Category Archives: Community benefit
The Network for Public Health Law and the U.S. Centers for Disease Control and Prevention (CDC) Public Health Law Program will host a webinar on Wednesday, March 26, 2:00-3:30 p.m. (ET), on cooperation between hospitals and local health departments on community health assessments, a new requirement for non-profit hospitals under the Affordable Care Act (ACA).
The ACA creates several new requirements for nonprofit hospitals to maintain tax-exempt status. One is that each hospital must conduct a community health needs assessment every three years, report on the needs identified and develop a strategy for responding to them.
In conducting the community health assessments, the law requires hospitals to get input from individuals with special knowledge of, or expertise in, public health. The goal of the assessment and follow up is to “reorient hospitals away from a primary focus on providing charity care and toward greater attention to community and population health issues,” says Mary Crossley, Professor of Law and former Dean at the University of Pittsburgh School of Law, who served as a scholar in residence at the San Francisco Department of Health and worked on the community health assessment issue there.
Crossley will be a presenter during the upcoming webinar, together with Corey Davis, JD, MSPH, Staff Attorney at the National Health Law Program and the Network for Public Health Law Southeastern Region, and Molly Berkery, JD, MPH a Senior Attorney with the CDC Public Health Law Program.
The webinar topics include:
- The new community health needs assessment (CHNA) requirements for charitable 501(c)(3) hospitals
- CDC resources for implementing the CHNA process
- Strategies for moving from the assessment stage to broader population health initiatives, with an emphasis on health department and hospital collaboration
- CHNA case studies
Register for the webinar.
>>Bonus Link: Read a NewPublicHealth interview with Mary Crossley.
>>Bonus Links: Read a selection of previous NewPublicHealth posts on community benefit:
The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, recently announced the fourth national call for proposals to fund health impact assessments (HIAs) through demonstration project grants and program grants. HIAs, a tool gaining in use across the world, identify and address the health impacts of decisions in other sectors, such as agriculture, education and criminal justice.
“The most common and serious health problems facing Americans—including diabetes, asthma, and injury—have roots in the conditions where we live and work,” said Aaron Wernham, MD, director of the Health Impact Project. “Policymakers at all levels can make a difference by factoring health into decisions on education, transportation, energy, budget and other important policy questions. People are increasingly finding health impact assessments an efficient and cost-effective way to do that.”
HIAs are quickly gaining tracking as tools that can help improve population heath. For example, as a result of an HIA on a housing redevelopment plan, community residents in Denver, Colo. now have improved street crossings, lighting and bike lanes. And an HIA on the Minnesota legislature’s decisions to address school integration and improve education outcomes for students of color resulted in several changes to the bill, leading to new partnerships between the state departments of health and education to bring public health into education decisions more broadly.
The new funding opportunities are available to government agencies, tribal agencies, educational organizations and nonprofits. They offer two kinds of awards:
- Demonstration project grants: The Health Impact Project will award up to six demonstration project grants for up to $100,000 each and provide training and technical assistance for single HIAs to inform a specific proposed policy, program, plan, or project. Applicants don’t need to have previous HIA experience, but preference will go to applicants proposing innovative topics for HIAs, such as criminal justice; education; fiscal and economic policy; and disaster recovery; or proposing work in states and regions that have seen relatively little HIA activity to date including U.S. territories, Alabama, Arkansas, the District of Columbia, Delaware, Hawaii, Idaho, Iowa, Louisiana, Maine, Mississippi, Montana, Nevada, New Jersey, New York, North Dakota, Oklahoma, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Virginia, West Virginia, and Wyoming.
- HIA program grants: These grants will support organizations with prior HIA experience to conduct one or more new HIAs and to implement a plan that establishes the relationships, systems and funding mechanisms needed to maintain a stable HIA program beyond the grant period. The Health Impact Project will fund up to five program grants for up to $250,000 each.
The deadline for initial grant proposals is April 2, 2014.
The Health Impact Project will host two webinars for potential applicants:
- Wednesday, March 5 at 3:00 ET - Demonstration project informational webinar (Registration required)
- Thursday, March 6 at 3:00 ET - Program grant informational webinar (Registration required)
Read more about HIAs on NewPublicHealth.
A conference in St. Paul, Minn., earlier this month examined ideas and emerging examples for building a healthier Minnesota by promoting the integration of health-related programs and community development to address health where we live, learn, work and play. The conference was convened by the Federal Reserve Bank of Minnesota and Wilder Research, the research arm of the Amherst H. Wilder Foundation. The gathering, which was a follow-up to an initial conference on the intersection of health and community development held in Minnesota a year ago, highlighted current successful cross-sector efforts throughout the state.
Elaine Arkin, manager of the Robert Wood Johnson Foundation Commission to Build a Healthier America, was a keynote speaker at the conference. Her remarks included the announcement that the Commission’s recommendations on early childhood and supporting healthy communities will be released in early 2013.
The highlighted projects included a task force on increasing access to healthier foods, often an obstacle in poorer communities; locating needed services alongside senior housing; a stable housing concept for people at risk of homelessness following a hospital stay; and a project underway to give kids living in trailer parks a safe place to play.
“The strategy that we used this year in engaging people with actual examples...was very effective in really acknowledging that this work is messy, that it does take time and that in order to keep people enthusiastic about it sometimes it does require giving people a pat on the back even just for the small progress that they’ve made,” said Ela Rausch, community development project manager of the Federal Reserve of Minnesota.
Following the conference, NewPublicHealth spoke with Ela Rausch and Paul Mattessich, PhD, Executive Director of Wilder Research.
NewPublicHealth: What were the key goals of this year’s meeting?
Paul Mattessich: The overarching goal is at the national level to bring together public health with community development finance in order to better address health issues, social determinants of health and improved community health. But what we did the first time a year ago was to try to get the two sectors to understand what each other does, what their vocabulary was, how best to work together and to start some networking.
This year the goal was to take the next step and highlight some examples where this cross-sector collaboration occurred, and to use that to try to further that even more and to underscore the fact that the two sectors really do address the same end goal, even though they do it in different ways. And if they team up they can do it more effectively.
The changing environment for health departments under the Affordable Care Act (ACA) was the focus of a very well attended early morning session at the American Public Health Association (APHA) annual meeting in Boston today, moderated by APHA public health policy analyst Vanessa Forsberg, MPP.
Hospitals and private health care providers will soon be competing with health departments for clinical services such as immunizations for a newly insured population, according to Forsberg. However collaboration may help departments keep and grow clinical services, as well as collaborate with new partners under other new ACA rules, such as community benefit requirements for hospitals to improve population and individual health.
“There’s a lot of innovation, a lot of people moving into that space and this is a clarion call to say public health had a head start and don’t let the space be taken from you, learn the finance side,” said James Corbett, M.Div, JD, an ethics fellow at the Harvard Medical School and vice president of charity care and ethics at the Steward Health Care System in Boston.
Opportunities for health departments, says Corbett, include focusing on addressing disparities, preventive health, innovative programs and partnerships that improve care and reduce costs.
A key example Corbett shared was a decision by Steward to hire community health workers whose services can be billed for under the ACA beginning January 1. Corbett says he looked at the hospital’s bad debt documentation by language and found trends, then convinced the hospital’s CEO to allow him to hire community workers who got iPads and then went out into the community to visit patients who hadn’t paid bills. They were able to use the devices to record identification and other information, then help the patients sign up for Medicaid and other assistance that allowed them to be covered and the health system to be paid.
The Health Systems Learning Group (HSLG) is made up of 43 organizations, including 36 non-profit health systems that have met for the last eighteen months to share innovative practices aimed at improving health and economic viability of communities.
The idea for the learning collaborative came from a series of meetings at the White House Office and U.S. Department of Health & Human Services Center for Faith-Based & Neighborhood Partnerships. The HSLG’s administrative team is based at Methodist Le Bonheur Healthcare Center for Excellence in Faith and Health in Memphis, Tenn., and at Wake Forest Baptist Health System in Winston-Salem, N.C. The Robert Wood Johnson Foundation provided a grant to share the group’s findings and lessons learned.
In addition to its other work, earlier this year the HSLG released a monograph that aims to help identify and activate proven community health practices and partnerships. Once identified, they can be combined with other evidence-based initiatives to reveal new pathways to transform unmanaged charity care into strategic, sustainable community health improvement.
Recently, NewPublicHealth spoke with the Reverend Doctor Gary Gunderson, vice president of the Division of Faith and Health Ministries at Wake Forest Baptist Health and co-principal investigator of the Health Systems Learning Group, about their vision for the future of healthy communities and the role that hospitals and health systems will play.
NewPublicHealth: What are the goals of the Health Systems Learning Group?
Gary Gunderson: The essence of the task was to help each other learn how we can fulfill our most basic mission. All of the Health Systems Learning Group members are not-profit. The vast majority are faith-based, and so in every case our essential mission boils down to improving the health of the community that created us.
All of the HSLG members are financially stable and we all provide a lot of charity care, but that does not add up to necessarily fulfilling our real aspirational mission and that’s what we came together: to see whether it’s possible to do that in the current environment. And our fundamental answer is that it is possible to do that, but we have to have some new competencies and expanded commitments in order to do it.
NewPublicHealth has written extensively about community development—how financial investments can in time make the places we live, learn, work and play healthier. To truly be successful, it’s a course that no one organization or institution or person can take alone. It’s about partnerships. Community developers, public health officials, foundations and bankers must all come together to determine a strategy for investing and reinvesting in communities.
On Tuesday, September 3, from noon to 5:15 p.m. EST, SOCAP Health will bring together in a live webcast an array of experts to explore this new “health impact economy” and discuss real-world examples of successful partnerships that are improving health in low-income neighborhoods. The event is being held by the Federal Reserve Bank of San Francisco, and additional sponsors include Social Capital Markets (SOCAP) and the Robert Wood Johnson Foundation.
Before Tuesday’s online event, take a look back at NewPublicHealth’s coverage of community development. Some of our biggest stories include:
Zachary Thompson, director of Dallas County Department of Health and Human Services, greeted the 1,000-plus attendees at last week’s annual conference of the National Association of County and City Health Officials (NACCHO) and expressed how honored he was to meet so many local health department leaders from across the country.
NewPublicHealth spoke with Thompson about Dallas’ particular health challenges and innovations the department has developed to help improve health in the community.
>>Read more NewPublicHealth coverage of the NACCHO Annual Meeting.
NewPublicHealth: Dallas ranks 67 out of 232 Texas counties in the County Health Rankings. What efforts are underway to help improve population health in the county?
Zachary Thompson: Dallas County is looking at various things, including adding more bike lanes and more parks where people can exercise. There’s a health assessment going on now to look at how all of the major stakeholders can come together to improve our health rankings. We have a great public health improvement work group that is working on ways to improve overall health in Dallas County.
NPH: West Nile virus was a major issue in Dallas last year. What are you doing this year to help keep the city safe?
Thompson: We had no deaths from West Nile virus in 2010 and 2011, then 20 deaths in 2012, which may have been a once-in-fifty-years event. Last year’s outbreak got everyone’s attention that West Nile virus is endemic in our community, and so we took the lessons learned and increased our resources.
We know what we improved on. We began to do year-round mosquito testing in 25 municipalities, and began meeting regularly with all the municipalities to assess their needs. Everyone has been on board with the overall integrated mosquito plan. So far this year we’ve had no human cases of West Nile virus. We definitely focused on preventive education—we started that earlier. We’ve also added additional ground-based truck spraying capabilities in the event that we needed to increase our spraying activity if we have a similar outbreak as last year. We have made insect repellent available for all senior citizens. Hopefully last year’s outbreak will have been a rare occurrence, but we’re prepared in any case.
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?