Title: Executive Director of Community Benefit, Community Health Network, Inc.
Education: JD, Indiana University McKinney School of Law; MS in biology, Atlanta University; BS in biology, Spelman College
Public Health Law News (PHLN):Please describe your career path and what drew you to public health law.
Keith:After receiving my master’s degree in biology, I worked for Eli Lilly and Company for several years in research, corporate environmental affairs, and medical affairs. Once I received my law degree, I was chief counsel in the Advisory Section in the attorney general’s office and was assistant counsel for then Indiana Governor Frank O’Bannon. I began my career in public health law as general counsel for the Marion County Public Health Department in Indianapolis, Indiana, after leaving state government. I was general counsel for nine years. It was here that I honed my legal skills in public health law, because the department was and continues to be very robust and innovative in fulfilling its statutory and mission mandate. The director, Dr. Virginia Caine, was a great mentor in public health for me, as was the administrative staff. They guided me, allowed me to grow, and made me stretch myself by giving me public health projects that I probably would not have gotten to do somewhere else, simply because I was a lawyer. I love it.
PHLN:What is Community Health Network?
Keith:Community Health Network is a nonprofit integrated hospital system that consists of nine hospitals, which include a behavioral health pavilion as well as heart and vascular and rehabilitation hospitals. It has approximately 15,000 employees and 2,400 medical providers. Its primary areas of focus are oncology, behavioral health, maternity, school-based care, primary care, and cardiovascular services.
PHLN:Now that you’re working for a nonprofit community health organization, do you still consider yourself a public health lawyer?
Keith:Absolutely. I believe that once you become a public health lawyer, you remain one even if you move to another practice area. It becomes a part of you. I continue to view my work through a public health lens. How does this issue affect the public? What are the legal requirements? What is the public policy on this issue, or is there one?
PHLN:What do you do as the Community Health Network’s executive director of community benefit?
Keith:I provide leadership in helping the Network maintain its nonprofit status by ensuring compliance with its annual Community Benefit and Form 990, Schedule H, report. Hospitals can qualify for tax-exempt status if they provide services that are beneficial to their communities. This is known as the community benefit standard. The 990 Schedule H form provides the public with financial information about nonprofit hospitals. I also conduct the triennial community health needs assessment, track these activities, manage different community benefit programs, and work with the community on these programs. I am also responsible for the Serve360, the Network’s employee volunteer and engagement program, which is an excellent vehicle for employees to volunteer their time and talents to different community organizations.
PHLN:How do you use your law degree in your day-to-day activities?
Keith:From an organizational risk and compliance perspective, I use it when I am reviewing the IRS requirements for completing the Form 990 H and reviewing what counts as community benefit. Moreover, fulfilling the legal requirement as mandated by the IRS requires that I learn the nuances of nonprofit law. Additionally, depending on the project, I may see a HIPAA privacy and confidentiality issue. Or perhaps a project is conducting research, thus human subject laws have to be followed. Also, transactional/contract issues might need to be addressed.
PHLN:What are the greatest challenges facing hospitals today?
Keith:Hospitals operate on small margins and are increasingly asked to do more with less, given the social determinants of health such as housing, poverty, social isolation, transportation, and food insecurity that cause and/or exacerbate health problems in patients. Therefore, they are required to be innovative and think outside of the box as it relates to integrated care.
PHLN:How is your organization working to implement innovative and creative community health services?
Keith:Community Health Network was started by a neighborhood on the east side of Indianapolis because residents recognized that the community needed a hospital. It was one donation at a time. This mission of community-oriented service continues today. We listened to our patients and realized that many of the issues they confront are related to social determinants of health.
For instance, we piloted a Medical-Legal Partnership (MLP) Program at our Community Hospital East. The MLP helped its very first client, a hospitalized patient, obtain the documents necessary to apply for Medicaid and Social Security disability. The patient did not have a copy of the document he needed to file for benefits that would allow him to transition from the hospital into long-term care. When his relative went to get a copy from a county agency, the agency said he could not obtain it under Indiana law. The MLP intervened, contacted the agency, and advocated for a liberal reading of the applicable statute to permit the relative access to the document. The county agency agreed, and the patient received the document.
Also, Community Health Network has a school-based program that has on-site nurses and behavioral health therapists to address students’ needs in the school and after-school setting. These services are free of charge to schools. Community offered these services after some school districts said that they could not continue to provide school-based nurses. We provide these services in 107 schools, with approximately 89,000 students. Having providers in the schools ensured a 95% return-to-classroom rate for students who came to them for services in 2016.
PHLN:In what other ways is your organization working to promote its mission and benefit the community?
Keith:Since 2016, Community has operated a food pantry called the Cupboard of Lawrence for residents of Lawrence Township, Indiana. A family can visit twice a month to receive food or personal items. To provide these services, we have partnered with multiple organizations, such as Gleaners Food Bank of Indiana and Midwest Food Bank. In 2017, we served approximately 14,000 households and 57,000 people. Also, we partnered with Brandywine Creek Farms to create the Rolling Harvest Food Truck, which takes fresh fruits and vegetables to areas that were food insecure. This enabled us to feed approximately 2,600 additional people.
We also have a Faith Health Initiative (FHI) whereby we support our faith partners by providing a variety of educational services designed to improve health awareness and access to care in several ways: 1) Speakers Bureau, 2) referrals to connect members with the right community resources, 3) monthly FHI Connect Newsletter, and 4) Faith Community nursing training and support, to name a few.
PHLN:Have community partners added value to these projects? If so, how?
Keith:Our partners add value every day by providing food donations and personal items to our food pantry. Additionally, because of our partnership with Indiana Legal Services, we receive approximately 10 referrals and requests for MLP information each week. We also average one to three presentations/meet and greets per month regarding the MLP and social determinants of health. Our Nurse Family Partnership is a result of our collaboration with Goodwill Industries to place a nurse with a vulnerable or new mom to teach her how to care for her child and to provide those wraparound services that ensure success. One last thing—we have partnered with Meals on Wheels on a pilot program to address food insecurity issues of patients with diabetes and chronic heart failure. By addressing the food issue, we are hopeful that we will see the patients’ health improve.
PHLN:You’ve been in your current position just over a year. How has your background in public health helped you in your most recent position?
Keith:It has been a tremendous help. Because so much of what we are doing requires measurable outcomes based on population health, I consider my time spent at the Marion County Public Health Department to be a valuable asset.
PHLN:Is the community benefit model more beneficial than less integrated healthcare delivery models? If so, can you describe how?
Keith:The community benefit model must be an integrated one. A silo approach is counterproductive because you are dependent on your colleagues to help drive the implementation strategy from your community health needs assessment (CHNA). Employees must understand how community benefit works, and the value it brings in helping to make their program initiatives succeed. For instance, because one of our outcomes from the 2015 CHNA is diabetes/obesity, it is incumbent upon Community Benefit to reach out to the health promotions sector, primary care sites, nursing, and population health to understand the current trends and diabetes programs being offered and be able to collaborate.
PHLN:What advice would you give other communities and hospitals interested in creating more comprehensive, community benefit health care?
Keith:I would recommend that they understand the community health needs assessment implementation strategy approved by their hospital board of directors. Second, it is essential that the hospital, from the board of directors to employees to providers, understand the definition of community benefit and its requirements. Third, organizations must talk to each other, share information, and not be afraid to have a successful failure.
PHLN:Have you read any good books lately?
Keith:I am currently reading A Wrinkle in Time.
PHLN:What would you be doing if you weren’t working in community health?
Keith:Practicing law or writing.
PHLN:Do you have any hobbies?
Keith:I like to read and run.
PHLN:Is there anything you’d like to add?
Keith:We should all support and advocate for the increased funding of public health.