Previous studies have focused on the role anchor institutions play in community development. However, less attention has been directed to how hospitals can effectively partner with community-organizations and residents as part of population health efforts. This article examines community views of one initiative developed by a major American children's hospital in partnership with local community organizations. The data for this study come from 35 in-depth interviews with local residents from the neighborhood adjacent to the hospital and two interviews with hospital administrators. Our findings suggest that the contexts in which hospitals and other non-profit corporations operate pose unique challenges to effective communication. In particular, hospitals and community organizations may think differently about the merits and nature of open communication. Especially when acting as anchor institutions working beyond their formal medical expertise, hospitals may struggle to communicate the scope and goals of their non-medical work in the community.

In recent years, policy developments in the United States have dramatically changed how nonprofit hospitals interact with surrounding communities. However, despite the importance of these changes encoded in Internal Revenue Service regulations, little is known about how these requirements have affected how nonprofit hospitals are approaching community health evaluation. We present qualitative findings from interviews with hospital employees and consultants overseeing preliminary rounds of community health needs assessments, as required by the Affordable Care Act. The sample comes from the Appalachian region of Ohio, an area targeted because of significant health challenges. Our findings suggest that the Affordable Care Act has led hospitals to formalize their processes, focus on developing an evidence base, cultivate local partnerships, and reflect on the role of the hospital in public health.

This article examines an important but largely overlooked dimension of the Patient Protection and Affordable Care Act (ACA), namely, its significance for Native American health care. The author maintains that reading the ACA against the politics of Native American health care policy shows that, depending on their regional needs and particular contexts, many Native Americans are well-placed to benefit from recent Obama-era reforms. At the same time, the kinds of options made available by the ACA constitute a departure from the service-based (as opposed to insurance-based) Indian Health Service (IHS). Accordingly, the author argues that ACA reforms--private marketplaces, Medicaid expansion, and accommodations for Native Americans--are best read as potential "supplements" to an underfunded IHS. Whether or not Native Americans opt to explore options under the ACA will depend in the long run on the quality of the IHS in the post-ACA era. Beyond understanding the ACA in relation to IHS funding, the author explores how Native American politics interacts with the key tenets of Obama-era health care reform--especially "affordability"--which is critical for understanding what is required from and appropriate to future Native American health care policy making.

The goal of this study was to understand whether Appalachian Ohio hospitals prioritized substance abuse in their IRS-mandated community health needs assessments (CHNAs) and if not, what factors were important in this decision. Analysis of CHNA reports from all 28 hospitals in the region supplemented interview data from in-depth phone interviews, with 17 participants tasked with overseeing CHNAs at 21 hospitals. The CHNA reports show that hospitals in this region prioritize substance abuse and mental health less often than access to care and obesity. Interviews suggest 4 reasons: lack of resources, risk aversion, concern about hospital expertise, and stigma related to substance abuse. Hospitals are playing a larger role in public health as a result of CHNA requirements but resist taking on challenging problems such as substance abuse. The report concludes by summarizing concrete steps to ensure that community benefit efforts address pressing health problems. The implications of this study are manifest in concrete recommendations for encouraging hospitals to address pressing health problems in their community benefit efforts.

BackgroundThe literature suggests that although adult hospitals are establishing population health programs around the country, there is considerable definitional ambiguity regarding whether interventions are aimed at the social determinants of health or the management of existing patient populations. U.S. children’s hospitals also undertake population health programs, but less is known about how they define population health. The purpose of this study is to understand how U.S. children’s hospitals define population health, and how institutions are adjusting to new preventive health care models.MethodsWe conducted semi-structured interviews with key stakeholders at ten hospitals with the highest amount of staff time dedicated to population health activities as reported in the 2016 Children’s Hospital Association’s population health survey. Using a semi-structured interview guide, we interviewed representatives from each hospital. Verbatim interview notes were coded and analyzed using the data analysis software Dedoose. Data analysis followed a modified constructivist grounded theory approach.ResultsOur results suggest that even population health innovators employ a variety of approaches that span both population health management and public health. We present further evidence that U.S. children’s hospitals are actively debating the definition and focus of population health.ConclusionsDefinitional debates are ongoing even within children’s hospitals that are dedicating significant resources to population health. Increased clarity on the conceptual boundaries between population health and population health management could help preserve the theoretical differences between the two concepts, especially insofar as they mark two quite different long-term visions for health care. Without agreement about the meaning of population health within and among institutions, hospitals will not be able to know whether projects aimed at addressing the social determinants of health are likely to improve the health of populations.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3303-7) contains supplementary material, which is available to authorized users.