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Creating a Successful Community Health Improvement Process

Understanding Community Health Improvement Processes and the Patient Protection Affordability Care Act April 10, 2013 Liz Lund, Business Development Manager. Creating a Successful Community Health Improvement Process. Outline: What is a CHNA? a CHIP? Patient Protection Affordability Care Act

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Creating a Successful Community Health Improvement Process

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  1. Understanding Community Health Improvement Processes and the Patient Protection Affordability Care ActApril 10, 2013Liz Lund, Business Development Manager

  2. Creating a Successful Community Health Improvement Process Outline: • What is a CHNA? a CHIP? • Patient Protection Affordability Care Act • Key Ingredients and Benefits of a CHNA/CHIP • Recommended Partners, Tools and Resources • BRMH’s Health Improvement Process • More Tools and Resources

  3. Community Health Improvement Processes • Understanding the new Accountable Care Act (ACA)/IRS Community Health Needs Assessment (CHNA) Requirements • Original hospital term: CHNA • Public health term: CHIP or CHIPP = Community Health Improvement Plan and Processes Both processes have similar steps, all with the same goal: Work strategically and collaboratively at the local level to improve the health of the community ►

  4. Patient Protection Affordability Care Act (PPACA) CHNA/CHIP Requirements: • CHNA/CHIP must be conducted at least every three years (Public Health currently does one every 5 years) • Demonstrate collaboration and broad input from the community served – including those with expertise in public health • Findings must be made widely available • Must adopt an implementation strategy PLAN “Community Health Improvement Plan & Process” Failure to meet in any given year = $50,000 excise tax ►

  5. PPACA Requirements - SCHEDULE H Schedule H is now a Supplement of IRS Tax Form 990 and is required by all non-profit hospitals The CHNA/CHIP is a component of Schedule H Overall Guiding Principles of IRS • Provide complete transparency • Improve tax compliance • Attempt to stabilize or decrease burden of community costs ►

  6. CHNA/CHIP Reporting Requirements The hospital’s CHNA/CHIP is required to: • Define our “community” including demographics and existing resources (we defined this as our county) • Explain how data is selected and obtained • Identify needs gathered from broad community input • Explain how we are helping to meet the needs identified with a focus on outputs and what we are doing to get closer to desired outcomes • Provide description of needs not being addressed and explanation of why (i.e., needs that may not be tied to our mission, strengths, abilities, or resources available) ►

  7. Benefits Beyond IRS Reporting… • Increase effectiveness of efforts through collaboration • Plan for future and health improvements of community • Reduce duplication of efforts in our community • Broaden community engagement and awareness around health issues • Create goodwill • Reduce health care costs • Assist with and enhance our Community Benefit reporting (currently a WHA initiative for non-profit hospitals) ►

  8. Key Ingredients of a CHNA S:Subjective Information - Stories / Symptoms - Obtained via Interview O:Objective Information - Data A:Assessment or Diagnosis - Problem P:Plan/Intervention & Evaluation - Action Steps

  9. Recommended Key Partners • Public Health • United Way • UW Extension • Schools and Universities • Community-based organizations • Chamber of Commerce • Local Government • Business Leaders • Local Citizens ►

  10. Some Recommended Resources:Wisconsin’s State Health Plans 11 Priorities 23 Focus Areas ►

  11. Wisconsin County Health Rankings • Published annually by the UW Madison Population Health Institute • Ranks health based on the multiple determinants of health (28 Health Factors & Outcomes) ►

  12. 2010-2012 Jackson County Health Rankings: More Specifics • Data is analyzed on the diverse factors of health in Wisconsin and now in all states in the U.S. • Compares how each county fares in various components of health  Health • Jackson County, WI Outcomes Mortality 2010: 69 71 2011: 68 69 2012: 68 66 2013: 61 38 • Jackson County’s rankings for Health Factors fare better (particularly for clinical care); however, due to issues with injury and early/young death, we have historically been ranked as one of the 5 least healthy counties in Wisconsin.  ►

  13. BRMH CHNA Planning Committee: • Black River Memorial Hospital • Ho-Chunk Nation Health Care Center • Jackson County Board Supervisor • Jackson County Interfaith Caregivers • Jackson County Public Health • Together for Jackson County Kids (TFJCK) • UW Extension • Western Dairyland Women’s Health Center • BRF School District • Population Health Institute / Population Health Fellow • Wisconsin Hospital Association / CHIPP Pilot Project Mentor

  14. How were top priorities selected? Planning Committee considered: • Needs identified through most recent assessments conducted by local agencies: TFJCK, Public Health, Western Dairyland, UW Extension, Ho-Chunk Nation • Ho-Chunk Health Care Center & BRMH visits from 2010-11 • Key informants/local agency contacts • 2010 & 2011 Jackson County Health Rankings and other data from recent local statistics • Healthiest Wisconsin 2020

  15. How were priorities determined? • Each Planning Committee member came up with 3-6 priorities • We noted some duplication and overlap and combined our categories accordingly

  16. Selected by CHNA Planning Committee: Top 7 Community Priorities • Access to health care services • Obesity/Nutrition/Diabetes • Mental Health • Injury/Safety • Dental • Prevention Education • Alcohol, Tobacco, & Other Drug Abuse

  17. Narrowing down the priorities • We then organized a Community-wide Forum in October 2011 to gather a broader section of community input related to these categories and narrow the selection of priorities

  18. Gathering Community Input: CHNA Forum – October 2011 1) “SPEED DISCUSSIONS” Participants selected priorities most important to them and learned more about the issues through table discussions and by sharing knowledge and experience 2) PRIORITIZE Report on top 7 issues and vote for top 3 priorities 3) TALLY and PRESENT TOP 3 PRIORITIES 4) “WORLD CAFÉ” Participants took part in roundtable discussions and considered strategies and resources that the community could engage to address the issues and also how the hospital might impact these strategies

  19. Narrowed Down to Three Priorities(in no particular order) Access to Healthcare Services • Transportation • Poverty/Finances • Large Aging Population (lack of providers - particularly appropriate cultural care) Obesity/Nutrition/Diabetes • Hypertension/Heart Disease/High Cholesterol • Access to Healthy Food • Need for increased nutrition education • Worksite Wellness ►

  20. Narrowed Down to Three Priorities – cont’d(in no particular order) Alcohol, Tobacco, & Other Drug Abuse • Increased need for Preventive and Rehabilitative Resources • Prescription Drug Abuse • Prenatal Tobacco Use • Chronic Disease issues, i.e. chronic obstructive pulmonary disease (COPD), cancer, heart/liver disease ►

  21. CHNA SUMMARY REPORT • Working draft in progress (45+ pages) • BRMH Board of Directors’ Strategic Planning process complete in August 2012 • Action Plan competed February 2013 - priorities that fall with our strategic plan and can be affected by BRMH were incorporated into this plan • Phases yet to complete:* Implementation & Evaluation * Planning for the next cycle • Complete CHNA Summary Report to be finalized in 2013 and be published on-line and made widely available to the public ►

  22. Recent Grant Awarded • Wisconsin Community Health Improvement Plans and Processes (CHIPP) Infrastructure Improvement Project: $5,000 towards resources • BRMH is one of ten sites selected • Through December 2013, all sites are piloting and evaluating tools/resources created by: • Wisconsin Association of Local Health Departments and Boards (WALHDAB) • UW School of Medicine and Public Health • Wisconsin Partnership Program • Other state-wide representatives, including Wisconsin Hospital Association ►

  23. Tools & Resources As a pilot site, we have access to tools and resources, including: • Wisconsin Guidebook(step by step guidance tool with associated checklists and templates) • Templates for Action Planningand guidance on their use • Indicators/Objectives for Action Planningfor the most commonly selected health priorities in Wisconsin • Guidance and Technical Assistanceon engaging stakeholders and community members • Cost Benefit informationabout CHIPPs to engage community leaders ►

  24. Questions?? Thank you! Liz Lund Business Development Manager Black River Memorial Hospital Black River Falls, WI (715) 284-1386 lundl@brmh.net

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