Executives and boards in every hospital in the United States are doing some fundamental thinking about what their hospital is now and what it should be as the so-called second curve of health care really kicks in. The answers will vary dramatically from one institution to another.

One thing is certain: all hospitals need to fully integrate into the continuum of care in their communities to meet rigorous new quality, outcomes and payment measures, and to cut their own expenses as reimbursements tighten. That will require leaders to consider hiring new kinds of personnel, using current employees differently and even sharing staffing resources with other providers and agencies in their communities.

In May, the Commonwealth Fund put the spotlight on one strategy to strengthen the continuum when it reported on the emergence of community health teams in eight states. These teams target Medicaid patients with complex medical needs. Funded by Medicaid, and in some cases private insurers, the locally based care coordination teams manage patients’ illnesses across providers, settings and systems of care. They consist of staff from nursing, behavioral health, pharmacy and social work and, according to the researchers, “provide crucial support to health care providers working in resource-limited small or medium-sized” primary care practices. To learn more, read here.

In the current issue of Hospitals & Health Networks, Charlotte Huff reports on how some hospitals are restructuring staff both inside and outside their four walls, to — among many other goals — ease the burden on physicians, promote wellness and prevent readmissions. “We have an economic incentive to not only coordinate care, but to really enhance compliance with care,” says David Nash, M.D., founding dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia. “The notion of the difficult patient … the noncompliant patient — well, that all now has an economic implication.”

Also in the June issue, H&HN staff writer Marty Stempniak reports on hospitals that are hiring community health workers to reach out to residents who face socioeconomic, cultural or other barriers to health care. The workers are often from the neighborhood in which they work, understand the local issues and are trusted by residents when it comes to discussions about health care. Community health workers can help people overcome whatever obstacles keep them from getting the right kind of care, and ensure they adhere to treatment and medication orders to avoid unnecessary readmissions or visits to the emergency department.

“I think there’s a real need in health care for a lower-trained workforce who can do a lot of the things that are not done in the current system,” says Matt O’Brien, M.D., medical director and co-founder of Puentes de Salud in Philadelphia. “So much of what impacts people’s health has to do with social factors that we don’t even address.”