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HAP Leader Helps Create Hospital Guide to Ensure Health Care Services in Vulnerable Rural, Urban Communities

November 29, 2016

A new report issued by the American Hospital Association (AHA) addresses ways in which hospitals can help ensure access to essential health care services in vulnerable rural and urban communities.

Andy Carter, president and chief executive officer of The Hospital and Healthsystem Association of Pennsylvania (HAP), serves on the 29-person health care leader task force that developed the report. The task force met with policymakers and hospital and community leaders during a 15-month period to identify essential health services, strategies to meet community needs, and barriers to those strategies.

Of Pennsylvania’s 67 counties, 48 are designated as rural. In addition, nearly eight out of ten (78.7%) Pennsylvanians live in an urban area. The challenges identified in vulnerable communities––poor economy, lower education and health literacy levels, environmental problems, higher rates of uninsured––result in a higher incidence of poor health and health-related disabilities.

“Hospitals play a critical role in the commonwealth’s vulnerable rural and urban communities, serving as the health care safety net, a primary provider or coordinator for related social services, and a key employer,” said Carter.

During 2015, more than 625,000 Pennsylvanians depended upon hospitals for their jobs through direct employment and the ripple effect, with a total economic impact of nearly $115 billion. In two-thirds of rural Pennsylvania counties, hospitals are among the top five employers. In about one-third of these counties, hospitals are the largest employer.

“Good health is part of a larger quality of life picture,” Carter continued. “The task force sees great promise in expanded population health and wellness initiatives to meet broader health needs more effectively. Partnerships with diverse community stakeholders and other health care providers will generate new models of integrated care and better alignment of resources.”

Essential health care services necessary in vulnerable rural and urban communities include:

  • Primary care services
  • Psychiatric and substance use treatment services
  • Emergency department and observation care services
  • Prenatal care
  • Transportation
  • Diagnostic or screening services
  • Home care
  • Dentistry
  • Strong referral structure

The task force report outlines emerging strategies that can help preserve access to healthcare services in vulnerable communities. These strategies were developed to provide options dependent upon demographics, geography, and other factors. A few of those strategies include:

  • Addressing social determinants of health, such as housing, food insecurity, risk behaviors, violence, and unemployment
  • Global budget payments, which are being discussed in Pennsylvania
  • Expanded outpatient services
  • Emergency medical and urgent care center models
  • Virtual care strategies such as telehealth, mobile apps, personal devices
  • Rural hospital-health clinic arrangements

“We can build bridges to healthier living, disease management, primary care services, and innovative medicine, but there are legislative and regulatory barriers that must be removed to ensure progress on this front,” said Carter. “The report addresses some of those concerns.”

Carter also emphasized that while rural and urban hospitals take their responsibility seriously, many are struggling to maintain their important community role. Currently, 29 percent of Pennsylvania’s rural hospitals have negative three-year average total margins, and 27 percent of urban hospitals have negative three-year average total margins.

“Lawmakers cannot impose any additional hospital payment cuts,” he said. “Hospitals need fiscal predictability and stability to adopt the right strategies and sustain them.”


Katie Byrnes (statewide)
(717) 561-5342
Twitter: @HAP_Media

Priscilla Koutsouradis (southeast)
(215) 575-3743
Twitter: @DVHCupdates

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