Researchers Analyze a Bold “Anchor Strategy” to Enhance Community Health and Wealth

A team of healthcare researchers has analyzed a population health management strategy that has a community connection at the core of its strategy, and shared that analysis in a “Perspective” op-ed published online last month in The New England Journal of Medicine.

David A. Ansell, M.D., M.P.H., Kaitlyn Fruin, M.D., Redia Holman, Ayesha Jaco, M.A.M., Bich Ha Pham, M.D., and David Zuckerman, M.P.P., have written the article, “The Anchor Strategy—A Place-Based Business Approach for Health Equity.” The article’s authors are affiliated with the Department of Internal Medicine at Rush University System for Health (David Ansell); the Care Management Program at Rush (Redia Holman); West Side United (Ayesha Jaco); the Department of Internal Medicine, Ronald Reagan UCLA Medical Center, Los Angeles (Kaitlyn Fruin); and the Healthcare Anchor Network, Washington, DC (Bich Ha Pham, David, Zuckerman).

They write that, “In 2016, Rush University System for Health, an academic health system in Chicago, adopted an anchor strategy to tackle the 16-year life-expectancy gap between Chicago’s West Side and the Loop. An anchor strategy is a place-based business approach to building community health and wealth by means of local hiring, investing, purchasing, and community engagement. The concept was first articulated by the Aspen Institute in 2001 with a focus on the community-building potential of universities but has recently gained momentum in health care. Among the largest property owners, employers, and purchasers in their regions, anchor health and educational institutions can stimulate local economic growth using their everyday business practices.”

Further, “In Rush’s case, a 2016–2019 Community Health Needs Assessment (CHNA) illuminated deep-seated structural racial health inequities that required efforts beyond traditional health care delivery and community engagement. We identified structural racism and economic deprivation as among the root causes of neighborhood life-expectancy gaps and in 2017 launched the anchor strategy to leverage Rush’s position as a large business in addressing these social drivers of population health. Later in 2017, Rush and 10 other health care systems joined the Democracy Collaborative, an economic-development think tank, to launch the national Healthcare Anchor Network (HAN). HAN is an independent 501(c)(3) organization that now has 75 health care system members; these members collectively spend more than $150 billion per year, purchase $75 billion worth of goods and services per year, hold investment portfolios totaling more than $500 billion, and employ more than 2 million people.”

As the article’s authors note, “Rush’s anchor strategy offers an evolving case study in place-based population health investments.2,3 An internal anchor-strategy committee comprising leaders from human resources, finance, construction, community engagement, and supply-chain operations sets annual targets for local hiring, participation in career pathways, investing, purchasing, and volunteering, all of which are included in a corporate dashboard. We decided that a critical step in this strategy was to designate employees, many of whom live in West Side neighborhoods, as the “first community.” We conducted internal ‘listening sessions’ and created a West Side employee resource group so that employees could inform the initiatives.”

Internal analyses showed that employees living in neighborhoods with low life expectancy had the highest rates of financial distress, as measured by lack of full participation in the 403(b) retirement plan, by emergency withdrawals from their retirement accounts to address such problems as evictions, or by garnishment of wages. As a result, the authors note, efforts to improve wealth-building among Rush employees included the creation of new career pathways and pension reforms that resulted in a 46-percentage-point increase in the proportion of employees with the highest level of 403(b) matching.

Further, “In 2018, Rush was joined by 5 other health systems — AMITA (now Ascension) Health, Cook County Health, Lurie Children’s Hospital of Chicago, Sinai Chicago, and University of Illinois Health — to establish West Side United (WSU), a racial-equity collaborative aligning investments in economic development, education, health care, and the built environment to benefit Chicago’s 500,000 West Side residents. The combined assets of these health care anchors are larger than those of any Illinois corporation and create potential for major collective impact. Under the umbrella of WSU, the 6 health systems conducted “listening tours” to identify and prioritize community needs. Community leaders sit on an executive leadership council that has equal representation from the community and the hospitals. Ongoing input is obtained through regular community meetings.”

The two biggest challenges to the anchor-strategy movement, the authors note, involve funding and outcome measurement. Nevertheless, they point out, despite the challenges involved, “[A]n anchor strategy can be an effective healthcare institution approach to address place-based, racial, economic, and other structural inequities that drive population health and wealth.”