With open enrollment coming to a close later this month, millions of Americans are gaining health insurance through the Affordable Care Act. Hospital leaders are hoping that surge in coverage will help cut down the amount of uncompensated care their institutions provide. But on the flip side, with the need for charity care likely diminishing, some worry that nonprofit hospitals' tax-exempt status could be put in jeopardy.

Some two-thirds of U.S. hospitals hold that tax-exempt status, earning them an annual financial benefit of more than $13 billion, according to an analysis released last week by the University of Pittsburgh Graduate School of Public Health. The study highlights the need for hospitals to work closely with public health professionals to develop and implement community health programs.

The ACA requires nonprofit hospitals to conduct community health needs assessments, the study points out, and to demonstrate the successes of their community benefits program. Hospital leaders have a lot on their to-do lists right now, but it’s critical that they work closely with public health officials to target their offerings to the community, says Jessica Burke, lead author of the study and associate professor of community and behavioral health sciences at Pitt Public Health.

"I respect that they are busy doing many things, but through a partnership, we could do even more," Burke says. "Hospitals have many programs that are already in place, and if they can work and partner with public health professionals, we can help to ensure that they're the right types of programs and that they are actually achieving what they were intended to. I don't expect and I know others don't expect hospitals to do it alone, but just to acknowledge that we can do a little bit better by working all together."

The growing need for health care providers and public health experts to work together also was one of the reasons why officials for three health care organizations, including the Centers for Disease Control and Prevention, last week unveiled the Practical Playbook, a guide for how to help bring providers and public health experts closer.

In the Pitt study, a multidisciplinary team of researchers — with backgrounds in community health, hospital administration, health policy and library sciences — scoured through thousands of published citations, looking for lessons learned from established community benefit programs. They narrowed the list down to 106 that met the criteria of being affiliated or funded by a hospital, focused on community benefit or outreach, located in the U.S. and with outcomes that have been evaluated.

What they found was a lack of a standard definition of what exactly a community benefit program is, few programs that are rigorously evaluated, very little published on the impact programs are having, and a prevalence of programs based in hospitals rather than out in the community. "Failing to reach outside of the hospital and into the surrounding community likely results in a failure to reach and affect those who are living in poverty and who are traditionally underserved," the study states.

Authors encourage nonprofit hospitals to follow the lead of both the Catholic Health Association and the American Hospital Association in the use of "rigorous" data collection and analysis to help "promote and clearly delineate their roles in community benefit" during this time of increased scrutiny of their tax-exempt status.

Kaiser Permanente’s Community Health Initiative is teased out as one example of a community benefit program that all hospitals should be emulating. There, they take a holistic approach to improving health and well-being by focusing on prevention and promoting healthy eating and physical activity. Hospitals must be "engaged in community-building activities that go beyond the provision of health care services to focusing on upstream, social, economic and environmental factors such as employment, income, housing, community design, community safety and the larger environment that are major contributors to population health," the study quotes from the Hilltop Institute at the University of Maryland Baltimore County.

Hospitals need to get outside of their four walls in this new world of health care, and public health can help them do it, Burke says.

"I think that it's through working together that we’ll have the greatest impact," she says."We all have great assets to bring to the table, and we can’t expect everyone to do everything. But the focus on community engagement and prevention with the goal of having a health impact is something that we can all get on board with."