Alaska Dept. of Health: RHTP Funding Cycle Updates: Reflections and Next Steps (September 11, 2026)

All right, good afternoon everyone. My name is Heidi Hedberg. I am the Commissioner for the Department of Health and I am welcoming you to the RHCP funding cycle reflections and next steps. With me today I have Betsy Wood. She is the Executive Director of the Office of Health Savings and we will be presenting with you today.

Our goal is the— we're gonna aim for about a 20 to 25 minute presentation and then we are gonna leave the remainder of the time open for Q&A. So as you are listening to the presentation, seeing the slides, if you have questions, feel free to enter it into the chat, or you are more than welcome to jot it down and we can get to the heart of the conversation, which is a two-way dialogue. Next slide.

Great. Alaska's communication has always had an approach, um, starting before implementation of RHTP. As you look at this wheel, as we developed the state application, we issued a request for information to gather those ideas, those priorities. Those potential approaches from communities and organizations across the state. And I think it gave us a really good early picture of where communities saw the greatest needs and the opportunities, and it really helped inform that application.

After the application, we continued that engagement rather than just treating that application at the end of that community input process. In January, we held a statewide convening to bring people together, um, across the program to help create that common understanding of where Alaska was headed. And since that application, uh, we have been out in community, uh, through our regional planning sessions, uh, working with our advisory council, our virtual impact series, and these types of webinars and office hours. And I think it's really important that we engage in that two-way communication and we keep it ongoing. I think that Alaska's input has really helped shape those RHDP applications, those initiatives, and I think that is going to what is going to propel us in that implementation.

But before we go any further, I really do want to pause and thank you. I want to thank Alaskans for showing up. I want to thank Alaskans for participating in that process. We have learned a lot together, and so from the bottom of my heart, thank you. I also want to thank the advisory committee for their participation.

They've given us a lot of guidance and input, and I want to recognize and thank our contractors, the Alaska Community Foundation, Minot and White House for their operational and technical support. It has greatly helped us as we have been moving through just an incredibly accelerated timeline. Um, that— can you believe, uh, it's, it's been 10 months since we received— or 9 months since we received our notice of award, and this time last year we were writing our application. Things are going really fast. Next slide.

So reflecting back, you know, when we look at a 5-year opportunity, we designed our program on a curve. And what you see is that the first 2 years are really intentional. It's, it's those stabilizing efforts to meet those immediate needs, um, to help build that strong foundation.

We will talk about this later, but what we saw was there are more needs than the resources available. And we're just scratching at the surface of the totality of needs. But we need to continue to move forward. And in years 2 through 4, what you're going to see is that we need to be intentional about shifting into a transformative posture. So year 2, we're still going to be in that stabilizing effort so that we can continue to meet those needs, and we are going to be moving into transformation so that we can build that capacity across the healthcare system.

I would say that from day 1 all the way through this program, we are going to continue to keep an eye towards that sustainability. I think this is really important for you as applicants as you're thinking about and preparing your year 2 projects, really be thinking about, am I stabilizing? Am I in that transformative state? And what is the sustainability of my project? Where do we need to be in that future state?

Next slide.

I have gotten this question a lot, uh, and the question is, So what have you learned? I think everyone has recognized how incredibly busy we have all been collectively, but what have we learned? What you see on the slide is not a total reflection of all of the lessons learned. It really is some of these salient points, some of our bigger takeaways. Um, first, we cast a really broad net and there was a large response.

Response to that broad net, and that it took more time for us to review all of those 1,800 LOIs and all of those applications. Second, we, because of, of just casting that broad net, you know, we were getting a lot of organizations that were saying, we're What are you focused on? What are your focus areas? And we've heard that, and I think that's a great example of where we need— where we are going to be shifting in year 2 with really elevating some of those focus areas that we want to lean into in year 2, working through this together. I would say sort of the third big focus area is around the review process.

We also saw that, um, there was a lot of ideas, but it was really hard to understand what the organization was trying to accomplish. And so we are going to be refining those questions in the application so that we can really be— have a clear idea and capture what is the problem, what is the solution, and what are you trying to accomplish as you're looking at that healthcare system in your community or your region. And I think that goes hand in hand with our guidance. We want to make sure that we are proactive in our communication, that we are getting information out up in front so that you can clearly see the guidance that has come out. I would say year 1 reflections, you know, sending these applications to CMS, seeing the questions that they are asking us on all of the applications.

Has really been enlightening, and you're going to see that the application portal is going to look different because we want to build those questions into the application process so that we can make it more simple. And finally, we want to continue the collaborative process. We started that way, and we want to continue that into the future through this, through this RHCP 5-year program. Next slide.

I would say another valuable learning experience over the past year has really been these regional planning sessions. We've completed 9. They have been incredibly rich. We have 4 more to go in this calendar year. You can see them on the slide, the communities that— or regions that have held regional planning session.

You need to know that the Department of Health, we bring an entire team. We're really intentional in this process. We do a lot of our homework, pulling the data, looking at that data landscape so that we can come prepared to facilitate a day-long series of workshops that looks at what is that landscape. What are those challenges? What are the opportunities?

And how can we leverage the RHDP funding so that we can advance the goals of that community or that region? The Department of Health, we learn a lot when we are in community. We build relationships. When you are in community, you see a lot. And so it's been really enriching from our perspective.

On the flip side, you know, we hear from the conveners, we hear from participants how appreciative they are of helping break down the RHDP program and helping them understand, bringing everyone together in community or region to facilitate through this conversation. At the end, we're working on reports to give back to communities so that they have something to point back to as they're applying for RHDP funding. So I think we are going to continue doing these. Our goal was to do a lot of them in year 1. I think we have accomplished that.

And then again, we want to do it in year 3. But it is taking a, a bit of its own interest, and I think there's a lot more communities are reaching out because of how productive the conversations are.

So now I, we're going to go to the next slide and I'm going to kick it over to Betsy and she's going to talk about operational improvements. So what we learned from year 1 and how we're incorporating those changes into year 2. Thank you, Commissioner. And as you mentioned, yes, we've made a number of changes to the process in response to a lot of the lessons that we've learned and the reflections that we have after year 1. We're really trying to make the next cycle easier to understand for applicants, easier to apply to, and faster to move through.

So first, I want to highlight that there will be one application instead of two stages. There will not be a separate letter of interest and then a second application. You will just apply one time.

In year one, applicants provided information at the LOI stage, waited through a review period, which was rather lengthy, and then had 3 weeks to develop the full application. We're going to streamline that this year. The process will move faster. Second, the questions will be more tailored to fit your project. We need more information to help with evaluation, but we also don't want applicants to be having to answer questions about equipment if you're not planning to buy equipment, or provide a bunch of information about workforce if your project really doesn't have anything to do with workforce.

So we're going to be tailoring that application to make it more flexible. Third, I want to highlight that organizations can submit up to 5 applications. Per opening, per round. The goal is to really encourage all of you to do some front-end prioritization and submit focused proposals that are centered on what you and your organization can achieve during each cycle. Fourth, we've learned a lot through the first CMS review and applicant clarification process about the level of detail that we need and the types of information that we— or information that we need about different elements of your project.

So in year 2 and going forward, we're trying to build those questions into the application from the start so that we can reduce the amount of back and forth that we have with applicants and additional follow-up questions that we have after you've submitted. And finally, I want to highlight that there will be 2 funding cycles per year, and we'll be publishing that calendar in advance. So as you're developing your ideas and thinking about what your organization is prepared to do and what you'd like to do. You— not every project has to be put into every cycle. You can think about, you know, we're working on this now, we may not be ready to apply in this moment, but next year or 6 months from now, that may be a better opportunity.

So we're trying to give organizations a little bit of that picture into when those application cycles are going to be opening up to them.

To help understand some of these year 2 changes that we're working on, um, we do think it's helpful to look back at where the time went in the first cycle. Our spring cycle, our first cycle had 2 separate applicant steps. So there was the 4-week letter of interest submission followed later by a 3-week full application. From the day that the letters of interest opened until we first started issuing award decisions was about 24 weeks. So while that overall cycle was really long, the time that you all had to develop your proposal was relatively short and, and split across 2 separate windows.

So we're trying to build out improvements with less time between stages and more time to prepare the application and a shorter overall path from opening to award decision.

This slide shows our target timeline for the fall 2026 cycle. So rather than another 2-stage, 24-week process, this is what we're working towards. We'll be announcing a firm date for the application period opening when it's finalized, but we are targeting that application to open in late September or early October. The application would be open for about 4 weeks, followed by roughly 4 weeks of processing and review. We do anticipate that there will be a clarification period, a final clarification stage with our applicants.

You know, while we're working on improving the initial application questions that we ask on the front end, we know that we are going to have some follow-up questions. We anticipate CMS having follow-up questions, so do be thinking ahead to understand that, you know, once we get through the application phase and the review phase, it's likely that the department will be coming back with more questions. But altogether, this means we're targeting about 11 weeks from application opening to awards beginning, compared to the 24 weeks that we've been working on under this first cycle.

All right, thank you so much, Betsy. So remember what we've reflected on for a year or two when we've you know, what are the priorities related to the department on year 2 funding? There are focus areas that we want to elevate in year 2, and this is specific to the fall cycle around Pay for Readiness, care coordination, and EMS. You'll notice a theme. It's all about readiness.

As you remember that slide that talked about the stabilization, transformation, sustainability, this is really leaning into— we need organizations to have the stabilization in these areas around pay for value, care coordination, and EMS so that they can be ready to start into some transformation efforts. And so when this is specific to the fall cycle, this spring cycle, we're going to reevaluate based on the responses of applications that we receive. Now, I would also like to call out the year 2 spring cycle that opens in 2027. That is when those continuing year 1 applications You need to reapply if you had projected that you need multi-year funding. You need to reapply for that funding in the spring cycle.

And then if you notice that yellow box, facility and renovations will be open in the spring. CMS has a cap on that type of funding, and we want to ensure that it's fair and equitable for all organizations as they're applying for that funding. And so that will be open in the spring. What you will also notice if you look at the lower part of that slide is that we are still going to have an open call for those 6 initiatives. If you have an idea that was deferred, you are in a good position because you have learned from those other organizations.

You've participated in these webinars. You have a more refined concept. Uh, so you are more than welcome to apply through that open call based off of those 6 initiatives. And then finally, down below, if you remember, there's 3 pathways. We have the planning pathway, the implementation pathway.

Those were open, um, year 1. They're gonna be open in year 2. The Alaska Community Foundation facilitates that portal for the planning and implementation. Pathways. The Department of Health is working to develop that third pathway, which is the state-directed targeted innovations.

We have a lot of work that we want to do with EMS in care coordination and a few other topics. And so we will be facilitating that through other mechanisms, but that is under development. Next slide.

So this slide provides some insight into how the application is likely to be structured to account for all of the changes that we've been talking about. There'll be one application portal regardless of what type of pathway you're trying to apply for or what type of initiative your project fits under. So you'll likely start by choosing the initiative that best fits your project, and you can submit a project under any of the 6 initiatives, but we really will try to align you to one of the initiatives at the beginning. You'll also identify for us whether your project fits under one of the focus areas that we've identified for that cycle. And if so, there may be a few additional questions that are specific to that work.

But if it doesn't fit with one of the department's focus areas, that's fine. The open call is there for strong projects that fall outside of the highlighted priorities for that round. So you will have the opportunity to submit your project in every round. After that, you'll choose whether you're applying for a planning pathway or the implementation pathway. And we'll provide more information about this, but at a high level, planning is for those earlier stage projects under $250,000, and it will have a shortened application.

We won't ask as many questions about the implementation because you're not there yet. You're in the planning phase. On the implementation side, We are looking for more information about those fully developed projects that are ready to move forward. There's some core project information that we will need to get from every applicant, including what's the need, what are you proposing to do, what's your work plan, what outcomes are you going to achieve, what does it cost, and what happens after the RHDP funding ends. So there will be core elements that you will see across every application.

But we will get a little more specific depending on the type of proposal or project that you have. As I mentioned before, if you're requesting equipment, we're going to ask you some more information about that equipment, and the intent is to help us understand some of those details so that we can communicate back to CMS that we have a fuller, rounder picture of what your project is and reduce the amount of time that we need to clarify with applicants on the backside. Side. If something doesn't apply to your project, you won't have to work through those questions. And again, you know, we, we do think that there are some areas that we expect to ask more questions and try to get around our sense.

And I think, you know, when you think about the questions we asked last time, there are a few more areas where we want to share what we mean by what we're asking. So I'll turn it back over to the Commissioner to share a little more insights about what we mean. Perfect. Thanks, Betsy. I appreciate that.

And as you reflect back on that visual graphic, the goal is we want to keep the application simple. We want targeted questions so we understand, so what you are applying or requesting funding for, but it's going to be a SMART form. So if you don't need equipment, we're not asking you those questions. So again, depending on time, it may be longer or shorter. The goal is to make it more efficient so that we can truly understand what you're applying for.

Again, applying all of those lessons learned, and I think CMS has really given us a lot more insight as we have pushed all of those year 1 applications over to them for review. That's why you're going to see a different type of application. Same easy tool. I think that ACF has a great tool that they use for grant management. So next slide, partnerships.

You know, years ago when Dr. Ann Zink and I started working together, she told me this powerful statement, and I've shared this before, but it really resonates with me and it stuck with my career. And she said, keep the patient at the center of the conversation and everything else is white noise. And as you translate that, what we're looking With this finite resource that we have with RHGP is how does this request transform the healthcare system? And we need to remember to keep the patient at the center of the conversation and ask ourselves, how do we change that system so the patient doesn't get lost, that client doesn't get lost? Because clients and patients, they move across organizations and settings and services.

Alaskans are highly transient. We are looking at how does this project interconnect with those various systems of care. Who are the partners that you are working with in planning, in implementation? Um, we also want to verify that a project is not being done in a silo, but there is a connection that is happening. So I would give two really good examples.

You know, one example is an EMR replacement. They would say it's just for organization. And I say, yes, it is. But the, the patients, their records are in your EMR. That partnership question is how is it linking to the HIE?

So when the patient is traveling through the healthcare system, those records are traveling with them, that the doctor that is seeing them can pull up those records. Very easily. I would give another example around facility upgrade. They say, well, we don't need partnerships, we're just going to do this thing with our facility. And I would say, well, the partnership question is, do you have local support?

Many of the year 1 applications had letters of support that really said, yes, this facility needs— this partner needs this. It will help us collectively as we are taking care of the residents in our community. So those are examples. We are going to change that partnership matrix a little bit to be more clear. And, um, you know, we will have future webinars where we will walk you through some really good examples of how people really demonstrated that partnership, um, working together as they were applying for funding.

Next slide.

So sustainability is something that came up a lot in year 1, and we think that this is an area where we want to provide a little clarity about what do we actually mean by that, right? Sustainability, sustainability is going to look different for every project, and it can look different in different communities. And so we're not expecting every applicant to show us the same kind of sustainability model. But we do want to know what's going to happen to the services that you're building or the project that you're building up once that funding ends. So for a planning or a technical assistance project, your sustainability plan may simply be that your work is completed and now you are left with a usable plan that you can come and present and say, this is what I would like to now implement.

That's, that's a sustainability plan enough. When you're thinking about services or new programs, you should have a realistic answer for what supports that work after the RHTP funding is done. So that could be a reimbursement pathway, third-party reimbursement, organizational funding, or some other funding source or a transition to, to funding and sustaining that on an ongoing basis. For technology or facilities, we may need to know whether or not your organization can support any ongoing maintenance or operating costs. After that federal investment is done.

We also wanna remind you that sustainability doesn't always mean continuation. Some projects are supposed to finish. So if your work is discrete and you have a defined end and it does not create an ongoing cost, you can tell us that. That's a, that's a completely fine answer. We just need to know what does it look like at the end of this.

And again, we're not asking for a guarantee that nothing's going to change, but we do need to know that you have thought about an off-ramp because this is time-limited funding. This is meant to be startup seed money, kind of push you in the direction that you need to go, build the supports, and then put you into that glide path. And so we just need to see that you have thought that through and that you have a realistic plan.

Perfect. So as we were, I've received this question many times. What does success look like? And it still remains the same. But I was just asked recently, last week actually, what does success look like to, to you, Heidi?

And I said that our patient outcomes would be better, our population health trending data would be, would be trending in the right direction, that providers would have that stability so they could keep their doors open, and that the patients, the clients, Alaskans would have access to the right care at the right time at the right place. That success still holds the same as year 1 as it does for year 2. But as you're listening to this webinar, as you are hearing our reflections in our year 1, I think it's really important that you continue to focus on that vision that we have under our 3 goals and looking at your project and how does it align with what success looks like.

And finally, we want to close with a reminder about what people should expect next and where to watch for updates. So first, our year 1 awards are still being finalized. I know many of you are in that process and in that cycle with us, and we really appreciate everybody's responsiveness and working with us as we move through that. If you've received notice that you were selected for an award, but you have not yet received that award agreement pushed to your organization, you should expect expect that to come your way within the next week. After that, if you have questions or if something still doesn't seem right, just reach out to us.

You can email our team at [email protected]. But I would say, you know, we're still working through those award agreements. We need— you should see them coming your way in about a week. Second, I want to share that we will have more information on awardee reporting. That is something that you can watch for in the future.

Every award is going to include both fiscal and programmatic reporting. We need to understand how you're spending the money. We need to understand what you're achieving. We do expect that reporting to be quarterly, and that first-year report is likely going to be due in January, looking back at the activities you've accomplished from the date of award through the end of December. So watch for that.

Just, you know, watch this space. We'll be reaching out to you. We'll be providing templates and guidance, and we'll have some reporting-focused webinars. Webinars coming up, but just wanted to flag that for folks who are looking ahead. We also want you to watch out for the upcoming events that we have.

We have regional convenings coming up in multiple locations. We're continuing this through the fall, and we have a year 2 kickoff September 23rd in Anchorage. So if you're in the Anchorage area or traveling to the Anchorage area, there will also be virtual options, but we'll be putting more information out about that where you can learn a little more about Year 2 and, and kind of head in that direction. But finally, we really just want you to keep an eye on our website. That's where we post applicant resources, our program updates.

You'll get information about the fall cycle when it opens. We'll be pushing out information out through our listserv. You know, I think one of the reflections that Commissioner shared about what we've learned in Year 1 is that we really cannot communicate enough, and we will continue to try to communicate as much as we we can so that you know where we are in the process, you know where you fit, and, and you know what's coming your way. Perfect. Thank you, Betsy.

So the next slide is our thank you again for this partnership that we have working together.