Providing Responsive Healthcare to Improve Community Health

Hospitals or health systems often serve as anchor institutions in their communities. When they invest in the communities they serve, it can mean more than building a new facility or subsidizing health clinics. Increasingly, hospitals are providing responsive healthcare: addressing non-medical influences that improve the health of the populations they serve.

Responsive healthcare translates into investment in the social drivers of health (SDOH), which are factors that affect health outside of the traditional healthcare system. According to the U.S. Department of Health and Human Services (HHS) Office of Health Policy, while clinical care impacts only 20% of county-level variation in health outcomes, SDOH affect as much as 50%.

The CDC defines social drivers of health as conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes. Healthy People 2030, an HHS initiative that identifies important situations influencing the health of the nation, has identified five SDOH:

• Healthcare access and equity
• Education access and quality
• Social and community context
• Economic stability
• Neighborhoods and built environments

Within those broad categories are several other drivers including safe and stable housing, food security, transportation, job opportunities, ability to pay utilities, and racism, discrimination, violence, and trauma.

Federal Laws Spur Hospital Community Health Investment

The medical literature is full of studies linking improved health outcomes with non-medical interventions, a cornerstone of the responsive healthcare movement. In addition, federal laws have codified specific steps healthcare organizations need to take that ultimately contribute to responsive healthcare.

Since 2010, for example, the Patient Protection and Affordable Care Act (ACA) has required nonprofit hospitals (which comprise nearly two-thirds of hospitals in the U.S.) and health systems, including teaching hospitals, to conduct a triennial community health needs assessment (CHNA) that identifies and prioritizes local health needs. A natural outcome of this has been the growth of new opportunities for healthcare organizations to intervene upstream to address poor population health through community-based initiatives.

Strategies to Implement Responsive Healthcare

A nationally representative online survey of about 300 hospitals, conducted by the Deloitte Center for Health Solutions in 2017, revealed several additional strategies that hospitals and healthcare systems can implement in their efforts to provide responsive healthcare in their communities:

• continue the move toward value-based care to spur more investment in addressing health-related social needs
• accurately and efficiently assess community needs
• co-create programs with community members
• cultivate internal and external buy-in
• identify and break down siloes within their organization to consolidate resources
• identify strategies to improve their ability to track health and cost outcomes and adopt consistent definitions and metrics around addressing social needs
• share leading practices and data on other organizations’ activities and strategies to direct investments, and scale what is working
   

Community/Hospital Partnerships in Action

These types of learnings and insights, combined with federal laws and other factors, have resulted in many examples of hospitals and health systems identifying and responding to a gamut of local community needs.

For the past 30 years, for example, the Center for Community Health and Health Equity (CCHHE) at Brigham and Women’s Hospital has partnered with over 100 organizations annually to elevate the health status of communities they serve in the Boston area, particularly those in minority or low-income neighborhoods. In just one year, through 2019, CCHHE partnered with:

• Boston Medical Center and Boston Children’s Hospital to provide $1.5 million over three years in local housing stabilization support
• Boston Public Schools to provide more than 500 students with education and employment opportunities through its youth programs

Another example is the Children’s Hospital of Wisconsin, which helped establish Project Ujima, one of the first hospital-based violence intervention programs in the nation, in collaboration with the Medical College of Wisconsin and the Children’s Service Society of Wisconsin. The program features a community-based home visitation model following hospital treatment, offering access to medical, behavioral health, legal, school, and social services to reduce the risk of recidivism for the youth and to help the entire family.

These examples illustrate a common theme: by enhancing the social drivers of health in the communities they serve, hospitals and health systems can contribute to improved community health.