1. Partners in Community Health: New Tools to Bring Hospitals, Public Health, and Communities Together November 11, 2010 | Washington DC Indu Spugnardi The Catholic Health Association

2. Overview The Catholic health ministry and the Catholic Health Association What is community benefit? Overview of community benefit framework Assessment and planning best practices/common issues and considerations Tips for working with your local hospital February 10, 20142

3. 3 Catholic Health Care in the U.S. Long tradition of meeting community needs 600 hospitals and 1,400 long-term care and other health facilities in all 50 states - Catholic health ministry is largest group of non-profit health care providers Mother JosephFather Damien

4. February 10, 20144 The Catholic Health Association The Catholic Health Association (CHA) is the national leadership organization for the Catholic health ministry CHA has been leader in community benefit for over 20 years –Categories and definitions –Promoting best practices –Education –Advocacy/policy

5. February 10, 20145 What is Community Benefit? To be reported as community benefit, a program must address an identified community need and meet at least one of the following criteria: –Improves access to health services –Enhances public health –Advances medical or health knowledge –Relieves or reduces the burden of government or community groups Adapted from 2009 Instructions for Schedule H (Form 990)

6. February 10, 20146 Community need can be demonstrated through: A community health needs assessment developed or accessed by the organization Documentation that demonstrated community need or a request from a public agency or community group was the basis for initiating or continuing the activity or program Involvement of unrelated, collaborative tax-exempt or government organizations as partners in the activity or program From 2009 Instructions for Schedule H (Form 990)

7. February 10, 20147 Categories of community benefit I.Charity care II.Government-sponsored indigent health care - unpaid costs of public programs –Medicaid –SCHIP –Medically indigent programs III.Community benefit services –Community health improvement services –Health professions education –Subsidized health services –Research –Cash and In-kind contributions –Community building activities –Community benefit operations

8. February 10, 20148 Assessment and planning are core steps in the community benefit framework

9. February 10, 20149 The Law - Assessment Community health needs assessment –Each hospital (not EIN) –Every three years –Takes into account input from persons who represent the broad interest of the community served by the hospital facility, including those with special knowledge of or expertise in public health –Widely available to the public Supplemental Information on Assessment In an explanation of provision the Joint Committee on Taxation advised assessment may be: –Based on current information collected by a public health agency or non-profit organization –Conducted together with one or more organizations, including related organizations

10. February 10, 201410 The Law - Planning Planning –Adopt an implementation strategy (community benefit plan) –Description of: How organization is meeting needs identified in assessment Needs not being addressed and reasons why –Must be disclosed on IRS Form 990

11. February 10, 201411 Definitions Community health needs assessment –A systematic and dynamic process, involving the community, of identifying and analyzing community health needs and assets in order to prioritize and act upon community health needs Implementation strategy (or community benefit plan) –Plan for addressing prioritized health needs and problems identified in the community health needs assessment

12. Assessment process - Overview Step 1: Plan and prepare for the assessment Step 2: Determine the purpose and scope of the assessment Step 3: Identify data that describes the health and needs of the community Step 4: Understand and interpret the data Step 5: Define and validate priorities Step 6: Document and communicate results February 10, 201412

13. Assessment process – Collaboration Opportunities Step 1: Plan and prepare for the assessment –Participate on assessment advisory committee –Help identify resources in the community Step 2: Determine the purpose and scope of the assessment –Provide input on the scope and purpose of the assessment Step 3: Identify data that describes the health and needs of the community –Participation in focus groups and community forums, help identify assets Step 4: Understand and interpret the data Step 5: Define and validate priorities –Participate in priority setting and validation processes Step 6: Document and communicate results –Help communicate the results of the assessment February 10, 201413

14. Planning to address community needs Community-wide plan to address health needs (asthma, obesity) Community-wide plan to address other needs (lack of safe, affordable housing, low high-school graduation rates) Hospital community benefit plan February 10, 201414

15. Planning process - Overview Step 1: Assess readiness to start planning Step 2: Form planning team Step 3: Develop goals Step 4: Select interventions to address prioritized problems Step 5: Determine resource needs and availability Step 6: Integrate community benefit plan with other organizational plans Step 7: Develop a written community benefit plan Step 8: Update the plan February 10, 201415

16. Planning process – Collaboration Opportunities Step 1: Assess readiness to start planning Step 2: Form planning team –Participate on planning teams – can help develop goals, select interventions, identify/obtain resources, plan evaluation Step 3: Develop goals Step 4: Select interventions to address prioritized problems Step 5: Determine resource needs and availability Step 6: Integrate community benefit plan with other organizational plans Step 7: Develop a written community benefit plan Step 8: Update the plan February 10, 201416

17. February 10, 201417 Guiding principles/Best practices Primary goal of assessment and planning is to improve community health Collaborate with community members –Collaboration with other providers and community partners expands community capacity to address health needs through a focus on shared vision, shared resources and skills, and broad participation in program planning, implementation and evaluation. Special attention should be given to the needs of vulnerable populations –These groups may include low-income persons, un/underinsured persons, immigrants, children, elderly, populations dealing with disparities in care Community assets are as important as needs –Community benefit plans should build on community assets (such as faith communities, schools, social service organizations) and not duplicate or erode them.

18. February 10, 201418 Guiding principles/Best practices Use existing public health data –Dont need to create a new survey to collect quantitative public health data. Include public health perspective in the assessment –This perspective might be found internally, in the community, or through public health departments or schools of public health Prioritize needs and target resources –Working with the community, identify the needs that the hospital and community together are best positioned to address. Target resources to where they are most needed and most likely to be effective.

19. February 10, 201419 Issues/Considerations Managing community expectations – all needs cannot be met at once –Prioritizing community needs must be a collaborative process. Remember everyone is working toward health status improvement and choices have to be made in the best interest of the community and within the realities of available resources. Aligning priorities –Provider priorities and community priorities may not always align – need constructive approaches to address this.

20. February 10, 201420 Issues/Considerations Meeting needs can be achieved several ways –By the hospital directly, by community/hospital partnerships or by others in the community (such as other providers or social service agencies) –Upstream vs. downstream interventions Need community involvement throughout the community benefit process –Need to turn prioritized needs into programs that make a difference. Community advocates can help hospitals plan and implement their community benefit programs, as well as measure and celebrate success.

21. February 10, 201421 Working with your local hospital Connect with hospital –Might not make a connection on your first attempt, keep trying. Good places to start are the community outreach department, mission department, communications office or executive office. –Do you have a contact in the hospital – employee, board member – that can help you make the connection? –Are you part of a coalition or collaborative that includes other organizations that are working with hospitals? Ask your partners if they can help you make the connection.

22. February 10, 201422 Working with your local hospital Involvement with community health needs assessment –Identify themes that are important to your stakeholders and highlight those in a white paper to be presented to the hospitals leadership and person who is coordinating the needs assessment. –Can members of your group serve on assessment planning committees/workgroups? –Collaborate with hospital and other community partners to identify communitys priorities (which might not include issues of all groups) –Do you have special skill sets (for example, public health expertise) that could be helpful to the hospital? –Has your group already done an assessment? Offer to share the report and discuss the findings. Do you conduct town halls or community forums that the hospital could participate in to validate assessment findings? Do you have access to data sets that the hospital could use?

23. February 10, 201423 Working with your local hospital Build a long term relationship –Can you participate in planning, implementation, and evaluation of programs? –Can you help advocate for change (with government, communities, organizations and individuals)? –In some communities community partners are creating formal agreements that outline roles and financial partners. –Give it time. Working collaboratively can be challenging but the benefits are worth the effort!

24. Resources The Catholic Health Association – www.chausa.org/communitybenefit www.chausa.org/communitybenefit –A Guide for Planning and Reporting Community Benefit –Evaluating Community Benefit Programs –COMING SOON – Resource on assessment and planning –Webinars on current issues The Association for Community Health Improvement – http://www.communityhlth.org/ http://www.communityhlth.org/ VHA Inc. – www.vha.com www.vha.com –Focus on Reform series –Community Benefit Center - https://www.vha.com/AboutVHA/CommunityBenefit/Pages/Default.aspx https://www.vha.com/AboutVHA/CommunityBenefit/Pages/Default.aspx February 10, 201424

25. Resources (contd) Healthy Communities Institute – http://www.healthycommunitiesinstitute.com/ http://www.healthycommunitiesinstitute.com/ County Health Rankings - http://www.countyhealthrankings.org/ http://www.countyhealthrankings.org/ The Community Guide - http://www.thecommunityguide.org/index.html http://www.thecommunityguide.org/index.html HFMAs Patient Friendly Billing project - http://www.hfma.org/HFMA-Initiatives/Patient-Friendly-Billing/Patient- Friendly-Billing / http://www.hfma.org/HFMA-Initiatives/Patient-Friendly-Billing/Patient- Friendly-Billing / February 10, 201425