As policymakers and regulators examine whether nonprofit hospitals are delivering sufficient value for their tax-exempt status, the conversation often centers on charity care. That’s an important measure, but it’s not the first stage of our work.
If community benefit begins only when someone needs charity care, we’ve started too late.
At Advocate Health, we contributed $6.27 billion in community benefit in 2025 — more than $17 million each day — and more than $24 billion since our system was formed in 2022. Those numbers are meaningful, but only because of what they represent. As our system has grown, so has our ability to invest where we are needed most. Scale done right does not distance a health system from its neighborhoods; it brings more resources back to them. That investment matters because the challenges facing our communities continue to grow.
Rising prices in basic necessities such as food, housing and transportation are already straining household budgets across the communities we serve. Affordability is critical because we are part of those communities, too. Our hospitals are led by community leaders, and our teammates live and work alongside the people they serve. Every dollar we invest in our communities returns to the people and places we call home.
Because we are not accountable to shareholders, we are able to invest in services and programs that benefit the communities we serve but that the market won’t reward. They include mobile clinics in neighborhoods private practices have left, medically tailored meals for patients managing chronic disease, and behavioral health services for teenagers and screenings that catch cancers before they metastasize. We invest in medical education because the country needs more clinicians, and we invest in research because the next breakthrough won’t fund itself.
The most significant shift in community benefit over the past decade has been the move upstream. Nonprofit health systems such as ours now identify patients eligible for financial assistance before care is delivered, screen for food insecurity and housing instability during clinical encounters, connect people to coverage they didn’t know they qualified for and deliver care in schools, homes and community settings. The goal is simple: to help people access support earlier so chronic conditions don’t become serious illnesses and acute needs don’t become financial hardships.
One example of this approach is Advocate Health’s school-based virtual care program, which supported more than 15,000 student visits in a single school year, with nearly 60% of those visits occurring in rural counties. When a child with a minor malady can be treated at school, a parent doesn’t lose a shift at work. A family avoids an emergency room bill that might have followed. That is community benefit, and it looks nothing like charity care.
Multiply that model across thousands of nonprofit hospitals nationwide — food pantries in clinic lobbies, mobile mammography vans, community health workers embedded in neighborhoods and sliding-scale pharmacies — and the scale of what nonprofit systems do to keep America healthier and more financially secure comes into focus.
That is true across the nonprofit hospital sector. Larger, integrated systems are increasingly able to standardize financial assistance, share best practices, invest in prevention and sustain services that are essential to community health but often under-reimbursed.
Charity care will always remain an essential responsibility of nonprofit health systems. But the future of community benefit lies further upstream. The ultimate measure of success is not how much hardship we help patients recover from. It’s how much hardship we help members of our community avoid altogether. That is the standard by which nonprofit health systems should ultimately be judged.
Kinneil Coltman is Advocate Health’s chief consumer and social impact officer.
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