Financing Population Health Improvement Workshop Summary (2015) / Chapter Skim
Currently Skimming:
3 Health Care System Investments in Population Health Improvement
3 Health Care System Investments in Population Health Improvement
Pages 13-24
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 13... ...
Hospitals and health systems can be an important source of funding for population health programs, largely as a result of the community benefit provisions in the federal tax code, which were redefined by the Affordable Care Act (ACA)
|
From page 14... ...
Barnett said that while these data are important for federal policy considerations, there is emerging evidence that it is local and regional stakeholders who will find the data particularly valuable because they allow them to determine what hospitals are doing in terms of providing community benefits and advancing the public's health. The data may also help researchers better understand the relationship between reimbursement shortfalls and community benefit efforts.
|
From page 15... ...
Their analysis of how these hospitals defined the community and its needs showed that less than one-quarter of the 44 hospitals studied identified the areas of concentrated poverty and health disparities in geographic terms, while one-third identified health disparities using racial or ethnic terms instead of location. "We cannot say at this juncture whether or not that was inadvertent or there was intent behind it," Barnett said, "but it highlights the need to begin to focus these efforts and to be more thoughtful about how the subsequent implementation strategies are designed to address these issues." Another aspect of the IRS reporting rules for Form 990 Schedule H is that they require hospitals to consider input from community stakeholders when developing the community health needs assessment.
|
From page 16... ...
In a brief comment on the issue of data pooling and data sharing, B arnett said that a recent study in California assessing the roles and contributions of community health workers and promotores (lay health advisors drawn from the Latino community) found that almost none of the community health centers could readily identify how these workers contribute
|
From page 17... ...
Unfortunately, Barnett said, the results from his community benefit study showed that most hospitals focus their efforts on clinical care, rather than social, economic, or physical environment factors. Barnett listed three priorities for moving forward.
|
From page 18... ...
For the past 2 years, Gary Gunderson said, senior staff members from a number of those systems, known collectively as the Health Systems Learning Group, have focused on the question of whether it is possible to succeed at that mission in the context of a policy framework that is still under construction, if not actively contested or sabotaged. "Our interest is not focused on whether we can meet the legal requirements of community benefit, as all of our participating systems are in compliance," Gunderson said, "but we are not satisfied at all with what those funds, which are spent almost entirely on emergency room care, are achieving." Gunderson said that, much as in the high-profile case of Jeffrey Brenner's "hotspotting" effort in Camden, New Jersey, which provides intensive social supports to help keep vulnerable patients from being readmitted to the hospital, Stakeholder Health focuses on keeping highly vulnerable patients out of the hospital by taking 3For additional information on the Dignity Health grants, see http://www.dignity health.org/Who_We_Are/Community_Health/STGSS044512 (accessed July 11, 2014)
|
From page 19... ...
Two members of Stakeholder Health, Dignity Health, and Loma Linda University Health, have shown other members the value of using social determinants data located on maps as a tool to guide their investment decisions, so they more carefully direct their health care assets in a manner that considers broader needs as articulated by their community partners, as they work together to transform health in their communities. Focusing on the funding implications of the learning group's findings, Gunderson said that the case for proactive engagement with the neighborhoods that are most vulnerable to health challenges is simple.
|
From page 20... ...
He also commented, as someone whose hospital is directly involved in charity care, on the perversity of a situation in which the biggest component of charity care involves emergency room costs associated with the poor and uninsured, but most hospitals -- including his -- focus a good amount of their marketing efforts on attracting patients to their emergency rooms, which are profitable for services provided to the insured and which represent a key transition to the hospitals becoming even more profitable through providing in-patient services. Stakeholder Health suggests, though, that health care systems can be important partners in community health despite this perversity.
|
From page 21... ...
"We found that this has been very useful," Cutts said, "because with many of our folks there were trust issues that kept them from using existing safety net clinics and other resources." Gunderson said that the Memphis program illustrates a key finding from Stakeholder Health -- that an ensemble of practices sustained by enduring partnerships built on trust and focused on mercy and justice can improve access and thereby lower the overall cost of care in vulnerable neighborhoods. Most important, he said, this is not something that can be done to the community, but it can be done with the community, and it demands that health care systems and their public health agency partners change decades-old practices and learn to practice the art of humility that is required for the best working partnerships.5 5Details about the Congregational Health Network's Memphis program can be found at http://www.innovations.ahrq.gov/content.aspx?
|
From page 22... ...
"I think the health care world is not quite ready to embrace affordable housing as a true partner yet," Agostino said, "but I think we are on the brink of something happening in this area." In her opinion, there is an opportunity for affordable housing providers to engage in well-defined program models that are tied to community wellness in their properties and that have them partner with health care providers to ensure that their tenants have good access to care and good adherence to care plans. Currently, Mercy Housing is working on developing service models that would provide reimbursement for some of those services, but over the long-term Agostino would like to be able to partner with health care organizations to provide more units of affordable housing as a component of population health.
|
From page 23... ...
He added, though, that in the California community health work study that he discussed, only two entities were able to demonstrate a significant return on investment, and both were health insurance plans who had the necessary claims data. Chang then asked each panelist to name one breakthrough action that would increase the spread and scale of population health initiatives.
|
From page 24... ...
Andrew Webber of Maine Health Management Coalition told the workshop that incremental changes are occurring in Maine, where chief executive officers of health care systems are investing in primary and integrated care and have an understanding of the business incentives of population health management.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.