By: Samantha Smith, AcademyHealth
Health care providers have long known that the care patients receive within their walls is just one of many factors that influence the health and wellbeing of a community. Nonprofit hospitals have always been charged with engaging in activities that improve the health of their communities, not only to fulfill their mission, but also to maintain tax-exempt status with the Internal Revenue Service (IRS).
Traditionally, these “community benefit” activities have been health care-focused—providing charity care to uninsured patients, conducting research, or offering training opportunities for health professionals. However, changes as a result of the Affordable Care Act like health insurance expansions and clarifications to the policy for tax-exempt hospitals have expanded this focus. With these changes, providers are encouraged to think less about traditional activities that may improve the health of a defined patient population and more about creative ways to improve the health of communities.
A recent Health Affairs blog post by Sara Rosenbaum and Bechara Choucair titled “Expanding The Meaning Of Community Health Improvement Under Tax-Exempt Hospital Policy,” highlights this trend. The authors note that while there can be a fairly broad interpretation of what “counts” towards community benefit spending, more can be done to open the door for hospitals to engage in community building activities outside the health sector, such as the creation of affordable housing or safe outdoor spaces for recreation.
This increasing interest in moving beyond the traditional role of a health care provider was also echoed in a recent report from AcademyHealth’s Translation and Dissemination Institute, “The AcademyHealth Listening Project: Improving the Evidence Base for Safety Net Health Care Delivery.” The report draws on interviews with more than 40 safety net delivery system leaders and other experts to provide an in-depth look at the evidence and data needs seen as top-of-mind in the coming years. In the interviews, safety net providers commented that much of their patient population has complex medical conditions that are often exacerbated by significant non-medical needs such as inadequate housing, lack of transportation, or poor access to healthy food.
In the AcademyHealth report, many safety net providers mentioned engaging in longstanding partnerships with community organizations such as schools and faith-based organizations to address these significant non-medical needs, while others noted that they are just beginning to think about these issues. For providers at both ends of the spectrum, reimbursement and long-term sustainability remain key barriers despite the availability of external grant funding opportunities and the potential to engage in qualifying community benefit activities.
Despite these challenges, safety net providers highlighted the importance of addressing social determinants of health and asked for more guidance on which determinants to address, what programs might work with their population, and how to evaluate the effectiveness of their efforts.
The need to address patients’ non-medical needs was one of many issues discussed in the complete report available here. This report is supported by Kaiser Permanente and is the third in the Institute’s Listening Project series, which looks to identify areas where new or better evidence could help inform timely issues in health policy and health care delivery.
Samantha Smith, M.S.P.H, is a Research Associate at AcademyHealth, where she supports the work of the Translation and Dissemination Institute through her involvement with the Listening Project and Rapid Evidence Reviews Project.