Partners in Community Health: New Tools to Bring Hospitals, Public Health, and Communities Together November 11, 2010 | Washington DC Indu Spugnardi The.

Partners in Community Health: New Tools to Bring Hospitals, Public Health, and Communities Together

November 11, 2010 | Washington DC

Indu Spugnardi

The Catholic Health Association

Overview

• The Catholic health ministry and the Catholic Health Association• What is community benefit?• Overview of community benefit framework• Assessment and planning best practices/common issues and

considerations• Tips for working with your local hospital

April 10, 2023 2

April 10, 2023 3

Catholic Health Care in the U.S.

• Long tradition of meeting community needs• 600 hospitals and 1,400 long-term care and other health

facilities in all 50 states - Catholic health ministry is largest group of non-profit health care providers

Mother Joseph Father Damien

April 10, 2023 4

The Catholic Health Association

• The Catholic Health Association (CHA) is the national leadership organization for the Catholic health ministry

• CHA has been leader in community benefit for over 20 years – Categories and definitions– Promoting best practices– Education– Advocacy/policy

April 10, 2023 5

What is Community Benefit?

• To be reported as community benefit, a program must address an identified community need and meet at least one of the following criteria:

– Improves access to health services– Enhances public health– Advances medical or health knowledge– Relieves or reduces the burden of government or community groups

Adapted from 2009 Instructions for Schedule H (Form 990)

April 10, 2023 6

Community need can be demonstrated through:

• A community health needs assessment developed or accessed by the organization

• Documentation that demonstrated community need or a request from a public agency or community group was the basis for initiating or continuing the activity or program

• Involvement of unrelated, collaborative tax-exempt or government organizations as partners in the activity or program

From 2009 Instructions for Schedule H (Form 990)

April 10, 2023 7

Categories of community benefit

I. Charity care

II. Government-sponsored indigent health care - unpaid costs of public programs– Medicaid

– SCHIP

– Medically indigent programs

III. Community benefit services– Community health improvement services

– Health professions education

– Subsidized health services

– Research

– Cash and In-kind contributions

– Community building activities

– Community benefit operations

April 10, 2023 8

Assessment and planning are core steps in the community benefit framework

April 10, 2023 9

The Law - Assessment

• Community health needs assessment– Each hospital (not EIN)– Every three years– Takes into account input from persons who represent the broad interest of

the community served by the hospital facility, including those with special knowledge of or expertise in public health

– Widely available to the public

Supplemental Information on AssessmentIn an “explanation of provision” the Joint Committee on Taxation advised assessment may be:–Based on current information collected by a public health agency or non-profit organization–Conducted together with one or more organizations, including related organizations

April 10, 2023 10

The Law - Planning

• Planning– Adopt an implementation strategy (community benefit plan)– Description of:

• How organization is meeting needs identified in assessment• Needs not being addressed and reasons why

– Must be disclosed on IRS Form 990

April 10, 2023 11

Definitions

• Community health needs assessment– A systematic and dynamic process, involving the community, of

identifying and analyzing community health needs and assets in order to prioritize and act upon community health needs

• Implementation strategy (or community benefit plan)– Plan for addressing prioritized health needs and problems identified in the

community health needs assessment

Assessment process - Overview

• Step 1: Plan and prepare for the assessment• Step 2: Determine the purpose and scope of the assessment• Step 3: Identify data that describes the health and needs of the

community• Step 4: Understand and interpret the data• Step 5: Define and validate priorities• Step 6: Document and communicate results

April 10, 2023 12

Assessment process – Collaboration Opportunities

• Step 1: Plan and prepare for the assessment– Participate on assessment advisory committee– Help identify resources in the community

• Step 2: Determine the purpose and scope of the assessment– Provide input on the scope and purpose of the assessment

• Step 3: Identify data that describes the health and needs of the community

– Participation in focus groups and community forums, help identify assets

• Step 4: Understand and interpret the data

• Step 5: Define and validate priorities– Participate in priority setting and validation processes

• Step 6: Document and communicate results– Help communicate the results of the assessment

April 10, 2023 13

Planning to address community needs

• Community-wide plan to address health needs (asthma, obesity)

• Community-wide plan to address other needs (lack of safe, affordable housing, low high-school graduation rates)

• Hospital community benefit plan

April 10, 2023 14

Planning process - Overview

• Step 1: Assess readiness to start planning• Step 2: Form planning team• Step 3: Develop goals• Step 4: Select interventions to address prioritized problems• Step 5: Determine resource needs and availability• Step 6: Integrate community benefit plan with other

organizational plans• Step 7: Develop a written community benefit plan• Step 8: Update the plan

April 10, 2023 15

Planning process – Collaboration Opportunities

• Step 1: Assess readiness to start planning• Step 2: Form planning team

– Participate on planning teams – can help develop goals, select interventions, identify/obtain resources, plan evaluation

• Step 3: Develop goals• Step 4: Select interventions to address prioritized problems• Step 5: Determine resource needs and availability• Step 6: Integrate community benefit plan with other

organizational plans• Step 7: Develop a written community benefit plan• Step 8: Update the plan

April 10, 2023 16

April 10, 2023 17

Guiding principles/Best practices

• Primary goal of assessment and planning is to improve community health

• Collaborate with community members– Collaboration with other providers and community partners expands community

capacity to address health needs through a focus on shared vision, shared resources and skills, and broad participation in program planning, implementation and evaluation.

• Special attention should be given to the needs of vulnerable populations

– These groups may include low-income persons, un/underinsured persons, immigrants, children, elderly, populations dealing with disparities in care

• Community assets are as important as needs – Community benefit plans should build on community assets (such as faith

communities, schools, social service organizations) and not duplicate or erode them.

April 10, 2023 18

Guiding principles/Best practices

• Use existing public health data– Don’t need to create a new survey to collect quantitative public health data.

• Include public health perspective in the assessment– This perspective might be found internally, in the community, or through public health

departments or schools of public health

• Prioritize needs and target resources– Working with the community, identify the needs that the hospital and community

together are best positioned to address. Target resources to where they are most needed and most likely to be effective.

April 10, 2023 19

Issues/Considerations

• Managing community expectations – all needs cannot be met at once

– Prioritizing community needs must be a collaborative process. Remember everyone is working toward health status improvement and choices have to be made in the best interest of the community and within the realities of available resources.

• Aligning priorities– Provider priorities and community priorities may not always align – need

constructive approaches to address this.

April 10, 2023 20

Issues/Considerations

• Meeting needs can be achieved several ways– By the hospital directly, by community/hospital partnerships or by others in

the community (such as other providers or social service agencies)– Upstream vs. downstream interventions

• Need community involvement throughout the community benefit process

– Need to turn prioritized needs into programs that make a difference. Community advocates can help hospitals plan and implement their community benefit programs, as well as measure and celebrate success.

April 10, 2023 21

Working with your local hospital

• Connect with hospital– Might not make a connection on your first attempt, keep trying. Good places

to start are the community outreach department, mission department, communications office or executive office.

– Do you have a contact in the hospital – employee, board member – that can help you make the connection?

– Are you part of a coalition or collaborative that includes other organizations that are working with hospitals? Ask your partners if they can help you make the connection.

April 10, 2023 22

Working with your local hospital

• Involvement with community health needs assessment– Identify themes that are important to your stakeholders and highlight those

in a “white paper” to be presented to the hospital’s leadership and person who is coordinating the needs assessment.

– Can members of your group serve on assessment planning committees/workgroups?

– Collaborate with hospital and other community partners to identify community’s priorities (which might not include issues of all groups)

– Do you have special skill sets (for example, public health expertise) that could be helpful to the hospital?

– Has your group already done an assessment? Offer to share the report and discuss the findings. Do you conduct town halls or community forums that the hospital could participate in to validate assessment findings? Do you have access to data sets that the hospital could use?

April 10, 2023 23

Working with your local hospital

• Build a long term relationship– Can you participate in planning, implementation, and evaluation of

programs? – Can you help advocate for change (with government, communities,

organizations and individuals)?– In some communities community partners are creating formal agreements

that outline roles and financial partners.– Give it time. Working collaboratively can be challenging but the benefits are

worth the effort!

Resources

• The Catholic Health Association – www.chausa.org/communitybenefit

– A Guide for Planning and Reporting Community Benefit– Evaluating Community Benefit Programs– COMING SOON – Resource on assessment and planning– Webinars on current issues

• The Association for Community Health Improvement – http://www.communityhlth.org/

• VHA Inc. – www.vha.com– Focus on Reform series– Community Benefit Center -

https://www.vha.com/AboutVHA/CommunityBenefit/Pages/Default.aspx

April 10, 2023 24

Resources (cont’d)

• Healthy Communities Institute – http://www.healthycommunitiesinstitute.com/

• County Health Rankings - http://www.countyhealthrankings.org/

• The Community Guide - http://www.thecommunityguide.org/index.html

• HFMA’s Patient Friendly Billing project - http://www.hfma.org/HFMA-Initiatives/Patient-Friendly-Billing/Patient-Friendly-Billing/

April 10, 2023 25