As the U.S. health care system undergoes transformation — transitioning from stand-alone hospitals to health care systems, improving care coordination and moving to value-based contracting — hospitals need to think outside the box, and their walls. The next step is progressing toward a health system that links health care with community stakeholders to create a network of organizations dedicated to improving population health.

The primary predictors of health status exist almost entirely outside of hospital or clinic walls. According to County Health Rankings & Roadmaps, clinical care accounts for only 20 percent of health outcomes. The majority of the variation is due to other factors: social and economic (40 percent), behavioral (30 percent) and environmental (10 percent). To improve population health, care systems will need to address these factors influencing people every day where they live, work and play.

ReThink Health’s dynamic simulation model demonstrates that while expanding coverage, delivering better care and enabling healthy behaviors and environments each contributing to improved health, their combined effect is far greater and more economically viable over time. This model reinforces what we intuitively know: The more health care and community organizations collaborate around a shared goal, the greater the impact.

Health care systems may already have a network of hospitals, primary care practices, specialists and federally qualified health centers working to improve the health of patients, but those organizations are not designed to address the upstream factors that affect health. Health care organizations should challenge themselves to redefine their system by aligning with outside organizations that share the goal of building a healthy community. Partners can range from local faith organizations, social services, chambers of commerce, public health departments, law enforcement agencies, schools, and housing and community development organizations. Collaborations between hospitals and community stakeholders are mutually beneficial and help to address the nonmedical factors that influence health.

One such communitywide collaboration comes from Stamford, Conn. Vincent Tufo, CEO of Charter Oak Communities, a housing authority turned urban development organization, explains, “You cannot have robust prevention without hospitals engaging with their communities. And not just with other health care organizations. To succeed in this work, hospitals need to tap into the existing resources and infrastructure their communities have to offer.” Charter Oak Communities collaborates with Stamford Hospital to transform Stamford’s West Side neighborhood, which experiences disparate health outcomes. Working together as part of the Stamford Community Collaborative, the organizations have revitalized a declining neighborhood with deteriorating housing into one with beautiful, affordable housing; healthy food options; an environment for active living; and access to jobs and businesses. Such collaborative, systemic approaches benefit the hospital and community and can make a lasting positive impact on community health.

This is a pivotal time in the transformation of the U.S. health care system. The building blocks are there. The challenge is to leverage this opportunity to develop a system that not only provides excellent health care, but also goes beyond patching up patients to foster an environment where everyone has the opportunity to live productive, healthy lives. 

Julia J. Resnick, M.P.H., is a program manager with the Association for Community Health Improvement and the Health Research & Educational Trust.

News from the AHA

Videos spotlight hospitals

The American Hospital Association and Health Research & Educational Trust’s “High-Performing Hospitals — Video Spotlight Series” showcases successes and lessons learned from 17 hospitals in the AHA/HRET Hospital Engagement Network. Rural, critical access and urban hospitals are profiled. Each video features many voices, weaving together the story of how they used best practices and peer-to-to-peer learning to reduce patient harm across the board. Sharing best practices and facilitating peer-to-peer learning were core elements of the AHA/HRET HEN. View the videos at the Hospitals in Pursuit of Excellence website at and at

Equity of Care toolkit

The AHA has released a free how-to guide to help accelerate the elimination of health care disparities and ensure that hospital leadership reflects diversity in the community. “Equity of Care: A Toolkit for Eliminating Health Care Disparities” includes tools and resources to support the Equity of Care initiative’s three goals: increase collection of race, ethnicity and language preference data; increase cultural competency training; and increase diversity in governance and leadership. Equity of Care is a collaborative effort of the AHA, American College of Healthcare Executives, America’s Essential Hospitals, Association of American Medical Colleges and Catholic Health Association of the United States. Visit

HPOE Live! webinars

Each month, the AHA’s Hospitals in Pursuit of Excellence initiative offers webinars that highlight top health care strategies and innovations. Previous webinars focused on redefining the hospital, building a culture of health, managing risk, engaging leaders in quality improvement and patient safety initiatives, and more. HPOE Live! webinars are free, but require advance registration. Visit to view the current list and previous presentations.