Health

HLTH21: Health systems targeting disparities should include community projects in their investment portfolios

Hospital systems enjoying strong returns from stocks and bonds may want to consider redirecting some of those dollars toward community investments such as housing, food access and locally owned businesses, each of which hospital representatives say can drive long-term stability and health across underserved neighborhoods.

At HLTH 2021, executive leadership members from Cleveland Clinic, UMass Memorial Health and Boston Medical Center highlighted the decade-or-more delta in life expectancies they’re seeing between different local areas.

The difference, they said, comes down to social determinants of health such as wealth, education, stable housing and structural racism—all factors contributing to worse outcomes and increased healthcare utilization.

“A plethora of data suggest that people who have lower income and education attainment have lower health status, and so do their children as beneficiaries of their parents’ resources,” Thea James, M.D., vice president of mission and associate chief medical officer at Boston Medical Center, said during a presentation. “We care because this situation results in what we have seen for years—patients who are caught between a cycle of stable and unstable, stable and unstable, with repeat ER visits and hospital admissions. Our treatments reset them to baseline health, but only to be discharged back to what is causing their instability.”

Even in a year where many major systems are reporting major gains from their portfolios, community investments—alongside diversified hiring practices and purchasing services from minority-owned businesses—are valuable levers provider organizations can deploy to address health equity, said Adam Myers, M.D., who until recently was the chief of population health and director of community care at Cleveland Clinic.

“We realized we have dollars, like most health systems do, where we invest in things like the stock market,” he said. “Why not take a portion of that money and redirect it toward investing in our own spaces and the communities around us?”

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For Cleveland Clinic, these investments include $6 million toward affordable housing located adjacent to one of its clinics, grocery stores in food deserts and a standalone laundry that serves Cleveland Clinic facilities as well as community members. Myers also noted a $180 million investment of the organization’s supply chain funds into local minority-owned businesses.

James similarly highlighted a 323-unit mixed-income housing project being constructed by Boston Medical Center that will have numerous units available for purchase so that residents can build wealth over time.

Douglass Brown, president of community hospitals and chief administrative officer of UMass Memorial Health, detailed plans to refurbish an aging boys’ and girls’ club into a community, arts and events space with a focus on serving immigrants.

But to see success, initiatives like these can’t be solo affairs, the executives said. UMass Memorial, for instance, recently partnered with community real estate and development group Civico Development to work on Tiny Home Village, a community of roughly 500-square-foot residences designed to house and preserve the dignity of the chronically homeless.

UMass Memorial may have had the funds and drive to tackle the project, but Civico’s local awareness and general business acumen helped the partners craft a stronger project for the surrounding community, Brown said.

The two organizations were actually introduced via a different project that ultimately went unpursued, but Brown said the groups’ shared values were enough to support a new collaboration.

“A track record of success and a mission-focused [team] was really important for us,” he said. “And, at the end of the day, someone who really shares our view of transformation.”

James reiterated these partnership must-haves but urged systems to do their research before making any collaboration commitments. She recalled an initiative between Boston Medical Center and an unnamed entity that rescued local businesses from foreclosure with restructured loans, which had to be called off after the provider learned its new partner claimed a portion of the owners’ equity as part of the deal.

“Really do due diligence on everything about your partners and understand who your partners are,” she said, “because it might not be obvious where you might not align.”

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Myers also warned providers not to be too heavy-handed in their community partnerships. Systems generally think highly of their expertise and capabilities, he said, and as a result often want to take full control of anything they’ve taken a monetary interest in.

“That’s exactly, in my opinion, the wrong approach to this space of promoting health equity,” he said. “Well-meaning healthcare organizations could, for instance, move into a community and say, ‘We’re going to establish a clinic here because there’s unmet need,’ and then inadvertently … displace and undermine the work of a federally qualified health center that’s already active and working in that community. Well-meaning efforts, if they’re not done in partnership, can actually make things worse.”

Speaking as an outsider, Civico Partner Taylor Bearden stressed the burdensome “layers and processes” that keep many potential partners from even getting an audience with their local health system. He said hospitals are missing out on opportunities if they don’t work to lower the bar—or raise others to it.

“[Health systems] need to collective embolden and build their capacity so that they can have a voice that’s heard,” he said. “Having a seat at the table takes time, and the challenge I’m seeing is there’s so many people who could benefit from the services, support [and] capital but don’t have the tools to get there.”

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