We’ve used this space to talk at some length about the shortcomings that follow from our “patchwork quilt” of state and federal standards for community benefit. Today, we’re taking a detour to talk about what’s right with community benefit—specifically, steps some hospitals are taking to address disparities in health through community benefit programs.

Naming the Problem The face and voice of America is changing. Racial and ethnic minorities currently comprise one-third of the U.S. population; nearly 47 million people—18 percent of the population—speak a language other than English at home. With this change in demography, the health of the United States as a whole is becoming increasingly dependent on the health of minority populations. Yet disparities in health are widespread, well-documented, and present in every factor that impacts how long and how well people live: from healthy behaviors to clinical care access and quality, and from social and economic factors (like income, housing, and education) to physical factors such as environmental quality. Each year, an estimated 83,000 deaths are attributable to racial and ethnic health disparities.

Fortunately, some hospitals are responding to factors contributing to disparities in health by creating community benefit programs that address all of the factors impacting health in their communities, including access.

Creating Solutions through Community Benefit Last week, hospital community benefit officers and consumer advocates shared their experiences with partnering to address health disparities.

First, we shared Community Catalyst’s vision for “community benefit” as goods, services and resources provided without reimbursement (or with partial reimbursement) to address community-identified needs and concerns, particularly those of groups who are underserved. Community benefit implies a partnership—a social contract, of sorts—between hospitals and their communities. This vision sees an active role for community partners in identifying community needs and assets and shaping the priorities hospitals choose to address. These programs can focus on a variety of issues impacting health equity—health care access through financial assistance or funding for free clinics, for example, or programs to increase access to healthy foods.

Then, hospital community benefit officers shared how hospitals are addressing health disparities:

• Vondie Woodbury of Trinity Health System, Mercy Health Partners and the Muskegon Community Health Project in Michigan shared how initial community efforts to increase access to care for the uninsured led to the creation of the Access Health Program, a community-based, non-profit cooperative that now partners with Mercy Health to provide access to a full range of services for small business employees who were previously priced out of the commercial insurance market. The program focuses significantly on educating members about healthy living and prevention. “First and foremost, we learned we had to democratize the [community benefit] system so that all of the voices in the community have a chance to shape what is happening. That’s been key to our success,” she said. Trinity hospitals also use a common enrollment form that asks questions to determine if patients are presumptively eligible for financial assistance, prescription drug help, food stamps, and a free vision program offered by a community partner. Trinity also sends outreach workers to visit patients who are behind on their bills and enroll them in financials assistance or Medicaid, rather than allowing their accounts to proceed to collections erroneously.

• In Sonoma County, California, the community benefit arm of Saint Joseph Health System takes a broad, comprehensive approach to address the social determinants of health, according to Dory Magasis Escobar. It deploys health promoters from the communities it serves to educate their friends and neighbors about healthy behaviors and available services, as well as sponsoring free services through community clinics. But it also teaches community members how to relate to systems of power in order to effect change. For example, the health system trains community leaders to respond to neighborhood concerns; participates in community coalitions; and engages in advocacy at the local, state, and federal level on issues that impact vulnerable members of its community.

While these hospitals are stellar examples, advocates can still make progress when local hospitals aren’t as inclined to partner with the community. “Be persistent,” said Claudia Lennhoff of Champaign County Health Care Consumers, an Illinois organization that first approached hospitals about improving financial assistance and debt collection policies. “We started out as adversaries because they wouldn’t meet with us. We were able to move that to a very different place and recently worked together to increase dental access in our community.”

Good News Is (Potentially) on the Way While hospital leadership plays a major role in determining community benefit programs, the Affordable Care Act also includes some new requirements that can help public health and community advocates raise their concerns. Starting in 2012, all tax-exempt hospitals will have to engage in a “community health needs assessment” and plan implementation strategies that take input from public health experts and community representatives. And while the final rules are still being written, the most recent document put out for comment by the IRS includes a substantial role for grassroots leaders and community members. (Community Catalyst submitted comments on this document.)

While it pays to understand the issues policymakers will be wrestling with in the coming months, community benefit planning processes should be underway in most hospitals. Health equity advocates should ask for a seat at the table, no matter where their hospitals are in the planning process. After all, we share a common vision for communities that promote the health of everyone.

– Jessica Curtis, Project Director, Hospital Accountability Project