Ensuring Access to Quality Health Care in Vulnerable Communities

Millions of Americans living in vulnerable rural and urban communities, their hospital is an important, and often their only, source of health care. As transformation in the hospital and health care field continues, some communities may be at risk of losing access to health care services and the opportunities and resources they need to improve and maintain their health. Integrated, comprehensive strategies to reform health care delivery and payment, within which vulnerable communities can make individual choices based on their needs, support structures, and preferences, are needed.

In this Invited Commentary, the authors outline characteristics and parameters of vulnerable communities as well as the essential health care services that hospitals should strive to maintain locally identified by the American Hospital Association Task Force on Ensuring Access in Vulnerable Communities. They also describe four of nine emerging strategies—recommended by the task force—to reform health care delivery and payment and allow hospitals to provide the essential health care services, along with implementation barriers and how to address them. While this Invited Commentary focuses on vulnerable communities, the four highlighted strategies (addressing the social determinants of health, adopting new and innovative virtual care strategies, designing global budgets, and using inpatient/outpatient transformation strategy), as well as the other five strategies, may have broader applicability for all communities.

Every day, hospitals and health systems are navigating the challenges and opportunities of a constantly changing health care environment. At the American Hospital Association (AHA), we have been focusing on meeting the demands of today and tomorrow by redefining the hospital—or the “H”—to best serve patients and communities, create new models of care and collaboration, address affordability and value, and advance health in the United States.

To advance the health of all patients and all communities, the AHA developed our Path Forward, with a commitment in five areas: access, value, partners, well-being, and coordination.¹ The health care field must work to ensure that all individuals have access to affordable and equitable health, behavioral, and social services; provide increased value to individuals; embrace the diversity of individuals and serve as partners in their health, including connecting with them in ways that make sense in the digital age; focus on well-being and partnerships with community organizations; and coordinate and integrate care.