From “Rural Bypass” to Regional Capacity: Building CA Hub-and-Spoke Specialty Care

January 16, 2026

By Sylvia Trujillo, MPP, JD and Emilia Ochoa-Ruiz, MS, PMP

Rural communities across California are facing a familiar pattern. When specialty access is limited and travel distances are long, patients often bypass local care to seek services elsewhere. This can result in delayed care, fragmented follow-up, or care that never happens at all. California’s emerging rural transformation proposals are explicitly designed to reverse this gravitational pull by strengthening local delivery systems and building rural hospital-led regional hub-and-spoke networks that make specialty support predictable, timely, and sustainable. 

Within the Rural Health Transformation Program overview, a core strategy is to connect regional rural hospital hubs with local clinics and telehealth spokes. The goal is to expand specialty access and enhance care coordination through transformation payments and evidence-based care models. 

What is especially compelling about California’s approach is the explicit emphasis on a digital “nervous system.” This is not positioned as a technology add-on, but as the connective tissue that makes regional capacity real. The program overview highlights real-time telehealth specialty access, eConsults, and remote patient self-monitoring as foundational tools to extend workforce reach and keep care local. The objective is not simply to add video visits. It is to create a repeatable pathway for rural primary care teams to reliably access specialty input, stabilize patients closer to home, and strengthen follow-up so fewer patients fall through gaps after discharge or referral. 

Designing Models That Reduce Friction 

Operationally, rural hub-and-spoke strategies are most effective when designed to reduce friction. This means minimizing delays, paperwork, and uncertainty for both patients and clinicians. For many rural communities, the most efficient approach is a blended specialty access model that includes: 

• Real-time tele-specialty care for situations where a specialist’s direct involvement is needed, such as complex medication decisions, maternal health consults, or specialty triage. 
• eConsults when primary care clinicians can manage patients locally with timely specialist recommendations. These models are often lower cost and easier to scale. 
• Remote monitoring during the time between visits, particularly following emergency department visits or hospital discharge, so early signs of deterioration are detected and managed before escalation is required. 

Defining the Hub’s Clinical Identity 

For organizations pursuing regional transformation funding, an essential early question is, “What should our hub be known for?” The strongest hubs do not attempt to cover every specialty. Instead, they focus on service lines that align with community needs and organizational readiness. Common examples include tele-behavioral health, cardiology support for hypertension and congestive heart failure, diabetes optimization, maternal health access, dermatology, post-discharge virtual ward monitoring, or telestroke partnerships. 

Once priorities are defined, successful hubs standardize workflows, build shared specialty networks, and create a single front door for referrals and eConsults. Governance is as critical as technology. Credentialing, escalation protocols, cross-coverage agreements, downtime plans, documentation standards, and feedback loops with primary care teams are what transform telehealth from episodic encounters into a reliable system of care. 

Field Notes for 2026 Planning 

• If referral routing is not simple, digital health tools quickly become perceived as extra work, and utilization drops. Ordering an eConsult or tele-specialty visit should be as easy as ordering a lab. 
• Start with one specialty where clinicians already feel the strain, such as long wait times, frequent transfers, or repeat emergency department visits. Early wins build trust and momentum. 
• Map workflows before purchasing technology. Platforms and devices should support the care model, not dictate it. 
• Engage CTRC early to evaluate readiness and vendor options, helping organizations avoid costly missteps. 

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