UC Berkeley

The introduction of the IRS Form 990 Schedule H and the 2010 Patient Protection and Affordable and Care Act (ACA) has challenged not-for-profit (NFP) health systems and hospitals to reassess the charitable practices that afford them tax-exemption. Many NFP health systems have been prompted to reexamine their roles, contributions, and impact in the communities they serve. These organizations have begun to explore alternative means to plan and strategically provide community benefit. As the regulatory landscape changes, the decision-making of leadership around community engagement may call for more transparent community engagement and efficient strategies that target specified needs. This will ultimately affect the goals and types of partnerships that are formed with various community stakeholders.

This research examines how large not-for-profit health care delivery systems establish partnerships aimed to improve community health. It is an exploratory project that examines the types of partnerships that these organizations engage in at system and hospital levels to affect the social and environmental conditions of their communities. Case studies were built around three different types of partnerships implemented by NFP health systems and hospitals through their projects and programs with community stakeholders. Each case study analyzed what took place before and while NFP health providers implemented partnerships directed toward community health. Through cross-case analysis, the degree to which principles of community-based public health and corporate social responsibility factor into the form, structure, and purposes of those partnerships were assessed.

Based on qualitative and quantitative data, four key characteristics were found to be consistent across the three partnership strategies examined. The findings emphasize the importance of purposeful strategic planning that is aligned with an organization's mission and responsive to its market environments. They also highlight the value of stakeholder engagement that is flexible, empowered, and sustained. I explore the implications of these findings in the context of the evolving policy and market landscapes shaped by new requirements of the IRS and the Affordable Care Act.