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CDFI Partnerships with Hospitals

CDFI Partnerships with Hospitals. Opportunity Finance Network Webinar October 2, 2019 Kevin Barnett, DrPH, MCP Senior Investigator Public Health Institute. All participant lines are muted during the webinar. Raise your hand to ask a question, or Type your question and hit Send.

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CDFI Partnerships with Hospitals

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  1. CDFI Partnerships with Hospitals Opportunity Finance Network Webinar October 2, 2019 Kevin Barnett, DrPH, MCP Senior Investigator Public Health Institute

  2. All participant lines are muted during the webinar. • Raise your hand to ask a question, or • Type your question and hit Send.

  3. CDFI Partnerships with Hospitals Opportunity Finance Network Webinar October 2, 2019 Kevin Barnett, DrPH, MCP Senior Investigator Public Health Institute

  4. Community Benefit Defined IRS definition - The “promotion of health for class of beneficiaries sufficiently large enough to constitute benefit for the community as a whole.” • Reference to a defined community suggests a population health orientation • Determining the minimum size for the “class of beneficiaries” needed suggests accountability for a measurable impact. IRS Rulings 69-545 (1969) and 83-157 (1983)

  5. Historical Tendencies in Practice

  6. Evolution in Practices:Areas for Improvement • Programmatic • Program scale inadequate to produce measurable impact • Lack of specificity in targeting • Lack of coordination across programs to take advantage of potential synergies • Proprietary orientation • Institutional • Lack of infrastructure for critical review and oversight • Lack of knowledge and understanding among leadership • Lack of integration of community benefit function • Inadequate FTE allocation and staff competencies

  7. Compliance – IRS Final Regulations • Setting priorities – “community input in identifying and prioritizing significant health needs, as well as identifying resources.” • Documentation of input – “take into account comments received on the previously adopted implementation strategy” • Focus on disparities – “ joint CHNA conducted for a larger area could ID a significant health need a need that is highly localized in nature or occurs within only a small portion of that larger area.” • Social determinants of health – “expand health needs to prevent illness, to ensure adequate nutrition, or to address social, behavioral, and environmental factors that influence health in the community.” • Evaluation – “the CHNA to include an evaluation of the impact of actions taken since the hospital facility finished conducting its immediately preceding CHNA.”

  8. Health Care Transformation Continuum Totally Accountable Care Organization GlobalPayment Hospital as “Total Health” Anchor Institution With shared ownership for the health of the community Community Infrastructure To Manage SharedROI SharedRisk SharedSavings Bundled Payments PCMH ID and Analyze Geographic Concentrations Of Inequities Align Resources With Diverse Stakeholders Episodic Patient Care ID and Analyze Factors Influencing Panel ID and Analyze Common Diagnoses Improve Health of Community Pay for Performance PCCM Readmission Penalty Hospital as Acute Care “Body Shop” FeeforService

  9. Coming to Terms with Health Inequities • Unhealthy housing • Exposure to array of environmental hazards • Limited access to healthy food sources & basic services • Unsafe neighborhoods • Lack of public space, sites for exercise • Limited public transportation options • Inflexible and/or poor working conditions • Health impacts (e.g., allostatic load) of chronic stress

  10. Leveraging Assets - Potential Partners and Roles • Public health agencies • Social service agencies • Service-based CBOs • CommunityAction As • FaithCommunity • Advocacy CBOs • UnitedWay • Local Philanthropy • City agencies • Associations Assessment, community outreach, evaluation, policy development Service coordination/integration, enhancement, leveraging Community engagement, mobilization, facilitation, policy advocacy Core operating infrastructure development, sustainability Alignment with planning priorities, secure political support

  11. Domains, Geography, and Focus of Interventions

  12. Integrate CB and Pop Health Mgmt • Optimize data collection/analysis • Focus on chronic diseases, PQIs • Geocoding utilization data • Addition of SDH indicators • Overlay of demographics (e.g., race/ethnicity, HH income, etc) • Data pooling with FQHCs, other hospitals • ID synergistic opportunities • Overlap between patient populations and place-based drivers • Start with readmissions, move to PQIs across payer groups • Facilitate links between care teams and CB activities • Set Triple Aim targets for patients, populations, people • Establish incentives across departments

  13. Center to Advance Community Health & Equity • CACHE uses tools and TA to build shared ownership for health through collaborative problem solving, focusing where health inequities are concentrated. Forms of support include: • 990H analysis and interpretation • GIS analysis of social determinants of health and related data. • Analysis of hospital utilization data. • Assessment of alignment opportunities across sectors. • Community development capacity assessment and alignment with pop health strategies.

  14. Service Area Exclusion of Geo Areas with Concentrated Poverty

  15. Redlining

  16. Ventura Tax-Exempt Hospitals – RegionalTotals(2016) 75.0%

  17. AHRQ Prevention Quality Indicators • PQI 01 Diabetes Short-term Complications Admission Rate • PQI 03 Diabetes Long-term Complications Admission Rate • PQI 05 Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate • PQI 07 Hypertension Admission Rate • PQI 08 Heart Failure Admission Rate • PQI 09 Low Birth Weight Rate • PQI 11 Community Acquired Pneumonia Admission Rate • PQI 14 Uncontrolled Diabetes Admission Rate • PQI 15 Asthma in Younger Adults Admission Rate • PQI 16 Lower-Extremity Amputation among Patients with Diabetes Rate

  18. Highest Rates 1. 93015 (53.34) 2. 93065 (32.02) 3. 93063 (26.53) 4. 93035 (22.98) 5. 93023 (22.86) County Average 12.35 PQI 15: Asthma in Younger Adults Admission Rate Region Average:97.99

  19. HASC Region Summary of Homeless Super Utilizers of the Emergency Department, 2017

  20. Areas of Hospitals/Health System Investment • Pre-development loans for affordable housing • Capital campaign bridge loan for low income dental care center • Revolving loan fund for small business development nonprofit • Scholarship Loan Programs for under-represented youth • Loans for child care businesses and other small business development • Healthy Food financing, e.g., grocery stories, corner stores • Housing linked with support services • Isolated seniors • Homeless people with behavioral health & substance issues • Reduce acuity of chronic diseases such as asthma

  21. Comprehensive Model (e.g., Anchor Institution) Categories Examples Collaborate to support food purchasing from sustainable producers Build capacity of local firms to provide goods and services Proactively invest in health career pathways Policies to hire justice involved youth Reduce medical waste and water consumption Increase energy efficiency Advocate for increased access to affordable healthy foods Work with public sector to improve access to transportation Provide pre-development loan for affordable housing that reduces LOS Co-invest in healthy food financing Align and focus programs in underserved communities Develop comprehensive approaches that build on evidence-based interventions • Procurement • Employment • Conservation • Healthy public policy • Community investment • Programs

  22. Strategic Engagement in Civic Affairs

  23. Alignment Across Sectors • Gap analysis of social support services • Current and potential growth capacity (numerator/denominator) • Cost-effectiveness • Development opportunities • Available land, zoning • Proximity to needs, populations, services • Public policy • Local dynamics, government leadership capacity • Build a common platform for strategic advocacy • Develop a continuum • Near term solutions to hospital pain points (Respite care, transitional housing) • Link to longer term affordable housing development

  24. Stephen Leffler, SVP CQO/CPHO University of Vermont Health Network

  25. Top 10 Readiness Factors • Resident and CBO engagement with cohesion in spirit and priorities. • Local philanthropy and anchor institutions fund infrastructure. • Comprehensive approach to health / CD alignment that includes allocation of returns for communities. • Provider/payer commitment to pursue risk-based contracts. • Partner commitment to data/information sharing. • Focus on a health problem with SDH across the time/ROI continuum. • Evidence-based intervention (with wrap around services, activities, policies, etc. to build comprehensive framework) at the core. • Engaged local government agencies (e.g., PH, SS, P&R, CED) • Engaged local elected officials, including city/county reps and mayor. • Links to regional planning strategy and priorities, including transportation.

  26. Let’s Stay Connected Kevin Barnett, DrPH, MCP Senior Investigator Public Health Institute Email: kevinpb@pacbell.net Katherine Johnson, MPA Senior Program Advisor Public Health Institute Email: katherine212@gmail.com

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