What’s Next for Pioneering Health Institutions Investing in the Social Determinants of Health?

Our research into how health institutions are participating in the community investment system suggested that only a small minority of health systems are actively investing in improving the upstream social determinants of health. Earlier this year, we took the opportunity to gather 10 of these leading institutions together to deepen our understanding of what it took these institutions to get where they are, what their next phase of work might look like, and what it would take to get there.

What’s happening. Investments came from different sources within the institution, took different forms, and were managed by staff with different titles, including innovation, external affairs, population or community health and community benefit. There was significant variation in the types of activities institutions chose as starting points when they began to look upstream or think about investments in improving community health, though most started with housing and employment. The array of motivations driving this activity was evident among the attendees at the meeting, and included mission alignment, a compliance orientation (i.e. avoiding penalties for readmissions), concern for the future of the city in which the institution is located, a perceived strategic imperative to experiment with upstream approaches as the health sector shifts from payment for “volume” to “value,” and the desire to advance the institution’s interests by building a strong reputation and network of relationships with the public sector and the community.

What’s next. Doing the work to make these investments generated momentum in the form of new relationships, experience, and greater confidence that in many cases led to an expanded range of activities.  Participants imagined that the next level of work for their institutions could take different forms: new interventions, new neighborhoods or geographies, bigger investments, new partners, or procedures that would begin to institutionalize community investment within their institutions.  While there was concern that without making community investment a regular part of health institution operations, it would be vulnerable to changes in leadership or priorities, there was a sense that doing so was possible if institutions had the right expertise, data, relationships, and could make the strategic case for this work.

What’s needed. There is an appetite for peer learning, as well as for guidance on what it takes to be successful in areas like community engagement, leverage, partnerships with CDFIs, and measurement of impact and financial returns. Seeing what peers had done, being able to interact with others, and learning about clear pathways to expanding this work could reduce the effort required to launch and manage community investment programs. Understanding how best to make the case for these investments, especially to senior leadership and to financial/investment/treasury staff, was a key priority for those in attendance. Additionally, champions of the work felt that external recognition by mainstream organizations through prizes, certifications, or awards for working in this area would add validation and legitimacy to their efforts.

To meet these needs, this fall we’re launching a new initiative called Accelerating Investments for Healthy Communities to help innovative non-profit hospitals and health systems advance and deepen efforts to invest in their communities, and inspire others to do the same. We are inviting small teams from a dozen pioneering institutions to come together to participate in learning labs to develop compelling narratives to advance investment; identify data, metrics, and indicators to capture the financial, strategic and health impacts of investments; analyze how a mission-aligned investment strategy serves the long-term institutional interests of hospitals and health systems by improving community health outcomes; and extend their engagement with partners to build sustainable capacity, empower residents and catalyze larger flows of dollars from other stakeholders. We’re excited about this next step, and look forward to sharing our work with you!

To learn more about our work and research, read Improving Community Health by Strengthening Community Investment: Roles for Hospitals and Health Institutions.

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