Speaker calls on audience to reach beyond 'tinkering' toward real change through collective action
By JUDITH VANDEWATER
ST. LOUIS — The disciplined process required for tax-exempt hospitals to assess and address community health needs in line with evolving Internal Revenue Service reporting requirements can be turned into a springboard for launching effective community collaborations that focus resources where they're needed and achieve meaningful, measurable improvements in population health.
That was the recurring message heard by more than 90 hospital executives, health lawyers and community benefit specialists during the "Assessing and Addressing Community Health Needs" conference, a national meeting cosponsored by CHA and VHA Inc. and held here in late July. CHA and VHA have collaborated on several community benefit assessment initiatives.
Catholic health providers have a tradition of assessing and addressing community needs that stretches back to their founders and foundresses, said Julie Trocchio, CHA's senior director of community benefit. Today that type of health outreach to the underserved and the community-based work to change social determinants of health typically falls under the heading of community benefit. "We don't provide community benefit because the IRS says we have to do it, we do it because that is who we are," Trocchio said.
Nevertheless, the IRS requirement that tax-exempt hospitals make public a comprehensive community health needs assessment beginning in their 2013 fiscal year has sharpened the focus on community benefit work and encouraged broad-based community collaborations toward shared health improvement goals. Most of the hospitals with representatives at the St. Louis meeting have either completed or are well along in the development of their initial IRS reports. In addition to posting the assessment on their websites, the hospitals must submit an implementation strategy for addressing community health needs to the IRS along with the 990 filings for fiscal 2013.
IRS guidance
Preston J. Quesenberry, an attorney in the IRS office of chief counsel, told the audience that he was unable to say when the IRS will publish its proposed final rules for conducting and compiling health needs assessments. He told the group that, in the meantime, filers can rely on guidance in the agency's "Notice and Request for Comments Regarding the Community Health Needs Assessment Requirements for Tax-exempt Hospitals." Guidance in that document will hold for six months after the completion of their health needs assessments, even if the final rules are published in that interim.
He said that hospitals, in conducting their community health needs assessments, can collaborate with sister institutions or competitors in their service area. However, each hospital must have and publicize a report identified as that hospital's assessment. Collaborating partners can use the same report content or can repeat large blocks of content, as long as each hospital posts its own report. And, importantly, Quesenberry clarified that a hospital with several campuses operating under one license is required to prepare and post only one report for those facilities.
Mountains of data
Meeting faculty offered how-to tips on mining mountains of health and demographic data to expose unmet health needs and hot spots of health disparity in communities. They presented practical advice about drilling down to the root causes of health issues and determining which needs should take priority because they are most pressing or perhaps because the proposed interventions will aid a part of the community with the highest burden of ill health or lowest income residents.
Keynote speaker Tyler Norris, senior advisor for total health at Kaiser Permanente, said the process of evaluating a community's needs and deriving plans to improve health should be inclusive, collaborative and transparent to the public.
"As leaders within the health care system, we need to be thinking about how we need to improve the quality of care and the means of care and how we deliver care in new ways," he said. But leaders also need to consider how a community benefit strategy can prime a community to make investment and planning decisions that will improve health and productivity, he noted.
Faith-based know how
Norris said community partnerships, particularly those led by faith-based and mission-oriented organizations, are capable of transcending partisan politics and actually achieving meaningful improvements in social and economic determinants of health. "We understand the value of spirit, mind and body and we are rooted in values that propel us," he told the audience.
Faith-based organizations know how to engage people from the business, government, nonprofit and public health sectors as well as the media, he said. They can work across political and geographic jurisdictions and across generations. "We need to have partnerships, because if we don't, there is not enough reach and intensity and duration to actually change anything," he said. Without that collective impact, health interventions aimed at changing behaviors can amount to "tinkering," he said.
Hospitals should be strategic in their community benefit assessments, setting priorities in a way that guides both nonprofit and for-profit investment, private philanthropy and socially responsible investors, Norris explained.
"We must become investment policy advisers for the health and quality of life in our communities … that is where the actual power is. Only when we do that do we actually have a chance to invest in that which will improve health and productivity," he said.
> CHA community benefit resources including assessment tools.