integrating the chna into the strategy

INTEGRATING YOUR COMMUNITY HEALTH NEEDS ASSESSMENT INTO YOUR STRATEGIC GAME PLAN

S t r a t e g i c P l a n n i n g + Ma r k e t i n g I n s i g h t s f o r H o s p i t a l s : A T h r e e - P a r t We b i n a r S e r i e s

J O N H E A D L E E ,P R E S I D E N T

L E E A N N L A M B D I NS V P

H E A L T H C A R E S T R A T E G Y

O B J E C T I V E S• Refresh on the required components of a CHNA

• Learn the similarities between a CHNA process and strategic planning process

• Learn how to use the information gathered in the CHNA for the strategic plan

• Share how healthcare organizations used a wellness and a brand strategy to improve the health of their population.

REQUIRED COMPONENTS OF A CHNA

R E Q U I R E M E N T S§ The Affordable Care Act includes a requirement that all 501(c)(3)

hospitals conduct a community health needs assessment in order to maintain their tax-exempt status. This requirement is in effect for the taxable year of each hospital beginning after March 23, 2012.

§ Investor-owned hospitals are exempt

§ Final Rules released December 31, 2014 (Happy New Year!)

IRS FORM 990 SCHEDULE H REQUIREMENTS

D O N ’ T J U S T C H E C K T H E B O X

Open letter to Hospital CEOs,

The Accountable Care Act requires hospitals to perform community health needs assessments (CHNA).

The CHNA can be a valuable strategic planning tool and source of information. Many CEOs are assigning responsibility for the CHNA to others in the organization who have no idea the strategic value of a CHNA.

Some organizations are “checking the box” performing the CHNA to meet the IRS requirement and do not appear to be using the information for meaningful strategic planning. Please don’t do this!

Sincerely,Stratasan

THE STRATASANCHNA PROCESS

FIVE STAGE PROCESSSTAGE 1 – Market Research AnalysisService area definition, market share, utilization

STAGE 2 – Community Health Needs Assessment and EvaluationSecondary Research

STAGE 4 – Community Engagement SummitCommunity involvement – sharing the information, prioritization and brainstorming solutions

STAGE 5 – Final ReportWritten report/presentation suitable for website

STAGE 3 – Validate FindingsPrimary Research: Survey ≈400 consumers, online survey associates and medical staff, interviews, focus group(s)

STAGE 1 – M A R K E T R E S E A R C H A N A LY S I S

§ Map hospital patient data to block group level – IP, OP, ED

§ Service area analysis

§ Analyze utilization – IP, OP, ED top diagnoses

§ Map Psychographics and demographics of area

§ Business and industry analysis, Commuter profiles (daytime versus nighttime population)

§ Market Share by ZIP Code, service line, In/Out Migration (either State data or Medicare)

STAGE 2 – S E C O N D A R Y R E S E A R C H A N D E VA L U AT I O N

§ Determine health needs and determinants

§ Socioeconomics and demographics

§ Public health data analysis

§ Access to healthcare issues

§ Hot Spot analysis

§ Evaluation of medically underserved, low-income and minority populations

§ Asset Inventory - document all other healthcare and non-profit groups in the community

§ Evaluation of the impact of actions that were taken since the preceding CHNA

POPULATION BY CENSUS TRACT

Source(s): Stratasan (2016); Esri (2015)

Yellow is positive up to the TX growthGreen is greater than the TX growthDark green is twice the TX growth rate

POPULATION GROWTH RATE

MEDIAN AGE MEDIAN INCOME

SMOKE 9+ PACKS OF CIGARETTES PER WEEK BY CENSUS TRACT

Source(s): Stratasan (2016); Esri (2015)

CONTIGUOUS COUNTY HEALTH RAKINGS + MEASUREMENTS

Source(s): Stratasan (2016); County Health Rankings (2015); Bureau of Labor Statistics (2015)

TX county rankings based on 241 counties.

Kerr Bandera Kendall Edwards Gillespie Kimble RealOverall Rank 72 33 6 132 16 78 179Health Outcomes 123 31 10 150 27 82 239Length of Life 138 20 13 119 39 64 240Quality of Life 123 77 14 179 33 142 170Health Factors 21 36 2 114 6 74 119Health Behaviors 18 21 5 23 14 19 104Clinical Care 9 73 2 234 6 216 164Social & Economic Factors 107 71 4 163 16 121 160Physical Environment 110 152 137 1 21 4 5Low Birth Weight 9.0% 9.3% 7.5% 9.4% 7.4% 9.7% 9.1%Adult Smoking 14% 14% 13% 13% 13% 14% 15%Adult Obesity 25% 28% 27% 29% 31% 30% 30%Physical Inactivity 30% 28% 22% 28% 28% 27% 29%Teen Birth Rate (per 1,000 female pop 15-19)

53 30 22 72 43 45 50

Diabetes 13% 12% 10% 16% 13% 13% 15%Uninsured 26% 25% 21% 35% 28% 32% 31%Pop per Primary Care Physicians 1,189:1 4,120:1 1,399:1 1,884:1 768:1 1,494:1 NA

HS Graduation 90% 92% 99% NA 96% NA NAUnemployment 4% 4% 3% 5% 3% 4% 6%Excessive Drinking 15% 16% 18% 14% 15% 15% 14%Long Commute 16% 59% 45% 26% 20% 19% 23%

• Health Outcomes: how long people live and how healthy people feel and low birth weight babies.

• Health Factors: health behaviors, clinical care, social and economic, and the physical environment.

KERR COUNTY, TX HEALTH RANKINGS

Community safety

Education – HS graduation, some college

Family & social support

Employment

Housing and commuting

Environmental quality

Income

STDs & Teen births

Alcohol use (Excessive drinking)Obesity, Diet & exercise

Adult Smoking

Uninsured, PCPs, Dentists, Mental Health providers

Preventable hospital stays, diabetic and mammo screening

Physical environment (10%)

Rank #110 out of 241

Social & economic factors (40%)

Rank #107 out of 241

Health behaviors (30%)Rank #18 out of 241

Clinical care (20%)Rank #9 out of 241

Health FactorsRank #21 out of 241

Programs and Policies

Length of Life: 50% Rank #138 out of 241 (Premature death)Quality of Life: 50% Rank #123 out of 241 (poor or fair health, poor

physical and mental health days, low birthweight)

Source(s): Stratasan (2016); County Health Rankings (2015)

Health OutcomesRank #123 out of

241

STAGE 3 – VA L I D AT E F I N D I N G S / P R I M A R Y R E S E A R C H

§ Stakeholder identification

§ Telephone and/or on-line community survey n=400

§ 10 -12 question on-line survey for associates and physicians

§ Input through focus group(s) and/or interviews

STAGE 4 – C O M M U N I T Y I N P U T A N D E N G A G E M E N T

§ Invite members of the community, stakeholders, leaders, public health, government, schools, clergy, law enforcement, non-profit agencies, United Way, Colleges, medical staff, underserved populations or representatives, minority populations, all ages, representative of whole community.

§ Leadership Forum (approx. 10 people) – leaders, secure commitment

§ Community Health Summit (approx. 100 people)

COMMUNITY HEALTH SUMMIT

STAGE 5 – F I N A L R E P O R T

§ Community Health

Report suitable for website, newspaper,

display at hospital summarizing the

process, data and the

summit.

IMPLEMENTATION§ After the assessment and prioritization of the top health issues, a

hospital must create an implementation plan:§ Community-benefit§ Community- building§ IRS encouraged joint CHNA implementation strategies

§ Based on the results of this CHNA, Peterson selected three of the identified significant health needs to address:§ Mental Health/Substance Abuse§ Chronic Diseases§ Access to Healthcare

EVALUATION OF IMPACT§ The hospital must include an evaluation plan of the impact of

activities in the implementation plan.

§ Measurement and Monitoring

AFTER THE ASSESSMENT… IMPLEMENTATION AND EVALUATION

Plan§ Engage Stakeholders§ Describe the program§ Focus evaluation design

Implement§ Gather credible evidence

Analyze and use findings§ Justify conclusions§ Ensure use and share lessons learned

Source: http://www.cdc.gov/eval/framework

PRIORITY ISSUES, GOALS AND MONITORING IMPACT

HealthIssue GoalStatement

WashingtonCoPre-CHNA

Score

Current(2016)ScoreWashington

Co Goal

NationalMedian/Avg

orRate

BestPractice/National

Benchmark HP2020GoalAccesstoCare

Populationtoprimarycarephysicianratio Increaseaccesstoprimarycarephysiciansby10% 1,601:1

2,112:1*measure

modifiedin 1,067:1 1,067:1 NA

Primarycarephysiciansper100,000pop Increaseaccesstoprimarycarephysiciansby10% 123.9 120.3 132.3 119.9 175 NAObesity

AdultObesity Decreaseadultobesityby5% 29.0% 33.0% 31.4% 27.8% 25% 10%decreaseChronicDisease%ofadultpopulationwithdiabetes

Decreasethenumberoftheadultpopulationwithdiabetesby2% 9.0% 10.0% 9.8% 9.7% 6.0% Decreaseby10%

DiabeticScreeningIncreasediabeticscreeningforMedicarepopulationto90% 86.0% 88.0% 90.0% 90.0% NA

HeartdiseaseReduceincidenceofheartdiseaseby10%in5years

183.6deathsper100,000 180

MammographyscreeningIncreasediabeticscreeningforMedicarepopulationto70% 69.0% 64.0% 70.0% 74.0%

CancerDeathRate Decreasethedeathrateby10%by2020 221.1 181.9 163.7 176.4 160.6160.6;10%improvement

CancerIncidence Decreasetheincidenceofcancerby10%by2020 453.0 436.3 392.7 453.7333.2(CalhounCo,

Smoking/Drinking/DrugAbuse

%ofadultssmoking Decreasesmokingby10% 18% 18% 16.2% 19.6% 13% 12%

CHNA AS A STRATEGIC PLANNING TOOL§ Listening beyond the CHNA integrating into the strategic plan and customer service

initiative§ Determining the health needs of the community is key to product line development§ Uncovering access issues assists with the physician/provider recruitment strategies§ Relationship building with the community§ Partnering with other resources in the community is key for population health§ A telephone or on-line survey can be expanded to not only include community health

issues, but also access and image questions.

§ The implementation plan of a CHNA should be a category within the facility’s strategic and implementation plan

§ Coordinate the timing of the CHNA prior to the beginning of the strategic planning process

Sharp Healthcare added community as have many other

systems and hospitals.

P I L L A R S O F E X C E L L E N C E

§ Baldrige Criteria 3, “Customer” includes “Voice of the Customer” and “Customer Engagement”

§ Process for listening to your patients and customers

§ Customer relationship strategies

§ Engagement as strategic action

B A L D R I G E C R I T E R I A

S T R AT E G Y

C H N A a s s t r a t e g i c p l a n n i n g t o o l s a l s o k n o w n a s …

“ W h y i n v e s t o r - o w n e d h o s p i t a l s p e r f o r m a C H N A ”

§ Politically and socially adept investor-owned hospitals are performing CHNAs

§ Why? See previous slides…

I N V E S T O R - O W N E D H O S P I TA L S P E R F O R M I N G C H N A s

WELLNESS STRATEGY

I N S I D E - O U T – H O S P I T A L E M P L O Y E E S C O M P A R E D

T O U . S . W O R K F O R C E

Higher burden of illness and higher healthcare costs

Higher percentage of

chronic conditions by

risk group

Compliance with common

preventive measures is consistently

lower

§ Improved access § Convenience§ Reduced absenteeism§ Improved productivity§ Improved health outcomes§ Strong employee retention

and morale§ Reduced healthcare costs

I N S I D E - O U T– C O M M O N E M P L O Y E R G O A L S

3 Hospital System – 323 beds- Tanner Medical Center – Carrollton- Tanner Medical Center – Villa Ricca- Higgins General Hospital

2,800 employees

150,000 residents

• Access to Care

• Social Determinants to Health

• Chronic Disease Issues• Obesity• Heart Disease• Diabetes• Cancer

• Mental Health

C H N A R E S U LT S

• Prevent + Reduce Tobacco Use

• Prevent + Reduce Obesi ty

• Increase Physical Act iv i ty

• Improve Nutr i t ion• Increase Access to + Demand for High Impact Qual i ty

Preventat ive Services

• Improve Communi ty Envi ronment to Support Heal th

A R E A O F F O C U S F O R M A R K E T I N G & C O M M U N I C AT I O N

• Prevent + Reduce Tobacco Use

• Diabetes Education, Prevention + Management

• Childhood Obesity Task Force

• Healthy Child Care Centers

• Healthy + Safe Communities

• Improve Nutrit ion

• Regional Food Systems Collaborative

• Cooking Matters Series

• Farmers Markets

• Local Food + Restaurant Challenges

• Community Gardens

• Nutrit ion Training in Schools

• Increase Physical Activity

• Weight Loss Challenges

• Healthy Life Classes

• Group Exercise Classes

• Youth Wellness Classes

• Faith Based Wellness

• Business + Industry Wellness

• Take 10 Training Classes – School Program

WA L K I N G T R A I L S

F I T N E S S T R A C K E R S

F I T N E S S T R A C K E R S

RESULTS

• Combined Employee Miles -- 192,000

• Average HDL (Good) – Improved 5.5 points

• Average LDL (Bad) -- Decreased 14.2 points

CAMPAIGN LAUNCH

52

53

Prevent + Reduce Tobacco Use

• Quit l ineFree counsel ing, resources + referral service for smokers

• Business + IndustryImplemented tobacco free pol ic ies

• Speakers BureauAvai lable health benef i t informat ion

Diabetes

• 17 Li festyle Coaches

• 74 Registered -- Each has lost an average of 10.8 pounds – 529 Total Pounds!

• 70% achieved measurable improvements

Improve Nutrition

Cooking Matters – Classes to provide nutr i t ion + educat ion and cooking instruct ion led by 46 Volunteer Instructors

Sponsored monthly cooking t ips at local farmers markets

Introduced SNAP benef i ts

Improve Nutrition

Exploring future partnerships for a Regional Food Systems Col laborat ive – including farmers, business, restaurant owners, chefs, school nutr i t ion directors + master gardeners.

Community Gardens

• Created 46 new gardens

• Benefited residents + food banks

• Grew Knowledge for Life

GARDEN CLUBS

BOYS & GIRLS CLUB

FAITH-BASED GROUPS

Educated Community Groups for Sustainability

4-H GROUPS

SCHOOLS

UNIVERSITY STUDENTS

COMMUNITY MEMBERS

Weight Loss Challenge

• Log your exercise• Keep a food diary• Track your weight loss• Calculate your BMI (body mass index)• Participate in local and regional exercise

challenges• Connect with friends or coworkers• Create your own group challenges• Share healthy recipes or encouraging

messages

Increase Physical Activity

• 233 Part ic ipants

• Lost more than 2,400 Pounds

• Local Businesses provided f inancial support

• Provided Exercise and Nutr i t ion Classes

-- Over 500 Attended

Physical Activity for Kids“Take 10 Program”

• 148 - 1st Grade Teachers Tra ined

• 10 min. bursts o f act iv i ty

• 3,000 area students added an addi t ional 30 minutes of physica l act iv i ty to the i r school day

• Tanner Designed Play about Nutr i t ion – reached 4,000 students K-3 rd

COMMUNITY + BRAND STRATEGY

124 Bed Hospital900+ Employees

Approx. 50,000 in County

69

I N T E R N A L T H E M E S

• Be Prepared - Know the Required Components of the CHNA

• Be Smart- Align your strategic planning with the CHNA process to save time and resources

• Be a Leader - Develop compelling messages that will educate and inform your community about the services offered from your organization.

• Be Accountable - Build measurements into your planning so you can celebrate your successes

W R A P U P

L E E A N N L A M B D I N

S T R A T A S A N

8 6 6 . 6 2 8 . 5 0 5 1 X 7 0 6

l e e a n n @ s t r a t a s a n . c o m

J O N H E A D L E E

T E N A D A M S

8 1 2 . 2 5 3 . 6 3 0 0

j h e a d l e e @ t e n a d a m s . c o m

W A N T T O T A L K ?

THANK YOU!