Five lessons for leaders to improve community health

By Joy Lewis, MPH, MSW and Samantha DuPont, MPH

Conference season is upon us, and this year we welcomed a new kid on the block: the “National Forum on Hospitals, Health Systems and Population Health: Partnerships to Build a Culture of Health,” sponsored by the Robert Wood Johnson Foundation (RWJF).

Over three unseasonably warm October days in Washington, D.C., RWJF brought together a variety of stakeholders from health care, public health, community organizations, and elsewhere, to discuss how we can all work together to improve population health.

Kaiser Permanente’s Ray Baxter, PhD, senior vice president, Community Benefit, Research and Health Policy, was featured in the “Roundtable on Innovations to Improve Community Health,” along with Mary Ann Christopher, MSN, RN, FAAN, president and CEO, Visiting Nurse Service of New York and Shelly Schlenker, MPA, vice president public policy and advocacy, Dignity Health.  Moderated by Jeff Levi of the Trust for America’s Health, the panelists shared some lessons learned in tackling population health from the provider point of view.  Here are some key insights we heard:

  1. All hands should be on deck, from the front line to the boardroom.

Gaining buy-in from leadership is key to any organizational practice change, but everyone in a health system can—and should—play a role in population health.  Boards, for example, can be powerful players in keeping an organization focused on its mission and goals.  Ray Baxter noted that Kaiser Permanente’s board has a community benefit committee that functions much the same as a quality committee—it oversees the impacts of community health initiatives and challenges the organization to improve.  Front line staff are also critical, and must be given the opportunities and resources to participate.  Dignity Health has developed a “social innovation award” which challenges employees to submit project proposals to improve patients’ unmet social needs.  Staff in the Visiting Nurse Service of New York are highly active in improving population health because they live and work in the neighborhoods in which they serve, and thus have an intimate view of community needs.

  1. Build population health into your organizational DNA.

It’s easy to think of population health initiatives as clinical or community benefit activities, but Ray Baxter of Kaiser Permanente pointed out that everything a health system does – from hiring, to purchasing, to its environmental practices – has an impact on health.  And so it’s important for a health system to “walk the talk” and ensure that it behaves in a way that promotes health at every turn.  “Our perspective has become that we really have to go beyond taking credit for good things that we do intentionally,” said Dr. Baxter, “and start taking responsibility for all the effects we have as an organization.”

  1. Lead the work—or don’t.

Although health systems are increasingly on the hook for costs associated with poor health outcomes, that doesn’t mean that they need to (or should) lead all the work, all the time.  Every community and every organization will have different assets and needs, and so leadership will look different in different places.  Mary Ann Christopher of the Visiting Nurse Service of New York shared how faith-based organizations emerged as leaders in recovery efforts in the wake of hurricane Sandy, and her organization took the approach of asking “what do you need from us” rather than, “here’s what we think you should do.”  Shelley Schenkler of Dignity Health described how her organization divested some of its primary care practices in low-income communities because they realized that existing community providers were better able to care for those populations.  As a result, they redirected their resources towards providing linkages to community providers.  Ray Baxter shared that Kaiser Permanente seeks new pathways and partnerships to meet non-medical, social and economic needs of people in communities it serves – which can play major roles in encouraging and empowering health.

  1. Policy change is critical for advancing the movement.

Panelists were very forthright about the policy changes needed to support population health.  What’s often the 800 pound gorilla in the room – fee for service payment – was openly acknowledged as an issue.  Panelists noted that moving towards bundled payments and payments for value will encourage providers to work together and improve quality.  Other wishes included: incentivizing the use of patient navigators, moving towards a health in all policies approach, adjusting payments based on socioeconomic factors, altering Stark or anti-kickback laws to promote partnerships, and changing scope of practice laws to expand use of alternate providers such as community health workers and paraprofessionals.

  1. The consumer is the real revolutionary.

Perhaps the most intriguing question of the session was saved for last: What do you think is the next big disruptive innovation we need to move this system towards a culture of health?  Without hesitation, the panelists agreed that patients, family members, and communities will be the real disrupters.  Innovation won’t come from systems doing needs assessments.  It will come from consumers themselves, who will define what they need and want and that will shape the health system accordingly.