Report recommends increased coordination and transparency and redirection of resources to address social and economic needs of communities

BOSTON (October 26, 2016) – Massachusetts tax-exempt hospitals invest more than a half-billion dollars annually into community benefit programs, but there is little evidence of the effectiveness of those investments and whether they benefit the communities served, according to a report released today by Community Catalyst. The unprecedented analysis offers one of the most comprehensive, publically available statewide reviews of hospital community benefits.

Hospitals Investing in Health: Community Benefit in Massachusetts examines the current state of hospital community benefit programs and offers recommendations to strengthen their coordination, transparency and impact. The report recommendations are timely as the Massachusetts Department of Public Health and Massachusetts Attorney General have said they are re-examining and revising the determination of need regulations and community benefit guidelines, which provide the framework for hospital performance and accountability in their community obligations.

“The goal of the report is to spark a conversation among the health care community, policymakers, community organizations and advocates in Massachusetts about how we can improve our approach to community benefit to ensure that the enormous expenditure of dollars is actually having a positive impact on the social and economic needs of communities,” said Rob Restuccia, executive director of Community Catalyst. “And because the Affordable Care Act raised the importance of community benefit as a critical tool to address community health, we see this as an opportunity to spur change across the country.”

The report authors, Enid Eckstein and Paul Hattis, MD, JD, MPH conducted a detailed review of hospital data submitted to the attorney general’s office, including a review of all community benefit spending by Massachusetts hospitals, including charity care, from fiscal years 2008 to 2015. They also interviewed public officials, health care experts and community leaders.

The authors found many hospitals have community benefit spending levels which are less than the 3 percent target level of patient expense suggested in the Attorney General’s Guidelines.  Moreover, they found fragmented community health improvement efforts, with unclear outcome goals, and in many instances, wasteful duplication of efforts and lack of coordination and alignment among hospitals working in the same communities.

The report asks hospitals to prioritize addressing the social and economic determinants of health and advancing equity as a central focus of community benefit programs.

“This report marks a new chapter in the conversation about how these hospital contributions can best serve the goal of improved community health. These are critical resources and we all have a stake in ensuring they benefit our communities,” said Audrey Shelto, president of the Blue Cross Blue Shield of Massachusetts Foundation, which provided financial support for the report.

Government agencies at all levels oversee community benefits at Massachusetts hospitals – the IRS, the Office of the Attorney General, the Department of Public Health and some municipalities. As a result, there is a lack of consistency in reporting, metrics, and timetables, which impedes efforts to make comparisons and promote transparency.

To create a more integrated, transparent process that makes strategic use of hospital community benefit resources and determination of need funds to address long-term population health needs, the authors’ make recommendations in the following areas:

  • Build on the attorney general’s voluntary guidelines to better promote public understanding
  • Align the attorney general guidelines with federal guidelines and existing state rules
  • Align the determination of need process with community benefit planning and oversight
  • Develop a common statewide approach on community benefits and population health
  • Evaluate community benefit practices and spending to meeting community and population health needs

Authors Eckstein and Hattis hope the report will “catalyze discussions among stakeholders with an aim to align more effective government agency oversight with cooperative efforts among providers and engaged communities.  The goal is to achieve higher levels of strategic investments in activities that affect social determinants and produce healthier communities.”

A wide range of advocacy and community organizations in Massachusetts have endorsed the report recommendations, including the Massachusetts Public Health Association, the Center for Community Health Education Research and Service, the Massachusetts Communities Action Network, Dudley Street Neighborhood Initiative, Chinese Progressive Association, Health Law Advocates, and Health Care For All.


About Community Catalyst
Community Catalyst is a national, non-profit consumer advocacy organization founded in 1998 with the belief that affordable quality health care should be accessible to everyone. We work in partnership with national, state and local organizations, policymakers, and philanthropic foundations to ensure consumer interests are represented wherever important decisions about health and the health system are made: in communities, courtrooms, statehouses and on Capitol Hill. For more information, visit Read our blog at Follow us on Twitter @healthpolicyhub.