« June 2013 Issue

Community Benefit: Bringing the Power of Community Voice to Local Hospitals

Hospitals frequently tout the support they provide to their local communities in the form of charity care, programs to improve the health of underserved populations, and investments in community health centers. Such "community benefit" programs, however, are more than just good-faith efforts to "give back" to the community. Non-profit hospitals are obligated and expected to serve local communities in exchange for their tax-exempt status. And with their vast resources, hospitals have tremendous potential to be vital partners in addressing health-related community needs, particularly disparities in health that influence how long and well people live -- from clinical care access and quality to housing, education, and jobs to healthy behaviors and food security.

But while many U.S. hospitals are doing exemplary work in these areas, there is wide variation throughout the country in how -- and how much -- hospitals choose to invest in community benefit.

"It's touch and go from hospital to hospital whether community benefit is a focus," said Jessica Curtis, who directs Community Catalyst's Hospital Accountability Project (HAP). "Sometimes efforts are purely public relations-driven while others dive more deeply into the root of a core issue the community faces. Hospitals also use different strategies to engage communities directly in conversations about their health. Some go deep; others don't. The lack of clear national standards for community benefit has contributed to these kinds of discrepancies."

Community Catalyst has long been facilitating partnerships between hospitals and community groups, particularly organizations that serve low-income and uninsured or underinsured individuals and families. A big part of HAP's work, which is supported by the Kresge Foundation, has been to advocate for a stronger federal regulatory framework for community benefit. These efforts paid off with new provisions in the Affordable Care Act (ACA) that seek to address wide variations in practice. The ACA created new federal standards for community benefits that require tax-exempt hospitals to conduct regular community health needs assessments; seek input from people representing the "broad interests of the community" and public health; implement strategies to meet needs identified by the assessments; and share this information widely with the community.

With stronger federal community benefits standards nearly in place (the regulations are still not final), HAP is focused on strengthening the community engagement component throughout the community benefit planning process and providing tools that advocates and community-based organizations can use to win a seat at the table with hospitals and other local stakeholder groups as they undertake community health needs assessments.

"The community health needs assessments offer an opportunity for hospitals and their community partners to move the needle on health equity," Curtis said. "It's really a starting point to understand what's happening in the community by gathering the data, engaging community groups that serve the disenfranchised, and convening all the stakeholders to talk about it and come up with a plan so hospitals can better respond to community-identified needs."

These stakeholders include community groups such as mental health centers, food pantries, and local churches, but can also include parks and recreation staff, local businesses, municipal government, and service organizations. Also key are neighborhood leaders, who truly understand the community at the grassroots level. These "other" representatives are helpful not only during data collection and community engagement, but are pivotal players when it is time to act on key priorities.

As a first step, HAP convened national stakeholders such as the United Way, the Catholic Health Association, PICO, Policylink, Trust For America's Health, and the National Association of City and County Health Officials in Washington in December. These groups represent community, faith, public health, hospital and government groups that will come together at the local level to work on community health needs assessments, to discuss best practices and how to engage community members in the process. Meeting participants shared best practices for engaging communities and highlighted the ongoing need to support engagement within their hospitals, health departments and community settings. Many expressed gratitude for a forum in which they could frankly share common values and frustrations they encountered when trying to engage communities or work with their counterparts in other professional settings. For example, one afternoon workshop featured hospital leaders who talked to public health and consumer advocates about the internal pressures they face that can drive hospital strategies and programs.

What else is next for the project? "We will pilot programs in two to three priority states that will train members of low-income and minority communities on effectively engaging in community benefits programming with local hospitals," said Curtis. "The idea is to put what we've learned into practice by providing the tools to support and build the capacity of local groups who are new to these efforts.

"The ultimate goal here is to develop an accessible framework that works across the country so community members will have a strong voice in this important work," Curtis added.