Becker's Hospital Review

Sign up for the COMPLIMENTARY Becker's Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035 57 How Investments in Community Health Pay Off By Helen Gregg and Bob Herman A ccording to a study from Duke University's Fuqua School of Business, a nonprofit hospital's average return on an equities investment in recent years has been about 11.3 percent. A study by researchers at Harvard Medical School found a hospital's return on investment in the health of low-income populations in its region can be as high as 3,600 percent. The Harvard study calculated the ROI of The Family Van, a mobile health clinic that travels to disadvantaged neighborhoods in Boston to deliver healthcare. Researchers compared the cost of operating the van with the cost of emergency department visits and the treatment of chronic conditions prevented by the mobile clinic. The researchers concluded that The Family Van's expenses were $565,700 in 2008, but it returned more than $20.3 million in value, for an ROI of 36-to-1. During fiscal year 2009, only about 5 percent of hospitals' community benefit expenditures were directed toward community health initiatives undertaken by the hospital directly, according to a study in the New England Journal of Medicine — which could very well represent a missed opportunity. Providing care to underserved communities is an obvious mission and function of many healthcare organizations. And under the Patient Protection and Affordable Care Act, it is required for all nonprofit hospitals to conduct a community health needs assessment every three years. These strategies also likely result in a decrease in unnecessary ED visits or a decline in avoidable chronic conditions, both of which can significantly impact a hospital's bottom line. Jeff Helton, PhD, an assistant professor of healthcare management at the Metropolitan State University of Denver, sees the clear financial advantage of providing this type of care. "When someone has a chronic condition like diabetes, hypertension or asthma and it gets out of control, the common place of treatment for that illness is the hospital ED," he says. "Because the hospital ED has to be operated 24/7/365 and has to maintain high levels of technology to meet emergency needs, they are a very expensive place to provide care." "Treating uninsured or underinsured patients [in the ED] hurts the bottom line by increasing unpaid costs," he adds, and actively treating these patients makes clear financial sense. Community benefit programs at Banner Health Banner Health, based in Phoenix, has created an extensive program to keep Phoenix-area kids healthy, in school and out of the ED. Banner Children's School-Based Health Centers, launched in 1994, provide free healthcare to uninsured children throughout the region through clinics inside schools that serve the largest population of low-income students. In school space licensed as a Banner outpatient treatment center and staffed by Banner nurse practitioners, the clinics offer a range of pediatric services. Banner also has a mobile health unit that travels to four additional communities. "The clinics offer sports physicals, camp physicals along with acute and episodic care for these kiddos, basically anything they would get in a primary care office," explains Megan Christopherson, Banner Children's child health and wellness senior manager and the program's director. Clinic visits are "completely free to the population we're serving," she says, and children needing more advanced care can see specialists for $5 through an agreement with Banner Children's specialists. Over the past school year, the clinics treated about 2,000 children. "Our biggest goal is to keep kids healthy and in school — and our mission's stayed the same throughout the years," says Ms. Christopherson. "We invite any uninsured child to come in for care." In addition to providing much-needed care to the children in the area, the program has financial advantages for the hospital. "It definitely benefits the hospital," says Ms. Christopherson. "Part of the plan was to help keep kids out of the ED who don't need to be there." And it's worked. "We have a survey for patients and their families [in the clinics], and one of the questions is, 'Where would you have gone if not for Banner's School-Based Health Centers?' For about nine out of 10 families, it's the ED," says Ms. Christopherson. Community benefit programs at Lahey Health At Lahey Health, a multihospital system based in Burlington, Mass., community benefit programs revolve heavily around cooperation with community stakeholders. Peter Short, MD, serves as CMO of Beverly (Mass.) Hospital and Addison Gilbert Hospital in Gloucester, Mass. — two hospitals within Lahey Health. He says Beverly and Addison Gilbert provide a combined $5 million every year in free, uncompensated care to their surrounding communities, and this program has been built through a three-phase process. First, hospital officials compile quantitative and qualitative data on their primary service area. Quantitative data includes demographic information like age and gender, social determinants of health like crime and employment, health status information like rates of chronic disease and finally access to care. Qualitative data includes interviews with local stakeholders, Dr. Short says. For example, Beverly and Addison Gilbert providers meet with town mayors, YMCAs, social service providers, school administrators and other community members to hear about the biggest health issues to those who see them most. "Each program is a partnership between Beverly and Addison Gilbert and the community, so it's critical that each town have a full understanding of what we found in our assessment and how we can work together to tackle

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