Reservoir Health helps organizations shape the policy, narrative, and market environments to enable health care innovation to reach patients.
We integrate policy, market enablement, and communications to shape how health care innovations are understood, valued, accessed, and adopted. We work with organizations developing new therapies, devices, diagnostics, digital health solutions, and models of care.
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2027 State Focus: Why Rural Health Is the New Policy Bellwether
More than 66 million Americans live in rural communities, where access to care depends on far more than insurance coverage. Long distances, workforce shortages, limited broadband and transportation, and hospital and pharmacy closures can delay everything from routine screening to specialized treatment.
Rural health is a critical test of whether policy delivers care patients can actually obtain. State policymakers influence that access through Medicaid, state-regulated commercial insurance, and state employee health plans. As the 2027 legislative sessions approach, several issues will challenge their ability to turn policy commitments into practical improvements.
Rural Americans face worse outcomes and a fragile care infrastructure.
Rural residents are more likely than urban residents to die prematurely from heart disease, cancer, stroke, respiratory disease, and unintentional injuries. The CDC estimates that tens of thousands of these deaths may be preventable. Provider shortages and closures make these conditions harder to prevent, diagnose, and treat.
Policymakers must protect the resources that sustain rural care while ensuring they benefit patients. The 340B Drug Pricing Program, for example, can support eligible rural hospitals, but its savings do not automatically lower patients’ costs. The challenge is balancing financial support for local services with transparency and accountability for how those savings improve access.
Access begins long before treatment.
Covered treatments offer little benefit to patients who are never screened, diagnosed, or connected to a provider. Rural access therefore starts with primary care, prevention, and timely diagnostic testing.
Complex chronic conditions, including cancer, Alzheimer’s disease and cardiometabolic care, reflect this challenging dynamic. Biomarker testing can help identify patients likely to benefit from targeted therapies, while emerging blood-based tests offer new possibilities for early detection.
State coverage policies for biomarker testing are expanding, with opportunities to address additional conditions. Yet rural patients may still struggle to reach testing facilities and specialists. These laws also vary in which plans and tests they cover and what utilization management they permit. Policymakers must consider how prior authorization, appeals, cost-sharing, and provider availability affect whether patients receive timely testing.
Coverage does not automatically create access.
A medication can appear on a formulary yet remain difficult to obtain because of prior authorization, step therapy, or coverage changes that prompt non-medical switching. Patients may face paperwork, additional treatment trials, and appeals before receiving their prescribed therapy.
Immunology provides a clear example. A study of 17 large commercial health plans found that, across the medications studied, an average of 78.6% of plans restricted psoriasis coverage beyond the FDA label; for psoriatic arthritis, the figure was 66.8%. Medications were most commonly covered as second-line treatments. Not every restriction is inappropriate, but these findings show why formulary coverage alone is an incomplete measure of access.
Within the insurance markets they regulate, state legislators can establish timely authorization standards, workable step-therapy exceptions, and continuity-of-treatment protections. These measures can help patients obtain clinically appropriate care without avoidable delays.
Policy choices can reduce or deepen rural disparities.
The federal budget legislation enacted in 2025 will put Medicaid at the center of state debates in 2027. New eligibility requirements and financing changes will force difficult choices about coverage, services, and provider payments. More frequent eligibility reviews and work requirements for certain adults also create a risk that eligible patients will lose coverage because of paperwork barriers.
Lawmakers will need to weigh additional Medicaid funding against competing budget priorities. Reducing services or provider payments could make care harder to obtain, while underfunding eligibility systems and enrollment assistance could increase coverage losses. Their budget decisions will shape both who remains insured and whether providers can continue serving them.
Rural health presents a major policy and advocacy opportunity.
The federal Rural Health Transformation Program will direct $50 billion to states from 2026 through 2030, supporting investments in prevention, chronic disease management, workforce, technology, and new care delivery models.
Stakeholders can help shape funding priorities, implementation, and measures of success. Their involvement can keep state decisions grounded in patients’ needs across prevention, diagnosis, treatment, and follow-up care.
The test for 2027 is whether these decisions make timely, effective care easier to obtain. How states meet that challenge in rural communities will offer an early indication of whether broader health policy is improving access in practice.
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Looking Beyond the Data: Putting the Patient Voice at the Center of Access
Health care organizations have more data than at any point in history. Claims data, electronic health records, patient-reported outcomes, and real-world evidence have transformed our ability to understand what happens within the health care system. Yet patients continue to delay diagnosis, abandon treatment, and disengage care for reasons that often remain invisible. The challenge isn't a lack of data; it's understanding what happens outside the health care system, before a patient ever enters care or after they quietly fall out of it.
That challenge was the focus of the 2026 Reservoir Advocacy and Alliance Network (RAAN) annual convening, where Reservoir’s network of experts and strategic partners explored emerging approaches to advancing patient access. The RAAN brings diverse perspectives and thoughtful insight to some of today's most pressing health challenges, while providing strategic counsel that supports Reservoir's commitment to reducing health disparities and expanding opportunities for better health.
This year’s conversation reinforced that barriers to health care access extend far beyond affordability. Participants noted that while claims and utilization data can show what blocked access, understanding the reason why requires a deeper dive into patients’ lived experiences including trust, stigma, cultural factors, health literacy, and competing responsibilities.
Uncovering The “Why” in Patients’ Experiences
The discussion featured Patient Access Pathways, a tool that addresses the “why.” Patient Access Pathways is Reservoir's proprietary survey and analytics methodology for uncovering access and affordability barriers from the patient's point of view. It uncovers complex and often invisible barriers that influence whether people seek screening, enter care, start treatment, and remain engaged throughout their care journey.
RAAN members pointed to Patient Access Pathways’ ability to change the way they view barriers to patient care, which for many is primarily through a financial lens. One member pointed to the fact that “it is easier to define issues of cost [and] issues of physical access than it is to think about things like emotional, cultural and logistical barriers.” But uncovering those less apparent barriers can shed critical insights into the patient journey.
Going Deeper to Improve Patient Access
RAAN members also emphasized the importance of understanding whether patients have access to health information, as well as what factors motivate them to act on it. Exploring patient perspectives and beliefs can better inform why some individuals do not seek care even when they have perceived access. To this point, members of the RAAN highlighted the value of trusted health messengers and adequate health literacy education to connect with populations that are not effectively served by broader campaigns and messaging.
The discussion also raised the importance of examining access through specific patient populations. For example, people who are uninsured, underinsured, enrolled in Medicaid, or covered through an employer may encounter very different challenges. RAAN members raised prior authorization as one specific example: even after successfully reaching a provider and receiving a diagnosis and prescription, patients may face complicated approval processes and may not know how to challenge a denial or request an exception. Taking the holistic patient experience into consideration helps inform solutions for populations that often face the greatest barriers to care, including people living with rare diseases, marginalized patient communities, veterans, and individuals with disabilities.
This year’s RAAN convening demonstrated that health care access is not defined by a single barrier or moment in the patient journey. Understanding why gaps in care persist requires looking at patients’ lived experiences alongside traditional health care data.
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Corporate Reputation Starts with Demonstrating Value
Companies invest considerable resources in being liked, respected, and trusted. These are worthy ambitions, but on their own they may not offer companies sufficient specificity to build a proactive corporate reputation plan. They don’t answer the question of what a company should actually do.
Reservoir’s value model begins with a practical question: How does your company create value for the people whose decisions matter to its success?
Brand and reputation are often used interchangeably. A brand encompasses a broad range of associations, both cognitive and emotional. Reputation is more specifically what people think of your company based on their understanding of its conduct and contributions.
That distinction matters because reputation programs are often built around broad goals like increasing trust, without defining what a company needs to do to earn it.
Understanding what stakeholders value gives a company a better basis for choosing where to invest. It also makes research more useful. A company may discover that people do not recognize the benefits it delivers, or that the benefits it emphasizes matter less than management assumes. Sometimes, the company simply needs to improve what it does.
Each finding calls for a different response.
An approach rooted in value connects reputation work to business priorities. A pharmaceutical company needs to understand what patients, clinicians and those paying for care value about its work, and where they see shortcomings. Those judgments affect the company’s ability to bring treatments into use and build support for future innovation.
The challenge is to communicate consistently while recognizing that stakeholders have different priorities. Helping people manage illness might mean greater independence to a patient, better treatment options to a clinician and fewer costly complications to a payer. These benefits can support the same corporate story, with evidence that matters to each audience.
Emotional storytelling can help people understand why those benefits matter. But a strong initial response to a story does not establish a lasting change in how people view the company. Reputation is built when the company continues to demonstrate that value through its communications, its decisions and, ultimately, people’s experience with it.
That is why reputation work belongs close to the business. Much of the work involves helping people understand contributions they have overlooked or taken for granted. It also requires knowing the business well enough to recognize when performance needs to improve and being candid about what the company needs to do.
Reputation is built by creating value that matters to the people important to the success of the business, demonstrating and communicating that value consistently, and improving where the company falls short. Understanding what stakeholders value is where that work begins.