Are we maximizing the potential of anchor institutions for community health improvement? Let’s start with schools and hospitals.
Hospitals are being drawn into the sphere of public health practice. The regulatory and reimbursement policies of the Affordable Care Act require not only demonstrable community benefit, but also decreases in readmissions for certain illnesses (see Hospital Readmissions Reduction Program). Moreover, the harsh reality associated with treating patients with illnesses associated with the environmental, economic, and social conditions in which they live means hospitals are expanding their role to include the population health of their communities.
Those conditions, particularly malnutrition and food insecurity, are compelling physicians and hospital administrators to grapple with the need for nutritional assessments upon admission, early supplemental nutrition intervention, and discharge planning that includes plans and resources for access to adequate nutrition (a problem often associated with re-hospitalization). Sending patients home to the same conditions that made them sick, or worsened their illness, is not an option.
But how to address these conditions in the community at large? By responding to the IRS-mandated community health needs assessment as an integral part of a comprehensive, nonprofit business plan, charitable hospitals can join with community partners to significantly ameliorate the social and environmental conditions that exacerbate poor community and individual health.
The first candidate for a community partnership may be the public school system. For example, the under-enrollment of some school meal programs suggests that supports for outreach and perhaps transportation are needed. In my state, Connecticut, the number of children likely to go without a meal is 1 in 5; in many neighborhoods the ratio is higher.
Schools have a “captive” population that is already supported by infrastructure (meal service) and varying degrees of revenue (USDA and state reimbursement for meals for eligible children). School meal programs can be improved by community benefit programs in a variety of ways:
- Further enhancement of nutritional quality (in addition to meeting minimum state and federal standards). Cleveland Clinic, for example, provides local public schools the professional help of its dietitians.
- Add-on programs, such as family dinners and summer meals. An incremental investment from hospital community benefit programs could augment existing public revenue to expand and enhance the basic operation of add-on programs. Arkansas Children’s Hospital is leading the way with this type of innovation, using its own facility to do so.
- Farm to School programs are well-suited to partnerships with charitable hospitals. These programs have made the greatest strides in improving not only the nutritional value of school meals, but in establishing education regarding food and agriculture that has long been missing in the curriculum.
The strong leadership at USDA welcomes these hospital–public school partnerships and is will help to facilitate them them. The data maintained by these publicly funded programs allow evaluation to demonstrate impact, which is a requirement for community benefit programs. Technical requirements that could seem to be barriers are not: USDA is making great use of regulatory flexibility.
Building on what works, with a little creativity and thought, makes sense as hospitals step more deeply into population health practice. Simply being able to care for their patients, without the detriment of social and environmental conditions that attenuate medical care, has become an imperative.