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.
Situated 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 in the course of the 2026 Digital Well being Summit placed on by the California Telehealth Useful resource Heart, Martin Entwistle, M.B.A., M.B., Ch.B., FRCSEd, chief of medical affairs at Marshall Medical Heart, mentioned his group is envisioning a hub-and-spoke mannequin with core capabilities that embody:
• 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 could have:
• Standardized workflows
• Interoperable information methods
• Expanded specialty entry
• Workforce growth for coaching, recruitment and retention
• Superior use of expertise with AI-enabled information administration
• A playbook for statewide replication.
“It’s actually essential that we share care, even when referral out is required, so we’ve got our sufferers again once more, with help for house well being, help for group care wraparound providers,” Entwistle mentioned. “If we’re capable of keep line of sight to our sufferers, then we are able to try 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 offer that wraparound continuity of care.”
He added that with all of the challenges rural supplier organizations are going through, to be efficient Marshall needs to be proactive and preemptive. “Which means not ready till a affected person identifies they want providers and are available to our clinic or our emergency division, so distant affected person administration and tele-services have so much to supply by way of line of sight about the place our sufferers are and the providers that they want.”
Entwistle mentioned Marshall is within the growth of a rural well being community, bringing collectively completely different supplier entities that may be mutually supportive as a result of they’ve completely different capabilities, capacities, and expertise.
He gave one instance: A number of years in the past Marshall was discovering it tough to maintain its behavioral well being and psychiatric providers. It labored out a relationship with the native federally certified well being heart, El Dorado Neighborhood Well being Heart, 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, in addition they have challenges in recruiting and retaining employees, however it offers 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, resembling Tribal Well being, or numerous 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 may additionally use the community mannequin to fill gaps in providers which can be fairly difficult. “One we’re engaged on proper now’s outpatient neurology. We’ve got tele-inpatient neurology. We’ve got very excessive functionality by way of stroke administration, neurology administration, after which our sufferers discharge house again into the group, and we’ve got a big 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’ve got the flexibility to offer 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 strategy to recruit and retain suppliers who work in multiple facility — they may attend clinics sooner or later per week in Marshall, after which go to a few of different companions, and in between Marshall is supporting sufferers over telehealth through 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 major care practices, resembling behavioral well being and ongoing care,” Entwistle mentioned. “We might use it to have the ability to scale up amenities for help of power care administration, resembling 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 which will give us higher pricing.”
The imaginative and prescient is that they begin constructing the hub and spoke in a smaller approach, after which over 5 years they develop to a degree that this can be a sustainable mannequin that builds at scale and retains sufferers locally with a variety of providers from specialists, major care, and ancillary providers, and is built-in and coordinated.
He mentioned that with assist from the California Telehealth Useful resource Heart, Marshall did a digital well being evaluation in 2025 to have 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 could possibly be climbing completely different hills and help one another in that course of? And that is working fairly effectively to date. It is early days, however it’s notably encouraging that since we bought off the bottom initially with 4 hospitals in California and one in Nevada, we’ve had yet another be a part of and extra are very to hitch that rural well being collaboration,” he mentioned. “We’ve additionally bought partnerships with Tribal Well being FQHCs. We additionally targeted on creating multidisciplinary groups with a variety of stakeholders internally which can be doing work or have experience in telehealth, distant affected person administration, AI, and care coordination. That has confirmed effectively worthwhile, as a result of it helps us by way of 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 hassle has a really shut match to the California Rural Well being Transformation Program targets.
