Community Health Needs Assessments (CHNAs) contain a wealth of valuable insight into a community’s specific needs but are often not fully leveraged by healthcare providers to drive organizational priorities. One reason is that CHNAs are frequently conducted independently of strategic plans and medical staff development plans. This represents a missed opportunity. It is both possible and likely advantageous to integrate the CHNA with strategic planning or medical staff planning processes to realize efficiencies and align and coordinate priorities, empowering the provider organization to serve its community optimally.
Every nonprofit health system is required to perform a CHNA at least every three years.1 CHNAs must contain both national and regional data on the health needs of the community and community perspectives obtained through interviews and community surveys. The data gathered as part of a CHNA can be integrated with a strategic plan or medical staff plan and inform other critical planning functions. Unfortunately, after meeting the requirements of the IRS and checking the box that the report is complete, many organizations file CHNAs away as other operational priorities take center stage. The result is a missed opportunity for the organization as the CHNA becomes a compliance exercise rather than a vehicle to gain valuable insight into the community and its unique health needs.
When CHNAs are combined with other key initiatives of the organization, the needs of both the community and the organization become aligned. Shaping a seamless alignment of community and organizational needs yields a variety of benefits including engaged community partners, explicit data-backed opportunities for improving community health, and the possibility of funding for access to primary care, behavioral health, and preventative health services.
The three approaches outlined below represent strategies crafted by Stroudwater to assist healthcare organizations in aligning community and organizational priorities, thereby unlocking the full potential of the CHNA process.
1. CHNAs and Strategic Planning:
The integration of a CHNA with a strategic planning process creates a holistic framework that aligns the true public health needs of the community with the priorities of the healthcare organization. Strategic planning involves creating a vision for a company’s future success and defining the tasks and measures needed to make that vision a reality in a disciplined way.
A CHNA can identify hidden needs within a community and highlight key social determinants of health that affect people’s long-term well-being, such as lack of access to nutritious foods, education, and affordable housing, which can be critical for strategic planning initiatives like provider recruitment. Stroudwater worked with Curry Health Network (CHN), a southern Oregon special health district comprising a hospital and several medical clinics, and produced a concrete and practicable strategic plan in concert with a CHNA. Stroudwater was able to incorporate the findings from the CHNA into the strategic plan, creating synergy between the reports and a greater focus on the specific healthcare needs in the county.
Developing an operable strategic plan and conducting a CHNA synchronously allowed CHN to truly understand its strengths and weaknesses in every capacity and create a solid and clear path forward. Creating one master document with future improvements and action items kept community health needs at the forefront of the strategic planning process. Additionally, having CHNAs and a strategic plan on the same three-year track is efficient from both a financial and time commitment perspective.
2. CHNAs and Medical Staff Development Plans:
A medical staff development plan can use the data and findings from a CHNA around needed services in a community to develop a more efficient provider complement for the healthcare organization. The data in CHNAs can shed light on access to primary care and mental health treatment and identify prominent chronic illnesses or behaviors that should be addressed in the community. Rural areas, for example, can be disproportionately affected by health and social issues such as diabetes, COPD, heart disease, addiction, and domestic violence.
Stroudwater collaborated with a southwest hospital on a Medical Staff Development Plan. The findings revealed that the county where the hospital is located had a higher percentage of its population engaging in high-risk health behaviors compared to state averages. Additionally, a lower percentage of adults were receiving annual screening exams compared to state and national averages, and the county’s mortality rate for lung disease outpaced state and national averages. Based on these specific outcomes, the recommendation was made to recruit a part-time pulmonologist within the next three years for the organization.
The resulting medical staff development plan was tailored to not only current services but also to the future needs of both the organization and the community. Further, having a streamlined, congruent plan allowed the organization to develop appropriate proformas that resulted in more effective recruitment and retention strategies supported by operations. In pairing a Medical Staff Development Plan with a CHNA, the CHNA data not only fulfills IRS requirements but influences the composition of future medical staff and shapes the trajectory of the healthcare organization.
3. CHNAs and Health Equity Analyses:
Health equity, and the recognition that some populations face greater barriers and require additional resources and opportunities to be healthy and access needed healthcare, is a critical issue in the United States. For example, equity is a major area of focus of the National Rural Health Association (NRHA). Many rural areas of the country face unique challenges and barriers to healthcare access. Racial, language, geographic, and other factors can create health disparities that have significant and long-lasting community impacts.
In August of 2022, CMS released the Inpatient Prospective Payment System (IPPS) ruling for FY 2023, which included three health equity-focused measures in the Inpatient Quality Reporting program. As of 2023, the IPPS rules for health equity “Commitment to Health Equity” will now be a requirement through the Medicare Beneficiary Quality Improvement Project (MBQIP) program and participating Critical Access Hospitals (CAHs) in 2025 with reporting starting in 2024.
The first measure required aims to assess a healthcare organization’s commitment to establishing a culture of equity and delivering more equitable healthcare by capturing concrete activities across five key domains: strategic planning, data collection, data analysis, quality improvement, and leadership engagement. CHNAs are a great way to begin to address these domains. Healthcare organizations embarking on the journey to creating equitable and inclusive organizations will need to collect community and population data like the data leveraged by a CHNA. It is now imperative to approach CHNAs through a health equity lens, starting with data collection and analysis. When possible, organizations must approach data analysis differently, stratifying population data not only by age but also by race, ethnicity, age, preferred language, gender, sexual orientation, gender identity, disability status, and other social-related factors. The more granular the data, the greater the development of more specific interventions that can be utilized to address health disparities.
Save Time and Resources
Organizations can unlock immense potential by viewing CHNAs not merely as compliance exercises but as foundational elements that can be coordinated with strategic plans, medical staff development plans, and health equity analyses. Stroudwater excels at seamlessly integrating CHNAs with these overarching initiatives, saving time and resources by avoiding duplicative efforts and minimizing data collection. The result is a comprehensive product that not only enhances the health and sustainability of both the organization and the community but also streamlines processes. Stroudwater’s expert team ensures that CHNAs are optimally utilized, supporting clients in realizing their full potential and harnessing their value to support both the community’s health and the organization’s sustainability and success.
To learn more about how Stroudwater can help unlock the full potential of your CHNA, please contact Clare Kelley or Stroudwater.
1 As of 2011, nonprofit hospital organizations are required by the IRS under Section 501(r)(3) to conduct a community health needs assessment (“CHNA”) every three years and adopt an implementation strategy to meet the designated needs of their community. Per the CDC, a CHNA is “a state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensive data collection and analysis.”