Category Archives: Community Benefit
The Community Health Initiative (CHI), a program of the Cincinnati Children’s Hospital Medical Center in Ohio, includes work with nontraditional community partners to support community organizing and address critical children’s health issues in the community. For example, using geocoding technology to identify areas of greatest need—“hotspots”—by mapping clusters of readmitted asthma patients to substandard housing units owned by the same landlord. CHI partnered with the Legal Aid Society of Greater Cincinnati, which helped tenants form an association and compel the property owner to make repairs. CHI also makes referrals to Legal Aid for patients who need help with Medicaid benefits or require other legal assistance. CHI has developed specific health metrics with which it evaluates the effectiveness of its programs and shares these data with local community organizations and CHI’s community partners.
The CHI work was featured in a new community benefit issue brief from The Hilltop Institute at UMBC, “Community Building and the Root Causes of Poor Health.”
NewPublicHealth recently spoke with Robert Kahn, MD, MPH, who is the Director of Research in the Division of General and Community Pediatrics at Cincinnati Children’s Hospital.
NewPublicHealth: What are the goals of the Community Health Initiative?
Robert Kahn: The Cincinnati Children's Hospital board established in its strategic plan for 2015 four goals that relate to the health of all 190,000 children in our county. The goals relate to: infant mortality, unintentional injuries, asthma, and obesity rates as they relate to hospital readmissions. Our plan is to build a strategy and an infrastructure to cover the ground between a more traditional clinical approach and a truly public and social wellbeing approach to these conditions.
NPH: Why are partners so critical?
>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.
NewPublicHealth was on the ground at the National Association of County and City Health Officials Annual 2012 conference, providing the latest conference news and in-depth interviews with conference speakers, as well as local success stories and a glimpse into the Los Angeles public health scene. Coverage highlights included:
- A discussion with Paul Kuehnert, new senior program officer for the Robert Wood Johnson Foundation and director of the Foundation’s Public Health Team, and former executive director for health for Kane County, Ill.
- A Q&A with Jonathan Fielding, MD, MPH, MA, MBA, director of the Los Angeles County Department of Public Health.
- Violence prevention discussions around the special screening of The Interrupters, including a talk with CeaseFire violence interrupter Ricardo “Cobe” Williams and a Q&A with Baltimore Health Commissioner Oxiris Barbot
- A photo tour of the L.A. City Emergency Operations Center, a model for collaboration around preparedness
- A site visit and photo tour of a corner store participating in the Long Beach Health Department’s healthy corner store initiative through the Healthy Eating Active Living Zone program.
At the conference, we also spoke with attendees about how local health departments are forging innovative new partnerships across sectors and across communities to meet shared goals and leverage resources. We asked: What’s the most creative, outside-the-box partner you’ve engaged with from a sector beyond public health? What did they add to the conversation and your joint efforts? What successes have you achieved as a result of partnerships? Who do you see as the most critical partners for public health?
A sampling of responses we heard from attendees are recapped below. Themes that emerged included the critical nature of partnerships between health departments and hospitals, Community Health Assessments and Improvement Plans as a catalyst for partnerships and sustained community health changes, and diverse partnerships across the community that each bring something valuable to the table.
Local health officials will be meeting in Los Angeles later this week at the NACCHO Annual 2012, the annual meeting of the National Association of County and City Health Officials. Key conference topics this year include:
- Affordable Care Act and its impact on local health departments and service delivery
- Chronic Disease Prevention and Control
- Transforming and Supporting the Local Public Health Workforce
- Building a Disaster Resilient Community
- Public Health Research
NewPublicHealth will be on the ground conducting speaker and attendee interviews, featuring session coverage and capturing the stories of public health departments across the country. Follow our coverage here.
In advance of the meeting, NewPublicHealth spoke with Robert Pestronk, MPH, executive director of NACCHO.
NewPublicHealth: How difficult is it to cull to the final session list for the meeting this week?
Robert Pestronk: The conference committee has once again done their wonderful job of selecting from among hundreds of potential sessions. I think the tracks selected are in areas that speak to the issues local health departments are confronting. They’re looking at transition into chronic disease prevention and control. They’re looking into and acting in many areas on the policy, system and environment and organizational change spectrum. There are big questions about the local public health department workforce and how that needs to change in light of both the reductions in funding and the increasing emphasis on new areas of work. And certainly, the need to have a resilient community and to have the health department play an important role in planning for disasters. The departments also need to do the best job that can be done to communicate to policymakers, to community members, to governing boards, the case for local health departments. These are timely, essential issues, and those attending the conference will hear from local health department officials and others who are grappling with these issues and coming up with ways to address them successfully.
NPH: Recent public health meetings have addressed the importance of both quantitative and qualitative research to improve public health. Are you seeing that at NACCHO as well?
Robert Pestronk: Both quantitative and qualitative research are becoming increasingly important. On the research side, I think that perhaps not just in the field of public health but in the human services or social services field generally the qualitative research has been seen as a poor step child to the quantitative that has been done at the medical or the research bench, and I think part of what’s happening is we’re coming to understand the importance of both styles and types of research. Researchers are coming to grips with the need for both types and also becoming more sophisticated in terms of the methodologies that they’re using. I think this convergence is a good thing, and I think that the recognition of the importance of both types of research by people and researchers in both areas is a very important development.
NPH: How important will the topic of Affordable Care Act be, now that the Supreme Court has ruled, at this year’s NACCHO meeting?
Robert Pestronk: We do have a couple of sessions on the Affordable Care Act, and I think that there’s going to be a lot of conversation among participants at the meeting about how the Supreme Court’s decision will play out in their state and play out across the country. Certainly, the changes in IRS rules for non-profit hospitals has opened up lines of conversation both at the member organization level as well as in local communities, either opened it up or enhanced that conversation, and I think that Medicaid and the way in which states either adjust or not adjust their programs to limit coverage are going to be conversations because those decisions have implications for the kinds of services that local health departments may need to continue to provide or not.
I think that other areas that will get discussed are the evidence that’s been generated from the funding that has been out there already. It’s going to be necessary to bring those stories forward to communicate why these changes are important for the health of their communities.
NPH: How does the Affordable Care Act help local health departments?
Robert Pestronk: It continues the nation down a road of assuring that people in communities have insurance coverage and have access to healthcare services regardless of whether their place of employment provides that as a benefit. So it will continue the conversation in local health departments across the country about the role that they should or shouldn’t and can or can’t play with respect to clinical care. I think that what we’ve learned is that some health departments will, because of the nature of the clinical resources available in their communities, need to continue to provide these services. I think that local health departments will hope that the expansion in dollars that are available through the Public Health and Prevention Fund continues over the next couple of years and that expansion will result in more opportunities for local health departments to become more active in the policy system in environmental and organizational change area. I think that the resources that are available through the Fund present opportunities for enhanced relationship-building within communities.
NPH: Collaboration is becoming a very important part of improving public health services delivery. Are we seeing both more in terms of recognizing how vital these partnerships can be as well as the actual collaborations at the local health department level?
Robert Pestronk:I think that in most cases local health departments have always been in a collaborative mode. They’ve always known that the resources that they have aren’t big enough and large enough in most communities to make a difference all by themselves. Those who are practicing in local health departments understand that to move the needle; to make a change to create the conditions in which people can be healthy requires collaborations around individual projects and programs as well as collaboration on the vision for healthier communities.
NPH: Shared services is also a topic of current important for local health departments—can you talk about its importance for local health departments?
Robert Pestronk: We have some sessions on that topic. I think that people will be interested in it. In some parts of the country, local health department districts or regions or two or more counties or communities have long been joined despite a law which might allow all individual counties or communities to have a local health department. And it’s not just shared services between local health departments; I think the conversations are underway about whether health departments are helped by collaboration or shared service arrangements with other service providers in communities as well. It’s the recognition that shared services among the public and private and non-profit sectors within a community are aimed at common goals. That includes between the media and local health departments, between the clergy and the local health departments, between businesses and local health departments—the notion of everybody on the same team rowing in the same direction, having the same vision for the community and sharing aspects of their resources with one another because some members or organizations in a community have expertise that others don’t. By combining those different assets with one another, health is more likely.
NPH: What’s your hope this year for some of the hallway conversations among meeting attendees?
Robert Pestronk: One of the major outcomes that we seek from the Annual Meeting each year is to have presented an opportunity where people around the country who face similar challenges can talk with one another about the work that they are doing and to gain enthusiasm and support and recognize the importance of persistence around difficult issues, and to recognize the importance of partnerships. It’s to give people opportunities to see what others are doing and to see how their success or what they’ve learned from failure can be adapted within their own communities. I think at a 10,000 foot level people may be grappling with the same kinds of issues. Here they can attend sessions that are of practical interest to them that will open up their eyes to the ways in which their peers are addressing an issue or have confronted an issue which they themselves may confront.
That was always as a local health department practitioner why I valued the NACCHO Annual Meeting so much was because it was a source of stimulation for me, it introduced me to my peers around the country. I always discovered that there was somebody doing something better than I or who had attempted to do something that I was interested in doing and the conference provided an opportunity for me to learn from them both there and then to establish a personal relationship with them so that if later I called them on the phone they would have a face to attach to the person on the other end of the line.
NPH: The intersection of public health and health care is at a critical juncture. What’s ahead at NACCHO on this issue?
Robert Pestronk: I think that one of the things that we’re going to be focusing on at NACCHO over the next year is what does the health department of the future look like? And clearly, again, based upon the resources that individual communities have this intersection between the clinical domain and the governmental public health practice domain is going to be an important conversation. I think that it’s going to play out differently in different communities because the resources that are available are different in different communities. I don’t think there’s going to be a one size fits all. I don’t think we’re close to having a national system in which these two separate domains are appropriately and proportionately resourced and appropriately and genuinely linked together in the ways that they might be. I think that we’re going to be on a long road in that direction over time.
NPH: Any sessions in particular you’d like to note?
Robert Pestronk: That’s like picking a favorite child! I’d say look carefully at the program ahead of time, pick sessions that are in areas that are familiar and pick sessions that are in areas that one knows nothing about because that’s a way of both discovering what’s immediately useful in terms of one’s own work in the community and it’s also useful in the long term because it often is the case that although one isn’t confronting a particular challenge at this time, one very well may be confronting it soon after. And also take time to have informal conversation with others because it’s often in that space where very interesting observations and relationships are made and joined, and those are ones that can last a lifetime.
Across the nation, health departments are exploring ways to share services, resources and functions across multiple public health agencies and jurisdictions. Often motivated by the need to do more with fewer resources, many health departments and elected officials are approaching cross-jurisdictional sharing as a way to improve efficiency as well as strategy to improve the quality of the services provided and, hopefully, the health of the affected communities and residents.
With support from the Robert Wood Johnson Foundation, the Kansas Health Institute (KHI) has been selected to form the Center for Sharing Public Health Services to assist public health agencies across the country that are considering or implementing cross-jurisdictional sharing. The team will include a national learning community of up to 18 competitively selected and funded sites. The Foundation has issued a call for proposals from health departments considering or working on shared relationships to join the new project. The members of the new learning community will help identify successful, innovative regional and shared approaches to help improve the quality, efficiency and impact of public health services.
Patrick Libbey, former executive director of the National Association of County and City Health Officials and a national expert on the issue of cross-jurisdictional sharing, will serve with Gianfranco Pezzino, MD, MPH, KHI senior fellow, as co-director of the project. Libbey also co-authored the first major environmental scan on the state of cross-jurisdictional sharing arrangements among U.S. public health agencies. NewPublicHealth spoke with Patrick Libbey about the new project.
NPH: What are some of the key reasons that health departments are exploring or entering into shared service arrangements?
Patrick Libbey: There are several reasons but the key ones are to improve their service capabilities and capacities and to be able to do things together that individually they might not have been able to do. This has been accelerated in some respects by the emergence of performance standards, notably, voluntary national accreditation of public health departments.
There is an increasing concern about being as efficient as possible in costs and other resources. And given the economy and the effect on local and state budgets, there’s an increased attention on how can we do well at lesser costs or at least without increasing costs. In public administration circles of all kinds, regionalization and shared services is one method being looked at and increasingly being used as a means of being more effective and efficient. Examples of different public sectors that have looked at or implemented shared services include schools, traditional government service areas such as fire and police, library services and parks and recreation. It’s not a question that’s emerging exclusively in public health.
NPH: What types of sharing relationships currently exist between local health departments, and how common are they?
Patrick Libbey: In every state we interviewed we saw evidence of shared arrangements. We need to think of shared services as a spectrum or a range of options. It can be as informal as almost a handshake agreement to share resources and equipment. In many places we saw service agreements, where a department might purchase a service they didn’t provide—more of a transactional arrangement. Particularly in the last decade there has been an emphasis on preparedness, and that has led to mutual aid agreements. We see arrangements where an official for one department on, say, Women, Infants and Children, might direct that service for a neighboring department but still remain on the full-time payroll of their own department
More complex arrangements include ones on a multi-jurisdictional basis, such as working jointly on community health assessments or joint epidemiology efforts covering all the participating jurisdictions. The most complex arrangements are where local health departments merge—in essence creating a new entity comprised of two or more former local health departments—or consolidate, where two or more departments are combined into an existing department.
NPH: What are good examples of shared relationships in place right now?
Patrick Libbey: There are lots of examples across the country. Several come to mind immediately. There are five relatively small health departments in the Colorado Rockies. They had environmental health services needs and only one of the five had the capacity to do it, so they worked out a way to share that capacity. They got needs met that they could not have met individually and as a result they are able to sustain the necessary expertise at the local level. From that, they then worked further to develop a joint community health assessment process, but will create individual improvement plans.
We tend to think smaller parties are the ones that need to share, but another example is a joint effort of the eight local health departments serving the greater Chicago metropolitan area including the Cook County and City of Chicago Health Departments. They do some of their planning and development work together, because in a sense, they share a population. People may live in one place but work in the other. So for public health emergencies, they have worked out arrangements for a single media communications process. It reduces confusion and gets out a clear message.
More recently, on a large scale, has been the merger of the Akron, Ohio, Health Department with the Summit County Health Department. This example gives you some idea of the complexities involved in a sharing effort at this scope. The merger came about as the result of a very thoughtful planning process beginning in mid-2009 including a thorough feasibility study, cost projections, political considerations and key partner and community involvement. Time was taken to ensure an orderly transition and to make sure necessary administrative and other operational details were carefully addressed before the merger was actually implemented. The newly merged Summit County Health Department began serving the population of Akron in 2011.
NPH: Have the relationships always been based on a need that emerged?
Patrick Libbey: What we saw for the most part was opportunistic—there was a funding opportunity or there was a need of service issue. We didn’t see as much proactive efforts, such as let’s get together up front, and agree to jointly fund a service or a capacity that could then be deployed as seen fit by the participating jurisdictions. What has been happening has been extremely pragmatic, though that may change over time or change as resources become more flexible. It has been reactive in a positive sense. But it works. That’s the litmus test.
You can demonstrate the benefits in ways that connect to the drivers—increased efficiency, increased cost-efficiency and improved service.
NPH: What factors contribute or detract from the success of these cross-jurisdictional relationships?
Patrick Libbey: There needs to be willingness on the part of both the health officials and the policy-makers. Not necessarily a champion, though that’s nice, but there needs to be openness to consider sharing services or capacities across jurisdictions . There also needs to be clarity up front about the intended purposes of such sharing. Improved public health performance and cost containment are both legitimate policy goals based often coming from different roles and perspectives. There’s some risk of conflict or perceived contradiction if the purposes of all the parties involved aren’t clear and attended to from the outset. There can be ways to get to a win-win opportunity but only when all the intended purposes are on the table.
Policy-makers need to know that their obligation to their constituency is met and potentially improved as a result of the service sharing and they need to have a say and an oversight in that. And health officials need to be in a position of assuring the public health needs of their respective jurisdictions are being met or improved. For the policy-makers, their obligation as an elected official is to their jurisdiction and their constituency. In that framework, they can’t willingly contribute to what may a greater good if it is seen as coming at a cost to the good of their jurisdiction. That’s not a turf issue, that’s a civic and an ethical issue.
Candidly, financial resources do make a difference. There’s a cost to putting shared arrangements together effectively. That cost sometimes is a direct expense in planning and implementing a shared arrangement and in other times it’s a lost opportunity expense, what else might have been done with the resources committed to developing the shared service relationship. It will cost something to take the time and energy to make this happen. Funding incentives have been helpful.
Long-term working relationships, history, the sense of local control and cultural factors—those are some of the other factors that are important to the success of a sharing arrangement.
NewPublicHealth: What will the Center’s goals be?
Patrick Libbey: The project will assist public health officials and policy-makers in how to consider the use of cross-jurisdictional sharing. One of the major features will be the recruitment of 18 sites across the country to serve as learning laboratories in a national learning community. These will include sites who are actively engaged in the development of cross-jurisdictional sharing arrangements, sites engaged in implementing such arrangements, and sites that have arrangements in place but are seeking to improve or expand them. The Center will provide technical assistance and support to these sites. The Center will also provide some technical assistance to other jurisdictions and organizations working on shared services. Beyond the benefit to the 18 sites and others directly receiving technical assistance, the Center will be capturing, synthesizing and sharing the learning from these efforts. This also includes gathering or developing if necessary useable tools for others to use. All the learning and resources will be shared with policy-makers, health departments and others with an interest in public health performance improvement. Put more simply, the overall intent really is to better understand, share and support ways in which cross-jurisdiction service sharing can be used to improve public health performance and efficiency.
>>Read more on sharing arrangements across public health department jurisdictions.
>>View for call for proposals to join the Shared Services Learning Community.
The National Network of Public Health Institutes (NNPHI) Annual Conference in New Orleans, La., concluded late last month. Now that the conference materials and presentations are available for download, we caught up with some of the attendees and NNPHI leaders to get their thoughts on conference highlights.
Ellen Rautenberg, President and CEO, Public Health Solutions and NNPHI Board Chair:
“Dr. Jo Ivey Boufford, a keynote speaker discussed activities Institutes are currently doing at the intersection of public health and primary care and provided her thoughts as to how Institutes might expand on these. She felt that Institutes were perfectly poised to keep the attention of policy makers on population health as they address cost and quality of the health care system.”
Bob St. Peter, President and CEO, Kansas Health Institute:
“It was a great conference. NNPHI walked the talk of multi-sectorial partnership. What other public health conference could you go to where the three keynote speakers are from the New York Academy of Medicine, the Federal Reserve Bank and AcademyHealth? Thinking beyond our traditional partners in public health is becoming increasingly important as our health system hopefully moves to one that is more accountable and more effective.”
NewPublicHealth also spoke with Christopher Kinabrew, MPH, MSW, director of Government and External Affairs for NNPHI to capture conference themes and highlights of the hallway conversations.
NewPublicHealth: What were some of the themes you heard in conversations by attendees?
Christopher Kinabrew: In terms of some of the themes that came through, one important one was that now more than ever, neutral conveners are needed at the state and local level for so many different initiatives. This is critical now in areas such as building bridges between health care and public health. That came through in the keynote from Jo Ivey Boufford and the discussion on the Institute of Medicine report.
There’s also this concept of “backbone organizations.” For many of these initiatives, it’s not a one-time thing. For community health assessments, for example—there’s the assessment itself, but then after that there’s a whole community improvement process. There needs to be some accountability and structure for that to happen. More and more we’re seeing the need for a backbone organization to continue that work. In some cases it’s the public health institute, and in other cases it’s an organization that spun off. I heard in some of the hallway conversations, some examples in the area of health information exchange where the public health institute incubated the exchange, but then in the end it became its own separate entity.
NPH: What other themes did you hear?
Christopher Kinabrew: Health reform was also a big theme for us at the meeting. There were so many comments that regardless of the outcome, “the genie’s out of the bottle.” These changes are happening. The decision will have an impact, but in many of these initiatives the conversation has already changed, so prevention is going to move forward regardless.
Another theme was about funding being consistently under attack. There was a lot of conversation about public health institutes being a hub or a nexus for alternative funding mechanisms. We’ve known for a while that the institutes are good at leveraging federal funding, private foundation funding, and contracts with state and local funding health departments—they’re able to do some things that perhaps other organizations can’t do because of that funding mix. David Erickson from the Federal Reserve also got people thinking about even more alternative financing and funding mechanisms for public health, in terms of working with community development financial institutions.
NPH: From what you learned at the meeting and during David Erickson’s presentation, what are some of the ways public health institutes, health departments and community development institutions can work together?
Christopher Kinabrew: It’s really about putting the social determinants of health into action. He made the comment that community development folks might need to change their language and terminology to say “we’re in the health business.” In terms of the evaluation and measurement of these investments, public health partners could bring the type of robust evaluation that goes on in the health sector to the table for community development. There was a lot of interest in increasing capacity across our membership in health impact assessments. That’s an areas where we could all work together to put some health measures in community development investments and boost the evaluation capacity. That’s an area where our members do tend to be really strong.
>>Read more on community development work to improve public health.
It’s not new to see our members working across sectors, but to me in this conference there was a marked difference in really working upstream across sectors to advance a health in all policies approach. This is something that’s talked about in the National Prevention Strategy. We held a breakout on health in all policies around the intersection of agriculture, food systems and public health. That session was packed.
NPH: You moderated the Town Hall on community health assessment. What came out of this discussion?
>>Read up on community health assessment as part of community benefit initiatives.
Christopher Kinabrew: We featured two national organizations—The Hilltop Institute and United Way Worldwide. We know from our members that first and foremost they want to share what they do and are looking for best practices. Martha Somerville, director of Hilltop’s Hospital Community Benefit program, laid the groundwork on community benefit responsibilities for nonprofit hospitals and for how public health institutes could facilitate meaningful collaboration between hospitals, health departments and community-based organizations. In her presentation and throughout all of the presentations, there was a theme that it’s not just about the needs assessment—it’s also about the community health improvement planning and the structure for implementing those strategies.
From Sandra Serna Smith at the United Way, we heard about their massive coverage and the strength of their network, in terms of covering 95 percent of the population. What was also interesting was learning about the United Way’s three pillars—education, income and health. They made the point that if any one of these isn’t strong, the rest fall. That really resonates well with our members.
We had Kevin Barnett from the Public Health Institute moderating the session. That was a great opportunity because he’s a content expert in community benefit and community health assessment. Two of our members also shared their experiences from the ground—the Texas Health Institute, which brought one of the local public health departments they worked with, and they told the story of how they worked together. Laurie Call from the Illinois Public Health Institute compared and contrasted her experience with two different counties. All of these examples included robust partnerships with public health institutes, health departments and hospitals, and United Ways were often involved sometimes as a funder but also as a partner in implementation.
An interesting question from the audience was, what sector didn’t you include in the process that you would have looking back? Both local panelists mentioned transportation. Looking ahead, that’s maybe a key sector we want to involve next year.
>>Read the rest of our NNPHI Annual Conference coverage.
The National Network of Public Health Institutes (NNPHI) Annual Conference kicks off today in New Orleans, La. Public health institutes are nonprofit entities that serve as partners and conveners to improve population-level health outcomes and help to foster innovations in the public health system. They serve as hubs of innovation, provide technical assistance, and offer a neutral point of convening to governmental public health agencies as well as other critical stakeholders.
This year's conference theme, "Leveraging Public Health Institutes for Systems Change," will share examples of public health institutes working in close collaboration with state and local health departments and a broad range of other partners to support opportunities for systems change. There are some new and interesting developments at this year's Annual Conference, which has seen an uptick in registration from around 120 attendees in previous years to more than 200 attendees this year (impressive in an era when travel budgets are scarce).
NNPHI also recently released a new call for proposals, with funding support from the Robert Wood Johnson Foundation, to enhance the performance of the public health system by supporting additional states to use the public health institute model to help address their pressing health challenges. The project will fund up to two states to advance efforts to establish a public health institute that meets NNPHI’s definition, with an ultimate goal of improving these states’ public health systems.
NewPublicHealth spoke with Christopher Kinabrew, MPH, MSW, Director of Government and External Affairs for NNPHI, for some highlights of this year’s conference:
- David Erickson, PhD, Manager of the Center for Community Development Investments at the Federal Reserve Bank of San Francisco, will be a keynote speaker and continued NNPHI collaborator in discussing the potential around keeping the relationship between public health and community development alive.
- Work is underway to determine the feasibility of developing a national tribal public health institute that addresses the needs and concerns of the 565 federally recognized American Indian tribes in the United States. The group spearheading this effort will be at the NNPHI conference for the first time this year.
- A Community Health Assessment Town Hall with representatives from the Hilltop Institute, United Way Worldwide and several public health institutes, will explore opportunities for collaboration around assessments, such as between public health and hospitals around new community benefit requirements.
>>Continue to follow NewPublicHealth coverage of the NNPHI Annual Conference this week.
Richard J. Umbdenstock, American Hospital Association: Opportunities for Collaboration Between Health and Health Care
The intersection of health and health care was an important theme at this year’s Keeneland Conference—during sessions on recent IOM reports, in hallway conversations, in discussions of Public Health Services and Systems Research that explores the most efficient ways to deliver public health services, and, notably, during the keynote address by Richard Umbdenstock, president and CEO of the American Hospital Association.
In his presentation, Umbdenstock talked about hospitals and public health, "collaborating for communities," and said that as health care providers, hospitals had tended to focus on treating the individual, rather than on prevention for the population. Now, he said, the money is gone and the public cares more about health, meaning it makes less and less sense for either hospitals or public health to be concerned with protecting their turf. “We need to incent health and deglamourize consumption.” Quoting a colleague, Umbdenstock said “what we need to do is create an epidemic of health.”
Umbdenstock spoke frankly when he told the attendees, “hospitals want to improve the lives of their patients, and not just their health care. Rather than wait for an [hospital] admission that won’t be paid, they’d rather get upstream on primary care.”
“Public health departments must be funded and supported so that wellness and prevention touches all and there are enough resources to do that,” said Umbdenstock. “And this is where research can play a big part—collaborative health research. We need to know the most effective collaborative models and the most effective ways to advocate for greater personal and community responsibility.”
NewPublicHealth caught up with Richard Umbdenstock following his talk.
NewPublicHealth: What are you hearing from hospitals about the new IRS community benefit requirement?
Richard Umbdenstock: Some hospitals have had similar responsibilities at the state level and many have had to put out accountability reports to their communities, so for many it’s not a new concept. In addition, hospitals have long been under a microscope and they also understand that community benefit is a wonderful community education tool. If they can tell it in a clear and consistent fashion, there’s a real opportunity for the public to better understand what hospitals and public health departments do.
NPH: Do hospitals and public health understand the critical community roles each one plays?
Richard Umbdenstock: I don’t think there’s any question what public health departments do after you’ve see them spring into action after a disaster, just as a lot of people don’t value what hospitals do until after they’ve been a patient. On a day-to-day basis we can all get so deep in our work that we just don’t see what the other person is doing. What we’re learning is that we all serve the same person.
Non-profit hospitals are required to provide a “community benefit” to qualify for tax-exempt status with the Internal Revenue Service. The Patient Protection and Affordable Care Act includes provisions for expanded community benefit opportunities with a focus on improving community and population health.
Massachusetts has had a similar community benefit provision at the state level for decades. NewPublicHealth recently spoke with Massachusetts State Health Commissioner John Auerbach, DPH, about what other states can learn from Massachusetts’ experience, particularly regarding the benefits – and challenges – of critical collaboration between public health departments and hospitals and other health care institutions.
NewPublicHealth:Massachusetts may have a leg up on some states when it comes to community benefit. Can you give us some background on that?
John Auerbach: The state Attorney General has long had community benefit guidelines that direct hospitals to address the non-hospital-based health and social needs of their patients. Consequently every hospital has been accustomed to implementing community benefit projects that follow the Attorney General’s criteria aimed at improving population or community health.
To help public health officials and policy-makers better understand the opportunity around the community benefit requirements for nonprofit hospitals, the Robert Wood Johnson Foundation funded the The Hilltop Institute at UMBC – a research center that focuses on the needs of vulnerable populations – to publish a series of issue briefs on best practices, new laws and regulations, and study findings related to community benefit activities and reporting. The most recent Hilltop Institute brief on community benefit and partnerships between hospitals, public health agencies and the communities they serve includes a discussion of an innovative asthma management program created by Children’s Hospital Boston. Last week, new data was published in the journal Pediatrics showing that this program reduced hospitalizations and emergency room visits, improved patient outcomes and saved $1.46 for every dollar spent.
NewPublicHealth spoke with Laurie Cammisa, Vice President for Child Advocacy at the hospital, about the project and the hospital’s approach to community benefit.
>>Read more on community benefit and the Hilltop issue brief series in a Q&A with Abbey Cofsky, program officer at the Robert Wood Johnson Foundation.
NewPublicHealth: The new IRS regulations on community benefit begin in March, but you are far ahead of the game with some of your community benefit initiatives. How did that come about?
Laurie Cammisa: The State Attorney General called for voluntary community benefit guidelines beginning in the 1990s, so we have been thinking about our initiatives since then. Our community benefit initiatives have included programs on mental health, child development, fitness and asthma. We have programs in each area, in partnership with communities.
NPH: Why is asthma one of the focus programs?
Jason Turner, PhD, a professor at the Saint Louis University School of Public Health, is the recipient of a Public Health Law program grant to study community benefit activities conducted by non-profit hospitals. These activities are required to maintain a hospitals’ tax-exempt status. Turner spoke at this week’s Public Health Law Research annual meeting about community benefit and NewPublicHealth checked in with him for an update.
>>Read a related Q&A with Abbey Cofsky, program officer at the Robert Wood Johnson Foundation, about public health opportunities from community benefit requirements.
NewPublicHealth: What is the scope of your grant?
Jason Turner: We’re looking specifically at the impact that state regulations have on the type of community benefit being provided. We’ll be presenting what the national picture looks like. We’ll also show a comparison between [different levels of] rigor of state reporting requirements—for example, does a hospital simply have to state that it has a community benefit program, or does it have to state specifically what the benefit program entails.
What we have found is that there is not one standard. Eighteen to nineteen states have community benefit regulations. The majority of state regulations are flexible—you just have to file your community benefit program with the state. Some, though, such as Texas, are very strict and require that hospitals meet a particular threshold, or be stripped of their nonprofit status within the state.
NPH: Will you be making recommendations for what you think states should ask hospitals for in order to qualify for the community benefit exemption?