Community Health and Well-Being: Is it Healthcare Organization’s Lane?

And, if so, can Healthcare Philanthropy Make the Case for Support?

By Amy Dorrill, FAHP, Community Health and Well-Being Practice Lead and Principal Consultant at Accordant

It has been a common topic of discussion. Whose lane is community health and well-being? And, more specifically, should community health and well-being actually be a healthcare organization’s lane?

For many, these questions prompt a visual–a picture of a pool, possibly an Olympic-sized pool with rows of swimming lanes. The pool lanes are divided neatly by racing lanes with all swimmers starting, swimming, and ending in “their lanes,” with no crossover of swimmers interfering with the path of other swimmers. Each lane is well defined, and each swimmer engages independently.

In reality, addressing community health and wellbeing is less like siloed lanes in a pool and more similar to a vast ocean, an ecosystem made up of many organisms including fish, plants, and coral along with factors such as weather and pollution that are deeply interconnected. Each “wave” impacts another, and each organism depends on others.

Community health–and a person’s health–is influenced by many factors including social, economic, and environmental. Negative health is attributed to multidimensional factors from the location of someone’s home, access to quality healthcare, access to healthy food, housing, transportation, and more throughout the lifetime of a person. To address community health, communities must operate within an ecosystem, engaging a holistic and inclusive solution. It will take policy, environmental changes, removal of existing barriers, equitable treatment, and more to move the needle. Who is best to lead this charge?

It is very rare for one organization to tackle this alone. For something this complex, it takes many organizations coming together. Community health requires representation from many aspects such as healthcare and public health, housing, transportation, government agencies (including parks and recreation), faith-based organizations, education (early childhood, primary, secondary, and colleges/universities), financial institutions, food banks, restaurants, and more. Additionally, civic organizations, trade agencies, community foundations, and other philanthropic agencies and even the media must be involved. Health equity, community health, and overall well-being must look beyond singular interventions to long-term, more systemic changes. It is multi-sectoral and demands multilevel collaborations with diverse approaches.

Expertise and resources are needed to identify the most important need(s) of the community, establish data collection systems to gauge a baseline and track progress, select the right strategies, execute on each strategy, fund each step, maintain marketing, and report out to provide transparency and accountability. It is a lot, and it is challenging; but it is not impossible.

Why are healthcare organizations stepping into this role? Healthcare organizations are seen by many as a significant contributor to address community health. Many even see healthcare organizations serving as the anchor institution of the community and the most logical to lead this charge. However, the healthcare industry is always shifting. Whether the future will deliver the exact value-based, population health fee structure that is presently on the table or will morph into something different, it is apparent a new healthcare model will continue to evolve. Why? First and foremost, the existing healthcare model is failing. The US continues to underperform other high-income countries on measures of healthcare outcomes, access to care, equity, and administrative efficiency even though it outspends other nations on healthcare by almost double.1 Based on this, it has become apparent our nation’s current model is ineffective.

Beyond the ongoing need to deliver better healthcare outcomes, the financial landscape and the shift in consumer expectations for a more holistic experience is forcing healthcare organizations to continually move beyond their walls for care. They must provide care and services that focus more on social determinants of health and prevention instead of the current methods of treating illness.

Let’s consider factors that place healthcare organizations as the most likely leaders in community health and well-being initiatives:

1. One of the largest employers: Hospitals are generally one of the largest employers in a community. This provides a general strength in numbers as well as having the ability to impact health equity through hiring and purchasing goods and services from local businesses.

2. Financial resources: Many healthcare organizations have one of the largest operating budgets in a community.

3. Data collection: Hospitals are already identifying health needs through a community health needs assessment (CHNA), a regulatory requirement of nonprofit hospitals participating in Medicare.

4. Expertise: Hospital physicians, nurses, and other clinicians have a history of providing preventative and curative care to patients and the community.

5. History of community outreach: Most hospitals have spent decades serving the community with a focus of promoting healthy behaviors and disease prevention through health fairs, health screenings, mobile clinics, and more.

6. Existing community partnerships: As of 2018, 74% of hospitals have entered into at least one type of community partnership.2

7. Mission-aligned: Hospitals’ mission statements are trending to more inclusive statements beyond just patient population. Four of the 2022 U.S. News & World Report top ten hospitals in the United States extend beyond patients.3 One example is New YorkPresbyterian Hospital, whose mission is, “It must be known, owned, and energized by all.” The New York-Presbyterian Westchester mission is, “To provide caring, high quality, fiscally responsible healthcare services that meet the needs and expectations of the communities we serve.”

8. Government regulations: The Affordable Care Act (ACA) expanded the responsibilities of healthcare organizations beyond clinical care to address the upstream social determinants of health.4

9. Financial pressure: Five percent of the population accounts for 50% of a healthcare organization’s total expenditures. Preventing diseases by addressing social determinants can reduce the cost of delivering more costly emergency care and hospitalizations for chronic diseases.5

These are all valid reasons for health organizations to take the lead role in community health and well-being; however, let’s remember hospitals and other care agencies cannot tackle it alone. The mere fact cutting healthcare costs through prevention and well-being could help health organizations with prevalently negative margins experienced since the pandemic. Investing in the creation of well-being initiatives could not only help reduce and even prevent high-cost treatment within their walls but also enhance the quality of life across communities they serve.

Community health is not healthcare’s lane to claim alone, but it does have an essential part to play with much engagement, involvement, and commitment. Health organizations can claim a leading role in these initiatives and invest in care outside of their walls that can result in a favorable return on investment. But, this is not just a numbers game. It’s the game of life, health, quality, and care. It’s time to get started.

So, if we can agree that it makes sense for health organizations to take a lead—or the lane—in community health and well-being, then consider the next question…is community health and well-being worthy of being a philanthropic case for support for healthcare foundations.

Determining if community health and wellbeing is the right philanthropic case for support for a healthcare foundation starts by asking three questions:

1. Is the proposed community health focus a strategic priority of the organization?

2. Is the organization positioned to lead the community health initiative?

3. Is the community health case aligned with donor interest?

Is the proposed community health focus a strategic priority of the organization?

Financial pressures, along with the desire to meet patient expectations and deliver better health outcomes, are moving healthcare organizations beyond their facilities to identify risks and provide preventive care and strategies. Government regulations and new payment models are supporting these new models. In fact, addressing health disparities and improving health equity is the top priority identified by Deloitte in a 2021 survey Deloitte Center for Health Solutions Survey of CEOs on health equity.6 It is time to provide not only health fairs, mobile units, and onsite pop-up health clinics but also to identify and address the social determinants of health underlining the health issues presented at the hospital. Of reporting hospitals, 84.2% screen their patients for the social determinants of health (SDOH), and 72% of hospitals report having at least one program or strategy to address the identified SDOH.7 As hospitals lead the community health charge, these numbers will continue to increase.

Is the organization positioned to lead the community health initiative?

The case must be made that your particular organization is one of the best organizations to execute the chosen strategies. Does the organization have the ability to execute and accomplish the community health goals? Does the community have trust and faith in the organization’s role to advance the chosen case? What resources and partnerships are available to help?

Is the community health case aligned with donor interest?

Funding is by far the limiting factor to advance community health. There is a substantial need for philanthropy in this space. In a survey conducted by ReThink Health, 82% state that, “Not enough funding for our services, programs, or policies,” is a barrier contributing to equitable community well-being. The next largest barrier was, “Short-term results matter more than longterm gains,” at 27%, which in itself has a financial implication.8

Philanthropy can be used to leverage a healthcare organization’s community health and well-being initiatives by simply providing seed funding–allowing the initiative to be ignited by philanthropy prior to becoming financially sustainable, while testing new and innovative opportunities with the ability to become a best practice model.

Even if an organization “needs” money, it doesn’t make it the ideal case for philanthropic support. Parking lots, replacement of machinery, and advancement of technology are all very important to the patient experience, but they are not usually the best cases for philanthropic support. The question comes down to is the community health case aligned with donor interest.

Many healthcare foundations have begun the journey beyond typical capital investments as they discover donors have the passion and capability to make positive impact in their communities beyond buildings and other projects. Community health has become increasingly more appealing and understandable to donors, especially after COVID-19. In fact, it has likely been a donor passion; however, there has often been little or no opportunity, or even request, for donors to consider gifts specific to the areas of well-being.

The fear has been that healthcare donors will not support non-traditional, non-capital community health initiatives. On the surface, it would appear that historical data would justify those fears. The 2022 Association of Healthcare Philanthropy Report on Giving Survey 9 identified the top three healthcare areas supported by philanthropy were: 55% other programs, 31% capital, 5% grants to outside organizations, 5% education, 3% charity care/patient assistance, and 1% employee relief/caregiver assistance. In 2019, the same AHP survey broke down the gifts in more specific categories with the top three listed as 20.5% construction and renovation, 19.6% patient care program support, and capital equipment at 14.6%, while community aligned initiatives represented a much smaller portion such as community support/advocacy at only 4.2%.10 The reality is that many healthcare organizations are not asking donors to support community health initiatives. While donors ultimately drive where their gift is allocated, donors do not usually give to projects not presented to them. Sixty-three percent of Fidelity Charitable donors designated their gifts to the highest need, following the direction of the trusted organizations.11

The sector with the second largest increase in philanthropic support in 2021 was publicsociety benefit with an increase of 23.5% equaling $55.85 billion. (Public-society benefit includes community improvement, civil rights and liberties, etc.)12 The same year, the health sector experienced an increase in 2022 by 7.7% after experiencing a reduction the previous year. While some nonprofit organizations have experienced a reduction in philanthropic support, other nonprofits saw a rise especially in social services/community-based initiatives. For example, Feeding America received 47% increase in charitable gifts taking over the top charity rankings by Forbes. Another dozen food banks moved into Forbes top 100 nonprofit list. Philanthropists saw the need and the impact making an upstream investment could have on more major, downstream issues such as a chronic disease.13

Corporations are increasingly focused on social/community impact as part of their Environmental, Social, and Governance (ESG) obligation. Corporations are moving further away from marketing/branding relationships with nonprofits as a golf or gala sponsor and more as a partner in addressing community health disparities. Seventy-eight percent believe it is no longer acceptable for companies to just make money. Corporations are defining their purpose and alignment to community impact to appease their stakeholders: employees, consumers, and investors.14 Community improvement and capacity building was ranked #6 for top causes receiving corporate grants in 2021.15

The question is not, “Are philanthropists giving to community health/well-being,” but “Where are philanthropists making gifts to advance community health?”

Now is the time to connect philanthropists with healthcare organizations that are leading the way to advance community health and well-being. Philanthropy officers specialize in connecting healthcare organization priorities with donors who have a passion for making transformational change. What better way for donors to make a wide-spread, positive impact than through identifying, addressing, and caring for the health needs of the community?

Getting Started

Philanthropy teams can start the process by expanding engagements and inquiries with current and potential donors. Ask broad, inclusive questions focused beyond the organization to identify what each donor cares about. Ask what other organizations they support and why (to determine passion, purpose, and intentions). Once well-being or other community health issues are surfaced, present the case in simple terms, sharing why healthcare organizations are adding community health, health equity, and well-being on top of core service lines. Connect the strategy with a familiar scope. For example, how does insufficient housing impact asthma? How will a positive change in housing have a positive change in asthma? How can their gift in this area impact the well-being of their communities and reduce the repeat patients visiting the emergency room with recurring asthma problems? Are they interested in talking with other organizations and partners who have joined in this effort?

While this is just a start to identifying and engaging donors, it IS the place to start. Including donors in the organization’s goals, mission, and impact can result in a long-time donor and partner in community health.

Health organizations are primed to take the lead role in community health and wellbeing. Healthcare philanthropy is primed to be a major funding source when community priorities are aligned with the healthcare organization’s priorities and the donor passion. The foundation’s philanthropic mission is to help support the parent organization while meeting the needs of its constituents. Therefore, foundations are increasingly pivoting to adjust their case for philanthropic support to align with new organizational priorities such as community health/health equity/well-being. The benefits are numerous. Investing in the creation of well-being initiatives could not only help reduce and even prevent high-cost treatment within the hospital walls but also enhance the quality of life for the communities they serve. Involving philanthropy–engaging and cultivating donors who want to advance and elevate the overall health of the people around them–is an ideal way to help fund a long-underserved need.

Amy Dorrill has 25+ years of front-line, leadership, and consulting experience at rural, community, system, and academic healthcare organizations. Her expertise includes securing community health and well-being (along with more traditional capital and clinical specialty care programming) philanthropic and strategic partnerships, leveraging governing and foundation board leadership, assessing and elevating philanthropy programs, working with organizations to identify the right strategic priority that aligns with philanthropic interest, and designing a case for support that inspires and engages philanthropic partners (grateful patients, community members, corporations, etc.)

Amy is the Community Health and WellBeing Practice Leader for Accordant, a consulting firm solely dedicated to healthcare. Accordant elevates health and well-being through philanthropy and partnership. Accordant delivers value in three key areas: elevating charitable giving, forging partnerships to promote healthy communities, and strengthening healthcare governance. Amy has previously served as Adventist Health’s Philanthropy Executive for Well Being, Blue Zones Project Philanthropy Executive, and has held other leadership positions at Emory University’s Nell Hodgson Woodruff School of Nursing and University Health Care System. Amy is a Fellow of Association of Healthcare Professionals (FAHP), and she holds a masters degree from the University of Georgia.

Endnotes

1 Commonwealth Fund, August 201

2 American Hospital Association, 2018.

3 US News, July 26, 2022.

4 New York Presbyterian, 2023.

5 JAMA Network Open, 2018.

6 Deloitte Center for Health Solutions Survey, 2021.

7 American Hospital Association Annual Survey 2021.

8 Rippel Foundation, 2022.

9 Association of Healthcare Philanthropy Report on Giving Survey, 2022.

10 Association of Healthcare Philanthropy Report on Giving Survey, 2019.

11 Fidelity, 2023.

12 Giving USA, 2023.

13 Forbes, 2022.

14 Cone/Porter Novelli Purpose study, 2018.

15 National Center for Charitable Statistics, 2021.