There is growing recognition that the social determinants of health—where we live, work, and play; the food we eat; the opportunities we have to exercise; our ability to live in safety—drive health outcomes. Of course, there is a large role for health care to play in delivering health care services, but it is indisputable that the foundation of a healthy life lies within the community. To manage true population health—that is, the health of a community—hospitals and healthcare systems must partner with a broad spectrum of stakeholders who share ownership for improving health in our communities.
The barriers to community health are formidable. Many people have inequitable access to adequate healthcare, and many states and communities are unable to provide such care universally. The availability and use of healthcare varies widely by geographical area and point of provision. Sadly, availability tends to be inversely related to the need of the population served.
In order to identify critical needs and to allow hospitals to create solutions, the Patient Protection and Affordable Care Act of 2010 (ACA) requires tax-exempt hospitals to create a hospital community health needs assessment every three years. The requirements include:
- Demographic assessment identifying the community the hospital serves
- A community health needs assessment survey of perceived healthcare issues
- Quantitative analysis of actual health care issues
- Appraisal of current efforts to address the healthcare issues
- Formulation of a strategy to implement necessary changes
In an ideal situation, the hospital CHNA is developed alongside community stakeholders. And as the plan is developed and analyzed, the community comes together to address issues collectively, ultimately working towards growing a healthier community.
A CHNA, when performed with wisdom and foresight, can be so much more than a governmental requirement. A CHNA is a valuable management tool to help hospitals understand how they can provide services appropriate to the facility and how to best satisfy the needs of specific populations they serve. It can help define a hospital’s focus for the future, strengthen the community's involvement and increase appreciation for the facility as a local healthcare provider.
The process can not only provide the institution with a wealth of information about the people it serves, but it can be a conduit for creating strong health coalitions that can address community needs together. In addition, engaging community decision makers and influencers in the CHNA process can develop powerful relationships that can ultimately benefit both hospitals and the communities they serve. Hospitals bring a lot to the table to improve population health, but they do not have to go it alone.
Hospitals can strengthen their partnerships to carry out a variety of health improvement activities, ranging from sponsoring walking groups or building walking trails for public use, to working among congregations and local schools, to leading the way in eliminating food deserts—those areas where health food choices are simply not available. The good news is that a wealth of partners and resources exists, and they have been strengthening the social determinants of health for decades.
As financial health payment models move toward population health, CHNAs are ideal starting points for hospitals and health systems as they position themselves for financial health. The shift in financing incentives from volume to value is refocusing provider organizations to look beyond care delivery and consider the factors that influence health.
As with any complex system, it is essential to test small changes and learn by doing. Each community is different, and effective platforms for community health improvement will be shaped by their local context. The core activities, however, are the same from place to place—building well within the hospital, aligning activities toward community health improvement, finding and engaging community stakeholders in community health improvement, and developing a portfolio of projects to improve community health.
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About the Co-Author
Amie Whittington is a tax senior manager in HORNE LLP's healthcare services practice. She primarily provides tax and consulting services to nonprofit and healthcare entities, including hospitals, doctor groups and physicians.