Co-Authored By: Kenneth Kaufman, Chair, Kaufman Hall, and Eugene A. Woods, President and Chief Executive Officer, Atrium Health

Providing equitable and accessible healthcare to America’s vulnerable populations has been a formidable long-term challenge for providers and policymakers. With new entrants and technology focusing on improving healthcare access and convenience, Kenneth Kaufman, Chair of Kaufman Hall, and Eugene A. Woods, President and CEO of Atrium Health, encourage us to consider how these innovations could affect our nation’s low-income and underserved populations.

This article is reposted with permission from the American Hospital Association.


In the past year, the number of Grubhub users grew 70 percent, from 9.2 million to 15.6 million.

In the past four years, the share of business transportation for Uber and Lyft grew from 7 percent to 72 percent.

In the past six years, the percentage of U.S. adults who own smartphones grew from 39 percent to 77 percent.

These statistics offer a snapshot of how the U.S. population has embraced innovative technology designed to make their lives more convenient. Although going out to restaurants may not seem so inconvenient, a large number of Americans find ordering from their smartphones to be more convenient and appealing. Using an app to call and pay for a ride is a big step up from the frustrations of finding and paying for a traditional taxi. And as those us with teenage children will attest, the smartphone has become the mother of all conveniences: the platform that puts all the instant interactions of the Internet economy at your fingertips anywhere and at any time.

Perhaps more than any other sector, healthcare interactions suffer from a lack of convenience. Finding a physician, scheduling an appointment, visiting care facilities, paying, managing care and information—all are long-time sources of irritation for patients. They are also vulnerabilities for traditional providers.

As we have seen in industries from transportation to telecommunication, innovative companies large and small are eager to exploit traditional inconveniences with technological innovation and aggressive competition—and consumers have welcomed the new options that result. We are seeing the same dynamic emerging in healthcare. CVS Health/Aetna is proposing using CVS’s 10,000 stores and digital tools to reinvent healthcare’s “front door.” Apple is creating state-of-the-art clinics and hiring “designers” to recreate healthcare for its employees. And Amazon is teaming with JPMorgan Chase and Berkshire Hathaway in an effort that likely will focus on creating a broad digital platform for healthcare.

These potential changes will be very attractive for many healthcare consumers. It’s hard to argue against more convenience and digital connectivity. However, while these improvements may reduce the frustrations that many Americans have with their healthcare providers, they do not automatically touch the deeper healthcare problems of our most vulnerable citizens—patients who have historically struggled with healthcare access, affordability, and equity.

America has 97 million low-income individuals, 45 million living in poverty, 28 million uninsured, and 74 million Medicaid and Children’s Health Insurance Program enrollees. The struggle for healthcare among low-income citizens is a major societal problem. A recent Commonwealth Fund study found that the United States ranked last among 11 developed nations in health equity, defined as the difference in care between low-income and high-income individuals. The United States also ranked last in access, primarily due to problems with affordability.

Race is another critical factor in care inequity. For example, African-American women are four times more likely than white women to die during childbirth. Infant mortality is more than twice as high for African-American babies than for white babies. And mortality rates for breast cancer are 42 percent higher for African-American women than for white women.

America’s not-for-profit hospitals play an important role in serving low-income people and other vulnerable populations. These hospitals provide more than $67 billion per year in total community benefits, including free and discounted care, care to Medicaid beneficiaries, and services to improve community health and increase access to care.

The conveniences promised by healthcare disruptors—such as personal health monitoring or online scheduling—will not solve the problems of populations who struggle simply to afford care, access care, and receive quality outcomes equal to those of the mainstream American population. In addition, by potentially drawing revenue and utilization from America’s traditional hospitals, disruption could actually weaken the financial position of the very organizations whose historical mission has been to serve the poor and the vulnerable.

America’s hospitals and health systems are thinking hard about their future in a disruptive environment, and rightly so. They are trying to enhance access, improve convenience, and create a better patient experience. Legacy hospitals are trying to develop more efficient and effective care models, incorporate telehealth, and untether themselves from a strictly facility-focused orientation. They are trying to broaden their sources of revenue, protect their financial health, and get the financial and intellectual capital necessary for healthcare’s next generation of care. And they are trying to figure out a role in relation to large, potentially disruptive new entrants.

As leaders in Washington D.C., and our state capitals, healthcare executives and our society continue to work through these issues, we must continue to think deeply about how we can continue—and improve—the ability to serve America’s underserved populations. As organizations develop new care models, new points of access, and new methods of contact, they should consider how those changes might negatively or positively affect the poor, the elderly, children, and the uninsured. As new partnerships are created, consideration should be given to how they can be used to enhance community benefit, address the social determinants of health, and improve access to care and continuity of care. And as financial resources are reallocated, careful attention should be paid to how those resources can support innovative community benefit. Real people – our friends, family and neighbors depend upon it.

American capitalism is always advancing toward a more efficient and effective model, reducing costs and providing consumers with better and more varied product choices. This has been the power of the American economy for more than 200 years. But such dramatic change can sometimes leave important parts of our society behind, depriving those citizens of the benefits of economic change. And when those benefits are access to fair and equitable healthcare services, then the social stakes are much higher and more meaningful than how quickly consumers can order and receive laundry detergent. These are large and complex social justice issues, and they deserve very close consideration.