11/05/2014 04:39 pm ET Updated Jan 05, 2015

Hospitals Must Establish New Community Linkages

Health-system markets are being pushed toward a volume vs. value-payment tipping point. This is driven by the confluence of states moving Medicaid and state-employee health benefits to value-based (risk) contracts, corporations securing national contracts for high-cost care episodes and commercial payers creating tiered health insurance. Successful population-health (value-payment) programs, whether fixed-price bundled services for individual patients or comprehensive services for a specific population, as with ACOs, require action based on these insights:

Outcomes depend on patients' behaviors over their lifetimes. Thus, patient and family participation must be increased. Success depends on getting "upstream" of medical care needs.

Broad local and regional communities, not individual institutions, can best allocate resources to improve the social determinants of health.

Indeed, improving community health depends more on the interactions among the parts than on individually optimizing the parts themselves. Hospitals and health systems have a time-limited opportunity to help develop community-health networks, the backbone organizations for improving population health.

To get started, leaders of hospitals, public- and private-sector social-service organizations, payers and representatives of the broader community must first frame the discussion from a policy perspective and then map linkages across the community.

Experience with community health networks underscores the importance of social determinants of health, teamwork within/across collaborating organizations and accepting risk within global budgets. Sustained system thinking across the community's health assets, shared insights, and much generosity and patience in every sector are critical factors for success and flow from visionary hospital leadership and community/political leaders. Case studies from Oregon and Connecticut, among others, show what can be done.

To get started, leaders would do well to convene a perspective-and-policy-setting discussion to frame context and mutual dependencies. Complex, foundational change is emotionally and organizationally disruptive. Thus establishing a fact-driven and respectful dialogue is an essential first step.

Community leaders, especially hospital leaders, should convene a community conversation and use linkage mapping as way to structure the conversation for progress. Based on readiness, one or more work streams would be selected to explore and improve the interactions between the parts.

Robert Whitcomb ( is a Providence-based editor and writer and a partner in Cambridge Management Group, a healthcare consultancy ( He is also a Fellow of the Pell Center for International Relations and Public Policy and a former editorial-page editor of The Providence Journal and former finance editor of the International Herald Tribune. This piece stems from the observations of those of his Cambridge Management colleagues Marc Pierson, M.D., Robert Harrington and Annie Merkle -- all of whom are population-health experts.