Doing Good and Doing Well: Corporate Social Responsibility in Post Obamacare America

Abstract

This paper looks how health systems can go beyond clinical care to address the social determinants of health and considers why this approach might be particularly relevant for Accountable Care Organizations (ACOs) touted by the Affordable Care Act. ACOs make profits by reducing the medical expenses of patient populations. The leading causes of death in the United States are tobacco use, insufficient physical activity, and an unhealthy diet. These risk factors are linked to increased incidence of a wide range of chronic diseases, the treatment of which places a tremendous financial burden on our health care system. Health care delivery and access are just a small part of the solution to our chronic disease crisis. Increasingly, strategies that address the social determinants of health--"the conditions into which people are born, grow, live, work, and age"-- are the ones that hold the most promise. In Massachusetts, Steward Health Care System supports a number of initiatives to address the social determinants of health in its patient population. Steward provides an example of how a hospital system can address the health of its patient population by moving beyond clinical care. The varied initiatives have also resulted in cost savings for the system.

For-Profit Hospitals Have a Unique Opportunity to Serve as Anchor Institutions in the U.S.

“…An 'anchor institution' is a large institution -typically an educational, health, or other large corporation -that is not only deeply embedded within the economic infrastructure of a community, but also plays a role in improving community life, and in the case of hospitals, community health (8)(9)(10)(11)(12)(13). Beyond job opportunities, anchor institutions invest in the social, economic, and health development of local communities as a signi cant part of their business models (10,13).…”

Contracting for integrated health and social care: a critical review of four models

“…ACOs are groups of primary and secondary care physicians, and other health care providers, potentially including hospitals, who will work together to avoid duplication of services (Fisher & McClellan 2011), so there is a strong emphasis on integrated care. The goals of ACOs are to align care, reduce costs, and increase quality of care primarily through primary care (Bennett 2012) with the emergence of a coherent vision for chronic disease prevention and population health (Corbett & Kappagoda 2013). While ACOs have been defined and interpreted differently by various leaders in the field, an ACO has been generally defined as "a local network of providers that can manage the full continuum of care for all patients within their provider network" (Ronning 2010, 47).…”

“…They also have incentives to promote healthy choices to their patient population, their employees, and the communities they serve, as those choices reinforce the preventive orientation of the health care delivered within an ACO. The most innovative ACOs will pursue a range of nonclinical interventions that address social norms at an individual and population level, both because these interventions align with their mission and because they are a cost-effective way to implement prevention (Corbett & Kappagoda 2013).…”

Developing a joint outcomes contracting model for integrated health and social care for older people

“…Incentives also promote healthy choices to their patient population, their employees, and the communities they serve, as those choices reinforce the preventive orientation of the health care delivered within an ACO (Corbett and Kappagoda, 2013).…”

“…ACOs are also strong on incentives to encourage health systems to health status, including the social determinants of health. Incentives also promote healthy choices to their patient population, their employees, and the communities they serve, as those choices reinforce the preventive orientation of the health care delivered within an ACO (Corbett & Kappagoda 2013).  The Alliance model focuses on the importance of trust, partnership, collaboration and commitment.…”