Community benefit strategies for a changing economy: in today's economic climate, meeting the healthcare needs of vulnerable populations through community benefit programs is becoming more important than ever. Three health systems discuss unique programs that are helping those at risk

Healthcare Financial Management, Feb, 2009 by Jeni Williams

Changes in the economy will affect the types of community benefit programs most needed by populations at risk, such as those who are chronically ill and the working poor, one community benefit expert says.

"We are seeing an increasing number of community benefit programs addressing access to care inequalities for vulnerable populations as well as tackling significant public health issues that impact overall healthcare delivery and costs," says Patsy Matheny, a community benefit consultant who was a contributing author for A Guide for Planning and Reporting Community Benefit, released in 2006 and revised by the Catholic Health Association (CHA) and VHA, Inc., in 2008, and who staffs the CHA's community benefit hotline, "What Counts."

Starting with tax year 2009, Schedule H of the revised Form 990 requires that hospitals collect and analyze additional data regarding their community benefit activities and the charity care they provide, and determine the value of both according to standards adopted by the IRS. As hospitals prepare to meet federal demands for greater accountability and transparency regarding community benefit, now is a good time for them to evaluate the impact of their community health programs and determine whether changes are needed in light of today's economy to more fully meet the needs of their communities.

"Community benefit programs are developed and implemented in response to community needs. As the economic climate changes, the community's needs will also," Matheny says. "Taking the time to evaluate the impact of community benefit programs in light of changes in the economy will help to ensure that the programs provided demonstrate good stewardship of the organization's resources. It's also an important step toward reinforcing community benefit as a core strategy for the organization."

Here, three health systems share unique community benefit programs that are making a difference in their communities by helping those most at risk--and reducing the costs of healthcare delivery as well.

Catholic Healthcare West

At Catholic Healthcare West's Marian Medical Center in Santa Maria, Calif., a program designed to help patients with congestive heart failure (CHF) avoid inpatient and emergency department (ED) care has significantly reduced ED visits and inpatient readmissions among program participants and reduced healthcare costs for patients, payers, and the medical center itself.

CHF is the most common diagnosis for Medicare patients and one of the top two admitting diagnoses for Marian Medical Center. It is an illness that has no cure. More than 550,000 Americans are diagnosed with this chronic illness each year, according to the American Heart Association, which estimated the direct and indirect cost of heart failure in the United States at more than $33 billion in 2007. Nationally, 18 percent of CHF patients who receive inpatient treatment are readmitted within 30 days, and 50 percent are readmitted within three to six months.

In 2002, Marian Medical Center hired a registered nurse to serve as a case manager for patients with CHF, meeting with patients while they are in the hospital and enrolling them in a free outpatient case management program. Every two weeks, the case manager calls these patients and monitors their health status through a series of questions regarding their health, answering any questions they might have about their treatment. When responses to questions about their health indicate the need for a patient to meet with a physician, the case manager assists in scheduling an appointment with the physician. The program also provides "real-time" clinical updates to physicians and other providers via fax and/or the Internet. Early intervention has enabled patients to receive treatment before their ailments become serious enough to require hospital care, enhancing patients' quality of life while reducing healthcare costs for patients, payers, and the medical center itself.

"The reduction in readmissions has been out standing," says Eileen Barsi, director of community benefit for Catholic Healthcare West. "Fewer than 1 percent of inpatients with CHF are readmitted within 30 days after discharge, and fewer than 5 percent are readmitted within three to six months, compared with 50 percent of patients with CHF nationally. Prior to the implementation of this program, Marian Medical Center's readmission rate for patients with CHF averaged about 20 percent. More than 800 patients have been helped through this program so far, and we estimate a cost savings of $1,800 per case."

The cost to support the program is minimal: the salary for a caseworker plus technology to support the program. Patients are enrolled in the program for one year, and are linked with community resources that provide medication assistance, nutritional services, and senior home repairs, when applicable.

Catholic Healthcare West, which is based in San Francisco, also sponsors a free chronic disease self-management program at 10 of its hospitals. Patients with chronic diseases are invited to attend a series of six two-and-a-half-hour workshops, held at local community centers or churches rather than at hospitals, that teach patients how to better manage their symptoms, improve interactions with their physicians, manage their medication plans, reduce stress, and become more empowered to care for their conditions. "We piloted the program at our California Hospital Medical Center in the heart of Los Angeles, where, based on the socioeconomic status of the residents, we have large numbers of high-risk patients," Barsi says. "We've seen a 50 percent decrease in inpatient admissions and an 80 percent decrease in ED visits among participants in this program."