Expanded community benefit programs were originally developed at New York University in the 1980s for the W.K. Kellogg Foundation. But the field was not ready at that time, despite an uptick in the same sort of pressures that we are experiencing today: increased uncompensated care and per diem costs, complex cross-subsidies, and state governments overwhelmed with the high cost of Medicaid. This second time around may be different.

In many hospitals today, community benefit initiatives to improve health status are in jeopardy, cut back and even eliminated because of bottom-line pressures. At the same time, leading institutions are broadening community benefit programs to include projects that have immediate potential to financially sustain the program and improve the institution's bottom line, while improving community health status.

These community-focused projects are designed to [1] improve management of the uncompensated care problem, [2] improve quality of care for disadvantaged patients and others, [3] reduce community health care costs, [4] improve access to nonemergency care, and [5] provide income-producing health promotion and health improvement services. These projects can improve the bottom line by reducing unnecessary costs of uncompensated activities and bring in new revenue.

Many examples of projects that lower costs for uncompensated services involve community-focused clinical care. Several of these have an immediate payoff by reducing uncompensated emergency department visits, admissions and length of stay. Others have longer-term payoffs. Projects to increase income may include sensitive community approaches to management of flexible payment programs and the collection of bad debts.

Memorial Health University Medical Center in Savannah, Ga., is one example of an institution with an expanded community benefit program. In addition to a variety of projects to improve community health, the program includes a continuing care coordinator and a Patient Financial Services Team. Eighty percent of so-called "self-pay" patients are now enrolled in Medicaid or other programs. Recidivism of patients using the ER for primary care has been reduced 68 percent.

Fortunately, the Association for Community Health Improvement has just organized a Community Benefit Interest Group that is now drawing renewed attention to the net income potential of community benefit programs that manage to improve the well-being of both their communities and their institutions.

For more information, e-mail communityhlth@aha.org, or call Michael Bilton, ACHI's leader, at (415) 248-8411 or me at (215) 561-5730.

Robert Sigmond is senior adviser to the dean, Drexel University School of Public Health, Philadelphia.

Contact rsigmond@philapeace.org