Rethinking Community Benefit Programs—A New Vision for Hospital Investment in Community Health, co-authored by Dr. Jay Bhatt, a friend and former Chief Medical Officer of the American Hospital Association (AHA), makes the case for healthcare systems to invest in the community outside their walls. Moving upstream from a “repair shop” to a “prevention program” will eliminate unnecessary misery, decrease cost, and ultimately save the healthcare industry from bankrupting itself and the nation.
One organization addressing the same subject is the Lown Institute, “a nonpartisan think tank advocating bold ideas for a just and caring system for health.” This group of experts studies and publishes papers analyzing and sharing current trends in healthcare. For the past few years, a triannual required public report by hospitals and healthcare institutions called Community Health Needs Assessment (CHNA) has been one focus of Lown, with consistent plea to direct more resources to the Social Determinants of Health (SDOH).
Hospitals and healthcare systems have responded robustly to the recent pandemic and many other crises. “Financial assistance is only one part of a hospital’s total community benefit and does not account for the numerous programs and services that hospitals tailor and provide to meet the many varied needs of their community. In addition, not all the services that hospitals provide to their communities are included as part of community benefit reporting and are not captured in the Lown Institute’s analysis,” stresses AHA.
Getting past the back and forth of the debate between historically successful, entrenched, well compensated, frontline organizations and backroom academic “think tanks” critics is critical. Currently, understanding and implementing changes that will address people, places, and policy to improve well-being and health should be everyone’s goal. Prevention is a viable economic model which helps everyone—folks across the economic spectrum as well as healthcare institutions—and is agreeable to those who were previously critics.
Proven solutions exist but are not typically embraced by organizations that could support comprehensive programs. Most commonly, altruistic healthcare systems are distracted by: (1) the tyranny of the present; (2) over-dependence on persistent chronic disease for financial survival; or (3) learned helplessness. The Oxford dictionary definition of learned helplessness is “a condition in which a person suffers from a sense of powerlessness, arising from a traumatic event or persistent failure to succeed. It is thought to be one of the underlying causes of depression.” Typically, learned helplessness is considered a characteristic of people trapped in resource-challenged communities for generations. But perhaps current healthcare colleagues’ unhappiness, disengagement, and dissatisfaction are also symptoms of learned helplessness.
Healthcare systems in their present form are persistently profit-margin squeezed. Fee-for-service rewards caring for sickness short-term, thus sadly disincentivizing spending precious resources to prevent illness long-term. Pay-for-performance when widely adopted will reward wellness, decrease sick care, and ultimately reform the healthcare industry. Possibly the money saved could be used for education and other benefits for the common good, particularly as nations compete globally for limited resources.
Returning to “Rethinking Community Benefits Programs” and documenting success with CHNA, the authors suggest: (1) policy reforms that incentivize investments in community health; (2) hospital-community partnerships; and (3) a renewed focus on the “investment” in community investment. Having a comprehensive plan—rather than failed (when measured objectively), single-directed focuses such as housing, food insecurity, or safety helping only one aspect of a complex problem—can add years of life expectancy or comprehensively improve the SDOH.
Organized programs have matured over the past fifteen years, culminating in longer lifespans and objectively improved SDOH.
