Leveraging Community Benefit to Support Healthy Communities

Gary Cohen and Chris Kabel
April 30th, 2014
This post was written by Gary Cohen, President and Co-Founder of Health Care Without Harm, and opens with an introduction by Chris Kabel, Senior Program Officer, Health, at the Kresge Foundation:
We are witnessing some exciting changes in America’s approach to health and health care.  While most of our nation’s political and media attention has been focused on expansions of coverage and access to health care, the Affordable Care Act also includes components that encourage hospitals and health systems to engage and support their communities in a more robust and effective way. 
Innovative local and regional partnerships around the nation are beginning to transition health systems from a paradigm that has rewarded hospitals for maximizing billable services to one that provides incentives for keeping people healthy and out of the hospital.  The Kresge Foundation is supporting efforts to shift the national discourse and institutional practices toward a greater emphasis on prevention, efficiency and health equity.
Community advocates and the nonprofit hospitals that represent 85 percent of U.S. hospitals have several tools at their disposal to accelerate this shift. Two key tools are Community Health Needs Assessments (CHNAs) and Community Benefit (CB) programs. Hospitals can use their CB funds to address a host of non-medical community conditions that affect residents’ health – everything from housing to public safety, economic opportunity, early childhood development and the built environment.
Kresge grantees such as the Hilltop Institute, Community Catalyst and Health Care Without Harm are working with hospitals to redesign their community benefit programs, inform community advocates about how to access CB funds, publish research and share best practices.  Gary Cohen, the president and co-founder of Health Care Without Harm, will now share his perspectives on the most promising opportunities to use CB funds to achieve better community health outcomes. 
Health Care Without Harm President and Co-Founder Gary Cohen
The Affordable Care Act (ACA) offers our country the opportunity to transform a healthcare system that has focused on sickness to one that prioritizes health. Under the ACA, non-profit hospitals are required to conduct community health needs assessments every three years and align their community benefit expenditures with community health priorities. 
This is not a small thing. Last year, hospitals reported spending $13 billion on community benefit, with the lion’s share going toward charity care and discounted Medicaid expenses. As more and more people sign up and receive healthcare, the percentage of charity care is likely to go down, freeing up funds for programmatic investments that support community health. Moreover, since one of the pillars of ACA is to address population health, for the first time hospitals are being challenged to look beyond the four walls of their facilities and understand what is happening in the communities they serve.
These changes in healthcare policy create an opening to achieve three fundamental objectives that will have cascading benefits for the country as a whole:Create an opportunity for community-based organizations to partner with local hospitals on neighborhood health issues.
Community organizations often lack political power and financial resources to address issues that impact community health. Violence prevention, food access, housing equity and other social service issues are all critical factors impacting people’s health. By partnering with local hospitals on these population health issues, community-based organizations can create greater leverage at the local level to move innovative programs toward wider adoption and also finance them through their healthcare partner’s community benefit money. With healthcare allies as validators and co-creators, programs that show strong outcomes that reduce healthcare costs can then become embedded in the core business strategy of the healthcare institution.
An example of using community benefit for this purpose is Health Leads, which trains college students to staff a desk in community clinics and hospitals to make social service referrals to low-income patients. Partners Healthcare in Boston has used community benefit funds to hire Health Leads because it frees up their clinical staff to focus on the patient’s medical issues while the Health Leads staff address their social care needs.

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