The BUILD Health Challenge is really designed to bring hospitals and health systems with public health bodies and community health organizations, to go more upstream to look at social and economic factors that influence health. All the results really come from phase one of this project. And there’s a new application round. But fundamentally, we want to address these social determinants.
What has been the timeline for the forward evolution of the BUILD Challenge?
It has come together within the last year.
How many of each type of organization are involved in the BUILD Challenge?
Each of the 18 projects requires at least one of each of [different types of organizations]—a hospital, a public health body, and a non-profit. And the average number of partners per project was about eight.
What did you find, overall, based on the experiences of the leaders of these initiatives?
A lot of health systems know that they should be addressing the issue of the social determinants of health, but don’t necessarily have the time, resources, or expertise. And in some cases, it’s not for them alone—regardless of where you are, community health resources will be essential under value-based payment models. So we’ve distilled four steps. It’s about formalizing the business case. To date, we’ve seen these activities be one-off projects. But we need to embed this into the fabric of our organizations.
And what were the most important elements involved?
Engaging leadership was one. Prioritizing your initial focus was the second (there are a lot of issues you can address in any one community, but you can dilute your efforts, so get good at one thing first). The third: build and strengthen your partner relationships. How do you bring these stakeholder groups together? And the fourth is, how you actually design the screening and referral protocols? Because you can set up a program, but if you don’t’ identify who needs the service, and identify those folks, you won’t have the ROI that you’re looking for.
Where do hospital-based organizations most stumble, with regard to those four important elements that came out of your research?
It’s in understanding the unique strengths that each party brings to the table. So there’s a flowing pace—identifying relationship needs, where to start; it needs to come from the ground up—what does the community want, and what do the hospital and the public health agency and the community-based organization bring to the table? In a lot of cases, the hospital brings the data. But the challenge is in managing the change management aspects of the project.
Do communities ask for the same thing, or different things?
That’s a great question. About 41 percent of the BUILD Health communities chose to focus on food and nutrition issues; that food/nutrition is closely linked to obesity and chronic conditions, and that seems more closely connected to traditional medical care, and folks are more comfortable starting there. More broadly, we see a lot of organizations focusing also on housing and transportation as the other top two issues; but violence and safety are also an issue.
How are the hospital-based organizations finding success?
It comes down to the fact that no provider has the time or resources to manage these issues, even though they strongly impact total cost of care. So it’s about integrating this data into systems, and connect to the community. So the hospital’s role is screening people and providing liaisons into the community. And that’s why the BUILD Health Challenge, by providing the funding and technical support to foster this collaboration, has enabled these organizations to create those links to help follow patients through the new continuum.
Could you provide a couple of examples of how this is playing out?
There are two different types of grants involved here. Some are planning grants, some are implementation grants. And we’ve also in the report showcased some examples from our Advisory Board consulting division. The BUILD Project has only been running for about a year, but we’ve already seen a lot of progress in a variety of areas. West Oakland in the San Francisco Bay Area. There, as in other places, the existence of food deserts represents a huge obstacle to health, putting the health of its residents at risk. Without access to healthy, affordable food, individuals are more likely to experience chronic stress, malnutrition, obesity, and related diseases. San Pablo Area Revitalization Collaborative’s efforts to address the West Oakland food desert led to the creation of the area’s first full-service grocery store in more than a decade.
Another example in California is what’s going on with the Youth Driven Healthy South Los Angeles initiative. In that instance, ten local youth were trained as Community Health Liaisons to help identify and craft upstream solutions for health issues plaguing Historic South Central Los Angeles. The youth have conducted key informant interviews, presented their findings at a series of town hall meetings, and received stakeholder buy-in to solutions for improving their community’s high prevalence of diet-related diseases.
In Cleveland, leaders of a program called Engaging the Community in New Approaches to Healthy Housing, continue to advance their campaign to rid the city of toxic lead paint, which can lead to developmental challenges and lifelong health issues. Their efforts have benefited from the attention and support of Sen. Sherrod Brown, who has drafted federal legislation to better protect Ohio families and called for increased funding from the U.S. Department of Housing and Urban Development (HUD).
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