Providers in Billings, Mont., came together more than 20 years ago to collaborate for a healthier community in what the AHA has described as an example of a “second generation” strategy for improving population health.

Billings Clinic, St. Vincent Healthcare and RiverStone Health – the local health department for Montana’s Yellowstone County, created the Healthy By Design community health-improvement initiative. It’s a “community coalition that is focused on making the healthy choice the easy choice” for the roughly 154,000 residents of Yellowstone County, says the program's community health improvement manager Heather Fink.

healthy-by-designIt grew out of an affiliated partnership called the Alliance, which was formed in 2001 by the CEOs of Billings Clinic, St. Vincent Healthcare and RiverStone Health to promote a culture of wellness throughout the county.

A recent AHA report, “Next Generation of Community Health,” points to Healthy By Design as an example of how hospitals and health systems can “take community health to the next level.” Partnering with hospitals and other health care organizations – the framework for Healthy By Design – “deepens the roots of access and understanding of community needs,” the report says. “It broadens the scope of activities in which a hospital can engage and strengthens the ability to sustain work in priority areas.”      

Billings, the largest city in Montana and the seat of Yellowstone County, is home to about 105,000 residents and a regional hub for health care services. Billings Clinic and St. Vincent Healthcare – Yellowstone County’s largest employers – offer a wide range of services and oversee facilities and clinics scattered across the county and state.

“Obviously we are going to compete, but we keep an eye open for collaboration where it makes sense to rally the forces together and see what we can do collectively,” says Luke Kobold, Billings Clinic’s director of strategic planning.

An early success of the Alliance was the opening of a “Community Crisis Center” in 2007 when Billings was lurching toward a mental health care crisis. The center reduced emergency department crowding at Billings Clinic and St. Vincent Healthcare – a key goal because the hospitals often did not have enough beds or doctors to treat the numbers of people who arrived with mental health and substance abuse problems.

The center also eased crowding at the county jail, which had been filled with homeless mentally ill people picked up on the streets for loitering and other misdemeanors. They were more in need of mental health and substance abuse treatment than incarceration.

Healthy By Design’s comprehensive community health needs assessments help it to identify issues of concern, align resources and bring together a broad range of agencies and community stakeholders to tackle the problem.

“We want to create lasting change and understand how we can have that long-term impact,” says Fink, whose position is funded by the three key partners.   

One example of that long-term impact is “Complete Streets,” the coalition’s work to foster healthier lifestyles and a healthier environment in Yellowstone County by creating a more walkable, bikeable community. The county has adopted bike lanes, sidewalks and bus lane accommodations that Fink says increases safety for bicyclists and pedestrians and encourages a healthier community, while improving quality of life.

“The Complete Streets policy shows how we can make streets more accessible to our residents and allow for easier transportation and for all modes of transportation,” she says.

healthy-by-design“Ten or so years ago we wanted to focus on more long-term sustainable policies and environmental change strategies,” says Tracy Neary, St. Vincent Healthcare’s vice president of mission integration. “After a couple of needs assessment cycles, we said ‘let’s dive all in’ and Complete Streets was one of those early efforts to transition from programmatic interventions to longer-term policies.”

Another initiative is a gardener’s market in a federally recognized food desert. The market offers public health and nutrition assistance and education, in addition to the weekly produce.

The coalition has implemented the 5-2-1-0 healthy living program that challenges residents to have five or more fruits and vegetables each day, two hours or less of recreational screen time, an hour each day of physical activity and zero sugary drinks. It also holds healthy living classes that focus on daily activities and recognize healthy community events.

The two hospitals’ large economic and health care presence in the county “opens a lot more doors to conversations” about improving community health, Kobold says. “It is powerful when there is a shared voice.”

Adds Neary: “From that formal agreement of the Alliance at the senior executive level down to front line staff, we have built trusted relationships. We have a history of working together through difficult discussions and sharing a vision of what we can accomplish together.”