Hospitals and health equity: Examples of novel strategies

Hospitals are placing greater focus on reducing health disparities in underserved communities, and some health systems are finding success with new approaches.

An NEJM Catalyst analysis published March 15 outlines some of the successes hospitals have found with their health equity efforts. Some focus directly on healthcare, while others focus on social needs that can have an impact on health.

“By emphasizing health, not just health care, leaders of these hospitals help achieve a broader good for the community at large,” the authors wrote.

The analysis points to the importance of working with community partners to have lasting success. In addition, hospitals can improve the reputations of their brand, and potentially, their financial performance, the authors wrote.

Read more: Making health equity sustainable: Helping patients and the bottom line

The analysis cited Boston Medical Center’s “StreetCred” program, which helps families with lower incomes file tax returns and claim refunds for visits to hospitals and clinics. Since launching StreetCred in 2016, the program has helped more than 6,000 families obtain more than $14 million in tax refunds.

Building on that success, StreetCred has created a coalition of 24 health and financial services organizations to share best practices on starting and financial services in medical settings. The coalition includes organizations in 10 states and Washington, D.C.

Sanford Health, based in Sioux Falls, South Dakota, has seen the benefits of its outreach to Native American communities, the authors wrote.

In South Dakota, Sanford offered a health program that aimed at pregnant women with low incomes. Participants received points for making healthy choices in nutrition, prenatal care and other areas, and those taking part were able to get diapers, nursing pillows, bathtubs and other items. Between January 2019 and December 2022, 325 women participated in the program, including 173 Native American women.

Read more: Moving health equity from goals to reality

In Wisconsin, 19 health systems came together to create “Be Well Fox Valley,” a partnership of health, community and philanthropy organizations aiming to improve community health conditions, including diet. In one venture, about 200 patients with diabetes took part in a 13-week program that offered free, healthy meals.

Memorial Hermann Health System, based in Houston, Texas, undertook efforts to help children get more active. The system created a soccer program for kids and also built a 1.1-mile sidewalk from a middle school to a local park. The effort involved additional lighting for safety and revamping the park’s basketball court.

In conversations with the leaders of some of the health systems, the authors highlighted some key elements of successful programs to improve health equity.

Evaluate the results

While it’s laudable to attempt new efforts to improve health outcomes, health systems must evaluate their success. And that may mean ending or scaling back some efforts to focus on more successful efforts. In the StreetCred program, leaders shut down some sites that weren’t serving as many patients with low incomes, so resources could be better directed to areas with higher demand, the authors wrote.

Listen to employees

Healthcare workers are interacting with patients, and they can offer health systems, and their leaders, invaluable insights on community needs.

“Well-managed hospitals empower employees to listen to, partner with, and advocate for patients,” the authors wrote.

Work with partners

The health systems cited in the analysis all collaborated with other organizations in the community, including financial institutions and other nonprofit organizations. By working with other groups on the social determinants of health, organizations can gain insights and expertise in other areas.

Focus on 'equity care'

While hospitals must provide charity care to meet their government obligations as nonprofit institutions, health systems can get a substantial return on investment on investments in health equity. Leaders from Boston Medical Center told the authors that investing $1 million to provide 10 heart surgeries is helpful, but $1 million can also finance 10,000 prenatal visits for women with lower incomes, an effort that can aid entire communities.

Do surveys, and do more

To address disparities, health systems need to be doing surveys of the communities to gauge their needs, including those that may not be immediately apparent. However, health systems can’t stop with the surveys. Once they have good information, they need to share the findings with the communities and plans to help meet those needs. If surveys don’t produce some kind of action, community members can lose trust in the health system.