California-based rural well being system Marshall Well being is working with companions to develop a coordinated regional community that expands specialty entry whereas strengthening native capability and retains sufferers in native communities.
Positioned within the Sierra foothills, Marshall consists of 111-bed Marshall Hospital, positioned in Placerville in addition to a number of outpatient amenities and greater than 190 affiliated physicians and suppliers in El Dorado County.
Talking through the 2026 Digital Well being Summit placed on by the California Telehealth Useful resource Middle, Martin Entwistle, M.B.A., M.B., Ch.B., FRCSEd, chief of medical affairs at Marshall Medical Middle, mentioned his group is envisioning a hub-and-spoke mannequin with core capabilities that embrace:
• Central referral + consumption coordination
• Tele-specialty visits (scheduled + speedy entry blocks)
• eConsults for PCPs and ED clinicians
• Distant monitoring to stop avoidable ED/hospital use
• Commonplace escalation pathways to tertiary companions
• Shared high quality, fairness, and efficiency reporting.
Marshall’s 5-year imaginative and prescient is the creation of a scalable, technology-enabled rural care mannequin that improves entry, fairness, outcomes, and monetary sustainability. It might have:
• Standardized workflows
• Interoperable knowledge methods
• Expanded specialty entry
• Workforce improvement for coaching, recruitment and retention
• Superior use of know-how with AI-enabled knowledge administration
• A playbook for statewide replication.
“It’s actually essential that we share care, even when referral out is required, so we now have our sufferers again once more, with help for house well being, help for neighborhood care wraparound companies,” Entwistle mentioned. “If we’re in a position to keep line of sight to our sufferers, then we will try this. However when a affected person’s been referred out and getting care elsewhere, if we lose sight of the affected person, it’s totally onerous to offer that wraparound continuity of care.”
He added that with all of the challenges rural supplier organizations are going through, to be efficient Marshall must be proactive and preemptive. “Meaning not ready till a affected person identifies they want companies and are available to our clinic or our emergency division, so distant affected person administration and tele-services have so much to supply when it comes to line of sight about the place our sufferers are and the companies that they want.”
Entwistle mentioned Marshall is within the improvement of a rural well being community, bringing collectively totally different supplier entities that may be mutually supportive as a result of they’ve totally different capabilities, capacities, and expertise.
He gave one instance: A couple of years in the past Marshall was discovering it troublesome to maintain its behavioral well being and psychiatric companies. It labored out a relationship with the native federally certified well being middle, El Dorado Neighborhood Well being Middle, which has higher reimbursement charges. It may do work sustainably that Marshall could not do, he mentioned. “It’s labored out to be an awesome relationship the place we refer, they handle. Regardless of that, additionally they have challenges in recruiting and retaining workers, but it surely provides a clue to how a hub-and-spoke mannequin may work,” Entwistle mentioned. “Think about if there have been extra entities concerned in that, so it consists of others, corresponding to Tribal Well being, or a variety of different hospital entities. Now we start to generate crucial mass that may make it extra possible for us to recruit and retain and unfold the workload round.”
He added that Marshall may additionally use the community mannequin to fill gaps in companies which might be fairly difficult. “One we’re engaged on proper now could be outpatient neurology. We’ve got tele-inpatient neurology. We’ve got very excessive functionality when it comes to stroke administration, neurology administration, after which our sufferers discharge house again into the neighborhood, and we now have a major hole in continuity of care,” Entwistle mentioned. “So we’re figuring out how may we fill that. Our present plan is to make use of our rural community to have a blended mannequin. How would we develop a blended mannequin the place we now have the flexibility to offer face-to-face seek the advice of visits in addition to tele-support?
He defined that they’re hoping they will generate crucial mass amongst these within the community, in order that they may discover a technique to recruit and retain suppliers who work in a couple of facility — they may attend clinics in the future per week in Marshall, after which go to a few of different companions, and in between Marshall is supporting sufferers over telehealth by way of distant administration.
They’re constructing out a 5-year imaginative and prescient for the agricultural well being community. “We might be utilizing it to fill the specialist space gaps and to offer help for main care practices, corresponding to behavioral well being and ongoing care,” Entwistle mentioned. “We might use it to have the ability to scale up amenities for help of persistent care administration, corresponding to hypertension, diabetes, and behavioral well being points. The thought is that we’re in a position to share infrastructure and have partnerships with know-how suppliers in order that we will develop scale which will give us higher pricing.”
The imaginative and prescient is that they begin constructing the hub and spoke in a smaller method, after which over 5 years they develop to some extent that this can be a sustainable mannequin that builds at scale and retains sufferers in the neighborhood with a variety of companies from specialists, main care, and ancillary companies, and is built-in and coordinated.
He mentioned that with assist from the California Telehealth Useful resource Middle, Marshall did a digital well being evaluation in 2025 to take a look at its technical functionality, readiness, and workflows.
Marshall and companions have developed a Sierra Well being Collaborative with 5 hospitals in California and one in Nevada. “We’re engaged on how we will mutually help one another. How can we keep away from all of us attempting to climb the identical hill once we may very well be climbing totally different hills and help one another in that course of? And that is working fairly properly to date. It is early days, but it surely’s notably encouraging that since we acquired off the bottom initially with 4 hospitals in California and one in Nevada, we’ve had yet one more be a part of and extra are very to hitch that rural well being collaboration,” he mentioned. “We’ve additionally acquired partnerships with Tribal Well being FQHCs. We additionally centered on creating multidisciplinary groups with a variety of stakeholders internally which might be doing work or have experience in telehealth, distant affected person administration, AI, and care coordination. That has confirmed properly worthwhile, as a result of it helps us when it comes to the event of our infrastructure, It is all about creating infrastructure, not simply having know-how you are going to throw on the challenges.”
Entwistle closed by saying that that is an thrilling time to be doing this work as a result of the trouble has a really shut match to the California Rural Well being Transformation Program objectives.