This brief on the lessons learned from federal and state models and programs to improve the value proposition and patient centeredness for rural hospitals is based on the Flex Monitoring Team's (FMT) extensive experience with hospital policy, federal and state demonstrations, community focused activities, and performance improvement. Based on an extensive review of program materials, evaluation reports, and grey literature, this brief identifies lessons learned from efforts to improve the value proposition for Critical Access Hospitals (CAHs) and rural hospitals. It offers a practical patient-centered definition of hospital transformation and identifies strategies (e.g., managing chronic diseases; screening for the social drivers of health (SDOH); working with their communities to address health-related social needs (HRSN); and improving access to primary and specialty care, wellness, and mental health and substance use services). These strategies can be directly applied by State Flex Programs (SFPs) to improve the value proposition and patient centeredness of their CAHs and support their participation in value-based payment models.