#NACoLeg - NACo | National Association of Counties · Should the revenue ruling for hospital tax- ... community engagement process 4. Create the CHNA document 5. Develop community

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© 2015 by the Catholic Health Association of the United States © 2015 by the Catholic Health Association of the United States

Community Benefit and Community Health Needs Assessments

National Association of Counties (NACo)

February 22, 2015

Julie Trocchio Senior Director, Community Benefit and Continuing Care

Catholic Health Association

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© 2015 by the Catholic Health Association of the United States March 13, 2015 6

Mother Joseph, born in Montreal, led a group of five missionaries to the Pacific Northwest. She was responsible for the completion of 11 hospitals, 7 academies, 5 Indian schools and 2 orphanages. As architect and artist, she designed and supervised their construction as well as fund raising.

© 2015 by the Catholic Health Association of the United States March 13, 2015 7

Community Benefit Objectives Programs or activities that provide treatment or promote

health as a response to community needs

and meets at least one community benefit objective:

Improve access to health services

Enhance public health

Advance knowledge

Relieve government burden

© 2015 by the Catholic Health Association of the United States 8

Identified by:

CHNA

Request by NFP or government or other documentation

Partnership with NFP or government

Community Health Needs

© 2015 by the Catholic Health Association of the United States 3/13/2015 9

I. Financial Assistance II. Government-sponsored indigent health

care – unpaid costs of public programs -- Medicaid -- State Children’s Health Insurance Program -- Medically indigent programs

III. Community Benefit Services

What Is Community Benefit??


Categories of Community Benefit Services

Community health services -- Community health education

-- Community-based clinical services -- Health care support services -- Social and environmental improvement activities

Health profession education -- Physicians, medical students -- Nurses, nursing students -- Other health professions

What is Community Benefit?



Subsidized health services -- Emergency and trauma services -- Behavioral health

Research -- Clinical research -- Community health research -- Health care delivery innovation




Cash and in-kind contributions -- Cash donations -- Grants -- In-kind donations

Community building activities -- Physical improvements/housing -- Economic development -- Environmental improvements -- Coalition building -- Advocacy for community health improvement



A Process:

Community Benefit is a planned, managed, organized and measured approach to health care organizations’ participation in meeting identified community health and health-related needs.



Building a Sustainable Infrastructure

Assessing Need

Planning

Evaluating

Communicating

Determining What Counts

Accounting for Costs

The Process


Questions Raised By Congress

Should the playing field be leveled for not-for-profit and for-profit healthcare?

Are hospitals sufficiently charitable?

Is the community benefit standard for tax-exemption adequate?

Should the revenue ruling for hospital tax-exemption be changed?


Affordable Care Act

Community health need assessment

Implementation strategy

Financial assistance

Charges

Billing/collections

Reporting


Overview of IRC 501(r) New Penalties

– $50,000 excise tax

– Potential loss of Section 501(c)(3) status with respect to any noncompliant facility

Meeting New Requirements for Tax-Exempt Hospitals


IRS: How is a Community Health Needs Assessment Conducted?

Identify and prioritize significant health needs of the community served by the hospital

May be conducted in collaboration or jointly with others

Must solicit and take into account input from persons who represent the broad interests of the community served including those with special knowledge of or expertise in public health

Written report must adopted by authorized body

Must be made publicly available


Description of the community served by the hospital

Description of the process used to conduct the assessment • Sources and dates of the data and other information used;

• Methods of collecting and analyzing data

Description of how information was solicited and used

If the hospital collaborated with others – who?

If the hospital contracted with a consultant – include qualifications

IRS: How is Community Health Needs Assessment Documented?


Describe input from persons who represent the broad interests of the community:

Summary of the input of these persons; how and over what time period

Names of organizations providing input and nature and extent of input

Describe the medically underserved, low-income, or minority population being represented by organizations or individuals providing input

IRS: How is Community Health Needs Assessment Documented? (con’t)


A prioritized description of all the significant community health needs identified through the CHNA, including a description of the process and criteria used in prioritizing such health needs

A description of the potential resources identified through the CHNA to address the significant health needs

Evaluation of impact of actions taken since previous CHNA

IRS: How is Community Health Needs Assessment Documented? (con’t)


IRS Form 990 Schedule H


The actions the hospital facility intends to take to address the significant health need

The anticipated impact of these actions

The resources the hospital plans to commit to address the health need

Any planned collaboration between the hospital facility and other facilities or organizations

IRS: What Does an Implementation Strategy Include?


Must be attached to hospital’s IRS Form 990 or provide on the Form 990 the URL(s) to access online

Not required but recommended: post on website

Questions on IRS Form 990 Schedule H

IRS: How is an Implementation Strategy Documented?

Presentation for the Health Steering Committee National Association of Counties Legislative Conference

February 22, 2015

The 2013 Wake County Community Health Needs Assessment

25 www.wakegov.com Denise Foreman, Assistant to the County Manager Regina Y. Petteway, Interim Human Services Director

Presenter

Presentation Notes

My name is Denise Foreman. Thank you for inviting Wake County to participate in this panel. Regina could not be with us today, so I will be presenting on behalf of Wake County. If there are questions I am not able to answer, I will collect them and send answers back through our NACo contact for this panel discussion.

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2013 Community Health Needs Assessment (CHNA)

This presentation will cover: Planning and

Implementation Positive Results A Few Tips from Wake

County Plans for the 2016

Assessment – Alignment with the “Healthiest Capital County Campaign”

www.wakegov.com

Sent from my iPhone

Presenter

Presentation Notes

Read slide as is…..

1. Establish a community health assessment team (or teams)

2. Collect and analyze existing statistics and data as well as information from a community door to door survey process

3. Determine priorities through a community engagement process

4. Create the CHNA document 5. Develop community health action

plans 6. Make the CHNA document and

action plans available to community partners

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Planning and Implementation Steps

Presenter

Presentation Notes

The first step was for the Human Services Director to appoint a HS Division Director with the authority to pull together key internal staff and representatives from key stakeholders (hospitals, Federally Qualified Health Center, United Way) to discuss alignment. The group became the “Assessment Team” and had about four meetings to understand requirements for the public health needs assessment, IRS requirements for hospitals, Federally Qualified Health Center requirements, and needs of other agencies involved. They agreed to move forward with one of the hospitals as the fiscal agent, and a shared budget of about $90,000. Three hospitals contributed $15,000 each. Wake County $10K, and United Way and others contributed the rest. A larger “Steering Committee” of 60 + partners was also formed of additional community stakeholders from across the county to assist with giving feedback on process, survey development, community engagement, and populating the final focus groups (see page 2 of the Community Health Assessment Executive Summary for a list of stakeholders). Stakeholders contributed an estimated $10,000 in in-kind space, food, and meeting support. The Assessment Team quickly release a “Request for Proposals” and hired the North Caroline Institute of Health to do data collection, implement a door-to-door health opinion survey and focus. They used the larger steering committee to confirm direction, get ideas for locations for focus groups, and to advertise and populate the community focus groups. The final priorities were selected in a community engagement process, where 5 sites across the county met at the same time and went through the same prioritization process. The NC Institute for Health quickly summarized the information and produced the Community Health Assessment document, with review along the way from steering committee members. Hospital then had only a few weeks to develop their community plans for submission to the IRS. From beginning to this point took 6 months. The “Health Department” had a few more months to develop their Action Plan. Moving forward, all partners have aligned implementation schedules for future assessment processes. The Community Health Needs Assessment and Action Plan are available at www.Wakegov.com. Hospitals and partners also have the assessment on their websites.

Positive Results

28 www.wakegov.com

Cost savings for the County - $10,000 plus staff time for 2013 Assessment compared to $75,000 and staff time for 2010 Assessment.

Community Ownership – 60+ partners using the same priorities and data (Top 3 priorities – poverty and unemployment; health care access; mental health and substance abuse).

Hospitals met their IRS requirements on time, and used the assessment for strategic planning and their community plans.

Wake County met state requirements. Also met a “Vision 2020”Goal of being data-driven in planning.

Presenter

Presentation Notes

Community Ownership is strong. Partners frequently reference the Community Health Needs Assessment data when applying for funding, including county Community Improvement Plan funding. This was the first time hospitals had to meet IRS requirements, and all three did so successfully Wake County met public health requirements for a community health assessment, and public health accreditation benchmarks which will help them continue to be a fully accredited public health agency.

A Few Tips for Success

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1. Appoint a Community Co-Chair and County Commissioner Co-Chair as leadership.

2. Start early with a timeline and be clear about deliverables. 3. Make sure to keep your Board of Commissioners informed and

engaged along the way. 4. Start with a small steering team (County staff and representatives from

partners who share fiscal resources). Also have a larger group of partners and stakeholders with specific roles, but who meet less frequently.

5. Contract out the scientific “hard stuff” (data collection and producing final documents).

6. Use the marketing expertise of your partners and connect the final information through their social media and yours.

7. Celebrate!

www.wakegov.com

Presenter

Presentation Notes

For the 2006 and 2010 Community Health Assessment, the County asked for a County Commissioner and a Community Leader to be co-chairs. This is a best practice for supporting community engagement for us, and was continued with the 2013 Assessment. Give yourself at least 6 months to 1 year to plan and implement your assessment process. Regular updates to the Commissioners in writing, and from their representative in the process helped assure their support and understanding of the importance of this collective impact process, the benefit for the community, and the cost savings for the County. We have discussed this one. The point is to meet more often with your smaller group that is more invested, but meet with your larger group and give them work to do that will benefit the process – not just “updates”. If you can, find a good university or business partner to contract with for the data collection, focus groups, community input sessions and writing of the document. It takes the experts way less time to do a wonderful job than if you try to “piece together” internal resources. Hospitals, businesses and larger non-profit have state of the art marketing teams. Use their expertise to consult with your contractor on producing a business-like, “actionable” document – one that people can easily use to find the information they need. Make sure you produce a few hard copies, but mostly have it available electronically. Celebrate the release of the document, and use it as a way to market next steps and use of the data.

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…….Moving Forward

Wake County is now aligning the 2016 CHNA Process with our “Healthiest Capital County Collective Impact Campaign”

County Health Rankings Data and Community Health Needs Assessment Data can be reported together

We have a coalition of 40+ partners; a recommended structure and plan to move forward; and are currently seeking fiscal partners

www.wakegov.com

Presenter

Presentation Notes

For the fourth year, Wake County was the healthiest county in North Carolina according to the County Health Rankings. We celebrate that, but also realize we are first in a state that was ranked 33rd, and that we still have major health indicators and disparities to address. In 2013, the Human Services Director and Board of Commissioners launched a “Healthiest Capital County Initiative” with leadership from the John Rex Foundation and many of the same community partners that participate in our Community Health Needs Assessment Process. We now have an even greater opportunity to align our County Health Rankings data and objectives with our Community Health Needs Assessment Process. If any of you have done that, and have ideas for us, we would like to hear them. We have about 40 of our partners in place, a recommended structure, and plan to move forward. From now through June, 2015 we will be seeking community fiscal resources and a little from the county to support this effort. We think we can make a difference in some of the indicators we selected over the next 5 years.

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Moving Forward With The Healthiest

Capital County Initiative - Highlights

Will address 5 indicators (Obesity, Food Insecurity, Children in Poverty; High School Drop Out Rate; Risky Youth Behaviors)

Negotiating with 3 community partners to lead Work Groups (Advocates for Health in Action/YMCA; United Way; Youth Thrive Coalition)

Seeking continued county support through the budget process; community stakeholder fiscal support and a community “home”

Expect to start implementation in July, including planning for the 2016 CHNA

www.wakegov.com

Presenter

Presentation Notes

Indicators are: Obesity Food Insecurity and the Food Environment Children in Poverty The High School Drop Out Rate Risky Youth Behaviors Obesity and Food will be covered in one workgroup Children in Poverty in the 2nd Drop Out Rate and Youth Behaviors in the 3rd We expect to be able to start implementation by July, 2015

QUESTIONS?

32 www.wakegov.com

33 www.wakegov.com

For More Information For an electronic copy of the 2013 Executive Summary and the Full Report, go to: http://www.wakegov.com/humanservices/data/Pages/default.aspx You may also contact: Edie Alfano-Sobsey, Wake County Human Services Epidemiologist at [email protected] Lechelle Wardell, Wake County Program Manager and CHNA Project Manager at [email protected]

http://www.wakegov.com/humanservices/data/Pages/default.aspx

http://www.wakegov.com/humanservices/data/Pages/default.aspx

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#NACoLeg - NACo | National Association of Counties · Should the revenue ruling for hospital tax- ... community engagement process 4. Create the CHNA document 5. Develop community