Making the Case for Collaborative CHI
The community health improvement (CHI) process brings together health care, public health, and other stakeholders to identify and address the health needs of communities—because working together has a greater impact on health and economic vitality than working alone. In fact, given separate policy requirements for similar activities, many of these groups are already working together to assess community needs and plan interventions.
Below are examples—organized by initiative type—of how hospitals have successfully engaged in collaborative, innovative work to improve the health of their patients and others in their communities. Hospitals are not doing this work alone; they are addressing critical health issues with public health, social services, and other partners in their communities. Several hospitals initiated these activities as a result of findings from their community health needs assessments (CHNAs). Many undertook community-based initiatives to address the needs of patients who are often clustered geographically and who interact frequently with the healthcare system (super utilizers).
Several of these examples are cutting edge initiatives that are demonstrating promising early results. A few can be found in the CHI Navigator Database of Interventions . Most of these examples highlight the impact of this kind of work on the financial bottom line, which is important as the health care system moves to value-based payments.
Update: Trinity Health Transforming Communities Grants
Trinity Health has announced an innovative new
Transforming Communities Funding Opportunity
that exemplifies the type of collaborative approach used by more and more health systems. The inaugural Transforming Communities grants and low-interest investment loans will provide six collaborative community partnerships with an anticipated investment of $80 million over 5 years to reduce tobacco use and obesity. The specific Transforming Communities goals align with several risk factors included in the CHI Navigator Database of Interventions, including tobacco use, unhealthy diet, and physical inactivity. Trinity provided the CDC CHI Navigator as a resource for those planning to apply.
Trinity recently announced the six awardees who will focus on policy, systems and environmental changes that can directly impact areas of high local need in reducing tobacco use and obesity.
These examples describe partnerships among health, healthcare, and social services organizations and the resulting synergistic impact on health outcomes.
Hennepin Health Creates an ACO that Reduces Admissions and ED Use–Hennepin County, Minnesota
Hennepin Health, a partnership among two health care providers (Hennepin County Medical Center, NorthPoint Health and Wellness Center), Metropolitan Health Plan (a county-run Medicare and Medicaid HMO) and the Hennepin County Human Services and Public Health Department created a safety-net Accountable Care Organization and provided integrated physical and behavioral health and social services (i.e., housing support and employment counseling) to low-income residents, thus reducing hospital admissions and emergency room use by more than 20% in its first year.
- Addressing Patients' Social Needs: An Emerging Business Case for Provider Investment
- How a Social Accountable Care Organization Improves Health and Saves Money and Lives
Housing Saves Health Care Dollars–Los Angeles, California
The Los Angeles Department of Health Services (LADHS) Housing for Health program facilitated the creation of thousands of housing units with co-located or coordinated clinical and support services by partnering with housing developers, case managers, health care providers, housing finance agencies and philanthropic organizations. Without permanent supportive housing, the LADHS was spending around $70 million per year on inpatient costs for homeless patients. By placing these patients in permanent supportive housing, Housing for Health has created a cost savings of $32,000 per person, per year, a 77% reduction in emergency room visits, a 77% reduction in inpatient admissions, and an 85% reduction in inpatient days.
- Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field
- Housing for Health: Los Angeles County Department of Health Services
- Public-Private Partnership Creates $18 Million Fund to Provide Housing for High-Need Homeless Patients in Los Angeles County
Successful ACO Reduces Cost of Care, Montefiore Medical Center–New York, New York
In its first year as an Accountable Care Organization (ACO), Montefiore Medical Center reduced the cost of care for its 23,000 Medicare patients by 7% and earned $14 million in shared savings payments from the Centers for Medicare & Medicaid Services by partnering with community organizations to provide wraparound services including housing, legal, financial, employment, and transportation assistance.
Local Community Health Networks Reduce Healthcare Costs, Community Care of North Carolina–North Carolina
The state of North Carolina created a partnership between the state, hospitals, physicians, social service agencies and county health departments to establish local, non-profit community networks. These networks linked low-income Medicaid enrollees with medical homes and case managers, and established data monitoring and reporting systems. This effort led to a statewide savings of $3.3 million for people with asthma, and $2.1 million for people with diabetes from 2000-2002.
Following are examples of the advantages of addressing asthma triggers in the home and promoting asthma self-education, in addition to treating acute asthma attacks. It’s worth noting that both Boston Children’s Hospital and Parkview Health System based their initiatives on findings from CHNAs.
Boston Children’s Hospital Gets Returns on Asthma Initiative–Boston, Massachusetts
Boston Children’s Hospital partnered with the Boston Public Schools, the Boston Public Health Commission, and community health centers to develop the Community Asthma Initiative (CAI). CAI provides case management, home environmental services, and education to children and their families in three low-income neighborhoods. In just 2 years, CAI generated a 60% reduction in the percent of patients with asthma-related emergency department visits, an 80% reduction in the percentage of patients with asthma-related admissions, and cost savings of $1,621 per child in year one and $2,206 per child in year two. For every dollar spent on the program, $1.46 is returned to society/insurers.
- Boston Children’s Hospital’s Approach to Community Health: Using programs to achieve systemic change
Parkview Health System Decreases Asthma ED Visits and Saves Money–Fort Wayne, Indiana
By partnering with school districts and public health departments to a) identify children and adults with asthma and b) deliver support services, resources and age-appropriate education to improve their ability to self-manage their asthma, the Parkview Health System was able to reduce the number of return emergency department visits. Its Emergency Department (ED) Asthma Call Back Program helped decrease asthma-related visits from nearly 22% to 15% in one year. By 2012, the ED Asthma Call Back Program’s return on investment rose from $20 saved for every dollar invested in 2009 to nearly $24 saved per dollar invested in 2012.
Sinai Health System Uses Community Health Workers to Reduce Urgent Health Resource Use–Chicago, Illinois
Sinai Health System achieved a 75% drop in the use of urgent-health resources by employing trained, culturally competent community health workers to provide individualized asthma education during three to four home visits over the course of 6 months. This effort also led to a 35% reduction in symptom frequency and a 75% reduction in urgent health resource utilization. They also achieved a cost-savings of nearly $6 per dollar spent on the intervention.
Cardiovascular Disease Initiatives
The following examples underscore the value of using a variety of approaches to address the underlying risk factors of cardiovascular disease. Many of these examples appear in the CHI Navigator Database of Interventions .
Statewide Obesity Prevention Strategy Increases Physical Activity
Nemours Health System–Delaware
A partnership between Nemours Health System, Delaware’s schools, child care providers, primary care practices, and community based organizations to influence eating and physical activity behaviors at a population level had multiple successes thanks to a combination of educational campaigns, policy change, and technical assistance. Those successes include slowing the increases in the rates of overweight and obesity among children (decreasing rates in some sub-populations), increasing the number of children getting the recommended five servings of fruits and vegetables a day, improving healthy eating and physical activity in child care settings, and increasing physical fitness in children in pilot-school programs; children in participating schools were fifty percent more likely to be physically fit than children in other schools.
- A Statewide Strategy to Battle Child Obesity in Delaware
- Statewide Policy and Practice Changes Encourage Schools To Promote Behavior Change in Students, Leading to Better Physical Fitness
Comprehensive Community Program Improves Health Habits
Allina Health–New Ulm, Minnesota
Allina Health collaborated with the Minneapolis Heart Institute Foundation to launch the Heart of New Ulm (HONU) project to reduce the number of heart attacks in the New Ulm area over a 10-year period. HONU helps support healthy lifestyle changes for residents through: worksite-wellness programs; tobacco control policy work; restaurant, convenience, and grocery store programs; continuing medical education for physicians; free community heart-health screening; and community educational programs and health challenges for individuals. Between 2009 and 2011, the project recorded improvements in healthy lifestyle behaviors and biometric risk factors that included an increase in the number of people eating five or more fruits and vegetables per day—from 19% to 33%—and a decrease in the percentage of residents with high blood pressure, from nearly 21% to less than 18%.
HEALTHY Armstrong: Local Coalition Improves School Nutrition
ACMH Hospital/Children’s Community Pediatrics–Armstrong County, Pennsylvania
ACMH Hospital/Children’s Community Pediatrics and the Armstrong School District partnered to conduct the "We Can!" program, which included community-wide promotion of healthy behaviors, providing wellness guides to schools, and supporting schools in providing better food options, and classroom education on healthy lifestyles and active field trips. Their successes included a near doubling in the number of minutes Armstrong County students spent in structured physical activity annually, from 402,142 minutes (2006) to 796,260 minutes (2007-2009). Another success was a drop in the number of high-calorie, low-nutrition meals being sold in schools, from 55% in 2006 to 37% in 2009.
- Community Coalition Supports Schools in Helping Students Increase Physical Activity and Make Better Food Choices
Health System Partnership with the YMCA and the Faith Community Reduces High Blood Pressure
Spectrum Health–Grand Rapids, Michigan
With African American women as their focus, Spectrum Health, the Greater Grand Rapids YMCA, the local Ministerial Alliance, and local churches launched Sisters in Action to provide an exercise, nutrition and wellness education program, as well as case management services over the course of 6 months. After just 16 weeks, nearly 42% of participants saw a drop in their body mass index. The program also helped program participants decrease their blood pressure, increasing the number of women with blood pressure in the ideal range from 39% to 59%.
- Six-Month Weight Management Program for African-American Women Church Congregants Improves Behaviors, Blood Pressure, and Body Mass Index
The Rural Health Initiative: Rural Outreach Improves Cholesterol Levels
ThedaCare–Shawano County, Wisconsin
ThedaCare partnered with health care, business, and agricultural leaders and organizations in Shawano County, WI, sending registered nurses with farming backgrounds to farms to provide free preventive health and occupational safety screenings to farmers, their adult family members, and their employees. This effort helped participants improve their eating habits, increased their levels of good (HDL) cholesterol from 45 to 51, and led to improvements in farm safety practices.
- Nurses Provide Free Health and Safety Screenings on Farms, Leading to Better Eating Habits and Cholesterol Levels, and to High Attendance at Followup Appointments
Methodist Le Bonheur Health System Reduces Readmissions and Costs–Memphis, Tennessee
By linking with over 500 faith communities, and training community navigators to connect discharged patients with a church-based volunteer liaison to arrange post discharge services and facilitate their transition back to the community, Methodist Le Bonheur Healthcare reduced hospital readmissions by 20% and recorded total sum charges of $4,000,000 less than for a similar group of patients who did not receive support from community navigators. These successes allow the hospital to keep funding the program, which costs between $750,000 and $1 million each year.
- Health Systems Learning Group (HSLG) Monograph
- Methodist Healthcare: Center of Excellence in Faith & Health
- Faith Filled & Healthy Communities: The Memphis Congregational Health Network
- Church-Health System Partnership Facilitates Transitions From Hospital to Home for Urban, Low-Income African Americans, Reducing Mortality, Utilization, and Costs
Behavioral Health/Substance Abuse Initiatives
The initiatives below underscore the impact of partnerships on substance abuse and behavioral health, important contributors to mortality and morbidity in these communities. It’s worth noting that Massachusetts General Hospital‘s efforts resulted from findings of their CHNA.
Massachusetts General Hospital Reduces Overdoses and Drug Related Deaths–Boston, Massachusetts
In the Charlestown neighborhood of Boston, MA, opioid overdoses were reduced by 50% (2004-2012) and drug-related deaths were reduced by 78% (2003-2008) thanks to a partnership between Massachusetts General Hospital, the Charlestown Substance Abuse coalition, the Charlestown Drug Court, the Boston Public Health Commission, and a social marketing firm. Together they run an anti-prescription drug overdose social marketing campaign, make referrals to treatment facilities, offer treatment as an alternative to incarceration, provide substance abuse curricula for children, and train local residents in the administration of Narcan (nasal naloxone) to reverse opioid overdoses.
- Massachusetts General Hospital: Center for Community Health Improvement
- Massachusetts General Hospital Center for Community Health Improvement: Charlestown Substance Abuse Coalition (CSAC)
Violence Interrupters Reduce Shootings and Murders
Advocate Christ Medical Center, CeaseFire Partnership–Chicago, Illinois
CeaseFire, a community organization that works in eight communities in Chicago, and Advocate Christ Medical Center, successfully joined forces to combat violence in five hotspot neighborhoods. Hospital response coordinators work with CeaseFire’s network of "violence interrupters" to mediate conflicts and reduce gunshot emergency department visits. Between 2000 and 2009, the city of Chicago experienced a 41-73% drop in shootings and killings in CeaseFire zones. Research showed that 16-35% of the reduction can be directly attributed to program efforts, as can a 100% reduction in retaliation murders in five of CeaseFire’s eight neighborhoods.
Social Determinants of Health Initiatives
These collaborations show impact on social determinants of health, including education, economic development and transportation, and have potential for long-term impact on the health and economic vitality of their communities.
Scholarship Program Improves Local Graduation Rates
University of Pittsburgh Medical Center–Pittsburgh, Pennsylvania
Big strides were made in education in Pittsburgh thanks to investment in the Pittsburgh Promise scholarship program through a partnership among the University of Pittsburgh Medical Center, Pittsburgh Public Schools, the Pittsburgh Foundation, and other funders. The program helped increase the local high school graduation rate in public schools from 63% to 72% and provided scholarships for alumni of Pittsburgh Public Schools to attend Pennsylvania colleges. These local educational and economic opportunities also led to an increase in the number of graduates enrolling in post-secondary education from 58% to 68% and retention of young residents, leading to the city’s first population growth in 50 years.
- Hospitals Building Healthier Communities: Embracing the Anchor Mission
- Pittsburgh Promise: The Impact Dashboard
Local Anchor Institution (Hospital) Creates Jobs
University Hospitals–Cleveland, Ohio
A unique collaboration between the City of Cleveland, local businesses, local trade unions (the Cleveland Building Construction Trades Council) and University Hospitals helped develop the Vision 2010 construction project focused on the use of a diverse and local labor force, local and sustainable suppliers, and women- and minority-owned contractors to build community wealth. This effort exceeded expectations and University Hospitals’ diversity goals by generating 5,200 construction jobs, $500 million in wages and 1,200 permanent jobs. This program has had lasting effects by investing in building the capacity of local women- and minority-owned businesses to fulfill large-scale contracts.
Seattle Children’s Hospital Reduces Carbon Footprint–Seattle, Washington
Seattle’s roads are seeing less traffic thanks to the Livable Street Initiative, a partnership between Seattle Children’s Hospital, community residents, community organizations, and advocacy groups. The initiative developed bike boulevards, road-safety improvements, and its own transit program. These alternative-commuting efforts helped keep 630,000 cars off of the road, reduced vehicle miles travelled by 6.5 million, saved 235,000 gallons of gas, and reduced carbon-dioxide emissions by 2,100 metric tons.