Population Health

A Foundation for Improving Social Determinants of Health

Today's potential donors want to address the root causes of poor health in their communities

By Laurie Larson

Although the central purpose of hospital and health system foundations has always been to help their organizations meet the ongoing financial challenges of providing care and to support community benefit programs, that purpose is gaining a sharper focus under value-based care models and their contingent attention to population health. Health care leaders are realizing that making meaningful improvements to their service population’s long-term health and well-being must include addressing social, economic, educational and quality of life issues — their community’s social determinants of health. And that imperative is intrinsically tied to their foundation’s function as well.

“The new focus on social determinants of health — looking outside the four walls of the hospital — is resonant and aligned with philanthropy’s existing purpose and work,” affirms Betsy Chapin Taylor, president of Accordant Philanthropy. “Many health care organizations are still stuck in the old paradigm of raising money just for capital campaigns, but philanthropy is so much bigger than that — and it can drive innovative social determinants of health initiatives.”

She adds that many potential foundation donors are already aware of, and concerned about, the negative social determinants in their communities. “Today’s significant donors are social-impact investors — they want to give money to achieve specific results, and they like to address the root causes of health problems in the community,” Taylor says. Such donors are looking for “conveners,” she says, those who know how to draw stakeholders together to activate change. Health system foundation trustees are, by definition, among those conveners — and donors — and they should reflect the community they serve.

“You want a variety of perspectives, those who have the pulse of the community,” Taylor says. “[Foundation trustees] know where the community is going and can provide robust solutions, as well as bringing in more allies.” Although there is no typical foundation board member profile, Taylor says, “it starts with passion — those who are aligned with [the foundation’s] purpose and who are active and avid champions for improving the health of their communities. They can come from many sectors and backgrounds, but they share a common goal — to elevate health care.” Similarly, foundation board chairs need to be coalition builders who can articulate a shared vision. “If [a person] can move and motivate people toward a common goal, that’s the right chair,” she says.

Foundation initiatives that revolve around social determinants of health also gain traction and credibility from foundation trustees who are also physicians. “You need visionary physicians at the table to help determine [social determinants of health] needs — they give legitimacy to determining what targets should be [when they talk] with community leaders and hospital executives,” says David Collis, president of the AdventHealth Foundation Central Florida.

Orlando Objectives

Orlando-based AdventHealth and the AdventHealth Foundation Central Florida can attest to the importance of physician champions for their numerous social determinant initiatives across 23 campuses statewide. Collis cites Steven Smith, M.D., senior vice president for translational research and chief scientific officer of AdventHealth Research Services, as a driving force behind many of those initiatives.

“We research health outcomes, economic outcomes and patients’ perspectives on those outcomes,” Smith explains. “This work can’t be top down. The ideas can be, but the work has to be grassroots.”

Two factors are vital to the success of that approach, he says. “The first is making sure social determinants of health initiatives are providing what is truly needed. You have to be a good listener and keep figuring out what you need to be doing — I call it ‘organized listening.’” Sustainability is the second critical factor. “You need to have a long-term impact [in targeted communities]. Don’t get in unless you can stay in.”

He adds that his department continually collaborates with the AdventHealth Foundation Central Florida on “high-risk, high-yield projects with patient-centricity” at their core. “The foundation is a force multiplier in this space. It has the will to improve community health and can go beyond what the hospital can do,” Smith says.

As a prime example of their work, Smith and his research colleagues have identified a firm link between local ZIP codes and access to health and other resources — and Orlando’s West Lakes community has been a proving ground for turning negative ZIP code-related statistics around.

“The West Lakes area had very few health care access points,” Collis says. “We looked at our main campus’s emergency department and we had 10,000 patients — approximately 1,825 of them children — showing up from West Lakes every year.” AdventHealth leaders and its foundation had already discussed building an early learning center in the city, as well as a health care and wellness center — and it became clear where they both needed to be.

“We decided it would be a great opportunity to build in West Lakes and provide children and families in that community with wraparound health services [i.e., team-based, coordinated health services provided to children and their families within their own community],” Collis says. Their efforts have been fortified by working with LIFT (“Learn, Identify, Focus, Transform”) Orlando, a nonprofit coalition of area business leaders who are partnering with West Lakes residents to accelerate community transformation through mixed-income housing, better economic viability and education, and improved community health and wellness.

Such timely synergies come from ensuring that foundation leaders are involved in system strategic planning as it happens, Collis says. “The foundation reports directly to the strategy function at AdventHealth, and we see these initiatives as they are conceived,” he says. “We sit at the table with our strategic leaders to [understand firsthand] the vision they have for the hospital over the next three to five years, and we talk about our communities’ biggest needs and the case for supporting each initiative. And we don’t raise funds for ideas that haven’t been vetted and approved.”

Taylor confirms that approach is gaining ground. “The biggest change I’ve seen with health care foundations is that they are now having meaningful conversations on the front end of strategic planning, finding out what health system initiatives most need to move forward,” she says. “Those leadership conversations are critical.”

The Affordable Care Act’s required Community Health Needs Assessments (CHNAs) offer another invaluable tool for keeping foundations’ fundraising efforts on track and helping health systems determine where to focus their social determinants of health efforts. “Community Health Needs Assessments give objective, consistent data on the needs of the community, what the issues are and how to prioritize those needs,” Taylor says.

Detroit Determinants

Within the Henry Ford Health System in Detroit, each of its eight hospitals determines its own social determinants initiative priorities based on CHNA results for the population it serves, and those initiatives are then tracked on a system dashboard. “CHNAs definitely determine which needs move forward,” says Michele Harrison Sears, senior director of foundation relations and new revenue with the Henry Ford Health System Foundation. Often, common needs arise across service areas. For instance, CHNAs identified opioid addiction as a common problem in several communities Henry Ford serves, resulting in the formation of a foundation-supported multidisciplinary taskforce to address chronic pain.

As another example, foundation funding also supports the Women-Inspired Neighborhood (WIN) Network, established 10 years ago by Detroit’s four major health systems to reduce alarmingly persistent high infant mortality rates in three targeted low-income city neighborhoods. “WIN provides a community of support for these predominantly single pregnant women, from prenatal care through the first 1,000 days of their babies’ lives,” explains Susan Hawkins, Henry Ford’s senior vice president of population health. “Community health workers who have been identified as natural leaders in their communities mentor expectant women, visiting their homes and connecting them to health care, social services and other neighborhood resources, from car seats to financial literacy education.”

Harrison Sears adds, “We don’t have to do it all — there are lots of partners out there. There are 200 programs that can help new moms — but who knows all that? The WIN Network ties all those resources together.”

CHNA statistics also revealed a shortage of nutritious, easily available food in many of Henry Ford’s surrounding neighborhoods. “It jumped out at us that we had consistent food insecurity among our very sick patients, and many people had to choose between food and meds,” Hawkins says. “We know we can’t improve patients’ health without addressing these social determinants.” A pilot is currently underway to measure how the improved availability of nutritious food might reduce unnecessary emergency department and hospital visits. The year-long pilot has enrolled 330 patients, most of whom deal with more than two chronic conditions. Patients who have been screened for food insecurity have supplemental groceries delivered every two weeks for a year through “Henry’s Groceries for Health.”

The health system and its foundation know that support for such programs can come from many sources — including within its four walls. “We have a history of employees being donors, and we are a national model for employee giving with our annual Employee and Physician Giving Campaign,” says Mary Jane Vogt, Henry Ford’s interim senior vice president of development. “It comes from our culture, which is a top-down model. Our employees see our leaders [donating], and they do the same. Also, we treat employees as donors, showing them appreciation and making them feel special.” She estimates the collective impact from all internal system donations is about $3 million annually.

“All of us know we have to move toward better population health, but it’s an unfunded mandate,” Taylor says. “[Health systems] don’t have the money to build out social determinant of health strategies, but philanthropy can get these programs built.”

Laurie Larson is a contributing writer to Trustee Insights.