1. Community Health Needs Assessment Setting Priorities

2. Building Leaders – Transforming Hospitals – Improving Care
Who We Are
Our Company
Our Team
Our Mission
Formerly known as Brim Healthcare we have a 45 year track record of delivering superior clinical & operating results for our clients
Our Executive Team has experience in managing hospitals from multi-billion $ healthcare systems to community hospitals
We believe that the combination of People, Process & Technology transforms healthcare & provides the required results
Management
Consulting
Placement
Technology
Turnaround Strategy
Financial
Operations
Corporate Compliance
Board Development
Regulatory Compliance and Accreditation Preparation
Lean Process Improvement
Community Health Needs Assessments
Execuitve Recruiting
Interim Executive Placements
Mid-level and Specialty Placements
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Update Verbiage
Building Leaders – Transforming Hospitals – Improving Care

3. Instructions for Today’s Webinar
You may type a question in the text box if you have a question during the presentation
We will try to cover all of your questions – but if we don’t get to them during the webinar we will follow-up with you by
You may also send questions after the webinar to Carolyn St.Charles (contact information is included at the end of the presentation)
The webinar will be recorded and the recording will be available on the HealthTechS3 web site
HealthTechS3 hopes that the information contained herein will be informative and helpful on industry topics. However, please note that this information is not intended to be definitive.  HealthTechS3 and its affiliates expressly disclaim any and all liability, whatsoever, for any such information and for any use made thereof.  HealthTechS3 does not and shall not have any authority to develop substantive billing or coding policies for any hospital, clinic or their respective personnel, and any such final responsibility remains exclusively with the hospital, clinic or their respective personnel. HealthTechS3 recommends that hospitals, clinics, their respective personnel, and all other third party recipients of this information consult original source materials and qualified healthcare regulatory counsel for specific guidance in healthcare reimbursement and regulatory matters.

4. Building Leaders – Transforming Hospitals – Improving Care
Speaker
Carolyn St. Charles, RN, BSN, MBA
Regional Chief Clinical Officer
Carolyn began her healthcare career as a staff nurse in Intensive Care.  She has worked in a variety of staff, administrative and consulting roles and has been in her current position as Regional Chief Clinical Officer with HealthTechS3 for the last fifteen years.   In her role as Regional Chief Clinical Officer, Carolyn St.Charles is the lead consultant for development of Community Health Needs Assessments. She also conducts mock surveys for Critical Access Hospitals, Acute Care Hospitals, Long Term Care, Rural Health Clinics, Home Health and Hospice.
Building Leaders – Transforming Hospitals – Improving Care

5. The Affordable Care Act added 501(r) to the Internal Revenue Code
The Affordable Care Act added 501(r) to the Internal Revenue Code. This provided that hospital organizations will not be treated as tax-exempt under 501(c)(3) unless they meet certain requirements. All of the provisions apply to taxable years beginning after March 23, 2010, except the Community Health Needs Assessment (CHNA).
Establish written financial assistance and emergency medical care policies.
Limit amounts charged for emergency or other medically necessary care to individuals eligible for assistance under the hospital's financial assistance policy.
Make reasonable efforts to determine whether an individual is eligible for assistance under the hospital’s financial assistance policy before engaging in extraordinary collection actions against the individual.
Conduct a community health needs assessment (CHNA) and adopt an implementation strategy at least once every three years.
A $50,000 excise tax will be imposed on a hospital that fails to meet the CHNA requirements with respect to any taxable year.

6. Final Regulations December 2014
The final rules issued December of 2014 are consistent with earlier guidance issued by the IRS in April of However, they include the following clarifications:
Expands examples of health needs to include preventing illness and addressing the social determinants of health
Gives hospitals flexibility if they are unable to obtain required community input
Adds requirement to use community input in setting priorities as well as in the assessment process
Requires that CHNA documentation must include evaluation of impact of any actions that were taken to address significant health needs since the previous assessment
The requirement that implementation strategies include a plan to evaluate planned actions was deleted from the final rule but the strategy still must include anticipated impact of planned actions
Source:
“Additional Requirements for Charitable Hospitals; Community Health Needs Assessments for Charitable Hospitals; Requirement of a Section 4959 Excise Tax Return and Time for Filing the Return; Final Rule,” 79 FR [December 31, 2014], pp )
“Community Health Needs Assessments for Charitable Hospitals,”78 FR [April 2, 2013], pp
Catholic Health Association: Assessing & Addressing Community Health Needs 2015 EDITION I I

7. Exempt or Not?
Governmental entities, which means that they are exempt under IRC Section 115 instead of IRC 501C3, do not have to file a Form 990 tax return AND they are not subject to the 501R tax regulations and therefore is not required to complete a CHNA. Some governmental hospitals that are referred to as “dual status” hospitals. A “dual status” hospital is a governmental hospital that has received 501C3 status in order to participate in certain employee benefits, which is typically a 403b pension plan. These hospitals are not required to file a Form 990; however, since they do have 501C3 tax status, they are subject to the 501R tax regulations and thus required to complete a CHNA.

8. Steps for Identifying Priority Community Health Needs
Understand and interpret the indicator data you have gathered from primary and secondary sources
Identify major community health needs
Develop priorities
Incorporate community health priorities in your Community Health Needs Assessment

9. Step 1 Understand and Interpret the Data

10. Analyze and interpret the data
County
State
United States
Percentage of adults aged 20 and older self- report that they have a Body Mass Index (BMI) greater than 30.0 (obese).
29.5%
26.4%
27.5%
Percentage of adults aged 18 and older self- report that they have a Body Mass Index (BMI) between 25.0 and 30.0 (overweight)
38.3%
35%
35.8%

11. Identify disparities 18-25 26-44 45-64 65+ % Obese 13.6% 26.0% 31.0%
27.2%
White
Black
Hispanic
% Obese
27.7%
35.4%
31.5%
Men
Women
% Obese
27.4%
26.4%
Community 1
Community 2
Community 3
% Obese
15.2%
25.3%
45.6%

12. Identify Disparities

13. Identify and understand causal factors

14. Review primary data Surveys – Focus Groups – Key Stakeholder Interviews – Hospital Data

15. Identify major community health needs
Prior CHNA
Secondary Data
Community Surveys
Hospital Data
Key Stakeholder Interviews
Focus Groups

16. IRS Note
IRS regulations state that health needs include the requisites for the improvement or maintenance of health status both in the community at large and in particular parts of the community (such as neighborhoods or populations experiencing health disparities) The regulations also note that these needs may include the need to address financial and other barriers to accessing care, to prevent illness, to ensure adequate nutrition, or to address social, behavioral, and environmental factors that influence health in the community A hospital may determine whether a health need is significant based on all of the facts and circumstances present in the community it serves (1.501(r)-3(b)(4)

17. Summary of Community Health Needs
ACCESS TO CARE
Secondary Data
Key Stakeholders
Community Survey
Lack of insurance coverage X
Access to dentists
Access to ophthalmology
Access to primary care
Access to specialty care
Access to Behavioral Health / Mental Health
Utilization of ED for urgent care
CHRONIC DISEASE
Key Stakeholder
Hypertension
Diabetes
Cancer
Stroke
Readmission rate for cardiac disease / CHF
SUBSTANCE ABUSE
Cigarette Smoking
Illegal Drug Use
Alcohol Abuse
DIET & EXERCISE
Nutrition and Access to Healthy Food
Physical Activity
OTHER
Child Abuse & Neglect
Homelessness

18. Summary of Community Health Needs
Vulnerable Populations and Community Resources
Vulnerable Populations – At-Risk
Community Resources
Lack of insurance coverage
Hispanic / Low-Income/ Young Adults
 Case Management for Low-Income to Sign up thru the Exchange. Nothing for young adults
Access to dentists
Low-Income / Children / Farm Workers
No services in any of the communities in the service area
Access to ophthalmology
Low-Income / Children 
Limited services -- requires access to transportation
Access to primary care
Rural Health Clinic / Farm Workers Clinic 
Access to specialty care
 Community - ALL
Very limited specialists
Access to Behavioral Health / Mental Health
Homeless / Chronically Mentally Ill
Mental Health Providers very limited
County Mental Health Services
Utilization of ED for urgent care
Low-Income
Not being addressed

19. A few words about the summary
Most hospitals have limited resources Ensure your summary of needs is manageable – i.e. poverty may be a big issue in your community –but are you going to be able to impact poverty overall? If a significant need is also the priority of another community organization – it’s OK for the hospital to identify it as a need and then collaborate with that organization You don’t have to present ALL the data from the assessment. Select data that is important to convey important points.

20. Step 3 Develop priorities

21. Determine who will be involved in setting priorities
Executive Team
CHNA Steering Committee
Board members
Key stakeholders / partners
There’s not a magic list ---- some hospitals have very large groups ---- others small groups
At a minimum include the CHNA steering committee and Public Health

22. IRS Note
Current IRS regulations state that input from persons representing the broad interests of the community should be taken into account in prioritizing significant health needs and identifying resources potentially available to address those needs.

23. Agenda Introduction by CEO 10 minutes
Public Health priorities minutes
Primary and Secondary Data 45 minutes
Break minutes
Development of priorities minutes
Identification of vulnerable & at-risk minutes populations and/or communities
Initial discussion about interventions to minutes address priority needs

24. Establish criteria for setting priorities
PRIORITIZATION CRITERIA
Magnitude / scale of the problem
The health need affects a large number of people within the community.
Severity of the problem
The health need has serious consequences (morbidity, mortality, and/or economic burden) for those affected.
Health disparities
The health need disproportionately impacts the health status of one or more vulnerable population groups.
Community assets
The community can make a meaningful contribution to addressing the health need because of its relevant expertise and/or assets as a community and because of an organizational commitment to addressing the need.
Ability to leverage
Opportunity to collaborate with existing community partnerships working to address the health need, or to build on current programs, emerging opportunities, etc.
There is not a mandated prioritization criteria that you must use – but you must use criteria. Consider asking the CHNA Steering Committee to establish criteria prior to the prioritization meeting.

25. Develop priorities
Ask participants to individually rank the health needs placing the health need with the highest concern on yellow, the second highest need on pink paper and the third highest need on blue paper
Facilitator groups input in order in graph form
Facilitated discussion about each priority
Other Options
Ranking 1 (least need) – 10 (most need)
Weighted Ranking (Weights multiplied by rating)
Discussion and Debate

26. Too Big Too Many Too Little Not Enough Just Right Just Right

27. Identify at-risk populations / groups / communities

28. Begin discussions about community partners and implementation strategies

29. Important Considerations
Depending on who you invited to the meeting to determine priorities you will need to validate priorities with community members and key stakeholders including public health If you have completed a community survey or community focus groups --- that is one way to show community input

30. Step 4 Governing Board Approval
Incorporate prioritized community health needs in your Community Health Needs Assessment
Request governing board approval of CHNA

31. World Health Organization
The context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate.

32. If you would like to talk about your CHNA Please contact me
Carolyn St.Charles
Regional Chief Clinical Officer

33.          x
Upcoming Webinars
November 4, 2016: A Deep Dive: Continuous Survey Readiness – Myth or Reality?
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December 2, 2016: Community Health Needs Assessment: Developing an Action Plan
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December 12, 2016: Leading Change: Shifting to Population Health Management
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