Hospitals and health systems are in the midst of a movement to keep patients out of hospitals by investing in more socially responsible programs.
“Our mission is to move from healthcare to health,” Kevin Unger, president and CEO of UCHealth Poudre Valley Hospital in Fort Collins, Colo., told Becker’s. “That means we’re excellent at treating sick people — but we need to become just as strong at keeping people healthy and out of the hospital.”
To achieve this, many hospitals are launching and expanding socially responsible programs, often in the form of community initiatives and improving access to outpatient care.
On June 24, the Lown Hospitals Index named the top socially responsible hospitals in the nation. The nonpartisan healthcare think tank evaluated more than 2,700 acute care hospitals nationwide across 54 performance metrics focused on health equity, patient outcomes and value of care.
Although many companies create hospital rankings, Lown’s index stands out for its comprehensive evaluation framework.
“I’ve spent my entire career working on quality, safety and patient experience, and I’ve seen how fragmented the measurement landscape can be,” Read Pierce, MD, chief medical officer at Denver Health, told Becker’s. “Some systems focus heavily on safety, others on satisfaction, others on reputation or branding. What I appreciate about the Lown Institute is that they’ve created a comprehensive evaluation framework — one that includes safety, effectiveness, cost and resource stewardship, all through a socially responsible and equity-driven lens. We were very pleased with the ranking and excited that the Lown Institute continues to represent a more holistic view of care delivery — going beyond some of the historical ranking systems — and pushes the field in a holistic direction.”
This ranking highlights the top 25 hospitals for socially responsible programs. And at many of these systems, social responsibility is more than an initiative.
“Social responsibility is not an initiative; it is woven into our culture,” Stephanie Conn, RN, MSN, CEO of East Liverpool (Ohio) City Hospital, told Becker’s. “We are just not here to take care of the community; we are the community.”
This ranking is also a call to other systems to improve their community programs.
“We aspire to inspire other healthcare systems to adopt similar community-centered strategies,” Shawn Parekh, CEO at Roxborough Memorial Hospital in Philadelphia, told Becker’s. “Together, we can transform healthcare delivery, ensuring that all individuals receive the equitable care they deserve. It is our responsibility to lead the way in fostering an inclusive healthcare environment.”
Becker’s reached out to the top-ranked hospitals for social responsibility, and asked them to share the programs that set them apart.
Christine Alexander, MD. President and CEO at MetroHealth System (Cleveland): What I tell our team and staff all the time is that every decision we make must be viewed through the lens of: What is best for our patients? What is best for our collective community — both our internal staff and the external community outside our doors? Every single decision goes through that test first. Sometimes those decisions are straightforward. Other times, they’re more complex, but that guiding principle always stands.
And when I talk about our internal community, I mean everyone who works here — but also our learners. You can’t separate that out. If we didn’t have learners, we wouldn’t have that constant push to ask, “How do we do this better?” or “What does the research show?” And you can’t have learners without patients. It’s all connected.
- When national guidelines shifted to recommend starting screening at age 50, we noticed that our at-risk population was showing more high-risk and advanced cancers during biopsies. That told us we weren’t screening early enough. So, we studied our data and said, “This doesn’t work for us.” We went back to earlier screenings — before national guidelines reverted — and we even started high-risk patients on screening mammograms earlier, calculating risk to tailor individualized care.
- We also have Via Sana, our on-campus housing development for low-income families. The first floor is a community center where people can learn computer skills, manage finances, or just gather. It’s a safe space developed with community input — literally by asking neighbors what they wanted in the building.
- We also have a school health program that started when we noticed kids in Cleveland’s municipal school district weren’t getting well-child visits or immunizations, and children with asthma were going to the ED instead of outpatient clinics. So we took care to them. We’ve expanded the program to 25 high schools, where we provide clinical services, including physical exams, routine lab work, care coordination, mental health screening and more. Students spend less time away from class, families don’t miss work and graduation rates improve.
- We also provide correctional medicine. We folded that work under our federally qualified health center look-alike umbrella to create continuity of care for incarcerated patients — and for when they’re released. This service provides more than 1,000 primary care and sick visits each month. We connect them with our mobile units or local shelters to keep them on track with their health needs.
Every single one of these programs began with someone providing direct care who said, “We need to do something about this.” From there, we explore the scope of the issue and assess what interventions could work. Then we ask, “Who else is already working on this? Who can we partner with?” Take our street medicine program, for example. It started because residents in our family medicine department attended a conference where someone talked about using concierge medicine to fund street medicine. Our residents came back inspired and said, “Let’s try it.” That grew into us providing care to the unsheltered during COVID and eventually into our mobile units serving shelters and campsites.
Ian Brown. Vice President and Chief Employee Experience Officer at Duke University Health System (Durham, N.C.): Over the past few years, Duke has invested about $7.1 billion in community benefit. We’ve helped provide over 200,000 prescriptions for nearly 17,000 individuals through a partnership with Lincoln Community Health Center. Our team also collected 700 pounds of food for the Food Bank of Central and Eastern North Carolina. These aren’t just numbers to us — they represent lives touched.
We’re investing in future healthcare professionals. Through the Office of Community Health, we have close to 40 summer interns, many of whom come from local high schools. We also partner with Durham (N.C.) Technical Community College to provide immersive training for careers like nursing assistants.
Duke Health also runs a program called the Collaborative to Advance Clinical Health Equity. The idea behind CACHE is that racial inequity in healthcare stems from the interaction between healthcare delivery systems and the communities they serve. We take ownership of addressing disparities by looking in the mirror, reviewing our clinical outcomes through the lens of race, ethnicity and socioeconomic status, and addressing root causes head-on. Here’s what that looks like in action:
- We identify clinical outcomes that significantly impact patient health and well-being.
- We evaluate those outcomes for racial, ethnic and economic disparities.
- We engage patients to understand what’s driving those disparities.
- And then we intervene — both inside and outside the healthcare system — to address those root causes.
These efforts have improved the quality of care we provide to our communities and reinforced our intentionality. We want people to know that Duke Health is not just a big hospital system — we are a partner in this community, committed to delivering care that has real, lasting impact.
Stephanie Conn, RN, MSN. CEO of East Liverpool (Ohio) City Hospital: Our deep commitment to health equity and social responsibility begins with meeting people where they are and removing barriers. At East Liverpool City Hospital, a member of [Ontario, Calif.-based] Prime Healthcare Foundation, we believe that healthcare extends far beyond the walls of our hospital and true wellness is rooted in access, equity, education and compassion. Whether it is through free essential community-wide health programs and events, food drives, behavior health outreach and counseling in our community centers, or educational events that promote access and awareness. This priority reflects the collective effort of all our staff — from clinical providers and support personnel to administrators and community partners, who go above and beyond to ensure we live out our mission with purpose.
Through school-based partnerships and our donated resources, we invest in the health of our next generation by providing free physicals, immunizations and mental health support directly to the students. Our resources support projects for improved absenteeism, building early healthy eating habits and growing the local health workforce through youth engagement, scholarships, student shadowing, clinical rotations, nurse extern programs and a robust internal medicine, family medicine and podiatry resident program.
We are proud to be a hospital that doesn’t just treat illness, but also actively works to uplift the communities we serve, partnering with local organizations to provide free mental health support, Project Dawn education, community-based counseling, suicide prevention efforts, crisis cards projects and community referral guide booklets.
Jennifer Cruikshank. CEO for Riverside University Health System-Medical Center (Moreno Valley, Calif.): As a safety-net hospital, social responsibility is a core component of what we do. We’re always looking to the future of our rapidly growing county to see how we can bolster our network and provide the best possible care to residents.
- In 2020, we opened an outpatient Medical and Surgical Center to increase access to specialty care and ease emergency department overcrowding.
- Since 2015, RUHS has opened seven new Community Health Centers across the county and expanded primary and specialty services at seven other existing clinics.
- Six RUHS Express Care locations help introduce patients to primary care physicians who will guide them on a path of long-term health and healing.
- We also work closely with our nonprofit RUHS Foundation to secure funding to purchase the latest medical technology, initiate campus beautification projects and provide much-needed comfort items for patients.
Together, our medical center and community health centers have increased access to lower-cost preventive care, and the results have demonstrated higher volumes. At the same time, we are working to avoid unnecessary emergency room utilization for all types of patients, including those with substance use disorders, behavioral health diagnoses and physical health needs.
Every day, our providers get to see the life-changing impact they make. They hear the stories of patients whose lives were permanently altered for the better by the services we provide. The everyday stories of patient successes — especially among those who face difficult life circumstances — is a reminder of the importance of our work and the value of social responsibility in medical care.
Shawn Parekh. CEO at Roxborough Memorial Hospital (Philadelphia): A key component of our strategy is the implementation of an AI-powered system that automates continuity of care discharge follow-up through text messaging. This cutting-edge technology provides patients with follow-up reminders for appointments and medication compliance, as well as access to community-based resources and health advice — all without requiring internet access or complex app installations. This ensures that we can effectively serve a diverse patient population, significantly enhancing patient outcomes and overall satisfaction.
- Our commitment to quality extends to the radiology department, which has made significant advancements by adopting state-of-the-art imaging technologies. These enhancements have equipped our technologists with advanced skills in CT calcium scoring, thereby improving screening options for patients. Additionally, our dedication to quality is further reflected in our stroke and [ST-elevation myocardial infarction] care protocols, which continuously enhance patient outcomes and survival rates.
- We have also expanded our inpatient senior behavioral health services to an offsite campus in Montgomery County [Pa.], adding 15 beds to meet the growing demand for timely and effective care for older adults.
- Chronic disease management is another key focus area. We have implemented specialized programs that offer personalized care plans for patients with conditions such as diabetes, hypertension and heart disease. Regular follow-ups, educational sessions and support groups help patients manage their conditions effectively, leading to improved health outcomes and a better quality of life.
The results of these efforts have been significant. We have observed a marked improvement in patient outcomes, with reductions in hospital readmission rates and increased patient satisfaction scores. Our initiatives have expanded access to care for underserved populations, ensuring that essential health services reach those who need them most. Furthermore, our commitment to addressing health disparities has led to measurable improvements in health metrics within our community, demonstrating the effectiveness of our community-focused approach.
Read Pierce, MD. Chief Medical Officer at Denver Health: As a safety-net system, we’re always thinking about avoiding overuse and maintaining cost efficiency. Every day we ask ourselves: how do we stretch every dollar we receive to deliver as much care as possible? We’ve had a number of initiatives in this space:
- Our pharmacy team has focused on getting the best, most affordable medications to our patients, stewarding our pharmaceutical resources wisely.
- We’ve worked to guide patients away from the ED when it’s not necessary by expanding access to urgent care and primary care. This gives patients more convenient, lower-cost options for their needs.
- There’s the equity domain. That means not just delivering great care within our facilities, but connecting patients to resources like housing, transportation and neighborhood-based care.
- We’ve launched specific initiatives for patients experiencing homelessness to expand access to long-term housing. We partner with Lyft to provide transportation, solving a major barrier for many. And, we bring care into the community through: federally qualified health centers, mobile health clinics and care teams embedded in most public high schools across Denver.
- School-based care allows teens to get the help they need without needing to go to the hospital — making care more accessible, less intimidating and less expensive.
- On the community care side, we’ve steadily increased the number of patients seeing us in the outpatient setting, faster than inpatient volume has grown. That’s been a deliberate effort to provide care where and when people want it, and it’s helped expand our FQHC footprint. Today, we’re the fifth-largest FQHC system in the country, and continuing to grow.
- Our comprehensive care clinic offers follow-up care the next day — or even the same day via telehealth — so patients don’t fall through the cracks while waiting weeks for a primary care appointment. The CCC has been fantastic for preventing readmissions, medication coaching and boosting patient experience. Patients love it because they can quickly connect with a provider, either virtually or in person. That level of responsiveness is often hard to achieve in primary care, even with EHR tools. So the CCC has really paid off in terms of both outcomes and experience.
John Rich, MD. Director of Rush University Medical Center’s BMO Institute for Health Equity (Chicago): It is difficult to spotlight specific initiatives across the Equity, Value and Outcomes domains the Lown Institute uses to gauge social responsibility, but I can say that sustained, specific and leadership-driven, organizational commitment to identify and address healthcare disparities must be present. For example, our CEO Dr. Omar Lateef is consistent in pointing out that no more studies are needed to show that structural racism is a public health emergency and specific actions are needed to address how structural inequities impact health. A very strong example of that type of specific action is the Rush Food is Medicine Program. When a patient comes to many of our outpatient clinics or the ED and screening questions indicate food insecurity, those answers can automatically refer them to onsite food banks where they are provided with a package of healthy proteins and produce. In addition, a community health worker assists them in registering for two subsequent home deliveries and supports them in staying connected to community resources we’ve partnered with. That food isn’t charity; it is medicine.
Kevin Unger. President and CEO of UCHealth Poudre Valley Hospital (Fort Collins, Colo.): Every three years, we conduct a needs assessment to determine the areas we should focus on. Access to care consistently ranks at the top, followed closely by behavioral health and care coordination. Our ultimate goal is to meet patients’ needs before they’re in crisis and end up in the ED. We focus on offering the lowest-cost, highest-quality options for care. We’re also heavily focused on equity — both in our pay structure and in ensuring that anyone who needs care receives it. It’s critical that we treat everyone equitably across the organization.
We partner with over 100 organizations in northern Colorado to better meet the healthcare needs of our communities. Some of our current initiatives include:
- Behavioral health cor-esponder program: We send a behavioral health specialist with law enforcement to assist patients in crisis. The goal is to de-escalate situations and avoid incarceration or unnecessary ED visits.
- Food pantry at family medicine center: FMC serves our underserved population, especially those without a primary care provider who would otherwise turn to the ED. Our food pantry — developed in partnership with the Food Bank for Larimer County — provides essential nutrition support. The number of people we’re serving through this program is doubling and tripling almost every year.
- 5210 school wellness program: This program reaches elementary and middle school students, teaching healthy lifestyle habits, including healthy eating, reducing screen time, getting one hour of physical activity and having no sugary drinks. We’ve also incorporated education around vaping, which is on the rise. Kids take these lessons home and influence their families’ behavior as well.
- Healthy harbors program: We visit high-risk or medically complex patients in their homes, helping prevent hospital visits. We assist new parents by evaluating their home environments and teaching them how to care for a newborn.
- Healthy hearts program: This is another school-based program focused on heart health. We conduct obesity screenings, promote nutrition, and host weekend 2K and 5K fun runs. The program, started by one of our cardiologists over 30 years ago, has expanded beyond Northern Colorado to the broader health system.
- Behavioral health expansion: We’ve committed $150 million to expand both inpatient and outpatient behavioral health services. This includes adding nine inpatient beds in northern Colorado and offering [electroconvulsive therapy], ketamine treatments and other outpatient modalities. We’re deeply committed to addressing the behavioral health crisis, both locally and nationally.
