David McMillan | Palladium - Dec 04 2019
U.S. Hospitals Can Change the Healthcare System

Source: Kaiser Permanente

Communities are a key stakeholder in health services across the globe, reaching disadvantaged patients and able to best understand and advocate for what specific groups need. Asking hospitals to understand the health needs of their communities is not a new phenomenon, and in the U.S., it’s legally mandated that non-profit hospitals complete a community health needs assessment (CHNA) every three years. Every hospital must solicit input from community members and make the assessments widely and publicly available with a written report – they even have to explain to the federal Internal Revenue Service (IRS) how they are addressing the significant needs identified in their most recent CHNA and what needs are not being addressed.

These assessments require resources to conduct and even more resources to execute well. But many hospitals operate at a low margin, meaning they don’t have much money left over to use for this additional requirement. Many health systems essentially consider it a check-the-box exercise. However, the CHNA process could be a real opportunity to spur innovative ideas and create a more sustainable healthcare system. Here are three ways hospitals can leverage the CHNA requirement:

1. Embrace Being a Leader

Healthcare is not just medical care; in fact, medical care explains only 10-20% of health outcomes. Other factors around behavior and environment – like nutrition, stable housing, access to transportation, and physical safety – play a larger role. These are called “social determinants,” and, because they’re considered within CHNAs, hospitals are finding themselves in a position of influence when it comes to these factors. Hospitals should embrace this leading role, but understand they can only do so much as individual entities. They need to find partners.

2. Overcome Sub-Optimal Partnerships

It’s easy for hospital systems to take on a glut of partnerships at limited scale to try and impact a social determinant like education or nutrition.
One leading hospital system identified literacy as a priority and has a goal to “partner with elementary schools to advance students’ academic success”. It has created pen pal and in-class read-aloud programs, both resourced by hospital employees. The programs, while making a positive difference, touch less than 1% of elementary school children in the city. It’s not a scalable solution.

Instead, hospitals should leverage the unique resources of the hospital system, such as their working relationships with utility, transportation, and insurance companies, in a way that could better maximize impact for the time and money invested.

3. Identify the Most Effective Impacts

The CHNA requirement actually gives hospitals the freedom to prioritize community health needs. Hospitals should focus on those they can most effectively impact. The goal should be to identify community-level solutions that are sustainable because they create greater economic value in conjunction with addressing a community health need.

For example, Cityblock uses health insurance to provide “wrap-around” services that target social determinants in order to increase the health of its members while decreasing long-term costs. In 2018, Kaiser Permanente announced its Thriving Communities Fund that will both preserve and offer low-interest loans to build affordable housing, in collaboration with a consortium of other organizations.

The opportunity for addressing CHNA priorities to drive greater hospital system sustainability is rarely considered a long-term strategy. Instead, it’s relegated to future focus or assigned to a small department to figure out in relative isolation. But with the right approach, hospitals can realize these three opportunities to create long-term, sustainable impact that addresses the health needs of their communities.

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