A new health crisis is looming on the horizon in the United States, and it will affect the most vulnerable people. I am not talking about another pandemic, the downstream impact of delayed preventive screenings, or even the ongoing substance use crisis. I am talking about the endangerment of America’s health care safety net, including the providers that serve marginalized communities.
Safety net providers are primarily in unserved and underserved communities, where people already face a higher burden of chronic conditions and high mortality rates. Providers in these communities rely heavily on Medicaid and Medicare dollars to help fulfill their mission: caring for low-income, uninsured, and underinsured patients. When you consider that more than three-quarters of hospitals have 67 percent of their in-patient days paid by Medicare and Medicaid, the scale of the issue is staggering.
As CEO of a leading preventive medicine health care association, many of our member physicians work on the front lines of the health care safety net in hospitals and public health departments serving marginalized communities and strive to meet community needs. But these reimbursement dollars do not always meet patients’ needs or fully cover the costs, and the situation worsens with continued cuts to Medicare and Medicaid payments, proposed cuts to the Centers for Disease Control and Prevention’s budget and under-investment in the public health infrastructure. To understand the scope of the problem, look at safety net hospitals or health departments in rural America. While there’s no single definition of safety net hospitals to give a clear number, consider that America’s Essential Hospitals, the trade organization representing hospitals with higher levels of under/uninsured patients, has 300 member institutions. There are approximately 3,489 local health departments strapped for talent and resources. When you factor hospitals and/or health departments in rural communities, you can see how these cuts can impact a large segment of the population.
Safety net providers in both hospitals and health departments are already straining under the burden of staffing shortages, increased patient needs and demands, and growing stressors on systems of care at the community level. Each of these factors individually should be cause for grave concern, but taken together, they create a confluence of cost and care factors that will leave vulnerable populations at greater risk.
The loss of health care providers in rural communities means those living in more remote areas will have to travel even farther for care — delaying critical interventions and slowing the process of much-needed preventive care to reduce risk. Americans living in low-income communities, who already bear a higher burden of chronic illness, will see services reduced, leaving far too many with nowhere to turn for care when they need it most.
It isn’t just a reduction in services that threatens access to care in these communities. Safety net providers also continue to see consistent turnover due to low reimbursement rates, burnout, and other factors. If these trends continue, the problem will become more dire. It will take intentional investments in growing the pipeline of clinicians with highly specialized backgrounds to right the ship. To truly make this adjustment and implement models that will improve the health of not just individuals but whole populations will require preventive medicine physicians.
It is imperative that federal lawmakers commit significant investments in providers with expertise in both clinical care and public health to implement a true value-based care approach. By extending residency rotations for preventive medicine physicians, we can achieve just that via a low-cost, high-value opportunity that will enable new models and new assessments to be developed, and support improved alignment with existing health department services, benefitting the entire community and helping the bottom line.
We know this is a model that works. The association consists of ambassadors like Victoria Schwartz have participated in, and helped lead, residency programs that create this shared value approach. In Cook County, Illinois, through Northwestern University, Schwartz is part of a program that gives residents an opportunity to earn a master of public health, conduct clinical care, and participate in projects with the department of health and local clinics addressing top community health concerns (such as gun violence and substance use disorder). The program has offered the opportunity for her institution to continue delivering direct patient care with deep value added by forging partnerships with local entities best poised to make community-level differences.
More must be done to not just protect safety net providers, but to also foster more partnerships like the one in Cook County and many others across the nation. Funding from the Health Resources and Services Administration can go a long way toward supporting and financing eligible programs, but more is needed.
Now, more than ever, the leaders in Congress must prioritize directing funds for preventive medicine programs, protecting institutions that serve vulnerable populations, and supporting initiatives that put value-based care at the forefront. The downstream effects of the pandemic are only just beginning to unfold, rates of chronic disease continue to rise, and potential economic downturn means more and more people will rely on essential services provided by safety net providers.
We can’t afford to wait for another pandemic or health crisis to highlight the stark disparities these institutions are straining to bridge.
Donna Grande is a health care executive.