Written by: the SHSMD Small/Rural Task Force
At SHSMD Connections 2025, strategy and marketing peers from small and rural organizations joined together for a focused member meet-up. Attendees had the opportunity to “speed date” in three of six different categories of interest for small and rural healthcare organizations. The conversations created space for candid dialogue around the realities small and rural health organizations face while moving beyond theory to practical, peer-driven insight.
Facilitated by four volunteer SHSMD leaders (Khrista Boster, Chief Marketing Officer, Woodlawn Health; Rachel Lott, Senior Strategist, Endeavor Management; Mark Crow, President, Tenth Crow Creative; and Sara Meyer, Director of Marketing, Business Development & Call Center, Wood County Hospital) and two SHSMD Advisory Board members (Terri Flood, Vice President of Marketing & Business Development at Wayne HealthCare, and Julia Yoder, Marketing & PR Director at Brookings Health System), the session unveiled the following insights.
Navigating Women’s Health & OB Challenges
Rural communities across the United States face increasing challenges in delivering women’s health and obstetric services as workforce shortages, financial pressures and declining reimbursement force many hospitals to reduce or eliminate local care options. As a result, many women must travel long distances for prenatal, delivery, and postpartum care—placing strain on families and increasing risks to continuity, trust, and long-term health outcomes.
These realities framed a focused discussion where marketing and strategy leaders shared candid, solution-oriented dialogue. Participants explored guiding questions related to service gaps, workforce limitations, funding reductions, and evolving models of care. Leaders consistently described women’s health as more than a single service line—encompassing preventive care, behavioral health, chronic disease management, and support across all life stages. However, they noted a growing disconnect between community expectations for comprehensive local care and the operational realities rural and small systems face.
Common challenges included difficulty recruiting and retaining OB providers, reliance on midwives or primary care physicians to fill gaps, financial strain from low-volume, high-risk services, and fragmented care when services are spread across regions. While alternative staffing and care models can preserve access, they also introduce regulatory, operational, and perception challenges.
A key theme throughout the discussion was the importance of strategic partnerships with health systems, federally qualified health centers, and community organizations. When grounded in shared outcomes and clearly communicated, these collaborations can support sustainability and community trust. Participants also shared innovative approaches such as bundling women’s health with primary care and pediatrics, leveraging telehealth, and positioning women’s health as a gateway to lifelong patient relationships.
Ultimately, the session reinforced that women’s health and OB challenges in rural communities are strategic imperatives requiring mission-aligned leadership, creative partnerships, and cross-functional collaboration.
Strategies for Medicare Advantage Plans
Small and rural organizations who have Medicare Advantage (MA) plans on their radar are concerned about lower reimbursement rates. Maintaining operating margin is fundamental for them to keep doors open and serve their respective communities. In general, participants identified their organizations as falling into one of two categories:
1. Health systems who no longer participate in some or any MA plans;
2. Health systems who remain in-network with MA plans while competitors drop MA, giving in-network providers a larger share of MA covered beneficiaries in their payer mix.
Concern centered around educating Medicare beneficiaries about MA plans vs. traditional Medicare. Because healthcare providers are not allowed to steer patients to choose one plan over another, one strategy is to host State Health Insurance Assistance Programs (SHIPs). The federally funded, state-run programs provide free, neutral counseling to help Medicare beneficiaries make informed decisions about Medicare and health coverage. Another strategy is to go to the people and bring information to them. Social workers, care coordinators and financial counselors will visit senior centers, community service groups and health fairs to educate beneficiaries and offer one-on-one conversations.
A common solution to help educate Medicare beneficiaries en masse about MA plans is coming together as an industry. In Texas, several hospitals collaborated on a campaign that encouraged Medicare beneficiaries to understand the difference between traditional Medicare and MA plans. In Nebraska, the state hospital association led similar efforts with a social media video campaign.
Positioning Marketing as a Strategic Partner in Your Organization
Members who gathered to talk about how to position the marketing department as a strategic partners walked away with the following key elements:
Take the Seat: Marketing professionals are often hesitant to take a seat at the C-suite table in smaller organizations, but they need to. For marketing to not be an afterthought, marketing leaders need to not only be at the table, but insist on always having a seat at the table. This mindset can be uncomfortable as many members in these discussions perceive themselves and fellow marketers as people pleasers.
Know Your Numbers: Strategy cannot function without numbers and attendees had a lot of conversation about how to measure marketing so it can become a strategic function, especially in regards to growth strategy.
So many times, it is hard for marketing to take a seat at the table. It is not always so freely given. However, that seat is often not taken because marketing professionals do not understand the value they bring to their organization. Their ability to understand strategy and to let numbers tell the story of the organization's viability should never be underestimated.
So how can marketing directors and professionals take a seat at the table? First, show the value they bring to the organization. Looking at the monthly financial statements, the number of office visits, and so much more, shows how they are helping to advance their respective organizations. Second, take that value and market yourself to the board, executives, and directors. Third, keep studying the numbers and bring them back to the daily tasks and campaigns you are running. You are not a cost center but a revenue generator.
Healthcare is in flux again, and more than ever, you are needed at the table in rural healthcare. So please take the seat.
Promoting Partnership Service Lines
Partnering with independent physicians, larger hospitals or systems, or third-party service line providers can help small and rural hospitals share the cost of operating specialized service lines while ensuring their community has access to higher levels of care. Legal and compliance obligations place guardrails on the traditional marketing process a hospital might undergo to promote these services. During the Small/Rural Member Meetup at SHSMD, we discussed how to navigate those legal relationships and set up the partnership on the front end for successful marketing.
Many attendees expressed they are not involved in the process of structuring service lines on the front end, but are brought in to support the promotion of that service line once the operational effort to develop it is underway. We talked about ways to gain more influence in the beginning of that process, like engaging with the team(s) or leaders responsible for developing service lines as part of the annual marketing budgeting conversation in order to anticipate those opportunities.
An important element of the conversation was the way legal or contractual relationships shape marketing efforts. (Note: Content of this writeup is not legal advice and readers should consult their organization’s legal counsel for any questions or advice on this topic.) Attendees used a variety of strategies depending on budget and resources. When a particular service line is driven by an independent provider’s patient panel, hospitals are taking care to avoid any legal or regulatory concerns regarding how the service is promoted. Some organizations limit their organization’s marketing efforts to basic physician information like what would be listed in their website provider directory, allowing the partner to take the lead role in marketing the service. Others work with legal counsel to draw up shared cost agreements that allow the hospital to take the lead role while ensuring legal and regulatory compliance.
When sharing service delivery across entities, for example, seeing an independent specialist in their office and then having a procedure done by that specialist at the hospital, marketers are directly engaging those partner providers to align clinical goals and marketing messages. This helps to adequately educate potential patients and allows marketers to weave clinically-relevant messaging into existing messaging.
Overall, we learned there is more opportunity for rural and small hospitals and marketers to seek out partnership opportunities in order to provide more access to care for their patients, enhance the hospital’s relevance to their communities, and support the organization’s long-term financial viability.
Strategies for Population Health & Social Determinants of Health (SDOH)
The discussion around population health and social determinants of health revealed a wide spectrum of engagement among small and rural health care organizations, ranging from early awareness to more active, community-embedded initiatives.
Some participants shared candidly that their organizations are still in relatively early stages, with limited formal population health infrastructure and few dedicated resources. In other cases, efforts are happening more organically rather than strategically, driven by passionate individuals, grant opportunities, or immediate community needs rather than a comprehensive roadmap.
Other participants described growing momentum and experimentation. Examples shared during the discussion included wellness programs, mobile screening initiatives, transportation support for patients, and closer collaboration with community-based organizations. For some organizations, population health work is becoming increasingly intertwined with access, workforce stability, and long-term sustainability, particularly in communities where health care providers are often one of the few remaining anchor institutions.
Across the group, there was broad agreement that while the intent and commitment are often strong, rural and small organizations face unique barriers: limited staffing, competing priorities, funding constraints, and challenges measuring impact in small populations. Participants emphasized that “doing population health” in a small or rural context often looks different than in larger systems. It may be quieter, more relationship-driven, and harder to quantify, but no less meaningful.
The conversation reinforced that rural and small providers are actively grappling with how to move from awareness to action, how to scale what’s working, and how to tell their story more clearly — both internally and externally — as population health and SDOH continue to shape the future of health care delivery.
Managing with a Small Team & Running Short Staffed
Attendees shared how to keep a small team operating effectively and making the most of the resources they had. One tip for prioritization was to always refer to the organization’s strategic plan to decide what comes first. Some specific areas of focus included:
Community Event Tips: Pay staff to attend community events to ensure success or give them SWAG or a PTO day in exchange for volunteering their time. Create a communication flyer before events with brand standards and expectations that are given to all attendees representing the organization. Find ways to make events fun to get more volunteers.
Project Management and Systems: ticket systems for work requests can create automation to add projects to management software like Zapier. Other programs people used included Basecamp, Hipporello, Freedcamp and Click Up. Using a project brief can also help marketing understand the request before meeting with the manager, plus it can be used with AI to develop content.
In addition, attendees stressed that health care recognitions should be in the purview of managers, not marketing and communications, to focus on. The organization’s apparel store is also a good spot to incentivize people. Members also encouraged one another to meet monthly with department managers to stay on top of what is going on for service lines and to meet their needs.
Conclusion & Keeping the Conversation Going
At the meet-up conclusion, attendees were encouraged to find their people and make at least one meaningful connection. Resources offered by SHSMD to keep the conversation going include the online Member Meet Ups as well as the MySHSMD online community for small and rural members. LinkedIn is another opportunity to connect with other small and rural champions.
Other steps SHSMD members from small and rural healthcare organizations can take to advocate include submitting proposals for next year’s SHSMD Connections and to volunteer for SHSMD’s committees. Together members can build a peer network of strategy and communication professionals dedicated to solving the challenges rural and small health care organizations face.