Nonprofit hospitals are required to meet their tax exempt, charitable obligations through the provision of services and activities to underserved populations under the general title of community benefit (CB). Health reform and associated stimulus funding will influence future CB programming in numerous ways, including:

1. Reduced demand for uncompensated care increased near term service demand for previously uninsured events,
2. Emergence of new incentives to promote health and wellness on a population basis though coordinated efforts of multiple stakeholders including health departments, schools and worksites
3. Mandates for comparative effectiveness assessments of various procedures and tools
4. Increased use of off-site hospital, coordinative care facilities such as medical homes to help “avoid unnecessary care,” \
5. And shifting the focus of community benefit requirements to emphasize investment in primary prevention.

We propose to demonstrate ways that resetting community benefits programming via regional analysis and mapping of health care utilization, health and social determinant databases will provide an evidence base for collaborative planning and shared investment among stakeholders to address both the symptoms and underlying causes of persistent health problems. Along the way, we will determine the resource requirements to attain those benefits, and identify indicators and outcomes to demonstrate their value for replication in other sites. Uniquely, under the demonstration, epidemiologists will be imbedded within a local health department or hospital planning council to help amass, maintain, analysis and display multi-sourced “standardized” information to continuously support and improve shared community benefits planning. We focus on roles hospitals can play to redefine collaborative approaches to both meet CB requirements and help “bend the cost curve” in health care finance and delivery.

We will organize, test, cost and evaluate initiatives in San Francisco and Dallas through direct monitoring of baseline and subsequent levels of health services use (primarily measuring ambulatory sensitive conditions frequency of use changes) observing influences these interventions might play in modifying local area physical and behavioral characteristics and determinants. We will also help formulate more informed targeting strategies to fulfill unmet needs. We expand the use of frameworks developed and implemented in 100s of hospitals under The Advancing the State of the Art in Community Benefit (ASACB) Demonstration of the Public Health Institute. We will broker technical assistance derived from the field research to diffuse best practices, so that communities and hospitals throughout the US can fast track toward scalable, sustainable programming relevant to their unique constituents and circumstances.