Introduction
With federal cuts to Medicaid from the 2025 budget reconciliation law (H.R.1) expected to increase uncompensated care by $278 billion over the next decade, disproportionately straining rural communities, health systems face growing pressure to rethink how they support uninsured populations without compromising financial sustainability. Ballad Health, a 20-hospital health system operating in the rural Appalachian region across KY, NC, TN, and VA, has challenged the tradition charity-care model through its Appalachian Highlands Care Network (AHCN). Launched in 2021, AHCN manages uninsured patients as a full-risk, value-based population, deploying community health workers and navigators embedded within trusted community-based organizations to address medical and social needs before they escalate into costly, avoidable care.
Read our latest case study that explores AHCN's approach to turning uncompensated care from a cost center into a strategic opportunity.
Key Takeaways
Plan for workforce constraints early. High-fidelity CHW models carry real scalability limits, so a tiered staffing strategy, spanning CHWs, navigators, existing staff, and external partners, lets programs grow without sacrificing quality of care.
Leverage trusted community relationships over cold outreach. Embedding enrollment staff directly within CBOs that already hold hard-to-reach populations' trust drove significantly higher enrollment than centralized call-center or mail-based outreach.
Manage uninsured populations from a value-based lens. Taking a three-pronged approach of addressing social needs, healthcare access, and chronic disease management together can reduce uncompensated care while turning a population often seen as a financial drain into a strategic opportunity.