POPULATION HEALTH PLANNING AND COMMUNITY …...neohospitals.org Kirstin Craciun, MPP, MSW Director,...

neohospitals.org

Kirstin Craciun, MPP, MSW

Director, Community Outreach

The Center for Health Affairs

POPULATION HEALTH PLANNING AND

COMMUNITY BENEFIT IN NORTHEAST OHIOMay 2017

PRESENTATION OBJECTIVES

The Center for Health Affairs | 3

Describe how recent state-

level developments will impact future population health

planning work in Ohio

Examine community benefit spending and examples of programming in Northeast Ohio

Identify key health

challenges and strengths in the

region

Define opportunities to improve health

outcomes in Northeast Ohio

KEY OBJECTIVES

STATE-LEVEL POPULATION HEALTH PLANNING


WHY DO THE SHA/SHIP MATTER?


THE STATE HEALTH ASSESSMENT (SHA)

INFORMS PROVIDES

Informs identification of priorities for the

State Health Improvement Plan (SHIP)

Provides template for state agencies

and local partners

(uniform set of categories and metrics)

A COMPREHENSIVE AND ACTIONABLE PICTURE OF HEALTH AND WELLBEING IN OHIO


THE STATE HEALTH IMPROVEMENT PLAN (SHIP)

PRESENTS SIGNALS

Strategic MENU of priorities, objectives

and evidence-based strategies

(For state agency leaders, local health

departments, hospitals and other state

and local partners)

Signals opportunities for partnership

with sectors beyond health

AN ACTIONABLE PLAN TO IMPROVE HEALTH AND CONTROL HEALTHCARE COSTS


SHA/SHIP PROCESS: CONCEPTUAL FRAMEWORK


2016 SHA HIGHLIGHTS

HEALTH OUTCOMES CAN BE IMPROVED RELATED TO…

HEALTH DISPARITIES CAN BE IMPROVED,

PARTICULARLY FOR…

HEALTH CARE ACCESS HAS IMPROVED, BUT

CHALLENGES REMAIN…

Mental Health and Addiction

Chronic Disease Rates

Maternal and Infant Health

Health Behaviors

African-Americans

Low-Income Individuals

Appalachian Counties

Behavioral Health and Dental Care

Disparities Accessing Care

Inadequate Insurance / Lack of Affordability


• Social determinants of health present challenges:

– Employment, Poverty, Income and Education

– Social Support

– Violence, Trauma and Toxic Stress

– Physical Environment

• Opportunities to address health challenges at every stage of life

• Improved data collection efforts needed:

– At local level and for specific groups of Ohioans

• Advocate greater pooling of data collection resources and data sharing

• Widespread agreement on health issues collaboration

• Sustainable healthcare spending a concern

2016 SHA HIGHLIGHTS


2017-2019 SHIP HIGHLIGHTS

MENTAL HEALTH AND ADDICTION

CHRONIC DISEASE

MATERNAL AND INFANT HEALTH






STATE

STATE-LEVEL OUTCOME EVALUATION

• Annual report or online dashboard

STATE-LEVEL PROCESS EVALUATION

• Quality improvement with state agencies semi-annually

LOCAL

LOCAL-LEVEL OUTCOME EVALUATION

• Encouraged to track data at county level when possible

LOCAL-LEVEL PROCESS EVALUATION

• Hospitals (and LHDs) required to submit CHNA and implementation plans starting ‘17

• Asking hospitals to identify any SHIP priorities, indicators and strategies in current plans (ODH to administer a survey to gather info)

• This information will serve as a baseline

• System for tracking and reporting implementation of SHIP strategies by local communities to be developed

2017-2019 SHIP HIGHLIGHTS: EVALUATION PLAN



SHA/SHIP Goals

Greaterlocal-level

collaboration

Better alignment

state / local

Community benefit

spending transparency

Collective impact

Efficient / effective resource allocation

Evidence-based

strategies

Focus on Priority

populations

Improved data

collection / reporting




ODH LETTER: HOSPITAL REPORTING REQUIREMENTS


•

ODH GUIDANCE: COMMUNITY BENEFIT


• Hospital community benefit spending on community health improvement and operations + cash and in-kind contributions compared to state and national averages:

• How aligned hospitals are with the SHIP and how they are collaborating with public health

GUIDANCE FROM OHIO DEPARTMENT OF HEALTH

RED

Below State Average

YELLOW

State Average or Above

GREEN

National Average or Above


SHA/SHIP RESOURCES

2016 SHA & 2017-2019 SHIP Reports

Governor’s Office of Health Transformation 2018-2019 Budget Proposals

State Action Plans

Community Strategy and Indicator Toolkits

Local Planning Guidance

Support Documents

https://www.odh.ohio.gov/en/odhprograms/chss/HealthPolicy/ship/State-Health-Improvement-Plan

COMMUNITY BENEFIT IN NORTHEAST OHIO


Programs / activities respond to an identified community health need

1 Not provided primarily for organizational benefit

2

COMMUNITY BENEFIT: 2 GUIDING PRINCIPLES


COMMUNITY BENEFIT OBJECTIVES

Improve access to healthcare services.

Enhance the health of the community.

Advance medical or health care knowledge.

Relieve or reduce the burden of government or other community efforts to improve health.

Programs / activities must meet at least one of these community benefit objectives:

Source: Catholic Health Association, Assessing and Addressing Community Health Needs


IRS FORM 990, SCHEDULE H


Financial Assistance at Cost

Medicaid ShortfallCommunity Health Improvement and

Operations

Health Professions Education

Subsidized Health Services

Research

Cash and In-Kind Contributions

COMMUNITY BENEFIT SPENDING BUCKETS


Note: Includes data for ACMC, Cleveland Clinic, Lake Health, Mercy Regional Medical Center, MetroHealth, Southwest General Health Center, St. Vincent Charity Medical Center and University Hospitals.

NORTHEAST OHIO COMMUNITY BENEFIT SPENDING

14%

38%

4%

30%

2%

8%

4%

2015 Community Benefit Activities

Financial Assistance at Cost

Medicaid Shortfall

Community Health Improvement andOperations

Health Professions Education

Subsidized Health Services

Research




14%

38%

4%

30%

2%

8%

4%


FINANCIAL ASSISTANCE AT COST

- Free or discounted health services provided to persons who meet the organization’s criteria for financial assistance

- Does NOT include: - Bad debt or uncollectible charges- Medicaid/Medicare shortfalls- Self-pay or prompt-pay discounts- Contractual adjustments to third

party payers



14%

38%

4%

30%

2%

8%

4%


MEDICAID SHORTFALL

- Medicaid allowable costs minus Medicaid payments



14%

38%

4%

30%

2%

8%

4%


COMMUNITY HEALTH IMPROVEMENT AND OPERATIONS

Community Health Improvement Services:- Activities/programs undertaken for express

purpose of improving community health. Community need established via CHNA or other.

- Categories:- Community health education- Community-based clinical services- Health care support services- Social/environmental activities w/ proven

evidence base

Community Benefit Operations:- CHNA activities and community benefit planning

and administration- Can include fundraising or grant-writing for

community benefit programs



14%

38%

4%

30%

2%

8%

4%


HEALTH PROFESSIONS EDUCATION

- Educational programs that result in a degree, certificate or training necessary to practice as a health professional

- Continuing education necessary to retain state license / board certification



14%

38%

4%

30%

2%8%

4%


SUBSIDIZED HEALTH SERVICES

- Clinical services, that respond to an identified community need, provided despite a loss to the organization

- Measured after removing losses from Medicaid, bad debt and financial assistance.



14%

38%

4%

30%

2%

8%

4%

2015 Community Benefit ActivitiesRESEARCH

- Studies/investigations receiving funding from tax-exempt or governmental entity with goal of generating generalizable knowledge for the public:

- Biological mechanisms of health and disease

- Safety/efficacy of interventions for disease - Laboratory-based studies- Epidemiology, health outcomes,

effectiveness- Behavioral or sociological- Healthcare delivery system changes- Communication of findings and

observations

- Does NOT include industry-sponsored research intended for publication



14%

38%

4%

30%

2%

8%

4% 2015 Community Benefit Activities

CASH AND IN-KIND CONTRIBUTIONS

- Contributions made to healthcare organizations and other community groups restricted in writing to an activity or program that meets the criteria for a community benefit


NE OHIO COMMUNITY BENEFIT SPENDING TREND



NE OHIO COMMUNITY BENEFIT SPENDING TREND


0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

9.00%

10.00%

2012 2013 2014 2015

Cash and In-Kind Contributions + Community Health Improvement Services and Community Benefit Operations as a Portion of Total Community Benefit

Combination of Cash and In-Kind Contributions andCommunity Health Improvement and Operations Cost

National Benchmark (Combination of Cash and In-Kind + Community Health Improvement andOperations Cost)

Community Health Improvement and Operations Cost



NORTHEAST OHIO HOSPITAL PAYER MIX: 2015

Includes data for: ACMC, Cleveland Clinic, Lake Health, Mercy, Metro, Southwest General Health Center, St. Vincent, UH

3%

14%

26%

16%

0%

2%

37%

2%

Medicaid

Medicaid HMO

Medicare

Medicare HMO

Other

Self-Pay

Non-Governmental Insurance (including BWC)

Charity Care


PAYER MIX IN NORTHEAST OHIO: 2012-2015



NORTHEAST OHIO REVENUE TREND: 2012-2015


HEALTH CHALLENGES AND STRENGTHS


OHIO HAS MANY HEALTH CHALLENGES


INFANT MORTALITY: OHIO


INFANT MORTALITY: NORTHEAST OHIO

Average 10-Year Infant Mortality Rate: 2006-2015

Source: Ohio Department of Health, Bureau of Vital Statistics


155 babies died in Cuyahoga County in 2015

Highest infant mortality rates in 2015:

Source: First Year Cleveland

INFANT MORTALITY: CUYAHOGA COUNTY

COMMUNITY INFANT MORTALITY RATE PER 1,000 ZIP CODE

Bedford 26.2 44146

Warrensville Heights 23.1 44128

Garfield 23.2/23.1 44105/44128

Shaker / Buckeye 16.5 44120

Kinsman 16.1 44104

Jefferson 15.8 44111

Detroit Shoreway 13.4 44102


PRENATAL CARE INITIATION: CUYAHOGA COUNTY

Source: First Year Cleveland, 2015 data

1st Trimester, 69.3%

2nd Trimester, 21.9%

3rd Trimester, 6.9%No Prenatal Care, 1.9%


OVERDOSE DEATHS IN NORTHEAST OHIO IN 2016

OPIATE EPIDEMIC: NORTHEAST OHIO

*Heroin, fentanyl, or a combination of the two Sources: Cuyahoga County Medical Examiner’s Office; Lake County Coroner’s Office; Lorain County ADAS Board **

CUYAHOGA COUNTY

• At least 517* (860 total)

At least 61 in February 2017, the single highest monthly fatality rate

LAKE COUNTY

• 72* (85 total)

Up from 28* in 2015 and 27* in 2014

LORAIN COUNTY

• 131 total

The cutting of heroin with fentanyl has played a

substantial role in the increase in heroin-related deaths

in recent years.


OPIATE EPIDEMIC: CUYAHOGA COUNTY

CUYAHOGA COUNTY OVERDOSE DEATHS 2013-2017*

Source: Cuyahoga County Medical Examiner’s Office revised 3-3-17


OHIO DRUG OVERDOSE DEATHS: 2012-2014


DRUG OVERDOSE DEATH RATE*: WORST 5 STATES

West Virginia (41.5)

New Hampshire (34.3)

Kentucky and Ohio (29.9)

Rhode Island (28.2)

Notes: *Per 100,000Source: CDC/NCHS, National Vital Statistics System, Mortality (2015 data).


OHIO ADULT OBESITY: BMI OF 30 OR MORE


OHIO ADULT OBESITY: BMI OF 30 OR MORE


Adult Obesity Rates*

NORTHEAST OHIO ADULT OBESITY

*BMI of 30 or more, 2017 County Health Rankings, based on 2013 data


LEAD POISONING: 2010-2014


OHIO: STRENGTHS

HIGH NUMBER OF PRIMARY CARE PHYSICIANS

LOW UNINSURED RATE VIOLENT CRIME RATE

Source: America’s Health Rankings, United Health Foundation, 2016


ASHTABULA COUNTY

MEDICAL CENTER

• Bridge to Fitness program

• Targets teenagers

• 5-week summer session- Two sessions per week - Exercise and educational activities at each session

• Led by ACMC’s athletic trainers

CLEVELAND CLINIC

• Minority Men’s Health Fair

• Launched in 2003

• Over 1,000 participants; 5,600 screenings in 2017

• Focuses on increasing healthcare access, raising awareness, boosting health literacy rates

NORTHEAST OHIO COMMUNITY BENEFIT EXAMPLES


LAKE HEALTH

• Partnered with two women starting an End 68 Hours of Hunger chapter

• Provides food for low-income schoolkids over the weekend

• Provide space to expand operations and $2,500 to help with administrative expenses

MERCY REGIONAL

MEDICAL CENTER

• Resource Mothers program

• Targets underserved women and infants in Lorain County

• Served 263 in long-term home visiting program and 935 in short-term program in 2016

• Goals = improve birth outcomes, promote healthy behavior and empower parents



METROHEALTH

• VIDA! Program Latina faith leaders and other community partners

• Preparing traditional dishes in a healthy way

• “Community Health Cooks” training program

ST. VINCENT CHARITY

MEDICAL CENTER

• Weekly community health screenings

• Blood pressure, blood sugar and individualized education

• Meet residents where they are (i.e. Cuyahoga Metropolitan Housing Authority sites, community meal sites, food pantries and community events)



UNIVERSITY HOSPITALS

• Centering Pregnancy program for at-risk moms at UH MacDonald Women’s Hospital

• Combines prenatal education and checkups with shared experience of a support group

• Has helped improved rates of prematurity, low-birthweight babies and breastfeeding initiation


OPPORTUNITIES FOR HOSPITALS


REGIONAL ASSESSMENT AND PLANNING

Decrease Assessment

Costs

Increase Efficiencies

Continue to Protect

Nonprofit Tax Status

Align with New State Population

Health Planning Guidance

Improved Health

Outcomes for

Northeast Ohioans...

THE CENTER’S REGIONAL PLANNING WORK


THE LEADING ADVOCATE FOR NE OHIO HOSPITALS


FOR MORE INFORMATION

GEORGE JENEY

Project Manager,Hospital Finance & Data Management

[email protected]

KIRSTIN CRACIUN

Director, Community Outreach

[email protected]

neohospitals.org

Questions?

THANK YOU!

Date post:	04-Mar-2020
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