Monday, July 6, 2009

Should Health Plans Spend Money on Community Service?

A couple of weeks ago I received the 2008 Annual Report from Harvard Pilgrim Health Care, the health plan at which I direct the ethics program. The theme of this year's report is "making our communities healthier." It describes the wide range of community activities Harvard Pilgrim funds through its Foundation and the community service done by staff, individually and in teams.

It's an excellent report (it's OK for me to praise it - I had nothing to do with writing it), but I'm not going to summarize it here. But the report got me thinking about whether in our wildly overexpensive health care system it makes sense for health organizations to spend money on anything other than their basic function.

It's easy to be cynical about corporate social responsibility programs. It's still possible to find material on the web about the Enron Foundation. Every company involved in the bailout that I've looked up has an impressive corporate responsibility statement. The wolf probably told Little Red Riding Hood - "Trust me - I'm with the corporate social responsibility program!" If community investment didn't pay off for publicly owned companies stockholders would demand that the community dollars go into dividends.

But for health organizations I think programs like the one at Harvard Pilgrim are tremendously valuable. Well planned investments, whether of money or human effort, can produce direct benefits in the community. But for a health plan, getting a lot of staff involved in hands on service strengthens the soul of the organization. It's so easy to get caught up in the organizational silo we live in that we lose sight of the human realities that health organizations serve. This is just as true in a Medicaid or Medicare office as in a private insurance company. And if God organized her angels into a corporate structure the same dynamic would probably apply.

Health organizations are specialized, but individual people and our communities aren't. For five years I was part of a board most of whose members had serious psychiatric disorders. I'd treated folks like the board members for all of my clinical career. But seeing them in a setting where we were fellow board members, working on common interests and chatting about our lives before and after the meetings, made me a better psychiatrist and, I hope, a wiser human being.

Well chosen corporate philanthropy is good public relations. That may strengthen the corporation's external image, but it doesn't make it a better version of what it's supposed to be. But involving members of the corporation in activities that evince the values the corporation is created to serve strengthens the "human capital" of the organization. Done right these activities have a direct impact on the community. But the impact on the corporation's culture and values lead to carrying out the basic health-related function better. I can't prove it, but I know it's true!

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