TO: HASC Board, January 31, 2017, Agenda Item V.F.

FROM: Mark Gamble, Senior Vice President/COO Scott Twomey, Senior Vice President/CFO      SUBJECT: Community Health Improvement Initiative/Reducing Health Disparities In September 2016, the HASC Board directed staff to develop a core competency to help hospitals reduce health disparities. Staff has identified HC2 Strategies, Inc. (HC2) as a credible and respected partner with whom we can share expertise and build infrastructure required to assist hospitals and other stakeholders to collaboratively reduce health disparities in and around the communities they serve (see Attachment 1 for information about HC2). RECOMMENDED ACTIONS: Approve the creation of a community health improvement initiative that will:

1. Assist hospitals and other stakeholders in developing regional Community Health Needs Assessments (CHNA).

2. Convene and support regional collaboratives focused on reducing health disparities identified in the CHNAs.

3. Form an LLC to support the initiative in partnership with HC2 and fund the $45,000 capital requirement.

DISCUSSION QUESTIONS:

1. Are we on track to help hospitals make a meaningful impact reducing health disparities and improving community health?

2. If not, what adjustments should we make to our approach? 3. Will you direct staff at your hospital(s) to participate in the initiative?

EXECUTIVE SUMMARY: Moving the needle on health disparities in Southern California will require substantial leadership to unify and drive multi-stakeholder alliances. Large-scale collaboratives working together will have a greater impact improving the health and wellness of people in the region than any organization could individually achieve. The long-term goal of this initiative is to demonstrate measurable improvement in reducing health disparities. The underlying steps to achieve the goal include: HASC and HC2 will create an LLC to pool talent, expertise, influence and funding for the

initiative. The LLC will be 60% owned by HASC and 40% owned by HC2 and will support the regional CHNAs and local collaboratives in each HASC county.

515 S. Figueroa St., Suite 1300 Los Angeles, CA 90071 213/538-0700 fax: 213/629-4272 www.hasc.org

 

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In conjunction with the HASC regional vice presidents, build and maintain cross-sector partnerships between hospitals, providers, payers, public health departments, foundations, universities, social service agencies, schools, community members, business groups and other partners.

Conduct multiple regional CHNAs to identify critical health needs within the region. Secure and leverage funding to support regional interventions through a combination of

donations, grants, and hospital participation fees1. Identify and prioritize collaborative intervention strategies to advance health equity and

maximize community benefit. Implement collective action plans that promote a balanced portfolio of interventions to have

the greatest regional impact. Develop a rigorous evaluation process to monitor progress and measure intervention

outcomes to ensure achievement of anticipated results. Reduce duplicative and costly efforts of the multiple organizations conducting individual

CHNAs in isolation. Help participating hospitals tell a compelling story of their commitment to community health

improvement and the impact it has on the residents in their local community. Create an option for hospitals and public health departments to “group purchase” CHNA

consulting services, thereby reducing the cost and complexity of CHNA process for individual hospitals.

In conjunction with regional vice presidents, coordinate with local Medi-Cal managed care health plans to confirm incorporation of a health disparities/community health improvement framework into their beneficiary outreach and payment models.

Nonprofit hospitals in California have been required to conduct CHNAs since 2006 with passage of SB 697. Through the CHNA process, hospitals make significant community investments. However, these investments often lack coordination with the broader community.

                                                            1 Note: grants and awards targeted for specific regional clusters, geographic areas or specific interventions will only be used for their intended purposes.

 

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The Affordable Care Act expanded the requirements for filing the CHNA to include comprehensive strategic plans that describe in detail how hospitals will address the needs of the community. It’s not uncommon for these strategic plans to be developed with minimal collaboration among other hospitals and stakeholders in the region, which results in a fragmented approach to community health investment and improvement. Measurably moving the needle on health disparities in Southern California will require substantial leadership to unify and drive multi-stakeholder alliances. HASC is well positioned to serve as a lead organization that supports both existing and newly created regional collaboratives. HASC has extensive experience managing collaboratives and HASC staff have solid relationships with many of the stakeholder organizations that will be instrumental in achieving success. BACKGROUND: The newly created LLC will: Establish an oversight committee to ensure participating organizations and the LLC follow an

established set of Guiding Principles (Attachment 2). Engage institutions, residents, and systems to help define problems and their solutions, and

advocate for agreed-upon changes within the scope of each collaborative. Support community building and development activities that address social determinants of

health. Identify innovative financing models for community health improvement. Conduct regional CHNAs in order to:

o Engage hospitals and other stakeholders in the regional CHNA process. o Secure funding. o Inventory prior CHNAs. o Collect, aggregate and analyze primary and secondary data in order to identify

opportunities for interventions. o Build consensus on the prioritization of findings. o Disseminate written reports that detail the findings of the regional CHNA. o Provide executive summaries of the findings in the CHNA to the leadership of

each participating hospital. Encourage hospitals to:

o Develop an organization-wide community health policy that includes a commitment to spend a defined minimum dollar amount on community health improvement and/or community development activities that address social determinants of health.

o Connect community benefit dollars with the hospital’s strategic plan. o Conduct a periodic audit of the organization’s internal resources and capabilities

dedicated to community health improvement. Develop cost benefit analysis for hospital investments in community health interventions. Disseminate and promote successful intervention strategies and best practices to increase and

sustain impact across multiple communities. Showcase the success of the collaboratives in publications, meetings with elected officials

and other decision-makers.

 

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Within the scope of the LLC, HC2 will: Provide management services, on-going staff support and subject matter expertise to the

LLC. Develop training curriculum for hospitals and other stakeholders on the social determinants

of health and health equity. Provide access to HC2’s affiliated 501(c)3 to receive and distribute grant funds as needed. Participate in governance and oversight of the LLC, 501(c)3, and social service providers. Recruit members for the initiative’s oversight committee. HASC will: Manage the regional collaboratives through the HASC regional vice presidents with support

from the LLC. Serve as the main conduit to hospitals and health systems. Ensure other HASC initiatives that improve community health, such as the Safe Prescribing

Guidelines, are incorporated into the effort to reduce health disparities. Recruit members for the initiative’s oversight committee. Provide back office support (accounting etc.) for the LLC. Participate in governance and oversight of the LLC and HC2’s 501(c)3. In conjunction with the regional vice presidents, coordinate with local Medi-Cal managed

care health plans to ensure they incorporate a health disparities/community health improvement framework into their beneficiary outreach and payment models.

Additional Subject Matter Experts: The LLC will link with other subject matter experts to help move the initiative forward: HQI (HASC’s representative in the Root Cause Coalition) The Root Cause Coalition is dedicated to addressing the root cause of food insecurity to

ultimately improve health outcomes. The national coalition continues to engage health care organizations, public health, government, food industry and others to collectively deploy effective education, advocacy, and community-based programing to improve health equity.

NHF Serve as a conduit and organizer of community based organizations within regional

collaboratives in the areas where they have expertize and relationships. Identify community members, nonprofits, or faith-based organizations to engage in strategic

planning sessions that ideas ways to address specific community health needs. Public Health Institute (PHI)/Public Health Alliance of Southern California Advise in the development of the LLC’s strategic plan and the ongoing effort. Provide relationship building with local public health departments. Integrate their data initiative (The California Health Disadvantage Index) into the CHNA

process. Assist in actions to advance collaborative implementation strategies between hospitals and

public health departments.

 

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FINANCIAL PROJECTIONS: The first 6 months will focus on the development of the LLC, as well as formation of the

collaborative and program launch, which will be funded by $75,000 in capital contributions; $45,000 from HASC and $30,000 from HC2.

Years 1 through 3, representing full 12-month programmatic years, rely on revenues from performing the CHNAs, analytics and program management fees for implementing the CHNAs.

Expenses are scalable based upon the number of participating hospitals and the particular needs of each hospital.

Year 1 assumes 27 hospitals participate and grows to 46 hospitals in Year 3.

There is upside potential in revenue and profitability based upon increased hospital participation and additional consultation services.

6 months Year 1 Year 2 Year 3

Revenues $ - 595,000$ 860,000$ 1,040,000$ Expenses 75,000$ 567,125$ 790,318$ 945,325$ Profit <Loss> (75,000)$ 27,875$ 69,682$    94,675$

 

  

   

    

     

We develop potential in  people,   communities, and  organizations, connecting to their  purpose, creating a better wor ld.   

Our Promise   

To re ‐ define the meaning and  processes of what it means to be  healthy in connected communities.  To co ‐ create innovative strategies  connecting health and healthcare.   To be a catalyst inspiring and  connecting people, organizations  and  communities to a transformed  world     

Our Gifts 

Visionary thought leadership that  brings an inspired future to the  world.  Creating presence today, drawing  out unique gifts and talents of  people, communities, and  organizations, leading to a  transformative future.   Strategy development that is  authentic and based on mission and  purpose.   

Attachment 1 

 

  

   

 

  

   

 

  

   

 

  

 

 

 

 

 

 

 

 

  

Huma Shah, DrPH, MPH has nearly 20 years of health care administration experience spanning behavioral health, 

community development and marketing. She is passionate about health care innovations, strategic management, 

leadership development, and advancing health policy. Dr. Shah has used her expertise in helping to reduce the 

stigma of mental illness and addiction in her community receiving industry related recognition from ADDY and the 

Health Care Public Relations and Marketing Association. In addition to outputting annual environmental scans for 

Loma Linda University (LLU) Behavioral Medicine Center, she has lead out on research and clinical outcomes by 

forging collaborations across the LLU health care system and academia. She most recently worked on strategic 

initiatives creating a strong organizational culture using a values based approach, that lead to over 90% patient 

satisfaction rates and high employee engagement scores. Preparedness and performance based matters. 

 

  

Attachment 2 - DRAFT Guiding Principles – FOR DISCUSSION PURPOSES ONLY2 In working together, we will build on our capabilities and improve health equity in our communities by accomplishing several long-term goals and objectives. Our approach would have participating organizations agree to shift from an isolated impact approach to community health improvement, to a model of collaboration based on a collective impact approach3. Create a Common Agenda, which includes:

Shared vision for change. Common understanding of the problem(s) to be solved. Joint approach to problem(s) solving through agreed-upon actions. Participants in each regional collaborative agree to participate in good faith in the process

to define the project and develop a budget. Shared Measurement Systems

Share common data indicators that are comprehensive and measure results. Consistently collect data and measure results on a short list of indicators both at the

community level and across all participating organizations. Ensure efforts remain aligned, maintain mutual accountability and learn from each

other’s successes and failures. Mutually Reinforcing Activities

Support a broad portfolio of evidence-based interventions. Participants agree to work together, but not necessarily take identical approaches to

improving the health of the community. Each participant’s approach will be based on local strengths and needs.

Coordination of these differentiated activities will be achieved through a mutually reinforcing plan of action.

Each participant’s individual effort must fit into an overarching plan if the combined efforts are to succeed.

Continuous Communication Consistent and open communication will be maintained across all participating

organizations to build and maintain trust, assure mutual objectives and ensure common purpose.

Every participating organization’s interests will be treated fairly — the priorities of one organization will not be arbitrarily favored over another.

Decisions will be based on objective evidence with the goal of achieving an optimal outcome.

Support Organization or Organizations Collaboration on this scale requires a supportive infrastructure to plan, manage and

support the initiative through ongoing facilitation, communication, data collection and reporting. HASC will serve as the project manager, data manager and facilitator.

HASC will also partner with other stakeholder organizations that are well-positioned to help drive improvement at the community level.

                                                            2 The final set of Guiding Principles will be developed by the oversight committee.  3 Kania, J, Kramer, M; “Collective Impact.” Stanford Social Innovation Review. 2011: 36‐41 https://ssir.org/articles/entry/collective_impact