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Coordinated Community Health Needs Assessments Planning, Policy and Advocacy

Coordinated Community Health Needs Assessments Planning, Policy and Advocacy. Paul Westrick, Columbia St. Mary’s Clare Reardon, Froedtert Health Wisconsin Comprehensive Cancer Control Program March 29, 2012.

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Coordinated Community Health Needs Assessments Planning, Policy and Advocacy

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  1. Coordinated Community Health Needs AssessmentsPlanning, Policy and Advocacy Paul Westrick, Columbia St. Mary’s Clare Reardon, Froedtert Health Wisconsin Comprehensive Cancer Control Program March 29, 2012

  2. A planned, managed, organized and measured approach to a health care organization’s participation in meeting identified community health needs. It implies collaboration with a ‘community’ to ‘benefit’ it’s residents – particularly the poor, minorities and other underserved groups – by improving health status and quality of life. What is Community Benefit?

  3. Partnership Background Public / Private Consortium 2007 5 Health Systems:Aurora Healthcare, Children’s Hospital & Health System, Columbia St. Mary’s, Froedtert Health, Wheaton Franciscan Health Care 4 FQHC’s: Milwaukee Health Services Inc, Outreach Community Health Centers, Progressive Community Health Centers, Sixteenth Street Community Health Center 3 Public:City of Milwaukee Health Dept., Milwaukee County Dept Health & Human Svcs., WI DHS and Medicaid Office Academic:Medical College of Wisconsin Affiliates: WHA, WPHCA, MCMS, FC3

  4. Partnership Mission Improve Health Care for Underserved Populations in Milwaukee County Goals Expand Coverage Ensure Access Improve Care Coordination Objectives Improve health & reduce disparities Reduce the total cost of care

  5. Secondary Objectives Community-wide plan / focused agenda Reduce duplication & fragmentation of efforts Enhance communication / coordination Leverage existing & secure new public and private funding Increase transparency & accountability Equitable distribution of burden

  6. Milwaukee County Profile County Health Rankings Overall 69 Mortality 67 Morbidity 71 Behaviors 64 Clinical Care 35 Socioeconomic 71 • Coverage • The Partnership’s primary focus is medically underserved Milwaukee county residents, defined to include those covered by government insurance programs and uninsured individuals with incomes below 200% of the federal poverty level. • Total Population: 948,944 • 45% (428,108) are vulnerable • 30% (287,108) covered by Medicaid • 55% (130,107) are children • 15% (141,000) uninsured

  7. 20% expansion in Badger Care coverage Primary Care Access Study Free & Community Clinic Inventory Medication Access Needs Assessment ED Care Coordination Initiative Secured / redirected over $12 million 2011 AHA NOVA Award for Community Collaboration Accomplishments

  8. Community outreach - mission driven Non profit status, tax exemption under federal and state scrutiny Some states - % of operating expenses Some states – active attorneys general PPACA – Health reform legislation includes rigorous IRS reporting for hospitals Community Benefit: A Brief History

  9. Uncompensated Care Health Services Screenings, prevention, community education Medical Education Building the healthcare workforce of tomorrow Research Community Building Social determinants (poverty - education, jobs, transportation, environment, etc) Wisconsin / 132 hospitals in 2010 $2,569,911,003 Including Medicare shortfalls Community Benefit Reporting

  10. Community Health Needs Assessment At least every three years Input of broad interests from the community served – including those with expertise in public health Make findings widely available Adopt an implementation strategy Failure to meet in any given year = $50,000 excise tax

  11. Each hospital required to report: How it is meeting the needs identified – develop and implement a Community Health Improvement Plan Description of needs not being addressed and explain why IRS Reporting Requirements

  12. Southeastern Wisconsin Community Needs Assessment Goal: Develop a collaborative model and tools to meet combined needs of health care and public health partners Avoid duplication and wasted resources Meet requirements of multiple stakeholders Shared costs Unit of measure – spread from Milwaukee County to 6 County SE Wisconsin area

  13. Adapted Aurora Community Health Survey tool to gather needs from the general community (Survey reports/tool: www.aurora.org/commhealth) Since 2003: CDC’s Behavioral Risk Factor Surveillance System - chronic disease, access to care, safety, preventive screenings and immunization Repeated every 3 years MHCP tool: streamlined questionnaire to allow space for youth oriented questions Ozaukee, Washington, Kenosha ,Waukesha, Racine Milwaukee Counties 21 hospitals / 19 health departments Primary data – Community Health Survey

  14. Purpose – to gather required information from “persons with expertise in public health” and “identify available community resources to address the need” 1. Of the following focus areas from the State Health Plan, please rank order the top 3 to 5 major health-related issues in your community: _____Alcohol and drug _____Chronic disease _____Communicable disease _____Environmental & occupational _____Growth & development _____Mental health _____Nutrition _____Oral health _____Physical activity _____Reproductive & sexual _____Tobacco _____Access _____Injury & violence Key Stakeholder Interviews

  15. Center for Urban Population Health City of Milwaukee, UW School of Medicine and Population Health, Aurora Healthcare County Health Rankings State/County/Municipal data WISH DHS BRFSS Family Health Survey Local Health Department data Hospital Utilization data ED utilization Preventable hospital admissions (Ambulatory Sensitive Conditions) Charity Care maps Secondary sources:

  16. Key Success Factors Strong functioning coalition: trust, leadership, accountability, focus & flexibility Commitment to shared plan - local health departments part of process Plan driven by multi-stakeholder assessment / analysis Aligned stakeholder investment, leveraging external funding for collaborative health improvement model

  17. Collaborative Community Healthcare Improvement Model COMMUNITY HEALTH IMPROVEMENT PLAN COMMUNITY NEEDS ASSESSMENTS SHARED COMMUNITY INVESTMENTS Assessment Process and Tools Secondary Data Analysis Community Will ORGANIZATIONAL SPECIFIC INVESTMENTS ORGANIZATIONAL SPECIFIC PLANS Goals / Priorities Strategies / Tactics Measurement Public Funding Priorities Private Philanthropic Priorities Health System Funding Priorities

  18. Determinants of Health • 10% Health Care • Quality improvement • Accessibility • 20% Social / Environmental • Built environment • Safe communities • 30% Genetic • Personalized medicine • 40% Behavior • Health education • Healthy communities McGinnis, J.M. et al. Health Affairs 2002;21(2):78-93

  19. Addressing Social Determinants Upstream Midstream Downstream Pro-Equity Policies Incarceration Good Paying Jobs Physical Activity Obesity AffordableHousing Quality Education Safe Neighborhoods Fair Standards of Living Homelessness Access to Healthcare Untreated Mental Illness Healthy Environment Low Birth Weight Access to Transportation No Racism Poor Health Status

  20. Thank-you! www.mkehcp.org

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