The expanded non-profit hospital community benefit requirement under the Affordable Care Act creates an important opportunity for community-based organizations and advocates working with their local non-profit hospital to address unmet community health needs. As we previously wrote about  here, the IRS’ proposed rules for non-profit hospitals encourage them to address disparities in health and financial barriers to care. Addressing these barriers and challenges can be accomplished through hospital community benefit spending, and it all starts with the Community Health Needs Assessment (CHNA).

Through funding from the Kresge Foundation and the Surdna Foundation, our Hospital Accountability Project (HAP) has worked closely with three communities (Bronx, NY; Minneapolis, MN; and Portland, OR) over the past several months. The HAP team provided technical assistance to a lead organization in each community and designed and co-facilitated a pilot curriculum for building grassroots capacity and fostering engagement in local non-profit hospital community benefit activities, including the CHNA.

What did we learn from these pilot sites? We learned that most community groups do not have enough background and context about the importance of non-profit hospital community benefits. They were shocked to learn that in 2002, the Congress Joint Committee on Taxation estimated the value of community benefit to be more than $12 billion. That figure is likely much higher today. Furthermore, as community members considered hospitals in the role of anchor institutions, meaning that they are usually one of the biggest employers in their communities and they are unlikely to relocate, they gained new perspective on the reasons for and benefits of close collaboration. A community group partnering with hospitals not only makes sense for the issues they are tackling, but also because the ACA requires hospitals to engage with vulnerable communities, which are often already served by coalitions and organizations in the community.

The groups we worked with also wanted to understand the financial information related to hospital community benefit spending reported annually on the IRS Form 990 Schedule H. We are working with The Milken Institute School of Public Health at The George Washington University, through funding from the Robert Wood Johnson Foundation, to develop and test a Community Benefit Web Tool prototype. This prototype will provide easy access to community benefit investment information from the Schedule H form, and, when finalized, will enable users to compare hospital investments on the basis of factors such as geographic location, community economic status, and hospital characteristics, such as number of beds and teaching status.

Our experiences with these three pilot sites taught us a great deal about how to prepare communities to engage with their local hospital community benefits activities. For example, many non-profit hospitals have been conducting their first CHNAs, and grassroots groups want to “get in on the ground floor.” Grassroots groups can partner with and help hospitals compile data about their community’s unmet health needs, prioritize those needs, identify and implement strategies to address community needs, and evaluate the impact, as we discussed in our recent CHNA Health Equity blog.

As a result of this work, we developed and tested a pilot curriculum, collectively titled: Putting People First: Working with Hospitals to Address Community Health. As part of Putting People First, we have made some exciting new resources available to help advocates and community-based organizations understand what community benefit is, how they can engage in the CHNA process, and how to partner with local non-profit hospitals to address some community needs that might not ordinarily be thought of as leading to good health outcomes. This includes workforce development, housing and economic development activities. We discussed these opportunities more in depth in our December 2013 webinar with the Democracy Collaborative and in our presentation What it Takes to be Healthy.

We look forward to sharing additional resources and tools with you, as they are developed. In an effort to share and learn more about how you are getting involved in your local non-profit hospitals’ community benefit planning process, we will be hosting a learning community call on September 26, 2014 from 1:00-2:00pm EDT. If you would like to participate, please click here.

For more information about the Putting People First curriculum and resources, please contact Michele Craig, Hospital Accountability Project Outreach and Training Coordinator at