Breaking the Myth: "No One Competes for the Poor"
A well-worn phrase in healthcare suggests that “no one competes for the poor.” But the reality is, every health system already takes financial risk for the underserved they just do it poorly.
Emergency rooms become the default access point, avoidable hospitalizations pile up, and billions of dollars flow into reactive, high-cost interventions that could have been prevented with earlier, smarter investments.
So, what if we actually competed for these patients—not as an act of charity, but as a strategic imperative that aligns mission, financial stewardship, and long-term sustainability?
Competing for the underinsured and uninsured means:
- Understanding them as customers, at least at the level we seek to understand the commercially insured.
- Investing in proactive care systems and navigation instead of reacting at the point of preventable crises.
- Using tax-exempt resources strategically, creating real return for both patients and the health system.
Health systems that view community benefit as a compliance exercise rather than a strategic asset are missing an opportunity—not just to serve, but to lead.
Innovating for Access
For nonprofit health systems to justify their tax-exempt status, they must prove real, measurable returns on community investment. That means rethinking access, designing smarter care models, and proving outcomes—not just intentions.
Some practical ways to make that happen:
- Stop waiting for the ER visit. Identify at-risk populations early and intervene with care coordination, digital access, and strategic outreach.
- Reallocate spending from waste to prevention. Instead of absorbing the financial drain of preventable readmissions and ED overuse, shift resources upstream.
- Expand healthcare’s role in economic mobility: job training, food access, housing, and transportation are healthcare issues, because they drive outcomes and costs.
This is not just a moral argument. It is a smarter business model that:
- Puts people first.
- Reduces uncompensated care and strengthens financial sustainability.
- Creates real competitive advantage in serving communities efficiently.
Nonprofit health systems cannot afford to be passive.
A Call to Compete for the Underserved
The most unsustainable strategy in healthcare is the status quo.
If health systems continue to wait for the underserved to show up in the highest-cost settings at the latest possible stage, they will burn billions in waste—and invite increased scrutiny on nonprofit tax exemptions.
But the alternative is powerful:
💡 Use strategic community investment to reduce long-term costs.
💡 Design better, more efficient care models tailored to real needs.
💡 Treat tax-exempt status as an active reinvestment strategy—not a passive compliance exercise.
It's challenging. Lead anyway.
