This monograph from the Health Systems Learning Group (HSLG) describes strategic partnerships between non-profit health systems and communities, based on findings and recommendations from a learning collaborative of 36 non-profit health systems and 7 other organizations between 2011 and 2013. The learning collaborative was created after a stakeholder meeting convened by the U.S. Department of Health & Human Services Center for Faith-Based & Neighborhood Partnerships. Many of the participating health systems were in the process of conducting the first generation of community health needs assessments required by the 2010 Affordable Care Act, and developing implementation strategies to improve the health of the communities they serve. The assessments confirmed the profound health disparities in communities, where inequities in policies and practices have resulted in social, economic, and physical conditions that present immense obstacles to improved health. These issues are driven by determinants that are beyond the capabilities of health care provider organizations and require working with diverse stakeholders to deliver the right balance of services and investments that improve health, reduce costs, and contribute to overall economic vitality.
The HSLG was administered by a secretariat housed at Methodist Le Bonheur Healthcare’s Center for Excellence in Faith and Health in Memphis, Tennessee and at Wake Forest Baptist Health System in Winston-Salem, North Carolina. The HSLG partners contributed financial and in-kind resources to support the 18-month developmental phase, with additional funding from The Robert Wood Johnson Foundation to support the dissemination of these findings and lessons learned.
While the HSLG endorsed the “triple aim” to improve the experience of care, improve the health of populations, and reduce per capita costs of health care, the members of the learning collaborative contend that it is not possible to achieve these aims without focusing on a fourth dimension that is embedded in all three: to reduce, and ultimately eliminate, the profound health disparities in many of our urban and rural communities.
With an increasing focus on a more planned, proactive approach to charity care aimed at reducing preventable emergency room and inpatient care for the uninsured, the basic issue has been good stewardship – making optimal use of limited charitable funds. A more proactive and strategic allocation of resources enables hospitals to help low income populations avoid preventable pain and suffering; this, in turn, allows the reallocation of funds to serve an increasing number of people experiencing health disparities.
Accordingly, each of the participating health systems made a commitment to take the following actions:
- To approach our community health work collaboratively, as one steward among many others with a responsibility to improve the health of our communities.
- To proactively invest a percentage of what we currently spend on charity care, with a focus in neighborhoods where there is clear opportunity to achieve substantial measurable improvements.
- To monitor our proactive investments, our finance departments will work together to develop new, standard financial metrics and accountability processes, and to share them broadly within the health care community.
- To extend the interval between readmissions beyond 30 days. To do this we will develop, benchmark, and validate new practices in population health management. In the process, we will jointly seek to share in the financial gains produced which would otherwise only flow to the payers.
-
To develop shared-outcome metrics and accountability measures to capture the impact of collaboration among government, private payers and community partners. We will invite vendors to create IT products that build capacity and connectivity in the complex partnerships at the heart of our new opportunities.
- To engage and collaborate with governmental partners, foundations and non-traditional partners, to leverage their mission with ours to favorably impact our communities and become economic engines within our settings. When possible, we will work even with our competitors to achieve the common good: healthier people in healthier communities.
- To better understand our diverse communities through the lens of race/ethnicity, linguistics/literacy and socioeconomics to ensure we are equipped to meet their needs in culturally appropriate ways.
The HSLG has been renamed and continues its work as Stakeholder Health: Transforming Health Through Community Partnership. The Stakeholder Health website includes additional resources on issues such as hospitals and healthy food, hospitals and housing, overcoming transportation barriers, community health navigators, and community health workers, available for downloading. The learning collaborative is planning to publish a followup report in 2016.
Ignatius Bau 