The typical fellowship program in HPM doesn't get mindblowing volumes of applications. It is a relatively small field. Apply where you want to live, or at institutions you want to be at for some specific reason.
There are no low tier programs. There are some that are comparatively less competitive as they get less applications -- think perhaps places where physicians are not usually interested in living. That said, you will find that curriculums are very similar across programs. This is because the milestones every program needs to address for accreditation basically takes up the majority of the 1-year fellowship.
There are leaders in the field working from coast to coast... including the midwest. For example, Sinclair is practicing out of Kansas, IIRC.
With all that said, the most competitive programs mostly are the same ones across all of medicine... Harvard, Mayo, UCSF, Stanford, etc etc.
Research opportunities aside, the education and experience you will obtain at those programs are not necessarily any better than you will get elsewhere... but these institutions have that je ne sais quoi -- so their app volumes are higher than average and thus more competitive for any given person to land in one of their few spots.
Look at curriculums (and didactics structure), look at geography, look at program characteristics (Do you want to attend an academic university hospital or a community hospital? A program with 1 fellow or 7 fellows?)
When you go to your interviews (perhaps virtual this cycle) pay attention to culture, patient volumes, and where graduates tend to practice.
Without knowing more about your app, it is hard to give even an estimate for application breakdown. If all things being equal and you chose to apply to 10 programs, 3 "reaches", 4 "targets", and 3 "safeties" isn't a bad way to go. But keep in mind the idea of reaches, targets, and safeties is born out of a selection process often revolving around numbers (SAT, ACT, cGPA, sGPA, MCAT, STEP 1, STEP 2). Fellowships typically don't focus in on Step 3 scores unless you failed or did very poorly. They really look for qualities that align with their mission and vision and the people that bear them -- plus, it is hard to label as reach, target, or safety when the measuring stick is so subjective and nebulous. Nevertheless, in all likelihood, you will get plenty of interviews and you won't have any problems making the best match list for you.
You picked a great field.
(I kid, I kid)