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Population Health is a Shared Responsibility

 |  By John Commins  
   June 12, 2013

One path toward better population health is for community and rural hospitals to create partnerships with local businesses and civic and government leaders, all of whom stand to enjoy the economic and social benefits of living in a healthier community.

Healthcare reform and the anticipated shift away from the traditional fee-for-service payment model toward a model that rewards value-based preventive care means that hospitals will have to play a greater role in managing the health of the populations they serve—even beyond hospital grounds.

And an effective way for hospitals to accomplish that goal would be to create partnerships with their local business, civic, and government leaders, all of whom stand to enjoy the economic and social benefits of living in a healthier community, says Stephen A. Martin, executive director for the Association for Community Health Improvement at the American Hospital Association.

"There is the common theme that the hospitals and the community stakeholders have to have and that is a willingness to come to the table to solve the health issues of their respective communities," Martin says. "If there is no openness from the various stakeholders, then we can't move the community toward wellness."  

These partnerships are especially critical for smaller hospitals in rural areas because of the unique pressures and lack of money and other scarcer resources that they face to treat a patient mix that is generally older, less healthy, less affluent, and more prone to overweight. The good news, Martin says, is that many hospitals have been doing this sort of community outreach for years before the Patient Protection and Affordable Care Act was even drafted.

"The change, although it's new, is not new," Martin says. "Here we have an emphasis with the ACA coming on line in 2014 and the requirement of of community benefit, so you are seeing more emphasis on the fact that hospitals cannot do all of this work alone when you step out of the four walls. So we are working with our partners and stakeholders to move our communities to better health and wellness and our hospitals play a critical role in doing that very thing, not just within the hospital to make someone well but also well while they are outside of the hospital setting."

Now, the focus will be more concentrated toward prevention, disease management, and promoting wellness activities. Not all hospitals are in a position to act on these three prongs in the value-based model.  

While hospitals are the logical providers of disease management, for example, it might make sense to work with the local public health agency to identify and prioritize the health threats your community faces so you can collaborate devise an effective population health improvement strategy.

Likewise, the wellness component might be best handled by gaining the active support of business leaders, such as the Chamber of Commerce, to promote workplace wellness initiatives. The local United Way or the community department of parks and recreation, or the mayor's office could be recruited to sponsor healthy activities and events promoting physical activity and good nutrition.

"It's the hospital that will play the vital role in that population health community benefit," Martin says. 

"So, in one instances there could be a situation in a small rural setting that the hospital is the center and the convener of a population health benefit strategy. In other settings such as a larger metropolitan urban setting it could be various stakeholders, the local public health department, United Way, Chamber of Commerce, varying parties all coming to the table to be the integral entity that moves these initiatives forward. The critical component is the hospital either playing the role of convener or coming to the table. It's not a one-size-fits all."  

What exactly that role will be can also depend upon the hospital. A larger academic medical center, or an integrated healthcare system with more resources and a larger staff might be able to take on more of the responsibility for population health than can a smaller rural hospital.  

Rural and community hospital leaders looking for some help on identifying population health issues and establishing programs to address those issues may consult a new guide from the ACHI and the AHA's Hospitals in Pursuit of Excellence initiative.  

"Each of these different structures and settings engage their communities in different ways," Martin says. "There is no cookie cutter way of approaching population health management because the dynamic here is the individual community, and each community is different."

AHA Report: The Opportunities and Challenges for Rural Hospitals in an Era of Health Reform

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

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