidence suggests that patients who fail to receive aftercare following their emergency psychiatric visit have 6 times higher odds of returning to the ED within 2 months.\u2076 Similarly, a person with hypertension is four times more likely to die from a stroke and three times more likely to die from heart disease if no after-care is received.\u2077"},{"acf_fc_layout":"icon_and_highlight","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"","icon":"checkmark","text":"19.6% Increase in Controlled Blood Pressure<\/strong>
<\/span>\r\n\r\nMean increase in rate of patients with a controlled blood pressure ICD-10 code across participating ToRCH Hubs and clinics."},{"acf_fc_layout":"icon_and_highlight","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"","icon":"checkmark","text":"18% Increase in Behavioral Health Follow-up After ED Visit<\/strong>
<\/span>\r\n\r\nMean improvement in behavioral health follow-ups after an ED visit, a critical National Committee for Quality Assurance (NCQA) quality measure, across participating ToRCH Hubs and clinics."},{"acf_fc_layout":"icon_and_highlight","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"","icon":"checkmark","text":"99% Invoice Acceptance Rate<\/strong>
<\/span>\r\n\r\nFrom 9\/3\/2024 - 11\/15\/2025, 99% of all CBO invoices were accepted and paid within 90 days, compared to medical billing 5-10% claims denial industry benchmark."},{"acf_fc_layout":"wysiwyg","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"impact","wysiwyg":"Figure 4:<\/b> ToRCH Impact to Date (Jun 2023-Nov 2025)<\/span><\/em><\/span>\r\n\r\n.<\/span>\r\n

Satisfaction with ToRCH Model<\/h3>\r\nToRCH Hub end users were invited to participate in a cross-sectional survey capturing feedback and satisfaction with Unite Us\u2019 platform as well as impact on administrative efficiency. In addition to the findings noted in figure 5, <\/span>88% of respondents agreed the ToRCH model improves overall patient care<\/b>, and a majority of respondents reported feeling less stressed about documenting outcomes and follow up on patient referrals since using Unite Us.\u00a0<\/span>"},{"acf_fc_layout":"icon_and_highlight","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"","icon":"checkmark","text":"17 Minute Time Savings Per Referral<\/strong>
<\/span>\r\n\r\nAverage time savings reported by ToRCH Hub end users (n=33) via a cross-sectional survey (September, 2025). This represents 1,067 administrative hours gained and approximately $26,675 in salary savings."},{"acf_fc_layout":"icon_and_highlight","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"","icon":"checkmark","text":"92% Report Improved Community Capacity and Collaboration<\/strong>
<\/span>\r\n\r\nOf surveyed HUB end users (n=33), 92% report the ToRCH model and shared incentives were key to improving community care coordination."},{"acf_fc_layout":"icon_and_highlight","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"","icon":"checkmark","text":"100% Express Confidence in Connecting Patients to Community Care<\/strong>
<\/span>\r\n\r\nOf surveyed HUB end users (n=33), 100% report they are confident in their ability to connect patients with community resources to meet their non-medical needs."},{"acf_fc_layout":"wysiwyg","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"impact","wysiwyg":"Figure 5:<\/b> ToRCH Workforce Impact to Date (Jun 2023 - Nov 2025)<\/span><\/em><\/span>\r\n\r\n.<\/span>\r\n

Compliance and Administrative Efficiency Gains<\/h3>\r\nUnite Us\u2019 platform capabilities also allow the Medicaid program to meet federal requirements under the waiver. The <\/span>grant tracking and reimbursement module<\/span><\/a> strengthens accountability by clearly demonstrating that payments are made only for services authorized in the waiver language. This transparency streamlines administrative oversight, reduces compliance risk, and helps ensure the program secures the full federal matching funds for which it is eligible.<\/span>\r\n
\"\"\"For the first time in my Social Work career, I finally feel like I'm truly making a difference in people's lives!\"<\/span>\r\n\r\n\u2013ToRCH Hub Social Worker<\/strong><\/blockquote>\r\n
\"It functions perfectly when referrals receive prompt responses and are accepted. Leaves me feeling good with less stress to know they are getting the help needed.\"\r\n\r\n\u2013Resources Specialist\/Social Worker<\/strong><\/blockquote>\r\nIn addition to those critical reporting capabilities, ToRCH end users reported an average of <\/span>17 minutes in time saved per referred case<\/b>, translating to <\/span>$27K in administrative cost savings alone<\/b>.<\/span>\r\n\r\n "},{"acf_fc_layout":"wysiwyg","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"","wysiwyg":"
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Partner Spotlight: Bothwell Regional Health Center<\/h2>\r\n\"\"As one of the six ToRCH hub leads, <\/span>Bothwell Regional Health Center <\/span><\/a>demonstrates how technology-enabled collaboration can move the needle on key metrics.\u2078<\/span>\u00a0<\/span>\r\n\r\nA recent study conducted by the Veterans Health Administration found that each additional in-person primary care visit was associated with a cost reduction of $721 per person per year.\u2079<\/span> Applied to the 10% increase from Q3 2024 to Q3 2025 in Bothwell patients with Adults\u2019 Access to Ambulatory\/Preventive Health Services (AAP) Gap Closure, this represents an estimated <\/span>$381K in reduced annual healthcare costs, for that measure alone.<\/b>\r\n\r\n "},{"acf_fc_layout":"wysiwyg","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"","wysiwyg":"
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Real People, Real Impact<\/h2>\r\nThe ToRCH model\u2019s primary objective is to proactively improve patient outcomes by addressing non-medical needs through examples like the following:<\/span>\r\n
\"I had a 32-year-old Army veteran who had been recently medically discharged. He was on the verge of losing his home because he was paying outrageous utility bills. He hadn't had heating\/cooling in his home for 2 years and was using 6 space heaters during the winter and 3-4 A\/C window units during the summer. He had also been seen in our ER 49 times for COPD, pneumonia, etc within a year. We were able to get him a brand-new heating\/cooling unit. His bills have become more manageable, and he has not been seen in our ER since he got the new unit and his children\u2019s outcomes improved.\"\r\n\r\nToRCH Social Worker<\/strong><\/span><\/blockquote>"},{"acf_fc_layout":"wysiwyg","_acfe_flexible_layout_title":null,"_acfe_flexible_toggle":null,"id":"","wysiwyg":"
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Lessons Learned: A Blueprint for Rural Health Innovation<\/h2>\r\nThe ToRCH pilot demonstrates that a community-led, hospital-anchored care model can be both effective and scalable in rural areas. Leveraging cross-sector collaboration and digital infrastructure, ToRCH increases access to social support while improving overall patient care and well-being. High referral resolution, efficient processes, and the integration of CBOs into care workflows signal strong potential for replicability and broader system impact, particularly in the rural health care setting. The findings reinforce the role of rural hospitals as care coordination leaders capable of advancing population health through strategic partnerships and data-driven strategies.\r\n\r\n
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Implications for Practice<\/h2>\r\n