Hospitals increasingly face not only changing market trends, but also evolving expectations of the role they should play in their own local communities.
Providers are increasingly expected to keep people healthy, decrease avoidable utilization and promote cost efficiencies. Accordingly, success in value-based payment reform and value-based care models will hinge on how well hospitals engage and care for community members that are not necessarily patients in the acute care setting.
To understand the needs of the broader community, non-profit hospitals and health systems should be closely correlating their value-based work with their Community Health Needs Assessment (CHNA). The CHNA can serve as a comprehensive tool for organizations to bridge their strategic plans and efforts with broader community improvement.
Why a Community Health Needs Assessment?
The Patient Protection and Affordable Care Act (PPACA) of 2010 mandated that tax-exempt hospitals conduct a CHNA every three years. The CHNA serves as a framework for hospitals to identify the health needs of their community, prioritize the most significant needs and commit to a three-year implementation plan to address a selection, if not all, of the most significant needs.
Hospitals that conducted their CHNAs after COVID-19 started in early 2020 saw stark contrasts in the significant needs of their community. While many of the same clinical issues remained, basic needs increased exponentially. Food insecurity, housing instability, job loss and the consequential increase in the number of uninsured and Medicaid enrollees soared, and will unfortunately endure for some time.
The federal objective of a CHNA is for charitable hospitals to provide a sufficient level of community benefit in exchange for their tax-exempt status.
For example, if the CHNA reveals a historically underserved community struggling with access to healthy, affordable food, a provider’s strategic initiative could be to provide nutrition and physical activity classes and offer referrals to conveniently located, community-based food benefit programs.
Other activities include prescribing vouchers for healthy food that can be redeemed in the hospital cafeteria to take home, making nutritionists available for questions in the hospital’s cafeteria, and hosting a regular Farmers' Market on the hospital’s campus.
CHNAs require a large investment in human and financial resources. To obtain a strong return on this investment, providers should go beyond applying the findings in the report toward the intended community health improvement goal and integrate them into the organization’s larger value-based care strategy.
How to Use Your CHNA for Success in Value-Based Models
Organizations that undertake a CHNA will identify the biggest clinical and social determinant of health issues in the community, prioritize by significance and commit to improvement efforts over the forthcoming three years. While the CHNA is not a substitute for a comprehensive hospital strategic plan, the data elements collected as part of the CHNA report – including demographics, socioeconomic status, health behaviors and health status – should be leveraged to inform the hospital’s strategic plans, especially a strategy for an increasing Medicaid population.
Here are four ways health systems can align a CHNA’s quantitative data and input from community members with their ongoing value-based model strategies.
- Target populations of greatest need. Assuming data are available, the CHNA assessment can identify populations (such as ethnically diverse groups or seniors) or geographies (food deserts or areas without sufficient clinical or social resources) that will most benefit most from interventions. Organizations can use this data to further focus outreach and activities on existing value-based populations that accelerate or deepen the impact.
- Prioritize investments. The CHNA can reveal that community needs have drastically changed and enable the hospital to reprioritize its efforts toward activities that generate a bigger clinical impact or improvement. This flexibility is important for hospitals, which must carefully funnel their limited resources toward the most consequential investments. This does not necessarily mean that current activities need to cease.
- Engage non-traditional partners. The CHNA regulations mandate that organizations incorporate input from persons who represent the broad interests of the community, including those with expertise in public health. These persons should also be involved in addressing prioritized needs using their organizational expertise across multiple clinical and social service areas. Examples include people who work in public health departments, school districts and community-based organizations (CBOs) such as community clinics, food pantries, homelessness agencies or faith-based organizations.
The right partners allow hospitals to do what they do best: focus on clinical inpatient care, but also extend clinical and social collaborations that potentially avoid the costly duplication of uncoordinated services. Another benefit of having the right CBO partner is opening up access to funding that can be applied to value-based interventions and activities. There are federal or state grant dollars available to CBOs and the community collaboratives in which they participate for which hospitals are not eligible.
- Use other publicly available CHNAs. All charitable hospitals are required to post their CHNA on a public website, and since 2014 CHNAs have included an evaluation of the impact of the actions they’ve undertaken. Health systems can glean learnings from other tax-exempt hospitals in their regions that serve similar populations or care for communities with comparable disparities. These evaluations offer insight into a number of existing activities and programs, how they are performing and what has proven successful or not. Knowing what isn’t working well can be just as helpful as knowing what is.
Done well, these activities will align with a provider’s broader population health goals, such as reducing unnecessary or inappropriate care, eliminating avoidable emergency department visits and decreasing readmissions.
For example, there is evidence that systemic health and social inequities have disproportionately affected people from racial and ethnic minority groups by placing them at increased risk of severe COVID-19 illness. While the entire community can benefit from outreach, education and vaccination efforts, focusing COVID-19 interventions on the underserved minority populations may eliminate the most critical hospitalizations and serious clinical outcomes.
As we’ve seen recently during the pandemic, providers continued to deliver regular back-to-school immunizations and seasonal flu shots to the community. However, more hospital resources are being reserved for the education, promotion and distribution of COVID-19 vaccinations due to the immediacy and greater severity of the need.
Integrating the CHNA with the organizational strategy is essential to advance value-based care – and avoid duplicative or siloed efforts.
Healthcare providers are reconciling the growing national focus on value-based models and payment reform with local socioeconomic changes presented by the continuing pandemic. They must also navigate differences in state Medicaid programs and policies, local pandemic-related job losses, resulting increases in the uninsured and a need to amplify the approach to social determinants.
These challenges affect communities differently – and therefore must be identified and addressed at the community level.
The increasing emphasis on value-based care models complicates what hospitals must become and by when. Particularly amid the pandemic, hospitals should leverage all available resources to inform their value-based care strategy – especially data insights that they already collect and analyze routinely like the CHNA.
Ready to turn your CHNA into an actionable delivery mechanism for value-based care?
Reach out to us and learn more about how Premier can help propel your value-based care journey.
Looking for more? Read how two members of Premier’s Population Health Management Collaborative, Atrium Health and Henry Ford Health System, leveraged their population health capabilities to address care inequities and community engagement during the pandemic.