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Investing in social services as a core strategy for health organizations: developing the business case

Social determinants of health — economic stability, neighborhood and physical environment, education, food, transportation, community and social context — can all impact health outcomes. With the growing emphasis on population and community health, how do hospitals and health systems make the business case for investing in social services to improve the health of their patients and communities?

A new report from the KPMG Government Institute focuses on building the business case for social services investment by healthcare organizations of all types. After defining social services investment and its common barriers, the guide focuses on these six steps:

  1. Identifying what to invest in
  2. Determining what success is by selecting the care outcomes
  3. Measuring costs of care
  4. Determining the appropriate investment model
  5. Setting up the return on investment approach
  6. Sensitivity analysis and investment kick-off

The appendices include several short business case examples from different types of healthcare organizations.

Source: Investing in social services as a core strategy for healthcare organization: developing the business case – a practical guide to support health plan and provider investments in social services. March. 2018. http://www.kpmg-institutes.com/ content/dam/kpmg/governmentinstitute/pdf/2018/investing-social-services.PDF. Also available from the Commonwealth Fund at http://www.commonwealthfund.org/~/media/files/publications/other/2018/investingsocialservices_pdf.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

NICUs: Disparities in care for very low birth weight infants

[From the medical journal literature]

Significant racial and/or ethnic variation in quality of care exists between and within NICUs.  Providing feedback of disparity scores to NICUs could serve as an important starting point for promoting improvement and reducing disparities.”

This was a study of data from the California Perinatal Quality Care Collaborative of 18,616 very low birth weight (VLBW) infants cared for in 134 neonatal intensive care units in California during the 5-year period 2010 to 2014.  Besides the conclusions on disparities (noted in the quote above), there were interesting descriptive findings about the characteristics of the VLBW infants.  Here are some of these findings:


  •   9 percent (Less than 751 grams)
  • 23 percent (751-1000 grams)
  • 29 percent (1001-1250 grams)
  • 39 percent (1251-1500 grams)
  • 28 percent (multiple gestation)
  • 76 percent (C-section)
  •   4 percent (in-hospital mortality)

Source: Profit, J., and others. (2017, September), 140(3).  Click here for OPEN ACCESS to free full text: http://pediatrics.aappublications.org/content/140/3/e20170918  Posted by AHA Resource Center (312) 422-2050, rc@aha.org


Diversity and Disparities: a Benchmark Study of U.S. Hospitals in 2013

Three key ways hospitals and health systems can address disparities in health care are:

  1. Increase the collection and use of race, ethnicity and language preference [REAL] data to identify where disparities exist
  2. Increase cultural competency training to ensure caregivers and other staff have a deeper understanding of diverse patients and their individual needs
  3. Increase leadership and governance diversity

A new survey report looks at what hospitals are doing on these 3 fronts, learning more about the strategies used and providing benchmarks for gauging hospital progress.

Top line survey results found:

  • Most hospitals are actively collecting patient demographic data — 97% collect data on race, 94% on ethnicity, and 95% on primary language.
  • 86% of hospitals provide cultural competency training to clinical staff, while nearly 65% require all employees to attend diversity training.
  • Minorities comprise 14% of hospital trustees, 12% of executive leadership, and 17% of first- and mid-management positions.
  • Nearly a third of patients are from a minority group.

Meanwhile, a new report from the Robert Wood Johnson Foundation and the Urban Institute compares how the U.S. and European Union approach eliminating health disparities. One key difference: the U.S. has focused primarily on racial/ethnic disparities rather than economic inequities, although they are often intertwined.


Diversity and disparities: a benchmark study of U.S. hospitals in 2013. Institute for Diversity in Health Management; Health Research & Educational Trust, 2014. http://www.diversityconnection.org/diversityconnection/leadership-conferences/diversity_disparities_Benchmark_study_hospitals_2013.pdf

Docteur E; Berenson RA. In pursuit of health equity: comparing U.S. and EU approaches to eliminating disparities. Robert Wood Johnson Foundation; Urban Institute, June 2014. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf414060

Related sources:

Earlier benchmarking surveys: 2011 2009

Equity of Care web site, a collaboration of the American College of Healthcare Executives, American Hospital Association, Association of American Medical Colleges, Catholic Health Association of the United States, and America’s Essential Hospitals. Accessed June 25 at http://www.equityofcare.org/

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

National Profiles of Health Care Systems in 14 Countries

How does the U.S. health system compare to those in other countries? The Commonwealth Fund has published comparative profiles of the national health care systems in each of these countries:

  1. Australia
  2. Canada
  3. Denmark
  4. England
  5. France
  6. Germany
  7. Italy
  8. Japan
  9. Netherlands
  10. New Zealand
  11. Norway
  12. Sweden
  13. Switzerland
  14. United States

Each national profile covers these health system aspects:

  • Health insurance
  • Public and private financing
  • Health system organization and governance
  • Health care quality and coordination, disparities, efficiency, and integration
  • Use of information technology and evidence-based practice
  • Cost containment
  • Recent reforms and innovations

Summary tables are also available for quick comparisons among countries on health system characteristics and performance indicators.

Source: Thomson S and others, London School of Economics and Political Science. International profiles of health care systems, 2013. The Commonwealth Fund, Nov. 2013. http://www.commonwealthfund.org/~/media/files/publications/fund-report/2013/nov/1717_thomson_intl_profiles_hlt_care_sys_2013_v2.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Health System Measurement Project: Trend Data on Nation’s Health System

Looking for national statistics on health care delivery in the US? The Department of Health and Human Services’ Health System Measurement Project may be a good place to start. It pulls together data from multiple federal sources to provide information on the state of the nation’s health system. Performance indicators are available on these topics:

  • Access to care
  • Cost & affordability
  • Coverage
  • Health care workforce
  • Health IT
  • Innovation
  • Population health
  • Prevention
  • Quality
  • Vulnerable populations

Source: Health system measurement project. Office of the Assistant Secretary for Planning and Evaluation, US Dept. of Health and Human Services, accessed Feb. 25, 2014 at https://healthmeasures.aspe.hhs.gov/

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

AHRQ Health Care Innovations Exchange

Looking for case studies on how to improve quality or reduce disparities in health care? The Health Care Innovations Exchange from the Agency for Healthcare Research and Quality is a good place to check.

AHRQ defines innovation as any new or altered product, service, process, system, policy, organization structure, or business model, but the innovation must be freely available, effective, truly innovative within its setting or target population, and focused on health care quality.  Technical, clinical, and educational innovations are generally excluded. The Agency invites submissions that receive an editorial review, with the innovations described in this general format:


  • Summary
  • Evidence rating
  • Developing organizations
  • Date first implemented

What they did

  • Problem addressed
  • Description of innovative activity
  • References/related articles
  • Contact the innovator
  • Innovator disclosures

Did it work?

  • Results
  • Evidence rating

How they did it

  • Context of the innovation
  • Planning and development context
  • Resources used and skills needed
  • Funding sources
  • Tools and other resources

Adoption considerations

  • Getting started with this innovation
  • Sustaining the innovation
  • Additional considerations and lessons
  • Use by other organizations

Those using the Exchange can browse or search by topics in these categories:

  • Disease or clinical category
  • Patient care process
  • Setting of care
  • Quality improvement goals and mechanisms
  • Patient population groups
  • Stage of care
  • Institute of Medicine (IOM) domains of quality
  • Organizational process
  • Quality tool topics
  • State

By registering on the site, users can sign up to receive alerts and updates, save innovations of interest, and share comments.


AHRQ Health Care Innovations Exchange. Agency for Healthcare Research and Quality, accessed Aug. 26, 2013 at http://www.innovations.ahrq.gov/

AHRQ health care innovations exchange: combined inclusion criteria for health care service delivery innovations and health care policy innovations. Agency for Healthcare Research and Quality, accessed Aug. 26, 2013 at http://www.innovations.ahrq.gov/inclusion/combined.aspx

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Community population health profiling and hot spot maps

Hot spot density maps were found to be an effective way to analyze and communicate the need for primary care in this project conducted in Alachua County, Florida, where the University of Florida (Gainesville) is located.  The maps identified such things as areas with high rates of Medicaid births, child abuse, and domestic violence.  The maps, which were shared widely in the community, were credited as being a highly effective way to portray data about health disparities.  Among the outcomes of the study was institution of a mobile clinic — a bus — staffed by UF medical students. 

Source: Hardt, N.S., and others.  Neighborhood-level hot spot maps to inform delivery of primary care and allocation of social resources.  The Permanente Journal;17(1):4-9, Winter 2013.  Click here for access: http://www.thepermanentejournal.org/files/Winter2013/Allocation.pdf Posted by AHA Resource Center, (312) 422-2050, rc@aha.org