It’s time to add a Community Health Needs Assessment to your to-do list.

The U.S. Treasury and IRS regulations for Community Health Needs Assessment (CHNA) requirements went into effect for all hospitals on March 23, 2012.  As part of the Affordable Care Act, hospital organizations are required to provide a Community Health Needs Assessment and adopt an implementation strategy which outlines how they plan to address the unmet health needs of the community they serve.  In addition, a separate assessment and implementation strategy must be provided for each hospital, even if an organization operates more than one hospital in the community.   With a $50,000 excise tax imposed by the IRS on any hospital organization which fails to meet the CHNA requirements of any taxable year, are you prepared?  You need to complete a CHNA and report it on your Form 990.

The requirements are not strictly defined for the assessment.

So what does a Community Health Needs Assessment involve?  Fortunately, the CHNA is defined in order to allow flexibility on the part of a hospital so it can reflect the individual nature of the community they serve and the budgetary constraints which all organizations face in these difficult times.  However, it does require that the report contain certain elements.  Among the usual background and methodological requirements, it needs to document that the assessment has taken into account the interests of all residents in the community a hospital serves, particularly hard-to-reach audiences like very low income residents and minority groups.  The CHNA also must identify the needs and gaps which exist in providing healthcare service based on area or audience.

Once you identify the needs, you need a plan to address them.

However, that’s not the end of the process.  Once the gaps are identified, hospital organizations must develop and adopt an implementation strategy.  This strategy must explain how the hospital intends to address the community health needs which are identified by the assessment.  Additionally, the strategy must be adopted by the hospital leadership, such as the board of directors, to ensure there is someone specific to champion the initiatives outlined in the strategy.  Presumably, that would also identify who is liable if the efforts to meet the community needs are either unsuccessful or not delivered.  While no enforcement guidelines have been issued thus far, it is fair to assume these could be on the horizon. Because of the requirement to make the plan widely available to the public (and not bury it in a Form 990), a hospital may invite criticism from a vocal entitled few who believe the strategy fails to address their interests.

Like all efforts, it’s best to start with a well thought out plan.

From a practical point of view, there are a number of ways to get started on your road to CHNA compliance.   First, you need a plan.  One model for planning is the National Association of County and City Health Officials (NACCHO) which recommends a MAPP strategy (Mobilizing for Action through Planning & Partnerships).   Basically, you assemble key community members, including some people with health or healthcare expertise, and design the strategy.   It also helps to have experts in conducting needs assessments to consult with your group.  Once you have the strategy, then the real work begins.

It’s best to employ a variety of techniques for a thorough investigation.

Having conducted needs assessment research for communities for many years, we strongly recommend a multi-modal approach.  It should include both primary qualitative and quantitative research, in addition to secondary research or indicator data.  You should consider town hall meetings, an online survey process through the hospital’s web site, or other public forums for citizen input.  Even physician practice or hospital patient surveys could incorporate a couple of questions.  You may also want to consider individual in-depth interviews or focus groups with community leaders, government officials, healthcare professionals, and service providers who interact with low income, minority, and other hard-to-survey audiences.  Also, consider telephone surveys or self-administered surveys which could be distributed through a variety of community efforts which allow input from a much wider segment of the community than can be reached by a telephone survey.  There is also plenty of secondary data available from the census and your county health department.

The key to the analysis is to identify unmet needs.

Once all the necessary data is collected, it’s time for analysis.  Generally, we find an integrated approach yields the greatest value and best results.  This means you need to align the various data sources by topic and interpret both the hard and soft data concurrently.  Using the qualitative along with the hard numbers provides a greater depth of understanding and helps inform the proposed implementation strategies.  The key is to identify the unmet needs keeping in mind unserved or underserved population groups, the underlying problems which are not being addressed, and the location of those with unmet needs.  Once the needs are identified, the next step is to prioritize the needs.  This can be based on the size of the population who has the need, the severity of the conditions which the needs represent, or the type of resources in the community which may be in place to address the needs.  It’s good to try to achieve goals by employing existing resources rather than having to develop them from scratch, particularly when first starting a Community Health Needs Assessment for the first time.

Write your implementation strategy, but don’t over promise.

The only guideline related to the Community Health Needs Assessment implementation strategy is that it must be written and available to the public.  With that said, it’s best to establish modest goals.  While it would be wonderful to have an implementation strategy to cure all cancer in your community, it’s a bit unrealistic.  A more attainable goal might be to start an education program so underserved residents know where they can access healthcare services.  The implementation strategy should outline the goals of the strategy, how your organization intends to achieve the goal, a budget for reaching the goal, and who will fund it.  Keep in mind, there are a number of foundations which provide grants for Community Health Needs Assessment efforts.  A good consultant can help you identify those grant opportunities.

 Remember to establish and follow your plan for a path to a successful assessment.

Like most endeavors, proper planning prevents poor performance.  Gather your team, establish a budget, develop your plan with a qualified consultant, establish a timeline, and gather your data.  Having a consultant with experience in the healthcare industry and needs assessments will not only reduce your personal workload for this effort, but will provide you with an outcome that offers incredible public relations value to your organization.  Imagine the free publicity and goodwill your hospital will achieve when you demonstrate the latest ways you are helping all residents of your community.

 Yes, it’s a big task, but you don’t have to go it alone.

SRA Research Group, Inc. (SRA) is a full service marketing research firm which can help you navigate these new Community Health Needs Assessment requirements.  With over 25 years of experience conducting healthcare marketing research and needs assessments, we can identify the issues facing your organization and the best ways to resolve them.   Healthcare marketing research has always been one of our main areas of focus.

SRA understands the dynamics and unique challenges affecting the healthcare industry, as well as the relationships and resources that are an integral part of delivering healthcare today. Rising costs, intense competition, employee satisfaction and retention, and greater consumer choice have placed enormous pressure on healthcare organizations to operate strategically. The success of a healthcare organization relies on competitive intelligence, market knowledge, and strategic planning.  Healthcare marketing research is an integral part of the strategy to succeed.

Our team has in-depth knowledge of the healthcare industry and our expertise in healthcare marketing research sets us apart. Healthcare providers who want to thrive, and not just survive, rely on our unwavering commitment to provide actionable healthcare marketing research that is cost effective and essential in meeting our client’s strategic goals.

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