“The Beautiful Bronx”, photo by Marcela on Flickr.
The 2010 Patient Protection and Affordable Care Act (ACA) is well known for giving millions of people across the United States access to health insurance as well as more affordable coverage options.
A lesser known but equally important set of provisions in the ACA mandates that nonprofit hospitals provide community benefits (CB) where they are located. Hospitals—because of these health reforms at the federal level (and increasingly, state level Medicaid reforms), and their role as anchor institutions— are uniquely positioned to leverage their economic power to support communities in addressing social, environmental, and economic conditions, known as the social determinants of health, that affect quality of life.
To maintain their tax-exempt status, nonprofit hospitals are required to provide community benefits and capture the investment through IRS reporting mechanisms. To guide how CB dollars are spent, hospitals are also required to conduct community health needs assessments (CHNAs) once every three years. CHNAs are meant to be participatory in nature, reflecting the needs and challenges of diverse groups in the community, and including marginalized voices.
As an anchor institution—an organization tied to the community in which it is located, and once established, tends not to move—a hospital has additional incentives to ensure that its mission of serving the community is not confined within its walls. A hospital that sees itself as an anchor, acknowledges that its institutional health is tied to the health of its community.
In the Bronx, cross-sector partners are working on an initiative that leverages hospital assets and community-based expertise to tackle asthma and its social determinants. The Northwest Bronx Community and Clergy Coalition (NWBCCC), along with the Bronx Cooperative Development Initiative (BCDI) and others are piloting the Bronx Healthy Buildings Program (Healthy Buildings).
Healthy Buildings is a holistic approach to addressing the root causes of repeat asthma-related hospitalizations and emergency department visits. This program is being supported in part by investment from Montefiore Medical Center who is partnering with St. Barnabas Hospital in the on-going NY state-wide Medicaid reform process. This 5-year process, known as the Delivery System Reform Incentive Payment (DSRIP) program, aims to reduce avoidable hospital use by 25% and shift health care institutions to invest in prevention. Because, asthma is one condition Montefiore and St. Barnabas are focusing on under DSRIP, Montefiore has leveraged designated funding to support Healthy Buildings.
Healthy Buildings should yield a greater return on investment for hospitals in the long run than existing approaches that deal with poor health outcomes but do not address underlying root causes. It is a prime example of the type of initiative that hospitals could sustainably support through their community benefit dollars. The program tackles disproportionately high rates of asthma in the community by addressing substandard housing conditions through green and healthy retrofits. Additionally, through a community-organizing component, tenants are empowered to identify concerns and demand action while deepening their education and leadership on health justice. The pilot program also creates jobs and wealth through the hiring of local contractors and the holding of firms to high-road workforce standards. Finally, it aims to lower asthma-related costs of health care, benefiting the hospital’s bottom line.
Health disparities in the Bronx demonstrate the disproportionate effects of environmental, social and economic conditions on people of color and people with low-incomes. But, a hospital’s economic assets can play a vital role in community and economic development, shifting poor health outcomes and nurturing overall wellness.
Post by Katherine Mella, a Post-Graduate Fellow with the Economic Democracy Project at MIT’s Community Innovators Lab. To learn more about the role of anchor institutions (such as hospitals, community colleges, universities and nonprofit institutions) in climate change mitigation and efforts around economic resilience, join our Twitter Chat from 3 p.m. to 4 p.m. EST on Tuesday March 29th. Check out this post for more information.