A few months ago, a group of “citizen journalists” — two dozen Newark, N.J., high school students supported by RWJBarnabas Health, Newark Beth Israel Medical Center and other civic partners — created a full-length documentary on food insecurity in their city, defining its prevalence, reporting on local entrepreneurial solutions and sharing their vision of a healthier hometown.
Theirs is just one example of the work emerging from the Healthcare Anchor Network, a blooming consortium of nearly three dozen health systems launched in May 2017. The network's overarching goal is to “reach a critical mass of U.S. health systems [that are] strategically improving community health and well-being by leveraging all of their institutional assets, including intentionally integrating local economic inclusion strategies in hiring, purchasing and investing.”
HAN is the brainchild of the Democracy Collaborative, an economic development agency in Cleveland, which was launched as a “democratic renewal” research center at the University of Maryland in 2000. The collaborative has since moved well beyond its research roots, offering field activities to expand community wealth-building, hosting nationwide roundtables to discuss transformative economic development solutions, and advising local governments, foundations and anchor institutions such as health systems on new strategies for addressing the root causes of socio-economic inequity in their communities.
The collaborative seeks to rebuild underserved, particularly low-income neighborhoods along more equitable and sustainable lines. Anchor institutions play a crucial role in achieving that goal. By definition, an anchor institution — typically an academic or health care organization — is place-based and, as such, tied to the long-term well-being of its community, often as its largest employer as well as a source of neighborhood stability.
“It is a moral and business imperative for health systems to consider their anchor role in their communities,” says David Zuckerman, director for health care engagement with the Democracy Collaborative. “This work is grounded in [looking through] an equity lens, realizing that social and economic inequities fall most often on low-income neighborhoods and communities of color. The long-term business case of health systems must address these inequities and find new ways of doing business.”
Evolution of the network
Three systems committed to advancing that anchor mission — Dignity Health and Kaiser Permanente, based in California, and Trinity Health, based in Michigan — wanted to learn from one another’s efforts, as well as those of other systems, and sought the support of the Democracy Collaborative.
“They asked us to convene a national meeting to elevate the discussion around social determinants of health and concentrate on solutions that had not yet been discussed,” Zuckerman says. The three systems co-sponsored that meeting in December 2016, hoping to attract 30 to 50 interested health leaders: 90 leaders from 40 systems wanted to attend.
Eleven “backbone coordinator” health systems helped build the HAN structure over several months, and additional targeted work groups have since evolved, bringing in those involved in their system's hiring, purchasing and place-based investments to learn from their peers and determine how to connect anchor mission goals to local community resources. There are currently 33 systems actively involved in the Healthcare Anchor Network, all paying a nominal fee to contribute to its sustainability. HAN leaders also have convened several all-network meetings to support the continued spread of new ideas.
“Change happens at the speed of trust,” Zuckerman says. “Through this peer-support network, we want to create a collaborative voice and collective work that can accelerate learning and make change happen faster. We know there is no one right answer, so we want to draw people together across a wide spectrum. The whole purpose of this approach is to get organizations to ask different sets of questions and to think differently about hiring, purchasing and investment — and we have to listen to local residents.”
As an example, the Newark student documentary will be shown at area community centers and churches, and used as a launching point for discussions with local residents on the greatest challenges their neighborhoods face in obtaining healthful, affordable food — and gather further insights from there.
“We are very intentional in asking for community input — what residents tell us will inform our policies and practices to change systems and structures,” says Michellene Davis, executive vice president and chief corporate affairs officer at RWJBarnabas Health, based in West Orange, N.J.
Rethinking business practices
HAN advisers have met with RWJBarnabas leaders and helped them develop a corporate anchor roundtable, co-chaired by Davis and the system’s CEO, that includes system leaders in human resources, supply chain and construction. Davis says HAN is helping the system change its business practices in revolutionary ways. As an example, “there is a natural strategic tension that happens when you start looking at procuring [supplies] locally,” she says. “It requires you to shift your practices, which are likely exclusionary in being a member of a group purchasing organization. Local businesses can’t come in at that global GPO price point — but we have the power to change that.”
Although RWJBarnabas still will work with GPOs, contracts for supplies that can easily be procured locally, such as paper towels and light bulbs, will now be supplied by local vendors. But challenges still remain for system departments like finance. “Our typical 45-day or 60-day revenue cycle won’t work for local businesses,” Davis says. “They have to be paid more quickly or they risk shutting down, so we must develop separate accounts-payable schedules for local versus national accounts.”
To support local hiring in better-paying jobs, RWJBarnabas has partnered with the city of Newark to offer classes that teach local residents “soft skills,” such as gaining the math knowledge needed to pass required tests for local utility company jobs. The system next wants to tackle affordable housing, providing more local jobs in the process and “developing a corridor where the new employees we hire will want to live,” Davis says, thereby championing neighborhood development. “This isn’t ‘either/or’ work, it’s ‘yes and’ work,” she adds. “To embed these changes in our institution is difficult but rewarding.”
Zuckerman says: “I really believe the first thing health care leadership must do is to find the moral imperative for this work. We have found that often some alarming statistic about a health system’s neighborhood hits home, pointing out a disconnect between the hospital and its community, and that spurs action.”
Writing a new playbook
For Chicago’s Rush University Medical Center, that alarming statistic came from discovering what it has called the “death gap” in its city. In the downtown Loop, life expectancy is 85 years; only six miles away on the West Side, not far from RUMC, it’s 69. “We knew we needed to redefine business as usual, with these disturbing life-expectancy gaps,” says David Ansell, M.D., senior vice president for community health equity at Rush. “We jumped at the opportunity to work with the Healthcare Anchor Network because the timing couldn’t have been better. We’ve learned that we are necessary but not sufficient to make these kinds of changes happen. It’s been a rich collaboration — this is a vanguard movement in its infancy, and we are teaching each other how to walk.”
Much of what Rush has learned has come through organizing West Side United, a group of residents, civic leaders, community organizations, health care professionals and hospitals representing nine West Side Chicago neighborhoods with 500,000 residents. The group meets monthly to address its communities’ many challenges, developing ways to increase local hiring, purchasing and investing, among other potential long-term solutions to social and economic disparities. Rush has committed $6 million over three years to support West Side investments.
Ansell attributes three key factors to the initiative's success to date. “First, we couldn’t have done this without our board's endorsing health equity as a strategy,” he says. “Second, our leaders had to operationalize this, creating a designated position among senior leadership. And finally, we named our employees as the first community we needed to support. They offer incredible insights into our neighborhoods — they have so much to teach us. This is an opportunity to help build our neighborhood wealth, along with better supporting our employees.”
To share its journey and lessons learned, Rush published The Anchor Mission Playbook in September, a how-to guide on becoming an effective anchor institution, partially supported by the Democracy Collaborative, and now part of the HAN resource library. Offering recommendations on how to “lift an anchor mission,” Ansell says the book is designed to help other health systems accelerate and align their efforts with local economic needs.
In addition to the Playbook and other publications, the Democracy Collaborative has collaborated with the Robert Wood Johnson Foundation to create three HAN toolkits on workforce, purchasing and investment that teach health systems how to create more inclusive local hiring, implement local sourcing practices and support place-based investments. The toolkits include case studies, key strategies, expected return on investments and common challenges. HAN plans to launch a fourth toolkit on anchor philanthropy in the near future.
“There is an urgency to fixing these historically perpetuated inequities, the structural racism and economic exploitation,” Ansell says. “As health systems, we are organized to heal and prevent suffering. Our healing now has to be around neighborhoods and the root causes of inequity.”
He adds: “What we mean by addressing inequity is not a rising tide that raises all boats. We are focusing on leaky boats and those who don’t have boats at all. Those who cannot thrive need our help the most.”
Reaching critical mass
“My ultimate vision for the Healthcare Anchor Network would be that all hospitals would do this work at some level,” Davis says. “States and municipalities would support policies to accelerate this work, and we would eliminate, not just reduce, disparities. It would no longer be a network. It would be the way things simply are.”
For Zuckerman: “We have what we need to do this work. We just need to better connect it all –– and if we don’t take this on, who will?”
Laurie Larson is a contributing writer to Trustee.
Want to take part?
Health systems interested in joining the Healthcare Anchor Network should contact David Zuckerman, director for health care engagement, at firstname.lastname@example.org. In addition, the Democracy Collaborative will host a panel discussion on the anchor mission of health care at the American Hospital Association’s 2018 Leadership Summit from July 26 to 28 in San Diego.
Pathways to population health
By Julia Resnick
The American Hospital Association’s Health Research & Educational Trust, along with the Institute for Healthcare Improvement, Network for Regional Healthcare Improvement, Public Health Institute and Stakeholder Health, partnered to develop Pathways to Population Health: An Invitation to Health Care Change Agents. Funded by the Robert Wood Johnson Foundation, Pathways to Population Health posits a framework for four portfolios of work that span the scope of population health, from clinical population health management to community well-being creation.
Foundational principles of the pathways framework are:
What creates health
- Health and well-being develop over a lifetime.
- Social determinants drive health and well-being outcomes throughout the life course.
- Place is a determinant of health, well-being and equity.
How can health care engage
- The health system can respond to the key demographic shifts of our time.
- The health system can embrace innovative financial models and deploy existing assets for greater value.
- Health creation invites partnership because health care is only one part of the puzzle.
To advance on the pathways to population health, health care organizations can adopt practices from each of four portfolios:
- Physical and/or mental health.
- Social and/or spiritual well-being.
- Community health and well-being.
- Communities of solutions.
In the framework, the portfolios are interconnected with one another and by equity, with each portfolio powering the others.
The Pathways to Population Health website offers several tools, including the "Compass." Health care change agents can use the Compass to determine the balance of their population health efforts within and across portfolios and also to identify areas for further focus and to assess progress.
Julia Resnick is senior program manager at the American Hospital Association’s Health Research & Educational Trust and Association for Community Health Improvement.