Hospitals and health systems are well-positioned to tackle "upstream" population health actions that keep community members in good health before they ever enter the healthcare system, according to Stuart Butler, PhD, a senior fellow of economic studies at the Brookings Institution in Washington, D.C.
Dr. Butler published an article in JAMA highlighting some of the barriers hospitals face when tackling upstream problems, and how they can overcome those barriers.
"Some hospital systems, such as Montefiore Health System in the Bronx, New York, have a long history of collaborating with the local community to tackle upstream problems," wrote Dr. Butler. "Some others, such as Washington Adventist Hospital in Maryland, are now experimenting with multiple approaches to building healthy neighborhoods. Indeed, there is growing interest in hospitals playing a greater upstream role."
For hospitals that want to become more active in improving community health, officials can expect to run into several obstacles including privacy restrictions and different data sharing systems that make it difficult to partner with local organizations and government agencies. Also, the financial benefit of a hospital's community outreach usually ends up in the pockets of the community and its residents, not the hospital itself.
To support hospitals trying to improve the health of their communities, Dr. Butler argues the following four steps must be taken.
1. More attention must be paid to creating metrics to measure the social and economic benefits of a hospital's community outreach efforts, or their "true return on investment."
2. Prioritize improving data integration so hospitals, schools, community institutions and government bodies can collaborate more easily and effectively.
3. Local, state and national government budgets and payment systems must provide flexibility and blend funds to achieve a joint return on investment. If a hospital effort results in reduced social welfare costs, those savings should be shared with the healthcare budget to reward the hospital.
4. Government jurisdictions should create new forms of investment capital to fund hospitals trying to undertake innovative community health approaches that may not results in hospital revenue.
"Hospitals are usually seen as the last resort in their communities — the place you go when other things fail. Yet they have enormous potential to be partners in improving the general health of the community," concluded Dr. Butler. "Unfortunately, there are obstacles to them playing this role. These need to be fixed."
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