The Lown Institute Hospitals Index – Evaluating Hospitals on What Matters

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The coronavirus pandemic has made clear the importance of high-quality hospitals for the health of communities, particularly communities of color and low-income communities. The pandemic has also exposed areas in serious need of improvement if hospitals are to equitably deliver the high-quality care that is essential to improving community health. Assessing how well hospitals are currently serving all their patients and communities is a key first step in improving their quality of care.

The Lown Institute, a think tank generating ideas for a just and caring system for health, has developed a tool to answer the question, “Are hospitals providing high-value care, achieving excellent patient outcomes, and meeting their obligation to advance health equity in their communities?” The Lown Institute Hospitals Index, is a novel way of evaluating and ranking hospitals in order to help them better serve their patients and communities, and to hold them accountable to addressing social determinants of health.

What Makes the Lown Index Different from Other Rankings?

National hospital rankings are typically based solely on patient outcomes and process of care. The Lown Index goes beyond this by also taking into account factors directly related to the hospital’s impact on its community. The Index is the first hospital ranking to evaluate how well hospitals serve people of lower income or education level, and people of color. It is also the first hospital ranking to consider the amount hospitals spend on community benefits, which are services and activities nonprofit hospitals support to improve the health of the communities they serve in order to maintain their tax-exempt status. By including these broader factors, the Index ranks hospitals not just on individual patient outcomes, but on hospitals’ efforts to promote health equity.

How Does the Lown Index Rank Hospitals?

The Index gives hospitals a composite score based on three categories, seven sub-components, and 42 detailed metrics, in order to provide a holistic ranking of hospital performance. The three categories are patient outcomes, value of care and civic leadership.

Patient Outcomes

Similar to other hospital rankings, the Index does take into account patient clinical outcomes, patient safety and patient satisfaction. These components evaluate a hospital’s performance as it relates to its patients’ health and experience of care. It includes measurements of readmission rates, avoidance of preventable patient safety errors, and hospital experience as reported by patients. The Lown Index, however, sets itself apart by looking beyond patient outcomes and including community health improvement in the rest of its scoring process.

Value of Care  

The value of care category assesses how well a hospital avoids the overuse of particular health care services that are medically unnecessary, provide no health benefits to patients, and contribute to financial waste and oftentimes needless patient suffering. The United States spends an estimated $345 billion annually on these services, commonly referred to as low-value care. The Index specifically looks at hospitals’ rates of overuse of 13 commonly overused medical services which have been shown in clinical trials to offer no benefit and are financially wasteful.

Civic Leadership

The Index also assesses civic leadership, a metric which combines assessments of pay equity, community benefit spending and inclusivity. The pay equity component measures the difference in compensation of hospital executives compared to health care workers without advanced degrees in the organization. The community benefit component measures how much hospitals invest in community health compared to their total expenditures. It also measures the proportion of low-income patients served, which is based on hospital patient revenue from Medicaid. Inclusivity is evaluated based on the extent to which a hospital’s patient population reflects the demographics of the community in which it is located (i.e., race, income, education level).

Hospitals are vital community institutions. They play a pivotal role in the health and well-being of their communities. They should strive not only to achieve excellent outcomes for their patients, but to provide meaningful services that promote the health of community members and reduce long-standing inequities. As an innovative new tool, the Lown Institute Hospitals Index can help hospitals – and their communities – measure what matters for overall community health and use this data to drive decision-making and improvement efforts.

At the Center, we work with partners on the frontline of new approaches to health care that can better meet the needs of every community, particularly people with complex health and social needs and historically excluded populations. Evaluating hospitals on how well they serve these populations is critical to advancing data-driven improvements to address health equity, and we welcome the introduction of this valuable new tool.