In PYA’s video series, “RHTP Roadmap: From Award to Outcome,” the first episode, “So You Won an Award. Now What?”, focuses on what organizations should do immediately after receiving Rural Health Transformation Program (RHTP) grant funding to position their projects for long-term success. Managing Principal Lori Foley emphasizes that future funding often depends on strong execution, accountability, and measurable results during the first year.
Foley provides a practical roadmap for helping organizations stay on schedule, avoid common implementation pitfalls, maintain audit readiness, and demonstrate the outcomes needed to support continued success and future funding opportunities. She offers key strategies for Week 1 and in the first 90 days.
The episode covers governance, change management, workstream leadership, compliance, financial oversight, technology planning, and risk management and encourages organizations to
- Launch with a structured kickoff process
- Engage the right stakeholders
- Clearly understand award requirements
- Develop a detailed work plan that aligns activities, budgets, timelines, and performance measures with the goals outlined in the grant application
- Establish clear ownership
- Document decisions and processes
- Track key performance indicators from the outset
- Create sustainable programs that can continue beyond the grant period
Contact PYA’s Rural Health Transformation team for more help with RHTP decision-making and implementation.
Stay informed:
- Submit questions about RHTP implementation and the video series on our RHTP webpage.
- Watch for episode announcements on PYA’s LinkedIn.
- Catch the videos on our website and our YouTube channel.
Video Summary
Receiving an RHTP award marks the beginning of implementation. In “So You Won an Award. Now What?”, PYA Principal Lori Foley discusses how organizations can translate award requirements and grant commitments into an actionable implementation structure.
The discussion covers the initial kickoff, workstream ownership, performance measures and baselines, financial approvals, change management, sustainability, technology dependencies, and regular risk review. The central message is to reread the award, establish one master work plan, assign accountability, document decisions, and identify risks early.
Key Takeaways
- Use the kickoff to align the team on the award scope, period of performance, restrictions, committed deliverables, measures, open questions, and next steps.
- Build one master implementation work plan from the award and submitted proposal, with clear workstreams, deadlines, budgets, restrictions, measures, and owners.
- Give each workstream one accountable lead and document decision rights, approvals, consultation needs, and escalation paths.
- Establish measures, data sources, baselines, financial approval processes, and reporting expectations early rather than waiting for reporting deadlines.
- Plan for sustainability, change management, technology dependencies, staffing constraints, and implementation risk from the beginning.
Frequently Asked Questions
What should an organization do immediately after receiving an RHTP award?
Start by rereading the award and submitted proposal and bringing the appropriate implementation leaders together. The kickoff should clarify the funded scope, period of performance, restrictions, committed activities and deliverables, required measures, open questions, and responsibility for follow-up.
What should an RHTP implementation work plan include?
The work plan should translate the award into defined workstreams and identify deliverables, deadlines, budgets, spending restrictions, performance measures, compliance requirements, and accountable owners. Keeping these elements together in one master plan gives the organization a common view of what must be accomplished and how progress will be monitored.
Who should be accountable for RHTP implementation workstreams?
Each workstream should have one clearly identified lead accountable for moving the work forward. The broader structure should also distinguish the executive sponsor who can remove barriers, the project leads responsible for day-to-day execution, and the operational owner who will carry the program forward after implementation.
When should RHTP measures and baselines be established?
Measures and baselines should be established at the beginning of implementation. Organizations should identify which measures will show progress, which will demonstrate outcomes, where the underlying data will come from, who will produce it, and how frequently it will be reported.
When should an RHTP awardee begin planning for sustainability?
Sustainability planning should begin with implementation rather than near the end of the grant period. Organizations should consider which costs will continue after grant funding ends, whether revenue or other resources can offset those costs, who will ultimately own the program, and how the new activities will become part of ongoing operations.
What commonly causes RHTP implementation efforts to fall behind?
Potential sources of implementation slippage include staffing delays, vendor and equipment lead times, slow clinical adoption, data and reporting gaps, community engagement issues, and budget or compliance questions. Regular project reviews can help identify these risks early so the organization can address them before they materially affect implementation.
Transcript: RHTP Roadmap: So You Won An Award. Now What?
Speaker: Lori Foley | 30:23
Hello. Thank you for joining us today as we kick off PYA’s RHTP Roadmap: From Award to Outcome. We know many of you have been feverishly applying for state grants of all shapes and sizes, and most states have begun notifying applicants of granted funding. In some instances, this has come with some back and forth, so that the final grant may look a little different than what was originally submitted. But either way, many of you have gotten that grant application over the finish line. PYA is excited to be a part of your journey and is focusing this series on helping you and your colleagues achieve success.
We’ve named this first episode, “So You Won an Award. Now What?” We know that your opportunities for success will improve with strong planning and execution. We all know there is a lot at stake since the future funding for many of you is contingent on meeting defined measures during this first period. Even if your grant is only a one-year grant, the topics we talk about today will be important to helping you execute well and achieve your goals and your priorities that you laid out in your grant application. Execution is paramount, and we want to make sure you leave those lasting effects for the patients in your communities that you serve. My name is Lori Foley, and I am the managing principal of PYA’s National Healthcare Consulting Practice.
I’ve been with the firm for over 25 years, and like many of you, I have spent these past few months digging deep into what CMS is putting out related to RHTP, and how the states are approaching their grant awards and their sprint to this initiative. I have also assisted healthcare organizations of various sizes, including associations, with their individual grant applications, which of course have varied state by state, even though all the states are sprinting toward those five key initiatives across all of the grants, PYA’s RHTP Task Force is a multifaceted team consisting of operations, finance, audit. We’ve got managed care team members, data analytics, and clinical transformation professionals coming together to develop this series to help you successfully move forward from award to outcomes.
So let’s talk about that kickoff. It’s important to get the right people in the room from the very beginning. Before any workstream starts, hold a kickoff meeting with leadership and workstream leads. You’re going to need to include a lot of people depending on your organization. It’s important to invite the executive sponsor, the grant or program manager. Your organization may have different individuals for finance and operations.
You’ve got legal to consider as well as compliance, information technology, human resources, clinical leadership, communications, and of course, any community or partner organizations that were named in the grant with you. In some settings, such as a small rural health clinic, this may be two or three people who are wearing many hats. In a very large organization, it may be 25 people who are each focused on specific areas that are interrelated and therefore need to be communicating together. It’s important to scale the invite list to be effective for you but not scale the agenda. What you need to cover is important, regardless of how many people you have in the room. Before you hold the meeting, we recommend sending the notice of award and the submitted proposal in advance so that everyone can read it ahead of time and be starting closer to your end objectives.
Once you have everyone gathered, it’s important to walk the award terms or talk about them out loud. Talk about the scope and the dollar amount. What is our period of performance that we’re aiming for? Is it multiple years or one year? Is it a partial year? We’ve seen that in a number of these grants.
What are the restrictions, and are there any matching or sustainability requirements? We know one of the key objectives of our RHTP is the activities we take are sustainable. While you’re together, think about three things that you need to get covered. First of all, what was awarded? What is the scope of the funding, what are the dollar amounts? How is it executed?
Is it prepaid or is it reimbursed? What’s the period of performance? And every restriction that is attached to that money needs to be articulated and shared with the group.
Second, what did we say we would do as part of our grant application? The activities and the deliverables, the timelines that you committed to, are all important to share in this meeting, in language that everyone in the room can clearly understand and that they can repeat to others as they are explaining what they are doing. Many times, you’re going to be pulling them from areas of their day job, so to speak, and so being able to articulate what they’re accomplishing will be helpful. We also need to talk about how we are going to be judged as part of this grant initiative. What are our measures and reports, our milestones that the state will use to decide whether this project and this initiative, the grant funding that they gave you, will work?
Be sure to close by capturing any open questions, any decisions that were made and any follow-ups, name workstream leads. We’ll talk about that a little bit more in just a moment, and then putting a recurring review or a recurring calendar appointment on your calendar so that we are all meeting on a regular basis, communicating well as you go throughout this process.
So now that you’re running a program, not a grant, it’s important that you remember that you are receiving funding to deliver measurable outcomes under a compressed timeline in many circumstances. So therefore, it’s important to really build a work plan that’s based on what the award requires, both in what you said you would do and what the state said you must do.
Remember that last slide when we said it’s important to explain the grants in plain terms. It is so that everyone understands your true north through this project. It’s important to start with a clear vision that is stated in very practical terms, easy to explain, easy to digest, easy to replicate, because you’re going to have to say it and write it a lot. It will all be critical to your ability to move fast and efficiently. Most of your work plans should really be focused on operational execution and change management. That’s going to be key, and we know that change management can only occur so fast, but again, we have those compressed timelines in many circumstances.
Be sure to organize the components of your grant award and organize them into defined workstreams with clear responsibilities identified, owned by specific individuals. You may have committees weighing in, and you might have them steering, but you need an individual to own it, move it forward. Be sure to identify your metrics and any milestones that you need to have set. Specific key components to identify will include your deliverables and your deadlines, your budgets and your related restrictions on spending and how those dollars must be accounted for. Including those performance measures on the front end is important, particularly as we try to get to data and baselines, and then also understanding compliance requirements and such.
Remember, the key objective is sustainability. So as we’re going through these processes, we need to be thinking about how this is going to survive past this sprint. As you go through the exercise, it helps to distinguish the executive sponsor. That person’s goal should be to remove barriers and provide authority. We need decision making. Project leads are going to run the day-to-day work, and they are going to be incumbent on your specific areas on how you’re able to execute and move the needle.
And then overall, who’s the operational owner? Who owns the program after implementation? They need to be involved because they need to help us set the processes so that the baton can be passed and then they can take it and carry it forward. In struggling projects, we see that these roles are often blended and unclear. So really hope that you get the opportunity and the time to set them here at the beginning, so that you can then leverage them as you move through the initiative.
So let’s talk about suggested workstreams that you need to stand up as part of this initiative. These are suggestions; they’re not a required structure. You want to add workstreams that the award specifically calls for. For example, construction, telehealth, workforce, community partnerships, and drop any that do not apply. We don’t need any noise.
You will also want to include some key areas that will be important to execute for your grant. For example, finance team members. This will include those who will be responsible for budget setup, identifying spend restrictions and making sure that they evaluate any of our expenses against those restrictions. They’ll handle cost classifications, which are important when we look at direct versus indirect cost treatment. They will be responsible for reconciling reimbursements, and they will have likely monthly variance reporting. And they definitely need to be preparing for audit readiness.
On the operations side of the table, we’re thinking through a number of areas, such as workflow redesign, scheduling, staffing models, space considerations, supplies, and of course, the actual delivery of services.
Your legal and compliance team members will also be involved. They will be thinking about subrecipient and vendor contracts, so they were involved probably from the very beginning. They will be looking at licensure and any credentialing considerations. Privacy and security are always paramount, and of course the award terms and conditions.
Our IT team will be key. In most of these grant awards, there tends to be a technology component. They will be thinking through things like systems and interfaces. Does the EMR have the right configurations? What about telehealth and connectivity, especially for launching new programs? They, of course, will be thinking about device procurement, security, and then technical sequencing, which will be important to getting from step A to B to C, so that we can execute.
When you think about your clinical and quality team, you’re looking at protocols, clinical champions, training, and then making sure we have the expected measures, that we’re capturing them and performing to them.
Your HR communications and community team will also be involved for key parts. Thinking about recruiting and onboarding if you’re expanding your workforce, internal messaging, relationships with partners named in the award, and if you are having to do training and expanding that workforce, they will be key in helping you manage that.
Size will matter again in a small clinic. One person may cover finance, legal, and HR. In another organization, it may be a separate team with its own subgroup and a standing team. Regardless of the size and the initiative, what does not change is that each workstream should have one lead that is accountable at the weekly review meeting that we talked about a few moments ago.
So one of the key things that will be important will be putting this structure in writing. This is for several reasons. First of all, if it’s only in someone’s head, it is hard to transfer knowledge, and if something works, it’s hard to easily repeat and leverage that. And if it doesn’t work, we don’t want to make those same mistakes repeatedly. Again, with a multi-year trajectory related to some of these grants, this will be important. Having a good roadmap written down as to how you have navigated through each step, and that you’re not starting at square one each time.
There will be enough uniqueness within the process that you’ll have to deal with. We certainly don’t want you to make it harder on yourself than it must be. So, this is an example of wanting to work smarter, not harder. So having a core area to save these documents, write information down, write down processes, decision factors, what was considered and what was discarded will all be important.
Some of the key things that you will need to include as you write down are your measures and your key performance indicators, your KPIs. We want to decide upfront what numbers will show progress, so activities or process measures, and which ones will prove success or our outcomes measures. Where each number is going to come from, who’s going to pull it, how often, what reports we’ll use-all those things are important to understand on the front end. We want to capture baselines now before the work starts.
The second set of information to write down are your financial approvals, really documenting the approval thresholds, who can commit funds and at what levels, what types of authorizations are required, how purchase requests and contracts get routed? Because again, there are tight timeframes and turnarounds for many of these. What is the expected turnaround? How do we expedite that? We want to make sure that we’re not slowed down by unknown approval processes because we don’t want to have project slippage.
Third, we include the suggestion that you build a RACI matrix. So, for every major activity named, who is responsible? Who does the work? That’s what responsible means. Who’s accountable? Meaning, who owns the outcome, and is it only one person?
We recommend one accountable owner. Who needs to be consulted? Whose input do we need to get before we decide? And then finally, who needs to be informed? They can be told after we’ve decided. The key is to outline all of the tasks that need to occur, identify the role that each individual will play, and then understand that this will need to be updated as you move through the process, things are going to change, and that’s important to document and again keep everybody on the same page.
From the project team perspective, it really is making sure we have the standing team that’s the framework that everything else hangs onto. We need to define the membership of that team. How often are we going to meet? And it may be faster in some areas, or more frequently, and then slow down depending on phases. What’s the escalation path to inform leadership? Again, we want to write it all down.
And a structure that lives in one person’s head does not survive the first month. So we want to make sure that this is sustainable and that you can execute.
So as not to get overwhelmed, we think it’s helpful to think about implementation in layers, breaking it down into consumable steps.
First is program governance, which sets the project direction. Where are we going? How are we getting there? Who are the decision makers? The bodies, the departments, whomever that may be, and how do we go ahead on the front end and determine any escalation paths and authority behind them that we need to know about? For many of you, you must move very quickly and efficiently.
The normal analysis and evaluation processes used within your organization may not hold, given the time requirements imposed by the state on the providers as they are executing on these grants.
Second is identifying the management team who will deliver how the work gets done, any process changes that we need to fully think about and vet out, how the programs are going to be assigned and implemented.
Those are all key to really understanding how we’re going to get through that second layer, and of course, that third layer, the hard one, is change management. How can we make this as sticky as possible? We need it to stick with our team members and our patients. Change behavior requires a lot of training, it requires communication, and it requires reinforcement. Rinse and repeat, rinse and repeat as we go through. So, thinking through each of these has a different question, and a weakness in any of these three layers can create risk for the other two categories.
Recall again that your initiatives are intended to be sustainable, and sustainability decisions begin at the very beginning, before the first dollar is spent. We need to be thinking about how are we making sure that we are making decisions and implementing these changes, the processes, these programs in a way that will continue after the grant funding ends. So, questions that we need to be asking immediately include that: What costs will continue after the grant funding ends? What revenue offsets are there for those costs? What do we need to be thinking about in the process of execution? And as we mentioned before, who will be owning the program once the grant ends?
How does it get absorbed into the day-to-day operations and activities of your organization? These types of considerations are going to be especially important for programs that include care coordination, telehealth launches, workforce programs, community health care workers, and then technology platforms. They are not once and done, no matter how we approach them in our grant.
Thinking about change management, this one’s a hard one, especially in the circumstances we’re dealing with. Ideally, we would like to plan it at a pace that people can absorb. We know that failure often occurs when change happens faster than it can be absorbed, or that there are too many changes all at once. Depending on your grant, though, this could be a significant challenge. There are some tangible barriers such as information technology, but the people side can be equally challenging. And if your grant commits you to a lot of different things in a rapid succession, you must really, really keep your guard up to be able to achieve the change that you want and sustain it.
For example, as mentioned, we know that information technology, again the base platform for many of the initiatives, can only move so fast. We’ve got to procure equipment. There must be interfaces. There need to be security reviews. Vendor queues are real constraints, and they’re helping many people in a short, compressed period. So, I think supply is going to be a bit of a challenge for some of these.
It’s important again that IT have a seat at the kickoff table that we identify all the technical dependencies that will impact your ability to execute. Make sure those are on the schedule early and then build milestones around them rather than assuming they will compress. Hopefully, you were able to consider that in your grant application, and maybe you spaced out some of the activities, knowing that those barriers would be real.
Thinking about your workstream size depends on the organization. So, for again, a small clinic, it may be a single individual who is able to execute in a couple of different seats. For a large health system, it may be a team, it may be subgroups of teams, it may be teams that haven’t worked together before having to come together. Regardless of your approach, it will be important again that you have the team identified and that you have a team lead who is herding your cats, if you will, moving everybody in the right direction, making sure we’re focusing on all the right important things.
We know people can absorb only so much change at once, so we want to sequence go-lives where we can. We want to train close to the change rather than months ahead. They need to be able to apply what they’ve learned quickly, and we want to protect time for training against clinical schedules, particularly where you have providers that are patient facing. But it is just as important for the staff that are supporting those providers as well. Wherever you can, we know it’s helpful to have a champion in each area. That person can help communicate the why of what you’re doing and not just the what, and they can help make a new workflow a default rather than optional.
We want to make sure that individual and your teams are reinforcing after go-live so we don’t have fading or attrition as we slide back into prior processes or perhaps prior behaviors prior to the launch of your new initiative.
We also want to schedule, make sure you have established regularly scheduled reviews. And by that, go back to your work plan, look at all your tasks, and make sure that we are color coding it on a regular basis for where we are in the project and if we have any risks. We want to identify risk early so that we can redeploy as needed and be sure to mitigate that risk when we can. Red, yellow, green is always a great way to look at it. Green means we are on track. It may not mean that we’re completed, but we’re on track as we are progressing.
Yellow means there is a little bit of rising risk, and red means there is significant risk that the team needs to be aware of and needs to address.
Once we leave every meeting, we want to make sure we have a good, organized meeting, have an agenda, know what you need to accomplish, know whether or not you need to create any subgroups for some side decisions to come back to the big group because most of these are going to be a big resource strain. You’re going to have a lot of resources that have a lot of things to execute on, so another meeting isn’t going to be desirable, but it is going to be important. So, we want to make sure that that meeting is as efficient as possible. Be sure to leave those meetings with a list of all of the items that were decided for the day, any open items that need to be followed up on, what’s the plan to update leadership and remove any barriers as you’re going through. Who’s communicating that? What are we communicating, and how are we continuing to march forward as you execute on that complex and detailed project management list?
It’s helpful too to know where we see slippage. So, knowing what usually goes wrong, most implementation slippage kind of traces back to a short list of predictable causes. Plan the mitigation before the review turns red. That’s our goal. We don’t want to get to red, but if we do, here’s what we’re going to do to resolve it.
Some key things I know that are integrated into several of the grant initiatives could include hiring and staffing delays. We know that takes a lot of time in certain areas and for certain positions. So, we want to make sure that you’re recruiting in parallel with your startup plans. If necessary and available, use interim or contracted resources to help make sure you’re hitting the timing deadlines. Even though it may not be the most efficient path forward, maybe from a cost perspective, but really making sure we’re able to continue to initiate and launch.
Also, considering we talked about it a little bit earlier, but the vendor and equipment lead times again, those are going to be real. Order those long lead time items first so that they can be in process, confirm installation dates before committing to milestones, particularly the go-live. So, you can pencil them in. You can tell people this is what we’re starting for, but until you get a firm date, you won’t know.
Thinking about clinical adoption again, we talked about it a little bit. Slow clinical adoption is always a barrier. Training early, training often, having your champions, making the new workflow the default as quickly as possible, working out the kinks but still pushing that forward.
Sometimes we’ll find delays as people are looking for data and reporting gaps, and that really comes down to trying to define the measures and the data sources. Doing that from the start will be helpful, not when the first report is due because then it’s too late, particularly if you need to be capturing information along the way. So, if you’re having to modify your workflows and processes to capture key information, where is it going to get stored? How are we going to access it? How can we pull it out in a reportable format that supports your grant reporting obligations?
Sometimes we must watch for community engagement drift. We want to make sure that there is a single relationship owner and scheduling plenty of touch points in advance. What does the community engagement look like? What are your partners? What role are they playing? How much or how little are they part of the conversation on the front end and the planning, absolutely on the deployment.
Who owns that relationship? Who’s a backup in addition to that ownership? So that we know if somebody’s out in a way that we don’t stall. How can we keep that process moving forward? Keeping them informed, getting the right information at the right time.
So again, your team is making the right decisions as they are building this plan and working their way through it, and then we hate budget and compliance surprises. So making sure that we understand we’re tracking our spends against restrictions from the grant monthly, that we’re escalating variances, that we’re asking questions if there are circumstances where we just don’t know. If it should be tracked this way or tracked that way, is this expense in it? Is it in? Is it out? Is it over our budget?
If it’s over our grant budget, then how are we going to reconcile that? Those are all critical things that you should be evaluating as they come up, and not just at the end of the day.
So again, just if I had to summarize it into five mistakes that we see new grant awardees make: waiting for reports before defining measures and then waiting to collect baseline information. We can’t wait for it to be perfect. Sometimes we’ve just got to move it forward. Hiring too late, underestimating that procurement process, and then again, thinking through our sustainability plan, we must start thinking about it now, and not at the end of year three or four or five, whenever your grant expires. It needs to be fundamental and foundational in all your execution and planning.
So, if you only walk away from this discussion remembering a couple of things. Remember this slide and stick to these decisions.
So, what do you do next? How do you start this week? Be able to track your process and your progress towards your original goal and know who’s responsible for contributing to those tasks. How are we moving the ball forward? While no one needs another meeting, we talked about that earlier. It’s critical that your team commit to those regular touch points wherever needed.
And again, evaluate. You may need to have more this week because you’re at a critical juncture, but it could be fewer. You may spread it out a little bit if people are doing things and it’s too early to come back and report.
Make sure that you reread the award. Prepare one master list. It will be very helpful to have one master project. Your work groups are going to absolutely have their own lists, but you need to have one that is capturing everything, and make sure that list includes every deliverable, deadline, every restriction, and measure identified, all in one place. As we talked about, it’ll be important to name your owners, one accountable owner per workstream. That person’s important for the workstream and the subsequent activities related to that.
We don’t want committees for decision making because that’s where people tend to get bogged down. Be sure to include that regular cadence with that standing agenda and our standard reporting format, so that familiarity will make it easier for everybody to know where to look for key information, key dates, key things as they’re moving along. If a key person, a key committee member, somebody is absent, they need to send a second so that nothing goes missed. We can’t risk something going missed in a meeting and they just missed it because they weren’t there, and then finally making sure you have your baselines, your measures, and you’re capturing those starting numbers now so you can prove your impact later. Again, quick out of the gate, you’re going to need to show your value for the dollars that the state has expended as you’re moving forward.
Now, if you received your grant award a few weeks ago, use this list to kind of measure your progress. Are you getting good traction? Do you need to focus and redirect your team to make sure you’re getting traction as you move forward? Do you have those regular meetings on the calendar? And are people coming? Are they coming prepared?
Are they coming with information or suggestions or work plans? More importantly, are those people reporting progress in those meetings? And is your time or is your timeline already at risk? If it is, this is the time to recalibrate, get it in line so that you can move that forward. Particularly with your future funding being contingent on success in the first year, you want to make sure you’re putting in the necessary time, structure, resources now to help have success. That will help you make sure you’ve got the right structure, the right reporting, the right cadence, all of that in place as you look for success with your first grant year, and then any additional funding in subsequent years.
We find that organizations that achieve the strongest outcomes are not always the ones with the largest budgets. They’re usually the ones that have established that accountability early. They measure consistently, and then they make course corrections quickly. And I think that’s a key challenge sometimes in a large organization. If we have to loop in a lot of folks to make course corrections, we’ve got to be able to expedite that process.
We hope this information has been helpful to you. And within the next few weeks, the PYA RHTP Task Force will be releasing videos on a variety of topics relative to this sprint that you are on. We will include topics on facility assessments, compliance planning, dashboarding, and demonstrating your achievements. Single audit preparedness will always be front and foremost for our colleagues. And then, towards the end of the year, we know we will have some insights into year two activities. We hope that you will join us and that your RHTP journey is successful.
And if we can help you as you go through that journey, be sure to contact me at lfoley@pyapc.com, and you can also learn more at pyapc.com/rhtp. And then thanks again for joining us today. Glad you’re here.
