Hospitals and health systems across the country are focusing on community health and creating new ways to improve the physical, emotional, mental and spiritual well-being of all people in our communities. This work includes integrating activities with public health, collaborating with community partners and building a community health infrastructure that is stronger, more targeted and more effective.
The American Hospital Association 2016 Committee on Research explored what the next generation of community health may look like as hospitals redefine themselves to keep pace with the changing health care landscape. The underpinning of effective community health is the development of strategic and meaningful collaborations that allow for sustainability and success in any given community.
The next generation of community health will serve as the foundation for total population health. Our efforts will help bring these definitions together and connect population health management — managing the health of a specific patient or clinical population — to the broader intersection of population health. By doing so, we are bringing together multiple sectors, which can be much more effective when connected together, including public health departments and other community organizations. This “new” version of community health acknowledges and emphasizes that investing in ameliorating the social and economic determinants of health will be as important as delivering high-quality medical services.
The Committee on Research recently released the report "Next Generation of Community Health" to encourage activity within the field to improve community health, offer an overview of current and new strategies, and spotlight tools and best practices.
Key considerations for health care leaders
Hospitals and health systems have long been committed to providing high-quality care and have consistently used “quality” language in goals and metrics reports. That mission, of course, will not change, but it will evolve. As hospitals look to adopt “second-generation” strategies and move toward integrating community health and wellness into all they do, health care leaders should consider three key elements:
- The spectrum of services offered by the hospital or health care system.
- Locations where care will be provided.
- Partnerships that will facilitate care.
The AHA Committee on Research report discusses (1) trends driving community health, (2) results from a community health focus, and (3) first- and second-generation strategies that benefit the community beyond the hospital walls.
This work aligns closely with the AHA’s Advancing Health in America initiative, developed to better communicate about changes in the U.S. health care system, enhance awareness and understanding of transformation paths, and underscore the importance of collaboration as well as proactive patient care. The strategy is forward-thinking about the role that hospitals and health systems will play in the future. The initiative’s website identifies tools and resources that hospitals can use to advance health and move toward the second generation of community health.
Trends driving community health
Many forces are driving change within the realm of community health, influencing hospitals and health systems to further expand care outside the traditional hospital setting and incorporate community health as a comprehensive part of the hospital's or health system’s mission.
Gaps in health insurance coverage still exist, as do social determinants of health that are significant barriers to health and wellness. The health care field must work toward improving total health status and infrastructure for good health within communities.
A holistic approach to health care accounts for how a patient perceives health and the physical, mental, environmental, social and spiritual factors that influence it. Hospitals are now looking more holistically to improve an individual’s health status and offer a better coordinated and more integrated approach to care. This includes building a community health infrastructure that allows access to healthy food, transportation to medical appointments, guidance on exercise and fitness, and more.
Value-based payment programs are being designed to reward hospitals for quality of care and our ability to keep patients healthy and living at home. Hospitals and health systems can be more intentional about decisions affecting how, when and where care is delivered within a community. Strategic collaborations are critical to support this work.
Results from a community health focus
There is consensus that the next generation of health care and, by extension, community health, will have the patient at the center of a better-coordinated and value-driven system of care. With these shifts, hospital and health system leaders and their governing boards will see further alignment between mission and philanthropy and the business imperative to keep patients and communities healthy. As traditional health care models evolve and align more closely with public health needs, the next generation of community health will be more pervasive, more efficient and more effective in keeping people healthy. Furthermore, as we address drivers of poor health such as socioeconomic status and social determinants of health, and expand to involve a broader base of community partners, the next generation of community health will succeed in greatly improving overall health status in all of our communities.
One result of a community health focus, achieving better health outcomes, occurs as hospitals implement evidence-based practices and interventions and help educate the health care workforce, patients and communities about achieving and sustaining healthier lives and community wellness.
Reducing health care disparities, another result of a community health focus, requires hospitals and health systems to work more closely with patients upon admission to collect data and better understand each patient’s external challenges. These challenges could affect care, recovery and possible readmission. Combining data collected on disparities with strategies that align outreach efforts to a specific subset of patients who are most in need will provide the greatest impact on improving community health.
Addressing social determinants of care and health is important to improve community and population health. More and more health care facilities are dedicating staff resources to social workers, patient navigators and discharge planners, as well as partnering with community organizations from the private sector, public service, and education and faith-based worlds. Interventions that target multiple determinants of health must take place along the continuum of care and at the same time as traditional medical care is provided.
First- and second-generation strategies
First-generation strategies to promote health and well-being will serve as the building blocks for further work in providing high-quality, high-value care (i.e., second-generation strategies), not only when patients are admitted to a hospital, but also as they travel throughout the continuum of other care settings, including their own homes.
First-generation strategies include conducting a community health needs assessment; establishing essential community partnerships with public health departments, social service organizations, law enforcement agencies, schools, businesses and other community entities; using organizational assessments and checklists to evaluate current practices, pursue continuous improvement, and formulate effective strategies for listening, communicating and collaborating with local communities; and hot-spotting to identify patterns, behaviors and interventions to better address patients’ needs and improve outcomes within their community. These strategies have brought great success and insight to the community health work done by hospitals and have informed population health strategy.
Second-generation strategies will build on what many hospitals are already doing and take community health to the next level. All hospitals — large or small, urban or rural — share a common mission of improving health, and these strategies will help hospitals further achieve that goal.
Second-generation strategies include collaborating with other hospitals to broaden a hospital’s scope of activities and strengthen its ability to work in priority areas. Partnering, not competing, with other health care organizations is proving to be an effective way to improve traditional medical care while simultaneously integrating care coordination techniques into sustainable models of improvement.
Community visioning is a new approach that brings together community stakeholders to share a vision of health and then build a true infrastructure for health to provide better access to care, neighborhood by neighborhood.
Using predictive analytics and big data helps health care organizations better manage and coordinate care across the continuum from prevention to end of life, while also identifying cost and utilization patterns. Hospitals can begin by looking at current community data and then collaborating with public health departments and other community organizations to collect additional, relevant data and also partner with universities or educational organizations for help with analysis.
National collaboratives can provide cohesiveness to existing efforts and offer resources to hospitals and communities for expanding and broadening their scope and infrastructure for success.
Achieving a population in which every individual has access to health care services without inequity or disparities is the ultimate goal of all hospitals, but it is a tall order. Hospitals and health systems are committed to working toward that goal. They offer a strong network for collaboration and can expand their effectiveness by working with other organizations at the local, state and national levels.
The Committee on Research report includes a list of resources from the AHA and other national organizations and a checklist, “Leadership Assessment on Community Health Readiness.” To access the report, visit www.aha.org/research/cor/community-health/index.shtml.
Eugene A. “Gene” Woods, American Hospital Association board chairman, is president and CEO of Carolinas HealthCare System, based in Charlotte, N.C.