Community Health Needs Assessments HOSPITAL NAME – PRESENTER NAME - DATE

1. Community Health Needs AssessmentsHOSPITAL NAME – PRESENTER NAME - DATE MHA Member Forum - Sept. 13, 2012

2. Why Are We Here? • Health care is changing, with or without the ACA. However, law requires hospitals to conduct community health needs assessments (CHNAs) to improve community health. • Goals today: review background, process, tools related to completing a CHNA. Answer questions, allow for sharing/discussion. • For CHNAs, tools available through MHA include: • handbook, sample communications documents, FAQs, website, links to regulations and completed assessments

3. What Is a CHNA? • A CHNA is a process by which hospitals must gather information about the health needs of their communities and develop/implement a plan to address those needs. • Effective tax years beginning after March 23, 2012. • Requires implementation strategy to be developed and attached to Form 990. More on reporting later!

4. Why Conduct a CHNA? • The Affordable Care Act requires tax-exempt hospitals to conduct a CHNA at least once every three years. • Goal is to improve community health.

5. Says Who? • Section 9007(a) of the ACA • Broad guidance • IRS Notice 2011-52, released July 2011 • Proposed regulations • IRS/Dept. of Treasury NPRM issued June 2012 • Definition of “hospital facility” for purposes of completing CHNA requirement

6. More about “When” Two important definitions to remember: • “Conducted” (for a CHNA) refers to when the CHNA document is made available to the public (via website). • “Adopted” (for implementation strategy) refers to the date on which the hospital organization’s governing body approves the plan.

7. When, continued • March 23, 2012 effective date. For example, if a hospital’s tax year starts Jan. 1, their first CHNA must be “conducted” no later than Dec. 31 2013. If their tax year starts July 1, their first CHNA is due no later than June 30, 2013. • The first CHNA for <INSERT INDIVIDUAL HOSPITAL NAME> is due <INSERT DATE> • Currently, implementation strategy must be “adopted” in same tax year as CHNA completed. • This must be considered before posting the completed CHNA report online.

8. CB vs CHNA – What’s New? • CHNA must include input from broad representation of community including those with expertise in public health. • Hospital/health system internal process vs community involvement • New regulations require IRS to be notified annually of implementation strategy to address needs. • New reporting requirements and financial penalties.

9. CB Programs as Assets • CHNA is really a process to identify gaps and assets. • Existing community benefit programs should be considered assets. • Existing community benefit resources and programs should be strategically analyzed; how can they help address needs identified via CHNA?

10. CHNA Process: Step by Step Christine Ameen, Ameen Consulting

11. The Definition of CHNA A CHNA is the process of gathering information and feedback about the health status of a community to identify programs and initiatives that will contribute to improved health status. • Information and feedback come from a variety of sources. • Community leaders, the health department, health care providers, residents and other key audiences fully participate in the process. • The process results in identifying unmet or under-met health needs. • The results are used by the nonprofit hospital to develop and implement programs and initiatives that will contribute to improved health status.

12. The Steps: START

13. 1. Plan and Prepare • If possible, hospitals should avoid duplicating efforts and consider partnering to conduct the CHNA. • Identify the community partners to engage • Public health department (s) • Other hospitals • Community Mental Health • Existing health care alliances and groups • FQHCs, free clinics, community-based clinics • Local residents, community leaders, business leaders • Other organizations (e.g., food bank, religious organizations, service groups) • Organize leadership resources • Advisory Group, for overall guidance and oversight • Work Group, for collecting, analyzing and interpreting data • Project Facilitator, to coordinate and lead the process.

14. 2. Determine Scope • Develop a purpose statement • Define the community • Must be defined in the CHNA document • May be based on the home address locations of a set percent of admissions, e.g., 75 percent. • May be defined by a target population, e.g., children • May be defined by a specialty area or targeted disease, e.g., rehabilitation • May be defined along county or zip code area boundaries • Target special populations: must have input from the following groups: • Medically underserved • Low income • Minority populations • Populations with chronic diseases.

15. 3. Gather Data • Use two types of data: • Primary data, such as surveys or interviews, that are collected firsthand • Secondary data that was originally collected by someone else but is pertinent to the CHNA • Must collect data for a Health Resources Inventory: • Current organizations that have some effect on health • Resources needed that are lacking • A brief explanation about how current and needed resources influence the health of community residents • Must collect feedback about health needs from the community: • Primary data via surveys, interviews, focus groups, listening sessions • Secondary data such as census/demographic data, risk factors, health incidence data • Hospital’s utilization data.

16. 4. Analyze and Interpret Data • Analyze primary data: • Quantitative data, e.g., disease prevalence, demographic characteristics, etc. • Qualitative data, e.g., content analysis of responses to open-ended questions • Analyze secondary data: • These data have been analyzed, so the focus is on identifying key findings that are relevant to the CHNA • Use key findings to identify the most pressing concerns or results • Interpret the data: • Compare to a standard • Compare to other results of similar data • Slice the data to look for population differences...

17. 4. Analyze and Interpret Data • Summarize the data: • Description of community participants who gave feedback • Community feedback about needs and adequacy of current health care resources • Gaps in service delivery as evidenced by the Health Resources Inventory • Key findings such as disease prevalence, risk behaviors • Key findings about the needs of special populations, especially the medically underserved, low income, minority groups and those with chronic diseases • The facts about social, economic and environmental conditions within the community that impact health outcomes of the community • Produce the “Summary of CHNA Findings” • Include an FAQ • Articulate the common messages to be communicated about findings.

18. 5. Share Findings • Share the “Summary of CHNA Findings” • Distribute the Summary as widely as possible • Post the Summary on the hospital’s website • Hold a news conference • Distribute a news release • Use social media sites, e.g., Facebook, Twitter, etc. Remember: The Summary of Preliminary Findings is not the final CHNA report!

19. 6. Determine Priorities • Decide how to prioritize: • Facilitated consensus • Majority vote • Rank order • Decision grid • Consider these factors: • The community’s capacity to address health priorities • How amenable each priority is to change • The influence of economic, social, cultural and political issues • The existence of programs already addressing a priority • Engage the community: • Hold focus groups across the community with people of all ages, races, cultures, classes, job roles, etc. • Use the agreed upon approach to ask each group to identify priorities • Use the results to identify and prioritize the final set of health needs.

20. 7. Produce and Publish the CHNA Report • Certain content is required • Specific questions must be answered • Report must be easily accessible via hospital website Meeting IRS/ACA requirements is significant concern for hospitals; therefore, specifics will be discussed on their own.

21. Develop and Implement • Identify which of the priority health needs the hospital will address: • Can continue the collaborative process that produced the CHNA • Can use the hospital’s internal resources and processes to develop and execute the implementation strategies • The governing board should be involved in selecting the priorities the hospital will address • The executive leadership may launch an internal planning process to develop the implementation strategies • A strategy may be a new service or program or it could mean enhancing a currently existing one...

22. Develop and Implement • Consider the following suggestions in planning strategies: • Collaborate or partner with other organizations in designing and delivering some of the services • Adopt evidence-based strategies already deemed as effective • Use a behavior change model to focus service delivery • Use an outcomes-based planning model • Build in the capacity to evaluate effectiveness, using an outcomes-based evaluation approach • Implement and evaluate • Use quality improvement processes ongoing.

23. CHNA Reporting and Publicizing Ruthanne Sudderth, MHA

24. Meeting Requirements Does the final CHNA report include: • A definition of the community served by the hospital • Demographics of the community • Existing health care facilities and resources in the community that may respond to the health needs of the community • How data were obtained • The health needs of the community • Primary and chronic disease needs and other health issues of uninsured persons, low income persons and minority groups • The process for identifying and prioritizing the needs and services to meet the needs • The process used to consult with persons representing the community’s interests • Any information gaps that limit the hospital’s ability to assess all of the needs...

25. Meeting Requirements Ask the following questions: • Did we take into account input from persons who represent the community served by the hospital facility? • Did we describe how hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. • Was the CHNA conducted with one or more other hospital facilities? (must list the other facilities) • Did we make your CHNA widely available to the public? How? • Did we address all of the needs identified in your most recent CHNA? If not, did you explain why?

26. Meeting IRS Requirements Along the way, did we… • Complete related sections on Form 990 - Schedule H? • Attach our most recent implementation strategy to your Form 990? • Complete our CHNA and adopt implementation strategy in the same tax year?

27. Publicizing Your CHNA • Final report must be posted to (or linked to from) the hospital facility’s website. • Provide feedback and reports to groups/individuals who provided input. • Other recommended methods: news releases, social media, copies in libraries, etc. • sample news release in handbook • Include summary of implementation strategy in/near CHNA report, if possible.

28. Some Closing Thoughts • CHNA is a good process for learning more about/enhancing relationships within the community • High-quality, useful data is important, but it isn’t the only key to a successful CHNA • Community engagement is major factor • Conducting CHNA will contribute to the hospital’s capacity to better serve the community • Conducting CHNA will also contribute to the community’s capacity to address its health needs.

29. Questions and Discussion Questions and Discussion? Thank you! NAME – CONTACT INFORMATION