NHS FPX 6008 Assessment 2 Needs Analysis for Change

Needs Analysis for Change

Needs analysis for change is used to define the gap between the existing and desired situation, to prioritise what actions should be taken, and how. It assesses the organisation, stakeholders, and external factors to inform decisions. The analysis helps leaders prioritise effective solutions to improve access, quality, and sustainability. The analysis highlights ways of addressing uneven healthcare funding for Intermountain Health’s rural and disadvantaged populations through policy, staffing, and telehealth strategies, and local workforce training.

Economic Issue Impact and Rationale

Disparities in the distribution of health-care resources in the United States limit access and quality in rural and disadvantaged communities, and have a downstream impact on the operations of Intermountain Health. Deficient funding leads to the closure of clinics and critical access hospitals, reduced service hours and staffing, and makes larger hospitals the default option. There is already a greater travel burden, longer time to the start of care, fewer preventive programs, referral issues for specialist care, and substantial uncompensated care, as well as an increased strain on emergency facilities (Keesee et al., 2024). Health-care workers report moral distress when they can’t provide timely and thorough care.

I chose this topic in particular because of the link between big-picture issues of funding and policy and downstream issues at the bedside and because of my personal interest in equity, patient advocacy, and stewardship. My observations from quality-assurance projects and clinical practice include that reimbursement rates and tight margins, not the actions of individuals, often determine if a community will be able to keep primary care offices open, have obstetric services, or have capacity in an emergency. This was further supported by peer-reviewed research and reports of federal workforce needs, which indicate there are significant primary care deficits in many rural counties (Bureau of Health Workforce, 2024; Coombs et al., 2022). This gap is critical to equitable health care.

The key gap I identified is a lack of proper, secure, and equitable funding for rural and safety-net providers across the region of Intermountain Health, resulting from low rates of Medicaid reimbursement, growing uncompensated care, and slim margins. These institutional pressures drive reductions in services, hiring freezes, and closures that affect Medicaid, low-income, and racial minorities, and are associated with higher rates of preventable hospitalisation and poorer health outcomes after loss of rural hospitals (Hoffman et al., 2025). Inequities will be reduced through targeted payment reform and increased telehealth, continued support for the safety net, and workforce development needed for capacity rebuilding. These changes would enable Intermountain Health to sustain rural services, improve service outcomes, and rebuild community relations in the long term.

Socioeconomic and Diversity Disparities

Disparities in funding disproportionately affect low-income, Medicaid enrollees and rural and minoritized patients. Hospital and clinic closures (more frequent in communities serving more Medicaid and racial minorities) are linked to more hospitalisations and greater mortality, with subgroup analyses showing greater relative disparities for Medicaid recipients and non-White patients (Hoffman et al., 2025). As of June 30, 2024, the US had 7,501 designated primary care Health Professional Shortage Areas (HPSAs) that serve 75 million people – or 22.3% of the population (Health Resources and Services Administration, 2024). 66.5% of these are in rural areas.

In Intermountain Health’s area, these inequities result in predictable gaps in access to care, with clinics on thinner margins reducing or eliminating services, and emergency and specialty care services consolidated in larger cities. These leave Medicaid patients and patients with unpredictable incomes with longer travel distances, delays in diagnosis, and poor management of chronic conditions (Medicaid and CHIP Payment and Access Commission, 2015). Reduced reimbursements and underpayments further compromise the financial stability of safety-net providers, perpetuating the cycle of limited capacity and increasing uncompensated care (Hulver et al., 2025). So, payment policies lead to observable socioeconomic and racial disparities in health care access and outcomes; well-targeted payment reform, ongoing support for safety-net clinics, and workforce development are critical to closing these gaps.

Evidence-Based Need for Change

Rural hospital closures result in worse outcomes and access. Hoffman et al. (2025) determined closures could increase inpatient death rate, increase transport time in the event of an emergency, and disproportionately negatively impact racially minoritised and Medicaid patients. The findings suggest local hospital capacity retention is not merely a matter of logistics, but a matter of life and equity, and propose strategies to prevent closure and reduce delays in transport, improving outcomes. There is robust evidence of the relationship between nurse staffing and education, and safety. Dahlerbruch et al. (2022) found that with a 10% increase in the number of nurses holding a Bachelor of Science in Nursing (BSN) degree, the odds of 30-day death for a general surgery inpatient decrease to 5.5%. This confirms that mortality and adverse experiences can be reduced and safety enhanced in rural facilities by raising staffing and education in rural facilities.

Fragility of rural sites is a payment policy issue. A report for rural providers estimated rural providers’ Medicaid losses, highlighting that rural hospitals may face substantial reductions in Medicaid revenue and increased uncompensated care (National Rural Health Association, 2025). These effects drive service downsizing and closure, so policy levers such as Medicaid rate increases or bridge funding are critical to an implementation strategy. As Haleem et al. (2021) highlighted, telehealth has increased access to care, reduced missed appointments, and supported chronic-disease management in rural areas, to improve quality of life and adherence rates. Telehealth provider-to-provider consultations and remote monitoring also provided increased access to specialties, partially compensating for facility losses. To implement, it requires broadband, training, and reliable payment, so telehealth is an augmentation and not a replacement for local services, and to alleviate the travel burden for low-income patients.

Predicted Outcomes and Growth Opportunities

Recent targeted payment changes, changes in Medicaid rates, and temporary bridge payments will shore up revenues for rural clinics and critical-access hospitals in Intermountain Health’s network. Protecting revenues prevents service-line reductions and closures, maintaining local primary-care, obstetric, and emergency capacity. For patients, this decreases the need to travel for care, saving time and money on travel and hotel stays, and accelerating diagnosis and treatment, avoiding costly downstream treatment (Mills & Bennett, 2025). For payers and the health system, avoiding closures avoids expensive escalations into emergency and inpatient care due to a lack of timely or continuous care.

Nursing staffing improvements, workforce investments in Bachelor of Science in Nursing (BSN) degree nurses, and increased primary-care workforce capacity will boost efficiency and safety, and the economic benefits. Reductions in adverse events and readmissions reduce variable costs and risk of malpractice, and staff turnover reduces the costs of ongoing recruitment and induction (Lasater et al., 2021). Expansion of telehealth services extends the benefits of workforce strength to reduce variable costs (per visit) and missed appointments, while increasing access to specialists, reducing patient time and income loss, and permitting clinics to increase patient load without commensurate capital investment (increasing marginal revenue per hour).

These, in turn, create regional prosperity and sustainability. Retained local jobs, services, and tax revenue support local retail and services, with flow-on effects. Reduced nonmedical and out-of-pocket costs (transport, days off) benefit patients’ personal economic stability and productivity (Malakellis et al., 2015). For Intermountain Health, the system will enjoy more stable margins, reduced uncompensated care, stronger negotiating leverage with payers, and better value-based performance metrics, providing a stable revenue stream to invest in prevention, training, and community initiatives.

Conclusion

Health care financing inequities have undermined rural and safety-net services, closing clinics and hospitals and further diminishing access for low-income, Medicaid, and minority communities. The problem is inequitable payment and thin margins that justify under-staffing, reducing services, and closing shop. Payment reform, workforce, and telehealth reinstate local capacity. This will save money, increase equity, and rebuild community resilience.