Making an impact: CHE Trinity Health

How the system leverages community investment for population health

In this regular series, Graham McLaughlin, the director of the Advisory Board's Community Impact program, sits down with partners doing exceptional work within their organization and in the community.

McLaughlin sat down with James Bosscher, Senior Vice President of Treasury and Chief Investment Officer of CHE Trinity Health, and Tonya Wells, Trinity's Vice President of Federal Public Policy & Advocacy, to discuss how they turn their organization's mission-based goals into a reality. This interview was condensed and edited by Justyn Kopack, senior editor.

Question: Jim, your ability to leverage CHE Trinity Health's resources and market power to drive positive "triple bottom line" outcomes has resulted in some incredible work over the past dozen years. What mindset is needed—personally and organizationally—for this approach to be a true lever for good, rather than just a way to generate financial return?

Bosscher: I came to Trinity from Ford Motor Company about 12 years ago because it was, and still is, a highly performing organization doing great things from a clinical standpoint. I knew those fundamentals would provide a great platform to leverage treasury functions to drive positive good.

However, the most important reason that I came—and why I’ve stayed—is that the values of Trinity Health align so clearly with my personal values. It's immensely satisfying to see what our teams have made happen in our respective communities.

Q: What did socially responsible investing look like at Trinity when you arrived?

Bosscher: I was fortunate to start with a solid base. I inherited a firm commitment to a socially responsible investing program, both community investing and shareholder advocacy.

At the time, we had a few million dollars for CDFIs [community development financial institutions] to provide cost-effective funding for organizations within our footprint and mission—things like affordable housing access and microdevelopment, day care facilities. We didn’t use the term at the time, but basically anything improving the social determinants of health in a community.

Q: That’s a great situation to come into. How has it grown since then?

Bosscher: In the dozen years since then, we’ve increased these community investments to $35 million annually.

One example is the addition of clinical scholarship programs, which are meritocratically and needs-based. This not only enhances the diversity of backgrounds and viewpoints among incoming clinicians, but the programs have helped us develop deeper relationships between our hospitals and the surrounding universities. We've also developed a high-quality clinician pipeline of individuals who want to go back and serve their home communities.

What a balanced TBL strategy looks like

 

Q: How do your investments in traditional equities fit into the triple bottom line approach?

“We purposely own all of the Fortune 500 stocks... so that we can dialogue with those companies to help drive change in their actions.”

Bosscher: Equities and community investments are equally important levers of impact. We purposely own all of the Fortune 500 stocks, and we don’t filter out any stocks, so that we can dialogue with those companies to help drive change in their actions. Within the larger investment strategy, it shows how we're doing our best to ensure companies make the right decisions for the good of the community, the company itself, and for us as we try to transform health.

Q: How do you keep community investments and equities balanced to maximize financial return and mission-based goals?

Bosscher: We have a number of portfolios, but I'll use the example of our operating fund because it's our largest. When it comes to our operating fund, it’s important to maintain a strong balance sheet and cash flow that can be reinvested back into the organization to ensure we have a high-quality infrastructure of buildings, technology and equipment. At the same time, like everything we do as an organization, those investment decisions are driven by our mission objectives and desire to provide high-value care to people in our communities.

It’s an ongoing challenge to maintain that balance. It really starts at board level. Our board of directors has been extraordinarily supportive and is fully behind these activities.

Wells: Building on Jim's points around board support and mission focus, CHE Trinity Health's mission and core values provide the connecting threads between the way we engage in shareholder activism and our community investing. If you read our founding principles, you can see very specific language that connects exactly to the work we’re doing. The basis for this work comes from who we’ve defined ourselves to be as an organization.

Getting results through shareholder advocacy

 

Q: Do corporations really change their strategy based on your activism? How do you ensure your advocacy is effective?

Bosscher: Corporations do change based on the advocacy of shareholders. I've seen our efforts work.

One of the main reasons we're effective is that our shareholder advocacy happens in a collaborative fashion with the Interfaith Center for Corporate Responsibility (ICCR), in which we play an active role. Members of ICCR work together to establish a number of advocacy priorities, and then individual members fulfill lead or support roles in establishing dialogues on the prioritized issues with the identified companies.

Q: Can you provide some examples of successful shareholder advocacy?

Bosscher: Our impact ranges from encouraging pharmaceutical companies to reduce pricing on products that address AIDS and other health crises in Africa, to working with the entertainment industry to keep smoking out of youth-rated films and ensuring retailer compliance with video-game rating restrictions.

The common objective is to get these companies to recognize the intersection of the best interest of people and communities and their own best interest. It’s an ongoing effort, but we are seeing a high degree of success.

Wells: Human rights and anti-human trafficking efforts are also focus areas. For example, we've worked with hotels, airlines and other businesses in the travel industry to help their employees learn how to identify and report suspected human trafficking situations.

Leveraging community investment for population health

 

Q: Let's shift focus a bit and talk about what community investment looks like on the ground when this all comes together. A great example is the Joy-Southfield Community Development Corporation (CDC), on the west side of Detroit, for which CHE Trinity Health provides a number of supports. Jim, I know your connection with the Joy-Southfield clinic also extends to the personal level, as it grew out of a mentorship program you started over 20 years ago. How has it developed over the years?

Bosscher: When the clinic opened in the early 2000s, it provided limited primary and preventive care once a month. Twelve years later, it has morphed into a highly functioning organization with a 3,900 square foot building that provides health care on one side and services addressing (non-medical) social determinants of health on the other.

Q: How has CHE Trinity Health's involvement helped "drive positive good" at the clinic, to use your phrase?

Bosscher: Partnering with local CHE Trinity Health hospitals has helped address resource challenges involved with this holistic approach, enabling the clinic to provide better care. We were able to move to quickly to provide a myriad of “win-win” supports, from access to grants, to furniture that would otherwise be disposed of. One hospital provided $25,000 worth of laboratory assistance. We even have a number of our executives sitting on various committees to ensure a sustainable, mutually beneficial relationship.

More recently, we've been able to quadruple the effectiveness of the effort by partnering with a local FQHC (federally qualified health center) and transitioning the provision of clinical care to this organization. The clinic can now offer urgent care as well as clinical, mental, and dental health services while, at the same, the Joy-Southfield can more intentionally address social determinants of health.

The program has been well-recognized by a number of entities as extremely creative, and our plan is to continue to grow and also to replicate it.

Q: What do the larger transformations in health care today mean for community investment like the clinic?

Bosscher: As a free clinic in the midst of changes brought on by the ACA, we’ve emphasized things like access to healthy foods, working with the community to decrease the level of violence and increase the opportunities for exercise. We even have a program now that will help create parks in the area.

I’m proud of what we’ve done so far, but I think we’re still on the threshold of having major impact in our communities. With the changing reimbursement landscape and new expectations for population health management, we’re going to need to work with stakeholders across each community much more effectively.

Wells: There’s no better time for the community investing work we’ve done to become more integrated with this work. Population health management gives us the opportunity to work with other partners in the community in a way that leverages our resources most effectively and help individual hospitals optimize their local relationships to better meet community needs. That deep understanding will help them make a transformative difference in the health of their communities.

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