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The one major metric missing from ‘Best Hospital’ rankings

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When it comes to “Best Hospital” rankings, there’s one key metric that’s historically been missing from the equation: equity.

Kyu Rhee, IBM vice president and chief health officer, said that in a study the company conducted comparing all of the rankings—including IBM’s own—there were no individual measures that considered the work hospitals do to mitigate disparities in care and outcomes. 

But that could soon change. COVID-19 is shining a light not just on infectious disease but also mental illness, chronic illness, and inequities, Rhee said. “This is a visibility moment,” Rhee explained during a Fortune Brainstorm Health virtual conversation on Thursday. These issues are “becoming more accentuated with COVID,” making this a key moment to rethink and reinvent hospital and health systems and “what measures matter,” he said.

The pandemic is not the only factor sparking this new line of thinking, said Josh Sharfstein, vice dean of public health at John Hopkins. “It’s both COVID and the reawakening of the understanding of racism—that crisis, too—that is fueling this,” he said. “This is a moment for every kind of institution in healthcare and beyond, including hospitals, to say what can we do to be part of the solution to the challenges facing this country.”

Sharfstein said the university has been examining what it would take to have hospitals orient their work toward preventing illness in the first place, rather than just taking care of sick patients. It’s a question that John Hopkins Center for Health and Equity has teamed up with IBM Watson Health to help answer. Together they’re working to come up with new metrics that could help assess hospital contributions to community health and equity. 

Rachel Thornton, associate director for policy at Johns Hopkins Center for Health Equity, said some of those metrics include the change in life expectancy and hospitalization trends over time in the hospital’s county. Since hospitals offer a chance to intervene on underlying health issues when a patient is admitted, measurements like tobacco cessation programs, screening for intimate partner violence, and infant safe sleep education are also key.  

Thornton said the new framework also takes into consideration how a hospital partners with local organizations and community-based programs, as well as how it behaves as an employer and economic engine—the diversity of its board and management, the hourly rate it pays employees, whether it provides high-quality affordable child care for workers. 

Thornton said that for every metric, they considered “existing evidence, best practices, and examples of what hospitals are already doing.”

Barbie Robinson, director of the Department of Health Services in Sonoma County, Calif., pointed to her district as a case in point of what happens when hospitals and healthcare systems integrate social determinants of health into their work: “We’re going to achieve reduction in disparities we want to see in the community.” 

Robinson said Sonoma County worked with U.C. Berkeley this past year to examine its most vulnerable population. The findings: 1{ce8ce7cc98bffdc4302011057a79600ea02c464c5536f1477c12acdb8bd79c00} of the county population accounts for 20{ce8ce7cc98bffdc4302011057a79600ea02c464c5536f1477c12acdb8bd79c00} of jail time, 28{ce8ce7cc98bffdc4302011057a79600ea02c464c5536f1477c12acdb8bd79c00} of annual behavioral health costs, and 52{ce8ce7cc98bffdc4302011057a79600ea02c464c5536f1477c12acdb8bd79c00} of nights in housing and shelter provided by homeless providers. She noted that this population is three times more likely to be African-American, even though African-Americans make up only 3{ce8ce7cc98bffdc4302011057a79600ea02c464c5536f1477c12acdb8bd79c00} of Sonoma County. 

Jack Westfall, director of the Robert Graham Center, said one of the barriers to implementing this mode of thinking comes down to financial incentives. He recounted a conversation with a hospital CFO who told him he loved the idea of focusing on community health, “but until population health pays, I need butts in beds. I need people in the hospital.” 

“One of the barriers in my mind is: How do we pay for health in America?” Westfall posited. “How do we shift our thinking to investing early in healthy living?”

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