Laurie Cammisa, Children's Hospital Boston: "We See Ourselves as Agents For Social Change"
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?
Laurie Cammisa: We have always done community health needs assessments over the years and over time we’ve looked at public health data and hospital data and know that asthma is the number one diagnosis for inpatient admissions, and it’s estimated that about 15 percent of kids in Boston public schools suffer from asthma. For the purpose of the IRS community benefit requirement, asthma, in terms of measurements and outcomes, has the best results.
NPH: You’ve had previous asthma education and awareness efforts. How is this program different?
Laurie Cammisa: This project uses a case management system. The biggest piece of it is that we have someone going into the home and looking at the environment in which the family lives. The triggers could be mice, or cockroaches, so we can hook them up to a pest management system for example. Or, by observing their kitchen, know they may need containers for food storage, or to get rid of a cat they’ve gotten to shoo the mice away. We get to do a lot of teaching, and help alleviate the triggers for asthma.
NPH: What is another community benefit project you’ve been working on?
Laurie Cammisa: Fitness in the City is another good example. We do that in partnership with eleven community health centers. We provide funding to the health centers to hire staff for fitness and nutrition programs; we provide funding that allows the health centers physicians to write prescriptions for free 3 month gym memberships for the entire family; and we bring the health center staff together quarterly to share best practices. In fiscal year 2011, 61 percent of the patients in the program either decreased or maintained their BMI after one year in the program.
NPH: How have you shared your community benefit experience and expertise?
Laurie Cammisa: A state has come to us for help replicating our asthma program, through an activist pediatrician in the community. And I have spoken to many groups about community benefit, including the National Association of County and City Health Officials and the Catholic Hospital Association.
I’ve been delighted to share our approach to community benefit. It is twofold: We have to respond to the IRS, but we see it as going beyond compliance. We want to demonstrate that we can make a difference by focusing on the most pressing issues for kids and by taking a strategic approach for models that we think can lead to systemic change.
Our asthma program could benefit 15,000 kids, and we serve 185 a year right now, but our state Medicaid program has looked at it, and the state legislature has set aside $3 million to replicate these kinds of initiatives, based on the evaluation we did of our program. We want to do right by kids, and also to move the field forward. We have dashboards and outcomes measured for each of the programs. With asthma not only can you show reduced emergency room visits, but also fewer missed school days and work days for parents.
NPH: How do you think hospitals should be thinking about the new community benefit requirement?
Laurie Cammisa: There is also a strong argument to be made for hospitals to think about community benefit as an opportunity and to take it seriously. We see ourselves as agents for social change. We don’t want to just provide services; we want to make a broader social impact.
>>Read more on community benefit.