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, stated his group is envisioning a hub-and-spoke mannequin with core capabilities that embrace:
• Central referral + consumption coordination
• Tele-specialty visits (scheduled + fast entry blocks)
• eConsults for PCPs and ED clinicians
• Distant monitoring to forestall avoidable ED/hospital use
• Customary 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 will have:
• Standardized workflows
• Interoperable knowledge techniques
• Expanded specialty entry
• Workforce growth for coaching, recruitment and retention
• Superior use of expertise 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’ve our sufferers again once more, with help for residence well being, help for group care wraparound companies,” Entwistle stated. “If we’re capable of keep line of sight to our sufferers, then we are able to do this. However when a affected person’s been referred out and getting care elsewhere, if we lose sight of the affected person, it is very onerous to supply that wraparound continuity of care.”
He added that with all of the challenges rural supplier organizations are dealing with, to be efficient Marshall needs to be proactive and preemptive. “Which means 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 stated Marshall is within the growth 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 heart, El Dorado Group Well being Middle, which has higher reimbursement charges. It might do work sustainably that Marshall could not do, he stated. “It’s labored out to be an ideal relationship the place we refer, they handle. Regardless of that, in addition they have challenges in recruiting and retaining workers, however it offers a clue to how a hub-and-spoke mannequin might work,” Entwistle stated. “Think about if there have been extra entities concerned in that, so it consists of others, corresponding to Tribal Well being, or quite a lot of different hospital entities. Now we start to generate important mass that might make it extra possible for us to recruit and retain and unfold the workload round.”
He added that Marshall might additionally use the community mannequin to fill gaps in companies which might be fairly difficult. “One we’re engaged on proper now’s outpatient neurology. Now we have tele-inpatient neurology. Now we have very excessive functionality when it comes to stroke administration, neurology administration, after which our sufferers discharge residence again into the group, and we’ve a big hole in continuity of care,” Entwistle stated. “So we’re figuring out how might we fill that. Our present plan is to make use of our rural community to have a combined mannequin. How would we develop a combined mannequin the place we’ve the power to supply face-to-face seek the advice of visits in addition to tele-support?
He defined that they’re hoping they’ll generate important mass amongst these within the community, in order that they may discover a approach to recruit and retain suppliers who work in multiple facility — they may attend clinics in the future every 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 supply help for major care practices, corresponding to behavioral well being and ongoing care,” Entwistle stated. “We might use it to have the ability to scale up amenities for help of power care administration, corresponding to hypertension, diabetes, and behavioral well being points. The concept is that we’re capable of share infrastructure and have partnerships with expertise suppliers in order that we are able to develop scale that will give us higher pricing.”
The imaginative and prescient is that they begin constructing the hub and spoke in a smaller manner, after which over 5 years they develop to a degree that it is a sustainable mannequin that builds at scale and retains sufferers in the neighborhood with a spread of companies from specialists, major care, and ancillary companies, and is built-in and coordinated.
He stated 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 are able to mutually help one another. How can we keep away from all of us attempting to climb the identical hill once we might be climbing totally different hills and help one another in that course of? And that is working fairly nicely up to now. It is early days, however it’s significantly encouraging that since we obtained off the bottom initially with 4 hospitals in California and one in Nevada, we’ve had another be part of and extra are very to hitch that rural well being collaboration,” he stated. “We’ve additionally obtained partnerships with Tribal Well being FQHCs. We additionally targeted on creating multidisciplinary groups with a spread of stakeholders internally which might be doing work or have experience in telehealth, distant affected person administration, AI, and care coordination. That has confirmed nicely 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 expertise 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.
