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Hospitals, Collaboration, and Community Health Improvement

Published online by Cambridge University Press:  01 January 2021

Martha H. Somerville ,
Laura Seeff ,
Daniel Hale  and
Daniel J. O'Brien
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Extract

Medical care in the United States traditionally has focused on the treatment of disease rather than on its prevention. Heart disease, cancer, hypertension, diabetes, and other chronic diseases are the primary drivers of American health care costs; compared to other high-income countries, U.S. health indices are lowest and costs are highest.

A “triple aim” — “improving the individual experience of care, improving the health of populations, and reducing the per capita costs of care for populations” — has gained traction, as the social determinants of health (non-genetic, non-clinical factors including health behaviors, social and economic factors, and the physical environment) are recognized as having significant effects on health outcomes.

Type
JLME Supplement
Information
Journal of Law, Medicine & Ethics , Volume 43 , Issue S1 , Spring 2015 , pp. 56 - 59
Copyright
Copyright © American Society of Law, Medicine and Ethics 2015

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References

National Center for Chronic Disease Prevention and Health Promotion, “Chronic Diseases and Health Promotion,” page last updated May 9, 2014, Centers for Disease Control and Prevention website, available at <http://www.cdc.gov/chronicdisease/overview/index.htm> (last visited February 11, 2015); The Organisation for Economic Co-operation and Development (OECD), “OECD Health Statistics 2014 – Frequently Requested Data,” available at <http://www.oecd.org/health/health-systems/oecd-health-statistics-2014-frequently-requested-data.htm> (last visited February 11, 2015).+(last+visited+February+11,+2015);+The+Organisation+for+Economic+Co-operation+and+Development+(OECD),+“OECD+Health+Statistics+2014+–+Frequently+Requested+Data,”+available+at++(last+visited+February+11,+2015).>Google Scholar
Berwick, D. M. Nolan, T. W. Whittington, J., “The Triple Aim: Care, Health, and Cost,” Health Affairs 27, no. 3 (2008): 759–769, at 760.CrossRefGoogle Scholar
University of Wisconsin Population Health Institute, “Our Approach,” County Health Rankings website, available at <http://www.countyhealthrankings.org/our-approach> and sources cited at note 7, infra.+and+sources+cited+at+note+7,+infra.>Google Scholar
Patient Protection and Affordable Care Act of 2010 (ACA), e.g., Titles I and II (expanding access to care); ACA §§ 3001 and 3025 (Medicare value-based purchasing and ACO shared savings); Davis, C. Somers, S., Public Health Provisions of PPACA Title IV: Prevention of Chronic Disease and Improving Public Health (2011), Network for Public Health Law Website, available at <https://www.networkforphl.org/_asset/x4mc6h/ACA-chart-formatted-FINAL.pdf> (last visited February 11, 2015).Google Scholar
A mean of 85% of community benefit expenses was attributed to charity care or other patient care services; only 5% was reported as community health improvement services. Young, G. Chou, C. Alexander, J. Lee, S. D. Raver, E., “Provision of Community Benefits by Tax-Exempt U.S. Hospitals,” New England Journal of Medicine 368, no. 16 (2013): 1519–1527. More recent evidence suggests that hospitals are continuing to assign relatively low priority to non-medical community health improvement efforts. See Barnett, K., Supporting Alignment and Accountability in Community Health Improvement (April 2014); National Network of Public Health Institutes website, available at <http://nnphi.org/CMSuploads/SupportingAlignmentAndAccountabilityInCommunityHealthImprovement.pdf> (last visited February 11, 2015).CrossRefGoogle Scholar
U.S. Department of the Treasury, Internal Revenue Service, 2014 Instructions for Schedule H (Form 990) (December 22, 2014), at 15–16, available at <http://www.irs.gov/pub/irs-pdf/i990sh.pdf> (last visited February 11, 2015).+(last+visited+February+11,+2015).>Google Scholar
Robert Wood Johnson Foundation, How Does Where We Live, Work, Learn and Play Affect Our Health? (September 2011), Commission to Build a Healthier America website, available at <http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf71339> (last visited February 11, 2015); Robert Wood Johnson Foundation, Overcoming Obstacles to Health (February 2008), Commission to Build a Healthier America website, available at <http://www.rwjf.org/content/dam/farm/reports/reports/2008/rwjf22441> (last visited February 11, 2015).+(last+visited+February+11,+2015);+Robert+Wood+Johnson+Foundation,+Overcoming+Obstacles+to+Health+(February+2008),+Commission+to+Build+a+Healthier+America+website,+available+at++(last+visited+February+11,+2015).>Google Scholar
26 C.F.R. § 1.501(r) – 3(b)(4), 79 Federal Register 78954–79016, at 79002 (December 31, 2014).Google Scholar
Mattessich, P. W. Rausch, E. J., “Cross-Sector Collaboation to Improve Community Health: A View of the Current Landscape,” Health Affairs 33, no. 11 (2014): 1968–1974.Google Scholar
12 U.S.C. § 2901(2014); 12 C.F.R. parts 25, 228, 345, and 195 (2014).Google Scholar
Federal Financial Institutions Examination Council, Community Reinvestment Act: Background & Purpose, Federal Financial Institutions Examination Council website, available at <http://www.ffiec.gov/cra/history.htm> (last visited February 11, 2015).+(last+visited+February+11,+2015).>Google Scholar
12 C.F.R. § 228.12(g) (2014).Google Scholar
Sprong, S. Stillman, L., Leveraging Multi-Sector Investments: New Opportunities to Improve the Health and Vitality of Communities (January 2014), Health Resources in Action website, available at <http://www.hria.org/uploads/reports/PPReport_r3_012714_pages.pdf> (last visited February 11, 2015).+(last+visited+February+11,+2015).>Google Scholar
79 Federal Register 78954–79016, at 79001–04 (December 31, 2014.Google Scholar
26 C.F.R. § 1.501(r) – 3(b)(3), 79 Federal Register 78954–79016, at 79002 (December 31, 2014).Google Scholar
If a hospital is unable to obtain input from any of these mandatory sources, it must describe its efforts to solicit such input in its CHNA report. 26 C.F.R. §1.501(r) – 3(b)(6)(iii), 79 Federal Register 78954–79016, at 79003 (December 31, 2014).Google Scholar
Local and state health departments seeking voluntary accreditation from the Public Health Accreditation Board (PHAB) must satisfy national standards that include collaborative community assessment. PHAB, Standards and Measures Version 1.5 (December 2013), Standard 1.1., at 13, PHAB website, available at <http://www.phaboard.org/wp-content/uploads/SM-Version-1.5-Board-adopted-FINAL-01-24-2014.docx.pdf> (last visited February 11, 2015). In several states, periodic needs assessment is a component of mandatory health department accreditation. See Office of State, Tribal, Local and Territorial Support, Menu of State Public Health Department Accreditation Laws, Centers for Disease Control and Prevention website, available at <http://www.cdc.gov/phlp/docs/menu-phdeptaccreditation.pdf> (last visited February 11, 2015).+(last+visited+February+11,+2015).+In+several+states,+periodic+needs+assessment+is+a+component+of+mandatory+health+department+accreditation.+See+Office+of+State,+Tribal,+Local+and+Territorial+Support,+Menu+of+State+Public+Health+Department+Accreditation+Laws,+Centers+for+Disease+Control+and+Prevention+website,+available+at++(last+visited+February+11,+2015).>Google Scholar
26 U.S.C. § 4959 (2014).Google Scholar
ACA § 9007(e), 26 U.S.C. §501 note, 124 Stat. 858 (2010).CrossRefGoogle Scholar
DeLeire, T. Joynt, K. McDonald, R., ASPE Issue Brief: Impact of Insurance Expansion on Hospital Uncompensated Care Costs in 2014 (September 24, 2014), Department of Health and Human Services website, available at <http://aspe.hhs.gov/health/reports/2014/UncompensatedCare/ib_UncompensatedCare.pdf> (last visited February 23, 2015).+(last+visited+February+23,+2015).>Google Scholar