Promoting a culture of health: Partnership composition

Improving health in communities has gained in interest and momentum. To take on local needs, health systems and public health entities are forming collaborations with others. The webcast Unique insights and approaches to population health highlighted the findings of a study of 12 such collaborations.

The basis for the webcast is the study Improving Community Health through Hospital-Public Health Collaborations, released in late 2014. The webcast provides proven recommendations for hospitals and health systems to consider for their current or potential partnerships. Leading the webcast discussion were the study’s principal investigator Dr. Lawrence Prybil, the Norton Professor in Healthcare Leadership and associate dean of the University of Kentucky College of Public Health, and study contributor and Grant Thornton LLP Health Care National Managing Partner Anne McGeorge. The webcast moderator was John Summerlin, senior manager in Grant Thornton’s Health Care Advisory Services practice.

This section of the webcast Q&A delves into both the overview and the details of the recommendation about composing a
successful population health collaboration.

Recommendation #1
To have an enduring impact, partnerships focused on improving community health should include hospitals and health departments as core partners but, over time, engage a broad range of other parties from the private and public sectors.

John Summerlin:

From an advisory standpoint, we see a lot of clients engaging in accountable care-type organizations. These clients typically include hospitals and physicians, and we see a variety in public health agencies and local employer groups. So we wanted to ask Dr. Prybil to give perspective on who the typical partners are. And what about the states, and the local state Medicaid agencies and their involvement in some of these partnerships?

A core group with a foundation of trust
Lawrence Prybil:
Partnerships are not easy. You have independent parties coming together around an agreed-upon purpose, but no one is in control. It’s a voluntary partnership or alliance of independent parties. This is not easy to manage.

So we believe it is important that you begin with core partners who have a foundation of trust. And if you try to bring together partners — whatever they are — to focus on some shared purpose, and there’s not a foundation of trust, they are very unlikely to succeed.

So partner we must, but we must choose our partners carefully.

In the partnerships we studied, all involved at least one hospital and in many cases more than that, and all involved a health agency or agencies, and all involved other partners. The successful ones started out with a smaller group of organizations who have some history of collaboration, have some knowledge of and trust for each other, and provide a stable core for a partnership.

We would not advise that you get 100 partners around the table on day one. That is a very steep hill to climb.

The exact purpose of these partnerships vary. Some have a very broad purpose. Some have a more focused purpose. But there is a defined purpose.  
Some of these partnerships have well over 100 partners. But there is an inner core of principal partners who are the rock on which these partnerships are based.

Who might they be, beyond hospitals, health systems and public health?

A natural partner is the school system.
School systems have the kids. They feed them, they provide some kind of exercise; they have a natural interest in having healthy kids. They have access to families, and families have to be involved.

A second logical partner is local employers.
Every business has a vested interest in a healthy workforce and a healthy community.

There is a commonality of interest. But employers are always diverse and diffused. So you would not want to start out your partnership bringing together 50 employers and try to get something to happen. But you might want to get one or two progressive employers who are big and prestigious and respected, and who share an interest in improving the health of the community.

Local government is a key player for a lot of reasons.
In several partnerships we studied, local government has really become a principal partner. Not just around the table but engaged, because they get it, too. They want to see improvement in the health of their community to attract jobs and to attract more employers.

In our view, you begin with a small core of truly committed partners. You add to that, over time, a collection of other partners who are consistent with your purpose, who share a commitment and with whom you can build trust.

Who isn’t around the table? In the partnerships we studied, too often health plans aren’t around the table.
We think health plans are a natural partner. They have a vested interest in improving the community health, but they haven’t yet gravitated enough to become major players in many of these partnerships.

How do the new IRS rules requiring tax-exempt hospitals to conduct community needs assessments fit into this population health management dynamic in the industry today?

Government roles
Anne McGeorge:
The IRS rules are very relevant here. The Affordable Care Act included a requirement that all hospitals conduct a community needs assessment every three years. This became effective last year.

The final regulations covering the specifics of these community needs assessments came out just before the holidays. Hospitals are required to take input from the following sources when they’re conducting community needs assessments:
  • One is state and local governmental public health agencies or other equivalent state or local agencies that have knowledge relative to the health needs of the community.
  • The second one is members of the medically underserved, low-income or minority populations, or organizations that serve or represent the interests of such populations.
  • And lastly, any written comments that were received on the hospital facility’s most recently conducted community needs assessment.

As the hospitals meet these requirements and conduct the community needs assessment, they will be reaching out — indeed, are required to reach out — to the public health agencies to conduct the needs assessment. Through that process they can naturally assess good opportunities to form these types of partnerships.

State agencies have played an important role. For example, we studied a partnership called the California Healthier Living Coalition initiated by the state Department of Aging. The aging of the population leads to chronic disease and ailments. Eighty percent of America’s health care costs are focused on caring for the chronically ill and disabled. This coalition is focused on expanding the availability of programs and education about chronic disease management to help the elderly and the nonelderly with chronic ailments to be more independent and healthier.

See Promoting a culture of health for the introduction to the Q&A. See also the study report, Improving Community Health through Hospital-Public Health Collaborations.