Collaborative Approaches to Community Health in Ohio

As a health services researcher living and working in rural Appalachian Ohio, I have many opportunities to see both the challenges and disparities that face my state and the efforts undertaken to address them. One such effort has been a state policy designed to bring together health systems and public health agencies to address the biggest issues facing the state’s communities. A close look at this approach led our research team to publish a recent study in Health Affairs on the extent to which hospitals and health departments align in their community assessment efforts.  

The 2010 Patient Protection and Affordable Care Act included a national mandate for nonprofit hospitals to conduct community health needs assessments (CHNAs) every three years. To complete this process, a hospital is expected to gather data to identify the prominent needs its community faces and then create a strategic plan to improve key health outcomes.

In turn, states have begun to consider how to build on this federal mandate in order to best serve their residents. One approach explored by several states, including Ohio, is a policy that directs nonprofit hospitals to work with public health departments, which often conduct their own community assessments. This type of policy is designed to foster collaboration between organizations and to ensure consensus regarding the greatest health challenges facing the state.

The shared understanding of needs is an important finding for communities.

Our research team has worked with hospital data and CHNA reports for years, using these administrative documents to understand the needs communities are facing and how hospitals are engaging with them. A policy recently implemented within Ohio standardized the expectation that hospitals and health departments would collaborate on these efforts. This presented an opportunity to explore the extent to which this collaboration was already occurring. To conduct this study, we collected community assessment and strategy documents from both nonprofit hospitals and county health departments across the state. We then compared those within the same county to understand how two different types of health care organizations are engaging with the same communities. 

In this process, we recognized that hospitals and health departments across Ohio are largely identifying the same needs. The most prominent across both types of organizations were mental health, substance use, and obesity. However, we found some key differences between the strategic responses of hospitals and public health departments. Hospitals were more likely to focus on strategies that were downstream by nature, aimed at treating health problems with clinical services. Public health agencies were more likely to consider strategies that were more upstream, focused on social determinants of health and preventing illness rather than on specific outcomes. These differences largely align with the traditional roles of each type of organization.

The shared understanding of needs is an important finding for communities. Communities may benefit from hospitals and health departments being on the same page and even working from the same data in exploring how to improve the health of those they serve. Our analysis indicates that this has already been occurring, but policies to further facilitate it are likely to continue the trend and formalize the practice. They open the possibility of addressing the most prominent needs through mandated collaborative efforts. We also found it appropriate that the organizations are drawing upon their own strengths, in terms of resources and expertise, to identify their different approaches to meeting identified needs.

Our findings offer a snapshot of how Ohio’s hospitals and health departments are navigating a shared health care landscape. As states consider how to effectively encourage and support collaboration between health providers and public health entities, they would do well to recognize that highlighting the varying strengths that the organizations themselves rely upon may be a key strategy. Nonprofit hospitals and public health departments have long been central stakeholders of community health. By encouraging hospitals, health departments, and other community organizations to partner and communicate in ways that result in a wide-ranging network of complementary supports and interventions, states have the potential to make the most use of the community resources that already exist.