AHA's 9-point plan for hospitals to help vulnerable communities

Policymakers also need to take action, report says

Hospital leaders can use nine strategies to maintain access to essential health services in vulnerable communities, according to a new report released by an American Hospital Association (AHA) task force.

The 29-member Ensuring Access in Vulnerable Communities task force, chaired by Ascension Health President and CEO Robert Henkel, developed the report over 15 months.

Defining vulnerable communities

Henkel said that the task force acknowledges there is no "one size fits all" approach to preserving health care access across different communities.

At the same time, the report identified several common attributes among rural and urban vulnerable communities, including:

  • Lack of access to primary care services;
  • Poor economic conditions;
  • High rates of uninsurance or underinsurance;
  • Cultural differences within the community;
  • Low education or health literacy levels; and
  • Environmental challenges.

In addition, the report noted that vulnerable rural communities often face an aging and declining population, while vulnerable urban communities more often have a high disease burden due to a lack of access to basic needs such as food, shelter, and clothing.

Defining needs

The report defined nine essential health services for communities: 

  • Primary care;
  • Psychiatric and substance misuse treatment;
  • ED and observation care;
  • Prenatal care;
  • Transportation;
  • Diagnostic services;
  • Home care;
  • Dentistry services; and
  • A robust referral structure.

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The task force detailed nine "emerging strategies" that can ensure access to one or more essential services:

  • Addressing the social determinant of health;
  • Implementing global budgets;
  • Adjusting inpatient and outpatient capacity to meet the needs of the community;
  • Building emergency medical centers, which provide ED care and outpatient services only;
  • Utilizing urgent care centers;
  • Adopting virtual care strategies such as telehealth and remote monitoring;
  • Designing frontier health systems, which can coordinate primary and specialized care in remote areas;
  • Increasing integration between rural health hospitals and "various types of health centers"; and
  • Developing partnerships between Indian Health Service (IHS) and non-IHS providers.

Some strategies can influence more services than others, AHA noted. For instance, the task force said implementing global budgets—which provide "a fixed amount of reimbursement for a specified population over a designated period of time"—can help address eight of the nine essential services by giving communities more flexibility and autonomy. Meanwhile, the report said that establishing urgent care centers can support three services: primary care, a robust referral structure, and diagnostic services.

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In a Modern Healthcare commentary, Henkel and AHA CEO Rick Pollack emphasize that the task-force report isn't intended to be overly prescriptive. "Hospitals can use the report and the real-world case examples it includes as a guide while taking into account the specific challenges, needs and support structures available in their communities," they write.

But Henkel and Pollack also say health care leaders need support from policymakers to adapt to a changing market. For instance, the report calls for expansions of Medicare coverage and payment for telehealth, among other policy changes.

"All [of the strategies] demand the health field embrace new ways of thinking—aligning in new ways, considering new partnerships and, above all, promoting health," Henkel and Pollack conclude (Henkel/Pollack, Modern Healthcare, 11/26; AHA News Now, 11/29; AHA task-force report executive summary, accessed 11/30; Ross, "On Call," STAT News, 11/30).

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