Promoting community health has not traditionally been considered a responsibility of hospitals and care systems. Yet, provisions in the Affordable Care Act paired with the transition to value-based contracts are driving hospitals to work outside of their walls to promote the health of the greater population, rather than treat patients only when they are ill. Although fulfilling community benefit is a requirement for nonprofit hospitals, some hospitals are going above and beyond to impact the socioeconomic, behavioral and environmental correlates of health.

As hospitals transform their operations to address population health improvement goals, their infrastructure, staffing and resources also must shift. A 2012 survey by the Association for Community Health Improvement and the American Hospital Association confirmed the wide variation in how hospitals structure their population health function and alluded to the myriad contributing factors that determine the extent to which hospitals engage in community health improvement work.

To augment this data and clarify the most important contributing factors, ACHI conducted qualitative interviews with hospital-based community health and community benefit leaders from across the country. Interviewees were selected randomly from the 2014 ACHI National Conference registration list; the individuals in the sample were geographically diverse and represented both large health systems and small, stand-alone hospitals. Interview questions covered a wide range of population health-related topics, including community partnerships, hospital resources for population health, population health champions and leadership, and challenges and opportunities for population health improvement.

Supportive and engaged leadership emerged as the key factor driving hospitals to undertake community health improvement efforts. Highly engaged leaders make improving the health of the community a priority by aligning it with the hospital’s mission and ensuring the availability of resources and staffing. In these hospitals, forward-thinking chief executives and boards are appointing leaders to new positions, such as chief experience officer or vice president of community health policy and strategy, to drive that agenda. Community benefit leaders reported seeing an increase in resources and focus since the passage of the ACA and project such an emphasis to continue in the coming years. While this focus on the community is novel for some hospitals, for others population health is ingrained in the culture. For example, one hospital in the Midwest tithes a percentage of its annual profits toward population health promotion.

The significance of engaged leadership transcended hospital size and location. Some small hospitals with limited financial resources emphasized that the support of their leadership allowed them to leverage their resources and community partnerships to considerably improve the health of their population.

Although not all hospitals have the capacity or desire to take on the full scope of population health improvement activities, engaged leaders allow the hospital to take on important ancillary roles to promote policies and best practices or leverage the hospital’s expertise and influence to convene community stakeholders and achieve mutual goals.

Hospitals are not expected to single-handedly improve the health of their communities, but doing nothing is not an option. The implementation of the ACA provides an extraordinary opportunity for visionary hospitals and care system leaders to seize the moment and take an active role in sustainably improving the health of their patient and community populations.

Visit the Hospitals in Pursuit of Excellence website at to access the report “Trends in Hospital-based Population Health Infrastructure.” 

Julia J. Resnick, MPH, is a research manager with the Association for Community Health Improvement and the Health Research & Educational Trust.

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