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Introduction
Advancing the State of the Art in Community Benefit (ASACB) is a multiyear, two phase project guided by four goals:
- To provide a framework for comparative analysis and performance assessment;
- To establish incentives for enhanced institutional commitment;
- To expand the strategic use of charitable resources by emphasizing primary disease prevention, community capacity building, and clear targeting to address disproportionate unmet health needs; and
- To provide a model to quantify community benefit activities that is exportable to hospitals, health systems, HMOs, foundations, and regulatory agencies.
During Phase I of the ASACB project (2002 – 2005), community benefit programmatic and institutional policy measures were developed to improve nonprofit hospital knowledge and tools for "proactively investing" in three desired outcomes:
- Reducing health disparities;
- Reducing health care costs; and
- Enhancing community problem-solving capacity for addressing health issues.
ASACB focused its Phase I work in these goal areas and developed four "uniform tools" to help hospitals organize their community benefit work:
(1) Content categories - created a framework to document community benefit program activities
(2) Accounting methods and criteria for community benefit designation - developed a set of methods to calculate the economic value of community benefit activities, and explicit criteria to determine what counts as community benefit
(3) Performance measures - developed a set of metrics at the programmatic and institutional policy levels that facilitate quality improvement and sustain organization-wide commitment. The performance measures are guided by five Core Principles:
(a) emphasis on disproportionate unmet health needs
(b) investment in primary prevention
(c) building an evidence-based continuum of care that links community health improvement to the delivery of clinical services
(d) emphasis on community capacity building
(e) collaborative governance(4) Guidelines for health professions education and training programs - created a set of guidelines that link health professions education and training programs to efforts to increase workforce diversity and reduce health disparities.
Phase II continues to document the benefits of a variety of proactive investments in community health improvement that emphasize community capacity-building, collaboration with diverse local stakeholders, and careful targeting to ensure access for communities with disproportionate unmet health needs (DUHN). ASACB is demonstrating that "leading-edge nonprofit hospital institutions" can establish standards for charitable behavior that facilitate organization-wide engagement, alignment with their charitable missions, and increased accountability for performance in the community benefit arena.
As well, in Phase II, four strategies are being used to test and refine the ASACB tools:
(1) Conducting a comprehensive review and enhancement of community benefit programs pilot sites are undertaking a comprehensive review of all community benefit programs to bring them into compliance with ASACB uniform tools and criteria
(2) Designing and implementing special focus content area (SFCA) demonstration projects at pilot sites – pilot sites are implementing initiatives that reflect priorities for increasing access to health care and reducing obesity in their local communities. The SFCA projects will test the use the ASACB's uniform tools while creating a collaborative, shared learning community.
(3) Developing and refining institutional policy measures that increase institutional community benefit accountability through governance, management, and operations – all partners are committed to implementing and monitoring institutional policy measures designed to enhance the governance, management, and operations of community benefit programming.
(4) Building support for and facilitating the implementation of the health professions education and training guidelines – work will continue to increase awareness and promote the adoption of the guidelines developed during Phase I to increase workforce diversity.
