Community Health Needs Assessment and American Hospital Association - Report Example

Community Health Needs Assessment and American Hospital Association [Name] --- Candidate 2016 [School Name] Abstract The purpose of this analysis is to examine the effect of Community Health Needs Assessment as established by the Patient Protection and Affordable Care Act of 2010. This includes an analysis of the implementation process and the intervention development. The analysis includes five cases of the Kaiser Foundations Hospital, and an assessment using principles established in the American Hospital Association. The finding shows that the CHNA is a useful tool for identifying community needs with a focus on access, affordability, and quality of health care. Further, it establishes the importance of collaboration in identification of the problems and in intervention development. I. Introduction The public health problem address is the health disparities found in the United States health care system, and the way to reduce them using the Community Health Needs Assessment, required by the Patient Protection and Affordable Care Act of 2010 among tax-exempt hospitals. [1] Problem generally: Health disparities The first problem noted in the American health care system is increase in health care costs that has caused a historical focus on patients with insurance or ability to afford the health care provided. Prybil, Scutchfield, Killian, Kelly, Mays, Carman, Levey, McGeorge, and Fardo, 2014 (2014) identifies that historically the system has been biased toward certain individuals because of per capita cost of care. The disproportionate outcome has been in disfavor of the seniors, individuals with chronic diseases, and those without insurance. The second problem is an inadequacy of access especially for the uninsured and underinsured facilitated by a focus on individual patient treatment leaving out the community aspect and the benefits of a public health perspective to health care. For example, the health care delivery system has been toward the needs and treatment of individual patients of the insured thus facilitating a system in which individuals benefit from good health outcome, while the vulnerable groups receive no or poor access (Barnett, 2012). Nonetheless, the community aspect is lacking as there is no collaboration between hospitals and public health communities. The third problem is poor medical outcomes especially with a growing rater of chronic diseases that show an association to the other two problems. For example, the outcome at a community level has shown high infant mortality rates such as in inner city neighborhood as well as continuation of cardiovascular related conditions creating a community crisis associated with poor access, lack of affordability, and quality of care. Therefore, health care outcomes within the United States system have been interplay of the three conditions. The response must therefore in turn address the three interrelated issues. [2] Proposed measure in improving community health through hospital-public health collaborations The Patient Protection and Affordability Act present health care facilities with a mandatory need for collaboration so as to collect data on community health outcomes. The Kaiser Foundation has been on the forefront of examining how the enactment of the Act will impact the health care system. The Act added the requirement that nonprofit hospital organizations will need to conduct community health needs assessment (CHNA) to maintain their tax-exempt status under Section 501 (c) (3) of the Internal Revenue Code at least every three years. Notably, the CHNA responds to the challenges of access, affordability, and quality of care notes as the underlying problems facing the United States health care system. The Kaiser Foundation Hospitals is a case example of a not-for-profit health system undertaking to fulfill the requirements of the CHNA by ensuring that its contribution to the community reflects the needs of the community served. Conducting CHNA offers an opportunity to promote affordability, quality, and accessibility for all community members served by the not-for-profit facilities. II. Background The Affordable Care Act of 2010 sought to respond to the disparities in the healthcare system by ensuring that the American people have more control over their health care outcomes. The Act promotes affordability, access, and improvement of health care quality for families, the aged, businesses and taxpayers. The United States represents one of the countries with the highest health care expenditure, but despite this show critical disparities among multiple population health including infants mortality and life expectancy as well as poor outcomes in terms of cost, access, and quality of services received (Prybil, Scutchfield, Killian, Kelly, Mays, Carman, Levey, McGeorge, & Fardo, 2014). The health disparities present a challenge considering that the country spends a large amount of resources on health care, but maintains poor outcomes based on per capita outcomes. Improving health care experience in terms of services, quality, accessibility, and outcome for all populations becomes an important part of the United States health outcome. A needs assessment framework provides a process through which the government and its agencies as well as other community actors can establish the limitations facing the health care system and determine the possible outcomes. The implementation of the CHNA stems from requirements posted by the Internal Revenue Services that requires implementation of Additional Requirements for Charitable Hospitals as established in the Affordable Care Act. The requirements comprise of conducting CHNAs, financial assistance, and hospital processes in charges, billing, and collection practices. The CHNA represent new requirements for the tax-exempt hospitals based on the Affordable Care Act of 2010. The assessments and strategies provide an opportunity for the system to realize better health outcomes for the communities by ensuring that hospitals have the information required to provide community members with care that meets their needs (Association of States and Territorial Health Officials (ASTHO), 2016). Another element is that the CHNA provides an opportunity for better hospital and community health collaboration, as the process must take into consideration the representatives of the community served and their interests including those with special knowledge and expertise in public health. The implementation of the CHNAs among the not-for-profit hospitals follows certain principles that provide pathways for the different collaborating groups. The following principles provide directions on possible directions. [2] Identify relevant frameworks for each bullet point listed below Rosenbaum ‘principles’ to consider (academic) – the Rosenbaum (2013) principles provide insight into factors that inform the implementation of the Affordable Care Acts CHNAs provisions for not-for-profit hospitals within the internal revenue services requirements. The three principles are “the social, economic and environmental conditions that act as the primary determinants of individual and population health; health care services for individuals; and public health activities that target populations and address individual health behaviors” (p. 1). The author then indicates that the success of these principles stem from the process of planning used to improve community health, the aspect of prioritizing and investing in evidence based interventions including innovative interventions, and review of findings of investments and incorporating them into ongoing cycle of evidence based assessment and improvement. Barnett (PHI, private nonprofit organization) - Barnett (2012) recognizes the three fundamental challenges facing the health care systems, notably the “dramatic and sustained increases in health care costs, combined with growing rates of chronic disease and persistently high rates of uninsured and underinsured” (p. 61). Therefore, the Affordable Care Act though retaining fee for service system provides a way to close the widening gap in accessibility by recognizing the need for a sustainable system of financing that shifts from filling hospital beds to keeping populations healthy. Hospital Associations and member group(ACHI/Association for Community Health Improvement) – the Association for Community Health Improvement (ACHI) (2014) emphasize on the role of hospital associations and other groups developing the culture of health, which refers to improving health and building strong relationships within the communities, hospitals, and health care systems and partnering with community stakeholders to address conditions, behaviors, and socioeconomic and environmental factors that affect health. The underlying principle by ACHI is culture of health, which denotes a healthy community that continues to focus on remaining healthy for all people irrespective of their ethnic, geographic, racial or socioeconomic situation. The goal is to ensure people live longer and healthier lives. Hospital Associations and member group (AHA/American Hospital Association) – Prybil et al. (2013) writing for the American Hospital Association identify the need for a paradigm shift in the American health care system through different elements, among the development of a culture of health within the communities, secondly building key partnerships among communities, service providers, and the public health system, and third in policy change. A culture of health means focusing on healthy living with as much zeal as that of treatment, and ensuring quality care is available to all when and where needed. The Association puts a critical emphasis on ten characteristics of a culture of health. The realization of a culture of health is an effort for all, including the hospitals, the public health departments, the communities, and other stakeholders. The collaboration among the different groups is essential for ensuring cohesion of the system, and improvement of the health care system with efficient and equitable delivery. The report further suggest that partnerships is critical for achieving a culture of health as the partners acts as vehicles for identifying and addressing community health needs, and have the capacity to reach a wide scope based on the range of local organizations and communities involved (Prybil, 2014). Notably, improving the health care system will be domain of many with various organizations taking part in the development of strategies and in sharing information. [3] Any sample evaluations An ASTHO publication of 2015 provides insight into the data collection process surrounding CHNA and the implementation process and identifies various benefits of the process. ASTHO (2015) analysis of the CHNA indicates that this intervention has two main elements. The first is the health needs assessment comprising of the process of conducting a CHNA at a hospital facility to define the community it serves and assess the community’s health needs. This involves taking into account the input of various individuals that represent the broad interests of the community and documenting the information. The collected information enable an expanded health needs outlook that will assist the hospital in improving access to care by eliminating financial and other barriers as well as to include other public health objectives such as prevention of illness, ensuring adequate nutrition, addressing social, behavioral, and environmental factors that influence community health outcomes. Notably, the new requirements seek to promote a holistic approach to health care delivery in which the hospital does not only focus on treatable problems but addresses community based problems that also affect health outcomes. Agreeably, the hospital may not identify all the issues listed but comprehensive CHNAs will ensure a better and focused health delivery system within the communities served. The second element of the CHNAs is implementation, which refers to the way the hospital plans to achieve identified needs including community and health needs. The facility may include additional challenges noted in the data collection process, and then establish interventions for prevention of illnesses and addressing social, behavioral, and environmental challenges identified (ASTHO, 2015). The development of the intervention requires that the facility consider comments and feedback from their previous implementation strategy, and if possible the hospital may collaborate with other facilities and public health departments when creating and implementing the strategy. III. Scope of the Project The goal of this project is to examine the effect of collaborative strategies on meeting community health needs, using the CHNA case examples. The project explains the CHNAs, the idea of collaboration, using the American Hospital Association as the agency of focus, within the United States of America. The idea is that hospital can public health collaboration is important. The AHA was founded in 1898 as is a not-for-profit association, and a national advocacy for health improvement among communities. It comprises of nearly 5,000 hospitals with a diverse health care system, networks, providers, and individual members. The agency offers education for health care leaders, and provides information on health care issues and trends [1] Overview of 5 sample CHNAs and implementation plans. Five case studies were identified in the implementation of CHNAs from the Kaiser Foundation Hospital, as follows. 1. San Francisco – the CNHAs was done in coordination with academic partners, the San Francisco Department of Public Health, and other not-for profit hospitals, with the goal of identifying and prioritizing community health needs. The facility serves the Bayview, Chinatown, Downtown, Visitacion Valley and Excelsior neighborhoods with a focus on vulnerable populations. 2. Oakland – the CNHAs identified various community health needs that included eating and exercise habits, socio-economic stability, violence, affordability of medical services including mental health and substance abuse services, chronic illnesses, and local primary care. Although the assessment considered data from various sources it did not have direct collaborations. 3. Haywar – the facility collaborated with another Kaiser Foundation Hospital identifying various health issues and priorities, among them access to preventive care, mental health services, safe environment, education and training, exercise, healthy food, and referral system. 4. Vallejo – the team achieve collaboration at county levels by working with the public health department and local medical facilities, and their implementation plan featured the participation of the collaborators as well ass assisting vulnerable groups. 5. Los Angeles – the data collection involved stakeholders from the community including health care professionals, government officials, social service providers, community residents, leaders, and other representatives. The implementation involved collaboration with local medical center, and together they developed an intervention addressing the identified needs including mental health service, eating and exercising habits, oral health, diabetes, cancer, substance abuse, injuries, and HIV/AIDs among others. Implementation plan The data collected among the five cases was mainly qualitative and included both secondary and primary data. The hospitals made their implementation plan based on the data collected. However, although the five cases recognized the importance of collaboration it was noted that not all achieved the collaborative aspect, or included it in their implementation plan. Scrutinize them to answer the 3 overarching questions below: 1. Are CHNAs effective in capturing those disparities? The five cases show that CHNA offers an effective way for understanding community vulnerabilities, and challenges. Each of the cases ended up with a comprehensive list of health care issues the community was undergoing, and a reflection of ways to address these problems. Based on the outcome of the five cases, it is therefore concluded that CHNA is effective for capturing data on health disparities, especially in relation to vulnerable communities. 2. Are the implementations plans consistent with the existing disparities identified in the CHNA and/or through other assessments (e.g., other scientific studies, surveys, interviews, etc.)? The Kaiser Hospitals Foundation developed implementation plans based on the priority list identified in the CHNA. While the plans promoted the three established targets of affordability, access and quality of health care services, these were within the priority areas identified. 3. What are the existing challenges and opportunities moving forward? What challenges do you find in the CHNA and governmental regulation from the perspective? The challenges identified and that may persists in moving forward is that collaboration despite being central to the execution of CHNAs, may not always be achievable as seen in the five cases. [2] How will you scrutinize them? (1) Qualitatively (focus on this for your paper) The findings of the five case show the importance of identification of social challenges as understood by the communities thus facilitating ownership of the interventions and ensuring that they focus on the real community health issues. Rosenbaum (2013) shows that identification of real social problems forms a core of the Affordable Care Act, in which the basic target is to improve community health by provision of direct investment that target wellness and prevention at both individual and community levels. The implication is that the interventions will lead to a healthier population. The principle may be achieved through elements such as increase in immunization drives, identification of new approaches to integrating primacy care into public health, and direct investment into clinical prevention. Further, the identification of the problem need to be collaborative as much as possible to ensure a comprehensive outlook on the issues. Rosenbaum (2013) promotes a collaborative, transparent approach to CHNAs that would be useful in accelerating assessment, planning, intervention, and evaluation of community health needs and improvement. The presented principles offer a feasible approach for hospital facilities and communities for achieving better community health outcomes. Moreover, development of a culture of health is dependent on how well the CHNAs identify comprehensively the health challenges and formulate a working plan. The plan would then include good health promotion across geographies, populations, and social sectors; healthy living for the entire society; and ensuring families and individuals have access to the means and opportunity for making healthy living decisions including living a healthy lifestyle (ACHI, 2014). Other characteristics are ensuring access to affordable and quality health care for all, no discrimination, efficient and equitable care, reducing on unwarranted and excessive health spending, public education, and collaborative decision making. The data collected further indicates that implementation of the CHNAs will revolve around investment, and working within identifiable domains. The underlying principle is the requirement for hospitals to begin investment in building population health capacity and optimally positioning the facilities for long-term economic contribution. The focus is on not-for profit hospitals that will achieve the stated improvement by collection and analysis of data on health status and understanding the factors that contribute to poor health as well as focusing on collaborative intervention. The second principle is on collaboration as the strategy for dealing with the symptoms and causes of health problems by leveraging on charitable resources, and building capacity to address complex health concerns in a cost effective manner. Barnett (2012) identifies five domains through which not-for profit hospitals can meet the Affordable Care Act requirements. These include patient – caregiver experience of care, care coordination, patient safety, preventative health, and at-risk population’s health. In achieving these domains, the not-for profit hospitals can partner with community based organizations and local public health agencies to develop and implement a multi-pronged approach to addressing the health issues IV. Public/Population Health Impact: Findings and Significance The use of CHNAs represents the broad interests of the community as the data brings in both expert and non-expert knowledge from public health officers and from the community members. The data collection requires collection of data from identified persons in the community including public health experts, members of the community, representatives and leaders of low income, minority, and medically underserved population and individuals with chronic conditions (Kaiser Permanente, 2013). The information considered must be from actual respondents. The hospital has the leeway to determine the public office to include in their data collection including local, state, tribal, and regional government officers. The reason for providing such leeway is in recognition of hospitals service to different communities and jurisdictions, and therefore may contact different levels. Part of the CHNAs is collaboration between the hospital facilities and public health departments, and other facilities as applies. The partnership will make it possible for the hospitals to include information obtained from the public health department that presents the needs to which the hospital can address. V. Conclusion The collection of data in CHNAs and development of implementation strategy shows a commitment toward achievement of the three identified goals; namely, affordability, access, and quality care, but with an additional element of public health. The Kaiser Foundation Hospitals provide examples of how hospitals have collected and utilized the information to meet the requirements of the Affordable Care Act and the establishments of the Internal Revenue Services. From the information collected, the hospitals are able to define a community benefit programs on the needs of vulnerable population, which represent evidence-based disparities in health outcomes, significant barriers to care and the economically disadvantaged. The program defined serves the high risk groups including those living in high poverty, lowest levels of health insurance, and lowest rates of high school degree completion. These provide the evidence on the possible workability of the CHNAs, and collaboration. The benefit of collaboration among the hospitals, public health agencies, and other parties toward assess and improvement of community health, although this was more dependent on the type of initiative. Nonetheless, understanding the interventions and challenges versus benefits found is useful in the development of future collaborations. The partnerships are useful in gaining knowledge on organizational arrangements, goals, and progress as well as lessons learnt. The most important part of the partnerships is working with groups focused on the same goal, which is improving community health. References Association for Community Health Improvement. (2014). Hospital-based strategies for creating a culture of health. Chicago, IL: Robert Wood Johnson Foundation, and Health Research and Education Trust, with ACHI. Association of State and Territorial Health Officials. (2015). The internal revenue service’s final rule: Charitable hospitals and community health needs assessments. State Health Policy. Association of State and Territorial Health Officials. (2016). Health systems transformation: Community health needs assessments. ASTHO. Retrieved from http://www.astho.org/Programs/Access/Community-Health-Needs-Assessments/ Barnett, K. (2012). Best practices for community health needs assessment and implementation strategy development: A review of scientific methods, current practices, and future potential. Report of Proceedings from a Public Forum and interviews of Experts. Atlanta, Georgia: The Centers for Disease Control and Prevention, July 11-13. Kaiser Foundation Hospital – Hayward. (2013). Community health needs assessment. Kaiser Permanente. Kaiser Foundation Hospital – Los Angeles. (2013). Community health needs assessment. Kaiser Permanente. Kaiser Foundation Hospital – Oakland. (2013). Community health needs assessment. Kaiser Permanente. Kaiser Foundation Hospital – San Francisco. (2013). Community health needs assessment. Kaiser Permanente. Kaiser Foundation Hospital – Vallejo. (2013). Community health needs assessment. Kaiser Permanente. Prybil, L., Scutchfield, F. D., Killian, R., Kelly, A., Mays, G., Carman, A., Levey, S., McGeorge, A., & Fardo, D. W. (2014). Improving community health through hospital – Public health collaboration. Insights and lessons learned from successful partnerships. Lexington, Kentucky: Commonwealth Center for Governance Studies, Inc. Rosenbaum, S. (2013). Principles to consider for the implementation of a community health needs assessment process. Department of Health Policy – School of Public Health and Health Services. Washington, D.C.: The George Washington University. Appendices 1. Competencies addressed The analysis involved critical evaluation of various works on CHNAs including the law aligned to the practice and determined its usefulness within the public health sector. The analysis showed that the process involves competencies such as researching and comprehension. 2. Overall reflection of your experience researching these topics.   The analysis provided an opportunity for learning about the implementation of the Affordable Care Acts and what it means for the practices of not-for profit organizations. The analysis goes beyond appreciating that the act promotes affordability, access, and quality of care to understanding that its achievement is a concerted effort among different stakeholders including the public health system, not-for profit facilities, and communities. Read More