Symposia & Meetings

Sara Rosenbaum, Harold and Jane Hirsh Professor of Health Law and Policy, School of Public Health and Health Services at George Washington University, began the day with her keynote, Hospitals’ Role in Community Health Improvement: The Evolution of Community Benefit. She discussed the distinction between community health improvement and community building activities and how the IRS reporting requirements and efforts to capture and define community benefit spending are moving toward one another but are not quite yet aligned. Keeping in mind the end goal of broader investments in community health by nonprofit hospitals, Rosenbaum offered three recommendations: 1) the IRS should clarify the relationship between hospital community benefit spending and the requirements of the CHNA; 2) the IRS should eliminate the distinction between “community health improvement” and “community building” on Schedule H of Form 990; and 3) there should be greater transparency in the implementation strategy phase of the CHNA process if communities are to be empowered and the upstream determinants of health addressed.

Christopher Koller, President of the Milbank Memorial Fund, provided comments on the keynote in his presentation titled Refining Hospital Community Benefit Programs. Stating that health care is the “pacman” of state budgets, eating up dollars, Koller highlighted the advantages that federalism can bring to the debate about shifting the paradigm to broader investment by hospitals in community health. He recommended that states: 1) build on federal hospital community benefit law to create state standards for community health improvement; 2) bring greater transparency to CHNA strategy implementation through regulatory strategies; 3) insist on provider payment reform that incentivizes the promotion of community health; and 4) support adoption of social services with demonstrated effectiveness.

Ruth Ann Norton, President and CEO of the Green & Healthy Homes Initiative (GHHI), gave the luncheon presentation, Advancing Community Health through Housing. She focused on lead poisoning and asthma as the leading health concerns for families living in unhealthy and unsafe households. Many children miss school because of asthma and triggers in the home are a major factor behind asthma attacks among children. Norton provided several examples of Baltimore families who are now thriving and whose overall physical and mental health vastly improved after GHHI intervened with simple, low-cost home-improvement solutions. She explained GHHI’s four-step model of receiving referrals, making an initial home visit, delivering home-improvement services, and evaluating outcomes.

Charles Milligan, CEO at UnitedHealthcare Community Plan of New Mexico and former Executive Director of The Hilltop Institute, wrapped up the day with his reflections. He summarized the topics and themes that emerged throughout the day and emphasized the importance of leadership at the state and local level in effecting change and driving community health improvement. Milligan explained the background and impetus behind Hilltop’s work on hospital community benefit policy; maintained that the reasons for establishment of Hilltop’s program persist; and stressed that going forward, advocacy both within hospitals and among state and local policymakers must continue. He ended with this final thought: that tax exemption is conferred by everyone in the community and that all should benefit—even those who never find themselves in need of a hospital.