Transcript Document

•
•
•
•
•
Coordinated Community Health
Needs Assessments
Planning, Policy and Advocacy
Paul Westrick, Columbia St. Mary’s
Clare Reardon, Froedtert Health
Wisconsin Comprehensive Cancer Control Program
March 29, 2012
•
•
•
•
•
What is Community Benefit?
A planned, managed, organized and measured approach
to a health care organization’s participation in meeting
identified community health needs.
It implies collaboration with a ‘community’ to ‘benefit’ it’s
residents – particularly the poor, minorities and other
underserved groups – by improving health status and
quality of life.
•
•
•
•
•
Partnership Background
Public / Private Consortium 2007
 5 Health Systems: Aurora Healthcare, Children’s
Hospital & Health System, Columbia St. Mary’s, Froedtert
Health, Wheaton Franciscan Health Care
 4 FQHC’s: Milwaukee Health Services Inc, Outreach
Community Health Centers, Progressive Community
Health Centers, Sixteenth Street Community Health
Center
 3 Public: City of Milwaukee Health Dept., Milwaukee
County Dept Health & Human Svcs., WI DHS and
Medicaid Office
 Academic: Medical College of Wisconsin
• Affiliates: WHA, WPHCA, MCMS, FC3
•
•
•
•
•
Partnership Mission
• Improve Health Care for Underserved
Populations in Milwaukee County
• Goals
– Expand Coverage
– Ensure Access
– Improve Care Coordination
• Objectives
– Improve health & reduce disparities
– Reduce the total cost of care
•
•
•
•
•
Secondary Objectives
Community-wide plan / focused agenda
• Reduce duplication & fragmentation of efforts
• Enhance communication / coordination
• Leverage existing & secure new public and private
funding
• Increase transparency & accountability
• Equitable distribution of burden
•
•
•
•
•
Milwaukee County Profile
County Health Rankings
Coverage
Overall
69
Mortality
67
Morbidity
71
Behaviors
64
The Partnership’s primary focus is
medically underserved Milwaukee
county residents, defined to include
those covered by government
insurance programs and uninsured
individuals with incomes below
200% of the federal poverty level.
Clinical Care
35
Total Population: 948,944
Socioeconomic
71
•
•
•
•
45% (428,108) are vulnerable
30% (287,108) covered by Medicaid
55% (130,107) are children
15% (141,000) uninsured
•
•
•
•
•
Accomplishments
• 20% expansion in Badger Care coverage
• Primary Care Access Study
• Free & Community Clinic Inventory
• Medication Access Needs Assessment
• ED Care Coordination Initiative
• Secured / redirected over $12 million
• 2011 AHA NOVA Award for Community Collaboration
•
•
•
•
•
Community Benefit: A Brief History
• Community outreach - mission driven
• Non profit status, tax exemption under federal and state
scrutiny
– Some states - % of operating expenses
– Some states – active attorneys general
• PPACA – Health reform legislation includes rigorous IRS
reporting for hospitals
•
•
•
•
•
Community Benefit Reporting
1.
Uncompensated Care
2.
Health Services
Screenings, prevention, community education
3.
Medical Education
Building the healthcare workforce of tomorrow
4.
Research
5.
Community Building
Social determinants
(poverty - education, jobs, transportation, environment, etc)
Wisconsin / 132 hospitals in 2010
$2,569,911,003
Including Medicare shortfalls
•
•
•
•
•
Community Health Needs Assessment
• At least every three years
• Input of broad interests from the community served –
including those with expertise in public health
• Make findings widely available
• Adopt an implementation strategy
Failure to meet in any given year =
$50,000 excise tax
•
•
•
•
•
IRS Reporting Requirements
Each hospital required to report:
• How it is meeting the needs identified –
develop and implement a Community Health
Improvement Plan
• Description of needs not being addressed and
explain why
•
•
•
•
•
•
•
•
•
•
Southeastern Wisconsin
Community Needs Assessment
• Goal: Develop a collaborative model and tools
to meet combined needs of health care and
public health partners
–
–
–
–
Avoid duplication and wasted resources
Meet requirements of multiple stakeholders
Shared costs
Unit of measure – spread from Milwaukee County to 6
County SE Wisconsin area
•
•
•
•
•
Primary data – Community Health Survey
• Adapted Aurora Community Health Survey tool to gather
needs from the general community
(Survey reports/tool: www.aurora.org/commhealth)
– Since 2003:
• CDC’s Behavioral Risk Factor Surveillance System - chronic
disease, access to care, safety, preventive screenings and
immunization
• Repeated every 3 years
– MHCP tool: streamlined questionnaire to allow space
for youth oriented questions
• Ozaukee, Washington, Kenosha ,Waukesha, Racine Milwaukee
Counties
• 21 hospitals / 19 health departments
•
•
•
•
•
Key Stakeholder Interviews
• Purpose – to gather required information from “persons
with expertise in public health” and “identify available
community resources to address the need”
1. Of the following focus areas from the State Health Plan, please
rank order the top 3 to 5 major health-related issues in your
community:
_____Alcohol and drug
_____Communicable disease
_____Growth & development
_____Nutrition
_____Physical activity
_____Tobacco
_____Injury & violence
_____Chronic disease
_____Environmental & occupational
_____Mental health
_____Oral health
_____Reproductive & sexual
_____Access
•
•
•
•
•
Secondary sources:
• Center for Urban Population Health
City of Milwaukee, UW School of Medicine and Population Health, Aurora Healthcare
– County Health Rankings
– State/County/Municipal data
•
•
•
•
•
WISH
DHS
BRFSS
Family Health Survey
Local Health Department data
• Hospital Utilization data
– ED utilization
– Preventable hospital admissions (Ambulatory Sensitive
Conditions)
– Charity Care maps
•
•
•
•
•
Key Success Factors
• Strong functioning coalition: trust, leadership,
accountability, focus & flexibility
• Commitment to shared plan - local health departments
part of process
• Plan driven by multi-stakeholder assessment / analysis
• Aligned stakeholder investment, leveraging external
funding for collaborative health improvement model
•
•
•
•
•
Collaborative Community Healthcare Improvement Model
COMMUNITY
NEEDS
ASSESSMENTS
COMMUNITY
HEALTH
IMPROVEMENT
PLAN
SHARED
COMMUNITY
INVESTMENTS
ORGANIZATIONAL
SPECIFIC PLANS
ORGANIZATIONAL
SPECIFIC
INVESTMENTS
Assessment Process and
Tools
Secondary Data Analysis
Community Will
Goals / Priorities
Strategies / Tactics
Measurement
Public Funding Priorities
Private Philanthropic Priorities
Health System Funding Priorities
•
•
•
•
•
Determinants of Health
10%
Health Care
• Quality improvement
• Accessibility
20% Social / Environmental
• Built environment
• Safe communities
30%
Genetic
• Personalized medicine
40%
Behavior
• Health education
• Healthy communities
McGinnis, J.M. et al. Health Affairs 2002;21(2):78-93
•
•
•
•
•
Addressing Social Determinants
Upstream
Midstream
Downstream
Pro-Equity Policies
Affordable
Housing
Incarceration
Good Paying
Jobs
Physical
Activity
Obesity
Quality
Education
Safe
Neighborhoods
Fair Standards of
Living
No Racism
Homelessness
Healthy
Environment
Access to
Transportation
Access to
Healthcare
Low Birth
Weight
Untreated
Mental
Illness
Poor
Health Status
•
•
•
•
Thank-you!
www.mkehcp.org
•