Category Archives: Community Benefit
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?
It's been an exciting year for us at NewPublicHealth! We launched in March, and nine months, nine conferences and 568 posts later, we are ready to ring in the new year.
Here's a glimpse into the inaugural year of NewPublicHealth, and the top posts by popularity.
- Power of Health IT for Public Health: A NewPublicHealth Q&A With Farzad Mostashari. This piece was a conversation with the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services (HHS), about the evolving public health informatics field.
- Dr. Douglas Jutte: My Patient's Most Pressing Health Concern Was a Broken Carburetor. Dr. Jutte provided a personal commentary on how unmet social needs—like access to nutritious food, transportation assistance and housing assistance—were sometimes the most critical in treating his patients. (Also check out a round-up of reader responses to this post.)
- Public Health and the Community Benefit: A NewPublicHealth Q&A With Abbey Cofsky. The Patient Protection and Affordable Care Act requires that non-profit hospitals, starting in 2012, perform a community health needs assessment, and that the assessment serve as the foundation of an implementation plan to address identified needs. NewPublicHealth spoke with Abbey Cofsky, program officer at the Robert Wood Johnson Foundation, about the public health opportunities this provision offers.
- The National Prevention Strategy: A NewPublicHealth Q&A With Surgeon General Regina Benjamin. Upon its launch, we spoke with the Surgeon General about the nation's plan for increasing the number of Americans who are healthy at every stage of life.
- Teen Birthrates Down in U.S. But Still Lag Behind Other Developed Nations. This article looked at the April Vital Signs report from the Centers for Disease Control and Prevention on the latest stats on teen childbirth, such as, "Girls born to teen mothers are about 30% more likely to become teen mothers themselves."
- Health Literacy: Reducing the Burden of a Complex Healthcare System. During Health Literacy Month, NewPublicHealth caught up with Linda Harris of the HHS Office of Disease Prevention and Health Promotion and Cindy Brach of the Agency for Healthcare Research and Quality about federal efforts to improve health literacy and to reduce the burden of a complex healthcare system.
- The County Health Rankings 2011: Mobilizing Action to Improve Health. NewPublicHealth's very first post announced the second annual County Health Rankings, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute that provides a standard way for counties to see where they are doing well and where they are not so they can make changes to improve health.
- What to Expect at the Health Data Initiative Forum: A Q&A With Todd Park. The Forum, presented by HHS and the Institute of Medicine, convened more than 500 people to showcase how health data can provide a rich seeding ground for new tools to support more informed decision-making by consumers, healthcare systems and community officials. NewPublicHealth spoke with Todd Park, Chief Technology Officer at HHS, to get his take on health innovation.
- HHS Leading Health Indicators: Health By Some New Numbers. NewPublicHealth was on the ground at the APHA Annual Meeting covering top news, including the announcement of the latest Leading Health Indicators from HHS, a set of the top national high-priority health issues and actions that can be taken to address them.
- Housing Policy is Health Policy: A NewPublicHealth Q&A With HUD's Raphael Bostic. Raphael Bostic of the U.S. Department of Housing and Urban Development (HUD) spoke with NewPublicHealth about the role of housing in health, and new collaborations across sectors that recognize that providing healthier, more affordable housing can lead to significant health outcomes.
Runners up included Q&As with CDC Director Thomas Frieden and Virginia Comonwealth University researcher Steven Woolf; a post on public health mobile phone apps and a commentary on the popular movie Contagion.
These were just a handful of the conversations that captured our readers' interests this year. Keep reading in 2012 for the latest in public health and new ways to prevent disease and health crises where they begin—in our communities.
Thanks for reading and for your always insightful comments. Have a happy, healthy New Year and we'll see you in 2012!
How do you meet the needs of a teenager who’s been suspended from school, has suicidal tendencies and has a mother with drug problems? How about a non-English speaking woman with tuberculosis, preschool-aged children, unstable housing and potential domestic violence issues? Or a homeless man with diabetes? In most cases, the social services that address needs like this – public housing, food stamps, temporary cash assistance – are silo-ed from each other and from health and public health services by funding streams, staff divisions and a lack of communication. Efforts to make health and human services work together take a whole-person approach to delivering care – and it takes a village.
The Public Health Informatics 2011 Conference included a session on how local health departments are working to advance the continuum of care by connecting public health, health care and social services. Social services provide basic needs – housing, affordable healthy food – that have a big impact on health, yet these systems often don't work together to support the end user. NewPublicHealth is on the ground with Public Health Informatics conference coverage this week .
Getting Health and Social Services Systems to “Talk” to Each Other
Daniel Stein, Stewards of Change cofounder, talked about the challenges of getting human services, health care and public health to “talk” to one another when they’re spread out across different systems, programs and agencies that all have different architectures, funding streams and approaches to problems.
Interoperability is the key, said Stein. What’s interoperability? Stein said just think of Expedia or Travelocity. These sites represent interoperability in action – pulling from varied systems with different databases and architectures, finding common terminologies to integrate them, and offering a single, usable interface where all of the information can be used at once.
Are you from a local health department? Please share stories from your departments here with the Robert Wood Johnson Foundation.
NACCHO Annual 2011, the annual meeting of the National Association of County and City Health Officials (NACCHO), is being held in Hartford, Connecticut. NewPublicHealth spoke with Raul Pino, interim director of the Hartford Department of Health, about the conference and the state of public health in Connecticut.
NewPublicHealth: Is Hartford excited to host the NACCHO meeting?
Raul Pino: Oh, we are super excited. We are not used to this kind of attention and to have public health officials from all over the nation come to our city is a big event.
NPH: We interviewed Robert Pestronk, NACCHO’s executive director, a couple of days ago, and he told us that Hartford is actually doing quite well – particularly in this era of budget cuts in public health departments. You’ve been able to announce some upcoming policies such as banning trans-fats and a restaurant scoring system. Given how difficult it is for so many health departments, how is it that you are achieving such successes and what lessons can other health department directors learn from you?
Non-profit hospitals are required to provide a “community benefit” to qualify for tax-exempt status with the Internal Revenue Service. To date, many hospitals have generally fulfilled this requirement by providing charity care to uninsured and underinsured individuals. The Patient Protection and Affordable Care Act (ACA) includes provisions for expanded community benefit opportunities with the assumption that the law will decrease the need for charity care in the future.
To help public health officials and policy-makers better understand the opportunity around the community benefit requirements in ACA, 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. This week, The Hilltop Institute held a symposium on Responding to Community Health Needs within the Framework of the Affordable Care Act. NewPublicHealth spoke with Abbey Cofsky, program officer at the Robert Wood Johnson Foundation, about community benefit in 2011 and beyond, and about the Foundation’s interest in the opportunities around community benefit created through ACA.
NewPublicHealth: We haven’t talked about community benefit on NewPublicHealth before. Is this a new concept?