Measuring the Health Impact of the Conversion

It is critical to determine the potential long-term effects on the community’s health care delivery system before the conversion is approved in order for both the community and the regulators to fully understand the conversion’s impact. Will a proposed hospital conversion result in the loss to the community of an essential emergency room or specialty clinic? Would a health plan conversion have a disproportionate impact on the state’s Medicaid population? One option is to commission a health impact study. By reviewing such factors as the health care needs of the community, the inpatient and outpatient service usage, the unique services provided at the facility and any demographic trends, your hospital’s role in the community and the impact of a sale or conversion can be better evaluated. Even if your state law does not require a health impact statement to be conducted, it is still possible for you to advocate for one.

Review the conversion application to determine if the new for-profit owner has made any written promise to continue services, or mitigate any negative health impact. Ask the regulators to place conditions on the sale or conversion to ensure that needed health services are protected.

What You Can Do:

• If the converting entity is a hospital, request that the available beds in the converting hospital and in the service area be evaluated along with expected demographic changes.
• Also, request an assessment of the community’s health care needs and a comprehensive evaluation on the hospital’s:
• number of patient days, broken down by payer (particularly Medicaid and other state or local programs providing care to the indigent population) annually for the last five years;
• number of hospital discharges, broken down by payer annually for the last five years;
• number of emergency services visits annually for the last five years;
• number of outpatient visits annually for the last five years;
• provision of charity care annually for the last five years; and
• unique services (such as emergency room, obstetrics, burn unit) offered at the facility.
• In the case of a conversion of a nonprofit health plan, assess the impact the transaction would have on accessible, affordable, quality health care for consumers.
• Does the proposed business plan of the for-profit insurer adequately address the health care needs of the community?
• How will the conversion impact health care specifically for vulnerable populations such as children, seniors, and people with disabilities, low income families, people with HIV and people with chronic illnesses?
• Does the conversion include a plan to provide affordable and accessible services and products that will meet the community's needs?

For a complete discussion, check out this publication written by Community Catalyst: “Looking at the Full Picture: Analyzing the Community Health Impact of Hospital and Insurer Transactions” (PDF)

Sample Health Impact Statements

Proposed Premera Blue Cross Conversion

Premera Conversion Study 1 (PDF)
Premera Supplemental Report –Aaron Katz (PDF)
Price Waterhouse Economic Analysis (PDF)

Proposed St. Luke’s Conversion

Press Release (PDF)
Impact Statement- St. Luke’s (PDF)