scripts/proximity_compute.py + scripts/investment_schedule.py. Numbers are representative until the quarterly regeneration runs against live HRSA/VHA/CMS datasets.Effective vs physical time-to-care — the honest framing
Two trajectories matter. Effective time-to-care drops substantially once telehealth is universal (Year 3) — specialty consult, tele-psychiatry, and triage all within reach via a Post Office 2.0 booth. Physical drive-time to acute surgical care ratchets from a 75-minute floor in Years 1-5 to 60-minute by Year 10 to a 50-minute long-run goal — geography and population density make a single uniform target impossible for the furthest tracts. Most healthcare needs fall into the first category.
Every Post Office 2.0 location gets a telehealth booth (FedCard-authenticated, exam-grade video, vitals-capable peripherals). Cross-state licensure reform removes the jurisdictional bottleneck. Workforce scaling (telepresenter + specialist rotation) is the rate-limiter, not capital.
- Mental-health crisis triage (tele-psychiatry, standard of care)
- Tele-cardiology, tele-oncology, tele-neurology consult
- Primary-care follow-up + prescription management
- Prenatal counseling + risk screening
- Dermatology screening + radiology reads
- Acute trauma surgery
- Labor & delivery
- Dialysis sessions
- Acute psychiatric admission
What each tier can actually deliver
Fraction of brick-and-mortar clinical value each tier delivers for each facility type. Some combinations are clinically impossible (dialysis via telehealth = 0%); others are standard-of-care today (tele-psychiatry = 75%).
| Facility type | Tier 1 · Telehealth | Tier 2 · Mobile | Tier 3 · Brick | Clinical note |
|---|---|---|---|---|
| Level II trauma | 10% | 15% | 100% | Telehealth triages; surgery requires brick |
| OB-GYN | 30% | 75% | 100% | Mobile handles routine; delivery requires brick |
| Specialty care | 60% | 70% | 100% | Tele-cardiology / tele-oncology widely practiced |
| Dialysis | 0% | 60% | 100% | Cannot dialyze via screen; mobile 3×/week viable |
| Mental-health crisis | 75% | 85% | 100% | Tele-psychiatry is standard of care |
| FQHC (Federally-Qualified Health Center) | 60% | 70% | 100% | Mobile primary care routine for rural circuits |
Tier 1 and Tier 2 make Tier 3's multi-year ramp socially viable. A rural community told "your Level II trauma center opens in 8 years" would reasonably ask what happens until then. The answer: telehealth in Year 1, mobile health in Year 2-3, permanent brick by Year 8. No tract waits 8 years for any access improvement.
Tier 3 exists because Tier 1 and Tier 2 cannot substitute for acute surgical care, emergency delivery, or dialysis. The plausibility gate (VHA expansion, hospital upgrade, integrated- care anchor) ensures facility commitments are buildable — no greenfield Level II in towns of 3,600.
Security-capacity subsidy exists because rural Level II trauma centers cannot be cost-recovered from trauma case volume. Per Blueprint Ch 20, these operate as public safety infrastructure — standing capability, not throughput.