- As the healthcare industry embraces patient-centered healthcare, organizations must work to ensure healthcare access to vulnerable communities, such as rural or urban regions. So says the American Hospital Association in a recent report.
According to the organization, vulnerable communities are more likely to have patients in poor health as a result of a declining or aging population, lack of access to primary care services, economic challenges, low insurance levels, and a lack of access to basic life needs (e.g., food, shelter.
Because of these challenges, healthcare in vulnerable communities is waning and needs industry cooperation to improve. “The ultimate goal is to provide vulnerable communities and the hospitals that serve them with the tools necessary to determine the essential services they should strive to maintain locally, and the delivery system options that will allow them to do so,” AHA said.
Those essential services include access to primary care, psychiatric and substance abuse disorder treatment, emergency department and observational care, prenatal care, transportation to care, diagnostic services, home care, dentistry, and a strong referral structure.
To guide healthcare organizations working toward extending these services to vulnerable communities, AHA researched and developed nine strategies. While some of these address payment issues that affect urban and rural healthcare access, others involve widespread patient outreach.
Address the social determinants of health
According to AHA, many barriers to healthcare access are unrelated to the number of services offered. Instead, they stem from the social determinants of health, or the factors that affect a patient’s ability or willingness to access healthcare services that do exist.
For example, patients might be unable to get to a doctor’s appointment because they lack transporation or food insecurity makes it hard for them to follow treatment-related diet regimens.
“We determined that addressing these challenges through enhanced clinical-community linkages would aid community members in more effectively accessing available health care services, which would, in turn, improve their health outcomes.”
Rural and urban healthcare industry leaders can assess the social determinants of health by screening patients for health-related social needs, highlighting the path to overcoming those barriers, and partnering with other social structures to offer continued assistance.
Reallocate workforce and patient volumes
In communities that do lack healthcare services, AHA suggests leadership reallocate workforce and patient volume.
Hospitals have seen a decrease in the number of inpatients visits and increase in the number of outpatients, AHA reports. To account for this shift, organizations should reduce the amount of inpatient services they offer to increase the amount of outpatient services they offer.
In doing so, healthcare organizations can provide better support where patients need it rather than leaving care gaps in high-demand areas. This strategy requires a tailored approach, changing from community to community depending upon patient needs.
Healthcare organizations can also drive this effort by creating alternative care sites. Emergency medical centers (EMCs), for example, can function as free-standing emergency departments.
“EMCs provide emergency services (24 hours a day, 365 days a year) and transportation services,” AHA explained. “They also would provide outpatient services and post-acute care services, depending on a community’s needs.”
Similarly, health systems can build urgent care centers to remove patient volume from the ED at inpatient facilities. Similar to emergency medical centers, urgent care centers can remove some of the patient volume from the ED at inpatient facilities.
“In some instances, a vulnerable rural or urban community may only need an access point for urgent medical conditions to be treated on an outpatient basis,” AHA explained. To meet that need, urgent care centers could treat injuries or illnesses that appear non-life-threatening but require treatment within about 24 hours.
Urgent care centers and EMCs not only improve the patient experience for those with urgent outpatient needs but also improve experience for those in inpatient settings. By redistributing patient volume, healthcare leaders can ensure patients will see the right level of attention and care from their providers.
Enlist telehealth and virtual care options
Telehealth services enable providers to meet with patients outside of the healthcare facility, bringing a more convenient, efficient, and cost-effective mode of healthcare delivery — especially helpful in extremely remote areas where it is difficult to maintain a strong healthcare workforce.
“These strategies could offer benefits such as immediate, 24/7 access to physicians and other health care providers, the ability to perform high-tech monitoring and less expensive and more convenient care options for patients,” AHA noted.
However, these strategies may be difficult to implement as a result of federal, state, community, and provider barriers, according to AHA.
For example, Medicare reimbursement is not set up in such a way conducive to some of the programs, and some states have physician licensure laws that would prohibit them from administering telehealth.
Communities could struggle with attracting and maintaining the necessary providers to build this healthcare infrastructure. And when communities do attract the needed workforce, those employees will face a time-consuming and arduous task of making the above initiatives possible.
“This is only the beginning,” AHA concluded in references to its strategies and solutions. “To fully ensure access to essential health care services, we will all need to do our part — vulnerable communities, the hospitals that serve them, and the association that serves us all.”
Given the financial resources and time it will require to implement these strategies, industry leaders across the nation and federal policymakers will need to implement support systems helping vulnerable communities flourish, AHA concluded.