Trends in Virginia's Community Health Needs Assessments December 6, 2016 In 2010, as a result of the Affordable Care Act, new IRS regulations went into effect for non-profit hospitals. One regulation was a requirement that non-profit hospitals conduct Community Health Needs Assessments – or CHNAs – every 3 years for tax years beginning after March 23, 2012 or the hospital would have to pay an excise tax.   CHNAs help ensure that hospitals have the information they need to provide community benefits that meet the needs of their communities. Hospitals that conducted their first CHNA in 2012 should be well in to – of have completed – their second CHNA.

Project Purpose In the Fall 2015, the Virginia Health Care Foundation conducted an analysis to review, record and summarize key information from each of 73 Community Health Needs Assessments (CHNAs) to determine the nature and depth of health challenges and priorities across the Commonwealth. The data and statewide analysis are expected to stimulate health improvement initiatives to address various community needs. This project was completed in partnership with the Virginia Healthcare and Hospital Association. In the Fall of 2015, the Foundation partnered with the Virginia Healthcare and Hospital Association to review, record and summarize key information from each of 73 CHNAs to determine the nature and depth of health challenges and priorities across the Commonwealth.   The data and analysis is expected to stimulate health improvement initiatives to address community needs. You will see there is significant commonality in findings while the assessment teams used different methods and different data to fuel their work. As I’ll share in more detail, behavioral health is a clear need in the majority of CHNAs, which include most Virginia localities – rural, urban and suburban.

Project Purpose & Methods The 73 CHNAs were conducted between 2011 and 2015: 65 non-profit hospitals 7 local health departments 1 local health foundation The Affordable Care Act (ACA) did not require a standardized method to conduct CHNAs so there is much variation in how hospitals approached the CHNA process. All of the CHNAs identified community health needs using a combination of existing quantitative and qualitative data and new data collected during the CHNA process.   73 CHNAs were conducted between 2011 and 2015: 65 non-profit hospitals 7 local health departments 1 local health foundation   Because the ACA didn’t require a specific method to conduct CHNAs there is a lot of variation in how the hospitals approached the process. All CHNAs identified community health needs using a mix of existing quantitative and qualitative data – CDC data, VDH data, etc and some collected new data – like surveys and focus groups. Hospitals must gather input from people who represent the broad interests of their community. So most have some kind of community advisory group or steering committee – or they included community members in focus groups, interviews or surveys.

Map of Localities Covered by CHNAs This map shows the localities covered by CHNAs. CHNA catchment areas are the same as a hospital’s service area. You’ll note that most, but not all Virginia localities are included in a CHNA. Localities that are not part of a CHNA are not in the catchment area of at least one non-profit hospital – or a local foundation or health department - that has recently done an assessment.

Executive Summary The Executive Summary reflects trends in what hospitals, foundations, or health departments identified as the needs within their respective communities and corresponding Implementation Strategies. Individual summaries for each Community Health Needs Assessment can be downloaded here: http://www.vhha.com/research/population-health/community-health-needs-assessments/ There were two main products from this analysis – an executive summary and individual fliers that summarize each of the 73 CHNAs.   If you are interested in reading a particular CHNA summary, go to this link on the VHHA website. You can also get to it from the Data section of the VHCF webpage. You can also download the Executive Summary from the same pages. The Executive Summary highlights trends in what the organizations identified as needs in their communities – with corresponding Implementation Strategies – or approaches to addressing the issues identified during the CHNA process. Many of the top health concerns, Critical Service Gaps and health professional shortages are inter-related. There were no behavioral health-related potentially avoidable hospitalizations, as the AHRQ algorithm hospitals relied on does not include behavioral health discharges.

Top 5 Leading Health Issues This slide shows the health issues that were identified as “top health issues” across CHNAs. You’ll notice two themes – obesity, heart disease and diabetes and behavioral health and substance abuse. 75% of CHNAs included behavioral health as a leading health issue. 60% of CHNAs identified substance abuse as a leading health issue.

Behavioral Health Noted as Top 5 Leading Health Issue We looked a little more closely at behavioral health in our analysis.   This map shows the localities mentioned in CHNAs, indicating Behavioral Health as a Top 5 Leading Health Issue. The darker shading means that locality noted BH as a Top 5 Leading Health Issue and is part of more than one CHNA catchment area. Lighter colored localities indicate that a smaller number of CHNAs that included that locality ranked Behavioral Health as a Leading Health Issue. *Point out localities where there was no CHNA.

Top 5 Critical Service Gaps Critical Service Gaps are services that are either insufficient or don’t exist in a community. Note that behavioral health appears here and as a top health need in 55 – or 75% of - CHNAs. And, Behavioral Health Services was cited as a missing or limited service far more than any other service gap (85% of CHNAs).

Behavioral Health Noted as Critical Service Gap This map shows the localities mentioned in CHNAs where Behavioral Health was noted as a Critical Service Gap. The darker shading means that locality noted BH as a Top 5 Critical Service Gap in one CHNA catchment area. *Point out localities where there was no CHNA.

Top 5 Implementation Strategy Priorities Hospitals are required to develop plans to address several priorities identified during the CHNA process. Increase Access to and/or Improve Behavioral Health Services Increase Navigation and/or Awareness of Available Resources Promote Nutrition, Wellness & a Healthy Lifestyle In addition to conducting the CHNA, each non-profit hospital is required to develop a corresponding Implementation Strategy that addresses several priorities identified during the CHNA process and aligns with the Critical Service Gaps.   About 2/3 CHNA Implementation Plans include recommendations to increase access to or improve behavioral health services. Specific implementation strategies noted in the CHNA documents are broad, and in many cases vague. Increase Access to Medical Care Address Obesity and Its Related Effects

Increase Access to Behavioral Health Noted as Implementation Strategy Priority This map shows the localities mentioned in CHNAs where Increasing Access to Behavioral Health Services was an Implementation Strategy Prioritiy. The darker shading means that the locality was in more than one CHNA catchment area that included Increase Access to Behavioral Health Service as an Implementation Strategy Priority.

Behavioral Health Throughout the CHNAs, behavioral health was identified among the Top 5 in: Leading Health Issues (55 CHNAs; 75%) Critical Service Gaps (62 CHNAs; 85%) Implementation Strategy Priorities (47 CHNAs; 64%) Of the 66 (90%) CHNAs reporting specific behavioral health concerns: 86% reported substance abuse 68% reported suicide rates 63% reported depression 85% of CHNAs indicated a shortage of behavioral health providers All 73 CHNAs mentioned behavioral health as a concern in their community. Of the 66 CHNAs that mentioned behavioral health as a health issue, service gap or implementation strategy priority: 86% reported substance abuse as a concern 68% reported suicide rates as a concern 63% reported depression as a concern   Also, 85% of CHNAs indicated a shortage in behavioral health providers.

Conclusion This analysis of Virginia’s recent CHNAs and Implementation Strategies: Shows surprising commonality in areas of concern across the Commonwealth Affirms concern regarding behavioral health needs in Virginia Provides insights into possibilities for future initiatives This analysis: Shows surprising commonality in areas of concern across the Commonwealth Affirms concerns regarding behavioral health in Virginia Provides insights into possibilities for partnerships and initiatives to improve access to behavioral health throughout Virginia

Next Steps Consider engaging in your nonprofit hospital’s CHNA and Implementation Strategy process. If it’s not already underway, it’s coming up soon! If there is no nonprofit hospital in your community, check with local foundations that fund health-related services or your local health department to see if they have an assessment planned or in progress. If not, encourage them to do one! Consider engaging in your nonprofit hospital’s CHNA and Implementation Strategy process – it’s either underway or coming soon. If there is not nonprofit hospital in your community, check with local foundations that fund health-related services or your local health department to see if they have an assessment planned or in progress.