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Community Health Perspectives is an occasional feature in which ACHI member columnists reflect on trends they observe, their experiences in the field, interpretations of current data and recent reports, promising activities, and best practices. Readers are invited to respond to and discuss the column on ACHI's LinkedIn and Facebook group pages. |
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Senior Leaders and the Strategic Alignment of Community Benefit Programs: The Example of DiabetesPosted: February 17, 2009By Patricia Matheny Community Benefit Consultant Sugar Grove, Ohio Moving community benefit from purely reporting numbers to strategic alignment as a core function of the organization requires, first and foremost, commitment from the CEO and other senior leaders. Yet, getting senior leaders to understand community benefit and see the business value is no easy task. Let’s make some assumptions. What keeps hospital leaders up at night are: 1) financial challenges, 2) physician relationships, 3) community pressure, and 4) clinical report cards. With these challenges in mind, there is no better issue than diabetes to demonstrate to senior leaders the value of community benefit programs to the organization. A productive discussion with senior leaders would show how community benefit programs linked into the care continuum for people with diabetes can:
Before you run to have this conversation though, let’s look at some diabetes facts and the role that community benefit programs can play with respect to diabetes. Diabetes: An Identified Community Need Diabetes is a costly disease in both physical and financial terms for individuals, employers, the community, and health care providers. Everyone knows someone with diabetes, often experiencing first hand the daily attention required for monitoring and treatment. The good news is that progression to diabetes among those with pre-diabetes (Fasting Plasma Glucose between 100 – 126 mg/dl) is not inevitable. Studies have shown that people with pre-diabetes who lose weight and increase their physical activity can prevent or delay diabetes and return their blood glucose levels to normal. The Diabetes Prevention Program Research Group, a large prevention study of people at high risk for diabetes, showed that lifestyle intervention reduced developing diabetes by 58 percent over three years. Also, many people with type 2 diabetes can self-manage and control their blood glucose by following a healthy diet and exercise program, losing excess weight, and taking oral medication. Chances are that you know at least some of the major diabetes facts and statistics. If you would like additional information to help you make the case for addressing the disease with community benefit programs, see Arm Yourself with More Facts about Diabetes at the end of this article. Roles for Community Benefit Programs Community benefit programs are ideally positioned to help prevent and control diabetes. Positioning the hospital as a leader in addressing a disease of epidemic proportions resonates well with board members, senior leaders, employees, and the public. Community benefit programs that provide prevention, early detection and treatment, and promote self management of diabetes can be instrumental in addressing primary, secondary, and tertiary care. Through a variety of activities, community benefit programs can raise awareness, increase knowledge, change attitudes, motivate and support changes in behavior. By providing education and access to care, programs can focus on self-care behaviors, such as healthy eating, being active, monitoring blood sugar and taking medications if prescribed. Community benefit programs can also link community resources into the care continuum, thereby increasing access to appropriate and timely services. Where to begin: some questions to ask Once you have the facts about diabetes, the next step is to understand and state the relevance of diabetes to your own organization and its partners.
Where to begin: internal conversations Begin by initiating individual or group conversations with internal staff working with diabetes and those who may have answers to the questions above. Diabetes service line directors, diabetes educators, and dieticians will have a wealth of information on the impact of diabetes on your organization. Talk with staff in quality improvement, the health plan, and nursing. Approach the medical director and physicians from the cardiac, neurology, ophthalmology service lines, as well as podiatrists, pharmacists, and exercise physiologists. Community benefit response: what you can offer A range of community benefit services can be linked into the diabetes strategy, either through hospital-run programs or by participating in community sponsored programs. Community benefit programs can provide self care programs on nutrition and exercise to prevent diabetes or to prevent progression of pre-diabetes to diabetes. Programs can support people in self managing their care through life style behaviors and medications. Community benefit programs can also make the linkage between providers to help ensure access to appropriate care. There is no shortage of pertinent community benefit interventions on this topic, delivered to the broader community with an emphasis on vulnerable populations. You might consider some of the following, depending on your community’s and your organization’s unique characteristics, resources, and needs:
Conclusion: Time to Meet with the CEO Community benefit approaches and programs can help hospitals and health systems tackle diabetes in ways that truly improve both people’s lives and the health care system. Opportunities exist to help those with: 1) diagnosed diabetes, to self-manage the disease; 2) undiagnosed diabetes, to become diagnosed and begin treatment; and 3) pre-diabetes, to prevent or delay progression to diabetes. Community benefit services weaved into the diabetes care continuum can also demonstrate to the CEO and other senior leaders the value of community benefit as a strategic and mission-focused business activity, not just a reporting of numbers to justify tax exemption. Now that you are armed with general diabetes facts, seek out practitioners in your organization and further educate yourself on how diabetes affects your organization. Once the organization’s objectives are known, you can easily identify or create community benefit programs that are integral to an overall strategy for reducing diabetes. Now, it’s time to have that conversation with the CEO. Arm Yourself with More Facts about Diabetes Prevalence The Centers for Disease Control and Prevention (CDC) have predicted that 1 in 3 babies born in the year 2000 will develop diabetes in their lifetime. As of 2007, 7.8 percent of the population in the U.S., approximately 23.6 million children and adults, have diagnosed and undiagnosed diabetes. This is a 13 percent increase over 2005. Plus, an additional 57 million people have pre-diabetes.
The disease significantly impacts ethnic and minority populations:
Complications and Co-Morbidities Diabetes is a chronic disease with devastating complications for the quality of life of patients and their families. In particular, diabetes:
Costs to the Health Care System and Hospitals One out of every five health care dollars is spent on people with diabetes, and one in ten health care dollars is attributed to diabetes. Diabetes is an expensive disease with a total estimated cost 2007 of $174 billion, including $116 billion in excess medical expenditures and $58 billion in reduced national productivity due to increased absenteeism and reduced productivity while at work. Two million people with diabetes have no medical insurance, and of those with coverage, approximately half are covered through the government programs. Direct Costs of Diabetes = $116 billion:
Fifty percent of medical expenditures attributed to diabetes is hospital inpatient care. A patient with diabetes has an increased risk of admission and a longer length of stay regardless of the reason for admission. Studies have shown that patients admitted for general medical conditions where diabetes is listed as a secondary diagnosis have a 50 percent longer average length of stay (14 days) than would occur if diabetes were not a complicating factor. Costs to Employers Indirect Costs of Diabetes = $58 billion (a 32 percent increase since 2002):
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The views expressed in this article are the author’s and do not necessarily reflect the positions or policies of the Association for Community Health Improvement. |
