Community benefit strategy for healthcare delivery organizations is evolving — and for many of those organizations the Affordable Care Act is bringing the importance of having a strategy into focus. While community benefit has existed in some form since the founding of non-profit healthcare — -and really is the reason these organizations still hold not-for-profit tax status — -the function has been carried out primarily as an income statement function. Far and away the leading community benefit line item has been and continues to be charitable care and the unfunded care cost of government healthcare programs.
The United States spends most of its healthcare dollars on access to care, which accounts for only 10% of health status. (New England Healthcare Institute, 2005)
The Affordable Care Act has renewed the attention community benefit receives from organization leadership. The requirement of a Community Health Needs Assessment and accompanying Implementation Plan is propelling organizations to more intentionally affect community health outcomes. It has also renewed organizational attention to public health, particularly the determinants of health.
The vast majority of healthcare delivery organization expenditures is spent on providing medical care. Spending on the provision of medical services will continue to dominate the share of organization expenditures. And it should. It is what these organizations do best and the majority do it well.
But access to care isn’t what keeps people healthy. Access to medical care only accounts for around ten percent of the average individual’s health status. What does account for a person’s health status is where they live, work, and play.
Community benefit spending, then, should focus on catalyzing place-based health improvement. While charity care must continue to be part of every organization’s community benefit strategy, healthcare delivery organizations should be strategically spending in the following areas related to place-based health improvement:
Accepting the determinants of health model demands an expanded definition of health. That expanded definition must include the concepts of social, mental, emotional and spiritual health to accompany the traditional definition of physical health. The expansion of this definition requires a reimagined approach to community health, particularly community health improvement.
There is no better beacon of community health than that of the hospital and the provider. At a macro level it’s imperative for the combined resources of the healthcare delivery system to provide the catalytic gusto to reframe the definition of health. On an individualized micro level, the healthcare system must begin, in earnest, connecting people to the places they live and the resources those places contain to support health and health improvement.