Achieving Health Equity

1. Achieving Health Equity How an anchor strategy can help improve well-being by building an inclusive and sustainable local economy

2. We know that where you live shouldn’t determine how long you live, but it does.

3. We know clinical excellence - but we could be making more of an impact. The Social Determinants of Health:

4. The Anchor Mission approach helps us get there. By leveraging our business practices around inclusive, local hiring and workforce development, local and diverse sourcing, and place-based investing, we can tackle these underlying causes of poor health by investing in the social and economic well-being of the communities we serve. 

5. The Anchor Mission A commitment to intentionally apply an institution’s long-term, place-based economic power and human capital in partnership with community to mutually benefit the long-term well-being of both.

6. We are not alone in this commitment! 

7. Healthcare Anchor Network Members • 40+ health systems with more than 600 hospitals. • Together, members employ more than 1 million people,purchase over $50 billion annually, and have over $150 billion in investment assets.

8. Whyinvest in health equity? • Although our healthcare system has spent many resources trying to improve health through quality and access, health inequities persist - and we ultimately treat them at high cost in our ERs. • Social determinants of health and structural barriers negatively impact our bottom line through increased utilization, perpetual poor outcomes and increased cost.

9. Whyinvest in health equity? • We are uniquely positioned as leading employers and economic engines in our communities.

10. How do we accomplish this work?  We can leverage our everyday business practices to impact economic factors that contribute to the overall well-being of our communities by creating community wealth through intentional:

11. Why “inclusive” & “local” The neighborhoods with the greatest inequities can be found in our own backyards, and often are communities of color.

12. How this work can be structured Rush University Medical Center is operationalizing this structure for Anchor Mission implementation

13. Inclusive, Local Hiring&Workforce Development Build community hiring pipelines that create opportunities for employment & career advancement

14. Inclusive, Local Hiring • Outside In - equip local residents for quality, high-demand frontline jobs that are connected to job pipelines • Inside Up - connect frontline workers to pathways for career advancement within the institution

15. Business Case and Short-term Impacts of Inclusive, Local Hiring  • Reduce employee turnover rates • Advance a more diverse and inclusive workforce that mirrors the community it serves • Create economic opportunities for local residents with barriers to employment and advancement • Leverage public resources by linking existing workforce development dollars to employer demand

16. Business Case and Long-term Impacts of Inclusive, Local Hiring  • Gain new savings and efficiencies in recruitment and training • Improve employee engagement, satisfaction and retention through effective training and career pathways • Develop stronger community connections to build a reputation of trust • Reduce the carbon footprint by increasing the number of employees living close to work

17. Key Strategies for Outside-In • Partner with and strengthen the capacities of workforce intermediaries • Utilize a cohort training model focused on specific positions, and set aside positions for cohort graduates • Develop a paid internship program with pathways to hire • Involve hiring managers in the training process

18. Key Strategies for Inside-Up • Offer job coaching and mentoring for new hires to map potential career pathways • Provide tuition assistance to support frontline employees in gaining new skills • Partner with local educational institutions and community organizations to develop advancement programs • Locate training programs on site

19. CASE STUDY University Hospitals Cleveland, OH University Hospitals focuses their workforce development initiatives on connecting community residents to jobs, and then to career ladders within the institution.

20. CASE STUDY University Hospitals Key Strategies: Positions of Focus: Environmental services Nutrition services Patient care assistant Operating room assistant Medical assistant • Designate geographic focus in high-poverty neighborhoods • Set aside positions for cohort graduates • Offer job coaching for new hires • Partner with local community organizations • Provide tuition assistance

21. CASE STUDY University Hospitals Impact: Positions of Focus: Environmental services Nutrition services Patient care assistant Operating room assistant Medical assistant • 111 hires in 2.5 years • Reduced interview to hire ratio for recruiters • 1-year retention rate at 80% for pipeline graduates, compared with 66% overall

22. CASE STUDY University Hospitals How is this work structured? • Staffing for the Step Up to UH and career pathway programs involves both organizational development and learning and talent acquisition • One point person connects human resources hiring and the community-based organization • Hiring managers participate at the departmental level

23. CASE STUDY University Hospitals

24. Inclusive, Local Sourcing Direct your institution’s everyday spending to support inclusive local businesses and uplift the community

25. Inclusive, Local Sourcing • Health systems nationwide spend $342 billion on goods and services annually, but less than 2 percent of that is directed at locally, minority, or women-owned businesses. • Shifting this spend is a powerful way we can improve community health by addressing racial and economic inequities.

26. Inclusive, Local Sourcing • Creating Connections - connecting existing local and diverse vendors to contracting opportunities within your institution • Building Capacity - building up the ability of the local business community to meet health system supply chain needs

27. Business Case and Short-term Impacts of Local Sourcing • Align sustainability, diversity, community health and community benefit priorities • Address supply chain needs and gaps • Connect existing local and diverse vendors to contracting opportunities • Leverage existing philanthropic and public funds to fund vendor development

28. Business Case and Long-term Impacts of Local Sourcing • Create more efficient and resilient supply chain • Save costs from new contracting opportunities • Facilitate job creation, which increases access to health insurance and reduces unemployment • Local spending has a multiplier effect that can increase local economic activity beyond the one purchase

29. Strategies for Getting Started • Embed local and diverse sourcing goals into RFPs & contracting processes • Unbundle contracts and carve out opportunities for new diverse and local vendors • Leverage long-term contracts with distributors, aggregations, and contractors to achieve procurement goals • Leverage upcoming construction and capital expansion projects

30. CASE STUDY Cleveland Clinic Cleveland, OH Cleveland Clinic works with existing vendors to facilitate a mentor-protégé program and has supported the creation of a network of local employee-owned businesses.

31. CASE STUDY Cleveland Clinic Areas of focus: Construction spend Sub-contracting with local MWBEs and employee-owned business Key Strategies: • Provide technical assistance and capacity-building training • Shifted contract for the operations of its laundry facility to a local, employee-owned business cooperative • Leverage large capital projects • Leverage contracts with large vendors and GPOs

32. CASE STUDY Cleveland Clinic Impact: • Cleveland Clinic’s support for the Evergreen Cooperatives, a network of start-up, community-owned businesses, enabled a major expansion of the Cooperative’s laundry in 2018, creating 100 local jobs and allowing employees to build wealth by sharing business ownership in the hospital's supply chain.

33. CASE STUDY Cleveland Clinic

34. Place-based Investing Align your institution’s financial and operational resources to address the upstream economic determinants of poor health

35. Place-based Investing • Place-Based Investment: Designate a percentage of investible assets to make local investments • Upstream Community Benefit: Address community health needs by allocating discretionary operating dollars to sustainable solutions that address economic, racial or environmental resource disparities

36. Business Case and Short-term Impacts of Place-based Investing • Further align capital with sustainability, diversity and inclusion, and community benefit priorities • Achieve a more diversified and impactful investment portfolio • Maintain a sustainable rate of return • Improve financial sustainability of community partners

37. Long-term Impacts of Place-based Investing Place-based investing creates healthy and thriving communities by increasing available capital for positive social, economic, or environmental impact across a wide range of areas: • Supporting local and diverse business development • Empowering low-income people to create, manage, and own enterprises • Addressing lack of access to affordable and nutritious food • Addressing housing affordability

38. Strategies for Getting Started • Shift deposits of cash and cash equivalents to local community banks and credit intermediaries that provide key financial services and resources to underserved communities • Invest in low-risk, fixed income products offered by community development financial intermediaries (CDFIs) • Over time, we can take an integrated capital approach to maximize local impact by coordinating investments across asset classes with grants, technical assistance, and other supports

39. CASE STUDY Bon Secours Health System Headquartered in Marriottsville, MD The goal of the program is to make impact investments with institutions and/or projects to promote access to jobs, housing, food, education and healthcare for low-income and/or minority communities

40. CASE STUDY Bon Secours Health System Fund Size: Focus Areas: Affordable food Housing affordability Local and small business development Other financial intermediaries that serve Bon Secours’ communities • $34 million to date (2.5% of long term reserves, with goal of 5%) Key Strategies/Investment Vehicles: • Intermediary investment (CDFIs) • Internal green revolving loan fund • Align community benefit with place-based investing strategies • Cash and cash equivalent assets into local banks and credit unions

41. CASE STUDY Bon Secours Health System How is this work structured? • The program primarily works with financial intermediaries. • Management selects and monitors investments, with Community Benefit identifying potential opportunities and Treasury providing due diligence. • Two staff members contribute time to managing community investments. After initial setup, operating the program has required significantly less time.

42. CASE STUDY Bon Secours/Enterprise Housing in Baltimore Over 800 units of affordable housing for seniors and low income residents across 11 developments

43. CASE STUDY Bon Secours in Richmond, VA In 2016, Bon Secours donated $140,000 from its annual cycle of community benefit funds to support efforts by the Maggie Walker Community Land Trust to acquire and develop four permanently affordable housing properties in the Church Hill neighborhood of Richmond.

44. An Anchor Strategy Benefits our Facilities  • Improve patient quality of care & lower hospital readmission rates • Improve employee engagement and satisfaction through stronger community connections • Further align capital with sustainability, diversity and inclusion, and community benefit priorities • Positionour institutionforthelong-termshiftfrom“volumetovalue”

45. Benefits our Community Relations  • Define a new role for our institution as a leader in advancing the way towards healthy communities • Create more meaningful connections with our community to build reputation of trust • Improve/strengthen relations with local government by being a more effective partner, job creator and catalyst for equitable economic development • Collaborate with other place-based anchor institutions

46. Benefits our Patients • Build community wealth • Expand access to affordable fresh food, affordable housing • Narrow health inequities by addressing the social, economic, and environmental factors that contribute to poor health outcomes and shortened lives

47. Improving health outcomes is our purpose To deliver on our mission and thrive as an institution, our communities have to thrive as well. Our future as a healthcare institution and the health and economic wellbeing of the community we serve are inextricably linked.

48. Collectively, we will make an impact nationally too