Alaska Dept. of Health: RHTP Funding Cycle Updates: Reflections and Next Steps with Q&A (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 going to aim for about a 20 to 25 minute presentation, and then we are going to 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 application, 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 Lighthouse for their operational and technical support. It has greatly helped us as we have been moving through just an incredibly accelerated timeline.

That— can you believe 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, um, 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, or 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. Uh, 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 wanna 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, 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 two 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 heard, you know, what are the priorities related to 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 gonna 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 wanna 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, um, 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 gonna 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 Uh, with this finite resource that we have with RHDP 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, that 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 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. 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 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 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. If you want to stop sharing, we are now going to go into Q&A. So I have not looked at the chat. I was trying to focus on the presentation. I did say at the beginning, at the top of the hour, that we really want to give this time back to you.

So it is up to you if you want to raise your hand. You're welcome to raise your hand and ask a question, or we will start going through the chat and start pulling out questions.

I will start with one, but Allison and Trish, if you want to start elevating questions too, that would be great. I think a common question that we're getting is, I received a denial letter, but I don't know why. Or the description in the letter was very generic and I want specific feedback. I had a really good idea. I know that would be a huge change in my community.

And my response is, I hear you, I see you. I think that When I said we cast the net wide, we cast the net really, really wide with ideas. And that $1,800, $2.5 billion, that was real. That was real. And I think that you are feeling that, that realness right there with that denial letter.

The needs exceed the available resources.

Recognize that some of it was, was, you know, deferred because we didn't have that clarity of sustainability, or we weren't really clear with, with what that work plan was. That's our lessons learned. We're going to refine year 2 so it's better. So maybe you have a great idea, it just really wasn't synced up. And so that's those targeted questions.

We recognize there's a lot of requests that people have for one-on-one technical assistance to get feedback on their application. And what we stated is that we don't have the capacity. We only have 5 staff. I feel like this is my full-time job, and I also have a department to run, um, to meet everyone's needs in that space. But we are offering limited one-on-one sessions.

So that prior slide, that September 23rd, if you're in Anchorage or flying through Anchorage and you're able to come, We are going to have sessions that I think will be really informative and meet that need for that one-on-one. And if you're able to schedule time, you know, we're going to try to accommodate as many as we can. So our goal truly is to support all communities and regions across the system. But again, those needs exceed those available resources. But to my second point, remember we have two cycles coming up.

We have the fall cycle and the spring cycle. So we also need to make sure that we are funding things that are aligned to our milestones, aligned to things that are in our application, because it is a competitive grant. Alaska is competing with the other 49 states, and so we need to show progress as we are working through this, the intent of this program, which is transformation. So keep all of those key insights in mind as you are preparing for the next application cycle. So what's our next question?

I'm seeing some questions around kind of how to approach year 2 and thinking about should they put— should applicants put together one really big application that includes all of their elements and how work together? Should they try to break them up? How do they think about that? And especially in the context of us looking for 5 applications from each organization per cycle, what do you, what do you want to share about that? That is a really good question.

I do know in the beginning what we said was you need to form what's going to be best for you. If you want to do many different applications, you can. If you want to do one application, Kian, it truly was up to the applicant which pathway you wanted to choose. Both of them were correct. Again, I would go back to the needs exceed the available resources.

And so I think that it is also the second statement I would say from a reviewer standpoint, it is much easier to review a singular project and to understand what is the scope, what are you trying to accomplish? How does this fit into your landscape of your healthcare system? Um, you know, 1 or 2 or whatever that number is according to what you're trying to accomplish. I think scoping it appropriately will help in that review process. Um, but it really is up to that organization.

Do you wanna add anything to that, Betsy? I think that you covered it well. You know, I think that we really want you to be thinking about what you and your organization can accomplish within that kind of 12-month performance period. And I know that there are a lot of folks out there that are thinking in multi-year projects and that building for transformation and kind of really shifts to the system takes time, and you do want to kind of look ahead to what does that look like in the future. And so we do understand that, you know, there needs to be a pathway for you to continue your projects, but we also want you to think about what is it realistic on that pathway for your organization to accomplish within that next year and, and kind of try to tailor your asks that way.

It helps on the review side a lot if you have really kind of thought through on the front end what is kind of most critical and most important for your organization to come in. You know, we have a lot of really great ideas across the state, and we have a lot of asks and a lot of need, and we want to support broadly. So really think about kind of what is it that is most critical for that next Yup. I, I would also remind organizations that when we get into reporting, so January is when those reports are going to be due, that is per grant. So remember that in the context with year 1.

Remember that in the context now we're breaking it out into 2 funding cycles. Reporting is critically important so we can capture that the money is going directly to what was it was intended for and that we are getting the outcomes we anticipated. And if not, we course correct together. But that is gonna be really important as well as what is your capacity to implement, use the funding within the timeline and to manage all of that reporting.

I'm also seeing some questions around people who had, um, your ideas in year 1 that either didn't proceed through the LOI stage, or maybe they've received notice that we're unable to move forward with it at the application stage. And there's a couple of questions that continue to surface. One is, do they need to submit a new application if they want to put that idea forward again? Do they need to do that, or can they just say, oh, can you put my old one back in the queue? And I think the second piece of that is saying, hey, I was interested in purchasing some equipment or adding this I was in this service line or doing something and I, and mine didn't move forward, but I did see another organization that did move forward.

What do you have to kind of share about some of that for folks where they can be thinking about how to improve their ask or how to refine their ask the next time? Yeah, well, the first question is yes, you have to reapply for funding. Remember, the application is going to look different. We are going to have targeted questions. So, you know, print off that application if you did, hold it, it will help you as you are reapplying for those funds.

I would say to the second question, I think Betsy and I can both take a stab at answering that, is remember that review process, we, the Department of Health had 3 reviewers per application and the department employee had experience on the topic. And it went through that review process and we looked at what was those average scores. Did it meet that threshold to move to that portfolio analysis? That portfolio analysis is looking at, are we meeting the milestones for year 1? Are we geographically dispersed in funding?

Are we looking across the 6 initiatives and do we have an equalized balance? Like, there— the, the evaluation process has been on our website. It has been there the entire time. Those are the documents and the questions that we used as we were going through that review process and that portfolio analysis. So some of it, you know, there was projects that scored really well and then it came to the portfolio analysis and we were looking at that portfolio analysis That's where we had to weigh the totality based off of who applied.

I would say my second question that I get a lot is, it seems like there's a lot of applications that were funded in Anchorage. Some Anchorage organizations, some Alaska organizations are based in Anchorage, but 100% of their work is within rural communities. So as you are sorting the funding requests and you're looking at that census or borough or municipal area, you can't say that funding is all going towards Anchorage because really some of those organizations really are there providing services for those rural and frontier areas. Do you want to add to that, Betsy? Yeah, the thing I would say too is that for some of the asks, you know, this is, this is a complicated federal program that comes with a lot of complicated parameters around how you can spend the money, how we can allocate the money, and what we can do with it.

And We're really trying to, to hold as much of that complication at the state with the state team as we can so that we don't share it out as a gift that nobody wanted to the whole group. But one of the areas that we do really need to be thinking about is some of these— there are caps on how we can spend some of the funds in certain areas. And when you think about facility renovation or you think about an equipment upgrade, those items fall into a cap. A capped category. Provider payments are another capped category.

EMR replacements are another capped category. And so when we're making those decisions, we're also looking at how do we think that we are tracking towards whether or not the funding that people are requesting falls into one of those capped categories. Now we've learned a lot in this process about what types of questions we need to ask about the projects and about the expenses so that we can understand, do you fit into this capped category or not, so that we know kind of how are we tracking towards those caps. But, um, you know, I'll say that I think the facility renovation asks and needs, the equipment upgrade asks and needs that we saw far exceeded the available funding in this first year. So you may have a project or an ask that was in that space that we couldn't support this first year, but we do encourage that if it's really a critical need for your organization, think about coming back again in next year.

And then even outside the capped categories, there were a lot of really great ideas that we looked at and said, you know, maybe there is an element of timing where it's just not quite right. Maybe there's a reimbursement pathway that we see opening up that hasn't opened yet, but you may want to consider that again in the next year. Next year. So, um, you know, think about the landscape, think about, um, you know, where you are, and, and think about situating your project into what you can realistically achieve in the next year, what you see that glide path being, and think about those refinements where you could say, hey, the landscape has changed a bit, or here's a little more information around why this is such a critical need. So some of those pieces are things that I would share.

There. I want to flag there's a couple of— I see a number of folks asking questions around the regional meeting that's coming up for the Greater Anchorage area versus the kickoff meeting for year 2. Those dates are one right after the other. If you want to spend 2 days with the Department of Health team, we are happy to have you. You're welcome.

The Greater Anchorage area regional convening is on September 22nd. The following day, that's where we will do more of a year 2 kickoff, provide more detail around kind of a carry-on to this conversation today. There will be a virtual option. I'm going to look at my team and they'll kick me under the table if I'm saying that incorrectly. But, you know, there will be a virtual option to participate and, you know, see the information that's being shared that day.

So, 22nd Anchorage Area Regional Convening, 23rd Year 2 Kickoff, both happening physically in Anchorage. And honestly, I would really encourage you if you are able to come in person, that's great. We do wanna provide a virtual option, but there's a lot of questions around the budgeting and sustainability and applications and how, so how do you change a healthcare system, right? Well, it's one bite at the apple, which is where it key into the words we're using, the readiness, like the department is focusing on the readiness to then become ready for some of these transformative efforts. We really want to work with you and guide you as we are improving the healthcare system.

So please attend if you're able to. And Commissioner, I think that leads nicely into some of the other questions that we're seeing, which is around the focus areas. So if you could talk a little bit about kind of maybe how those focus areas were developed for this, for this round, and then also what people should be thinking about when they're thinking about you know, are they— are we going to prioritize focus areas? Are we going to— are they going to score more highly? What should people be thinking about when they are moving into this evaluation stage?

Part of it was just the reflection on that number of LOIs that we received. Like, we received a large volume of LOIs on EMS. I have been in conversations with EMS agencies EMS Advisory Committee. And it really, when we looked at the LOIs and all the conversations, really kind of saliented and crystallized in sort of these readiness areas that we need to start with. And so that is where we are elevating and focusing within EMS.

These are the areas that we need to do. Whether that is going to be prioritized over open call, I think that we are still in a fluid situation. I think we are, responding back to the feedback we received, which is, "Would the Department of Health please prioritize and help us understand where you're going?" And that's our acknowledgement. How it addresses with the funding, we're still working on that. Again, we have to balance across the initiatives and align it to our milestones.

So it is not the only thing that we are going to be focusing on. But it was also in the reverse. We also saw that there was not a lot of requests in the readiness area, um, around care coordination. And so we wanted to elevate that because we, that is an area that we really need to step into when we are hearing hospitals say, look, it's really hard to discharge. We're not sure, um, where the patient can go.

When we're working with OCS, when we're working with our guardians, like those connections we really need to lean into so that we can make sure that we're caring for that patient as they are moving through that system. And so that's— think of care coordination as an umbrella term, and that's something that we are going to be leaning into and elevating, but it is not the only focus. And then I would say that third area around pay for value, that is that is its own goal, pay for value. And we did see some, but not a lot of readiness. I think everyone still is trying to settle in with what are those models, but organizations need to become ready so that they can implement and step into those models.

And everyone across the system is at different levels. And so that's where it was our sort of focused area to say, okay, we are going to help you in crafting some questions so you can identify, yeah, that's actually where my organization is. We are, we are leaning into those focus areas. So we're still working through, again, building out year 2, that application portal. It is quickly approaching.

We don't have a launch date yet publicly announced, but I would say you can see we're having a webinar today. The 23rd, we are coming together because we want to make sure that you are prepared and you understand where the department is at, and we hear from you where you're at so we can do this together.

Thanks, Commissioner. I think there's also a couple questions that I've seen that have come through that are looking ahead to the, to the future of the program and are interested in, you know, continuity as administrations change, as new leadership comes in. You know, we knew when, when this program dropped into our laps a year ago that we are looking ahead and saying, wow, we're gonna navigate these through some, some changes in leadership. And so is there anything that you can share about processes we're, we're building at the state level and direction that we've gotten from our federal partners around what we should be thinking about over the life of the program? Yep.

So first, the application that we submitted doesn't change. The, the 3 goals, the 6 initiatives, they do not change. We have an amazing team. I love working with our team. We have been transparent and very open from the very beginning.

And remember, as I started this webinar, we are in this together. So there is an administration change coming. We wanna make sure that the incoming administration understands the structure of this program. Who all of the partners are, contractors, the staffing, how everything is working together. We're gonna lay that out in a transition plan so that if people move, the work is going to continue and is going to continue to be seamless.

So that is the goal. We do not want the administration changeover to be a disruption to the administration of the RHCP program. Does that make sense? It does. And I think the other thing that I would add for people to be thinking about, what we continue to hear from our federal partners is that they are looking for states to follow through on the plan that they laid out in their initial application.

And that's where when we continue to, to kind of guide folks back to the initiatives that are outlined in that project narrative, that's really intentional because CMS is looking for us to say, here's how, you know, here's how all of the building blocks that we're placing around the state come together to build those initiatives, to build up to that plan that we made at the beginning. And CMS has been very clear with us and very clear with other states that they are not open to significant changes to the initiatives that were laid out and that were approved on the front end by CMS. And so, you know, I think we all learn more as we grow through this process. And I'm sure everybody in every state across the country is thinking, oh, I wish that I had phrased that differently, or I wish that we had structured this that way, because you don't know what you don't know. But I will say it also, I think, lends a degree of stability to the program as you look ahead, as you look to a new administration, you look to a change, and you know that that You know, kind of those initiatives and that structure really is the North Star for this program.

And we built it to be community-driven on purpose. What we said is we knew that this was going to go for a long time and that we wanted to hear from folks across the state because, you know, people in seats may change, but the people who are doing the work out in community are not going to change and the needs are not going to change. And we wanted to kind of really build a program and a structure that, that can sustain that over the life of the program. So do look for continuity and what are the goals and what are we trying to achieve.

Yeah, good job. And then I'm also seeing some questions here around, you know, the, the 5 applications, and I just, I think it's been answered some in the chat, but I want to say, you know, this is a reflection of how, how we're growing and building the program, right? I think every time we go through this process, we're going to learn a lot and we're going to identify areas that we'd like to try and see how does it work if we do it this way. And I think, you know, the intent right now is that we're looking at for each cycle that opens, you may submit 5 applications. That doesn't mean 5 applications over the life of the program.

It doesn't mean 5 applications applications per fiscal year. I promise I'm not going to try to make you try to unpack the fiscal year versus the state fiscal year versus the all the things. Just, you know, each time the cycle opens, we'd like you to limit yourself to 5 applications. I will say that if we go through this round and that really doesn't work, we can always adjust in the future as we move forward. I think that's what we're, we're learning as we have kind of built up a framework that we've used through this first cycle.

We've identified areas that we say, gosh, we could really make it easier for applicants if we did this. We could make it faster and smoother for the review process if we did that. So we're going to try that next time, see how that goes, and then we'll continue to learn and to grow and to evolve the process. Our intent really is to make this smoother and easier to move through. We know it is an incredible lift for all of you to invest your time and your energy and your resources into even telling us what your idea is.

That's before you even get out of the gate and start to work. So we're doing everything that we can to improve the process and to make it easier to engage with. I would also just add, like, there's a, you know, each organization has a different level of capacity, and the funding needs to be spent by certain deadlines. It is critical. And so I think part of this is tempering the enthusiasm with like, we can do it all, and measuring ourselves.

Like, if we're going to transform a system, there's gonna be shock to the system, and we need to make sure that we are measuring this out across state. Um, and so that's where it's, it's a little bit of an equalizer, um, to help with that capacity within that organization. And remember that grant reporting that comes in, that's a lot of grants to be, uh, managing at the same time. So it's important that we again are looking at the capacity of the organization to effectuate the project and the alignment to the work and what can be done in these short cycles. So that we can continue to accelerate this transformation journey that we are on within the healthcare system.

And speaking of the short timelines and the short cycles, we're also seeing a lot of questions where people are asking, you know, I had planned for an 11-month period and then time is taking the time that it takes. And if I need to pare my budget down because I don't think I'm going to be able to spend, what do I do? Part of that is you will work with, um, with the team that's working with you to finalize all of your details and the award agreement. And, um, you can work with us on an individual basis. But I'm also seeing questions that are coming out about, um, well, what are you going to do if there's unspent funds?

You know, you plan to spend all of this and then it doesn't work out, and what happens? Will we get an extension? Will there be more time? And, um, Commissioner, I don't know if you want to address that or if you'd like me to take— will there be more time for me to spend my money? Will there be more time to spend money?

Yeah, I was gonna say, so you said no. Yeah, there's no more time. CMS has been super clear with all states. Alaska is no different from all of the other states on this timeline. That's where you saw us identify we have to have a more efficient, effective application process so that we can get into a better cycle for the fall and the spring.

Spring because we learned a lot in that first year. So if you— I know we're at time— if you're an organization that says, now that I've received my award, I don't have the time to do this body of work, you need to come back to us so that we can modify that agreement and work through accordingly. Thank you, guys. So much. We are now at the top of the hour.

I knew we would not get through all of the questions, but we do plan to have more webinars. We're going to be in person on the 23rd of this month. So please continue to reach out to that [email protected] email. Your questions are really helpful because then we can pull people together to have that to a conversation. So thank you everyone.

Take care. Bye-bye. Bye-bye.