1. Community Health Needs Assessment 2018
Building Leaders – Transforming Hospitals – Improving Care

2. 45 Years of Delivering Results1
HealthTechS3 is a 45 year old, award-winning healthcare consulting and strategic hospital services firm based in Brentwood, Tennessee with clients across the United States.
We are dedicated to the goal of improving performance, achieving compliance, reducing costs, and ultimately improving patient care. Leveraging consultants with deep healthcare industry experience, HealthTechS3 provides actionable insights and guidance that supports informed decision making and drives efficiency in operational performance.
Our consultants are former hospital leaders and executives. HealthTechS3 has the right mix of experienced professionals that service hospital clients across the nation. HealthTechS3 offers flexible and affordable services, consulting, and technology as we focus on delivering solutions that can be implemented and provide a positive, measurable impact.

3. Strategy – Solutions – Support
GOVERNANCE & STRATEGY
Affiliation Consulting
Executive & Management Leadership Development
Strategic Planning & Market share Analysis
Community Health Needs Assessment
Compliance Consulting Services
FINANCE
Performance Optimization / Margin Improvement
Revenue Cycle & Business Office Operations
Productivity & Staffing Consulting - Optimum Productivity Toolkit
CLINICAL CARE & OPERATIONS
Continuous Survey Readiness
Quality Assurance Performance Improvement
Lean Culture
Customer Experience
Clinical Resource Management
Care Coordination – Primary Care Practice
Physician Practice & Clinic Assessment
Long Term Care Consulting
Swing Bed Consulting
Perioperative Services Consulting
RECRUITMENT
Executive Recruitment
Manager and Clinical Positions
Physician / Provider Recruitment
Information Technology Professionals
Interim Placement

4. 4th Quarter 2017 – 1st Quarter 2018 Webinars
Understanding Team Based Care in the Primary Care Setting Host: Faith Jones Date: December 21, 2017 Time: 12:00 Central Register Here: How to Develop and Implement an Effective Productivity and Staffing Management System Host: Carolyn St.Charles, RN, BSN, MBA, Regional Chief Clinical Officer Date: January 5th, 2018 Time: 12:00pm CT Register Here: What’s New in the 2018 Regulations for CCM?: Understanding the Alphabet Soup of Care Management Host: Faith M Jones, MSN, RN, NEA-BC, Director of Care Coordination and Lean Consulting Date: January 18th, 2018 Time: 12:00pm CT Register Here:
Challenges/Opportunities in Population Health Management IT
Host:  Diane Bradley, PhD, RN, NEA- BC, CPHQ, FACHE, FACHCA, Regional Chief Clinical Officer Date: January 22nd, 2018 Time: 12:00pm CT Register Here: 
Continuous Survey Readiness: Yes it’s Possible Host: Carolyn St.Charles, RN, BSN, MBA, Regional Chief Clinical Officer Date: February 2nd, 2018 Time: 12:00pm CT Register Here: 
Office of Inspector General Work Plan: Change towards Transparency
Host: Cheri Benander MSN, RN, NHA, CHC, NHCE-C Health Services Consultant, HealthTechS3 Date: February 8th, 2018 Time: 12:00pm CT Register Here: 

5. 2018 Webinars (cont’d)
Strategies to Maximize Service Lines and Improve Accountability Host: Diane Bradley, PhD, RN, NEA-BC, CPHQ, FACHE, FACHCA, Regional Chief Clinical Officer Date: February 16th, 2018 Time: 12:00pm CT Register Here: Funding Diversification Takes Planning: Do you have a Grant Plan? Hosts: Faith M Jones, MSN, RN, NEA-BC, HealthTechS3 Director of Care Coordination and Lean Consulting; and Bianca Policastro, Vice-President, The Policastro Group Date: February 22nd, 2018 Time: 12:00pm CT Register Here: Community Health Needs Assessment – Your Partner in Population Health Host: Carolyn St.Charles, RN, BSN, MBA, Regional Chief Clinical Officer Date: March 2nd, 2018 Time: 12:00pm CT Register Here:
Strategic Alignment of Practice Measures in Care  Coordination: Making it Meaningful
Hosts: Faith M Jones, MSN, RN, NEA-BC HealthTechS3 Director of Care Coordination and Lean Consulting; and Deb Anderson, Business Relationship Manager, Health Technology Services Date: March 22nd, Time: 12:00pm CT Register Here: 
Cost Effective Care Models That Improve Outcomes
Host: Diane Bradley, PhD, RN, NEA- BC, CPHQ, FACHE, FACHCA, Regional Chief Clinical Officer Date: March 23rd, 2018 Time: 12:00pm CT Register Here: 
Recruitment Tips: Get It Right The First Time
Host: Peter Goodspeed, Vice President Executive Placement Date: March 26th, Time: 12:00pm CT Register Here: 

6. 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 our team (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.

7. Regional Chief Clinical Officer
Speaker
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 and conducts mock surveys for Critical Access Hospitals, Acute Care Hospitals, Long Term Care, Rural Health Clinics, Home Health and Hospice. Carolyn also provides assistance in developing strategies for continuous survey readiness and developing plans of correction.
Marlene McAllister is senior nursing leader transitioning toward retirement. Ms. McAllister has over 20 years of experience in senior executive positions both domestic and international and has consulted in a variety of settings.
Ms. McAllister served as the Chief Nurse Executive with St. John Medical Center in Tulsa, Oklahoma and had a key role in the infrastructure design of the patient care areas and the strategy of a new patient care model. Subsequently in 1996, Ms. McAllister served ORBIS International as a consultant/strategist and later joined the executive team as the Vice President of Organizational Development and Human Resources from In this role, Ms. McAllister was responsible for global human resources, strategic planning, business planning, quality improvement and organizational development and design. Most recently, Ms. McAllister served as the Chief Nursing Officer at Medical Center Health System and the Co-Director of the MCHS/Texas Tech Center of Excellence for Evidence-Based Practice in Odessa, Texas.
Ms. McAllister holds a Bachelor of Science Degree in Nursing from the University of Arkansas and a Master of Science Degree in Nursing from the University of Colorado. Ms. McAllister is a Johnson &Johnson/Wharton Nurse Executive Fellow from the University of Pennsylvania, Pennsylvania.
Ms. McAllister and her family reside in Tulsa, Oklahoma. Ms. McAllister serves the community as a member of the Tulsa Opera Fund Development Committee and an advisory committee member for the establishment of a German POW camp museum in Szubin, Poland.
Carolyn St.Charles
Regional Chief Clinical Officer

8. IRS Code §501(r)
Section 9007 of the Patient Protection and Affordable Care Act, Public Law (the "Affordable Care Act"), created section 501(r) of the Code adding new requirements effective beginning with the first tax year on or after March 23, 2012, that 501(c)(3) hospitals must conduct a CHNA at least once every three years in order to assess community need and annually file information (by means of Schedule H (Form 990)) regarding progress toward addressing identified needs. (IRS). Hospitals can involve partnerships with other clinical, public health, and population health focused organizations. Section 9007 furthermore established tax penalties for hospitals that do not comply, as well as reporting requirements.

9. IRS Code §501(r)
The IRS takes the position that §501(r) applies to all hospitals exempt under §501(c)(3), whether or not they may be owned by government or political subdivisions. Accordingly, the IRS intends to apply the CHNA requirements to every hospital that is been recognized as an organization under §501(c)(3). Critical Access Hospitals are NOT excluded IF they are a §501(c)(3) Government or District Hospitals are NOT excluded IF they are a §501(c)(3) OR have §501(c)(3) status due to participation in a 403(b) retirement plan.

10. IRS Code §501(r) – CHNA + More
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.

11. Audits
As required by the Patient Protection and Affordable Care Act (ACA), we continue to review hospitals for compliance with IRC section 501(r). As of June 30, 2016, we had completed 692 of reviews and referred166 hospitals for field examination. Issues for which referrals were made are:
Lack of a Community Health Needs Assessment (CHNA) under IRC 501(r)(3)
No Financial Assistance and/or Emergency Medical Care Policies under IRC 501(r)(4)
Billing & Collection Requirements under IRC 501(r)(6)
Source: Tax Exempt and Government Entities, FY 2017 Work Plan

12. Welcome to 2018

13. Before you start - take time to assess your last CHNA

14. Questions
Answers
1. We actively involved senior leaders, including medical staff, and community partners in the development of our CHNA.
Definitely – Maybe – No
2. We solicited community input in the development of our CHNA.
3. Our CHNA and implementation plan was completed and approved by the governing board according to the IRS timeline.
Definitely – Maybe - No
4. The CHNA and Implementation Plan were posted on our web site.
5. We actively worked with senior leaders, medical staff and community partners to implement the priorities identified in our CHNA.
6. We provided periodic feedback to senior leaders, medical staff, community partners and our community about progress in meeting identified priorities.
7. We are meeting the goals identified in our implementation plan.
8. Our CHNA made a difference in improving health in our community.

15. Questions What worked well? Why? What didn’t work well? Why?
Did your CHNA make a difference
in your community? How do you know?
What should you do different?
What will make your CHNA stronger
and better meet the needs of your
community?

16. Opportunities – External
SWOT Analysis
Strengths – Internal
Active Senior Leader Involvement
Opportunities – External
Community survey did not adequately represent at-risk populations
Lack of community feedback on published CHNA
Weaknesses – Internal
Insufficient time (resources) to develop comprehensive CHNA
Threats – External
IRS reporting requirements
Competitors using CHNA as a way to not just show community benefit – but as an aggressive marketing tool

17. The 8 Steps referenced in the presentation are adapted from the following publication:
Health Research & Educational Trust. (2016, June). Engaging patients and communities in the community health needs assessment process. Chicago, IL: Health Research & Educational Trust.
Accessible at:

18. Pre-Planning – Don’t start from scratch
Who was on the steering committee? Will it be the same or different? Why?
What was the CHNA service area / community? Will it be the same or different? Why?
What community partners / organizations were involved? Will they be the same or different? Why?
How did you identify the needs of vulnerable or at-risk populations? Will you use the same process or a different process? Why?
What were the results of your implementation plan did you meet your targets / goals? Why or why not?
Did you partner with another organization / hospital previously? Will you partner again? Why or why not?

19. Identify and engage stakeholder
CHNA in 8 Steps
Step 1
Identify and engage stakeholder
Look broadly at your community and identify stakeholders that are actively working with vulnerable and at-risk populations. Consider patient / family councils or other groups that can bring a community perspective.
A few examples:
Public Health – County and State
Providers
Senior Centers
Schools
YMCA
Social Organizations
Homeless Outreach
Low Income Housing
Drug and Alcohol Coalitions
City / County Officials
Law Enforcement
The Governing Board represents your community too!

20. CHNA in 8 Steps Step 2 Define the community
In defining your community consider the geographic area served, and the hospital’s target populations and principal functions. Most hospitals utilize their service area – but this is not absolutely required.
IRS requires that community may not be defined in a way that excludes certain populations served by the hospital (for example, low-income persons, and minority groups)
Community members and patients can help to ensure that the definition of the community is inclusive.

21. Collect and analyze data
CHNA in 8 Steps
Step 3
Collect and analyze data
Collect primary and secondary data, both qualitative and quantitative including data about social determinants of health. Patients and community stakeholders can provide perspectives to complement quantitative findings through surveys, interviews, focus groups, and community or town meetings. Ask community stakeholders to share information they have or surveys they have done.

22. Secondary Data - So much data so little time
Internal
External
CDC Community Health Improvement Navigator
CDC Youth Risk Surveillance Data
CDC Wonder
Free
Publishes leading causes of death each year
County and State Health Department
County Health Rankings
Free and easy to use
Lacks depth for certain variables of interest
Behavioral Risk Factor and Surveillance Survey
Free but requires statistical software to access all variables
More depth and versatility in data
Employment Security Department
Enroll America
Health Resources & Services Administration (HRSA) Data Warehouse
Healthy People 2020
State of Obesity – Robert Wood Johnson
U.S. Department of Health and Human Services
U.S. Census Bureau
Free comprehensive source of demographic and socioeconomic data
Other organizations published needs assessment – i.e. health department, etc.
US National Library of Medicine - MANY resources
ER visits
Readmissions
Length of Stay
Diagnosis codes
chronic disease
Payor source
Charity care
Uninsured
Strategic Plan
Business Plans

23. Hospitals in Pursuit of Excellence (HPOE)
Community Health Initiatives at the American Hospital Association link:
HPOE: Hospitals in Pursuit of Excellence is the American Hospital Association's strategic platform to accelerate performance improvement and support delivery system transformation in the nation's hospitals and health systems.
Social Determinants of Health HRET, ACHI and the Institute are working to support hospitals and health systems as they address social determinants of health, eliminate health care disparities and provide comprehensive care to every patient in every community—all of which improve community health. We are currently developing a series of resources on how hospitals can address the social determinants of health in their communities. Stay tuned for reports, case studies, webinars and videos on various social determinants of health, including:
Social Determinants of Health Series: Transportation
Social Determinants of Health Series: Housing
Social Determinants of Health Series: Food Insecurity

24. Healthy People 2020 - Social Determinants of Health
Health and Healthcare
Access to Health Care
Access to Primary Care
Health Literacy
Neighborhood and Built Environment
Access to Healthy Foods
Quality of Housing
Crime and Violence
Environmental Conditions
Economic Stability
Poverty
Employment
Food Security
Housing Stability
Education
High School Graduation
Enrollment in Higher Education
Language and Literacy
Early Childhood Education and Development
Social and Community Context
Social Cohesion
Civic Participation
Discrimination
Incarceration

25. Primary Data - Key Stakeholder Interviews
Do you provide services to vulnerable or at-risk populations?  If Yes, please identify the populations.
In _____ County, which populations or groups do you think have the greatest challenges in achieving and maintaining good health?
What are the three (3) most frequent health-related conditions or behaviors that you believe affect at-risk or vulnerable populations?
What are the three (3) critical factors (social determinants of health) that contribute to health challenges for at-risk and vulnerable populations? (Individual, System and/or Environmental factors)
Are there strategies/programs in the community that have been successful in addressing health related challenges including social determinants of health?
If the Hospital and community partners were to choose only 2/3 initiatives to work on over the next 3 years, what do you think they should work on?
Does your organization or group have any specific resources that are currently available to help with any of these initiatives?
The Hospital chose several initiatives to work on in 2011.  How do you think we did?

26. Community Survey - If you do a survey - Keep it simple
Demographic Questions
1. What are the three most important health issues in ____ County? Please list only three.
2. What three things are preventing people in ____ County from being healthy? Please list only three.
3. What three things should ____ Hospital and our community partners focus on to improve the health of our community? Please list only three.
4. Please share any other comment you may have.

27. Beware the data Does the data tell a story? Or is it just numbers?
Is the data outdated? Is there more current local or State data?
What populations – groups – communities are most at risk? What are the disparities? What are causal factors?
Is the data statistically significant? Is there really a difference?

28. Select priority community health issues
CHNA in 8 Steps
Step 4
Select priority community health issues
Consider including: Steering Committee + Key Stakeholders + Community Members Present the data collected Prioritize based on CRITERIA (IRS requirement)

29. Example - Prioritization Criteria
Community
“What do you believe is the most important health or concerns confronting the residents of ___ County?”
Local Experts
Rank identified potential needs including needs of priority populations
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.

30. Document and Communicate
CHNA in 8 Steps
Step 5
Document and Communicate
Share CHNA draft with key stakeholders and solicit feedback Is it understandable? Should it be translated into other languages? Should there be a “Cliffs Notes” version? Must be approved by the governing board. Must be posted on your web site and copies must be available at no charge to the community.

31. Plan Improvement Strategies
CHNA in 8 Steps
Step 6
Plan Improvement Strategies
IRS allows 4 ½ months after the completion of the CHNA to complete the Implementation plan. Use the time to work with community partners and your community and develop sustainable solutions. Must be approved by the governing board.

32. Developing an effective action plan
What is the “root cause” of the problem?
Will it impact vulnerable and at-risk populations?
Is it sustainable?
Can it be measured?
Are there community partners?

33. Example Implementation Plan
Priority One: Improve access to primary care including prenatal care in the _____ Hospital & Clinics service area. Background and Rationale Early and continuous prenatal care is an important strategy for improving the long-term health of the mother and preventing adverse birth outcomes. _____ County is not meeting the Healthy People 2020 goal of 77.9% of pregnant women receiving prenatal care in the first trimester. The rate for all women in _____ County is 63.4%, for women with Medicaid 62%, and for undocumented women 66.1%. We believe that adding additional primary care providers and providing information about the importance of early prenatal care will increase the percentage of women who are seen within the first trimester.

34. Example Implementation Plan cont.
Objective 1: Provide community resources and education focused on the importance of prenatal care in the first trimester of pregnancy Indicator: Percentage of pregnant women who are seen by a provider during the first trimester of pregnancy Target: 77.9% (Healthy People 2020 Target) Interventions 1. Distribute parenting resource guide in the Family Birth Center, OB/GYN, and Family Practice Clinics. The parenting resource guide will also be available on-line on the Hospital & Clinics web site. Responsibility: Marketing By When: December Implement a Centering Pregnancy Program. The Centering Pregnancy program is a group care model for 6-10 pregnant women with similar gestational ages. They meet during 10 sessions over 6 months. Educational themes include nutrition, mental health, family planning, stress reduction, and exercise. The Centering Pregnancy model is especially effective for underserved mothers who lack access to comprehensive quality prenatal education. Responsibility: Dr. ____ By When: December Measure and report number and percent of pregnant women seen by a provider during the first trimester at least twice per year to primary care providers Responsibility: Dr. ____ and ____ By When: December 2018

35. Implement improvement plans
CHNA in 8 Steps
Step 7
Implement improvement plans
Implementing the plan is critical. Continue to involve key stakeholders and community partners. Ensure that you have the resources ($ and time) to effectively implement the plan.

36. CHNA in 8 Steps Step 8 Evaluate progress
Implementation plan should include measurable objectives. Continue to provide feedback to the community - key stakeholders – governing board. Revise plan if needed. It’s OK!

37. CHNA - Common Problems
Lack of focus on vulnerable at-risk populations (we are looking at our whole community)
Lack of acumen in interpreting data
Lack of input and collaboration with key stakeholders
Lack of involvement of key stakeholders in developing implementation plan
Implementation Plan not seen as a tool to drive improvement – not an active important document
CHNA and implementation plan not posted on hospital web site

38. Data-base of evidence-based interventions for the four action areas!

40. Thank you!
If you would like more information - or - have questions - or - would like to discuss a CHNA for your facility, please feel free to contact me.
Dallas Office
2745 North Dallas Parkway, Suite 100, Plano, TX 75093
Brentwood Office
5110 Maryland Way, Suite 200 Brentwood, TN 37027
Our Phone
Main Office:
Executive Placement:
Carolyn St.Charles