In March 2012, the IRS thrust hospitals into the new health care reality created by the Affordable Care Act. Regulations went into effect requiring hospitals to submit a community health needs assessment, or CHNA, and implementation strategy on a triennial basis. This requirement expanded hospitals' responsibility beyond acute care toward prevention, and beyond the hospital walls into the community.
As the financing of health care shifts from volume to value, requiring such an undertaking was intended to assist hospitals in identifying opportunities to better serve their patient populations, including the uninsured and underinsured. To meet this requirement, hospitals collaborated with community providers to define health problems that need to be addressed.
But, it is one thing to come up with ideas on paper and quite another to turn those ideas into reality. Designing and executing a structure for effective partnership, prioritizing needs, setting a timeline for achieving change and establishing objectives for measuring the impact of those strategies requires a level of collaboration with community organizations that is new to most hospitals.
Implementing Your CHNA Plan
Here are six critical steps for turning the opportunities your hospital identified in its CHNA into a robust community health program, one that strengthens your organization by meeting the needs of the diverse populations in your market.
1. Provide organizationwide education on CHNA. Executing the vision behind the CHNA requires many different departments to work together. But often, departmental leaders who may participate in community health projects are not involved in the crafting of the CHNA, and may not even know their hospital completed such an assessment.
It is imperative for those who were tasked with assembling the CHNA to educate other leaders throughout the organization about it. Doing so will help to generate excitement, buy-in and ideas for community health activities. It also will identify individuals within the organization whom department leaders can contact if members of the community approach them about participation in or development of a project.
2. Identify your champions. As indicated by former Sen. Tom Daschle at a forum for national health care leaders, successful population health management will require "resiliency, innovation, engagement and collaboration" (The Wall Street Journal, Sept. 25, 2013).
An important step is to designate a senior administrator who will "own" community health and report directly on its progress to the CEO. This individual will be the sole internal point person — the one who will invite and receive innovative ideas as they bubble up throughout the organization, bring research and promising practice models from across the country to the organization, and coordinate partnerships and collaborative work with community providers.
This person also will be tasked with building trust and facilitating integration among hospital departments that may have worked independently of one another in their silos, but no longer can afford to do so. For example, as reimbursement is based on value and improved health outcomes, finance and quality departments will need to join forces to reduce readmissions and to improve patient safety, satisfaction and long-term outcomes, all while cutting costs.
3. Mine the data. Hospitals must invest resources to gain a better understanding of their return on investment in various community-focused activities. A successful transformation to a value-based provider will begin with mining current data. For example, a review of frequent visitors to the emergency department, readmission rates and lengths of stay may determine how much the organization is spending on charity care and if those dollars are being used effectively to improve patient health.
This analysis will help to define focused strategies: specific neighborhoods for outreach and patient engagement, cultural factors in the design of patient-centered care, and community providers that will serve as the most effective partners for collaboration.
Organizations should have gathered tremendous amounts of valuable information in completing their CHNAs. The next step is to dive more deeply into the data to identify places where resources will have the greatest impact on achieving the organization's goals and the ACA's Triple Aim.
4. Identify where the hospital's mission, expertise and goals for growth intersect with community health needs. An examination of the organization's mission and goals, leadership, governance and role in the community will help in moving toward a value-based system and building an infrastructure to support an upstream, patient-centered design. This transition will require a culture shift from the acute care needs of the individual to improving the health of a complex community.
Facilitate a task force of hospital representatives and essential community partners to outline a set of initial priorities and a timeline for implementing projects to achieve those objectives.
5. Support a cultural shift among employees and trustees. Hospitals shouldn't try to make this transition alone. Instead, work to create across-the-board investment in collaboration. Build a bridge from the acute care setting in the hospital into the community where effective, post-acute follow-up care, as well as prevention and early intervention, can be delivered best. There are numerous providers in each community who have the skills, whose mission can align with that of the hospital and will benefit from such a partnership.
Working with other providers can lead to innovation using a wide range of resources, including allied professionals and satellite community-based settings, and can more effectively support patient self-management and family-centered care.
6. Budget for program development. While there is not likely to be a revenue stream to support these community health activities initially, they are doomed to fail without financial backing and resource allocation. Depending on the scope of an activity, funding usually comes out of the hospital's or a single department's strategic planning budget.
More private and public funders are bullish on investing in strategies that may reduce health care costs over the long term, especially if they are replicable. Engaging a grant writer, if there isn't one already on your staff, could be money well spent.
In addition, those departmental leaders and staff members tasked with overseeing and executing community health projects must be given the time and departmental funds to administer these programs, with the understanding that they are not likely to generate a significant financial return on investment quickly.
Taking the Lead on Innovation
The new health care environment offers hospitals an opportunity to enhance their goals and roles as essential community providers. The shift in resources and focus will require leadership and coordination within the hospital and with community partners. For each organization, setting the course will require taking new risks, making tough decisions and having difficult conversations.
At this time, when the transition needs to begin, there is no clear path to follow. But the open road is an exceptional opportunity for each organization to create something truly innovative that advances its mission, serves the specific needs of its community and uses the unique expertise of its team. You and your organization can be seen as a transformational leader in health care rather than just a vendor of health services.
Joan Dentler is the president and CEO, and Ellen Sanchez is the director of community collaborations at Avanza Healthcare Strategies in Austin, Texas.