External requirements can lead to a strategic shift and community engagement.
By Karen Seaver Hill
Since their inception, children's hospitals have demonstrated a commitment to improving child and community health as an expression of their mission. This commitment to community benefit is also the basis for tax-exemption as a not-for-profit health institution. Over the years, IRS requirements on the reporting of the community benefit provision have become increasingly rigorous. Chief among the changes is the role of a community health needs assessment (CHNA) to identify areas of focus and an implementation plan set against such needs.
Since the 2008 passage of the first community benefit reporting requirements, a series of regulations have been put in place to incentivize hospitals to understand what the significant health needs of the most vulnerable populations are; build programs and activities to support those needs; and finally, measure the impact of the hospital's effort in addressing health needs and disparities. Doing this, a hospital will contribute to the maintenance of its tax-exempt status.
The newest IRS requirement is an impact evaluation, and some children's hospitals report unease with this latest obligation. Health care reporting has historically focused on volumes, census and study participants rather than outcomes. When assessing progress of a big health problem, measuring is daunting, particularly when the scope of the problem goes beyond the health system. This can expose where the health system's goals were too global to be effectively measured for community benefit impact. The focus should be on evaluating the effectiveness of the programming: What did the organization want to accomplish, and did it do that? As the IRS-driven cycle of assessment, implementation and measurement takes place over the course of three years, it suggests a window in which to measure progress.
At Children's Mercy Kansas City, the evolution of community benefit reporting requirements drives a parallel evolution in the organization's approach to community health improvement. The focus is on building a system-wide strategy for advancing the health of children across the Kansas City region, says Margo Quiriconi, director of Community Health Initiatives. "Hospitals tend to be very departmental in their approach to community issues to begin with, and as a result, accountabilities are siloed," she says. "We want to make a measurable impact on community health, so an integrated strategy is critical."
Children's Mercy recently completed its second comprehensive community health needs assessment since the IRS established reporting requirements. The hospital is using CHNA findings to trigger an internal goal-setting process among leadership—identifying health disparities among area children it is best poised to impact. An important and growing part of this process is aligning the community health priorities with the strategic direction of the hospital. Aligning a complementary set of goals, built against the assets and business drivers, will yield greater impact inside the hospital system and outside in the community.
In Washington, D.C., Children's National Health System conducted a similar overhaul in approaching its second district-wide CHNA. Children's National is part of the DC Healthy Communities Collaborative, a coalition of four hospitals and four federally qualified health centers.
A process that was led by a third-party vendor in the past, this year the Collaborative brought the CHNA process in house. Children's National led the project and widened its scope of influence. The Collaborative worked on building and executing the CHNA together, so health indicators and non-disease specific factors combine to illustrate the community health of the District. A key to successful efforts will be the strength of relationships in the community and the engagement of residents. "This will put Children's National in a position to conduct an impact evaluation that measures programs while charting meaningful community health progress," says Desiree de la Torre, director of Community Affairs and Population Health Improvement.
Community benefit reporting, while a federal requirement, offers opportunities to improve a long legacy of community health and child advocacy efforts. In a CHA survey, 48 percent of respondents indicated that data from their most recent CHNA is used to inform population health strategy. Impact evaluation is an important driver to understand what's working with which populations to help children reach their optimal health potential. When the engines of identification, intervention and measurement come together to inform hospital strategic direction and community health, it yields true community benefit.
Karen Seaver Hill is director, Community and Child Health at CHA. Send questions or comments to firstname.lastname@example.org.