Strategic Initiative 5.0: Community Programs
Create opportunities for hospital/health systems to coordinate/collaborate to identify and address the health needs of the community and improve the benefits they provide to the Northeast Ohio community.
Overview
The Center for Health Affairs will convene the membership and other organizations as necessary in order to plan and execute an assessment of the un‐met health needs of the Northeast Ohio community. Data will be provided at a sufficient level of detail that hospitals will be able to utilize it in their planning of community programming. The assessment will be distinct from the market research individual hospitals conduct for business planning purposes.
Core Value
The Patient Protection and Affordable Care Act, the health reform legislation that became law in early 2010, imposes several new requirements on nonprofit hospitals. Among these are requirements pertaining to community health needs assessments. Specifically, the law mandates that nonprofit hospitals:
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Conduct a community health needs assessment at least once every three years.
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Adopt an implementation strategy that addresses the needs uncovered by the assessment.
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Incorporate into the assessment input from those representing the interests of the community served by the hospital, including those in public health.
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Make the assessment publicly available.
The completion of a community needs assessment by The Center for Health Affairs will facilitate the membership’s compliance with these requirements.
Deliverables
In order to ensure the assessment is useful and provides information suitable for developing an implementation strategy as required by the law, data will be parsed into multiple analyses with the intention of meeting the varied needs of the membership.
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5.1.1 County‐Specific Data: County‐level data will be provided for each county within the CHA membership.
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5.1.2 Adult and Pediatric Analyses: To meet the needs of both general acute‐care and pediatric hospitals, separate analyses will be available to allow a thorough understanding of both adult and pediatric health needs.
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5.1.3 Regional Roll‐up: An over‐arching analysis will highlight the findings at the regional level.
Overview
The Center for Health Affairs is the federally designated Northeast Ohio regional healthcare coordinator for hospital emergency preparedness. In this role, The Center works with the Ohio Department of Health and administrates the fiscal and program functions for the federal hospital preparedness grantsreceived through the Assistant Secretary for Preparedness and Response (ASPR), a division of the U.S. Department of Health and Human Services.
The ASPR Preparedness Grants have been available to the region’s 28 eligible hospitals for eight years and fund work to protect against, mitigate, respond to and recover from a hazardous event. The Center for Health Affairs has administrated and distributed over $8 million to Northeast Ohio hospitals.
Core Value
Preparing for disasters is a priority in hospitals and crucial to maintaining the health and welfare of both patients and staff. By properly identifying threats, vulnerabilities and potential consequences of emergency events, a facility can plan and prepare to mitigate them, thus protecting the facility and the community at large. Through this program hospitals have access to both federal funds and significant consulting guidance for just this purpose. Particularly now, in an economy prompting careful review of every expenditure, this program gives hospitals extra leverage to tackle preparedness issues. Key features in the preparedness program include:
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Funding that wouldn’t otherwise be available to hospitals to increase response capacities and capabilities.
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Two preparedness experts on staff at The Center who are readily available to hospitals to assist in their planning and who dedicate time to onsite consulting and guidance for each hospital on at least an annual basis.
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A liaison at The Center to coordinate the response of 28 hospitals in an event and to represent hospitals in work with other area organizations involved in emergency planning, such as the Emergency Management Agency, Emergency Medical Services and safety forces. This work directly alleviates some of the demand on hospital staff resources.
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Access to agencies contracted with The Center to assist hospitals with writing plans and holding classes and exercises.
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The incorporation of other community healthcare facilities, such as clinics, in planning in order provide assistance to hospitals in an event in triage and referral as well as surge situations, thereby alleviating emergency room stress.
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Program directives that assist all the hospitals in standardizing certain equipment as well as plans allowing the exchange of staff, equipment and supplies in an event through regional and state Memorandums of Understanding.
Deliverables
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5.2.1 Manage ASPR Grant: The Center for Health Affairs will continue to lead the administration of the ASPR grant regionally and ensure hospitals meet the necessary requirements for continued funding.
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5.2.2 Technical Assistance: The Center will provide training and guidance to hospitals to support their efforts to improve planning and response. The Center will also continue to serve as the communication liaison in the emergency operations center for all regional hospitals during an event.
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5.2.3 Regional Exercises: The Center has taken the lead to ensure regional hospitals have the opportunity to participate in at least one regional exercise each year that will both facilitate their preparedness efforts and fulfill requirements under the Joint Commission on Accreditation of Healthcare Organizations.
Overview
It is crucial to provide the community with evidence of the total value hospitals return to their communities. We’ve already discussed the economic impact approach, but in this effort we hope to clearly demonstrate that the community receives back far more than it invests in the way of tax exemptions.
Core Value
Hospital tax‐exempt status is almost constantly under scrutiny and those that would like to eliminate often take the narrowest view of its justification: charity care. The Center will develop a report that estimates the aggregate hypothetical tax liabilities of its members and compare that to total community benefit. This report will clearly demonstrate that hospital tax exemption is a sound business decision
and a sound public policy decision.
Deliverables
5.3.1 Aggregate Return on Investment: The Center will aggregate IRS 990 Schedule H data and compare it with hypothetical tax liabilities.
Overview
As the impact of healthcare reform begins to take hold, it is clear one of this community’s real challenges will be dealing with the primary care needs of a newly insured population. Efforts are under way to provide electronic medical record linkages with community health centers. There are also efforts underway at the community level to better coordinate the myriad of existing resources available for primary care.
Core Value
Unmet primary care needs traditionally find their way to hospital emergency rooms. The experience of the Massachusetts universal coverage clearly bears out this assumption. By collaborating now with existing organizations focused on providing primary care to under‐served populations, we may be able to mitigate some of impact of pent‐up demand attendant with healthcare reform.
Deliverables
Overview
The Behavioral Health Roundtable was established in response to hospital administrators’ concerns about long lengths of stay in Emergency Departments (EDs) by patients with behavioral health needs. Behavioral health administrators from all hospitals in Cuyahoga County began meeting to identify shared problems. After one year, the public sector was brought into the collaborative to jointly assist in addressing the needs of the patients and both systems that serve these individuals. This public‐private collaborative has been recognized as a best practice within the State of Ohio.
Core Value
Inefficiencies within the healthcare system have led to significant strain on hospital resources regarding the care for patients with behavioral health needs. The roundtable is working toward solutions that alleviate some of these pressures. The roundtable facilitator coordinates hospitals and community agencies for the purpose of addressing shared Emergency Department challenges in the provision of quality, cost‐effective care. Participation in other behavioral health initiatives at the local and state levels serves to keep the participants up to date on any changes in regulation or reimbursement as well as the impact of the state budget on behavioral health services overall.
Deliverables
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5.5.1 Lapsed Medicaid Workgroup: This subcommittee is working on identifying reasons for the significant increase in lapsed Medicaid, which burdens the entire system – both private and public. As healthcare reform moves forward and more individuals enter the Medicaid system in the state, there will be greater delays within the system.
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5.5.2 Secured Site Workgroup: This subcommittee is charged with developing and implementing a secure, password‐protected website accessible through SharePoint and hosted by The Center. The purpose of this initiative is to house specialized treatment plans for those individuals with behavioral health needs who frequent all of the EDs and are also involved with the public system. Access to these treatment plans will assist providers in the provision of appropriate quality care including the utilization of cost‐effective resources. Once this site goes live the goal is to eventually implement an electronic bed board that will allow providers to assess local resources.
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5.5.3 Other Collaborative Initiatives: The Behavioral Health Roundtable is represented within several other local and state initiatives including: the Ohio Hospital Association Behavioral Health Workgroup, the Ohio Behavioral Health and Managed Medicaid Collaborative, IMPROVE (Implement Medicaid Programs for the Reduction of Avoidable Visits to the Emergency Department), and a Woodruff grant project related to emergency mental health services across the county.