Marshall Health is laying out a five‑year plan to link rural hospitals, clinics and telehealth services across the Sierra foothills, aiming to keep more patients within their home communities while expanding specialty access.
Coordinated hub‑and‑spoke model under development
During the 2026 Digital Health Summit, Martin Entwistle, chief of medical affairs at Marshall Medical Center, described a hub‑and‑spoke framework that would centralize referral intake, schedule tele‑specialty visits and offer e‑consults for primary‑care doctors and emergency‑room clinicians. The model also envisions remote monitoring to curb unnecessary emergency visits and standard escalation pathways to larger tertiary hospitals.
The network would rely on interoperable data systems, shared quality reporting and a playbook that could be replicated statewide. He said the goal is to create “standardized workflows” that let providers share infrastructure and use AI‑enabled data tools without having to reinvent each component from scratch.
Local partnerships already showing results
Marshall’s recent collaboration with El Dorado Community Health Center illustrates how a hub‑and‑spoke approach can fill service gaps. When the medical center struggled to sustain its behavioral health program, the federally qualified health center stepped in, leveraging higher reimbursement rates to keep those services alive. “We refer, they manage,” Entwistle noted, adding that the partnership also highlighted staffing challenges common to rural providers.
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He suggested that expanding the network to include Tribal health entities and additional hospitals could generate the needed mass for recruitment and retention. “If more groups join, we can spread the workload and make positions more attractive,” he said.
Tele‑neurology and other specialty gaps
One pressing issue is continuity of care for neurology patients. While Marshall can deliver tele‑inpatient neurology and excels in stroke management, patients returning home often lack follow‑up. The network would blend face‑to‑face consults with tele‑support, allowing specialists to rotate between sites while still providing remote care to patients who remain at the center.
This mixed model could let a neurologist work one day a week at Marshall, then travel to a partner facility, and use telehealth to monitor patients in between visits. The flexibility aims to attract clinicians who prefer part‑time rural work without sacrificing access for local residents.
Building the infrastructure, not just buying technology
In 2025, the California Telehealth Resource Center helped Marshall conduct a digital health assessment, reviewing technical capacity and workflow readiness. The findings guided the creation of the Sierra Health Collaborative, a group that now includes five California hospitals and one in Nevada, with additional members expressing interest.
Entwiddle emphasized that the effort is about “creating infrastructure, not just having technology you’re going to throw at the challenges.” The collaborative also works with Tribal health federally qualified health centers and assembles multidisciplinary teams that span telehealth, remote patient management, artificial intelligence and care coordination.
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External perspective on rural health networks
Health policy analysts have long warned that isolated rural providers risk losing patients to larger urban systems. A recent report from the report notes that coordinated networks can improve both financial stability and patient outcomes, especially when they integrate data sharing and joint staffing models. Marshall’s plan aligns with those recommendations, though its success will depend on sustained funding and the ability to attract specialists to remote locations.
Looking ahead to a scalable rural care model
The envisioned network aims to support primary‑care practices with specialty back‑up, manage chronic conditions such as hypertension and diabetes, and provide behavioral health services across the region.
By sharing resources and leveraging telehealth, Marshall hopes to achieve a sustainable model that can be scaled beyond El Dorado County.
Entwistle concluded that the timing feels right, as the initiative dovetails with the California Rural Health Transformation Program’s goals.
