9 ways to bolster vulnerable communities

Millions of Americans in both urban and rural communities are unable to access essential health care services. A new report from the American Hospital Association, Task Force on Ensuring Access to Care in Vulnerable Communities, offers nine innovative ways to improve access for vulnerable populations — which the AHA defines as those experiencing lack of access to primary care, a poor economy, high rates of uninsured and low health literacy, among other things.

The guide provides a blueprint for health care leaders across the country to follow as they struggle to get vulnerable populations the care they need, says AHA President and CEO Rick Pollack.

“Many hospitals face challenges maintaining access to health care services in their communities and this report provides a pathway to ensure every hospital has an opportunity to be an access point and an anchor of service,” he says. “The strategies outlined in this report can serve as a roadmap for all communities as hospitals begin to redefine how they provide more integrated care.”

The AHA convened a panel of nearly 30 experts from health systems and state hospital associations to formulate the report. Its release follows 15 months of task force meetings, listening sessions around the country and conversations with policymakers. The nine recommendations are:

1. Address the social determinants of health: Screening patients to identify any unmet social needs, helping patients navigate community services and encouraging better alignment between the hospital and such services.
2. Global budgets: Adopting bundled payments for each episode of treatment, which could provide financial certainty for hospitals in vulnerable communities while also encouraging hospitals to contain health care cost growth and improve quality by focusing more on services that improve health and decrease the need for hospital services.
3. Inpatient/outpatient transformation: Reducing inpatient bed capacity to a level that more closely reflects the needs of a community while also enhancing outpatient and primary care services.
4. Emergency medical centers: Utilizing an EMC model would allow existing health care facilities to meet a community’s need for emergency services without having to provide costly inpatient acute care services.
5. Urgent care centers: Offering an access point for urgent medical issues that can be treated without a hospital stay.
6. Virtual care: Harnessing technology to maintain or bolster access for patients, including offering 24/7 access to physicians via video, monitoring patients remotely from their homes, and offering less-expensive, more-convenient care options.
7. Frontier health systems: Better serving isolated “frontier communities” through the creation of local, integrated health care organizations similar to accountable care organizations. These frontier health systems would knit together health providers to coordinate preventive and primary care along with extended care, inpatient and emergency services. Unlike ACOs, they’d also offer transportation services to patients and enable them to return to their hometowns for follow-up care.
8. Rural hospital health clinics: Integrating care between rural hospitals and the various health centers in the community to facilitate integration of primary, behavioral and oral health, and allow for economies of scale between those institutions.
9. Indian Health Services: Developing partnerships between IHS and other providers with the goal of increasing access to health care services for Native Americans and Alaskan natives, improve quality and promote better coordination.

Of course, each community has its own needs, and only parts of this list will apply to certain service areas, notes Robert Henkel, president and CEO of Ascension Healthcare in St. Louis. “Our goal is to address the varying health care issues within our country’s diverse communities. The solution to improved care is not ‘one size fits all,’ and we must continue to take into account the unique needs of individuals in both urban and rural areas. We have to continue advocating for access to quality health care services in the most appropriate settings for all.

For further details on those nine strategies — along with the barriers to their adoption and the AHA’s advocacy agenda on this front — visit aha.org/ensuringaccess. — Marty Stempniak