Community Health Needs Assessments (CHNA): A National Perspective

Transcription

1 Community Health Needs Assessments (CHNA): A National Perspective Michael Bilton (mbilton@aha.org; ) Executive Director Association for Community Health Improvement (ACHI) American Hospital Association November 8, 2012 Prepared for Community Health Assessments: Successful Montana Models by Montana s Rural Health Initiative

2 Community health assessment is a critical strategic planning and management tool for health care organizations. Community Health Assessment Checklist. VHA, Inc

3 We underestimate the degree to which the transformation of care must extend beyond medical care to social services, transportation, self care and communitybased support. Ian Morrison, Health Care Futurist Massively Coordinated Care, H&HN Daily. May 1,

4 Six Step Community Health Assessment Process ACHI and AHA members have access to this guide using their member log-in. 4

5 CHNA and Affordable Care Act of 2010 Act created new community benefit requirements Requires community health needs assessments (CHNA) by tax exempt hospitals every three years Input from persons who represent the broad interests of the community including those with special knowledge of or expertise in public health Adopt an implementation strategy to meet the community health needs identified 5

6 Needs Assessment Components * 1. Community served, and how determined 2. Assessment process and methods Data sources & dates, analytical methods, gaps, collaborators, contractors 3. Prioritized community health needs, including methods/criteria to determine 4. Existing health care and other resources available to meet needs Michael Bilton Association for Community Health Improvement * 6

7 Implementation Strategy Components* 1. Describes how hospital plans to meet each identified community health need 2. Identifies programs and resources, and anticipated impact 3. Describes any planned collaboration 4. Approved by hospital s governing body Michael Bilton Association for Community Health Improvement * 7

8 Other Organizations Conduct CHNAs Public Health Departments (accreditation) Federally Qualified Health Centers (required) United Ways A wide array of health, social and human service organizations 8

9 Community Health Assessment in a Context of Health System Change 9

10 Suggests partnerships to conduct CHNAs and develop community health improvement plans Its health priorities are reflected in many hospitals existing community programs Many of its recommendations lend themselves to action based on CHNA data 10

11 Current Context and Related Factors National Quality Strategy (March 2011) One of three Aims: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and environmental determinants of health in addition to delivering higher quality care (emphasis added) One of six Priorities: Working with communities to promote wide use of best practices to enable healthy living Source: 11

12 Current Context and Related Factors Accountable Care Organizations Patient Centeredness Criteria: Evaluate health needs of assigned population, identify high risk individuals and develop care plans for targeted populations, including use of community resources. (emphasis added) Quality Measurement: Includes measures for readmissions, and admissions for ambulatory care sensitive conditions Source: AHA Regulatory Advisory on ACO Final Rule, Nov. 8,

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14 Hospitals as Community Health Supplemental Material Assessment and Improvement Partners 14

15 A Few Resources Used by Hospitals Association for Community Health Improvement s ACHI Community Health Assessment Toolkit ( Catholic Health Association s Assessing and Addressing Community Health Needs ( Many state and national level organizations, academic institutions, and firms are offering assessment tools and services, to both hospitals and public health 15

16 Examples of State and Regional Resources Hospital Council of Northwest Ohio ( has been conducting collaborative CHNAs since Dallas Fort Worth Hospital Council Foundation ( offers a community health data warehouse and assessment tools. Iowa, Missouri and New Jersey hospital associations have offered CHNA training (webinars, conferences). The North Carolina hospital association s collaborative CHNA program with public health, focused on reducing care costs and health disparities. 16

17 Healthcare Executive, July/August 2010 Community Health Needs Assessment in the trade press 17

18 CHSD: Community Health Services Development Program

19 History Offices of Rural Health work with Critical Access Hospital Programs and rural communities. MORH has managed the CHSD process in Montana over the past 20 years. CHSD philosophy Health is a local affair, Health care delivered in rural communities is affordable, high quality and necessary for the health of the community Citizens of rural communities/counties should take responsibility for the health of their community Effective problem-solving by communities is the most important factor in the survival of rural health services

20 Why do a CHNA? Patient Protection and Affordable Care Act Accountability A Community Health Needs Assessment is a tool to help hospitals ensure their community benefit activities are related to needs identified in their community Community Input A process that helps engage the community and facility together in strengthening the healthcare system

21 Steps in CHSD Hospital and community members form a Steering Committee to drive process Secondary health data is gathered and reviewed A customized community survey is created A random sample survey is mailed out to community Focus groups conducted Steering committee meets to review data Data used to inform a prioritization process of needs Strategic plan is developed

22 Survey Question Themes Health care utilization Service awareness Community/Public Health Insurance Demographics

23 Community/Public Health What are the most important health issues facing your community? How healthy is your community? What would make your community a healthier place to live? Common health issues identified: Obesity Chronic disease Cardiovascular, cancer, diabetes Need of health and wellness activities

24 CHSD Outcomes Community engagement Community health goals Strengthened healthcare services Community investment in the future of the health system

25 How has the information been used? Marketing service awareness, annual report Development of community health group/coalition/task force Community Health District Successful grant applications Transportation Mobile dental unit Development of new services/programs Nutrition and fitness programs Tobacco free campus Urgent Care/After hours clinic

26 Who is doing CHSD this year? Anaconda Big Sandy Columbus Glendive Hamilton Livingston Lewistown Poplar/Wolf Point Ronan Roundup Scobey Prioritization/ Implementation planning: Ekalaka

27 Contact Information Natalie Claiborne, MPH Assistant Director Montana Office of Rural Health Montana State University Bozeman, Montana

28 Dahl Memorial Healthcare Association, Inc., Ekalaka, MT Community Health Services Development Survey & Implementation Planning July 2011 & September

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30 DMHA Mission 30

31 Carter County, Montana Ekalaka County Seat 2009 Population 1202 Area 3340 square miles Over 85 miles N to S Population Density 0.35 people/sq. mi 31

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33 CHSD in Carter County CHSD Survey July 2011 CHSD Implementation Planning September 2012 What s Next? 33

34 CHSD Survey Steering Committee Selection Survey Marketing Focus Groups Report Community Feedback 34

35 CHSD Survey Steering Committee Selection Six members Culturally & geographically diverse Age Location within county Family situation Economically Gender Community minded Initial meeting Staff leadership 35

36 CHSD Survey Survey Community support Marketing Newspaper article Gift certificate Focus Groups 2 locations & groups Community support 36

37 CHSD Survey Survey Report Steering committee Hospital board Community Feedback Annual association meeting 37

38 CHSD Implementation Planning Scheduling The Process The Results 38

39 CHSD Implementation Planning Scheduling 2 sessions Association board Staff leadership Food 39

40 CHSD Implementation Planning The Process Vision 5 to 10 years Mission Values Strengths & resources What makes us unique? What are we known for? Weaknesses & opportunities What s missing? 40

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42 CHSD Implementation Planning The Results Goals Indicator Strategy Tasks Who s responsible Completion time Commitment 42

43 CHSD Implementation Planning What s Next? 43

44 CHSD Implementation Planning Contact Information: Nadine L. Elmore, CEO Dahl Memorial Healthcare Association, Inc. (406)

45 Community Health Needs Assessment for Billings Clinic and Yellowstone County Jeanne H. Manske Community Benefit Coordinator November 8, 2012

46 Our Mission: Health Care, Education, Research Our Vision: Billings Clinic will be a national leader in providing the best quality, patient safety, service and value.

47 About Billings Clinic Integrated medical foundation model led by physicians Community governed, not-for-profit organization Quality care is delivered by 240 employed physicians and more than 3,400 clinical and support staff 272-bed tertiary hospital with 90-bed assisted living center and seven regional clinics in Montana and Wyoming Level II Trauma Center with two fixed-wing planes Family Birth Center with Level III NICU

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49 The Alliance: What unites us? Shared focus on patient care and community health Employees engaged in community organizations Shared responsibility to care for vulnerable populations Shared CHAs in 1994, 2006,

50 The Alliance 50

51 The Alliance Shared Vision: Together, our purpose is to provide leadership in improving our community's health, including for those who are underserved and most vulnerable, in ways that surpass our individual capacity.

52 2006 Results Yellowstone County residents are struggling with these modifiable health risks: 89.1% present one or more cardiovascular disease risk factors 62.7% are overweight or obese Only 41.4% meet physical activity recommendations

53 Alliance Response to the CHA Action: Form the Healthy by Design Advisory Committee Vision: A community that is Healthy By Design Mission: Collaborate across sectors to create healthier lifestyles

54 New Partners at the working table Better Billings Foundation Big Sky EDA Big Sky State Games Billings Family YMCA Cancer Control Coalition Chamber of Commerce/CVB City-County Planning Dept. Community health advocates League of Women Voters McCall Development MET Transit MSU-Billings MSU Extension Service Nutrition for the Future Safe Routes to School School Health Advisory Committee

55 Community Health Assessment It is, after all, a community health assessment Collaboration improves the process more buy in on the front end of the process Collaboration provides additional resources to ensure the assessment is used and the health of the community is improved Meets the needs of stakeholders and the IRS

56 Collaboration on the Front End 1. The 3 organizations appoint key leaders to finalize questions & coordinate focus groups 2. The 3 representatives research and select a vendor PRC vendor of choice Benchmarks, trend reports, tested questions, proven results Share cost & time Took 6 months from start to press release

57 What Questions to Ask? Base from vendor Trending from last survey Internal review each organization Back to Geneva for finalization New topics replace dated topics Screen time IN, fluoride OUT

58 The process of collaboration in survey design Org Org Orgs Alliance Unified Org Organizational Review of Questions Organizational desires evaluated against unified desires Single survey designed

59 2010 PRC Community Health Assessment BENCHMARKING State BRFSS data (CDC) US Survey Data (PRC National Health Survey) Healthy People 2020 targets State and national vital statistics Telephone Survey Random sample of 400 adults 150 survey items, minutes 4.9% maximum error Each percentage of the total sample represents roughly 1,114 county residents Secondary Data Public Health Data/ Vital Statistics Focus Groups 1. Physicians and Other Health Professionals 2. Legislators 3. Social Service Providers 4. Educators 5. Employers

60 2010 PRC Community Health Assessment Experience Fair or Poor Physical Health Similar to MT & US findings Significantly worse than found in 2005 Sources: PRC Community Health Surveys, Professional Research Consultants, Inc. [Item 5] Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia. United States Department of Health and Human Services, Centers for Disease Control and Prevention (CDC): 2009 Montana data PRC National Health Survey, Professional Research Consultants. Notes: Asked of all respondents.

61 2010 PRC Community Health Assessment Experience Fair or Poor Physical Health (Yellowstone County, 2010) Sources: 2010 PRC Community Health Survey, Professional Research Consultants, Inc. [Item 5] Notes: Asked of all respondents. Income categories reflect respondent's household income as a ratio to the federal poverty level for their household size: low income = below poverty or 100% to 200% of poverty; "middle/high income" = over 200% of poverty. 25% of county adults experience activity limitations due to a physical, mental or emotional issues(similar to US).

62 2010 PRC Community Health Assessment General Health Mental Health Disease Preventive Care POSITIVE TRENDS Deaths from: Heart Disease, Stroke, Diabetes, Pneumonia/Influenza, Alzheimer s Disease Cholesterol Screening Children's Routine Medical Care NEGATIVE TRENDS Overall Health Evaluations Suicide Rate High Blood Pressure Prevalence Breast Cancer Screening Health Risk Behaviors Maternal & Infant Health Fruit & Vegetable Consumption Cigarette Smoke in Homes Infant Death Rate Teen Births Overweight Prevalence Cirrhosis/Liver Disease Deaths Births to unwed mothers Refer to the summary tables in the back of the Executive Summary for a full disposition of the benchmarks and trends.

63 The process of collaboration in action planning Org Org Org Organizational Review of Results & Action Planning Orgs Commu nity Organizational desires & assets evaluated with community desires & assets Unified Plan to Improve the Community s Health (PITCH)designed

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65 Policy Change Target Entire Population Healthy Communities Target Multiple Sectors Population Scale Single Sector Individual Where many entities are now Neighborhood Community State National Geographic Scale

66 National Prevention Strategy America s Plan for Better Health and Wellness

67 Billings Clinic s Community Health Improvement Plan Internal Board Committee for Community Health Improvement (CHI) reviewed and approved CHI Plan Strategic Operating Plan includes objectives and steps towards community accountability via our work with Alliance and community health improvement Internal CHI goals are based on matching needs with available resources, such as clinical quality goals and measures that match with community needs (diabetes prevention)

68 Collective Next Steps Planning/Budgeting for next cycle in 2013 Ongoing assessment of federal requirements, stakeholder needs and organizational goals

69 Lessons Learned/Advice This takes longer than you think it will (timeline plus flexibility) Needs high level and organizational support & dedicated staff Communicate frequently with partners Develop shared vision/goals for assessment Realize there will be bumps in the road

70 Resources Association for Community Health Improvement American Public Health Association Catholic Health Association Community Health Centers for Disease Control & Prevention County Health Rankings National Association of County & City Health Officials National Prevention Strategy df Public Health Accreditation Board

71 The journey continues

72 Questions? Slides and recorded version of the webinar will be posted at For questions or comments, contact Julia at Thank you for participating in today s webinar!