AHA opens the door to hospital access strategies

The integration of rural hospitals with health clinics and the use of technology to provide 24/7 care are among the strategies developed by an American Hospital Association task force to assist hospital leaders with preserving access to health services in vulnerable rural and urban communities. The strategies set out in the task force’s report are designed to assist providers amidst growing pressures on the health care sector. The report recommends reforms for health care delivery and payment designed to identify and provide the essential health care services individuals need. The report also considers policies which may serve as a barrier to implementation of the strategies.

Status quo

The country has nearly 2,000 rural community hospitals and more than 2,000 urban community hospitals. Because of their location, the hospitals are what the AHA calls “the anchor for their area’s health-related services.” The report notes, however, that the hospitals face challenges in the form of: remote location, limited workforce, constrained resources, and financial instability. The survival of the hospitals is important because the hospitals serve as a critical health care access point in vulnerable communities.


To assist the hospitals, the task force identified: characteristics and parameters for vulnerable communities, essential health care services, and emerging strategies to ensure the hospitals are able to provide those essential services. The nine strategies include:

  • addressing the social determinants of health (housing, utility needs, food insecurity, interpersonal violence, education, employment, low income);
  • implementing global budget payments, which provide greater financial certainty for vulnerable hospitals;
  • shifting inpatient resources to resources devoted to outpatient care;
  • the use of emergency medical centers to allow existing facilities to provide emergency medical services without having to maintain inpatient beds;
  • the use of urgent care centers as a viable outpatient alternative to emergency medical centers and inpatient hospitals;
  • implementing virtual care strategies like telehealth;
  • the creation of local, integrated health care organizations (called Frontier Health Systems) for very small, isolated frontier communities;
  • integration between rural hospitals and health clinics like Federally Qualified Health Centers (FQHCs); and
  • improved coordination between Indian Health Service (IHS) facilities and other providers.


The task force acknowledged several barriers to the implementation of its strategies, including federal statutory and regulatory barriers. Additionally, the task force noted that certain facilities may have difficulty transitioning to new payment models or novel care delivery mechanisms like telehealth. The AHA acknowledged that the ability to attract and retain health care providers will continue to be a difficulty at the community level. To be successful, the AHA report notes that communities will need to expend time, effort, and finances, while hospitals will need to improve technology infrastructures and care planning.

Highlight on Virginia: Health Opportunity Index maps out disparities

An updated version of the Virginia Health Opportunity Index (HOI) allows consumers, policymakers, and providers to evaluate multiple social determinants of health as they impact different geographic areas of the Commonwealth. The Virginia Department of Health’s Office of Minority Health and Health Equity (VDH-OMHHE) originally developed the HOI to provide a picture of the social, economic, educational, demographic and environmental factors that impact community health. Since its inception, the HOI has been redesigned into a continuously updated source of information to help stakeholders engage with changing health data using a convenient, visual dashboard.

Dashboards and Indicators

The HOI website uses a number of interactive dashboards and maps to allow consumers, policy-makers, and providers to interactively examine the HOI data. With separate dashboards for counties, health districts, and legislative districts, the HOI interface is designed to allow scrutiny of the data at multiple different levels of detail. The HOI relies on 13 indicators, which were chosen to serve as the building blocks of the HOI. The indicators were selected for their influence upon health, stakeholder input, and the availability of data on those factors for all of the relevant geographical areas in Virginia.  The indicators are all focused on determining an individual’s opportunity to live a long and healthy life in a particular area.


The HOI dashboards synthesize the 13 indicators into four different profiles: the Community Environment Profile, the Consumer Opportunity Profile, the Economic Opportunity Profile, and the Wellness Disparity Profile. The Community Environment Profile is an indicator of social and natural measures, including air quality, population turnover, population density, and walkability, which refers to street connectivity and public transit accessibility. The Consumer Opportunity Profile measures the availability of consumer resources, including access to and the affordability of food, transportation, housing, and education. The Economic Opportunity Profile evaluates economic opportunity in individual communities by measuring employment accessibility, income inequality, and the number of individuals actively participating in the workforce. The Wellness Disparity Profile provides a measure of the disparate nature of access to health care services within in a community. The Wellness Disparity Profile indicates access by measuring the number of physicians in a community, the number of uninsured individuals. The Profile also more broadly considers whether community members have access to a primary care physician and the means to pay for care.


According to VDH-OMHHE,” the HOI is remarkably predictive of health outcomes.” The VDH-OMHHE believes that because the HOI explains the majority of life expectancy variation in Virginia’s Census Tracts, the HOI influence is comparable to that of the World Health Organization’s Social Determinants of Health (SDOH). In other words, Virginia believes that its HOI does as good of a job predicting health outcomes as the economic and social predictor of health used by the Centers for Disease Control and Prevention (CDC). The HOI is premised upon an understanding that place matters and, with appropriate spatial modeling, health care can be improved. The HOI provides a wealth of information. Now, stakeholders need to put that information to good use in order to start improving health across the state of Virginia.