The AHA November 29 released a report, “Ensuring Access in Vulnerable Communities,” that offers hospital leaders nine innovative ways to preserve access to essential health services in vulnerable rural and urban communities.

Strategies range from integrating rural hospitals with health clinics in the community to using technology to provide 24/7 care in isolated areas. The report found that vulnerable communities often lack access to primary care, or are hobbled by a poor economy, high rates of uninsured and low health literacy, among other things.

“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,” AHA President and CEO Rick Pollack said at a Washington, D.C., press briefing. “This is all about redefining the ‘H.’ 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 report’s release culminates 15 months of work by the AHA’s 29-member Task Force on Ensuring Access in Vulnerable Communities. The task force sought broad feedback on its work and received input from more than 700 hospital and community leaders during that period.

Its nine recommendations are:

Addressing 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.

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.

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.

Emergency medical center (EMC):Utilizing such 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.

Urgent care center:Offering an access point for urgent medical issues that can be treated without a hospital stay.

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.

Frontier health system: Better serving isolated “frontier communities” through the creation of local, integrated health care organizations, similar to accountable care organizations (ACO). 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 also would offer transportation services to patients, and enable them to return to their hometowns for follow-up care.

Rural hospital health clinic: 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.

Indian Health Services (IHS):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.

Task force chairman Bob Henkel, president and CEO of Ascension Healthcare in St. Louis, Mo., said the report recognizes that 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.”

Some of the strategies will involve congressional or regulatory action at the state or federal level. Federal policymakers, some of whom provided input to the task force, “also are looking for solutions to these problems,” noted AHA Chairman Jim Skogsbergh, president and CEO of Advocate Health Care in Downers Grove, Ill. “We are all in this together.” He added, “There is a lot more work to be done, and the AHA is here to help.”

Task force members Christina Campos, administrator of rural Guadalupe County Hospital in Santa Rosa, N.M., and Karen Teitelbaum, president and CEO of Chicago’s Sinai Health System, noted some common themes among hospitals serving vulnerable communities.  “A scarcity of resources and difficulties with reimbursement and regulations are common to everybody,” said Campos, who described the report as a “robust look” at the issues and challenges facing vulnerable communities.

Teitelbaum took aim at “statutes and regulations that do not fit the current time in health care.” She said “providers need much more flexibility in terms of forming partnerships and how we reimburse for care and how we keep people healthy in the community.”

The report provides detailed information on each strategy, case studies and a complete advocacy agenda and assistance strategy. 

Watch an AHA video about the report. 

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