Recently, the Hospital Accountability Project (HAP) and the Democracy Collaborative co-hosted a webinar, “Community Benefit and Anchor Institutions: Linkages and Opportunities,” exploring how the Affordable Care Act’s (ACA) community benefit requirements may be opening new doors to work on economic development initiatives that benefit communities.
Community Benefit Can Be an Avenue for Economic Development
Federal community benefit standards create a pathway for non-profit hospitals to invest in economic development initiatives that are informed by and respond to community-identified needs. According to IRS guidelines, these initiatives can include “assisting small business development in neighborhoods with vulnerable populations and creating new employment opportunities in areas with high rates of joblessness.” Michele Craig, Outreach and Training Coordinator for HAP, shared that community members and advocates may be able to engage non-profit hospitals around similar initiatives by participating in the hospital’s community health needs assessment (CHNA) and implementation planning.
Economic Opportunity Influences Health Outcomes
Currently, community benefit dollars are predominantly used to support access to care for uninsured, underinsured and lower-income people who rely on a hospital’s financial assistance policy or participate in means-tested public insurance programs like Medicaid or CHIP. Despite ACA’s coverage expansion, the need for these programs is likely to remain – particularly in states that fail to expand Medicaid. So, how can community advocates talk about economic development with local hospitals?
While access to care remains critical for many, some hospitals are beginning to base their strategic planning or community benefit programming around a framework that incorporates the social and economic determinants of health. This framework incorporates access to clinical care but goes beyond it, placing it in context with other factors that impact how long and how well community residents are likely to live. Some of these additional factors—the physical and built environment, joblessness and economic opportunities, poverty rates, educational opportunity, family and social cohesion, healthy behaviors—have direct connections to economic development.
Panelist Dan Hodgkins, Vice President of Community Benefit at Community Health Network in Indianapolis, shared how access to health care and workforce development go hand in hand. Currently there are 90 school nurses provided by the hospital network in Indianapolis working with families to manage student chronic illnesses. Nurses are able to provide care on site while increasing “seat time” for students. Absenteeism has decreased and the potential for more high school graduates has increased, which positively impacts each student’s future earning potential. The hospital’s investment in a child’s wellbeing now ensures that there will be qualified workers contributing to the overall wealth of the community.
New Models for Economic Development: Hospitals as “Anchor Institutions”
But, community benefit (as it is defined in the health policy context) isn’t the only avenue hospitals can use to invest in their local economies. According to the Democracy Collaborative’s David Zuckerman, some communities are now centering economic development around local universities and non-profit hospitals, which tend to be among the largest local employers. As institutions, they often have vested interests in the local community and are unlikely to leave. This can solidify their commitment to engaging in the long-term prosperity of communities. In such cases, the community’s interests in improving economic opportunity locally may also serve hospitals’ bottom lines. The Democracy Collaborative recently released Hospitals Creating Healthier Communities, which outlines how hospitals have successfully moved the needle in rethinking their economic and community engagement strategies.
Allison Manuel, our panelist from Northwest Bronx Community and Clergy Coalition (NWBCC) shed some light on the current relationship the coalition is developing with the Montefiore Medical Center. Focusing on their previous economic democracy campaign outcomes, NWBCCC found that creating a multi-stakeholder approach is essential in building a deeper and more meaningful economic agenda. They began by revisiting their past relationship with Montefiore through local procurement. With support from Community Catalyst, NWBCCC is now also investigating the links between hospital community benefit and economic development approaches that can help solve issues like intergenerational poverty in the community.
Looking Ahead: Measuring Performance
There may be similarities in how these two worlds evaluate hospital economic development models. Merging the work of economic development and the ACA community benefit requirements provide hospitals with a great opportunity to impact the communities they serve. Over the course of this blog series, we will begin to make those connections.