Community Health Needs Assessment 2013. As part of the federal requirements included in the Affordable Care Act (ACA), nonprofit hospital systems under 501(c)(3) status are required to conduct a broad based community health needs assessment (CHNA) at least once every three years, beginning with tax year 2013. While generally consistent with California (SB697) requirements, the ACA also requires that that the CHNA development process incorporate expertise and feedback from specific individuals and groups (community leaders, residents and public health experts), that the CHNA be made available to the public online, and that the CHNA be filed with the IRS.T
The 2013 CHNA process has been conducted against a backdrop of significant local and national change. New models for healthcare delivery are developing across the country, informing and stimulating efforts to make local health care delivery systems more effective and efficient. The Affordable Care Act, with its promise of expanded access and its emphasis on the prevention of chronic disease and the elimination of health disparities, represents a new and powerful platform from which to address the basic issues of access, affordability and quality. An emerging understanding of the impact of social determinants on health status is changing long-held beliefs about prevention and health promotion. These and a variety of other local initiatives and developments, highlighted below, are nurturing an environment of collaboration, innovation and change, which has the potential to improve health and wellbeing for all Sonoma County residents.
Aligning with Triple Aim. Triple Aim is a framework developed by the Institute for Healthcare Improvement (IHI) that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions that:
- Enhance the patient experience of care (quality, access, and reliability)
- Improve the health of populations
- Reduce or control the cost of health care
The IHI Triple Aim entails ambitious improvement at all levels of the system. To be effective, it is important to harness a range of community determinants of health, empower individuals and families, substantially broaden the role and impact of primary care and other community based services, and assure a seamless system of care. The Affordable Care Act (ACA) reflects Triple Aim thinking, including: accountable care organizations (ACOs), bundled payments, and other innovative financing approaches; new models of primary care, such as patient-centered medical homes; sanctions for avoidable events, such as hospital readmissions or infections; and the integration of information technology.
The Affordable Care Act (ACA). Together, the Patient Protection and Affordable Care Act and the Reconciliation Bill make unprecedented investments in health delivery systems that will fundamentally change the country’s health insurance and health care delivery systems. The dramatic expansion of insurance coverage will mean more people can access primary and preventive care. The law’s direct investment in health centers and in the primary care workforce will provide a necessary backbone of support for service delivery. The Affordable Care Act expands access to health care for many people who had not been able to obtain coverage before, including people with pre-existing conditions, people in their 20s whose coverage under their parents’ insurance used to be terminated, and people with incomes above previous Medi-Cal limits.
Patient Centered Medical Home (PCMH). While the medical home concept has its origins in pediatric care, the concept has expanded as the general healthcare system shifts from a focus on episodic acute care to a focus on managing the health of defined populations, especially those living with chronic health conditions. Sonoma County’s community health centers, working with Redwood Community Health Coalition (RCHC), are developing the patient centered medical home. The PCMH approaches the organization and delivery of health care around the patient’s needs. New healthcare models like the PCMH provide greater access to health care providers, the coordination of care and individual empowerment over health decisions.
Focus on Collective Impact. Sonoma County health and social services organizations have a history working collaboratively across sectors on issues of mutual concern. “Collective impact” is an approach to solving societal problems based on the idea that coordination of efforts among organizations working toward similar goals can result in greater impact in the community. A collective impact approach requires the commitment of all sectors – including nonprofits, government, business, and philanthropy – to coordinate their efforts around a clearly defined goal. All collective impact initiatives share five key components: a common agenda, shared measurement, mutually reinforcing activities, continuous communication, and infrastructure support.
Fostering Understanding about Social Determinants. Complex relationships exist between the health status of populations and socioeconomic factors such as income, education level, stress and generational racism. The research is clear that shortfalls in medical care are responsible for a fraction of illness and death. Also important are the conditions in which people live, work and age. A third group of factors, social and economic conditions, are also now recognized as key determinants of health status. Social and economic Inequities can contribute to inequalities in health status. While it is difficult at the local level to change underlying conditions such as generational racism, stress and income inequity, it is possible to address the neighborhood conditions (both natural and built) that can perpetuate these health inequities. Place-based projects in Sonoma County like Health Eating Active Living (HEAL) and Health Action, that focus on changing policies and practices in schools, places of employment and other community settings are seen as promising strategies to reduce disparities and promote community health.
Reducing Health Disparities. Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups. In Sonoma County, communities of color and low-income families and individuals suffer disproportionately from lack of access to health care and the impact of social determinants and the built environment on their health and well-being. Recognition of the role of health disparities is driving new prevention strategies focused on improving health by enhancing access to economic, educational, employment, and housing opportunities.
The Community Health Needs Assessment is a critical planning document for the hospitals, and a call to action for the community on health needs. Every individual and organization can find a place on The Spectrum of Prevention (Appendix I.) and join the work to improve overall health and well being in Sonoma County.