Issue link: https://beckershealthcare.uberflip.com/i/868709
84 THOUGHT LEADERSHIP Q: What types of issues did you identify through your work in the American Hospital Association's Task Force on Ensuring Access in Vulnerable Communities? How have your findings influenced initiatives at RWJBarnabas Health? BO: I came to that task force with a bias that urban vulnerable com- munities are most desperate for healthcare services and programs de- signed to address social determinants of health. e most eye-opening message for me was how much rural vulnerable communities are suf- fering as well. When I heard my colleagues from around the country talk about their lives and healthcare situations, I was surprised to learn of the depth of the struggles they face. The task force reinforced our previous notions that social determi- nants of health are critical, and we learned from programs around the U.S. that have begun to address them. I hope it will continue to be a growing wave of acknowledgment that we can't just make sure we have enough CT scanners or clinics open any given number of hours, but that we need to go deep into our communities to have an impact. Q: Can hospitals run effective population health manage- ment programs without addressing social determinants of health? BO: Absolutely not. That's a great question, and I think it's a ques- tion that should be a guiding principle if you aim to implement any form of population health management. I look at [population health] as a custodial responsibility for the people in our commu- nities. It's not just about the services that go on in hospitals and clinics. If that's all you focus on, you miss opportunities to be suc- cessful in population health. To have a custodial responsibility for a community means you have to talk to people about lifestyle choices. It's pretty intrusive to tell people how to eat and how oen to exercise, but it is necessary. We can sit back and say we're a great hospital with terrific clinical ser- vices, and making these things available equals population health. Just focusing on optimizing care inside the hospital can no longer be our mission. Q: What steps must all hospitals begin to take to address the non-medical factors that influence patients' health? BO: If you're going to address population health, you have to look at the social determinants. en you must look and think, if you're a hospital, what tools do you have at your disposal to make a differ- ence? For us, we're a big business. We are going to use our business to create programs to address social determinants. For example, there is turnover every year. We can set aside a certain number of jobs for people in vulnerable communities. If we're buying millions of dollars worth of widgets, we think of how we can buy from minori- ty-owned businesses in the community. How can we offer members of the community nutrition counseling in our building, as well as churches and supermarkets? I believe the way to succeed in popu- lation health is to take this anchor we call a healthcare system and change our course of business to address social determinants and create programs around them. n What I'd Like to See When Congress Resumes the Healthcare Debate By Michael Dowling, President and CEO of Northwell Health T he ACA has been one of the most hotly debated legis- lative issues in the history of this country. For seven years, Republican lawmakers have been calling for a repeal of the ACA, and after months of congressional drama, it appears their efforts have stalled for the time being. This is not a loss or a win for either politi- cal party, but instead a moment for careful reflection. It is not simply policies that need fixing, but the political mechanisms that are supposed to turn theory into action. Though the democratic process is historically slow, the gears of this legislative machine have seemingly ground to a halt. This is a dangerous precedent with serious implications, in- cluding an increasing loss of trust in the institutions of gov- ernment. It seems as though compromise is a dirty word to many law- makers in Washington. If we have learned anything from Congress' recent healthcare efforts, it is that meaningful leg- islation cannot be crafted by one party alone. Hopefully, the failed attempts to repeal the ACA will prove to members of Congress that they need to reach across the aisle to come up with solutions that provide robust, affordable coverage to Americans. Partisanship, excessive ideological fervor and negativity do not work. It is also important to appreciate that while improvements need to be made in our healthcare system, there is much that works well. Our successes have greatly surpassed any failures. Plans offered up by House and Senate leadership over the past several months were often projected to hurt more peo- ple than they helped. These options are simply unaccept- able. People need insurance and access, and any policy that leaves more people without coverage is not deserving of consideration by Congress. Nevertheless, steps must be tak- en to address fundamental problems with the ACA. What needs to be done Cost-sharing reduction (CSR) subsidies are essential for sta- bilizing individual insurance markets, and though funding for CSRs has been secured through 2017, lawmakers need to ensure these payments continue in 2018. Congress also needs to strengthen the individual mandate, which impos- es penalties that many Americans elect to pay instead of buying insurance plans. The purpose of this mandate is to encourage healthy people to participate in the market so