Hospitals around the country are starting to look for ways to connect with populations in their market area to provide community benefit with a more significant impact on the health of their communities than in the past.
With the emphasis on population health that has come with the Patient Protection and Accountable Care Act, hospitals are expected and required to go beyond the provision of charity medical services and support a continuum of care that begins with prevention and early treatment and follows acute care with transitional support that facilitates patient self-management. Whereas, until recently, the work of hospitals has been to treat the sick and fill the beds, hospitals are now rewarded for keeping people healthy and beds empty.
Responding to this new call means looking at health through a much broader lens, and addressing the factors that impact health much earlier on that continuum — and that starts with prevention. As discussed in a December 2013 Huffington Post report, only 10 percent of the determinants of health are at the far end of that spectrum, managed by the care given at hospitals. The remaining 90 percent is what population health addresses, and what hospitals are now expected to address as well.
While serving in this role can clearly offer an opportunity for hospitals to more directly fulfill their mission to provide community benefit, it can seem daunting. But hospitals don't have to work alone. There are many individuals and organizations in all communities whose respective work has always been to address population health and who can serve as valuable partners to hospitals, as well as benefiting from the collaboration themsevles. Those that come to mind immediately include federally qualified health centers, mental health and maternal/child health and nutrition programs. They are joined by many other programs with a focus that is even further "upstream" and address the social, economic and environmental factors that account for the majority of health problems: job training, affordable housing, food justice, adult literacy programs and domestic and youth violence prevention programs, to name a few.
By working in collaboration with these organizations to address population health, hospitals can achieve the new community benefit goals and serve an essential healthcare leadership role. The American Hospital Association has done a great job of pulling together examples of how hospitals are making their mark with a wide range of programs that support health from many directions and all along the continuum.
Here is a selection of five initiatives that represent innovative local responses to challenges facing so many of our communities and provide testimony to the power of partnership.
1. Avera McKennan (Sioux Falls, S.D.). Obesity among both adults and children is a problem challenging every community in our nation. Many partnerships are bridging medical services and fitness/exercise programs to facilitate patient compliance with lifestyle and behavior changes needed to improve or manage their condition. AHA Community Connections highlights an obesity prevention program that approaches the challenge from a different direction.
In response to obesity's emergence as a primary health issue in their Community Health Needs Assessment, Avera McKennan partnered with a community-based organization, Ground Works, to provide financial support for the development of teaching gardens at schools in an underserved neighborhood. The gardens facilitate a more nutritious diet and increased exercise, offering a vehicle for educating young children and their families about healthy eating while providing a safe venue for outdoor physical activity.
Though perhaps beyond the hospital's intended outcome, the design offers an additional benefit by providing participating youth with the opportunity to experience their own contribution to the betterment of the family and neighborhood, which is known to serve as a protective factor against future involvement in negative behaviors (e.g., violence and gang participation).
2. Norwalk Hospital (Norwalk, Conn.). Norwalk Hospital takes a different approach to the same problem of obesity with Project Learning with Energy from Activity and Nutrition. Partnering with public health, an elementary school and a business, Project LEAN offers children a chance to learn and practice healthy behaviors at the beginning of their school day. They start each morning with 30 minutes of vigorous exercise, followed by a free nutritious breakfast. Nutrition education is provided in the classroom weekly with interactive lessons and activities. Family learning is provided as well at evening events at the school.
Norwalk Health Department, Jefferson Elementary School and Pepperidge Farm are working together to prevent obesity with a program that addresses the need for knowledge, regular exercise in a safe environment, good nutrition and family support. This program may also have additional positive impact beyond the stated obesity prevention objectives, as providing exercise and good nutrition at the beginning of the school day will support the children's ability to concentrate in class and perform well academically.
3. Fairfield Medical Center (Lansing, Ohio). Prescription drug abuse is increasingly a leading cause of death in many communities, including Lancaster. Specifically, opiate addiction has surfaced in recent years as one of the most prevalent, according to the Centers for Disease Control and Prevention.
Recognizing the urgency of the problem in their community and the potential impact of a broad coalition of service providers to intervene at various points along the continuum of care, Fairfield Medical Center partnered with law enforcement, judges, business owners, social service agencies, and recovering addicts and their families to create the Fairfield County Opiate Task Force. Their coordinated efforts provide numerous portals of engagement for individuals and families in need of support, education and treatment. The hospital took an additional innovative step, initiating a policy limiting opiate prescriptions in its emergency department.
4. Memorial Healthcare System (Hollywood, Fla.). Effective parenting is of value not only to the members of the immediate, current family but is also said to impact seven generations to come by modeling and establishing healthy behaviors as the norm. Memorial Healthcare System has chosen to help strengthen vulnerable families during times of extreme stress with its program Family TIES. The program provides opportunities for high-quality experiences shared by parents and their children, training in communication and techniques for managing difficulties and setting family and individual goals. By supporting these mental health services, Memorial helps prevent neglect, substance, family and child abuse.
5. Garden Park Medical Center (Gulfport, Miss.). Investing in individuals early in their development, Garden Park Medical Center supports Excel By 5. This program brings awareness to communities across the state of the importance of providing children under the age of five and their families with the resources for success, including education, healthcare and safety. Excel By 5 identifies gaps in services and promotes community collaboration to meet the needs of the community's children. The children benefit as the parents, grandparents and caregivers gain understanding of children's needs and how best to meet them. The goal is healthier, school-ready children.
Pursue your own initiative
This is just a sampling of the myriad possibilities to get you thinking about your community needs, your team's expertise and potential partnerships, and to start your creative juices flowing. From these examples we see that because the health issues we aim to address are multi-faceted and interwoven with other areas of our lives, as we partner up to meet one health challenge, we oftentimes strengthen the individual in other ways as well. And those benefits go beyond the individual to the family and neighborhood, improving the health of the community.
Hospitals that wait for someone to hand them a plan to follow will be left out of the game. We encourage our clients to begin this process. It is critical that hospital leaders work with their teams to develop strategies they can implement on a limited basis now. Not all will be effective and none will be perfect right out of the gate, but through evaluation and redesign, their population health efforts will evolve.
Ellen Sanchez is director of community collaborations for Avanza Healthcare Strategies (formerly ASC Strategies), which provides healthcare organizations with strategic guidance, with a focus on outpatient services and community collaborations. With 25 years of experience in community outreach, education and health promotion, Ellen has designed and implemented many successful programs from the ground up and turned existing programs into models of innovation.
More Articles on Hospital Collaborations:
Finding Allies, Building Alliances: Q&A With Gov. Mike Leavitt on the Need for More Collaboration in Healthcare
An Inside Look at the National Rural ACO
Choosing the Right Communications Network to Help Link Collaboration and Reimbursement