As hospitals and health systems brace for financial uncertainty tied to the One Big Beautiful Bill Act, one issue is drawing renewed focus: those who skip or delay care — often due to cost, coverage loss or access barriers.
This issue was recently highlighted among seven pressing questions for health system leadership, amid efforts to prepare for the ripple effects of the legislation. Leaders said delayed or forgone care, while still difficult to quantify, is a strategic priority.
“Providing timely and appropriate care is a top priority for our patients and our organization,” said Patrick Kokoruda, vice president of access transformation at Cleveland Clinic. “We know that timely care can help prevent issues from turning into larger problems that require more serious treatment. Getting patients to the right provider quickly ensures timely care and that the right treatment is available.”
In July 2025, 36% of adults said they had skipped or postponed needed healthcare in the past year due to cost — a figure that rose to 75% among uninsured adults younger than 65, according to KFF.
Leaders recognize that delayed care triggers ripple effects across the system: worsening health outcomes, more intensive interventions, rising acuity in EDs and steeper long-term cost curves. As Jacob Robinson, president of Little Rock-based Arkansas Heart Hospital, put it: “There are hospitals in Arkansas that could see major impacts from delayed or deferred care. We’re already in a really challenging financial landscape. Expenses are rising at rates far beyond inflation, and reimbursement isn’t increasing at the same pace.”
Becker’s connected with Mr. Kokoruda, who leads access strategy at a large academic medical center, and Mr. Robinson, who oversees operations at a cardiovascular specialty hospital, to discuss how their organizations are responding — and what they are prioritizing.
Mr. Kokoruda noted that Cleveland Clinic is reaching out to patients who are due for screenings or services they have not scheduled.
“We want to make it proactive, easy and convenient for them to set up care,” he said. “Through our access team and call center, we’re generating outbound messages to patients when they’re due or overdue — for instance, for colorectal cancer screening, mammograms, cervical cancer screening, annual wellness visits, and more.”
At Arkansas Heart Hospital, the focus is providing high-quality services as efficiently as possible, according to Mr. Robinson. He specifically emphasized the hospital’s work with respect to cardiovascular care.
“In Arkansas, we’re in the heart of the cardiac belt. We face some of the highest rates of heart disease and obesity. Many of those challenges are rooted in rural access, economic hardship and lack of preventive care,” Mr. Robinson said.
“Our clinic model is based on rural access. We bring physicians, staff and diagnostics from the metro area into local communities. That’s been at the core of what we’ve done since we opened more than 25 years ago — our commitment to rural communities.”
Mr. Robinson said the hospital is, however, increasing efforts to provide more testing in both rural locations and Little Rock — including through its clinic network — so patients do not have to travel far for care.
“We also focus on prevention through community screenings and outreach programs, including a corporate screening program that offers low-cost or free heart screenings,” he said. “These help us detect disease early, especially in populations that otherwise wouldn’t know they have heart issues. Those are two core components of what we offer at the heart hospital.”
Cleveland Clinic also emphasizes the importance of timely care. Mr. Kokoruda said this occurs during patient interactions, whether the patient is calling to schedule, self-scheduling or in a clinic with a provider.
“We want them to feel comfortable utilizing care when they need to, rather than waiting,” he said. “We know that when screenings aren’t done at the recommended intervals, or when patients delay care despite symptoms, problems can progress and lead to more costly treatment plans. Our focus is on preventive care — ensuring patients get screenings on time and that they have timely access to a primary care provider.”
He said the academic medical center is also ensuring timely access through its primary care network and urgent care sites. For example, the organization recently launched extended specialty clinic hours, offering appointments on evenings and weekends — in addition to Cleveland Clinic’s existing urgent care availability.
The organization also continues to expand virtual options and is modernizing self-scheduling. It offers shared medical appointments for dozens of conditions and has extended hours for certain surgeries and specialties. Mr. Kokoruda said patients may also opt in to receive text notifications when earlier appointments become available.
“We encourage patients to sign up [for notifications] … through MyChart or when speaking with a caregiver,” he added. “We’ve seen tens of thousands use that feature to move up faster as capacity opens or schedules shift.”
And, from a strategy perspective, given the ripple effects delayed or skipped care can have on an organization, such as inpatient and ED volumes, access is a key quality and financial measure for both leaders and their organizations moving forward. Mr. Kokoruda said that means ensuring patients can get appointments with Cleveland Clinic providers within the needed time frame based on clinical necessity — and in the communities where they live.
“It’s a big part of many of our strategic conversations,” he said. “It’s about identifying the patients who need to be seen sooner, based on symptoms or diagnoses. We’re prioritizing urgent and medically necessary patients through a variety of methods — including exploring AI capabilities. We’re also focused on recruiting and retaining providers. Fluctuations in clinician numbers affect our capacity, so ensuring we have the workforce to meet community needs is a top priority. That includes recruitment and retention, optimizing schedules in Epic, and ensuring outpatient capacity is aligned with demand.”
Beyond ‘sick care’
While delayed care remains a top concern for hospital leaders, their strategies also reflect broader shifts toward prevention and long-term health outcomes.
Mr. Robinson was promoted to president of Arkansas Heart Hospital in October after serving as the hospital’s chief strategy and operations officer. He said one of his priorities is a more expansive focus on health outcomes, rather than internal operations.
“It’s a mindset shift. It’s the age-old adage: healthcare versus sick care. We do a really good job of offering sick care, but we call it healthcare. I think there are some incredible things we do in sick care,” he said. “But there’s great value in offering true healthcare, which is more prevention- and education-based.”
He specifically pointed to AHH’s intensive cardiac rehab program, which is designed to help prevent a second cardiac event through supervised exercise, nutrition education and lifestyle coaching. The overall goal of the program is to improve long-term outcomes.
“In my mind, that’s excellent care,” Mr. Robinson said. “But what if, instead of just rehabilitation, we had ‘prehabilitation’ — going into communities with supervised exercise, nutrition, education and coaching to prevent the first cardiac event?
“That’s where my mind goes with this role change [to president]: How do we partner with communities, rural hospitals and local clinics? How do we increase education, screening and opportunities to prevent cardiovascular disease before it starts?”
