Enhancing the Role of Hospitals in Improving Population Health

About Us

The Enhancing the Role of Hospitals in Improving Population Health (EHPH) Learning Center was established to support the Robert Wood Johnson Foundation’s (RWJF) efforts to expand the number of hospitals and health systems active promoting healthy communities and committed to a Culture of Health.   The EHPH Learning Center is focused on learning systematically across the field and is exploring ideas to transform health and health care and advance community health and well-being.

The EHPH Learning Center is located at the NYU Langone Department of Population Health and staffed by Leora Horwitz, MD MHS, Jim Knickman, PhD and Carol Chang, MPH MPA.    Leora is an associate professor and director of the Center for Healthcare Innovation and Delivery Science.  Her recent research has focused on better coordination of hospitals and communities during the patient discharge process.  Jim is the Derzon Chair in Health and Public Affairs with appointments at the Department of Population Health and NYU Wagner.  He has many years of philanthropy experience, most recently as the president of the New York State Health Foundation.   Carol is directing the EHPH project and is a former RWJF staff member who developed early grant making focused on population health including overseeing the Foundation’s Health and Society Scholars Program.

Support for the EHPH Learning Center is provided by the Robert Wood Johnson Foundation

Driver Diagram

A Driver Diagram, highlighting key drivers of hospital investment in community health was developed to provide an organizing framework to support learning across a number of programs and stakeholders:

Primary Drivers

  • Mission and/or leadership explicitly focused on community health
  • Business case
  • Market concentration/competition
  • Multi-sector partnerships
  • Legislation and government policies

Secondary Drivers

Mission and/or leadership explicitly focused on community health

Secondary drivers:

  • Leadership engagement and learning
    •   Leadership knowledgeable of the social determinants of health (SDOH)
  • Leadership accountability
    •   Leaders held accountable for community health

Business case

Secondary Drivers:

  • Return on investment

Evidence of strategies to reduce costs and improve outcomes

  • Reputation and relationships
    • Reputation and relationships in community such as quid-pro-quo for approvals, public relations, etc.
  • Impact investment structures
    • Impact investment structures such as available investment resources and staffing expertise
  • Health system alignment
    • Health system internal strategic alignment and capacity
  • Philanthropic resources
    • Availability of grants and other philanthropic resources
  • Alignment and capacity
    • Health system internal strategic alignment and capacity
  • Payer mix and behavior
    • Payer mix and behavior such as population-based reimbursement

Market concentration/competition

Secondary drivers:

  • Peer behavior
    • Following, learning, support from peers
  • Patient and staff appeal
    • Community improvements to attract staff and retain patients

Multi-sector partnerships

Secondary Drivers:  

  • Community health need
    • Emergent health issues in a community such as the opioid crisis
  • Integrated networks
    • Integrated networks of community partners and resources
  • State/local alignment efforts
    • Participation in state / local (i.e., public health departments) efforts to coordinate and align health assessments and interventions
  • Community-based organization capacity
    • Community-based organizations capable of fully engaging in all stages of planning and implementation
  • Investment leverage
    • Ability to leverage investment dollars
  • Dedicated staffing
    • Committed staffing or backbone or intermediary organization
  • Data availability
    • Data availability, exchange and sharing

Legislation and government policies

Secondary drivers:

  • Federal policies
    • Federal policies such as new payment models that incentivize SDOH
  • State polices
    • State policies such as Medicaid policy and investments in SDOH
  • Local policies
    • Local policies such as zoning and investments in the SDOH
  • Community benefit and Community health needs assessment (CHNA)
    • Requirements associated with Community Benefit and the CHNA

Actions

Mission and Leadership: leadership engagement and learning

Actions: 

  • Develop curriculum (pop health, SDOH) in schools that train health leaders
  • Support and disseminate thought leader publications and speeches
  • Support executive conferences (i.e. ACHE) with focus on community health
  • Develop and support peer network

Mission and Leadership: leadership accountability

Actions:

  • Provide guidance on board composition and engagement
  • Include incentives for community health in CEO compensation
  • Provide guidance on Board and C suite recruitment and training
  • Include SDOH criteria in peer rankings/ratings (i.e. US News and World Report, accreditation, Moody’s, Modern Healthcare)
  • Support recognition and awards and communication regarding awardees

Business Case

Actions:

  • Support for linking funding resources/identifying leverage
  • Support research/evaluation to provide clarity around definitions and metrics
  • Support research/evaluation on impacts of investments on health systems (cost-effectiveness, ROI and savings)
  • Support research/evaluation on impacts of investments on community health (i.e., housing, food security, social isolation and transportation
  • Pilot and evaluate evidence-based models
  • Dissemination of evidence-based practices (conferences, journals, NAM workshops, communications)

Market concentration/competition

Actions:

  • Support for linking funding resources / identifying leverage
  • Support research/evaluation to provide clarity around definitions and metrics
  • Support research /evaluation on impacts of investments on health systems (cost-effectiveness, ROI and savings)
  • Support research/evaluation on impacts of investments on community health (i.e., housing, food security, social isolation and transportation
  • Pilot and evaluate evidence based models
  • Dissemination of evidence-based practices (conferences, journals, NAM workshops, communications)

Multi-sector partnerships

Actions:

  • Build health system alignment and capacity (TA, workforce training, playbooks, tool kits)
  • Support to bring geographically co-located health systems together (TA, examples, models, guidance)
  • Build CBO capacity (TA, playbooks, tool kits, etc.)
  • Develop partnership guidance (shared goals, governance structures, strategic planning)
  • Develop synthesis and case studies
  • Support for convening

Legislation and government policies

Actions:

  • Create centers (i.e., Tobacco Free Kids)
  • Communicate evidence of impact to policymakers
  • Support advocacy