Recipe for Developing and Sustaining a Successful Community Benefit Framework

Transcription

1 Recipe for Developing and Sustaining a Successful Community Benefit Framework ACHI Spring Training for Health Champions Los Angeles, CA March 11, 2009 Catherine Rees, MPH Middlesex Hospital Michelle Davis, BS, RN Winfield Brown, MSB, MHA, FACHE Lowell General Hospital

2 Today s Objectives Provide a blue-print for Community Benefit medium-sized community hospitals Review methods of engagement for executive leadership, governance, physicians, staff, and community partners Offer solutions for potential barriers Review the development of a community coalition created by LGH s Community Benefit initiative

3 Agenda Hospital Overviews Key Ingredients: Our CB Program Development Processes Matching Programs to Community Needs Challenges/Solutions

4 Recipe for Developing and Sustaining a Successful Community Benefit Framework ACHI Spring Training for Health Champions Los Angeles, CA Catherine Rees, MPH Manager, Community Benefit Middlesex Hospital, Middletown, CT March 11, 2009

5 Where We Are Located Day Kimball Johnson Memorial Hartford Rockville General Sharon Univ of CT HC CCMC Manchester Memorial John Dempsey Charlotte St. Francis Windham Hungerford Community Mem. Bristol Hospital of Central CT William W. Backus MIDDLESEX St. Mary s MidState New Milford Waterbury CT Hospital Landscape: 30 acute care hospitals (29 are not-for-profit, 1 is for-profit) Greenwich Stamford Danbury Norwalk Griffin Yale-New Haven Saint Raphael Milford Bridgeport St. Vincent s Medical Center Lawrence and Memorial Industry in Middlesex Health System Service Area: Middlesex Hospital Wesleyan University Pratt & Whitney Small Business Community

6 Middlesex Health System Service Area Rocky Hill Marlborough Middlesex Hospital Outpatient Center MMC, Shoreline MMC, Marlborough MHS Primary Care Assisted Living Community Family Practice Group Homecare Cromwell Middlefield Portland Middletown Durham Madison Haddam East Hampton Killingworth Chester Deep River Colchester East Haddam Essex Salem Lyme/ Old Lyme 22 Towns Total 248,000 Total Square 623 Guilford Clinton Westbrook Old Saybrook

7 Middlesex Health System Our system: Middlesex Hospital 275 bed acute care community hospital 24,000 sq ft ED Named a Thomson 100 Top Hospitals Outpatient Behavioral Health Services Disease Management Family Practice Group Family Practice Residency Assisted Living Facility Outpatient Surgery Center Shoreline Medical Center Marlborough Medical Center Cancer Center Homecare

8 CB Program Objectives - Timeline Year 1 (mid-fy06) Year 2 (FY07) Year 3 (FY08) Year 4 (FY09) Infrastructure Development Adoption of Industry Standards (CHA/VHA Guide) Inventory Collection (CBISA) Internal Standards Board Engagement Staff Engagement (all levels) Internal Communication (w/in organization) External Communication (community) Development of CB Policy Establishment of Yearly Goals Planning - assessing community needs Planning - involving community partners

9 Key Ingredients Executive Involvement Reporting Structure Dedicated Resources Governance Staff Involvement Goals Internal & External Communications External Resources

10 Key Ingredient Executive Involvement Focus of CEO s Departmental Leadership meetings Theme of Annual Meeting (includes corporators, Board, medical staff, management staff); subject of CEO s opening address; CB Video Year 1 Year 2 Year 3 CEO Initiative main ingredient! CEO & Exec. Team support (on-going) CEO shares timely CB articles with Executive team and CB staff (on-going) CEO asks for term Community Benefit to be incorporated into Hospital s revised mission statement

11 Key Ingredient - Reporting Structure Board Of Directors CEO CB Steering Committee (developed Yr. 1; expanded Yr. 3) VP of Philanthropy (Yr.4) Manager, CB (Yr.3) VP of Operations, CMO of Community Medicine Yrs. 1-3 CB Coordinator Yrs. 2-3; Project Specialist Yr.1 Mental Health/ Sub. Abuse Sub-Committee (Yr. 4) Geriatrics Sub-Committee (Yr. 4) COPD Workgroup (Yr. 3) Financial Assistance Workgroup (Yr. 4) 990 Workgroup (anticipated in Yr.4, FY09) Health Assessment Outgrowth

12 Key Ingredient Reporting Structure Steering Committee Members Senior VP/COO CFO VP of Development VP of Clinical Services VP of Nursing/CNO Board member Medical Director of Family Practice Medical Director of Pediatrics Medical Director of Behavioral Health Clinic Director of Finance Manager, Public Relations Manager, CB Project Specialist Structure & Functions Oversees all CB operations Inventory Internal Standards Areas of Focus/Direction Internal & External Reporting Assessment & Strategic Plan Health Assessment Sub-Cmtes Meets quarterly (sub-committees meet every two months) Schedule H, 990 A forum to: set programmatic parameters; discuss local and national CB news

13 Key Ingredient Reporting Structure CB Policy States Purpose of Program Activity Domains: 1.) Access to Care; 2.) Community Health Initiatives; 3.) Good Citizen Activities Health Assessment: regular intervals; development of strategic plan for each assessment Steering Committee: composition (@ least 1 Board member) and functions Reporting: defines frequency of reporting to Board of Directors Institutionalizes the program!

14 Key Ingredient Dedicated Resources 0.5 FTE CB Coordinator replaces 0.25 FTE Project Specialist Year 1 Year 2 Year 3 CMO of Community Medicine adds Director of CB to her role Project Specialist is assigned (@ 0.25 FTE) 0.5 FTE CB Coordinator becomes full-time CB Manager (Director of CB accepts another hospital)

15 Key Ingredient Governance CEO gives overview of new CB program to Board Board member joins Steering Committee Board reviews CB goals (on-going) Board tasks CFO with review of Charity Care & Bad Debt Year 1 Year 2 Year 3 Board presentation by Director of CB CEO requests inclusion of CB programmatic profiles in Board meeting materials (on-going) CEO requests CB to be integral part of special presentation to Board (by outside consultant) CB policy is approved by Board

16 Key Ingredient Staff Involvement Presentation given to management staff by Director of CB Implementation of CBISA platform Inventory collection starts (centralized model of data entry) Departmental staff meetings (CB & Health Assessment) Year 1 Year 2 Year 3 Focus of CEO s departmental leadership meetings One-on-one meetings with directors/ managers/supervisors to review CB and uncover activities (on-going) Focus of Hospital s annual symposium for management CB Video

17 Key Ingredients Goals Year 1 & Year 2: Informal goals: focus on infrastructure development; inventory collection Year 3: Concrete targeted goals are established Departmental education on program, policy and reporting procedures Departmental reporting/responses Preliminary Health Assessment targeted initiative (COPD) Heath Assessment; Community Advisory Group Year 4: Health Assessment strategic plan Focus on Charity Care Institutionalizes the program!

18 Key Ingredient: Internal Communication Weekly newsletter (STAT!) Departmental presentations Intranet link (on the horizon)

19 Key Ingredient: Internal & External Communication Annual Report Health Assessment CB video Internet link (on the horizon)

20 Key Ingredient External Resources Local National Participation in State Hospital Association CB User Group Mandatory reporting to Connecticut Hospital Association effective FY06 Listservs Site-visits Conferences Audioconferences Listservs Google searches

21 Our Community Benefit Programs: MHS FY07 % of Total $$s Community Health Improvement Services - A 44% 7.5% 25.5% 17.5% Health Professions Education - B Subsidized Health Services - C Research - D Financial and In-Kind Contributions - E Community Building Activities - F Community Benefit Operations - G 2% 1% 2% Charity Care & Medicaid Shortfall 0.5% Total Benefit: $20.8M Numbers Served: 87,297

22 Matching Programs To Community Needs Comprehensive Inventory Ability to link programs to community needs/requests Chamber of Commerce Healthcare Council Local schools DPH Existing coalitions Health Assessment: In order to target health initiatives, must understand health status of the community Extension of CB policy Commissioned external statisticians; used publicly available data sources Community engagement in process: community advisory group; qualitative mapping

23 Matching Programs To Community Needs Health Assessment Priority Areas: 1.) Geriatric Services Access and Coordination 2.) Mental Health & Substance Abuse Coordination of services between providers 3.) Need for COPD Program Where do we go from here? A call to action it takes a community!

24 Community Benefit Program Highlight Center For Chronic Care Management: Adult Asthma Pediatric Asthma Diabetes Education Chronic Heart Failure Medical Nutrition Therapy Smoking Cessation Child Weight Management Chronic Obstructive Pulmonary Disease (on the horizon) Benefit: FY07: $921,972; 2,722 served 10 th Anniversary over 10,000 patients served

25 Challenges/Solutions: Executive Buy-In Explain the importance of CB: Plus $32 billion in in federal, state and local subsidies for hospitals/year Justification of tax-exemption (know the value of your tax exemption) Large aggregate dollars at stake! Secures community partnerships Is necessary for the success of the program; institutional buy-in Mandatory Schedule H reporting in 2010 (don t want to be caught off guard)

26 Share the news Hospital Found 'Not Charitable' Loses Its Status As Tax Exempt By Lucette Lagnado Thursday, February 19, 2004 The Wall Street Journal In an unusual move that is sending shock waves across the hospital industry, Illinois authorities have revoked the taxexempt status of a prominent Catholic hospital. Their decision follows a determination by local tax authorities that the hospital wasn't a charitable institution, in part because of the way it treated needy patients CEO & Executive Team timely CB articles Nonprofit Hospitals, Once For the Poor, Strike It Rich With Tax Breaks, They Outperform For-Profit Rivals JOHN CARREYROU & BARBARA MARTINEZ / Wall Street Journal 4apr2008 Nonprofit hospitals, originally set up to serve the poor, have transformed themselves into profit machines. And as the money rolls in, the large tax breaks they receive are drawing fire "Some nonprofit hospitals seem to forget that their operations are subsidized with generous tax breaks. They allow their priorities to get out of whack," says Sen. Charles Grassley. The senior Republican on the Senate Finance Committee threatened last year to introduce legislation forcing nonprofit hospitals to provide a minimum amount of charity care In return for not paying taxes, nonprofit hospitals are supposed to provide a "community benefit," a loosely defined requirement whose most important component is charity care DECEMBER 18, 2008 Grassley Targets Nonprofit Hospitals on Charity Care By JOHN CARREYROU and BARBARA MARTINEZ Sen. Charles Grassley is weighing proposing legislation in early 2009 that would hold nonprofit hospitals more accountable for the billions of dollars in annual tax exemptions they enjoy, aides to the Iowa senator said. The legislation would require nonprofit hospitals to spend a minimum amount on free care for the poor, also known as charity care, and set curbs on executive compensation and conflicts of interest, according to staff members for Mr. Grassley, ranking Republican on the Senate Finance Committee.

27 Challenges/Solutions: Governance Engagement In this environment, it is essential for governing boards to be aware of the storms brewing over community benefit, to monitor their hospital s community benefit planning process and activities, and to ensure that information about their community benefits reaches their patients, legislators, the business community, and the general public

28 Challenges/Solutions: Governance Engagement Provide Board with: programmatic profiles and industry updates Give Board presentations at key points in CB program development/milestones Invite Board member(s) to join Steering Committee, or, be a guest for key CB meetings Ask Board to review CB goals; Strategic Plans

29 Challenges/Solutions: Reporting Structure & Dedicated Resources Reporting Structure: Formation of oversight committee; multidisciplinary: including key departments and decision-makers Dedicated Resources: Outline program objectives and resources required to meet those objectives Share what other hospitals are doing: dept. where CB is housed; reporting structures, etc.

30 Challenges/Solutions: Staff Involvement & Increased Reporting One-on-one meetings Departmental presentations (highlight dept. specific activities) Management staff presentations (including Grand Rounds for MDs Builds enthusiasm De-mystifies program Provides activity contacts Accept variety of reporting methods (specific form, , voice mail, interoffice mail, etc.) No benefit is too small!

31 Increased Reporting: Activity Log - Time Consuming, But Worth It! Activity Occurrence Freq. of Event Freq. of Data Collection Contact Dept. Notes Countable Under CHA/VHA Guidelines CC All Things Pink! Breast Cancer Awareness - All Things Pink! Mid. Oct. Annually Lisa C. Cancer Center 1.) Collect all Cancer Center staff hours (including planning; day of event) 2.) Numbers served (exclude any staff attendance & pro-rate expenses, if necessary) 3.) Food, entertainment expenses, rental costs (sound/av equipment, etc.) 4.) Get from PR: Peg s time; costs for publicity, advertising, photography, videography (note: enter as a separate occurrence so the PR dept. gets credit for involvement) 5.) Room usage 1.) Broad Category: A - Community Health Improvement Services 2.) Sub-Category: A1 - Community Health Education 3.) Count: "Health promotion and wellness programs" Paramedics - Stroke Education to Community Members Stroke Awareness Presentations On- Going Quarterly Brad F. Paramedics 1.) Request info. directly from Brad, but cc: Craig R. 2.) Only count numbers served 3.) Don't count salary or supply costs, as they are rolled up elsewhere under Paramedics as a subsidized service 4.) If Brad gives presentations to the community in N1, etc. can apply room usage valuation 1.) Broad Category: A - Community Health Improvement Services 2.) Sub-Category: A1 - Community Health Education 3.) Count: "Education on specific diseases or conditions, such as diabetes or heart disease; health education lectures and workshops by staff to community groups"

32 Challenges/Solutions: Staff Involvement & Increased Reporting Ongoing Communication: USA Today (i.e. frequency trumps content) Personalized feedback (departmental activity reports) Mandate: State? Hospital Association? Schedule H Give examples of CB activities If an executive initiative, mention in s of inventory solicitation Dedicated address for reporting Intranet site for staff to learn about CB, reporting process, CB contact; obtain reporting forms, etc.

33 Contact Information Catherine Rees, MPH Manager, Community Benefit Middlesex Hospital 28 Crescent Street Middletown, CT (860)

34 Recipe for Developing and Sustaining a Successful Community Benefit Framework Winfield Brown, MSB, MHA, FACHE Michelle Davis, BS, RN

35 Meet Lowell General Hospital Independent, not-for-profit 218 bed community hospital. 1,800 employees, 420 physicians Financially stable Growing in volume and market share

36 Meet Lowell General Hospital Main Service Lines: Maternal Child Health Heart & Vascular Cancer Surgery Emergency Acute Care (photo of LGH)

37 Lowell, Massachusetts 35 miles Northwest of Boston (map of Lowell in comparison to Boston etc.. Also feature Saints Medical Center)

38 Community Served by LGH Greater Lowell area comprised of City of Lowell and 10 surrounding suburban communities. Serving 105,749 Lowell Residents Average income in Lowell Serving xxx surrounding towns Average income of surrounding towns.

39 Snapshot of Lowell 2 nd largest concentration of resettled Cambodians in the United States. 3 rd largest Cambodian community outside of Cambodia. A single-female heads 1/3 of families. 20% of Children living in poverty (2x the state average) 2 nd lowest proportion of mothers receiving adequate prenatal care in the state. 8 th highest teen pregnancy rate in MA. 4x the state smoking rate.

40 Snapshot of Surrounding Communities 70% families earning income greater than $50,000 Over 90% population White Non- Hispanic Over 95% English speaking (other facts/ideas?)

41 Community Benefit in Massachusetts Attorney General s office mandates submission of an Annual CB Report within 5 months of end of fiscal year. Full Text and Summary available to public through AG s office. AG s Community Benefit Guidelines differ from CHA/AHA guidelines.

42 LGH s CB Recipe 2005 Mix together community benefit activities from Lowell Community Health Center and VHA with a pinch of activities from LGH. Place into mandated annual report and place on shelf until the end of next fiscal year.

43 New Recipe Separate CB from Planning & Research department and place in new Community Health & Education department. Add in a 40 hour a week Manager of Community Health & Education and a 40 hour a week Community Health Educator to be responsible for CB. Slowly stir in Planning, Communication, CBISA, reporting methods, and serve to entire community.

44 Key Ingredient- Plan Community Benefit needs to be imbedded in the Strategic Plans for the hospital. Include Board in planning process. Utilizing a needs assessment develop an annual CB plan.

45 Key Ingredient- People Community Benefit is the perception of the community of what you are doing. How do you spread the word about your community benefit? How do you get your entire organization involved?

46 Key Ingredient- Reporting How do you capture all your CB activities, when they are spread across the organization? Utilization of CB Software Decentralized model- users across the hospital. Buy in from Finance Reporting Out Employees, Community, Board, GLHA

47 Key Ingredient- Reporting Image of LGH playbook as way we spread CB info to employees. Image of Annual Report as way to report to board. Image of FYH/Calendar of events/newspaper Letter from Norm as ways we report out. Image of dashboard if we have one.

48 30 minute meals How do you simplify a recipe so all levels of cooks can be successful? Make it personal to each department. Tie it in to other initiatives i.e. Magnet Journey (picture of magnet bus) Accountability.

49 Measurements Key Metrics Recipe s fail if measurements are not followed Core Measures Metric Baseline 2014 Goal Heart Failure 65% 98% Acute Myocardial Infarction 96% 99% Community Acquired Pneumonia 65% 93% Surgical Care Infection Prevention 54% 93% Community Health Status Indicators Smoking Reduce % of cigarette smoking adults in PSA 13.5% 12% Maternal Child Health Increase % of adequate prenatal care for LGH patients 56% 75% Increase % of breastfeeding moms for LGH patients 68% 80% Obesity Reduce % of obese adults in PSA 20.7% 15%

50 A Dash of Success and watch things grow.. LGH Community Benefit Recipe Community Health & Education Department Hour Manager 40 Hour Community Health Educator Hour Manager 32 Hour Community Health Educator 32 Hour Mind/Body Program Coordinator 24 Hour Maternal Child Health Education Coordinator 8 Hour Cardiac Health Educator 8 Hour Community Health Assistant

51 Community Health & Education Growth , , Classes Attendees

52 Community Benefit Expenditures 12 $10,610, Millions $2,885,347 $4,906,

53 LGH Community Benefit Recipe Key Ingredients: Community Partners Greater Lowell Health Alliance

54 How will this recipe be different from others? Sustaining vision Solid group of partners Comprehensive and diverse partners

55 What will the organization look like? GLHA Executive Committee GLHA Staff Member Committee Chairs Networking/ Education Committee Cultural Competency Healthy Weight Task Force Tobacco Task Force Future Task Forces

56 GLHA Vision The Greater Lowell Health Alliance is comprised of healthcare providers, business leaders, educators, civic and community leaders with a common goal to help the Greater Lowell community identify and address its health and wellness priorities.

57 Executive Committee Organizations City of Lowell Lowell Community Health Center Lowell General Hospital Lowell Public School Department Middlesex Community College Saints Medical Center University of Massachusetts-Lowell VNA of Greater Lowell

58 GLHA Successes Insert screen shots of various press for GLHA. Pictures from Julie of walking Wednesdays.

59 Why does GLHA work? Greater input Greater execution power Extends LGH s reach

60 Next Steps CB is a work in progress Hardwiring and durable

61 Contact Information Winfield Brown, MSB, MHA, FACHE VP Administration Lowell General Hospital 295 Varnum Avenue Lowell, MA Michelle Davis, BS, RN Manager, Community Health & Education Lowell General Hospital 295 Varnum Avenue Lowell, MA

62 Key Metrics Measurements Recipes fail if measurements aren t followed! Core Measures Metric Baseline 2014 Goal Heart Failure 65% 98% Acute Myocardial Infarction 96% 99% Community Acquired Pneumonia 65% 93% Surgical Care Infection Prevention 54% 93% Community Health Status Indicators Smoking Reduce % of cigarette smoking adults in PSA 13.5% 12% Maternal Child Health Increase % of adequate prenatal care for LGH patients 56% 75% Increase % of breastfeeding moms for LGH patients 68% 80% Obesity Reduce % of obese adults in PSA 20.7% 15%

63 Community Benefit Recipe Add a dash of success and watch things grow.. Community Health & Education Department 2006 = 40-Hour Community Health Educator 40-Hour Manager 2009 = 40-Hour Manager 32-Hour Community Health Educator 32-Hour Mind/Body Program Coordinator 24-Hour Maternal/Child Health Ed Coordinator 8-Hour Cardiac Health Educator 8-Hour Community Health Assistant

64 Watch It Rise Community Health & Education ,500 3,645 1, * Classes Attendees * estimated

65 Community Benefit Spending $10.6 $11.0 Millions 8 6 $4.9 4 $

66 LGH Community Benefit Recipe Secret Ingredient: Community Partners & Greater Lowell Health Alliance

67 GLHA Purpose The Greater Lowell Health Alliance is comprised of healthcare providers, business leaders, educators, civic and community leaders with a common goal to help the Greater Lowell community identify and address its health and wellness priorities.

68 How This Recipe Is Different Affiliated non-profits help sustain a clear vision for Community Benefit Solid, committed group of partners Comprehensive and diverse Board of Directors

69 Setting the Table The Organization Today GLHA Executive Committee GLHA Staff Member Committee Chairs Networking/ Education Committee Cultural Competency Healthy Weight Task Force Tobacco Task Force Mental Health Task Force Future Task Forces

70 Invited Guests Executive Committee Organizations City of Lowell Lowell Community Health Center Lowell General Hospital Lowell Public School Department Middlesex Community College Saints Medical Center University of Massachusetts-Lowell VNA of Greater Lowell Former CHNA 3 members Community member

71 GLHA Successes

72 Why does GLHA work? Greater input inclusion of diverse organizations Greater execution power Extends LGH s traditional reach Multiplies CB dollars Positions us for grant dollars Measurement

73 Next Steps CB is a work in progress Hardwiring and durable Create additional task forces for GLHA aligned with Healthy People goals

74 Bon Appétit!

75 Sources Statistics used in this presentation were derived from the Massachusetts Community Health Information Profile (Mass CHIP)

76 Executive Chefs Contact Information Winfield Brown, MSB, MHA, FACHE VP Administration Lowell General Hospital 295 Varnum Avenue Lowell, MA Michelle Davis, BS, RN Manager, Community Health & Education Lowell General Hospital 295 Varnum Avenue Lowell, MA