Making the grade: Why it’s so difficult to make the Lown Hospitals Index Honor Roll

Since 2020, the Lown Institute has published the Lown Hospitals Index, a unique ranking of social responsibility that takes into account not only patient outcomes but also value of care and health equity.

Hospitals that perform exceptionally on all three categories (outcomes, value, and equity) receive Honor Roll designation on the Lown Index. This year, out of 2,718 acute care hospitals, 123 made the Honor Roll; out of 900 critical access hospitals, 37 made the Honor Roll; and out of 331 systems, 11 made the honor roll. That’s less than 5% of hospitals or systems ranked.

Why it’s hard to get all “A” grades

Why is it so rare for hospitals to get on the Honor Roll? Hospitals are expected to deliver great patient outcomes, and are rewarded for achieving quality benchmarks such as avoiding readmissions. However, our health system has fewer incentives for achieving goals around value and equity. Although value-based payments are increasingly prevalent, most healthcare payments are still provided through a “fee-for-service” model, in which hospitals are paid more for doing more.

There are also few incentives for hospitals to achieve equity goals, such as giving more in financial assistance and paying CEOs moderately. In fact, the more uninsured and publicly-insured patients hospitals care for, the less revenue they make, due to differences in reimbursement rates between public and private insurers. Hospitals that do well on outcomes, value, and equity have to swim upstream to prioritize aims that are not always rewarded in our current system.

Hospitals that make the grade

What do we know about hospitals that make the Honor Roll? They are more likely to be nonprofit hospitals, although not exclusively. Many of the Honor Roll hospitals have a history of caring for communities of color and underserved patients. Some are “integrated” systems with their own insurance arm, which means they take on some of the cost of paying for care. Many have partnerships or affiliations with universities, which builds a pipeline for new clinicians.

Want to learn more about the Honor Roll hospitals? We spoke with hospital leaders about how they clear this high bar — watch the video recording! And check out our conversation with hospitals CEOs from the LOWN26 conference on how they are achieving their social responsibility goals in challenging times.