Millions of Americans living in vulnerable rural and urban communities depend upon their hospital as an important, and often only, source of care. These communities and their hospitals, however, face many challenges. As the hospital field engages in its most significant transformation to date, some communities may be at risk of losing access to health care services. It will be necessary for payers and health care providers to work together to develop strategies that support the preservation of health care services for all Americans.

Recognizing this, the American Hospital Association board of trustees created a task force to address these challenges and examine ways in which hospitals can help ensure access to health care services in vulnerable communities. The Task Force on Ensuring Access in Vulnerable Communities considered a number of integrated, comprehensive strategies to reform health care delivery and payment.

Its report defines the characteristics of vulnerable communities — both rural and urban. It then sets forth a menu of options from which communities may select based on their unique needs, support structures and preferences, including nine emerging strategies. 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. While the task force’s focus was on vulnerable communities, these strategies may have broader applicability for all communities as hospitals redefine how they provide better, more integrated care.

At the AHA’s recent Rural Health Care Leadership Conference in Phoenix, the task force released a discussion guide designed specifically for hospital and health system trustees to help them ponder the critical questions raised by the report. The guide outlines eight questions ranging from “Which of the populations or communities we serve could be considered vulnerable? And why?” to “What role(s) should our board play in gaining input, buy-in and acceptance from the community to implement new strategies for ensuring access?” The discussion guide can be tailored for your board’s needs as part of the agenda for a board education session, leadership retreat or strategic planning session.

You can find the guide, the full report and a video archive of a panel discussion of the report from the Rural Health Care Leadership Conference online

Andy Stern (, is chair of the American Hospital Association Committee on Governance and a trustee of Medical City Dallas Hospital in Dallas.