The Alabama Thesis

Maternal Health and Where the Data Takes Us

Health Rounds — Wed, 17 Jun 2026 18:55:45 GMT

Women living in counties with the highest travel times (top 20 percent) could travel up to 71.9 miles and 78 minutes, on average, to reach their nearest birthing hospital.

A woman in Perry County, eight months pregnant, drives 90 minutes to her prenatal appointment. The hospital in her town stopped delivering babies three years ago. She does this every four weeks. In the third trimester, every two.

That 90-minute drive is not only inconvenient, it’s the precursor to why many women who give birth in Alabama, and their infants, don’t come home.

Alabama’s maternal mortality rate is 38.6 deaths per 100,000 live births. The national rate is 18.6. That’s more than twice as bad which in Alabama means roughly one woman dies in childbirth every two weeks.

Nationally, Alabama ranks 9th in maternal mortality, 3rd in infant mortality, and 4th in preterm birth rate. But these numbers aren’t fixed. They’re the result of specific, traceable decisions, which means they can be traced back and changed.

How it got this bad

A maternity care desert is a geographic region with no birthing hospitals or birth centers offering obstetric care, and zero obstetric providers (such as obstetricians, certified nurse midwives, or family physicians who deliver babies).

More than 37% of Alabama counties are maternity care deserts. No OB. No midwife. No place to give birth within a reasonable distance. Getting to prenatal care means a long drive on a good day. Getting to an emergency department means hoping you actually make it.

The deserts are growing because hospitals have been closing their maternity wards. Why? Delivering babies is expensive, reimbursements are low, and Alabama hasn’t expanded Medicaid. The math puts a hospital administrator in an impossible spot.

They absorb the losses until they can’t. Then someone has to decide: close the ward, or close the hospital.

Medicaid already covers 42% of all births in Alabama. Expanding it would reduce the financial pressure that’s pushing hospitals out of the delivery business. This policy fix is well known, highly debated and Alabama women are living with the consequences every day.

What’s been done

Concerted efforts have gone into solving this problem for years and Alabama has made progress. The state extended postpartum Medicaid coverage from 60 days to a full year after childbirth, which matters a lot for new mothers who used to lose coverage sooner. Alabama also joined the federal Transforming Maternal Health model, which connects pregnant women to food, housing, and substance use support. The Yellowhammer Fund launched a mobile health unit running reproductive and maternal care into rural counties.

These are investments by people who deeply understand the problem. They’re also not enough.

Out of six key maternal health initiatives recommended by the March of Dimes, Alabama has adopted two. There’s no statewide doula reimbursement. No guaranteed home visiting for new mothers and programs that exist reach too few people.

The Solution: a county-level innovation

The usual question is: who pays for healthcare? The better question is: who’s already paying for the damage?

Employers are.

Every time a worker loses a pregnancy, takes extended leave, or comes back to work caring for a sick infant, an employer eats that cost. Turnover. Disability claims. Lost work. They’re already paying for this problem. They’re just not getting anything back for it.

That’s the opportunity.

Employers across Alabama (e.g.manufacturers, utilities, school systems, hospital networks, regional banks), operate in the same counties where their workers live and give birth.

What if they funded a county-level maternal health program? Not as an employee perk, but as something built to solve their problem, the way a company funds a United Way campaign or a wellness program. No insurance approval needed. No Medicaid waiver. No policy reform. Just an investment in the county where their people live.

Nobody has built this in Alabama.

How it would work

Alabama already has the foundation. It’s called the Alabama Coordinated Health Networks, or ACHN. Nurses, social workers, and regional teams use it to manage maternity care for women on Medicaid across the state.

The gap? ACHN reaches women on Medicaid, through medical staff, at medical visits. It doesn’t reach every other pregnant woman in the county. It doesn’t reach anyone between appointments. And it doesn’t reach them through someone who actually knows her community.

That’s where the navigator comes in.

A community perinatal navigator is a trained individual from the county she serves.

She knows the back roads.

She knows the churches.

She knows the reasons someone might miss an appointment.

She checks in between visits. She catches high blood pressure before it turns into an emergency. She connects women to help before something goes wrong. One navigator can support 20+ women at a time w/ the help of technology. A small team can cover a rural county’s highest-risk pregnancies for about $150,000 a year.

That’s less than the cost of six preterm births.

She works alongside ACHN, not in place of it. When a woman needs medical care, the navigator gets her there. The system already exists. She’s the missing piece between that system and the women the system it doesn’t reach.

The second part is a basic care kit.

Text alerts for warning signs. A blood pressure cuff at the 20-week visit. A 24-hour phone line. Video visits with an OB. A ride to her appointment if she needs one.

The goal is simple: every woman in the county gets the same basic support, no matter where she lives.

None of this needs a new law or a new billing code.

The third part sets this apart from every program that starts strong and fades out?

A public dashboard that shows whether it’s working. Not an internal report only a few people see. Actual numbers, updated often, that employers can point to and say “our money did that”.

What about financials?

The financial burden of preterm birth is heavy. Claims data indicates that a premature infant often incurs tens of thousands more in initial healthcare costs than a full-term child.

An efficient, navigator-led maternity initiative could essentially fund itself by averting even a few instances of preterm birth, unnecessary emergency visits, or serious maternal health crises. What could be interesting is if we could show, in any given year or quarter, that this program was actually generating a positive, validated ROI.

If outcomes got really good, the community could also provide teams a bonus.

Ideally, innovations like these would work in the eyes of a community without needing a Medicaid waiver. A solutions like this instead could be seen as tool employers view as a benefit worth investing in for a healthy community and healthy workforce; the same category as a corporate wellness program or a United Way contribution.

This would overcome one thing that slows most healthcare innovation down: policy reform.

It wouldn’t apply here, and that’s the point.

Share The Alabama Thesis

What happens if it works

Here’s where we go past the data, get speculative, and imagine the possibilities.

If five Alabama counties run this model and outcomes get better over a few years, a few things happen.

Employers have real data on the ROI.
Insurers have complication numbers they can use.
Mother’s get the care they need
A new workforce category, maternal health navigators, gets professionalized.
A new venture is formed in Alabama to help other states improve.

But of course, that’s not a guarantee.

This requires building training programs, pulling employer coalitions together, and finding county leadership that can actually run it. None of that is easy. But it has precedent. Versions of this model have cut maternal mortality in rural Mississippi, Appalachian Kentucky, and Rwanda.

These solutions exist, they just haven’t been organized here yet.

How we work

Innovation isn’t always hard tech or a unicorn startup. Innovation is simply the “practical implementation of new ideas that create measurable value”.

And the innovators aren’t always scientists or startup founders. Sometimes they’re a fiduciary in a rural Alabama county deciding that enough is enough.

Alabama already has the answers for the maternal health crisis. It is in the data, in the counties, in lived experiences, and in the businesses that have been absorbing the consequences of this crisis for decades.

AHR is the proverbial midwife (pun intended). Not delivering the solution, but making the delivery possible.

Alabama counties are receiving rural health transformation dollars right now. Most don’t have a plan for what to build with them. Alabama Health Rounds works with county leadership, employers, and local health systems to figure that out. If that’s where you are, reach out.

Better health is worth at least $21B a year in Alabama. Let us show you the math.

Will Wright — Fri, 22 May 2026 14:08:42 GMT

The idea in brief

In business, investing in health is too often seen as a cost, not a driver of profits (e.g., health benefits). We propose a different idea: health actually drives the bottom line. Healthy people show up to work more, work better, and are more economically active. Moreover, healthy communities are more attractive to talent and business. In Alabama, we estimate that investing in health could drive an annual $21 billion lift for Alabama business. This is a 6% boost to GDP. To capture this, however, will need a new approach to investing in health. In this piece, we walk through how we arrived at this number and provide high-level points for how communities capture this growth.

Health is wealth

Most of us know that health is wealth. But when you talk to business owners, running their business usually takes precedence to investing in their employee’s health. That’s understandable. But let’s ground on a few simple facts about health that I think we can all agree upon:

Fact 1: Being sick is very expensive. Ask a CFO and they will tell you that healthcare costs are some of the biggest, uncontrolled costs they deal with. Last year, healthcare costs jumped 15% for most employers alone. For individuals, out of pocket healthcare costs are one of the top issues most Americans deal with. It’s pricey out there.
Fact 2: Being sick means people can’t work or can’t work well. I recently had the flu and I was knocked out for two days. Now imagine if I had a heart attack, cancer, or was dealing with depression? I would be out for weeks recovering and when I got back, I would not be my full self. That’s not great. It’s not great for business, it’s not great for communities, and it’s of course not great for people. For businesses, this issue is known as absenteeism and presenteeism and it costs the economy billions a year.
Fact 3: Being sick long term means people can’t work at all. Disability - whether short or long term - means a person produces no income and usually draws a benefit check. This is definitely not great for business and in fact it is a tax on American workers. Millions are disabled currently in America and in Alabama we have one of the highest rates of people with a disability among states.

Now flip all these points and the economic value of health becomes more clear. Healthy people work better, have more money to spend on goods and services and pay more in taxes. This is why health is worth gold to an economy.

How much wealth are we talking about? In Alabama we estimate about $21 billion a year.

To get to a number, we’ve used a modified version of this cost-of-illness equation.

Total Opportunity =

Reduced medical and related costs such as tests, ofﬁce visits, hospital stays, drugs, and travel to and from visits
Reduced productivity lost due to things like missing work (absenteeism), being less productive at work (presenteeism) and becoming disabled.
Reduced years of life lost which impacts how much money can flow into the economy from healthy folks being able to consume goods and services.

There are also more intangible costs like improving the reputation of a community and attracting talent and businesses, but we will leave these out of the equation for now.

So let’s figure out how much we’re talking about here. To calculate the opportunity, we need some estimates. Roughly speaking, we believe the following to be accurate:

Reduced Medical and Related Costs: $8 billion. This is money spent on hospitals, doctors, drugs, devices, and long-term care. National per-capita health spending hit $15,474 in 2024. Alabama’s spending isn’t lower than the national average, because Alabamians are sicker. For a population of 5.2M, total direct medical care nets out at $80B. Assuming we could save 10% off that bill if we were healthier, that’s $8 billion of opportunity right there.
Reduced Productivity Loses: $4 billion. This refers to the output lost when employees don’t show up to work, work less productively than they could or just remove themselves from the workforce altogether (i.e. become disabled). Published estimates suggest these costs are around ~$3,500 per employee per year. At 2.2 million employees in Alabama and seeing that Alabama has nearly double the disability rate of the average American state, we believe we could cut this rate in half saving roughly $4 billion.
Reduced Years of Life Lost: $9 billion. This is also a major contributor to the economic cost of poor health. For someone who dies before their time, those are lost days of work and spending (not to mention time with loved ones - which is priceless). In Alabama, life expectancy is lower than the national average and we experience about 11,800 years of life lost before 75 (compared to 7,500 for the US average) for every 100,000 residents. If we closed that gap, we would add about 4,300 years per 100,000 residents or ~224,000 years of life per year. Assuming 60% of these years are working years, multiplied by the average GDP per head, we get a $9 billion opportunity.

Taken together, that’s a $21 billion economic opportunity each year that’s available if we just got to the national average in health.

So how do we unlock this opportunity?

If you believe me (and I hope you do) that health is wealth, the issue is this: how do unlock it? We know that investments in the health of the public can work very well (imagine a world without safe, clean drinking water) and yet it seems hard for many communities to make real progress on investing in the upstream drivers of health.

This is a known problem. As articulated by the de Beaumount Foundation, there are three broad issues holding business leaders back from investing in the drivers of health of their communities.

Investing in upstream drivers of health feels unrelated to a business’s bottom line. Many business leaders equate public health with regulation, political advocacy, or crisis response, making it difficult for them to see how they could add value to their own business.
Investing in health feels long-term and abstract, while businesses are focused on the now. Business leaders are focused on what affects them today: revenue, profitability, workforce etc. Investing in health, in contrast, is often seen as a long-term endeavor with unclear or distant payoffs.
Investing in public health can feel polarizing - both nationally and locally. Business leaders worry that their involvement in public health efforts could signal political partisanship and alienate customers or employees. Interactions with health departments specifically can feel risky.

We believe we can overcome all three of these issues. But we need to think and act like a business. The approach, in short, is to strategically address these issues directly.

At Health Rounds, we’re looking to do the following:

Tie investing in health to the bottom line: Addressing the upstream drivers of health in a community can be tied directly to the bottom line for most businesses. For instance, when a homicide occurs, there is evidence that business suffers. This can be translated into cost estimates for business leaders which can help guide investment decisions.
Measure health investments like a business leader would: Businesses are run on near real time data. For instance, launch a marketing campaign and a business leader can see impact the same day. With health investments, too often it takes years to know if they are working. We want to change that. We think investments in health need more continual data collection to better determine which interventions are working more quickly so we can stop spending on those that are not helping. Therefore, we need to invest in data systems that can do that.
Discuss health investing as you would any business investment: Health investing should not be polarizing. If you’re right, left or center, living a healthy life is good for communities, families and business. In fact, for Health Rounds, we believe health can be a business. People everywhere spend money on their health every day and sometimes what’s needed is to recruit or start the right business in a community to change the trajectory of health. We believe health is good business.

This approach will work with focus and a clear strategy. It’s also a calculation that can scale down to a community, such as a county or city. We’re working to prove it out at Health Rounds.

Return on Patience

Health Rounds — Wed, 29 Apr 2026 16:51:36 GMT

Lowndes County and Shelby County are ninety miles apart. They share a state, a healthcare system, a governor, and a set of federal health programs that apply equally to both. What they don’t share is life expectancy. Shelby County residents live, on average, twelve years longer.

Twelve years. The gap between a grandmother who watches her grandchildren graduate and one who doesn’t. A man who retires and one who doesn’t make it there. And this isn’t an anomaly; it’s the map of Alabama, county by county.

Alabama’s health crisis has been documented since before most of us were working in this industry. Reports have been written. Task forces convened. Federal dollars allocated. The gap still has not closed.

We want to make an argument about why. And it isn’t the argument you’ve probably heard.

The prevailing assumption is that Alabama has a healthcare delivery problem: not enough providers in rural counties, not enough access. And how do we fix this? With capital. Capital to attract doctors and keep rural hospitals open. Grants to fund initiatives. Expand Medicaid. Get Medicare or private insureres to pay more per service.

Yes, we need capital and…

we need to think differently about how we deploy that capital.

That’s because it will take a really long time for us to get enough grants and tax-payer dollars and higher premiums to solve the problem.

To improve our health quickly, we need to invest capital differently.

We know that other nations spend less per capita than we do on health (Lowndes county included) and consistently get better outcomes. The interventions that have moved health outcomes most in human history weren’t expensive: antibiotics, clean water, flushing toilets. Low-cost, unglamorous, and transformative. What Alabama needs isn’t just more money or technology to fix the problem; it needs capital built for the kinds of solutions that actually work here.

Low-cost, unglamorous, and transformative.

The problem is that the capital structures we use to fund healthcare innovation were engineered for a completely different kind of problem, and that mismatch is doing real damage that rarely gets addressed directly. When you apply the wrong instrument to a problem long enough, not only do you fail to solve it, you make it harder to solve.

Venture capital was built for a specific kind of company, one that can go from zero to a billion in five years and scale without asking permission. In healthcare, permission is the whole job.

That structure produced the internet economy, the mobile economy, and a lot of genuinely valuable things. In healthcare, it’s producing something different.

Between 2020 and 2022, digital health attracted an unprecedented wave of venture capital: over $29 billion at its peak.¹ What followed was a slow-motion collapse that should have started a more serious industry conversation than it did. Some examples:

Babylon Health raised over $1 billion, went public at a $4.2 billion valuation, and was delisted within two years.
Olive AI raised $902 million to automate hospital operations and shut down in 2023.
Bright Health raised $1.9 billion and exited five states in a single year before the business failed entirely.

These weren’t bad ideas. Several of them were built around real problems. What killed them was the structural mismatch between what they were trying to build and the timelines their capital demanded.

Healthcare doesn’t let you ship, learn, and exit in five years. Care delivery transformation can take a generation. The preventive health infrastructure that actually decreases cost e.g. community health workers, care navigation, behavioral health integration, the upstream interventions that keep people out of emergency rooms, takes years to produce outcomes at a scale that satisfies a fund’s return schedule.

When you force those timelines together, founders feel the pressure whether or not anyone says it out loud. They optimize for what converts in a demo instead of what changes behavior over five years. They chase customers who close fast instead of communities that need them most. At the portfolio level, power law logic shapes (read: distorts) the kinds of companies that get built.

To improve health dramatically, Alabama doesn’t need moonshots. What good is a unicorn if someone in Lowndes County is still choosing between their blood pressure medication and their phone bill?

The companies healthcare actually needs are systems builders: slower, harder to categorize, built around the unglamorous work of making care reach people who need it. They almost never survive a conventional fund cycle.

Instead, capital flows to legible problems that can demonstrate growth metrics investors already know how to read. Oncology platforms. Digital front doors. Prior authorization automation. Real problems, all of them, and they’ll keep attracting capital because the category is familiar.

The interventions with the most actual leverage in health don’t look like that. They live where behavioral health meets primary care, where social determinants meet clinical intervention, where a community health worker and a county health department and a self-insured employer all need to be part of the solution at the same time. These opportunities span multiple systems, don’t fit in neat SaaS categories, and don’t produce an exit in seven years. So they don’t get funded.

In Alabama, this plays out in concrete terms. The interventions with the most potential e.g., a cardiologist rotating through Lowndes County three days a week, or a care navigator funded by employers whose workforce health costs are driving their margins, can’t access conventional venture funding because their returns are measured in avoided hospitalizations and population outcomes, not multiples. And philanthropy, while valuable, doesn’t build the sustained infrastructure that survives a single grant cycle.

We have unintentionally built a capital ecosystem perfectly aligned with the wrong outcomes. Then we look at the map; Lowndes County, Shelby County, ninety miles, twelve years and wonder why nothing has moved.

A different approach requires investors who came in knowing the context.

Patient capital aligned with healthcare looks like a structure where the investment timeline is built around the actual pace of healthcare transformation from the start. That means investors who understand the compounding happens later and, when it does, it tends to be larger than conventional healthcare VC has been positioned to capture. That’s a different LP conversation than most healthcare funds are having. It’s also the only one that makes sense for the problem.

It means going beyond the familiar to fund the interventions most funds won’t; like the multi-stakeholder, cross-system plays that are hard to categorize, hard to pitch, and have been avoided by capital precisely because of their complexity. In healthcare, what looks “unscalable” to traditional VC often describes the opportunities that actually work. Healthcare companies fail for a lot of reasons. Rarely is it because the science or technology was wrong. Usually it’s because they hit a system they, both founders and investors, weren’t prepared for.

Alabama is where this gets tested.

Not just because it’s the most resource-constrained market in the country, though it competes for that title; because solving the problem here, with this history and this level of capital avoidance and this twelve-year life expectancy gap between two counties you can drive between in under two hours, is a different kind of proof than solving it somewhere easier. If a different capital structure can move outcomes in Lowndes County, it can move them anywhere.

As goes healthcare in the Deep South, so goes the nation.

The money is there. What’s been missing is a structure that doesn’t mistake a long proof timeline for a failing investment.

And, we think someone should build it.

¹ Rock Health, Digital Health Funding: 2022 Year in Review. rockhealth.com

We built something. We want to know what you think.

Health Rounds — Thu, 02 Apr 2026 20:12:05 GMT

There’s a stat that’s been sitting with our team since we first pulled up this dashboard a few days ago.

Lowndes County and Shelby County are ninety miles apart. They share a state, a flag, the same heat in August. Yet… there’s a twelve-year gap in life expectancy between them. Twelve years. That stat alone is a reckoning sitting in a spreadsheet that almost nobody has easy access to...until now.

Shelby County

Lowndes County

We’ve built the Alabama County Health Navigator: a public dashboard that pulls together health data for all 67 Alabama counties in one place, using public data and a proprietary scoring model developed by AHR board member Darrell Bilbrey. This Dashboard ranks counties by composite health risk.

Explore the Alabama County Health Navigator →

You can filter by the Black Belt.
You can filter by Alabama’s 37 Appalachian counties.
You can sort by life expectancy, pull up a county narrative, look at social determinants, and start asking the questions that usually require an academic institution or a federal grant to even pose.

We’re sharing it now because we think the best thing we can do is get it in front of people who know things we don’t.

But first, a word on the limitations about what you’re looking at.

This dashboard was built on free, publicly available data; which is both a testament to what’s actually out there and a reminder of its limits. Most of the underlying data is two to three years old.

The most recent CMS Medicare data available is from 2023. CDC behavioral data, which tracks things like smoking rates and whether people can afford their prescriptions, runs even older in some cases.

So, if something changed in your county last year, this dashboard won’t show it yet.

There are other gaps worth naming...

Medicare Advantage data isn’t released at the county level by CMS, which creates a blind spot in counties with high Medicare Advantage enrollment.

Some of the data (America’s Health Rankings, for instance) is only available at the state level, not by county.

And the underlying surveys that feed federal health databases have real methodological limits (e.g. self-reported data is notoriously hard to pin down, and sample sizes in smaller counties are thin enough that some numbers are suggestive, but not definitive.

The SPHA score you’ll see in the upper right corner of the dashboard is Darrell’s proprietary scoring model, his lens for ranking counties by health risk. Darrell spent over three decades inside Alabama’s health data infrastructure. He built this on his own time, with free public data, because he thought someone should.

He can walk you through the logic, and we’ll be sharing more on that.

We’re telling you all of this not to undercut the tool, but because we think transparency is how you build tools and feedback loops worth trusting and guiding investment.

In short, this is a starting point.

What we’ve found, even with these constraints, is that the patterns are hard to ignore.

Some counties have zero federally qualified health centers; the free or sliding-scale clinics that are often the only realistic option for uninsured or low-income residents.

Some have no cardiologists.

Some, like Walker County, show up third-lowest in the state on life expectancy despite a composite risk score that looks fine on the surface.

These contradictions are where the interesting questions live. That’s what we want from you: questions.

If you’re a public health leader, a county commissioner, a researcher, a clinician, an employer operating in one of these counties, how would you use something like this?

What’s missing? What’s the first thing you looked for, and did you find it? What’s the “so what” that matters most to you?

Leave a comment. Send us a note. We’re treating this as a live, evolving resource, and the next phase of building it depends on what people who work in these communities actually need from it.

We will be sharing a deeper look at the methodology and what we’re seeing in the data in an upcoming issue. But go explore first. Sort by life expectancy. Click on a county you know. Read the narrative. And tell us what you think.

Explore the Alabama County Health Navigator →

The Alabama Thesis | March 2026

Health Rounds — Thu, 19 Mar 2026 19:56:14 GMT

So, What is the Alabama Thesis?

A publication of Health Rounds, the Alabama Thesis surfaces the innovators, publishes the research, and makes the case (with data) that Alabama isn’t a cautionary tale, but a preview. It’s where cracks in the system first become visible.

It’s also were immense opportunity resides.

If you look closely, the deep south is a proving ground so well-defined and so measurable that the solutions built here won’t stay here. They’ll travel to every community in America that looks like Alabama.

And there are a lot of communities that look like Alabama.

In this Issue: (A quick read before you read.)

What we’re focused on solving in 2026 (1 of 2 priorities): Healthcare costs in Alabama are forcing people to skip care. The state received a D+ for healthcare affordability, with 1 in 3 residents skipping recommended procedures and over 25% rationing medication because they cannot afford it. Read more.
One Chart - Specialty care access in Alabama is 10-25 percentage points worse than the national average.

Investment tracker: we track $290M in healthcare venture investment from Feb 28 to March 5th.

Events, Grants & RFPs: we’re tracking 5 some with deadlines coming up soon.
Expertise requests: We’re seeking to connect start ups with experts for a small honorarium. Share 30 minutes of your time to help innovators move their ideas forward.

Our Innovation Focus For 2026

One of our priorities in 2026 is to address healthcare affordability in Alabama. This is top of mind for the whole country, but especially true for Alabama. TheWest Health-Gallup State of the States 2025 put a number on something Alabamians already know. Alabama earned a D+ on healthcare cost; the lowest mark in its report card.

One in three Alabama residents skipped a doctor-recommended procedure last year because they couldn’t pay for it. More than one in four cut their medication dose in half to make it last. These are not fringe cases; they are the majority experience for a significant share of the state.

…and it’s not just us.

Nationally, the numbers are moving in the wrong direction, too. Forty-seven percent of Americans say they’re worried they won’t be able to afford healthcare in 2026 (a record high since West Health and Gallup began tracking in 2021).

One in five Americans couldn’t afford their prescriptions in the past three months. The daily stress burden of healthcare costs has doubled since 2022.

For Alabama, ranked 47th in health outcomes nationally, cost is the issue underneath every other health challenge in the state. Cost determines whether people complete their treatment, whether they show up at all, and over time, whether a preventable condition becomes a catastrophic one.

We’ll be talking about this and looking to solve this challenge throughout the year. If you are interested in supporting our work, please reach out.

One Chart

Specialty Care Access in Alabama vs. U.S. Rural Benchmarks

Alabama’s rural population faces specialty care shortages that run 10–25 percentage points above the national rural average across mental health, primary care, cardiology, and dental. Specialty deserts are the leading driver of preventable hospitalizations in Alabama’s Black Belt and Appalachian counties, where residents are often two to four hours from the nearest specialist.

Why This Matters for Alabama

Alabama is one of only a handful of states where the full weight of the rural health crisis is visible in every data point simultaneously:

32% of the population is rural
The Black Belt runs through 12 counties with among the highest preventable hospitalization rates in the nation
Health outcomes rank 47th nationally

The Rural Health Transformation Program has put $203 million in first-year funding behind a concrete plan that includes reimagining solutions for regional health hubs, maternal care expansion, scaling telehealth, and workforce. The money is here and the models now exist. The question is: who in Alabama is ready to execute?

If your organization is tackling the cost and access, we want to hear from you.

P.S. We’re following the more than 20 major health systems who have recently formed the National Specialty Care Access Coalition (NSCAC), a coordinated effort to close rural specialty care gaps through telehealth and shared care pilots.

Investment Tracker

Three converging forces are reshaping where capital is going this month:

AI is absorbing the entire clinical workflow stack. Point solutions are DOA.
Value-based care startups are proving their models work despite macro headwinds
The federal government just made “backing the insurgent” an explicit policy goal.

For the first time in a while, venture incentives and the regulatory incentives are aligned and pointing in the same direction.

Events · Conferences · RFPs · Grants

CONFERENCES

2026 Rural Health Conference · March 18–20, 2026 Hosted by the Alabama Rural Health Association. Strategic dialogue on workforce development, telehealth integration, financial sustainability, and population health for rural Alabama. If the RHTP and NSCAC are your two reasons to attend any conference this year, this is it.

SAMHSA Behavioral Health IT Pilots · Applications ongoing SAMHSA launched 9 federal pilot programs to test health IT standards for behavioral health data sharing. States and provider networks can apply. More info via Becker’s Behavioral Health.

GRANTS & PROGRAMS

Rural Health Transformation Program (RHTP) · State applications ongoing - The $50B federal program is actively disbursing to states with organized execution infrastructure. Ohio ($202M), Wyoming ($1B), Idaho ($1B) have already secured allocations. Alabama has not announced a coordinated state application strategy.

NSCAC Specialty Care Coalition · Health system partnerships open The newly launched National Specialty Care Access Coalition is actively seeking rural health system and telehealth partners to co-develop specialty care pilots in cardiology, neurology, and oncology. Contact through Managed Healthcare Executive.

RFPs & DEADLINES

HHS 340B Rebate Model RFI · Comment period open, watch for deadline - HHS scrapped its existing 340B rebate pilot after legal challenge, then released a new RFI soliciting input on how a replacement program should be designed. This directly affects Alabama’s rural safety-net hospitals and Critical Access Hospitals. AHA news brief.

Project Opportunities

*All opportunities include a modest honorarium in exchange for your time and insights.

Seeking: Cash-Pay Clinic Leaders

Who you are

You run a cash-pay practice. You know what actually happens between patient check-in and checkout.

Ask

A team building healthcare automation effort needs your reality check. Share about your actual daily workflow. Your insight determines whether this effort becomes genuinely useful to clinics like yours.

Commitment

One (1) 30-minute conversation

Seeking: Rural/Community Primary Care Directors

Who you are

Your patients need dermatology, but the next appointment is 4+ months out or 60+ miles away. You’re managing skin concerns in primary care because you have to, not necessarily because you want to.

Ask

Someone’s developing derm access solutions and needs to understand how you’re actually managing this now.

Commitment

One (1) 30-minute conversation

Seeking: Rural Oncology Experts

Who you are

You treat cancer patients without a major oncology center down the hall. You coordinate care across county lines.

Ask

A team building rural oncology tools want to hear what you wish existed.

Commitment

One (1) 30-minute conversation

Health Rounds is published monthly by Alabama Health Rounds. alhealthrounds.org

Share The Alabama Thesis

February 2026

Health Rounds — Tue, 17 Mar 2026 14:51:40 GMT

What is Health Rounds?

Health Rounds is a network of innovators focused on developing new ventures to solve Alabama’s hardest health challenges and scale these across the globe. The goal: move Alabama from 47 to 25th in health outcomes by 2035.

👀 In this issue:

The Choctaw model for healthcare logistics
Why it matters for Alabama
Standout healthcare VC deals from January 2026
Opportunities to support healthcare innovation happening Alabama

What’s New

Drones as mission critical healthcare infrastructure vs novelty.

The Choctaw Nation just landed a federal SMART Grant to build drone delivery infrastructure for medical supplies across rural Oklahoma. The USDOT’s program director called it a potential “national model for rural healthcare logistics.”

Why It Matters For Alabama

Thirty-two percent of our population lives in rural counties with limited access. The Choctaw model could become a template for rural Alabama counties facing similar geography and workforce gaps.

And the impact? It’s striking… 👇

One Chart - Medical Supply Delivery

Time Impact of drone vs traditional methods

Source: Nature, Comparative modeling of Drone vs Traditional Logistics

Virginia rural areas - went from 50 min to under 10 min for 80% of residents
Scotland islands - went from 2-6 hours by ferry to 15 minutes by drone
Rwanda (Zipline) - now delivers 35% of their national blood supply via drone

With the medical drone delivery market projected to grow 10x by 2034 and rural healthcare infrastructure still woefully underbuilt, Alabama innovators and investors have ground-floor opportunity to create essential infrastructure for rural communities.

Investment Tracker

Five standout healthcare VC deals from January 2026

Healthcare venture capital kicked off 2026 with outsized rounds. The five deals below, spanning Seed through Series D, capture investor conviction across clinical AI, biopharma, women’s health, hospital operations, and virtual care.

Combined, these rounds total over $720 million and illustrate where money in healthcare is flowing…at least for now right now.

Events

Grand Rounds: Safe Clinical AI & Prompt Engineering - February 18, 2026 Hosted by Marnix E. Heersink Institute for Biomedical Innovation

2026 Rural Health Conference - March 18 – 20, 2026, the conference will advance strategic dialogue around workforce development, telehealth integration, financial sustainability and population health for rural Alabama

Project Opportunities

*All opportunities include a modest honorarium in exchange for your time and insights.

Seeking: Cash-Pay Clinic Leaders

Who you are

You run a cash-pay practice. You know what actually happens between patient check-in and checkout.

Ask

Commitment

One (1) 30-minute conversation

Seeking: Rural/Community Primary Care Directors

Who you are

Ask

Someone’s developing derm access solutions and needs to understand how you’re actually managing this now.

Commitment

One (1) 30-minute conversation

Seeking: Rural Oncology Experts

Who you are

You treat cancer patients without a major oncology center down the hall. You coordinate care across county lines.

Ask

A team building rural oncology tools want to hear what you wish existed.

Commitment

One (1) 30-minute conversation

Spread the Word

Help us grow our network. If you know folks that want to improve the health of Alabama and drive innovation…

Subscribe now