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Population Health Fuel? Community-Based Initiatives

 |  By John Commins  
   October 23, 2013

The need for big changes driven by healthcare reform brings tremendous opportunities for community hospitals to play an even greater role in the health and welfare of the people they serve. Having a leadership strategy is crucial.

 

HLM Intelligence Report on Population Health

Hospital and physician leaders across the country have expressed legitimate concerns about the population health movement and their responsibilities for controlling health outcomes that are almost entirely determined by what happens outside of the hospital walls.

Clinicians can provide the best medical care in the world and can give a patient explicit post-discharge instructions and a medication regimen only to see that patient return to the emergency department a week or so after discharge back into his reality. In the brave new reimbursement world, providers will have a financial stake in that readmission.

Fair or not, that is the new reality of healthcare reform and to their credit most hospital and physician leaders have that I have spoken with have accepted their new responsibilities.


See Also: Targeting All-Cause Readmissions an Ambitious Strategy


The good news is that change of this magnitude will bring with it tremendous opportunities for community hospitals to play an even greater role in the health and welfare of the people they serve. Improving population health will require that everyone in the community play their part, and that someone takes the lead.

And there are few more-trusted or qualified people in most communities to play a leadership role than hospital executives and physicians.

If you're stuck for ideas about how you can improve your community's health, the Trust for America's Health and the New York Academy of Medicine have released a new report detailing 79 evidence-based disease and injury prevent programs from around the world that have been shown to work.

The report, A Compendium of Proven Community-Based Prevention Programs, includes peer-reviewed studies that evaluated the effectiveness of community-based programs to reduce tobacco use, injuries, asthma, alcohol abuse and sexually-transmitted infections, increase physical activity and improve eating habits.

Jeffrey Levi, executive director of TFAH, says the initiatives are designed to take place outside of the hospital walls. "That is deliberate … because we are seeing growing evidence that what happens inside the clinic has to work hand-in-hand with what happens outside the clinic."

"When you think about the biggest cost drivers for the healthcare system you think of things like obesity and diabetes. You can do the best diabetes management or prevention in a clinical setting. If you are sending someone out into a community where fresh food isn't available or it's difficult to walk you are not going to achieve those goals," Levi says. "We also know that things like a diabetes prevention program, which is a community-based activity, has been more successful than medical interventions."

"Similarly, if you have a problem with falls among the elderly, look at what happens in the community. You can do the best diagnostics in the world in the healthcare setting or you can be in the hospital dealing with the consequences of those falls, but the real prevention is going to happen in the community."

There are many good reasons to embrace these community-based initiatives. First of all, they're not a bunch of touchy-feely gobbledygook. These are concrete, common sense ideas that have been shown to work.

For example:

  • The Partnership for an Active Community Environment steering committee in New Orleans, LA installed a six-block walking path and school playground in a low-income neighborhood. The proportion of residents who were active increased significantly in the neighborhood with the path and playground, where 41% of those engaging in physical activity were moderately or vigorously active, compared to 24% to 38% of residents in similar neighborhoods without the path.
  • Nearly 300 urban, poor children with asthma from four zip codes were identified through logs of emergency department visits or hospitalizations, and offered enhanced care including nurse case management and home visits. One year of data show a significant decrease in any asthma ED visits and hospitalizations, and any days of limitation of physical activity, patient missed school, and parent missed work. There was a significant reduction in hospital costs compared with the comparison community, and a return on investment of $1.46.

The report features community health initiatives from across the United States, and across the world, including China, France, Australia, and Wales. Levi says the common denominator for all of these proven strategies is leadership.

"If you are talking about community hospitals, many of which are non-profit and have new requirements under the Affordable Care Act around community benefit this compendium is certainly a place to look," he says. "After hospitals have done their own health needs assessment and have identified a particular area where they would like to work this report is a good resource for identifying the kinds of interventions we know will make a difference."

"The only caveat I would put in there is that each of these initiatives needs to be adapted to a local community in some way. And it is important both as a direct resource and also sometimes we have to convince hospital CEOs and other leaders that actually this community prevention thing works. And this shows that there is a good deal of evidence to suggest that it does."

Even better, many of these proven strategies won't costs hospitals anything beyond time and commitment, and when they work the improved population health will be a net positive for the hospitals' bottom line.

Plus, many of these strategies involve local leaders working with one another to improve their communities. This is not about some federal mandate. This is about hospital leaders working with their local United Way and other civic leaders to provide tangible improvements to the communities they love and serve.

And finally, perhaps most importantly, many of these strategies engage the people in the community to take an active role in improving their health. Nobody wants to be morbidly obese. But if you're a low-wage manual laborer who comes home after dark to unlighted streets with no sidewalks in a crime-infested neighborhood, it is hard to muster enthusiasm for a walk around the block. Likewise, it's hard to eat fresh vegetables and other healthy food if the only nearby shopping is cans on a shelf at the Kwik-E-Mart.

"Everyone wants to be healthy and sometimes it's for different reasons. But they also face obstacles. If we remove those obstacles, I think people will make the healthier choices," Levi says. "Personal responsibility is certainly paramount, but you cannot expect people to exercise that personal responsibility in an environment that doesn't support it. We need to be making the healthy choice the easy choice."

And now, more than ever, hospital and physician leaders have the opportunity to make that happen for the people they serve, their neighbors.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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