Changing the Landscape of Improving Population Health: Epidemiology Unites Public Health and Non-Profit Hospitals for Affordable Care Act-Required Community Health Needs Assessment

BACKGROUND: Charitable hospitals are required by the Internal Revenue Service (IRS) to conduct community health needs assessments (CHNA), which are intended to inform how hospitals apply their community benefit dollars to community health improvement activities. In 2014, the IRS revised CHNA requirements for charitable hospitals to maintain tax-exempt status. The CHNA must include substantive input from state, local, or tribal public health agencies with data and expertise relevant to population health needs. A consortium of five local public health agencies (LPHA) collaborated with Centura Health, a health care network, to develop integrated CHNAs among seven hospitals in the Denver metropolitan area.

METHODS: LPHA epidemiologists and health planners strategically aligned efforts with Centura Health leadership at seven hospitals within a seven county region, encompassing a population of 3 million. Objectives, timelines, roles and responsibilities were defined for a 12-month project period. LPHA representatives prepared demographic profiles of hospital service areas; population health trainings including a standardized quantitative data presentation summarizing 50 population health indicators; a compilation of evidence-based practices; and facilitation tools for prioritizing health focus areas. Efforts were guided using conceptual frameworks from the Health Impact Pyramid, Social-Ecological Model, and Triple Aim.

RESULTS: Seven integrated CHNAs were developed within 12 months among Denver Centura Health hospitals, sharing common goals with LPHAs around two prioritized focus areas: promoting mental health and preventing obesity through healthy eating and active living. A portfolio of evidence-based practices regionally-adopted by LPHAs were displayed within the context of customized health impact pyramids that identified the population health focus, target age group, implementation setting, and regional collaboration. LPHAs used descriptive epidemiology to identify at-risk populations and systematically outline potential strategies, which guided efforts towards selecting interventions that aligned with LPHA initiatives. Centura hospitals’ community health improvement plans (CHIP) will employ system-wide approaches for mental health and obesity screening, training, and referral to community-based services.

CONCLUSIONS: Five Denver metropolitan area LPHAs harmonized efforts to systematically use quantitative and qualitative epidemiologic methods to drive data-informed decision making for identifying and prioritizing the community health focus for Centura Health’s CHNA. As a result, CHNA committees at seven hospitals committed to three-year health priorities for mental health and obesity prevention; each hospital’s CHIP has strategies and programs for health care and community settings that leverage existing LPHA initiatives. This data-driven effort allowed public health to strengthen collaborative and productive relationships with hospitals, and enhance the collective impact on improving population health.