Hospitals, Communities Work Together on 'Population Health'

Federal Policies Play Role in Fostering Change

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Julia Resnick is senior program manager at the Association for Community Health Improvement, an affiliate of the American Hospital Association and the Health Research & Educational Trust.

Posted: Wednesday, June 28, 2017 5:30 pm

When it all comes down to it, sustainability is really about designing healthy places to live and work for generations to come.

So, it only stands to reason that hospitals can be important allies in that endeavor. After all, who knows better how to promote wellness than the institutions established with that very mission in mind? If your community isn’t already integrating resources from local healthcare institutions into its sustainability plans, now might be the time to reach out.

Julia Resnick, senior program manager at the Association for Community Health Improvement, an affiliate of the American Hospital Association and the Health Research & Educational Trust, said hospitals are more receptive to community engagement than ever before, but sometimes they need a little nudge.

“We’re recognizing that we’re a health system now, and we have to be responsible for the health of people, not just treating people when they’re sick, but keeping them out of the hospital in the first place. That is a very different business model, which is frankly quite scary to a lot of hospitals,” Resnick said.

She said research suggests healthcare only accounts for about 20 percent of general health and that, according to a nationwide survey in 2015, more hospitals are beginning to align their missions with “population health,” collaborating with community organizations, public health departments and programs that address the socioeconomic determinants of health in a community.

“So, if hospitals are really deeply committed to improving the health of the communities they serve, then partnerships with housing and community development, transportation and public safety should all be involved,” she said.

Carol Kawecki, vice president and senior program manager at Healthy Housing Solutions, Inc., based on Columbia, Md., said hospitals are moving in this direction based in part on recent changes to federal policies.

“In the last decade, and especially since 2011, the national government has moved more – from a health policy standpoint – toward focusing on prevention,” she said. “The National Prevention Strategy was adopted in 2011 and has as a goal to promote the health and well-being of all Americans. One of its strategic directions is building healthy and safe community environments, and another is eliminating health disparities.” Both of these goals integrate nicely with the objectives of smart growth and sustainability, she said.

Kawecki said the U.S. spends $3.7 trillion annually on healthcare, but only about 20 percent of that spending actually results in marked improvements in the length and quality of life. She said “downstream problems” like obesity, depression, asthma, lead poisoning and secondhand smoke can be mitigated by “upstream solutions” like providing access to healthy foods, safe and walkable streets, reduced air pollution and improved housing conditions.

U.S. Internal Revenue Service tax code and the Affordable Care Act both require tax-exempt hospitals to conduct community health needs assessments (CHNAs) every three years. These assessments look at a variety of “community-building categories” that include housing improvements, economic development activities, environmental improvements, leadership development, coalition-building, community health improvement advocacy and workforce development, Kawecki said.

“The IRS recognizes that these categories are legitimate actions that hospitals can engage in to promote community health,” she said. “It’s important if you are working in any of these areas that you think about how you could engage hospitals in the process.”

Along with assessments, nonprofit hospitals also need to conduct community benefits planning and report their activities to the IRS in that same three-year cycle. These reports are open to the public and Kawecki said local sustainability leaders should be reading them to see where they might be able to get involved. Once a municipality gets buy-in from the hospital, they can earn a place at the table to help implement smart-growth concepts that meet the community needs identified in the CHNA, she said.

Resnick said a hospital’s CHNA needs to include these items:

  • Review data describing community health
  • Solicit and take into account input from the community
  • Identify significant health needs of the community
  • Prioritize needs for action
  • Describe strategies to address prioritized needs
  • Approach adopted by hospital authorizing body

She said obesity was the most commonly identified priority need in the latest round of CHNAs, with approximately 70 percent of hospitals including it. Other priorities identified include (in descending order) access to care, behavioral health, substance abuse, diabetes, prevention and screening, chronic condition management, cardiovascular disease, socioeconomic issues, insurance coverage, tobacco addiction and cancer.

The Association for Community Health Improvement has recently updated its Community Health Assessment Toolkit.

“The state of the field has advanced a lot,” Resnick said. “Community engagement is front and center because everybody benefits from it.”

She said hospitals gain a better understanding of their communities and the social determinants that they’re experiencing; they get community buy-in for their CHNA and implementation strategies; and they strengthen relationships with stakeholders. For communities, engagement with hospitals gives them a new perspective, knowledge and experience with healthcare issues, a shared commitment to improvement and a new source of investment in the process.

Resnick advises hospitals to establish robust relationships with community stakeholders, not just every three years when a new CHNA is due, but ongoing inclusion throughout the planning and implementation of projects. Depending on a community’s priorities, these relationships might be with law enforcement, schools, housing departments or environmental organizations.

Developing implementation strategies is both the most difficult and the most important step in the process, Resnick said. “This is the crux of the whole thing. Once you know the needs, then what do you do?” It’s critical that partner organizations stay involved, she said.

“As a community, how are you going to address all the facets that impact each need? If it’s obesity, then what are the schools doing; how is urban planning working so people can get out and exercise; where are there food deserts and grocery stores; can people access affordable fruits and vegetables? Bringing that all together under one plan and tailoring it to the culture of the community is a lot of hard work,” she said.

“There’s a reason this pathway is a cycle, because community health improvement isn’t a one-time thing. You need to keep working on it, keep evaluating, and see what’s working and who else needs to be involved,” Resnick said.

Resnick and Kawecki participated in a workshop on this topic at the 2017 New Partners for Smart Growth Conference in St. Louis earlier this year.

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