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The Health Review Sadie Conrad, Mariah Senecal Reilly and Nicole Savage

Grow for Life: Implementing a System of Sustainable Health in our Urban Populations By: Mariah S. Senecal-Reilly Lead: The underlying cause of many health related issues is poor nutrition. Much of the population’s poor health could be addressed by instituting green infrastructure in urban areas to produce fresh and nutritious food. Let’s be honest with ourselves, the health sector encompasses a vast array of issues and problems with even more solutions and fixes to try and address them. However, something that is often overlooked, perhaps purposefully, is the true root cause of many health related issues. My proposal is that we address the root cause of many issues instead of alleviating a wound with a Band-Aid. The lurking problem that many organizations do not elevate to a level of importance comes down to the very simple solution of what we as humans put into our body for fuel. Food and diet. For many populations, the chronic conditions present are both obesity and malnutrition. An oxymoron you say? Yes, for many populations in the United States, specifically urban and minority populations (though not inclusive to those populations), the food they eat causes them to be obese or overweight while simultaneously not providing them with enough nutrients to lead healthy and active lives. Instead of addressing the myriad of issues that come along with poor nutrition which include but are not limited to; decreased cognitive function, cancer, heart disease, impaired mental health, poor dental health, and a variety of other conditions, we need to get to the root of all of these issues and put into place a sustainable infrastructure to allow and encourage all populations to eat healthy nutritious food. If this were to occur, we would see a reduction in disease as well as other non-healthful habits, which in turn would increase quality of life for many individuals and lessen the burden on non-profit and governmental organizations to meet the health needs of these populations. Urban agriculture, although a relatively new phenomenon, has real potential to be the solution to the problem of poor nutrition in the urban areas of the United States. For urban and populations, there is often the problem of food deserts to deal with, where fresh, nutritious, and healthy food is not available due to geographic location. Coupled with inefficient resources, this is a recipe for health disaster. These areas often only contain corner stores, which have extremely limited options with even fewer healthy choices. Not only would the addition of agricultural infrastructure help to directly reduce health issues, but it would also help to reduce environmental issues faced by urban areas as well, due to the addition of various green spaces. Non-profit organizations, specifically health based ones, could be the cornerstone of this effort through the addition of urban agricultural programs to their offered services. This could be organized through a coalition of local non-profits in order to combine resource and to more effectively target needy populations and areas. As proposed by the Urban Design Lab of New York City, there is a process by which communities can implement urban agriculture, however, we as a nonprofit sector must adapt it to fit our own needs. The first step in this process would be to identify spaces in target areas that could support the infrastructure for an urban agriculture project. These could be vacant lots (often city-owned), rooftops, edible landscaping, spaces where greenhouses could be set-up, and community owned spaces.. The second step in this process would be to identify the clientele of the area and to get the surrounding community involved and invested in the infrastructure/project. Non-profit organizations could be responsible for various zones, and the clients served in that area would utilize the specific zone’s agricultural set-up. If no other option

was available, non-profit organizations could utilize their own spaces as an area to set-up agricultural processes. Urban agriculture is a great way to create green spaces in cities, as well as to engage communities in the process of good-health. The third step would be to provide support and programming to encourage healthy behaviors and utilization of the gardens to improve the diet of these populations. To increase the longevity and sustainability of each zone, it is encouraged that the coalition hire an urban agricultural coordinator to assist the zones with the growing process. A way to make this monetarily sustainable could be the utilization of fee-based CSA’s, based upon income level, where EBT could be accepted in lieu of actual money, so that people could utilize their public assistance to purchase healthy food. An example of the successes that can be brought about from such a project can be found in the community of Syracuse, New York, where many of the nonprofit organizations joined together to form the Healthy Life coalition. Using the combined resources of all involved and expertise of a member organization Syracuse Grows, organizations were designated a zone near which they were housed and the appropriate type of urban agriculture was identified. Each organization utilized a curriculum to recruit the clients that the organizations already served as well as recruiting neighborhood residents. This program was so successful that the coalition is now growing enough food to feed not only their members but neighbors and members of the wider community as well and thus helping to resolve the issues of malnutrition and obesity caused by food desert conditions. Only with a focus on food as a catalyst for health can afflicted populations begin to move forward into healthy lifestyles and plentiful healthy food availability for those with resource constraints. Along with the obvious health and food production benefits, there are often other benefits associated with urban agriculture such as energy savings, property value increases, and water conservation among others. Utilizing urban agriculture to provide low-income, poverty – stricken communities with a way to consume healthy foods is a sustainable way to initiate and provide healthy lifestyles for populations that would otherwise be stuck in a cycle of poor health. Word Count: 980

Healthcare Consolidation: What Does It Mean For Independent, Nonprofit Institutions? By: Sadie Conrad Lead: Consolidations in healthcare are becoming more and more prevalent as smaller institutions are slowly being squeezed out of the market. Survival for many independent, nonprofit hospitals will depend upon their ability to proactively identify and negotiate affiliations with greater systems. The buzz in healthcare these days is economies of scale. New guidelines under the Patient Protection and Affordable Care Act are changing how hospitals operate, especially in regards to billing, collections, and uninsured patients. Skirting around antitrust regulations, consolidations in healthcare are rapidly increasing. Over 300 hospital mergers have taken place in the United States since 2007. These integrated systems promise enhanced managed care for patients and

cost savings. Affiliating with a larger system is becoming a necessary means of survival for many independent, nonprofit institutions. With Goliath looming in the horizon, what does this mean for your small non-profit hospital? Of the 4,973 community hospitals in the United States, 58% are not-for-profit, 21% forprofit, and 21% are run by state and local governments. But the tide is shifting. Hospitals in financial trouble are being sold to for-profit systems. However, few nonprofit healthcare giants have positioned themselves as leaders in this changing environment. In 2012, the Poudre Valley Health System and the University of Colorado Hospital merged to create the not-for-profit University of Colorado Health System. The system linked together a high-performing community health network with an academic medical institution. It has since expanded to 6 hospitals in Colorado, 2 hospitals in other states, and a plethora of providers. The loss of autonomy and independence by hospitals after joining UC Health has varied. For example, voters in Colorado Springs decided to lease Memorial Hospital to UC Health and hand over full operation and governance. Ivinson Hospital in Wyoming is affiliated with the system but still maintains its own board. With more than $1.5 billion annual net revenue and 14,000 employees, UC Health has quickly become one the largest locally-owned, nonprofit health systems in the country. Providing an alternative approach to affiliation, the Mayo Clinic launched the Mayo Clinic Care Network in 2011. As opposed to a full mergers or acquisitions, a network is an alliance of organizations that share resources while maintaining their own identities and governance structures. Institutions wishing to join the network must meet clinical performance measures. Provider organizations and institutions pay a subscription fee for access to Mayo’s expertise, physicians, and research. eConsult is an available program that provides access to specialists without needing to leave the community. AskMayoExpert is a web information system that enables doctors to quickly connect with expert clinical information. Business Process and Administrative Consulting Services gives tools and expertise to assist with the integration of clinical care and practice models. For Mayo, the network expands its national reach in order to compete for alignment with community providers. Other nonprofit industry leaders such as the Cleveland Clinic have similar networks of collaboration and affiliation. Aligning with nationally recognized systems is expected to improve the quality and efficiency of care in communities. UC Health and Mayo Network provide different models of affiliation, but foundational to both models is a flagship research institution. Non-profit community hospitals expected to survive in the changing American healthcare environment are the ones affiliated with research institutions and universities. The benefits of non-ownership models such as Mayo’s network is that member institutions have access to vast medical expertise, research, and brand without losing autonomy and control. However, affiliations may not help financially troubled institutions stay afloat. Mergers and acquisitions provide financial stability, wield greater market power, and attract providers and patients with integrated medical records and care. The fatal error many small nonprofit hospitals make is waiting until they are in financial danger before looking for partners. This leaves them vulnerable to stocking horses ready for an easy takeover. It’s vital to start identifying potential partners and systems that align with your organization’s values and mission now. In 2011, 25% of potential hospital mergers fell apart after signed letters of intent because many failed to perform appropriate financial, cultural, and operational due diligence before signing. Mergers often fail because of the inability to integrate on a cultural level and perform detailed research on the compatibility with potential partners.

Hospital boards need to be careful before aligning with systems that don’t reflect their own values and mission. For example, some nonprofit health systems such as Ascension Health in Detroit have closed hospitals in urban areas in favor of expansion into the suburbs. While these actions may be financially promising, they jeopardize the core principals of nonprofit institutions. A key question hospital leadership needs to ask is how potential affiliations will affect their ability to address community needs. Does merging jeopardize access for clients? Check Your Politics At The Boardroom Door By:Nicole Savage Lead: Health nonprofits must leave personal politics out of the decision making process. Here are reasons why and strategies to make sure an organization’s actions are aligned with their mission. When it comes to nonprofits that administer, conduct research or are in any way involved with providing health services, there is no room for politics. In the midst of the recent government shutdown and debacle of implementing the Affordable Health Care Act you may think I’m overly idealistic or live under a rock. But I implore to read on. Just about every aspect of health and the healthcare industry are highly politicized issues. Whether it’s a women’s access to reproductive care or the use of stem cells research, to a large extent, the United States government decides on what citizens can and can’t do with or to our bodies. However, after these decisions are hashed out on amongst Congress they shouldn’t be re-hashed amongst a nonprofit board of directors. Fulfilling the mission of the organization should not be impeded by individual politics and opinion. Organizations must constantly revisit their mission to ensure their decisions and actions are aligned. The category of ‘health nonprofits’ encompass a vast network of organizations that help people improve or maintain their health in numerous ways. However, the idea of abiding by an ethical code has been discussed mostly in terms of nonprofit hospitals and their board members. Understandably so, as direct care providers to an entire community, hospitals should abide by legal regulation and high ethical standards to be accountable to the people they treat. Here, remaining apolitical is a matter of ethics, accountability and responsibility. Healthcare providing nonprofits enjoy tax exemptions in exchange for providing a public service. The services and care provided by these organizations should not be subject to the will and opinion of the individuals who are in charge. This moral and ethical obligation of health providers must also be observed by those providing indirect care. Health advocacy, research and voluntary health associations are responsible for helping citizens access care and should maintain the same obligation to remain apolitical. There are two particular issues that point to this need for personal politics to stay out of the decision making process of how nonprofits administer indirect care. That is: the growing necessity of collaboration amongst organizations and the unique relationship between nonprofits and the public. Limited resources and funding has required nonprofits organizations to work together to provide services. Sometimes organizations do this on their own with the understanding that combining efforts is the best way for both to provide a service. However, more than ever the government, funders and other entities are calling for organizations to work together. A recent

example of this type of collaboration on a larger scale is the formation of the New York Women’s Equality Coalition. This organization represents more than 500 groups that were brought together to support Governor Andrew Cuomo’s women’s rights agenda which encompasses many of their individual interests. While many of these groups have overlapping interests their specific priorities, opinions and processes must be reconciled to support the overall goal for the coalition. Beyond advocacy work, for many organizations their financial livelihood and ability to fulfill their mission depends on their ability to collaborate with other groups. The unique relationship with nonprofits and the public further require the dissolution of political opinion and decision making. Our stakeholders are extremely invested in our causes and therefore hold us to a higher standard. Again, being on the receiving end of charitable donations, tax emptions status and government funding makes nonprofits de facto public entities. And as such, we are accountable to the entire public, for they are our stakeholders. Even those who don’t make use of our services are invested in how we do our work. Individual politics cannot affect the decisions we make to provide care to even the smallest group of people. Susan G. Komen’s 2002 decision to stop funding Planned Parenthood demonstrates the result of allowing personal opinion guide decision making and underestimating public engagement. The necessity of creating a culture of accountability to the public requires constantly aligning an organization’s decisions and strategy with its mission. Health policy and decision making is (and always will be) a highly debated issue within the government. And individual board members and employees will always have political opinions on these decisions and health issues in general. An organization can work to shape and challenge health policy however, individual members of a board must only act within that capacity. Nonprofits need to make this point clear in the bylaws that govern the organization. It’s impossible to ensure that every board member holds the same political opinion. In fact diversity of thought and opinion are assets to an organization. However, these assets should be utilized to execute the mission of providing a service. The process of aligning actions to mission must become a part of the organizational culture for nonprofits in the health field. Word Count:797

The health review  
The health review