Hospitals are under a lot of pressure. They are facing what we call a problem of “balancing two boats” at the same time, while the stream is moving really fast. For example, hospitals are transitioning from fee-for-service to value-based payments. And they are moving from a provider-centered mindset to patient-centered mindset. These are big transitions, and they bring up a lot of questions about how to handle the tension between where we are now, and where we’re going.
What’s producing all of this tension? Well, hospitals often feel caught between the business models that keep them afloat and the realities of what we understand about what produces health—what keeps the people living in their regions afloat. Hospital systems are forming their own interpretations about how to respond to these pressures. But we believe there’s an emerging, all important, question that is being overlooked in these interpretations; and it’s a question that needs to be answered first. That is, what role should hospitals play in their regions? If the answer to that question turns out to be something different than what the role hospitals currently play, then there are more questions. For example, what new business models, work cultures, and responsibilities will be needed for any new role? Without clear roadmaps and endpoints, many hospital leaders are understandably reluctant to begin a journey like this. Yet, some are finding the courage to take the lead. These leaders among leaders are stepping up and finding a way to determine the desired endpoints so they can construct the roadmaps themselves. ReThink Health’s Hospital Systems in Transition project team is identifying a handful of them as project partners who are ready to stand at the forefront of this challenge and begin to pave the way forward.
Looking back to see forward
In a quick look into the history of hospitals, we found that US hospitals have transformed themselves at least four times in the eyes of the people they serve. They’ve gone from being perceived as almshouses and “Houses of Death” in the 1700s, when they were mostly funded as charities, to the “Homes of Science and Knowledge” a hundred years later when nursing and surgery came to the forefront. After the Great Depression, there was a period of substantial regional and national investment in “Our Community’s Hospitals.” Then in the 1970s and 80s a new perception came about. Hospitals started being associated with “Big Business,” an idea that has continued until present day. We see, however, that hospitals are on the precipice of another big shift in this new era of population health.
What will be the next dominant perception?
Who will decide and shape this perception?
And, how will hospital system leaders bring that new perception forward?
At ReThink Health, based on a decade of high-profile work identifying how stewards can equitably transform health and well-being in their regions, we believe hospital leaders will want to be seen as stewards. Stewards are people and organizations who take responsibility for working with others to drive transformative change in regions—in this case, they’re pursuing the health and well-being of all people. ReThink Health’s best hypothesis is that active stewardship among key players in a region is the only effective path to population health. Professionals from many sectors are already beginning to take on this role, partnering with others to transform health and well-being—hospital leaders included. For example:
- Some hospitals have defined themselves as so-called anchor institutions, and are committed to the responsibilities that entails. Such institutions affect their region’s health and well-being by recognizing that as large institutions, they have a major economic imprint in a region, and they must act accordingly to benefit the region’s economy and people. Their actions might include hiring or sourcing locally, or investing in local communities.
- Some hospitals have started initiatives to improve aspects and conditions that influence health outcomes of individual patients to maximize population health (housing, transportation, food access, and more).
- Some hospitals are investing in environmental sustainability and renewable energy.
Early innovations like these are beginning to shape what it would mean for a hospital to embrace its role as a regional steward. But without a clear way to engage both internal and external stakeholders and understand their perspectives and constraints, these innovations could be either short-lived, anemic, or even contribute the existing health inequities. To that end, ReThink Health is partnering with three pioneering hospital systems in which leaders are ready to embark on the journey of Becoming Stewards and explore and define their role in creating their region’s health and well-being. We are working together with these partners, and in relationship with the hospitals’ internal and external constituencies, to determine any new role and what it might take to transition to that role, including the possibility of:
- negotiating a new set of community relationships and partnerships, and
- mapping and navigating internal organizational obstacles and responses.
With these new relationships and understandings, hospital leaders will be able to determine what it means for their own hospital system to become a steward working in collaboration and alignment with other people and organizations in their region to create lasting change. What we find will serve as a guidance for pioneering hospital leaders in other regions, who can build on the early lessons of what’s involved in shaping and transitioning to a new regional role.
ReThink Health is partnering with leaders from three pioneering hospital systems, representing diverse regions across the United States, who are ready to explore and define their role as stewards of their region’s health and well-being. As they sign on, we’ll update this page.
We are honored and excited to be working with ReThink Health in this three-year engagement. The exchange of perspectives and concepts is already enriching our understanding of ourselves and our communities. Our goal is to affect community health through the development of a community-based mental health model that is scalable and sustainable.
We’re incredibly excited to participate in this transformation project in partnership with ReThink Health, to guide our health system in how to interact with the communities we serve, with the goal to improve health. Our partnership will write the playbook of how hospitals and health systems interact with communities to achieve health equity.
Pedja Stojicic, MD
Ella D. Auchincloss
Pedja Stojicic, MD
“Our work is about how people and communities could reach their full potential for health and well-being. Not some people, but all the people. Not some communities, but all communities. This is what gets me excited about Rippel.”—Pedja Stojicic, Project Director
Joined Rippel: 2015
Current Roles: Pedja is project director for the ReThink Health initiative’s Hospital Systems in Transition project.
Career: Pedja previously led the ReThink Health’s initiative’s resident engagement work, including an R&D project that studied and documented how different organizations engage residents and communities to participate in health system transformation. He also served on the Community Activation for System Stewardship team that advised the Center for Medicare and Medicaid’s Quality Improvement Organization Leadership, Organizing in Action program. The research work that Pedja co-created with the Resident Engagement Team is published in a second edition of The Practical Playbook: Public Health and Primary Care Together published by the DeBeaumont Foundation, Center for Disease Control, and Duke University. Pedja is an advisory board member of the Leading Change Network, and he taught community organizing at the Harvard Kennedy School of Government with Professor Marshall Ganz, one of the ReThink Health pioneers. In the past, Pedja has served as president and executive director of Youth of JAZAS, a large Serbian NGO fighting HIV/AIDS, and as a World Bank Consultant to the Ministry of Health of the Republic of Serbia supporting health care financing reform.
More about Pedja: Pedja describes himself as a radical optimist, which he practices whenever he organizes people to fight for social justice or prepares a cup of Ichibancha Japanese green tea for his partner. He has a passion for Mediterranean and Middle Eastern foods and flavors and is a big believer in community, science, and dogs (especially Jack Russell Terriers).
Education: University of Belgrade School of Medicine (MD), Harvard School of Public Health (MPH)
Ella D. Auchincloss
“At Rippel, we pursue an inspiring, yet daunting transformative agenda for equitable health and well-being; it’s about a lot more than health care. We’re willing to strategically tackle the big issues, but with a sober sense of what is doable.”—Ella D. Auchincloss, Project Director
Joined Rippel: 2011
Career: Ella has spearheaded many resident engagement efforts for Rippel’s ReThink Health initiative, coaching a wide variety of partner organizations and teams in change leadership, and developing Community Activation for System Stewardship, in which she and her team advised the Center for Medicare and Medicaid’s Quality Improvement Organization Leadership, Organizing in Action program. She also directed a research project exploring tax credits’ potential as a source of sustainable financing for population health. Before joining Rippel, she founded The Leadership Development Initiative, a faith-based teaching and coaching program for resident outreach. She is also a fellow of the Leading Change Network at Harvard University’s Kennedy School of Government. Prior to her work in resident engagement, Ella worked in the financial services sector.
More about Ella: In 2015, Ella was awarded the Barbara C. Harris Award for Social Justice by the Episcopal City Mission in Boston, Massachusetts for her founding of The Leadership Development Initiative. Ella is a recovering Wall Street professional, and is most at home in drafty church basements and other community settings, leading story slams and singing freedom songs. She is at her best when she is near the ocean in the company of her beloved dog.
Education: Harvard Divinity School (MTS), Babson College (BS)
“My experience working in a part of Brooklyn where the life expectancy is 11 years shorter than in the neighboring Financial District—and infant mortality rates almost double NYC’s rate as a whole—made me want to change the system at the regional level to help improve these disparities.”—Anna Marie Creegan, Project Director
Joined Rippel: 2014
Current Roles: Anna is project director of the ReThink Health initiative’s Portfolio Design for Healthier Regions project.
Career: Anna led design and implementation for Rippel’s enterprise-wide evaluation framework, and has contributed to many R&D and place-based projects for the ReThink Health initiative. She also led the development of an assessment tool to measure regional progress along ReThink Health’s Pathway for Transforming Regional Health. Anna has over ten years of experience working with local and international health efforts across the US and Latin America, including as program manager for Community Planning and Health at nonprofit Community Solutions, where she led a health impact assessment and developed plans for revitalization, sustainability, and care coordination.
More about Anna: Anna loves traveling and the outdoors—especially hiking and skiing in her native Colorado Rocky Mountains—and seeing her young children growing to love it as well.
Education: University of Denver (MA), Fordham University (BA)
“After many years in international work, I find Rippel brings me to focus on the local issues around health and well-being, for a better future for all humanity—locally and internationally.”—Sarah Rial, Program Coordinator
Joined Rippel: 2017
Career: Sarah was previously program director for the nonprofit My Sister’s Keeper and served as senior executive assistant at Management Sciences for Health. Sarah is founder and president of Global Partnership for Peace in South Sudan, which engages South Sudanese communities across the globe in working collectively for peace and social justice.
More about Sarah: Sarah has received numerous awards for her work as a community organizer, activist, and advocate, including the 2010 Eleanor Roosevelt Award for Human Rights. Her activist colleagues have described her as, “A warrior sister with a quiet wisdom.”
Education: The American University in Cairo (MA); University of Massachusetts (GradCert), University of Juba (BS)
“I believe that the health of communities is ultimately shaped by who is and isn’t at ‘the table.’ I’m excited to be part of a team that is boldly imagining a more equitable future while also developing tangible steps to take towards that future.”—Iueh Castro Soh, Project Manager
Joined Rippel: 2019
Career: Iueh cares about building healthy communities and developing leaders. He was previously a management consultant at Oliver Wyman where he advised C-suite executives in the provider, payer, and life science space. He focused primarily on helping health systems develop and pursue a population health strategy amid shifting competitive and reimbursement pressures. In 2018, he worked in the Boston Mayor’s Office of New Urban Mechanics, a civic innovation team. There, he pioneered Rebuilding Together, an ongoing meeting group and advisory council that aims to develop returning citizen (formerly incarcerated) leaders and reshape their image in Boston. Iueh has also served as a volunteer community organizer on racial and economic justice campaigns in Oakland and Boston. At Rethink Health, he is currently authoring a report investigating the role of community organizing on shaping the role of local healthcare systems.
More about Iueh: Iueh loves to hunt for tasty street foods—especially tacos. You can often find him at a park playing pick-up basketball to decompress and get to know his neighbors.
Education: Haas School of Business, University of California Berkeley (BS), Harvard University Kennedy School of Government (MPP)
“Before joining Rippel, my work was confined to individual nutrition and health interventions with specific populations, funded solely by grants. At Rippel, I get to be part of work that breaks through the silos to help stewards move down the path towards sustainability—both of their finances and their mission.”—Katherine Wright, Senior Program Associate
Joined Rippel: 2016
Current Roles: Katherine leads the cross-coordination of Rippel’s three ReThink Health initiative project teams focused on jumpstarting transformative change, and provides high-level research and content support to ReThink Health’s Portfolio Design for Healthier Regions and Hospital Systems in Transition teams. She also continues to promote and present on Beyond the Grant: A Sustainable Financing Workbook (published in 2018).
Career: Katherine previously worked on multiple sustainable financing and R&D projects for Rippel’s ReThink Health initiative, where she explored topics like social impact investing, resident engagement, and the potential of tax credits as a source of sustainable financing for population health. Notably, she co-authored Beyond the Grant: A Sustainable Financing Workbook. Katherine led the design of the workbook’s Financing Wizard that lets users create and practice the art of financial planning for their collaborative population health work. Before joining Rippel, Katherine coordinated and provided research and evaluation support for interventions focused on healthy eating, SNAP-ED, and women’s heart health with Tufts Friedman School of Nutrition Science and Policy, the Jean Mayer USDA Human Nutrition Research Center on Aging, and Michigan State University Extension.
More about Katherine: Katherine was ranked second in the Indiana SkillsUSA Commercial Baking competition, which helped inspire her career path to health and nutrition work.
Education: Friedman School of Nutrition Science and Policy at Tufts University (MS), Michigan State University (BS)
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What Would it Mean for Hospital Leaders to be Stewards of Their Regions’ Well-being?
Hospitals are under a lot of pressure. They are facing what we call a problem of “balancing two boats” at the same time, while the stream is moving really fast. These big transitions bring up a lot of questions about how to handle the tension between where we are now, and where we’re going.