Medicaid and the Middle Class

Community Benefits Reporting

What is community benefits reporting?

HMOs and/or hospitals file an annual report on the public health benefits they provide to the broader community they serve. They assess the health care needs of the communities they serve, identify targets for assistance, and develop programs to address those needs. Reports include program descriptions, levels of spending, and an evaluation of the program’s impact. HMOs and hospitals are asked to substantively involve the community in the needs assessment, choice of target, program development and evaluation.

What kinds of programs are included in the reports?

Typical programs include AIDS prevention programs, free immunizations, health screenings, early childhood intervention efforts, domestic violence awareness initiatives, reduced premiums for the uninsured, teen counseling, and substance abuse prevention programs. Report summaries identify best practices in public health programs as well as data collection, community health assessment, program evaluation and effective mechanisms to elicit community involvement in health planning.

Which other states have community benefits reporting?

Massachusetts is the most advanced in community benefit reporting. Last year, HMOs and hospitals reported spending $6.8 and $286.6 million, respectively, on benefits to Massachusetts communities. Reporting is voluntary but all institutions comply. Reporting has led some HMOs without programs to establish community benefits programs and helped others to tailor their assistance to maximize effectiveness with limited dollars. Reporting has also improved the relationship between the institutions and their communities. Nine other states also have community benefit reporting by either HMOs and/or hospitals.

Which CT HMOs report in Massachusetts?

Aetna, CIGNA, ConnectiCare, Healthsource and Kaiser/CHP all file community benefit reports in Massachusetts and operate in Connecticut.

What are the benefits to CT of reporting?

Prevention programs designed to address identified health care needs will improve the health of all CT residents. This will improve the quality of life in CT and reduce costs of health care for all payers, including the state. Community involvement in health care policy planning will lead to better integration with existing programs, reducing duplication and ensuring community commitment to the success of the program. Best practices will be identified to improve service delivery into the future.

For questions, call Rep. Vickie Nardello 240-8661