Recently we wrote about the changing health care landscape brought on by multiple factors, including payment reform and provisions of the Affordable Care Act and IRS regulations. Until a few years ago, hospitals and health systems had been charged with monitoring and improving the health outcomes of their patients, as measured by disease rates, morbidity, and mortality. With the Affordable Care Act and a shift towards value-based payment models came the expectation that these systems would be accountable for community, rather than patient, health. Required assessment processes and improvement plans, new and growing partnerships, and evolving approaches to improving health outcomes have followed.
While these shifts present new, exciting opportunities for health care institutions and the communities they serve, new challenges have also emerged. We’ve worked with dozens of hospitals and health systems across the country as they aim to be more strategic and impactful in their role of improving community health. Many hospitals are experienced in providing investments in their community beyond their hospital walls, but it is a challenging endeavor. In our work across the country, we hear common themes as hospitals aim to improve community health in this challenging environment:
- Hospitals have a long history of investing in their community, but these investments may not align with other strategic processes in which hospitals are involved. For example, a hospital’s strategic implementation plan, required by the IRS, identifies community needs and how the hospital will address them, but these plans might diverge from other hospital-defined priorities and community benefits activities. This is further complicated as hospitals engage with other entities in collaborative prioritization and planning to develop community health improvement plans (CHIPs). The environment is ripe for alignment, though getting all stakeholders on board can prove challenging. Common barriers that hospitals face in changing their community health investment strategy include the persistent focus on patient – rather than community – health outcomes, competing priorities, and long-held practices such as building goodwill by funding pet projects and initiatives.
- Related is the hospitals’ constant challenge of demonstrating an improvement in health outcomes, often in a short timeframe. Further, demonstrating an impact on community health – a task generally requiring a longer timeframe and greater commitment – is even tougher for those looking for relatively quick results on their investments.
- Finally, many hospitals are committed to the health of the communities they serve, but are not prepared to take on the lead role responsible for significant improvements in community health, rather than patient health. Nor do they want to be valued primarily as the source of funding of community health investments.
So, what is a hospital in the current environment to do?
First, all stakeholders in community health – especially hospitals – should fully acknowledge the pressure put upon themselves in the effort to have an impact on population health. Even small changes in population health – moving the needle slowly toward improved outcomes – can mean a notable improvement in health status for a sizable portion of a community. When we are realistic about what can be achieved – including taking into account the size of the investment – then hospitals can indeed meet the goals of their investment, particularly in creating positive trends over time.
In addition, the pressure of leading and/or being solely accountable for the health of a community is daunting for many hospitals. Not only do strong community partnerships help to relieve that pressure, but there is enormous opportunity to make an impact on population health when efforts are aligned. In fact, IRS guidelines require that community benefit goals align with identified community needs. Imagine the combined investment of 1) hospital grantmaking, 2) other funding initiatives in the community such as those by community foundations and community development organizations, and 3) the initiatives, programs, and services happening every day on the part of community-based organizations. Hospital investment can leverage existing efforts and bring them to greater scale and impact. And, by defining appropriate evaluation measures, hospitals can demonstrate the change brought about by their investment, to share in credit and accountability.
There are other advantages to aligning hospital efforts with others’ efforts in the community. Being a strong partner demonstrates the dedicated interest of a hospital in the welfare of the community. And having a clearly defined role as a partner, particularly related to the nature of the hospital’s financial contribution, can also help to alleviate the “piggybank” mentality hospitals sometimes contend with.
Many hospitals have begun to effectively make this shift. Boston Medical Center, for example, has announced a significant investment to improve health by recognizing and addressing the fundamental health determinant of stable housing. Their investment is based in strong partnership with multiple organizations and agencies throughout Boston already engaged in housing efforts.
Regardless of a hospital’s investment dollars, aligning efforts with community partners with a common focus on community health outcomes can meet the multiple requirements and demands of hospital investment, and have a lasting impact on community health.
See HRiA’s practice brief and related tools: Maximizing investment in community benefit implementation strategy